bluuebunny/crossref_metadata_2025_split huggingface dataset:
Keratitis after Implantation of Intrastromal Corneal Ring Segments (Intacs) Aided by Femtosecond Laser for Keratoconus Correction: Case Report and Description of the Literature
Authors: Levy Jaime , Lifshitz Tova 
Published: January 2018

Purpose. The majority of reported cases of infectious keratitis after intrastromal corneal ring segment implantation have been described after mechanical implantation of the segments. We present a case of keratitis after implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser for keratoconus correction and review the relevant literature. Methods. A 31-year-old woman with keratoconus underwent uneventful sequential implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser performed 6 weeks apart. Two months after surgery in the second eye, she complained of red eye, pain, and decreased vision of 2 days’ duration. Left eye visual acuity was 20/100. Results. Slit-lamp examination of the left eye revealed a stromal infiltrate at the lower segment near the incision site. The infiltrate progressed despite topical treatment of vancomycin and ceftazidime. Cultures were negative. The inferior segment was removed and the inferior channel irrigated with antibiotics. One day later, significant fibrin and 1-mm hypopyon were detected in the anterior chamber. Significant improvement was observed after adding topical amikacin and amphotericin B. Six months later, a small stromal scar is present at the inferior incision site and best-corrected visual acuity is 20/25. Conclusions. To our knowledge, this is the second reported case of keratitis after implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser for keratoconus correction. Prompt and adequate treatment is essential to prevent irreversible reduction of visual acuity.
Fundus Autofluorescence and Spectral Domain Optical Coherence Tomography in Early Detection of Plaquenil Maculopathy
Authors: Kelmenson Amy T. , Brar Vikram S. , Murthy Ravi K. , Chalam Kakarla V. 
Published: January 2018

Purpose. To report fundus auto fluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) findings in a patient with early hydroxychloroquine maculopathy. Methods. A 50-year-old man presented with complaints of ring-like shadows in front of his eyes. He had been on hydroxychloroquine (Plaquenil) 400 mg orally twice daily for 10 years (5.14 mg/kg/day). Fundus examination revealed granular hypopigmentation in an arcuate pattern in the inferior parafoveal area bilaterally. The patient underwent further evaluation with SD-OCT and FAF imaging. Functional changes were assessed by microperimetry Results. Hypopigmented lesions on the fundus were autofluorescent and SD-OCT corresponding to this area revealed loss of inner segment-outer segment, suggesting loss of photoreceptor layer in the affected area with underling dysfunctional retinal pigment epithelium. Conclusions. Findings on SD-OCT and FAF imaging support the histopathologic findings described in cases of hydroxychloroquine maculopathy.
Intravitreal Ranibizumab for Choroidal Neovascularization Associated with Retinal Astrocytic Hamartoma
Authors: Querques Giuseppe , Kerrate Houda , Leveziel Nicolas , Coscas Gabriel , Soubrane Gisele , Souied Eric H. 
Published: January 2018

Purpose. To report on a patient with retinal astrocytic hamartoma, who developed a choroidal neovascularization (CNV), effectively treated by intravitreal ranibizumab injections. Methods. A 74-year-old woman who, 12 years before, had been diagnosed with a yellow-gray lesion in the left eye (OS) presented in our department for OS decreased vision of recent onset. Results. Upon a complete ophthalmologic examination including ultrasonography, fluorescein angiography (FA), and spectral domain optical coherence tomography (SD-OCT), the patient was diagnosed with retinal astrocytic hamartoma and coincident CNV on its foveal border. Six months after 3 monthly intravitreal ranibizumab injections, FA and OCT revealed the CNV closure and absence of intraretinal and subretinal fluid on the foveal border of the retinal astrocytic hamartoma. Conclusions. Associations between retinal astrocytic hamartoma and CNV have not been previously reported. Intravitreal ranibizumab injection appears an attractive therapeutic option for patients showing such an unusual association.
Unilateral Retinal Hemorrhages with Subarachnoid Hemorrhage in a 5-Week-Old Infant: Is This Nonaccidental Injury?
Authors: Reddy Aravind R. , Clarke Michael , Long Vernon W. 
Published: January 2018

