bluuebunny/crossref_metadata_2025_split huggingface dataset:
External Lacrimal Punctum Grading: Reliability and Interobserver Variation
Authors: Kashkouli M.B. , Nilforushan N. , Nojomi M. , Rezaee R. 
Published: January 2018

Purpose To test the reliability and interobserver variation of external lacrimal punctum (ELP) grading. Methods In a population-based epidemiologic study, ELP was visually graded based on slit lamp examination (grade 0 to 5), as described previously Grades 0, 1, and 2 are for closed or stenotic ELP and grade 3 is for normal ELP (subjective grades). Grades 4 and 5 are for larger than normal (slit) ELP measured in millimeters by slit lamp beam (objective grades). Upper and lower ELP were graded by an oculoplastic surgeon and a senior ophthalmology resident. Both observers were masked to the reading of the other. Both observers were familiar to the grading system for past few years, although the oculoplastic surgeon had more experience in this regard. Patients with previous periocular surgery, medial lid mass obscuring the ELP, anatomically distorted punctum, and subjects with grade 4 and 5 ELP (objective grades) were excluded. The intraclass correlation coefficient test was used for the statistical analysis. Results There were 632 eyes from 174 (55.10%) male and 142 (44.90%) female subjects. Subjects' ages ranged from 7 to 87 years (mean ± SD = 54±17.56). The intraclass correlation coeficient test showed a positive and strong correlation between two observers for grading the upper (value=+0.87, 95% CI: 0.84 and 0.88, p=0.000) and lower (value=+0.91, 95% CI: 0.90 and 0.92, p=0.000) ELP. In general, the less experienced observer tended to overestimate both upper and lower ELP grading. Conclusions Reliability of the new ELP grading makes it a recommendable option for use in the clinic and comparing reports on ELP pathologies.
Primary Intraocular Lymphoma: Another Great Masquerader
Authors: Gallagher M.J. , Cervantes-Castañeda R.A. , Bhat P. , Yilmaz T. , Foster C.S. 
Published: January 2018

Purpose To describe diverse and atypical presentations of the most common masquerader in neo-plastic masquerade syndromes. Methods Retrospective interventional case series. The authors identified three patients who presented with atypical and diagnostically challenging masquerading manifestations. These patients were eventually found to have primary intraocular lymphoma (PIOL). Their case histories, presenting signs and symptoms, diagnostic tests, and treatments are described. Results Patient 1 masqueraded as viral retinitis and branch retinal vein occlusion but was resistant to 5 weeks of oral and intravenous acyclovir. Patient 2 presented with choroidal infiltrates and vision loss. This patient had had breast carcinoma for the last 25 years and secondary metastasis was suspected. Patient 3 had chronic uveo-retinitis and a chronic Propionibacterium acnes infection was suspected. All three patients were diagnosed with PIOL. Conclusions PIOL is an aggressive masquerader and not only presents clinical diagnostic difficulties but also requires expert tissue handling and analysis, so that early diagnosis can be made and therapy can be instituted.
Diffuse Retinal Pigment Epitheliopathy among the Inhabitants of Brahmaputra Valley of India
Authors: Bujarborua D. , Choudhury A. 
Published: January 2018

Purpose To analyze the patient demography and the various fluorescein angiography (FA) features of diffuse retinal pigment epitheliopathy (DRPE) cases among the inhabitants of the Brahmaputra Valley of India and to see if there is any ethnic variation in its clinical presentation and risk factors. Methods This is a retrospective study in a clinical practice setting with study population of Aryan and Mongoloid races. Data analysis of 30 cases (40 eyes) of DRPE of 262 consecutive cases of central serous chorioretinopathy (CSC) was done. The various features of these cases were compared and statistically evaluated with the findings of CSC cases with symptom duration of 6 months or more and cases with recurrent episodes. Results A total of 11.45% had DRPE that had average symptom duration of 3.50 years. Logistic regression showed high risk for DRPE if sensory retinal detachment (SRD) persists for more than 18 months. Systemic hypertension was another significant risk factor, whereas multiple RPE leaks appeared to be weakly significant. DRPE was predominant in eyes of patients having first acute episode of CSC in later age and fairly large retinal pigment epithelial detachments (PEDs) contributed to its development. Role of exogenous corticosteroid, retinotoxic drugs, and tobacco consumption could not be assessed properly due to inadequate sample size. Conclusions The main factor for the development of DRPE is the persistence of SRD for more than 1.50 years. Fairly large leaking PED and onset of primary CSC in later age appear to contribute towards its development. Except for these, no major variation from Western studies was observed.
Vigabatrin-Induced Visual Dysfunction in Chinese Patients with Refractory Epilepsy
Authors: Hui A.C.F. , Liu D.T.L. , Wong K.K. , Man B.L. , Leung T. , Lam P.T.H. , Lam D.S.C. 
Published: January 2018

