bluuebunny/crossref_metadata_2025_split huggingface dataset:
Naturalistic, Prospective Study of Glaucoma and Ocular Hypertension Treatment in France: Strategies, Clinical Outcomes, and Costs at 1 Year
Authors: Rouland J-F. , Le Pen C. ,   The Ophthalmologists of the Glaucoma Study
Published: January 2018

Purpose To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with glaucoma or ocular hypertension (OH) in France. Methods Patients were recruited between 1998 and 2000 in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure [IOP] levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management in patients receiving monotherapy or combination therapy. This article reports results of an interim analysis of 1-year follow-up data for patients having at least two contacts with a study ophthalmologist. Results Data were analyzed for 283 patients and 549 treated eyes. Ocular hypotensive monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 3.4 ± 0.5 years after diagnosis, primarily due to insufficient IOP control (62.8%). Mean IOP reductions after 1 year of second-line therapy were 3.0 mmHg in eyes treated with latanoprost monotherapy versus 2.1 mmHg in those receiving beta-blocker monotherapy (p=0.02) and 5.4 mmHg in eyes treated with the latanoprost + timolol combination versus 4.1 mmHg in those receiving combination therapies that did not include latanoprost (p=0.01). Although second-line treatment with latanoprost was more costly than treatment with beta blockers, the average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy, and latanoprost + timolol was less costly than therapeutic combinations without latanoprost. Conclusions Insufficient IOP control is the main reason for changing first-line treatment in patients with glaucoma or OH. After 1 year, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior IOP control at an acceptable cost.
Pregnancy-Related Papillophlebitis
Authors: McLoone E.M. , Best R.M. 
Published: January 2018

Purpose To report a case of pregnancy-related papillophlebitis in a woman with an uncomplicated pregnancy and no identifiable coagulation defect. METHODS Clinical evaluation and fundus photography. Results Spontaneous recovery occurred post-delivery without treatment. CONCLUSIONS Venous thromboembolic events of the eye are a rare complication of pregnancy unless associated with toxemia. This case report of a pregnant patient with papillophlebitis indicates that the natural clinical course of this condition is one of spontaneous resolution and treatment is there fore unnecessary.
Lidocaine-Assisted Xylocaine Jelly Anesthesia versus one Quadrant Sub-Tenon Infiltration for Self-Sealing Sclerocorneal Incision Routine Phacoemulsification
Authors: Sekundo W. , Dick H.B. , Schmidt J.C. 
Published: January 2018

Purpose To compare the effect of Xylocaine jelly and intracameral lidocaine with one quadrant instant sub-Tenon infiltration for self-sealing sclerocorneal phacoemulsification. METHODS One hundred patients were enrolled into a prospective randomized study, receiving either a combination of topical 2% Xylocaine jelly and 0.5 ml of intracameral 1% lidocaine or sub-Tenon infiltration with 2 ml of 2% Xylocaine on the operating table. All patients underwent a standard divide and conquer phacoemulsification procedure through a superior sclerocorneal frown incision followed by implantation of a polymethylmethacrylate intraocular lens. Intraoperative pain was indicated by the patient by squeezing the bedside nurse's hand, who allocated it to particular stages of surgery on a chart. After surgery, patients assessed the pain experienced using a 10-unit visual analogue scale. Results Pain was indicated on 31 occasions during the operation in the sub-Tenon group (mainly the injection itself) and 67 times in the topical group. The median overall subjective pain score was 3 in the jelly group and 0 in the sub-Tenon. Five eyes (10%) had to be converted to sub-Tenon during the surgery because of intolerable pain. CONCLUSIONS Whereas lidocaine supported Xylocaine jelly anesthesia provided acceptable analgesia for 90% of patients operated, sub-Tenon anesthesia proved to deliver better intraoperative comfort in all patients receiving sclerocorneal incision cataract surgery.
A Simple way to Prevent Indocyanine Green from Entering the Subretinal Space during Vitrectomy for Retinal Detachment Due to Myopic Macular Hole
Authors: Facino M. , Mochi B. , Lai S. , Terrile R. 
Published: January 2018