Purpose. Retinal hemorrhages are an important sign in the setting of nonaccidental injury (NAI) (abusive head injury) in young infants and form a very important part of the evidence in support of the diagnosis. The diagnosis of NAI has serious social and legal implications. Other causes of retinal hemorrhages in an infant, such as birth trauma, accidental head injury, subarachnoid hemorrhage, other less common disorders of clotting, leukemia, and infections such as endocarditis, need to be considered and ruled out in making a diagnosis of NAI. Methods. Descriptive case report. Results. A 5-week-old child presented with rapid onset of symptoms of drowsiness and hypotonia, unilateral retinal hemorrhages, and an intracranial hemorrhage in the posterior fossa. NAI was high on the list of differential diagnosis, which caused considerable anxiety in the parents. The cause of the intracranial hemorrhage only became apparent at repeat neuroimaging several weeks later. Conclusions. The case is presented to point out arteriovenous malformation as a possible cause of retinal hemorrhages in this age group where an early diagnosis of the etiology is often not possible. A diagnosis of NAI, commonly associated with a similar clinical presentation, can have serious social and legal implications.
Clinical Results with the Use of a Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery
Authors: Khouri Albert S. , Vaccaro Anzhelica , Zarbin Marco A. , Chu David S. 
Published: January 2018

Purpose To evaluate surgical outcomes using a temporary intraoperative keratoprosthesis (KP) in patients undergoing combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP). Methods From January 2001 to August 2008, medical records of 23 patients undergoing combined KP/PPV/PKP for traumatic and nontraumatic corneal and retinal pathologies were studied. Only patients with ≥6 months follow-up were included. Patient characteristics, diagnoses, visual acuity, intraocular pressure, and status of the retina and cornea at baseline, and postoperatively on day 1, months 1 and 6, and yearly until the last follow-up, were collected. Functional (best-corrected visual acuity: improved, stable, worsened) and anatomic outcomes (clear corneal graft, retinal reattachment) were defined prior to review. Results Twenty-four eyes underwent combined KP/PPV/PKP (mean follow-up 36 months). At final follow-up, best-corrected visual acuity improved in 8 (40%) eyes, remained stable in 8 (40%), and worsened in 4 (20%). Corneal graft was clear in 18(79%) eyes; 5(21%) had graft failure. Retinal reattachment occurred in 22 (92%) eyes; 2 (8%) developed a localized traction retinal detachment not warranting additional surgery. Derangement in intraocular pressure was common (13 [54%] eyes). Three eyes (13%) showed signs of phthisis preoperatively that resolved with reestablishment of normal intraocular pressure postoperatively. Conclusions Temporary KP during PPV/PKP surgery allowed surgical intervention in eyes with complex anterior and posterior segment disease. Corneal graft clarity and successful retinal reattachment was possible in the majority of eyes.
Anatomic Evaluation of Macular Holes with Silicone Oil Tamponades in Highly Myopic Eyes Using Optical Coherence Tomography
Authors: Qian Jing , Jiang Yan-Rong 
Published: January 2018

Purpose To observe the postoperative status of the macula after vitrectomy with silicone oil tamponade for macular hole-related retinal detachment in highly myopic eyes by optical coherence tomography (OCT), to analyze the factors associated with anatomic success, and to evaluate the possibility of successful silicone oil removal. Methods OCT was used to follow the postoperative changes in the macular area of 51 highly myopic eyes, and other information was obtained from patient records. Results OCT confirmed that successful retinal reattachment was achieved in 41 eyes (80.4%) after the initial surgery, and all of them underwent silicone oil removal postoperatively. The macular holes were closed in 20 eyes (20/41), all of which remained retina attached after silicone oil removal. In 21 (21/41) macular hole nonclosed eyes, recurrent retinal detachment (RRD) occurred in 8 eyes (8/21) after silicone oil removal. There were statistically significant association between posterior staphyloma and the presence of macular hole (p<0.001). Macular hole closure significantly increased the chances of successful silicone oil removal (p=0.003). Improved postoperative best-corrected visual acuity was significantly associated with macular hole closure (p=0.012). Conclusions OCT helps predict anatomic and functional outcomes of highly myopic eyes with macular hole-related retinal detachment. Posterior staphyloma may prevent macular hole closure. Silicone oil removal can be performed when macular hole closure was confirmed by OCT, while in eyes with nonclosed macular holes, silicone oil removal may lead to RRD.
Intravitreal Ranibizumab in the Treatment of Choroidal Neovascularization Associated with Idiopathic Central Serous Chorioretinopathy
Authors: Konstantinidis Lazaros , Mantel Irmela , Zografos Leonidas , Ambresin Aude 
Published: January 2018