Purpose Bilateral visual field constriction has been reported following the use of the antiepileptic drug (AED) vigabatrin. The incidence of retinal toxicity is variable and there are limited data in Asian populations. The authors report the results of ophthalmologic examination in Chinese patients taking this drug. Methods The authors identified two groups of patients with refractory epilepsy: one group on vigabatrin and another cohort of patients taking other AEDs. The authors recorded the medical history and performed visual acuity testing, intraocular pressure measurement, slit lamp biomicroscopy, and conventional automated perimetry with Humphrey Visual Field Analyzer II in all patients. Results Eighteen patients - 8 men and 10 women - with a mean age of 23.8 years who were taking vigabatrin were reviewed. Length of treatment with this drug ranged from 13 months to 5 years and the mean daily dosage was 1581 mg. None of the patients in either group had a history of coexisting optic nerve diseases or other neurotoxic drug use. Twenty of 36 (55.6%) eyes of the vigabatrin users showed significant bilateral visual field defects with 80% showing a concentric pattern, compared with none in the control group. Conclusions The authors confirmed a high prevalence of visual field constriction associated with vigabatrin in Chinese patients. The use of alternative novel techniques such as measurement of the retinal nerve fibre layer thickness and perimetry may detect early retinal damage and result in even higher incidences. Visual field monitoring is recommended in patients who continue to take this drug.
A New Visual Field Test in Empty Sella Syndrome: Rarebit Perimetry
Authors: Yavas G.F. , Küsbeci T. , Eser O. , Ermis S.S. , Coşar M. , Öztürk F. 
Published: January 2018

Purpose Several visual field defects can be seen in empty sella syndrome (ESS). In this study, the authors aimed to evaluate the visual field defects in patients with ESS by rarebit perimetry and to compare the results with Humphrey perimetry. Methods Left eyes of 13 patients with ESS and left eyes of 15 age-matched normal subjects were included in the study. Visual field testing was performed by Humphrey Visual Field Analyzer II (Fast-pack 30–2 strategy) and rarebit perimetry (regular test). Statistical analysis was performed by independent-samples t-test, Mann-Whitney U test, receiver operating characteristic (ROC) curves, and Pearson correlation test. Results Humphrey perimetry mean deviation was −3.67 dB in control group and −6.06 dB in patients with ESS (p=0.12). Mean hit rate calculated by rarebit test was 91.8% in control group and 75.9% in cases with ESS (p=0.005). Area under ROC curve was 0.756 for Humphrey visual field test and 0.827 for rarebit hit rate (p=0.59). There was a significant correlation between rarebit hit rate and Humphrey visual field test mean deviation (r=0.755, p±0.001). Conclusions Rarebit perimetry correlates significantly with Humphrey perimeter in detecting visual field defects related with ESS and has a higher sensitivity and specificity.
Bilateral Macular Detachment Caused by Bilateral Optic Nerve Malformation in a Papillorenal Syndrome Due to a New Pax2 Mutation
Authors: Samimi S. , Antignac C. , Combe C. , Lacombe D. , Renaud Rougier M.-B. , Korobelnik J.-F. 
Published: January 2018

