Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Obstructive Sleep Apnea Patients Having Surgery Are Less Associated with Glaucoma Thu, 24 Jul 2014 10:07:07 +0000 Objective. To investigate if different treatment strategy of obstructive sleep apnea (OSA) was associated glaucoma risk in Taiwanese population. Methods. Population-based retrospective cohort study was conducted using data sourced from the Longitudinal Health Insurance Database 2000. We included 2528 OSA patients and randomly selected and matched 10112 subjects without OSA as the control cohort. The risk of glaucoma in OSA patients was investigated based on the managements of OSA (without treatment, with surgery, with continuous positive airway pressure (CPAP) treatment, and with multiple modalities). The multivariable Cox regression was used to estimate hazard ratio (HR) after adjusting for sex, age, hypertension, diabetes, hyperlipidemia, and coronary artery disease. Results. The adjusted HR of glaucoma for OSA patients was 1.88 (95% CI: 1.46–2.42), compared with controls. For patients without treatment, the adjusted HR was 2.15 (95% CI: 1.60–2.88). For patients with treatments, the adjusted HRs of glaucoma were not significantly different from controls, except for those with CPAP (adjusted HR = 1.65, 95% CI = 1.09–2.49). Conclusions. OSA is associated with an increased risk of glaucoma. However, surgery reduces slightly the glaucoma hazard for OSA patients. Hsin-Yi Chen, Yue-Cune Chang, Che-Chen Lin, Fung-Chang Sung, and Wen-Chi Chen Copyright © 2014 Hsin-Yi Chen et al. All rights reserved. Role of Intravitreal Antivascular Endothelial Growth Factor Injections for Choroidal Neovascularization due to Choroidal Osteoma Wed, 23 Jul 2014 08:33:59 +0000 We treated 26 eyes of 25 young patients having a mean age of 30 years with intravitreal vascular endothelial growth factor (VEGF) inhibitor for choroidal new vessel (CNV) formation overlying choroidal osteoma over a mean follow-up of 26 months. Mean number of injections was 2.4 at 6 months, 3.2 at 12 months, and 5.5 at 24 months. CNV was subfoveal in 14 eyes, juxtafoveal in 5, extrafoveal in 5, and peripapillary in 2. By paired comparison, mean decrease from baseline was 119.7 microns at 6 months (; ), 105.3 microns at 1 year (; ), and 157.6 microns at 2 years (; ). BCVA improved by 3.3 lines at 6 months after therapy (; ), 2.8 lines (; ) at 1 year, and 3.1 lines (; ) at 2 years. We conclude that intravitreal anti-VEGF injections improve vision in majority of eyes with CNV from choroidal osteoma. Ahmad M. Mansour, J. Fernando Arevalo, Eman Al Kahtani, Hernando Zegarra, Emad Abboud, Rajiv Anand, Hamid Ahmadieh, Robert A. Sisk, Salman Mirza, Samuray Tuncer, Amparo Navea Tejerina, Jorge Mataix, Francisco J. Ascaso, Jose S. Pulido, Rainer Guthoff, Winfried Goebel, Young Jung Roh, Alay S. Banker, Ronald C. Gentile, Isabel Alonso Martinez, Rodney Morris, Neeraj Panday, Park Jung Min, Emilie Mercé, Timothy Y. Y. Lai, Vicky Massoud, and Nicola G. Ghazi Copyright © 2014 Ahmad M. Mansour et al. All rights reserved. Sustained-Release Corticosteroid Options Wed, 23 Jul 2014 00:00:00 +0000 Sustained-release corticosteroid treatment has shown to be a promising strategy for macular edema due to retinovascular disease (i.e., diabetes and retinal vein occlusion) and for the treatment of noninfectious posterior uveitis. Clinicians now have the option of three sustained-release corticosteroid implants: Ozurdex (Allergan Inc., Irvine, CA) which releases dexamethasone and two devices that release fluocinolone acetonide, Retisert (Bausch & Lomb, Rochester, NY), and Iluvien (Alimera Science, Alpharetta, GA). Each has different physical characteristics and duration effect and has been approved for different indications. Herein we provide a summary of the current clinical knowledge regarding these implants. Mariana Cabrera, Steven Yeh, and Thomas A. Albini Copyright © 2014 Mariana Cabrera et al. All rights reserved. Gender and Uveitis Tue, 22 Jul 2014 09:22:34 +0000 Chi-Chao Chan, Debra A. Goldstein, Janet L. Davis, and H. Nida Sen Copyright © 2014 Chi-Chao Chan et al. All rights reserved. Evaluation