bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypericin-Enhanced Argon Laser Photocoagulation for Subfoveal Choroidal Neovascular Membrane in Age-Related Macular Degeneration: A Pilot Study
Authors: Sobaci G. , Bayraktar M.Z. , Karslioğlu Y. , Durukan A.H. , Hurmeriç V. , Aykaş S. 
Published: January 2018

Purpose To evaluate the efficacy and safety of hypericin-enhanced argon laser photocoagulation (H-ALP) in the treatment of subfoveal choroidal neovascular membrane (CNM) secondary to age-related macular degeneration (ARMD). Methods After preliminary studies for definition of parameters, argon-green laser was administered 4 hours after single dose of oral 1800 mg hypericin (Saint-John's wort tablets, 0.3%, 300 mg) with a subthreshold light fluence, 24 J/cm2 in 34 eyes (20 with subfoveal classical and 14 with subfoveal occult CNM). Additionally, histopathologic examination was done in two eyes destined for enucleation and exenteration. Maintenance therapy (one tablet, twice a day) was performed for the following 6 months. Anatomic (complete closure of CNM) and functional success (improvement of final visual acuity in three or more Snellen lines) were analyzed with minimum 6-month follow-ups. Results Histopathologic examinations revealed photothrombosed choriocapillaries together with minimal retinal pigment epithelial disruption in H-ALP exposed areas. One to four (mean 1.88±0.91) treatment sessions were applied in 6 to 29 months (mean 12.2±5.1 months) follow-up period. Twenty-three (67.6%) eyes had 12 months follow-up. Two eyes in each group had functional success (20% in subfoveal classical and 14.3% in subfoveal occult CNM), which had a minimum 12-month follow-up. Anatomic success was achieved in 16 of 20 (80%) eyes with subfoveal classical and 10 of 14 (71.4%) eyes with subfoveal occult CNM. Severe gastric irritation was noted in 1 (2.9%) and pigment epithelial rupture in 2 (5.9%) patients. Conclusions H-ALP is a novel and low-cost treatment for subfoveal CNM secondary to ARMD. It seems its efficacy depends on the photodynamic and antiproliferative properties of hypericin. Comparative studies are required to apply this new technique in ophthalmic practice.
25-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy
Authors: Yanyali A. , Celik E. , Horozoglu F. , Oner S. , Nohutcu A.F. 
Published: January 2018

Purpose To evaluate the effectiveness, feasibility, and safety of the transconjunctival sutureless vitrectomy (TSV) system for a variety of vitreoretinal diseases. Methods In this retrospective study, the authors evaluated 71 eyes of 63 patients who underwent pars plana vitrectomy (PPV) with the 25-gauge TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (29 eyes), diabetic macular edema (14 eyes), macular epiretinal membrane (13 eyes), endophthalmitis (5 eyes), vitreous opacities secondary to Behçet's disease (4 eyes), vitreous hemorrhage secondary to branch retinal vein occlusion (4 eyes), and vitreous hemorrhage secondary to age-related macular degeneration (2 eyes). Epiretinal membrane and internal limiting membrane removal, endolaser photocoagulation, and air-fluid exchange were performed when required. Results Mean follow-up was 3.6 months (range 1–8 months). Mean overall visual acuity (VA) was counting fingers (range light perception to 0.4) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p=0.000). Statistically significant VA improvement was observed in eyes with vitreous hemorrhage, diabetic macular edema, and macular epiretinal membrane. VA improved postoperatively in all eyes with endophthalmitis and vitreous opacities secondary to Behçet's disease. The surgery was completed without conjunctival and scleral suturing in all eyes. Mean intraocular pressure (IOP) was 17.2 mmHg (range 10–26 mmHg) preoperatively, 12.4 mmHg (range 6–24 mmHg) on the first postoperative day, 16.6 mmHg (range 10–33 mmHg) at 1 week, and 15.4 mmHg (range 10–20 mmHg) at 1 month postoperatively. On the first postoperative day, IOP was below 10 mmHg (between 6 and 9 mmHg) in 12 eyes (16.9%). In these eyes, IOP was normalized within 1 week without affecting the visual outcome. Five eyes (7%) had transient increase of IOP controlled by topical antiglaucomatous medications. Vitreous washout using 25-gauge TSV system was performed in two eyes, in which vitreous hemorrhage recurred. Conclusions The TSV system was observed to be feasible, effective, and safe for a variety of vitreoretinal diseases. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time, and postoperative inflammatory response, and improve patient comfort.
Nocardia Keratitis: A Case Report
Authors: Matuska S. , Rama P. , Cavallero A. , Paganoni G. , Spinelli A. , Brancato R. 
Published: January 2018

