bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Diclofenac as Prophylactic Treatment for Verteporfin-Associated Low Back Pain
Authors: Theelen T. , Hoyng C.B. 
Published: January 2018

Purpose The authors report on the therapeutic effect of intravenous diclofenac on verteporfin associated low back pain (LBP), which is the most frequent adverse effect of photodynamic therapy (PDT) for macular degeneration. Methods The authors studied 818 patients who received PDT with verteporfin for choroidal neovascularization. Systemic blood pressures were recorded in all study participants half an hour before PDT treatment. All patients who experienced LBP during verteporfin infusion were asked to grade their pain as mild (1), moderate (2), severe (3), or unbearable (4). Results Thirty-three patients had LBP during their first verteporfin infusion. Of these, 11 subjects (1.34% of all) reported increased pain scores (level 2 to 4) and received intravenous diclofenac ahead of their next PDT. Patients with LBP during verteporfin infusion had significantly higher systolic blood pressures than uncomplicated cases (180 mmHg vs 155 mmHg, p=0.01). Treatment with intravenous diclofenac short before PDT significantly reduced the patients' mean pain score by 1.8 levels (p=0.0001). Conclusions In this study, intravenous application of diclofenac short before verteporfin infusion effectively prevented verteporfin associated LBP in patients with systemic hypertension.
Shaken Baby Syndrome: Intending to Harm or Attempting to Help?
Authors: Felekis T. , Asproudis I. , Gorezis S. , Kritikou E. , Siamopoulou A. , Peschos D. , Aspiotis M. 
Published: January 2018

Purpose To describe the role of ophthalmologists in shaken baby syndrome evaluation. Methods Case report. Results A 3.5-month-old girl was admitted to the Pediatrics Clinic with lethargy. The mother, who brought in the baby, claimed that the baby had fallen from her cradle 6 hours ago. Clinical examination showed signs of head injury. Ophthalmologic examination was requested and revealed extensive retinal hemorrhages bilaterally covering the whole fundus, and retro-hyaloid hematoma in the right eye. Computerized tomography neuroimaging documented large subdural hematomas exerting force on the brain parenchyma. The sum of the results of the clinical and neuroimaging examination-retinal hemorrhages and subdural hematomas-was indicative of violent shaking of the baby. Coronal evaluation was unable to determine whether the baby was abused by her parents or whether she was accidentally hurt. Conclusions Ophthalmologic examination is necessary to document shaken baby syndrome since it reveals the retinal hemorrhages which together with the neuroimaging findings are almost always present in such cases. However, even when all the signs of shaken baby syndrome are present, it is difficult and sometimes destructive for a parent to be falsely accused of abusing his or her own child.
Different Presentations of Ophthalmic Aspergillosis
Authors: Willermain F. , Bradstreet C. , Kampouridis S. , Libert J. , Koch P. , Dediste A. , Saussez S. , Caspers L. 
Published: January 2018

Purpose Aspergillus species is found worldwide and does not normally cause disease. However, when the immune system is compromised, it can invade many organs and be responsible for severe disease. The authors present cases with both classical and atypical features of ophthalmic aspergillosis. Methods Case series of three patients. Results All patients were female and had a long history of methylprednisolone use. The first two presented with endogenous endophthalmitis. One case was unilateral with a classical presentation of endophthalmitis. The other presented with a very severe bilateral acute retinal necrosis like syndrome. General work-up revealed disseminated disease in both cases. The diagnosis was made by serum immunologic testing in one case and after direct examination and culture from vitrectomy in the other. Despite intense antimycotic therapy, both patients died. The third patient presented with a unilateral progressive painful orbital apex syndrome. An orbital lesion was demonstrated by computed tomography scan and was unresponsive to methylprednisolone. Diagnosis of sino-orbital syndrome was made on biopsy. The lesion responded poorly to different antimycotic therapies, invaded the chiasma, and the patient lost all visual acuity. Conclusions This case series illustrates that ophthalmic aspergillosis can present acutely with a devastating intraocular inflammation or more indolently in the setting of sino-orbital aspergillosis. Both forms have a poor visual prognosis and the systemic form is frequently associated with a fatal outcome.
Spectral Domain OCT Documented Resolution of Recalcitrant Macular Edema after Intravitreal Bevacizumab in Branch Retinal Vein Occlusion
Authors: Chalam K.V. , Keshavamurthy R. , Brar V.S. 
Published: January 2018