Purpose Papillorenal syndrome is an autosomal dominant entity due to PAX2 gene mutation, involving optic nerve and renal malformations. Methods The authors report a 19-year-old man with bilateral macular detachment associated with optic nerve pit in one eye and morning glory syndrome in the other eye. The patient underwent three-port pars plana vitrectomy, endolaser photocoagulation, and C3F8 gas tamponade in his best eye. A medical history of vesicoureteric reflux and kidney hypoplasia led to genetic analysis. Results Molecular genetic PAX2 analysis revealed a novel nondescribed mutation in exon 3. One year postoperatively, ophthalmologic outcomes were satisfactory with complete flattening of the retina and improvement of the best-corrected visual acuity to 11/10. Conclusions PAX2 is involved in the optic vesicles, genital tracts, kidney, and central nervous system embryogenic development. The association of optic nerve and renal malformations should lead to the suspicion of papillorenal syndrome with PAX2 mutation.
Long-Term Progression at Individual Mean Intraocular Pressure Levels in Primary Open-Angle and Exfoliative Glaucoma
Authors: Stewart W.C. , Kolker A.E. , Sharpe E.D. , Day D.G. , Konstas A.G.P. , Holló G. , Astakhov Y.S. , Teus M.A. , Stewart J.A. 
Published: January 2018

Purpose To describe progression and non-progression rates at individual mean intraocular pressure (IOP) levels for patients with primary open-angle and exfoliative glaucoma. Methods A meta-analysis of five previously published retrospective studies describing progression and non-progression rates at individual intraocular pressure levels over 5 or more years of follow-up. All patients had primary open-angle (four studies) or exfoliative glaucoma (one study). Results This meta-analysis included 822 patients of whom 655 (80%) had primary open-angle glaucoma and 167 (20%) had exfoliative glaucoma. In total, 220 patients progressed (27%), while 602 (73%) remained stable over 5 years. The mean IOP was 20.0 for progressed and 17.1 mmHg for stable patients (p=0.0004). The peak IOP was 29.1 for progressed and 23.6 mmHg for stable patients (p=0.0014). At an IOP level >18 mmHg, 49% of patients remained stable; at 18 mmHg, 78%; between 13 and 17 mmHg, 82%; and <13 mmHg, 96%. Additional factors associated with progression were older age (p=0.0004) and exfoliative glaucoma (p=0.0001). However, multivariant regression analysis identified only mean IOP as a risk factor for progression (p=0.039). Conclusions This study suggests that maintaining an IOP well within the normal range over 5 years in patients with primary open-angle or exfoliative glaucoma helps to prevent glaucomatous progression.
Effective Treatment with Topical Cyclosporine of a Child with Steroid-Dependent Interstitial Keratitis
Authors: Miserocchi E. , Modorati G. , Rama P. 
Published: January 2018

Purpose To report a case of steroid-dependent idiopathic interstitial keratitis in a child successfully treated with topical cyclosporine 2% drops. Methods Case report. Results The authors describe a case of a 6-year-old boy with a history of recurrent idiopathic bilateral interstitial keratitis. The patient had recurrent episodes of corneal inflammation that became more frequent and severe during the follow-up, and caused severe corneal opacities and visual loss. Long-term treatment with topical corticosteroid was required to avoid corneal scarring that eventually caused secondary elevation of intraocular pressure. Topical cyclosporine 2% was therefore introduced as a steroid sparing agent to treat the keratitis. The treatment was continued for 1 year and the patient achieved a complete remission of corneal inflammation with resolution of corneal scarring and normalization of intraocular pressure. Conclusions In this child with recurrent episodes of interstitial keratitis, topical cyclosporine 2% has been shown to be a safe and effective alternative for treating corneal inflammation.
Artificial Neural Network-Based Glaucoma Diagnosis Using Retinal Nerve Fiber Layer Analysis
Authors: Grewal D.S. , Jain R. , Grewal S.P.S. , Rihani V. 
Published: January 2018

Purpose To develop, train, and test an artificial neural network (ANN) for differentiating among normal subjects, primary open angle glaucoma (POAG) suspects, and persons with POAG in Asian-Indian eyes using inputs from clinical parameters, optical coherence tomography (OCT), visual fields, and GDx nerve fiber analyzer. Methods One hundred eyes were classified using optic disc examination and perimetry into normal (n=35), POAG suspects (n=30), and POAG (n=35). EasyNN-plus simulator was used to develop an ANN model with inputs including age, sex, myopia, intraocular pressure (IOP), optic nerve head, and retinal nerve fiber layer (RNFL) parameters on OCT, Octopus 30-2 full threshold visual field, and GDx parameters. Results With two outputs (POAG or normal), specificity was 80% and sensitivity was 93.3%. Ninety percent of POAG suspects were labeled as abnormal in this analysis. ANN assigned the highest importance to Smax/Imax RNFL on OCT followed by cup-area (OCT) and other RNFL parameters (OCT) for two outputs. With three outputs (normal, POAG, and POAG suspect), ANN gave an overall classification rate of 65%, specificity of 60%, and sensitivity of 71.4% with a target error rate of the training set at 1%. The parameters for three outputs, in decreasing order of relative importance, were Savg, vertical cup-disc ratio, cup-volume, and cup-area on OCT. Conclusions An ANN taking varied diagnostic imaging inputs was able to separate POAG eyes from normal subjects and POAG suspects. The network had reasonable sensitivity with three outputs; however, it had a tendency to mislabel POAG suspects as POAG.
Orbital Metastasis Associated with Primary Breast Carcinoma in a Man Detected during Peribulbar Anesthesia for Cataract Surgery
Authors: Polito E. , Pichierri P. , Occhini R. , Loffredo A. , Moramarco A. , Balestrazzi A. 
Published: January 2018