Purpose To describe a case of Nocardia keratitis resistant to 2% amikacin, with a toxic-allergic reaction to fortified topical 5% amikacin, and recurrence of the infection with topical corticosteroids. Methods Nocardia was diagnosed from a smear and positive culture and identified as Nocardia asteroides by gas chromatography and quantitative fatty acid analysis using the Microbial Identification System. Treatment was started with topical 2% amikacin, which was subsequently raised to 5% because of clinical resistance. Results A toxic-allergic reaction was observed after 5% amikacin so the drug was discontinued and commercially available drugs combining 1% chloramphenicol, 0.5% tetracycline, and 18 mil IU colistin with 0.3% ofloxacin were given. These were well tolerated and the infection improved quickly. After 1 month the antibiotics were discontinued and topical 0.1% clobetasone was given to reduce scar formation. The infection recurred after 1 week but responded to 3 months of the previous antibiotic combination and its sensitivity was checked with the Epsilometer test. Conclusions Nocardia keratitis may not respond to 2% topical amikacin and fortified topical 5% amikacin may cause a strong toxic-allergic reaction. A commercially available combination of chloramphenicol, tetracycline, and colistin, with ofloxacin, may be effective but the treatment must be continued for several months. Topical steroids should only be used with considerable caution since they can lead to relapse of the infection.
Visual Outcome after Excimer Laser Refractive Surgery in Adult Patients with Amblyopia
Authors: Roszkowska A.M. , Biondi S. , Chisari G. , Messina A. , Ferreri F.M.B. , Meduri A. 
Published: January 2018

Purpose To evaluate the visual and refractive outcome in adult patients with refractive and anisometropic amblyopia treated with photorefractive keratectomy. Methods An interventional non-comparative study was performed on 50 consecutive patients with amblyopia treated with photorefractive keratectomy. Sixty-eight eyes of 18 participants with bilateral refractive amblyopia and 32 participants with unilateral anisometropic amblyopia were studied. The photorefractive keratectomy was performed with MEL 70 G-Scan excimer laser. Follow-up was 1, 3, 6, and 12 months after the treatment. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), refraction, and corneal transparency. Results In 64.7% of eyes, the UCVA at 12 months after the treatment was better than or equal to their preoperative BCVA. A total of 82.4% of eyes improved their BCVA one or more lines. No eye lost lines of BCVA, 17.6% remained unvaried, 50% gained one line, 20.6 % gained two lines, and 11.8% gained three lines of BCVA. The number of lines gained correlated strongly with diopters of anisometropia between eyes (p<0.01). The mean sphere changed from –5.62±3.37D to –0.47±1 D, mean cylinder varied from -2.36±1.57 to –0.18±0.41 D, and the spherical equivalent varied from –6.82±3.1 to –0.45±1.08 D. No clinically significant haze was observed. Conclusions Excimer laser refractive surgery appears to be a safe and efficient procedure in the treatment of ametropic and anisometropic amblyopia in adults. Adult patients with anisometropic and refractive amblyopia could benefit from the refractive treatment with significant improvement of the visual acuity.
Pseudoexfoliation Syndrome and its Antioxidative Protection Deficiency as Risk Factors for Age-Related Cataract
Authors: Zoric L. , Miric D. , Milenkovic S. , Jovanovic P. , Trajkovic G. 
Published: January 2018