of the Repeatability and the Reproducibility of AL-Scan Measurements Obtained by Residents Tue, 22 Jul 2014 07:32:10 +0000 Purpose. To assess the repeatability and reproducibility of ocular biometry and intraocular lens (IOL) power measurements obtained by ophthalmology residents using an AL-Scan device, a novel optical biometer. Methods. Two ophthalmology residents were instructed regarding the AL-Scan device. Both performed ocular biometry and IOL power measurements using AL-Scan, three times on each of 128 eyes, independently of one another. Corneal keratometry readings, horizontal iris width, central corneal thickness, anterior chamber depth, pupil size, and axial length values measured by both residents were recorded together with IOL power values calculated on the basis of four different IOL calculation formulas (SRK/T, Holladay, and HofferQ). Repeatability and reproducibility of the measurements obtained were analyzed using the intraclass correlation coefficient (ICC). Results. Repeatability (ICC, 0.872-0.999 for resident 1 versus 0.905-0.999 for resident 2) and reproducibility (ICC, 0.916-0.999) were high for all biometric measurements. Repeatability (ICC, 0.981-0.983 for resident 1 versus 0.995-0.996 for resident 2) and reproducibility were also high for all IOL power measurements (ICC, 0.996 for all). Conclusions. The AL-Scan device exhibits good repeatability and reproducibility in all biometric measurements and IOL power calculations, independent of the operator concerned. Mehmet Kola, Hikmet Duran, Adem Turk, Suleyman Mollamehmetoglu, Ahmet Kalkisim, and Hidayet Erdol Copyright © 2014 Mehmet Kola et al. All rights reserved. Comment on “Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis First Human Intraocular Infection Report” Tue, 22 Jul 2014 05:43:25 +0000 Luigi Toma, Enea Gino Di Domenico, Grazia Prignano, and Fabrizio Ensoli Copyright © 2014 Luigi Toma et al. All rights reserved. The Effects of Intravitreal Bevacizumab in Infectious and Noninfectious Uveitic Macular Edema Mon, 21 Jul 2014 12:16:56 +0000 Background/Aims. To assess the effect of intravitreal bevacizumab injection (IVBI) for the treatment of macular edema due to infectious and noninfectious uveitides. Design. Retrospective interventional case series. Methods. A chart review was performed on all the patients who were diagnosed with uveitic macular edema (UME) and received 1.25 mg of IVBI at two referral centers in Riyadh, Saudi Arabia. All included patients had their visual acuity and macular thickness analyzed at baseline and at 1 and 3 months following IVBI and any sign of reactivation was noted. Results. The mean age of patients was years with a mean followup of months. Ten patients had idiopathic intermediate uveitis, 9 patients had Behcet’s disease, 10 had idiopathic panuveitis, and twelve patients had presumed ocular tuberculosis uveitis. Following IVBI, the mean LogMAR visual acuity improved from at baseline to at 1 month and at 3 months (, at 3 months). The mean macular thickness was  μm at baseline. Following IVBI macular thickness improved to  μm at 1 month and to  μm at 3 months of followup (, at 3 months). Conclusion. Bevacizumab was effective in the management of UME associated with both infectious and noninfectious uveitides. Intravitreal bevacizumab induced remission of UME with infectious uveitis and had no immunosuppressive effect against infectious agents. Hassan Al-Dhibi, Issam H. Hamade, Ali Al-Halafi, Maan Barry, Charbel Bou Chacra, Vishali Gupta, and Khalid F. Tabbara Copyright © 2014 Hassan Al-Dhibi et al. All rights reserved. Eye Movement Control Mon, 21 Jul 2014 08:41:37 +0000 Stefanie I. Becker, Gernot Horstmann, and Arvid Herwig Copyright © 2014 Stefanie I. Becker et al. All rights reserved. Risk Factors for Glaucoma Suspicion in Healthy Young Asian and Caucasian Americans Mon, 21 Jul 2014 08:18:59 +0000 Purpose. To determine the prevalence of certain risk factors for glaucoma in a healthy, young population and to compare these risk factors between Asian Americans and Caucasians. Methods. 