Purpose A case of orbital infiltration by breast carcinoma in a male patient causing mild enophthalmos and subcutaneous mass detected accidentally during peribulbar anesthesia for cataract surgery is discussed. Methods The authors report a case of a 65-year-old man who came to the Ophthalmology Department for cataract surgery. During the presurgery peribulbar injection, a hard palpable mass located under the inferior left eyelid was noted, together with mild enophthalmos. A historical clinical screening revealed that 5 years previously the patient had undergone a right radical mastectomy to treat a ductal carcinoma of the breast. Results The patient underwent an incisional biopsy of the orbital mass that confirmed the clinical hypothesis of a metastasis. Discussion This case highlights the importance of the collection and screening of detailed clinical information on the patient before every ophthalmic operation including cataract surgery. The occurrence of progressive enophthalmos can represent an unusual symptom of orbital metastasis, commonly presenting with proptosis and diplopia.
Mild Topographic Abnormalities that Become More Suspicious on Scheimpflug Imaging
Authors: Wolf A. , Abdallat W. , Kollias A. , Fröhlich S.J. , Grueterich M. , Lackerbauer CA. 
Published: January 2018

Purpose Although several screening methods exist, postoperative corneal ectasia after refractive surgery is a severe complication. One possibility for this might be the fact that screening methods may fail in detection of preoperative risk factors such as forme fruste keratoconus (FFKC). Methods Retrospective evaluation of four cases that showed only mild changes of FFKC on placido-based topography but revealed indicative findings on Scheimpflug imaging (Pentacam®). Results While in placido-based topography evaluation of corneal topography did not show a clear FFKC, the evaluation of corneal topography on Scheimpflug imaging together with the data of spatial corneal thickness revealed distinctive FFKC in all cases presented. Conclusions Although both methods bear the risk of not detecting pre-existing FFKC, Scheimpflug imaging seems superior to placido-based corneal topography alone.
Two-site Phacotrabeculectomy versus Bimanual Microincision Cataract Surgery Combined with Trabeculectomy
Authors: Bayer A. , Erdem Ü. , Mumcuoglu T. , Akyol M. 
Published: January 2018

Purpose To compare the results of two-site phacotrabeculectomy with microincision cataract surgery (MICS) and trabeculectomy. Methods Fifty-eight eyes with coexisting cataract and glaucoma were randomly assigned to have a trabeculectomy in a superior quadrant combined with phacoemulsification and intraocular lens (IOL) implantation through temporal clear corneal incision (two-site phacotrabeculectomy group), or a trabeculectomy in a superior quadrant combined with MICS followed by IOL implantation from the trabeculectomy incision (MICS + trabeculectomy group). The main outcome measures were preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), and complications. Follow-up was period was 12 months. Results Twenty-eight two-site phacotrabeculectomies and 30 MICS + trabeculectomies were performed. Mean age of the subjects was 67.4 years. Mean preoperative IOP was 24.6±5.7 mmHg in the two-site phacotrabeculectomy group and 23.7±5.5 mmHg in the MICS + trabeculectomy group (p=0.52). At 12 months postoperatively mean IOP was 14.5±3.0 and 14.3±3.4 mmHg in two-site phacotrabeculectomy and MICS + trabeculectomy groups, respectively (p=0.8). Preoperative and postoperative glaucoma medication numbers were similar and mean number of glaucoma medications decreased in both groups after the surgery (p<0.05). BCVA improved in both groups. Twenty-six of 28 eyes (92%) in the two-site + trabeculectomy group and 27 of 30 (90%) in the MICS + trabeculectomy group had clinically apparent filtering blebs at 12 months (p=0.71). Postoperative complications were comparable. Conclusions MICS + trabeculectomy provided 1 year IOP control comparable to that with two-site phacotrabeculectomy with similar amount of complications and similar final BCVA.
Assessment of Cup-To-Disc Ratio with Slit-Lamp Funduscopy, Heidelberg Retina Tomography II, and Stereoscopic Photos
Authors: Durmus M. , Karadag R. , Erdurmus M. , Totan Y. , Feyzi Hepsen I. 
Published: January 2018