Purpose Pseudoexfoliation syndrome (PES) seems to be a systemic condition. However, to an ophthalmologist it represents a continual challenge, due to unclear etiology and pathogenesis, and because of a potential for development of an aggressive glaucoma, and cataract surgery complications. According to some findings, PES could be a factor of hastened aging, which means that it could be considered as a secondary aging factor. Methods Frequencies of secondary aging diseases (non-insulin dependent diabetes mellitus, atherosclerotic myocardiopathy chronic obstructive lung diseases, arterial hypertension, and PES) were investigated in 162 patients with age-related cataract and 55 age- and sex-matched control subjects, and analyzed by a logistic regression. The authors also determined elements of antioxidative protection in a group of sera from patients with cataract and PES, and compared them to those obtained from patients with cataract without PES (activity of catalase and peroxidase, glutathione, vitamins C and E), and total antioxidative protection (%iMDA). Antioxidant defense of aqueous humors, expressed as a rate of induced malondialdehyde (%iMDA), and total thiol groups in the lens corticonuclear blocks (TSH) were estimated in samples of 17 patients with PES and cataract and 55 patients with cataract only. Results Logistic regression showed the highest odds ratio for PES (OR=4.516; p<0.05). Catalytic activity of serum catalase had significantly lower values in patients with PES (p<0.05). Antioxidative defense of aqueous humor and lens had lower values in patients with PES. Conclusions The results indicate that PES might be a significant factor for cataractogenesis. At least a part of pathogenesis alterations in an eye with PES could be the result of higher intensity of oxidative stress.
Preoperative Factors Influencing Visual Outcome following Surgical Excision of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration
Authors: Shimada H. , Fujita K. , Matsumoto Y. , Mori R. , Yuzawa M. 
Published: January 2018

Purpose To evaluate long-term visual acuity outcomes and the influences of various preoperative factors on visual outcome in patients undergoing surgical removal of choroidal neovascular neovascularization (CNV) caused by age-related macular degeneration (ARMD). Methods The authors studied 146 eyes of 146 patients who were followed for at least 1 year after surgical excision of CNV associated with ARMD. Surgical indications included subfoveal active CNV localized mainly above the retinal pigment epithelium (RPE) and a standard Japanese decimal visual acuity of 0.3 or worse. CNV above the RPE was diagnosed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. CNVs were divided into completely classic CNV or mainly classic CNV. The relationships of the postoperative logarithm of the minimum angle of resolution (logMAR) visual acuity with preoperative logMAR visual acuity, the shortest distance from the center of the foveal avascular zone to the CNV margin, CNV size, and age were analyzed. RESULTS Final logMAR visual acuity was improved (defined as a logMAR visual acuity increase of 0.2 or more) in 78 eyes (54%), stable in 47 (32%), and worsened in 21 (14%). Stepwise regression identified CNV size as a significant factor influencing final logMAR visual acuity (R2 = 0.213, p<0.0001), while preoperative logMAR visual acuity, shortest distance from the center of the foveal avascular zone to the CNV margin, and age showed no significant correlation with final logMAR visual acuity. Surgical complications included retinal detachment in six eyes (4%), subretinal hematoma in four eyes (2%), macular hole in three (2%), and proliferative vitreoretinopa thy in two (1%). CNV recurred postoperatively in 18 eyes (12%). In 92 eyes with completely classic CNV, visual acuity was improved in 57 (62%), stable in 27 (29%), and worsened in 8 (9%). In 54 eyes with mainly classic CNy visual acuity was improved in 21(39%), stable in 20 (37%), and worsened in 13 (24%). Conclusions Surgical excision of CNV for ARMD was effective for completely classic CNV, and better postoperative visual acuity was achieved in cases of small CNV. Given the fact that photodynamic therapy (PDT) has only been used in Japan since 2004, future study should compare PDT and surgical excision in Japanese subjects for relative merits against surgical risk and postoperative complications, to define indications for PDT and surgical excision.
Severe Orbitopalpebral Emphysema after Nose blowing Requiring Emergency Decompression
Authors: García-Medina J.J. , García-Medina M. , Pinazo-Durán M.D. 
Published: January 2018

Purpose Orbital emphysema is a frequent condition associated with medial wall fractures after blunt trauma. It is usually a benign, self-limited phenomenon. The authors are unaware of previous reports of severe orbital emphysema needing emergency decompression with no evidence of any previous significant trauma such as the case presented herein. Methods/Results A 51-year-old woman had painful swelling of the left orbital region that prevented her from opening her eyelids. She complained of a coincident cold with abundant mucous rhinorrhea. She had blown her nose vigorously several times. A computed tomography scan revealed a left proptosis, an extensive orbitopalpebral emphysema, and a blowout fracture of the medial wall of the left orbit. A complete ophthalmic examination was only possible after a needle decompression. No significant ocular damage was observed, so outpatient treatment was provided. Twenty-eight hours later, the swelling had almost disappeared, and the ocular assessment was normal. Conclusions A forceful expiratory effort raising intranasal pressure may cause a medial wall orbital fracture. If the airway hyperpressure episodes are repeated, a severe orbitopalpebral emphysema may develop. Should there be any suspicion of vascular compression, it must be drained to allow the assessment of visual function and theoretically prevent a potentially irreversible ischemic visual loss.
Endogenous Endophthalmitis by Propionibacterium Acnes associated with Leflunomide and Adalimumab Therapy
Authors: Montero J.A. , Ruiz-Moreno J.M. , Rodríguez A.E. , Ferrer C. , Sanchis E. , Alio J.L. 
Published: January 2018