Purpose We evaluate the functional and anatomic outcome after intravitreal ranibizumab treatment in patients with choroidal neovascularization (CNV) related to chronic central serous chorioretinopathy (CSC). Methods This is a small case series of 5 eyes with CNV associated with chronic CSC treated with intravitreal injection of 0.5 mg ranibizumab in the Jules Gonin University Eye Hospital from July 2007 to July 2009. Baseline and monthly follow-up visits included best-corrected visual acuity (BCVA), fundus examination, and optical coherence tomography (OCT). Fluorescein and indocyanine green angiography (ICG) were performed at baseline and repeated at least every 6 months. Results We studied 5 eyes of 4 patients with a mean age of 66 years. Mean follow-up was 21 months (SD 1.9). The mean number of intravitreal injections administered for each patient was 10(SD4.6). The mean initial BCVA was 0.23 (decimal equivalent) (logMAR 0.64, SD 0.13). At the last follow-up, mean BCVA was 0.44 decimal equivalent (logMAR 0.36, SD 0.31). Mean central macular thickness (CMT) measured with OCT was 330 μm (SD 43) at baseline and decreased at the final follow-up to 243 μm (SD 44). Persistent intraretinal or subretinal fluid on OCT and/or multifocal areas of increased choroidal permeability on ICG angiographies were present in all patients at the last follow-up visit. Conclusions Intravitreal ranibizumab appeared to be an effective treatment of CNV related to chronic CSC. However, residual intraretinal or subretinal fluid and increased choroidal permeability persisted. Prospective controlled studies are warranted to evaluate the long-term safety and efficacy of intravitreal ranibizumab.
Pseudophakic Eye Globe Disruption
Authors: Motolese Llaria , Motolese Paolo Alfonso , Frezzotti Paolo , Fruschelli Mario , Motolese Eduardo 
Published: January 2018

Purpose Scleral rupture due to bulb bursting can result from a heavy contusion. Owing to refined surgical techniques and the use of antibiotics and cortisone-based medication, more conservative concepts have followed. In major ruptures, the results were almost always very poor, with atrophy or subatrophy of the eyes. Methods A 63-year-old man with major left ocular trauma and intraocular lens dislocation in the subconjunctival area was referred to the authors for clinical and surgical evaluation. Results Surgery was performed 3 weeks after the trauma to allow for improvement in the patient's condition. The reabsorption of a palpebral-frontal hematoma, which made bulb exploration almost impossible, was fundamental in order to proceed. After 1 year, the best-corrected visual acuity was 0.9. In fact, great improvements in surgical techniques in recent years have allowed us to consider the problem of major rupture in a new way, both technically and from an organizational point of view. Conclusions In terms of organization, the concept of urgent surgical procedures must be reevaluated, because besides traumatic damage, incomplete surgical measures may result. This makes all treatment useless, in both barely equipped and highly specialized centers.
Experience with Intravitreal Bevacizumab as a Preoperative Adjunct in 23-G Vitrectomy for Advanced Proliferative Diabetic Retinopathy
Authors: Mota Sergio E. Hernández-Da , Nuñez-Solorio Silvia M. 
Published: January 2018

Purpose To evaluate the safety and efficacy of intravitreal injection of bevacizumab before vitrectomy in advanced proliferative diabetic retinopathy. Methods A randomized clinical trial was performed on 40 eyes of 40 patients. Inclusion criteria were advanced proliferative diabetic retinopathy with fractional retinal detachment and HbA1c <7%. Patients were randomly assigned into 2 groups. Patients in one group had an intravitreal injection (1.25 mg) of bevacizumab 48 hours before 23-G pars plana vitrectomy surgery was performed, whereas the other group did not. Best-corrected visual acuity, intraocular pressure, and fundus photographs were taken prior to surgery 1 week and 3 and 6 months postoperatively. Results Effective vitrectomy time was 8.05 minutes in the bevacizumab group vs 16.8 minutes in the non-bevacizumab group. Statistically significant differences were observed in visual acuity at 1 week and 3 and 6 months follow-up between the 2 groups (p<0.05 for each visit). Also, there was less bleeding intraoperatively in the bevacizumab group. Mean final visual acuity in the bevacizumab group was 0.82 logMAR and 2.01 logMAR in the non-bevacizumab group. Conclusions Adjuvant intravitreal injection of bevacizumab prior to vitrectomy in diabetic retinopathy with fractional retinal detachment significantly eases the procedure, diminishing intraoperative complications, and leads to a better visual outcome.
Ultrasound Biomicroscopy Imaging of Sclerotomy in Children with Cataract Undergoing 25-Gauge Sutureless Pars Plana Anterior Vitrectomy
Authors: You Caiyun , Wu Xiaoming , Ying Liang , Xie Lixin 
Published: January 2018