Purpose Cystoid macular edema is one of the important causes of visual loss in branch retinal vein occlusion. Proximity of the cyst to the external limiting membrane and disruption of the layer on time domain optical coherence tomography is associated with poor final visual outcomes. The authors describe pre- and post-intravitreal bevacizumab spectral domain optical coherence tomography features in a case of cystoid macular edema associated with branch retinal vein occlusion that was resolved after treatment with intravitreal bevacizumab. Methods A 50-year-old woman was diagnosed with cystoid macular edema due to branch retinal vein occlusion and underwent intravitreal injection with bevacizumab after the primary treatment with laser photocoagulation failed. Results The patient's visual acuity recovered from 20/40 to 20/20. Spectral domain optical coherence tomography documented complete resolution of a large foveal cyst (150 μm by 280 μm) and recovery of the discontinuity of the external limiting membrane 1 week after treatment. Conclusions Spectral domain optical coherence tomography is a useful tool in identifying the ultrastructural changes associated with cystoid macular edema associated with branch retinal vein occlusion and identifying the possible factors involved in prognosticating visual outcome after effective treatment.
Conjunctival Displacement to the Corneal Side for Oblique-Parallel Insertion in 25-Gauge Vitrectomy
Authors: Shimada H. , Nakashizuka H. , Hattori T. , Mori R. , Mizutani Y. , Yuzawa M. 
Published: January 2018

Purpose To assess the usefulness of the method of oblique-parallel trocar insertion with conjunctival displacement to the corneal side in 25-gauge (G) transconjunctival vitrectomy. Methods 25-G vitrectomy was performed in 77 consecutive eyes. Before making oblique-parallel trocar insertions, the conjunctiva was conventionally displaced superiorly in 35 eyes, but was displaced toward the corneal side in 42 eyes. After surgery, the distance between the scleral and conjunctival wounds was measured with calipers. The frequency of scleral wound exposure was assessed. Results After cannula removal at the end of surgery, inferior repositioning of the superiorly displaced conjunctiva was observed, while marked posterior repositioning of the corneal side caused displacement of the conjunctiva due to gravity. The superior displacement distances between the sclera and conjunctival wounds were 2.4±0.3 mm at the infusion port, 2.0±0.4 mm at the superior temporal port, and 1.9±0.4 mm at the superior nasal port, while the corresponding distances for corneal side displacement were 3.6±0.5, 3.5±0.5, and 2.5±0.5 mm, and were all significantly (p<0.0001) greater with corneal side displacement. The frequency of scleral wound exposure due to conjunctival damage around the cannula (infusion port) was significantly (p=0.0164) lower for corneal side displacement (0/42; 16.7%) than superior displacement (5/35; 14.3%). There was no postoperative endophthalmitis in all 77 patients studied. Conclusions In 25-G transconjunctival vitrectomy, using oblique-parallel trocar insertions with the conjunctiva displaced toward the corneal side results in marked posterior repositioning of the conjunctiva after cannula extraction. Corneal side conjunctival displacement is technically easy and completely covers the scleral wound. This method is expected to be effective in preventing endophthalmitis.
Comparison of Mersilene Mesh and Autogenous Fascia Lata in Correction of Congenital Blepharoptosis: A Randomized Clinical Trial
Authors: Salour H. , Aletaha M. , Bagheri A. 
Published: January 2018

Purpose To asses the functional results and complications of Mersilene mesh as an alternative to autogenous fascia lata in the management of low function ptosis. Methods In a randomized clinical trial, 31 eyelids with poor levator function were operated on. In 16 eyelids Mersilene mesh (Group A) and in 15 eyelids autogenous fascia lata were used for frontalis suspension procedure (Group B). Results Nine patients with congenital unilateral and 11 patients with bilateral ptosis underwent sling procedure. There were no differences between the two groups with regards to functional (lid fissure height stability) and cosmetic (lid margin contour) results. Eyelid fissure increase was 4.00±1.46 mm in Group A and 3.13±1.72 mm in Group B. Change in eyelid fissure in both groups was significant (p=0.00, paired t-test), but intergroup difference was not significant (p=0.141, independent sample t-test). Follow-up for Group A was 14.2 (range 6–26) months and for Group B was 15.1 (range 9–29) months. Dermatochalasis was seen more in Group B (B/A = 10/2) and extrusion of Mersilene mesh was seen in two cases of Group A and none of Group B. Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the two groups. Conclusions Mersilene mesh with long-term functional results and low rate of complications is a suitable alternative to autogenous fascia lata as a suspensory material in ptosis surgery.
The Ultima© Foldable Scleral Fixation Intraocular Lens: A 2-year Follow-Up
Authors: Migliorati G. , Brusini P. 
Published: January 2018