120 healthy graduate students (mean age years) underwent a comprehensive ophthalmic examination. Regression analyses controlling for age, sex, and refraction, comparing glaucoma risk factors in Asians () and Caucasians (), were performed. Outcome variables included family history, intraocular pressure (IOP), spherical equivalent, central corneal thickness (CCT), mean deviation (MD) and pattern standard deviation (PSD), and disc and retinal nerve fiber layer (RNFL) parameters. Results. 61% of subjects were female; the mean spherical equivalent was D; and the mean axial length (AL) was  mm. Regression analysis showed race affected spherical equivalent (), AL (), IOP (), and cup to disc area ratio (CDAR) (). Family history, CCT, MD, and PSD did not vary between Asians and Caucasians (). In this study, we found Asian Americans, compared to Caucasians, had  D greater myopia; greater IOP by  mmHg; and larger CDAR by . Conclusions. In our study population, young, healthy Asian Americans had greater myopia, IOP, and CDAR as compared to Caucasians, suggesting that racial variations can be important when diagnosing glaucoma. E. Lauren Doss, Linden Doss, Ying Han, Susan Huang, Travis Porco, Melike Pekmezci, and Shan Lin Copyright © 2014 E. Lauren Doss et al. All rights reserved. Evaluation of Pachymetric Measurements with Scheimpflug Photography-Based System and Optical Coherence Tomography Pachymetry at Different Stages of Keratoconus Sun, 20 Jul 2014 07:40:51 +0000 The aim of this study was to compare the central and peripheral pachymetric measurements determined with Sirius system and Visante OCT and evaluate the agreement between them at different stages of keratoconus. Measurements were not significantly different in all patients and subgroups and showed high correlation for the corneal thicknesses of the entire cornea in different stages of keratoconus. Betül İlkay Sezgin Akçay, Engin Bilge Özgürhan, Ercüment Bozkurt, Tuğba Kurt, Yusuf Yıldırım, Mediha Gülen Coşar, Aydın Yıldırım, Jülide Canan Umurhan Akkan, and Ahmet Demirok Copyright © 2014 Betül İlkay Sezgin Akçay et al. All rights reserved. Correlation between Intraocular Pressure Fluctuation with Postural Change and Postoperative Intraocular Pressure in Relation to the Time Course after Trabeculectomy Thu, 17 Jul 2014 12:16:41 +0000 Background. To investigate the correlation between intraocular pressure (IOP) fluctuation with postural change and IOP in relation to the time course after trabeculectomy. Methods. A total of 29 patients who had previously undergone primary trabeculectomy with mitomycin C were examined. IOP was obtained at 1, 2, 3, 6, and 12 months and then every 6 months postoperatively. Results. The postural IOP difference before surgery was  mmHg, which was reduced to  mmHg at 1 month,  mmHg at 2 months,  mmHg at 3 months,  mmHg at 6 months,  mmHg at 12 months, and  mmHg at 18 months after trabeculectomy ( each visit). The filtering surgery failed in 7 out of 29 eyes. Postural IOP changes were less than 3 mmHg in those patients who did not require needle revision at every visit. However, in patients who did require needle revision, the increase in the posture-induced IOP was greater than 3 mmHg prior to the increase in the sitting position IOP. Conclusions. Assessment of postural IOP changes after trabeculectomy might be potentially useful for predicting IOP changes after trabeculectomy. Kazuyuki Hirooka, Kaori Tenkumo, Eri Nitta, and Shino Sato Copyright © 2014 Kazuyuki Hirooka et al. All rights reserved. The Mitochondria-Targeted Antioxidant SkQ1 Downregulates Aryl Hydrocarbon Receptor-Dependent Genes in the Retina of OXYS Rats with AMD-Like Retinopathy Mon, 14 Jul 2014 12:04:43 +0000 The mitochondria-targeted antioxidant SkQ1 is a novel drug thought to retard development of age-related diseases. It has been shown that SkQ1 reduces clinical signs of retinopathy in senescence-accelerated OXYS rats, which are a known animal model of human age-related macular degeneration (AMD). The aim of this work was to test whether SkQ1 affects transcriptional activity of AhR (aryl hydrocarbon receptor) and Nrf2 (nuclear factor erythroid 2-related factor 2), which are considered as AMD-associated