Purpose To investigate the healing course and features of sclerotomy in children with cataract undergoing 25-gauge sutureless pars plana anterior vitrectomy by ultrasound biomicroscopy (UBM) imaging. Methods 25-Gauge sutureless pars plana anterior vitrectomy was performed in 15 eyes for congenital or developmental cataract surgery (mean age 6.9 years, range 5–10 years). Time of anterior vitrectomy, intraoperative and postoperative clinical observations, postoperative complications, and UBM imaging of sclerotomy sites were evaluated. Results The mean time of anterior vitrectomy was 40.9 seconds (range 26–53 seconds). A stable intraocular pressure and a slight disturbance on vitreous were found intraoperatively Postoperative inflammation in anterior chamber was mild with fast postoperative recovery. Fluid leakage, vitreous incarceration, hypotony or any other complications were not noted in any of the eyes. UBM imaging showed that the sclerotomy was detected as a gape through the sclera on day 3 and decreased in size obviously on day 7 after surgery. The internal opening of the gape was cured on postoperative week 2 with inability to detect its internal lip. The scleral wounds in 11 (73.3%) of the eyes were undetectable at week 3 by UBM imaging and all sclerotomy sites were cured at week 4 postoperatively. Conclusions UBM imaging on pediatric cataract eyes showed that healing of a 25-gauge sclerotomy was rapid and no leakage or vitreous incarceration from the scleral wound was found.
Efficacy and Safety of Short-Duration Topical Treatment with Azithromycin Oil-Based Eyedrops in an Experimental Model of Corneal Refractive Surgery
Authors: Merayo-Lloves Jesús , Blanco-Mezquita Tomás , Ibares-Frías Lucía , Cantalapiedra-Rodríguez Roberto , álvarez-Barcia Ángel 
Published: January 2018

Purpose To assess the tolerance and side effects of azithromycin eyedrops at the ocular surface after corneal refractive surgery in an experimental animal model. Methods The effect of azithromycin eyedrops was evaluated in hen corneas that underwent laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) surgery in 1 eye, using the fellow eye (not manipulated) as a control. Animals were treated bid 3 days prior to surgery and 3 days after surgery with T1225 1.5% azithromycin eyedrops or saline eyedrops (balanced salt solution), or were left untreated as a control. Clinical course and cell biology (apoptosis, proliferation, and differentiation) measurements were assessed. Results Infections were present in the following proportions of corneas operated on by LASIK: 0% treated with azithromycin, 60% treated with BSS, and 30% untreated. No corneal abscess or keratitis were present in any PRK or unmanipulated corneas. Conjunctival edema and redness were less prevalent in LASIK-operated eyes treated with azithromycin than in BSS-treated or untreated eyes and were not observed in any PRK or unmanipulated corneas. In PRK-operated eyes treated with azithromycin, a decrease was observed in the apoptosis and an increase in the stromal proliferation. There were no differences in these parameters for LASIK and unmanipulated eyes. Conclusions Topical administration of T1225 oil-based azithromycin eyedrops was well tolerated in both unmanipulated hen corneas and those treated with corneal refractive surgery (PRK and LASIK). T1225 demonstrated a potent antibiotic effect after LASIK treatment.
The Frequency of Pseudoexfoliation Syndrome in the Middle Black Sea Region of Turkey
Authors: Cumurcu Tongabay , Kilic Rasit , Yologlu Saim 
Published: January 2018

Purpose To assess the frequency of Pseudoexfoliation syndrome (PEX) and evaluate its association with specific ocular diseases in patients attending the Department of Ophthalmology at Gaziosmanpasa University Hospital. Methods A prospective study was conducted at the Gaziosmanpasa University Hospital between December 2007 and December 2008. A total of 831 subjects aged 45 or above attending the general ophthalmic clinics were recruited for this study. Each patient underwent complete ophthalmic assessment, including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, gonioscopy and fundus examination. Results Of the 831 subjects, 12.2% had PEX. Pseudoexfoliation was bilateral in 74.2% of cases, significantly associated with cataract, glaucoma, age-related macular degeneration (AMD), and phacodenesis. Of the patients with PEX, 43.6% had cataract, 6.9% had glaucoma, 7.9% had AMD, and 0.9% had phacodenesis. In addition, 9.8% had cataract + glaucoma, 13.7% had cataract + phacodenesis, and 17.8% had all of them. The prevalence of PEX had a tendency to increase with age but had no sex predilection. Conclusions The study findings enhance our knowledge of PEX in Anatolia, particularly in the Middle Black Sea region.
Hip replacement of the ovine hip with a zero dislocation rate
Authors: Blom A.W. , Hubble M. , Eldridge J. , Learmonth I.D. , Goodship A.E. 
Published: January 2018