Purpose To describe a new scleral fixation foldable intraocular lens (IOL): the Ultima©. Methods The novel IOL is a new scleral fixation acrylic hydrophilic foldable lens that offers a 360° sulcus support due to its round geometry. It can be folded and inserted through a 4 mm clear cornea incision. Twenty-five eyes implanted with the Ultima© lens were followed for 2 years. Results Twenty-two eyes showed visual improvement, two eyes had no functional improvement, and one eye had visual deterioration. The IOL remained well centered and showed no signs of tilting in all patients during the entire follow-up. Conclusions The main advantages of the Ultima© IOL include the lack of tilting and the minimum postoperative astigmatism. It also allows a clear retinal examination and provides an excellent barrier for silicone oil between vitreous cavity and anterior chamber.
Influence of IOP Measurement through the Wrong Eyepiece of the Slit Lamp on Goldmann Applanation Tonometry
Authors: Kubota T. , Nagata T. , Tawara A. , Okada H. , Ishibashi S. , Yamashita M. , Harada Y. , Yanase M. 
Published: January 2018

Purpose This study examined whether intraocular pressure (IOP) measurements through the wrong eyepiece of the slit lamp may be a source of error. Methods Seven skilled observers measured the IOP from seven healthy subjects. The observers used a Haag-Streit Goldmann applanation tonometer with two types of slit lamps (Haag-Streit and Rodenstock). In the Haag-Streit slit lamp the prism of the tonometer is aligned with the right part of the slit lamp optics. Conversely in the Rodenstock slit lamp, the prism is aligned with the left. Each observer measured the IOP of each subject through the right eyepiece, through the left eyepiece, and under binocular vision. Results The IOP measured with the left eyepiece of the Haag-Streit slit lamp was significantly higher than that measured with the right eyepiece and binocular vision. The IOP measured with the right eyepiece of the Rodenstock slit lamp was significantly higher than that measured with the left eyepiece and binocular vision. Conclusions IOP measurement through the wrong eyepiece of the slit lamp may be a source of error.
Intravitreal Bevacizumab versus Combined Bevacizumab-Triamcinolone versus Macular Laser Photocoagulation in Diabetic Macular Edema
Authors: Faghihi H. , Roohipoor R. , Mohammadi S.-F. , Hojat-Jalali K. , Mirshahi A. , Lashay A. , Piri N. , Faghihi Sh. 
Published: January 2018

Purpose To evaluate the additive effect of triamcinolone to bevacizumab in comparison to standard macular laser photocoagulation versus bevacizumab in the management of diabetic macular edema (DME). Methods In a prospective, randomized clinical trial, 130 eyes of 110 patients with type 2 diabetes with DME were included. Eligible eyes were randomly assigned to 1.25 mg intravitreal bevacizumab (42 eyes) (IVB group) or combination of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide (41 eyes) (IVB+IVT group) or macular laser photocoagulation (47 eyes) (MPC). Central macular thickness (CMT) and visual acuity changes at week 6 and 16 were assessed. Results The mean age of the patients was 57 ±7 years. Patients were followed 16 weeks. At week 6, all the three groups showed significant reduction in CMT but the reductions for IVB and IVB+IVT were significantly more than MPC (p<0.001). At week 16, the response was not stable for IVB (p<0.001), but IVB+IVT maintained its superior status to MPC (p<0.001). At week 16, visual acuities were essentially unchanged for the two groups of MPC and IVB and improvement for IVB+IVT was marginal and at most was 0.1 log MAR. No patient developed uveitis, endophthalmitis, or thromboembolic event. Conclusions Single intravitreal bevacizumab or triamcinolone plus bevacizumab injection brought about significantly greater macular thickness reduction in diabetic patients in comparison to standard laser treatment. However, the response for bevacizumab alone was short-lived. Reduction in macular thickness was only marginally associated with visual acuity improvement in the triamcinolone plus bevacizumab injection group.
Frequency, Characteristics, and Risk Factors of Late Recurrence of Retinal Detachment
Authors: Zhioua R. , Ammous I. , Errais K. , Zbiba W. , Ben Younes N. , Lahdhiri I. , Meddeb Ouertani A. 
Published: January 2018