Purpose To present a safe and simple method of preventing indocyanine green (ICG) from entering the subretinal space in patients undergoing vitrectomy for retinal detachment caused by myopic macular hole. PATIENTS AND METHODS Four consecutive highly myopic eyes (three phakic, one Pseudophakic) with retinal detachment due to myopic macular hole were operated on by pars plana vitrectomy. The ICG-assisted peeling of the internal limiting membrane was performed after temporarily closing the macular hole by means of a small bubble of perfluorocarbon liquid (PFCL) in order to prevent ICG from entering the subretinal space. Results Retinal reattachment was successful in all patients, and anatomic closure of the macular hole occurred during the follow-up period (range 3 to 10 months). CONCLUSIONS A small bubble of PFCL prevents ICG dye from entering the subretinal space during vitrectomy for retinal detachment due to macular hole in highly myopic eyes.
The Effects of Three-Piece or Single-Piece Acrylic Intraocular Lens Implantation on Posterior Capsule Opacification
Authors: Bílge A.H. , Aykan Ü. , Akin T. , Ünsal U. 
Published: January 2018

Purpose To evaluate the development of posterior capsule opacification (PCO) in patients implanted with 5.5 mm optics, single-piece or three-piece acrylic intraocular lens (IOL) in cataract surgery prospectively. Methods This study was carried out on 267 eyes of 249 patients implanted with three-piece, 5.5 mm optics, acrylic IOL and 252 eyes of 244 patients implanted with single-piece, 5.5 mm optics, acrylic IOL by phacoemulsification technique between September 2001 and February 2003. A total of 519 eyes of 493 patients were prospectively evaluated for PCO development during the 25-month period. All the patients were analyzed periodically with anterior segment retroillumination photography. The data provided were analyzed with chi-square method. Results The results between the two groups for PCO development were not statistically significant. However, there was a prominent opacification of the posterior capsule where the optic and haptic junction of IOL was positioned in some patients implanted with single-piece IOL. During the follow-up period, no patients implanted with either three-piece or single-piece acrylic IOL required Nd:YAG laser capsulotomy. Conclusions Biocompatibility and reduced rate of PCO development are among the leading features of new generation IOLs. The intracapsular implantation of 5.5 mm optics acrylic IOLs resulted in decreased incidence of PCO and therefore greater patient satisfaction. Further studies investigating the effects of IOL optics, haptic structure and length, capsulorrhexis size, and IOL material and design features on PCO development will clarify the subject.
The Effects of Cyclopentolate on Intraocular Pressure and Retrobulbar Hemodynamics in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma
Authors: Taner P. , Unal B. , Demirbaş E. , Ergin A. 
Published: January 2018

Purpose To evaluate the changes of intraocular pressure (IOP) and retrobulbar hemodynamics after cyclopentolate administration in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Methods Eighteen patients with pseudoexfoliation syndrome and 18 patients with pseudoexfoliation glaucoma were enrolled in the study. After baseline measurements of IOP, the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of the ophthalmic, central retinal, and posterior ciliary arteries were investigated by color Doppler imaging. Then, 1% cyclopentolate was instilled in one eye of each subject. After 45 minutes of instillation of the cyclopentolate, the measurements of IOP and retrobulbar blood flow velocities were repeated. The results were compared with those of 20 age-matched normal subjects. Results Neither IOP nor retrobulbar blood flow velocities changed significantly in control subjects after cyclopentolate administration. IOP increased significantly after cyclopentolate instillation in pseudoexfoliation syndrome (p=0.004). Retrobulbar blood velocities did not change significantly after the cyclopentolate in this group. In pseudoexfoliation glaucoma group, it was observed that basal mean IOP showed a statistically significant increase after cyclopentolate drop (p=0.002). Although blood flow velocities of ophthalmic artery did not change significantly, PSV and EDV of the central retinal and posterior ciliary arteries decreased significantly (p<0.05) and RI of the posterior ciliary artery increased significantly (p=0.01) after cyclopentolate instillation. Conclusions On the basis of our findings, pseudoexfoliation appears to be a predictive factor for an IOP rise after cyclopentolate. In pseudoexfoliation glaucoma patients, an increase of IOP after cyclopentolate could lead to a decreased retrobulbar blood flow. IOP must be rechecked after cyclopentolate administration in these patients to avoid further damage to the ganglion cells.
Intraobserver Reproducibility of Retinal Nerve Fiber Layer Measurements Using Scanning Laser Polarimetry and Optical Coherence Tomography in Normal and Ocular Hypertensive Subjects
Authors: Lleó-Pérez A. , Ortuño-Soto A. , Rahhal M.S. , Martínez-Soriano F. , Sanchis-Gimeno J.A. 
Published: January 2018