Purpose To report a case of unusual endogenous endophthalmitis associated with the use of leflunomide and adalimumab. Methods A 48-year-old woman on treatment with leflunomide and a dalimumab for rheumatoid arthritis developed an endogenous endophthalmitis caused by Propionibacterium acnes. Diagnosis was confirmed by polymerase chain reaction and positive cultures. The patient underwent surgical treatment and intravitreal vancomycin, but the eye developed retinal fibrosis and untreatable retinal detachment. Results This report of endogenous endophthalmitis associated with the use of anti-tumor necrosis factor alpha (anti-TNF-α) drugs is consistent with those in the literature. P. acnes may induce pathologic reactions in compromised patients and cause endophthalmitis, but only after ocular surgery or in intravenous drug users. The Naranjo probability scale indicated a probable relationship between the drugs and the infection. Conclusions Awareness of atypical infectious conditions in patients on anti-TNF-α drugs is critical for early diagnosis and good outcome.
The Efficiency of Limbal Conjunctival Autografting in Pterygium Surgery
Authors: Kilic A. , Gurler B. 
Published: January 2018

Purpose To investigate the efficiency of limbal conjunctival autografting technique in pterygium surgery. Methods Eighty-four eyes of 68 patients with pterygium were treated by simple excision technique and 29 eyes of 24 patients with pterygium were treated by limbal conjunctival autografting technique. The definition of recurrence was fibrovascular tissue over the limbus onto the cornea in the area of previous pterygium excision. Results The ages of the patients were between 25 and 88. The follow-up periods ranged from 6 to 25 months. The patients treated by simple excision technique were followed up for 6 to 25 (average 15±6) months and the patients treated by limbal conjunctival autografting technique were followed up for 7 to 24 (average 17±5) months. The recurrence rates were 27% (23 eyes) and 7% (2 eyes), respectively. There was a statistically significant difference in the recurrence rate between the patients who underwent simple excision and those who underwent limbal conjunctival autografting (p=0.016). Conclusions Limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium. It has a low recurrence rate when compared with the simple excision technique.
A Sphenoid en Plaque Meningioma Aggravates Exophthalmos in a Patient with Thyroid Ophthalmopathy
Authors: Asproudis I.C. , Petsanas A.P. , Nikas A.N. , Vranos G.H. , Kalogeropoulos C.D. , Polyzoidis K.S. 
Published: January 2018

Purpose To describe the rare case of a patient with thyroid ophthalmopathy whose unilateral aggravated exophthalmos was caused by the development of an ipsilateral sphenoid wing en plaque meningioma. Methods Case report. Results The ophthalmologic examination included visual acuity assessment, anterior segment examination, funduscopy, ocular motility examination, and exophthalmometry. Magnetic resonance imaging (MRI) of the brain and orbit revealed the existence of a sphenoid meningioma. Removal of the tumor through a pterional craniotomy was performed. The histologic examination showed that it was an en plaque meningioma. There were no postoperative complications and no recurrence of the tumor was revealed 24 months after the operation. Conclusions Detailed ophthalmologic examination and MRI of the brain and orbit are necessary in every patient with deterioration of the exophthalmos even if the suggestive cause seems obvious.
Blood Pressure Effects on Retinal Vessel Diameter and Flicker Response: A 1.5-Year Follow-Up
Authors: Nagel E. , Vilser W. , Fink A. , Riemer T. , Lanzl I. 
Published: January 2018