Purpose To evaluate the frequency, characteristics, causes, and risk factors of late recurrent retinal detachments (LRRD). Methods The authors retrospectively analyzed 445 eyes operated consecutively for rhegmatogenous retinal detachment between 1990 and 2003 by the same surgeon. Only eyes with complete reattachment after a minimum follow-up of 6 months were included. The authors defined LRRD as detachment occurring at least 6 months after a complete retinal reattachment. Results Nine eyes had a LRRD (2.02%). Mean age was 52.55 years. Six eyes had scleral buckle procedure and three eyes had vitrectomy silicone oil injection then silicone oil removal. LRRD occurred after an average period of 54 months. During follow-up two patients had a removal of extrusion of scleral buckling material. New or reopened breaks were associated with LRRD in all eyes. Endo-ocular surgery was carried out in seven eyes. The retinal reattachment was achieved in the seven eyes. Final visual acuity ranged from 20/400 to 20/60 after an average follow-up of 37.8 months. Relation between aphakic eyes (and more generally nonphakic eyes) and LRRD was close to significant value (p=0.05). LRRD was statistically independent (p>0.05) of myopia, preoperative pseudophakia, vitrectomy for initial detachment, scleral buckle removal, and cataract surgery after reattachment. Conclusions LRRD were rare. Most of them were due to a retinal break. This break can be a new break, or reopened break especially after removal of scleral buckle material. Vitreous traction, at the vitreous base, seemed to be the cause of these breaks.
Evolution of Idiopathic Epiretinal Membrane Studied by Optical Coherence Tomography
Authors: Theodossiadis P.G. , Grigoropoulos V.G. , Kyriaki T. , Emfietzoglou J. , Vergados J. , Nikolaidis P. , Theodossiadis G.P. 
Published: January 2018

Purpose To study the evolution of idiopathic epiretinal membrane (IERM) as examined by optical coherence tomography (OCT) in the 1-mm-diameter circle centered on the fovea. Methods In a case series study 71 subjects (71 eyes) with idiopathic epiretinal membrane and macular thickness greater than 220±10 μm were evaluated by OCT. The fellow healthy eye of 52 patients was used as the control group. The mean follow-up was 36 months. Measurements of macular thickness at baseline and at the final examination were performed. Best-corrected visual acuity was expressed as the number of letters read on the Early Treatment Diabetic Retinopathy Study chart. Results Within the inner macular central circle of 1 mm diameter the thickness of the fovea increased by an average of 12.29% (p<0.001) during follow-up in the study group while in the control group the foveal thickness decreased by −0.44% (p=0.43). The mean increase of the fovea thickness was accompanied by a modest decrease of best-corrected visual acuity from a mean 43.26 letters at baseline to a mean 39.20 letters at the last examination (p<0.001). Conclusions In the study group the macular thickness increased during a mean follow-up period of 36 months. The average increase between the baseline and the final examination at the inner central circle of 1 mm diameter was 12.29%. Decrease of the macular thickness was not observed in any of the studied cases. The mean decrease of visual acuity was 9.4%. OCT also depicted with accuracy the changing morphology of the affected macula during the study period.
Sutureless Amniotic Membrane Fixation with Fibrin Glue in Symptomatic Bullous Keratopathy with Poor Visual Potential
Authors: Chawla B. , Tandon R. 
Published: January 2018

Purpose To report a sutureless method of amniotic membrane fixation using fibrin glue in two cases of symptomatic bullous keratopathy with poor visual potential. Methods Under topical anesthesia, the loose epithelium was debrided up to 1.0 mm from the limbus and fibrin glue was applied uniformly and thinly onto the corneal surface. Cryopreserved amniotic membrane was evenly placed over the cornea and once a firm and uniform adhesion was achieved, excess membrane was trimmed off. A bandage contact lens was applied. Results In both the cases, complete relief from symptoms was obtained and 3 weeks later, the ocular surface had completely re-epithelialized. At 6 months follow-up, both patients were symptom free without the need for any medication. No complications were observed. Conclusions This technique of amniotic membrane fixation is a simple, effective, and safe procedure whereby a stable and secure adherence of the amniotic membrane with the corneal surface is achieved avoiding the use of sutures.
Pseudophakic Macular Edema and Oral Acetazolamide: An Optical Coherence Tomography Measurable, Dose-Related Response
Authors: Ismail R.A. , Sallam A. , Zambarakji H.J. 
Published: January 2018