Purpose To evaluate quantitatively the intraobserver reproducibility of measurements of the retinal nerve fiber layer (RNFL) in healthy subjects and an ocular hypertensive population using two nerve fiber analyzers. Methods Sixty eyes of normal (n=30) and ocular hypertensive subjects (n=30) were consecutively recruited for this study and underwent a complete ophthalmologic examination and achromatic automated perimetry. RNFL were measured using scanning laser polarimeter (GDx-VCC) and optical coherence tomography (OCT Model 3000). Reproducibility of the RNFL measurements obtained with both nerve fiber analyzers were compared using the coefficient of variation. Results In both groups the authors found fair correlations between the two methods in all ratio and thickness parameters. The mean coefficient of variation for measurement of the variables ranged from 2.24% to 13.12% for GDx-VCC, and from 5.01% to 9.24% for OCT Model 3000. The authors could not detect any significant differences between healthy and ocular hypertensive eyes, although in normal eyes the correlations improved slightly. Nevertheless, the test–retest correlation was slightly better for GDx-VCC than for OCT Model 3000 (5.55% and 7.11%, respectively). Conclusions Retinal mapping software of both nerve fiber analyzers allows reproducible measurement of RNFL in both healthy subjects and ocular hypertensive eyes, and shows fair correlations and good intraobserver reproducibility. However, in our study, GDx showed a better test–retest correlation.
Etiology of Childhood Blindness in Izmir, Turkey
Authors: Cetin E. , Yaman A. , Berk A.T. 
Published: January 2018

Purpose To identify the anatomic sites and the etiology of childhood blindness and to discern treatable and preventable causes. Methods The records of 998 patients seen in the authors' pediatric ophthalmology unit between June 1998 and May 2002 were examined retrospectively. A total of 148 patients who had visual impairment and blindness according to World Health Organization criteria were included in the study. They are classified according to the etiology based on time of insult and the anatomic site of visual loss. Results The most common anatomic site of visual loss was retina, with a rate of 25.0%. The etiology according to the time of insult was unknown in 45.2% of the patients, of whom 20.2% had cataract. Genetic disorders were responsible in 25.0% of the patients. In 69.6% of the patients, the causes of visual impairment were considered either preventable or treatable, including cataract, retinopathy of prematurity, genetic disorders, and refractive errors. Conclusions A high percentage of our patients had avoidable causes of childhood blindness. Genetic counseling services, as well as national screening programs for amblyopia, red fundus reflex, and retinopathy of prematurity, should be established.
Optic Nerve Damage in Highly Myopic Eyes with Chronic Open-Angle Glaucoma
Authors: Jonas J.B. , Budde W.M. 
Published: January 2018

Purpose To compare the amount of optic nerve damage in relation to intraocular pressure in highly myopic eyes with chronic open-angle glaucoma versus non-highly myopic eyes with chronic open-angle glaucoma. Methods The comparative clinical observational study included 1841 eyes of 1100 patients with chronic open-angle glaucoma. The highly myopic study group consisted of 25 eyes with a myopic refractive error equal to or higher than −8 diopters. It was subdivided into eyes with an optic disc size larger than 2.7 mm2 and eyes with an optic disc smaller than 2.7 mm2. The control group included the remaining, non-highly myopic eyes (n=1816). For all patients, a morphometric analysis of color stereo optic disc photographs was performed. Main outcome measures were morphometric optic disc measurements and intraocular pressure. Results In the highly myopic, large-optic-disc study group compared with the control group, maximal and minimal intraocular pressure readings were significantly (p<0.05) lower and neuroretinal rim area corrected for optic disc size was slightly (p=0.16) smaller. Comparing the total highly myopic study group with a control group adjusted for optic disc area, neuroretinal rim area was significantly (p=0.039) smaller in the study group with no significant difference in intraocular pressure measurements between the groups. Conclusions At a given intraocular pressure in chronic open-angle glaucoma, optic nerve damage may be more pronounced in highly myopic eyes with large optic discs than in non-highly myopic eyes. This may suggest a higher susceptibility for glaucomatous optic nerve fiber loss in highly myopic eyes than in non-highly myopic eyes.
Bilateral Complete Avulsion of Ocular Globes in a Le Fort III Maxillofacial Fracture: A Case Report and Review of the Literature
Authors: Unal S. , Argin A. , Arslan E. , Demirkan F. , Aksoy A. 
Published: January 2018