Purpose The study examined the influence of individual blood pressure changes over time on retinal vessel diameter and the latter's response to flicker light. Methods The diameter of a retinal arterial and venous segment was measured continuously online with a Dynamic Vessel Analyzer in 20 patients twice (mean interval between examinations of 24 months). Eleven patients had no cardiovascular disease. Nine patients had arterial hypertension and were untreated at the time of the first measurement; at the time of the second measurement they were undergoing various antihypertensive therapies. Each test consisted of a 50-s baseline plus three 20-s periods of flicker stimulation followed by an 80s period of observation. During the examinations the blood pressure was measured at 1-minute intervals. Results In the hypertension group changes in the mean arterial blood pressure (MAP) correlated significantly with changes in the arterial baseline diameter (y=–0.1 - 0.37x, r=0.74, p(increase)<0.03). A comparison of the two measurements showed no such relationship in the group of cardiovascularly healthy subjects. The venous baseline and the arterial and venous flicker response did not change significantly in either group between the two measurements and showed no relationship to blood pressure changes. Conclusions In hypertensive subjects, long-term therapy-related changes in blood pressure induced a change in the arterial baseline by approximately +3.7 μm/-10 mmHg MAP. An influence of lowering MAP to the arterial flicker response could not be detected.
Sarcomatoid Carcinoma and Orbital Apex Syndrome
Authors: Sadaba L.M. , García-Layana A. , Garcia-Gomez P.J. , Salinas-Alaman A. 
Published: January 2018

Purpose To report a case of sarcomatoid carcinoma and orbital apex syndrome in a previously healthy adult. Methods A previously healthy 45-year-old man presented with exophthalmos of the left eye and a mass visible through his left nostril. A biopsy was performed and immunohistochemistry was used to confirm the diagnosis of the tumor. The patient was treated with chemotherapy and radiotherapy. Results After treatment, we observed a substantial reduction in the size of the mass, but side effects of treatment developed. The visual acuity of the left eye was no light perception. Eight months later, the patient presented with bone and liver metastases, and he died 4 months later. Conclusions Sarcomatoid carcinoma is an aggressive tumor that can produce compressive symptoms with very poor visual and survival prognoses. A cranio-orbital computed tomography scan should be performed when patients present with symptoms of conjunctivitis and orbital apex syndrome.
Late Leakage of Filtering Bleb in a Patient with Orbital Pseudotumor
Authors: Luk F.O.J. , Leung D.Y.L. , Yuen H.K.L. , Lam D.S.C. 
Published: January 2018

Purpose To report an unusual case of spontaneous late leakage of filtering bleb in a patient with orbital pseudotumor. Methods Single case report. Results A 53-year-old woman developed spontaneous leakage of bleb in her right eye 23 years after trabeculectomy with application of mitomycin-C (MMC). Two weeks later, her symptoms were blurring of vision, increasing redness, and dull ocular pain in the right eye. The inflammatory signs were suggestive of endophthalmitis, orbital cellulites, or pseudotumor. Absence of ophthalmoplegia, fever, and raised white cell count, together with the computed tomographic scan finding, confirmed the diagnosis of orbital pseudotumor. She responded well to oral steroids. Conclusions Orbital pseudotumor may initially present with spontaneous late leakage in a bleb augmented by MMC. Orbital pseudotumor should be added to the list of differential diagnoses when facing a patient with an inflamed, chemotic, proptotic eye in the presence of a late bleb leak.
Allergic Contact Dermatitis Caused by Latanoprost Ophthalmic Solution
Authors: Lai C.-H. , Lai I.-C. , Chi C.-C. 
Published: January 2018

Purpose Latanoprost is a prostaglandin F2α analog that lowers intraocular pressure by increasing uveoscleral outflow. Herein we describe two cases of allergic contact dermatitis (ACD) to latanoprost. Methods A 69-year-old man with open-angle glaucoma developed erythematous erosive swelling of bilateral eyelids after 4 months of latanoprost therapy. An 84-year-old man with open-angle glaucoma had pruritic erythematous plaques on the bilateral lower eyelids after latanoprost therapy for 4 months. Results In both cases, latanoprost was discontinued and the condition gradually resolved in 1 month. The eyelid lesions recurred in days upon latanoprost rechallenge, but subsided after cessation of rechallenge. Conclusions ACD should be suspected if patients on latanoprost therapy have pruritus, erythema, swelling, or erosions on the eyelids even when the symptoms appear after several months of therapy, especially in the elderly.