Purpose Although uncommon after phacoemulsification surgery, cystoid macular edema (CME) is an important cause of postoperative reduction of vision after cataract surgery. To demonstrate an optical coherence tomography (OCT) measurable, dose-related response to orally administered acetazolamide in a patient presenting with pseudophakic CME. Methods A 76-year-old woman with reduced vision in right eye due to cataract had uneventful phacoemulsification. Surgery was complicated by early onset endophthalmitis that was treated with intravitreal antibiotics with good visual recovery. At 6 months follow-up, she presented with further reduction of vision (0.5 LogMAR) due to CME and a central foveal thickness (CFT) of 587 μm. Results Acetazolamide treatment was started in combination with topical ketorolac. At a daily dose of 500 mg, CFT and visual acuity were 262 μm and 0.34 LogMAR, respectively. Dose reduction of acetazolamide to 250 mg/day was associated with worsening of the CFT to 335 μm. CFT was subsequently measured at 230 μm on increasing the acetazolamide dose to 500 mg/day and measured 353 μm when acetazolamide dose was halved. CFT was 478 μm when acetazolamide was ceased. Conclusions In this report, the authors have shown a dose-related response of pseudophakic CME to oral acetazolamide. This would suggest that the clinical response to oral acetazolamide may be titrated to the extent of CME and monitored by OCT.
Development of Full-Thickness Macular Hole despite Previous Posterior Vitreous Detachment and Vitrectomy for Retinal Detachment: Two Cases
Authors: Sheth H.G. , Bainbridge J. 
Published: January 2018

Purpose To report the delayed development of idiopathic full-thickness macular hole in eyes with previously documented complete posterior vitreous detachment that were vitrectomized during surgery for rhegmatogenous retinal detachment. Methods Two interventional case reports with serial color fundus photographs and optical coherence tomography scans. Results Case 1: A 62-year-old man underwent vitrectomy cryoretinopexy and intraocular gas tamponade for rhegmatogenous retinal detachment associated with a complete posterior vitreous detachment. Three years later, he developed a full-thickness macular hole in the same eye. Peeling of the inner limiting membrane and gas tamponade resulted in complete closure of the macular hole with improvement in visual acuity. Case 2: A 70-year-old man presented with a macula-off inferior retinal detachment and counting fingers vision. Vitrectomy cryoretinopexy to a single tear, and gas tamponade was successful and acuity improved to 6/9. He subsequently developed retinal redetachment associated with a new retinal tear and was treated by further vitrectomy and gas. He developed a full-thickness macular hole in the same eye 2 years later with acuity dropping to 1/60. Conclusions Macular hole formation may occur in the context of vitrectomized eyes. These observations support the hypothesis that anteroposterior vitreomacular traction, while traditionally implicated, is not always essential for the development of macular holes.
Triamcinolone-Assisted Vitreous Imaging Using B-Scan Ultrasonography
Authors: Mourtzoukos S. , Mangouritsas G. , Feretis E. 
Published: January 2018

Purpose To evaluate the echographic vitreoretinal patterns before and after intravitreal injection of triamcinolone (IVTA) in eyes with opaque media and several pathologies. Methods One eye with pseudophakic cystoid macular edema and two eyes with postoperative endophthalmitis and opaque media were examined using B-scan ultrasonography before and after 0.1 mL ITVA (4 mg Kenacort). The obtained images were compared and the two eyes with endophthalmitis underwent pars plana vitrectomy (PPV) the same day. The relationship between intraoperative and echographic findings was evaluated. Results Vitreous was relatively anechoic in all three cases before ITVA. Postinjection examination improved visualization of vitreous and posterior hyaloid face (PHF) and revealed vitreoretinal adhesions. The echographic findings confirmed intraoperatively in the two vitrectomized eyes. Conclusions Triamcinolone-assisted ultrasonography enhances imaging of the PHF. This method might be useful in cases with opaque media regarding PPV planning and prognosis. It is suggested to be applied in selected cases taking into account the beneficial diagnosis information versus the risks to IVTA application.