Purpose The purpose of this paper is to demonstrate a case of bilateral complete avulsion of the globes following maxillofacial trauma. Methods A 23-year-old man with bilateral complete globe avulsion following a maxillofacial trauma. Both globes were luxated out of the orbit and suspended on the skin of the upper lid below the brows. No direct or indirect light reflexes or any eye movements could be noted. Computerized tomography showed complete lacerations of both optic nerves at a level just anterior to the optic canal. There were also multiple fractures corresponding to Le Fort III fracture with Le Fort II components. The brain parenchyma was normal with an exception of brain edema. As the globes were unsuitable for repositioning, both were enucleated. The maxillofacial fractures were immobilized with plates and screws. Although the patient gained consciousness with normal vital signs in the early postoperative period, he died on the ninth day due to Pseudomonas aeruginosa infection, despite invasive antibiotic treatment. Discussion The optic nerve and the globes are very resistant to mild and moderate trauma. The avulsion of the nerve at the canalicular or more posterior level may demonstrate central nervous system complications resulting in life-threatening conditions. The most critical issue in complete globe avulsions with a transected optic nerve is to rescue the vision. In total transected optic nerves the final eyes could only have had cosmetic benefits. In spite of promising experimental research on optic nerve regeneration, there are unknowns, such as the methods to eliminate the risk of anterior segment ischemia and phthisis bulbi. Conclusions Globe avulsions with a complete optic nerve cut remain a challenging problem. More research is required to better understand the pathophysiology of optic nerve repair.
Comparing Measurements of Retinal Nerve Fiber Layer Thickness Obtained on Scanning Laser Polarimetry with Fixed and Variable Corneal Compensator
Authors: Da Pozzo S. , Iacono P. , Marchesan R. , Vattovani O. , Ravalico G. 
Published: January 2018

Purpose To compare retinal nerve fiber layer (RNFL) thickness measurements obtained on scanning laser polarimetry (SLP) with commercially available instruments coupled with fixed (FCC) and variable corneal compensator (VCC). Methods Forty-two eyes of 42 patients underwent a complete ophthalmologic evaluation and achromatic automated perimetry (24-2 program, SITA standard strategy). Nineteen eyes were healthy (average mean deviation: -0.12 dB ± 2.26) and 23 glaucomatous (average mean deviation: -4.92 dB ± 6.49). All patients underwent SLP with both FCC and VCC. Adequate compensation of corneal birefringence on FCC-SLP was checked acquiring macular retardation map (MRM). RNFL thickness was evaluated considering superior and inferior maximum (SM, IM), average thickness and ellipse average (AT, EA), and superior and inferior average (SA, IA). Mean values (±SD) for each parameter measured by the two polarimeters were compared and linear regression calculated. The ability of each parameter to discriminate between normal and glaucomatous eyes was evaluated on both polarimeters calculating area under ROC curve. Results A significant linear correlation for all parameters was noted (r range: 0.65–0.78). VCC produced slightly higher thickness values than FCC, both in normal and glaucomatous eyes. On both polarimeters, area under ROC curve for all parameters discriminated adequately healthy from glaucomatous eyes (range: 0.68–0.81). Conclusions In a highly comparable and selected group of normal and glaucomatous eyes, FCC-SLP and VCC-SLP showed considerable concordance in measuring peripapillary RNFL thickness, both for sectorial and global parameters. Proper corneal birefringence compensation provided separation of normal from glaucomatous eyes on both polarimeters.
Iris Atrophy, Serous Detachment of the Ciliary Body, and Ocular Hypotony in Chronic Phase of Vogt-Koyanagi-Harada Disease
Authors: Saari J.M. , Nummelin K. 
Published: January 2018