Ovine and caprine animals are frequently used as in vivo models for both total hip replacement and hemiarthroplasty. Historically the complication rate, particularly the dislocation rate, has been high. In studies involving animals it is imperative to keep complications to a minimum, both to reduce the distress of the individual animals, and also to keep the number of animals used in each study to the absolute minimum required. We describe an approach that has had a dislocation rate of zero out of 69 hips (mean follow-up 11 months). The authors recommend this approach in ovine and caprine studies of the hip joint.
Distal Femoral Cortical Hypertrophy: Predisposing Factors and Their Effect on Clinical Outcome
Authors: Katsimihas M. , Katsimihas G. , Lee M.B. , Learmonth I.D. 
Published: January 2018

The clinical and radiographic features of 109 hybrid total hip replacements performed between 1986 and 1992 in 96 consecutive patients were retrospectively reviewed. A cementless Harris-Galante (HGP1) cup and a 32mm monobloc straight Muller stem were used in all cases. The overall prevalence of distal femoral cortical hypertrophy (DCH) was 43.1%. Male sex, underlying diagnosis of avascular necrosis and Charnley grade A were among the factors that predisposed to the development of DCH. The prevalence of stem radiolucencies was lower in the group of patients who developed DCH compared with those without hypertrophy. The Harris Hip Score ranged between 5 and 54 preoperatively and the average HHS was more than 80 postoperatively. No association was found between DCH and thigh pain.
Thirty-two Millimetre Heads and Accelerated Polyethylene Wear in Total Hip Arthroplasty
Authors: Blom A.W. , Madhavan P. , Lee M. , Learmonth I.D. 
Published: January 2018

In total hip arthroplasty 32 mm heads are often used as the greater diameter is thought to contribute to improved stability. However, greater head diameter can also lead to greater volumetric wear. We compared polyethylene wear between patients with 32 mm heads and those with smaller heads. All patients who had Harris Galante1 metal-backed, uncemented cups inserted between 1986 and 1996 at our institute were annually reviewed clinically and radiographically. Accelerated polyethylene wear was noted between the fifth and seventh postoperative year in 17 out of 165 total hip replacements with 32 mm heads, but only in 21 out of 961 total hip arthroplasties with smaller femoral heads. In all 17 THRs, accelerated wear was also associated with thin polyethylene (<6 mm). This paper highlights a potentially serious problem. When 32 mm metal heads are used with uncemented cups and polyethylene liners, there is a risk of accelerated acetabular wear in patients with thin polyethylene.
Ochronotic Arthropathy with Severe Articular Involvement Necessitates Total Joint Replacement
Authors: Gasparini G. , Cerciello S. , Vasso M. , Cillo M. 
Published: January 2018

The aim of this paper is to describe the pathological and clinical features of alkaptonuria (AKU). AKU clinical presentation is identified as ochronosis, the dark pigmentation of skin and cartilage that is caused by progressive accumulation of homogentisic acid (HGA) in connective tissues. We also discuss surgical considerations about joint replacement, which represents the only treatment in the case of severe articular degeneration. We report the case of a middle-aged female with both hip and knees affected. She underwent bilateral hip replacement and right knee arthroplasty. Preoperatively, the patient was examined clinically. Harris Hip Score (HHS) and Hospital for Special Surgery score (HSS) were completed for both hips, and for the right knee. Radiographs were made of both hips and the knee, in different projections. HHS for the left and right sides at the latest follow-up (11 and 9 years after surgery respectively) were 98 and 95. HSS 3.5 years after surgery was 97. Alkaptonuria is a rare inherited pathology caused by deficiency of the enzyme homogentisic acid oxidase (HGAO). Skeletal involvement is frequent and causes severe cartilage damage. HGA levels in blood and urine and articular symptoms make the diagnosis certain. Therapy is still debated: diet offers good results in young people while high doses of C vitamin seem to reduce the amount of deposits. Articular localizations usually lead to joint replacement. In this case functional and radiographic results are excellent even at long follow-up.