genes in the retina of OXYS and Wistar rats. Our results showed that only AhR and AhR-dependent genes were sensitive to SkQ1. Dietary supplementation with SkQ1 decreased the AhR mRNA level in both OXYS and Wistar rats. At baseline, the retinal Cyp1a1 mRNA level was lower in OXYS rats. SkQ1 supplementation decreased the Cyp1a1 mRNA level in Wistar rats, but this level remained unchanged in OXYS rats. Baseline Cyp1a2 and Cyp1b1 mRNA expression was stronger in OXYS than in Wistar rats. In the OXYS strain, Cyp1a2 and Cyp1b1 mRNA levels decreased as a result of SkQ1 supplementation. These data suggest that the Cyp1a2 and Cyp1b1 enzymes are involved in the pathogenesis of AMD-like retinopathy of OXYS rats and are possible therapeutic targets of SkQ1. M. L. Perepechaeva, A. Yu. Grishanova, E. A. Rudnitskaya, and N. G. Kolosova Copyright © 2014 M. L. Perepechaeva et al. All rights reserved. A Clinical and Confocal Microscopic Comparison of Transepithelial PRK and LASEK for Myopia Thu, 10 Jul 2014 11:43:43 +0000 Purpose. To compare the clinical and confocal microscopic results of transepithelial PRK versus LASEK for correction of myopia. Materials and Methods. Twelve patients with myopia received transepithelial PRK in one eye and LASEK in the other. In transepithelial PRK-treated eyes, the corneal epithelium was removed with 40 microns of excimer laser ablation and in LASEK-treated eyes with 25-second application of 18% ethanol. Time to epithelial healing, ocular discomfort, uncorrected and best corrected visual acuities, manifest refraction, haze, greyscale value, and keratocyte apoptosis in confocal microscopy were recorded. Results. The mean time to epithelial healing was significantly longer after LASEK (4.00 ± 0.43 versus 3.17 ± 0.6 days). On day 1, ocular discomfort was significantly higher after transepithelial PRK. The grade of haze, keratocyte apoptosis, and greyscale value in confocal microscopy were significantly higher in transepithelial PRK-treated eyes at 1 month. All transepithelial PRK- and LASEK-treated eyes achieved 20/25 or better UCVA and were within ±1.00 D of emmetropia at final visits. Conclusions. Both transepithelial PRK and LASEK offer effective correction of myopia at 1 year. However, LASEK appeared to induce less discomfort and less intense wound healing in the early postoperative period. Safak Korkmaz, Kamil Bilgihan, Sabahattin Sul, and Ahmet Hondur Copyright © 2014 Safak Korkmaz et al. All rights reserved. Aqueous Interleukin-6 Levels Are Superior to Vascular Endothelial Growth Factor in Predicting Therapeutic Response to Bevacizumab in Age-Related Macular Degeneration Thu, 10 Jul 2014 09:16:54 +0000 Objective. To prospectively evaluate the effect of intravitreal bevacizumab on aqueous levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with exudative age-related macular degeneration (AMD) and correlate clinical outcomes with cytokine levels. Methods. 30 eyes of 30 patients with exudative AMD underwent intravitreal injection of bevacizumab three times at monthly intervals. The aqueous samples prior to the 1st injection (baseline) and 3rd injection were analyzed for VEGF and IL-6 levels. Subjects were subgrouped based upon change in the central subfield (CSF) macular thickness on SD-OCT at 8 weeks. Group 1 included patients () with a decrease in CSF thickness greater than 10% from the baseline (improved group). Group 2 included patients () who had a decrease in CSF thickness 10% or less (treatment-resistant). Results. In subgroup analysis, in both groups 1 and 2 patients, compared to aqueous VEGF, aqueous IL-6 levels showed a better correlation with CSF thickness on SD-OCT ( and 0.71, resp.). Conclusions. Aqueous IL-6 may be an important marker of treatment response or resistance in wet macular degeneration. Future therapeutic strategies may include targeted treatment against both VEGF and IL-6, in patients who do not respond to anti-VEGF treatment alone. Kakarla V. Chalam, Sandeep Grover, Kumar Sambhav, Sankarathi Balaiya, and Ravi K. Murthy Copyright © 2014 Kakarla V. Chalam et al. All rights reserved. Evaluation of the New Digital Goldmann Applanation