Purpose To compare optic disc measurements achieved by slit-lamp funduscopy, Heidelberg Retina Tomography II (HRT II), and stereoscopic optic nerve photos (SONP) in glaucomatous, ocular hypertensive, and normal eyes. Methods A total of 176 eyes (glaucomatous [n=87], ocular hypertensive [n=40], and normal eyes [n=49]) of 90 participants were studied. Each participant underwent a full ophthalmic examination, including automated perimetry, slit-lamp funduscopy, HRT II, and SONP. To compare the three different methods being investigated, the following measurements were used: vertical cup to disc ratio (VCDR), horizontal cup to disc ratio (HCDR), and cup to disc area ratio (CDR). Slit-lamp funduscopy was evaluated only with respect to VCDR. HRT II and SONP were evaluated with all three measurements (VCDR, HCDR, and CDR). Results CDR measurements in ocular hypertensive eyes did not differ significantly according to the measurement methods used (p=0.4). CDR in the other groups of participants, as well as VCDR and HCDR, all differed significantly within each group according to the method used (p<0.05 for all). Mean VCDR measured with funduscopy was smaller than mean VCDR measured with either HRT II or SONP in the glaucoma and ocular hypertension groups (p=0.0001). However, overall, the three methods showed a strong correlation in terms of VCDR, HCDR, and CDR measurements. Conclusions Despite the correlation among the three methods, the significant differences between their measurements of optic disc parameters may be too large for these methods to be used interchangeably in clinical situations.
Orthokeratology Associated Microbial Keratitis
Authors: Shehadeh-Masha'Our R. , Segev F. , Barequet I.S. , Ton Y. , Garzozi H.J. 
Published: January 2018

Purpose To report the clinical course, microbiologic findings, treatment, and outcomes of overnight orthokeratology associated microbial keratitis. Methods Four cases of overnight orthokeratology associated microbial keratitis are reported. Results Four patients aged 14–23 years (mean 18 years) who had central or paracentral corneal ulcers were included. Visual acuity at presentation ranged from 20/30 to hand motion. In all cases Pseudomonas aeruginosa was cultured from corneal scrapings or storage solution. In all patients the infection resolved with intensive topical antimicrobial treatment. Final best-corrected visual acuity ranged from 20/25 to 20/200 according to the location, size, and density of the corneal scar, which complicated all cases. Conclusions Infectious keratitis is a significant, visual threatening complication of overnight orthokeratology. Eye care practitioners should be aware of this complication and educate their patients of the importance of lens hygiene and prompt medical care when symptoms or signs of keratitis appear.
Capsule Fixation Device for Cataract Surgery
Authors: Sergienko N.M. , Kondratenko Y.N. , Yakimov A.K. 
Published: January 2018

Purpose The authors present a patient with Marfan syndrome who underwent cataract surgery using a novel device for fixation of capsular bag. Methods The capsule fixation device (CFD) is poly(methyl methacrylate) arch with double-armed bent hook that can be introduced into the anterior chamber through the clear corneal incision, placed with a rest on the capsule equator, and sutured to the sclera without injury of the capsular bag. A 16-year-old patient with Marfan syndrome underwent consecutive phacoemulsification with in-the-bag intraocular lens and CFD implantation on both eyes. Results During the surgery handling the CFD was technically simple with good visualization. The preoperative best-corrected visual acuity was 0.3 and 0.1 and postoperatively 0.6 and 0.8 in the right and left eyes, respectively. The postoperative follow-up was over 9 months. Conclusions Use of the CFD was successful in a case of lens subluxation with no complications observed during the period of follow-up.