Purpose To describe iris atrophy, serous detachment of the ciliary body, and ocular hypotony in a patient with chronic phase of Vogt-Koyanagi-Harada (VKH) disease. Methods Ocular examination and follow-up including digital infrared transillumination imaging of the iris was done in a 52-year-old woman with chronic phase of VKH disease. Results Infrared transillumination imaging showed extensive atrophy of the iris stroma and occasional pigment clumps both in the pupillary and ciliary zones of the iris, and detachment of the ciliary body in both eyes. Conventional transpupillary transillumination using white light showed only minute patchy atrophy of the pigment epithelium in the pupillary zone. Treatment did not normalize bilateral shallow retinal detachment of the posterior pole, serous detachment of the ciliary body, or severe ocular hypotony. Conclusions Severe atrophy of the iris stroma, retinal detachment of the posterior pole, serous detachment of the ciliary body, and ocular hypotony may occur in chronic phase of VKH disease.
Reflex Epiphora in Patients with Dry Eye Symptoms: Role of Variable Time Schirmer-1 Test
Authors: Singh Bhinder G. , Singh Bhinder H. 
Published: January 2018

Purpose To report reflex epiphora in patients with dry eye symptoms and describe the role of variable time Schirmer-1 test. Methods The study was conducted in 16 consecutive dry eye patients (32 eyes), nine male and seven female, aged 16 to 73 years (mean 48.56±16.68 years), presenting with reflex epiphora. Each eye was subjected to Schirmer-1 test and the time elapsed in total wetting of the 35 mm strip from its placement into the conjunctiva was noted and test was graded. This was compared with symptomatology, closed chamber infrared thermometry, humidity, fluorescein tear break-up time (FTBUT), fluorescein stain test, and Lissamine green stain. Results Schirmer-1 test differentiated reflex epiphora in dry eye patients into groups 0 to 4 based on time it took to wet the 35 mm strip (Group 0 = ≤5 min; Group 1 = ≤2 min; Group 2 = ≤1.5 min; Group 3= ≤1 min; Group 4 = ≤1/2 min). The score was −0.04 in 8 eyes, −0.03 in 10 eyes, −0.02 in 2 eyes, −0.01 in 6 eyes, and 0.00 in 6 eyes in Groups 4, 3, 2, 1, and 0, respectively. Reflex epiphora had a statistically significant correlation to the symptomatology (p<0.001), lissamine green staining (p<0.001), closed chamber humidity difference (p<0.001), and FTBUT score (p=0.001). Fluorescein stain test and difference in infrared thermometry did not show any correlation. A statistically significant correlation existed between severe and mild to moderate reflex epiphora (p=0.002). However, the two groups separately failed to show any statistically significant relationship with the symptomatology (p=0.16), Lissamine green (p=0.69), humidity difference from close to open eye position (p=0.17), and FTBUT (p=0.25). Thermometry and fluorescein stain test showed no relationship. Conclusions Schirmer-1 test with variable time quantifies reflex epiphora in dry eye patients, which was significantly related to the other tear function tests.
Discrimination between Normal and Early Glaucomatous Eyes with Scanning Laser Polarimeter with Fixed and Variable Corneal Compensator Settings
Authors: Brusini P. , Salvetat M.L. , Parisi L. , Zeppieri M. , Tosoni C. 
Published: January 2018

Purpose To evaluate the ability of scanning laser polarimetry (SLP) with a fixed corneal polarization compensator (GDx-FCC Nerve Fiber Analyzer) compared to one with a variable one (GDx-VCC) in the discrimination between healthy and early glaucomatous eyes. Methods Forty patients with early glaucomatous visual field defects, having a mean deviation of 3.1 ± 1.6 dB and a pattern standard deviation of 3.1 ± 0.9 dB, and 40 controls underwent both GDx-FCC and GDx-VCC. One eye per patient was considered. The cut-off point, taken as the value dividing healthy from glaucomatous eyes with highest probability, was determined for each GDx parameter. Linear discriminant functions (LDFs) were separately developed for GDx-FCC and GDx-VCC parameters. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) for discriminating between healthy and glaucomatous eyes were calculated for each GDx parameter, both according to the GDx normative database and after the selection of new cut-off points, and for the LDFs. Results All software-provided parameters showed low sensitivity and high specificity. The selection of new cut-off points improved the performance of all GDx parameters: VCC parameters performed better than FCC parameters; the largest AROCs were associated with the superior/nasal ratio for the GDx-FCC (0.86) and with the Number for the GDx-VCC (0.87). The LDFs provided an AROC of 0.89 with both the GDx-FCC and the GDx-VCC parameters. Conclusions The GDx-VCC showed a higher ability in the early diagnosis of glaucoma when compared with the GDx-FCC. The individuation of the right cut-off point of selected parameters with both GDx settings performed better than the software-provided parameters, and comparably to the GDx parameters-based LDFs.