Tonometer for Measuring Intraocular Pressure Thu, 10 Jul 2014 08:43:42 +0000 Purpose. To compare a new digital Goldmann applanation tonometer (dGAT) that measures intraocular pressure (IOP) in 0.1 mmHg increments to a standard Goldmann applanation tonometer (sGAT). Methods. This study included 116 eyes of 60 subjects. A single examiner first measured IOP in triplicate using either sGAT or dGAT, which was randomly chosen. After a 5-minute interval, the next set of three consecutive IOP was measured using the other GAT. Results. The mean IOP measured with sGAT was 16.27 ± 6.68 mmHg and 16.35 ± 6.69 mmHg with dGAT. Pearson’s correlation coefficient was 0.998 (). The subjects were divided into three groups based on the mean IOP: IOP < 14 mmHg, 14–20 mmHg, or >20 mmHg. The Pearson’s correlation coefficient within each group was 0.935, 0.972, and 0.997 (), respectively. The difference within the three consecutive IOP measurements (maximum–minimum) for dGAT (0.72 ± 0.34 mmHg) was significantly smaller than those with sGAT (0.92 ± 0.42 mmHg, ). Even in patients with equal IOP (zero left-right difference) with sGAT (), dGAT detected IOP differences between the left and right eyes (0.47 ± 0.31 mmHg). Conclusion. Compared to sGAT, dGAT measurements are highly reproducible and less variable. Yuta Sakaue, Jun Ueda, Masaaki Seki, Takayuki Tanaka, Tetsuya Togano, Takaiko Yoshino, and Takeo Fukuchi Copyright © 2014 Yuta Sakaue et al. All rights reserved. Intravitreal Bevacizumab Alone or Combined with Macular Laser Photocoagulation for Recurrent or Persistent Macular Edema Secondary to Branch Retinal Vein Occlusion Mon, 07 Jul 2014 11:37:41 +0000 Background. To evaluate the efficacy of intravitreal bevacizumab (IVB) injection with or without macular laser photocoagulation (MLP) for recurrent or persistent macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. Thirty-four eyes underwent IVB injection for ME secondary to BRVO as a primary treatment. Twenty of the 34 eyes experienced recurrent or persistent ME after the first IVB. Nine of the 20 eyes (Group 1) were retreated with IVB combined with MLP. The remaining 11 eyes (Group 2) were retreated with IVB alone. Results. In Group 1, the postoperative best corrected visual acuity (BCVA) improved compared with the preoperative value at all follow-up visits, although no statistically significant improvement was observed at 6 months. In contrast, BCVA significantly improved from 0.53 to 0.40 at 6 months () in Group 2. Conclusion. Combined therapy tended to have a smaller effect on visual acuity compared with IVB monotherapy. Takafumi Hirashima, Tomoyuki Chihara, Toshitaka Bun, Takao Utsumi, Miou Hirose, and Hideyasu Oh Copyright © 2014 Takafumi Hirashima et al. All rights reserved. Inhibition of Return in Fear of Spiders: Discrepant Eye Movement and Reaction Time Data Thu, 03 Jul 2014 00:00:00 +0000 Inhibition of return (IOR) refers to a bias against returning the attention to a previously attended location. As a foraging facilitator it is thought to facilitate systematic visual search. With respect to neutral stimuli, this is generally thought to be adaptive, but when threatening stimuli appear in our environment, such a bias may be maladaptive. This experiment investigated the influence of phobia-related stimuli on the IOR effect using a discrimination task. A sample of 50 students (25 high, 25 low in spider fear) completed an IOR task including schematic representations of spiders or butterflies as targets. Eye movements were recorded and to assess discrimination among targets, participants indicated with button presses if targets were spiders or butterflies. Reaction time data did not reveal a significant IOR effect but a significant interaction of group and target; spider fearful participants were faster to respond to spider targets than to butterflies. Furthermore, eye-tracking data showed a robust IOR effect independent of stimulus category. These results offer a more comprehensive assessment of the motor and oculomotor factors involved in the IOR effect. Elisa Berdica, Antje B. M. Gerdes, Andre Pittig, and Georg W. Alpers Copyright © 2014 Elisa Berdica et al. All rights reserved. Novel Lutein Loaded Lipid Nanoparticles on Porcine Corneal Distribution Wed, 02 Jul 2014 09:33:14 +0000 Topical delivery has the advantages including being user friendly and cost effective. Development of topical delivery carriers for lutein is becoming an important issue for the ocular drug delivery. Quantification of the partition coefficient of drug in the ocular tissue is the first step for the evaluation of delivery efficacy. The objectives of this study were to evaluate the effects of lipid nanoparticles and cyclodextrin (CD) on the corneal lutein accumulation and to measure the partition coefficients in the porcine cornea. Lipid nanoparticles combined with 2% HPβCD could enhance lutein accumulation up to (μg/g) which is 4.9-fold higher than that of the nanoparticles. CD combined nanoparticles have 68% of drug loading efficiency and lower cytotoxicity in the bovine cornea cells. From the confocal images, this improvement is due to the increased partitioning of lutein to the corneal epithelium by CD in the lipid nanoparticles. The novel lipid nanoparticles could not only improve the stability and entrapment efficacy of lutein but also enhance the lutein accumulation and partition in the cornea. Additionally the corneal accumulation of lutein was further enhanced by increasing the lutein payload in the vehicles. Chi-Hsien Liu, Hao-Che Chiu, Wei-Chi Wu, Soubhagya Laxmi Sahoo, and Ching-Yun Hsu Copyright © 2014 Chi-Hsien Liu et al. All rights reserved. Evaluation of the Endothelial Cell Density and the Central Corneal Thickness in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma Tue, 01 Jul 2014 12:31:42 +0000 Purpose. Evaluation of central corneal thickness (CCT) and endothelial cell density (ECD) in patients with senile cataract and coexisting pseudoexfoliation (PEX) syndrome with glaucoma (PEXG) and without glaucoma using specular microscopy. Participants and Methods. The study included 122 patients (217 eyes). In this group of patients we identified 133 eyes with PEX syndrome (65 with glaucoma, 68 without glaucoma) and 84 eyes without PEX syndrome. ECD and CCT were measured in each eye by specular microscopy. Results. ECD in eyes with PEX syndrome without glaucoma (2297 ± 359 cell/mm2) and in eyes with PEXG (2241 ± 363 cell/mm2) was lower than in the control group (2503 ± 262 cell/mm2) (). CCT in eyes with PEXG (508.2 ± 32.6 μm) was thinner than in eyes with PEX syndrome without glaucoma (529.7 ± 30.3 μm) and control group (527.7 ± 29.4 μm) (). Conclusions. This research shows that in eyes with PEX syndrome, both with and without glaucoma, ECD was statistically significantly lower than in the control group. In patients with PEXG, CCT was statistically significantly thinner than in the PEX syndrome and control group. Bożydar T. Tomaszewski, Renata Zalewska, and Zofia Mariak Copyright © 2014 Bożydar T. Tomaszewski et al. All rights reserved. Sex and Reproduction in the Transmission of Infectious Uveitis Tue, 01 Jul 2014 11:56:16 +0000 Current data permit only speculations regarding sex differences in the prevalence of infectious uveitis between women and men because uveitis case surveys do not uniformly report gender data. Differences in prevalence that are reported in the literature could relate to simple differences in the number of women and men at risk for infection or to biological differences between men and women. Compared to other types of uveitis, infectious uveitis may be directly related to occupational exposures or sexual behaviors, which differ between women and men, and may mask actual biological differences in susceptibility to ocular manifestations of the infection and its prognosis. In infectious uveitis for which there is no element of sexual transmission and data is available, prevalence of ocular disease is roughly equal between women and men. Women also have a unique relationship with infectious uveitis in their role as mothers. Vertical transmission of infections such as herpes simplex, toxoplasmosis, and cytomegalovirus can produce severe chorioretinitis in neonates. Janet L. Davis Copyright © 2014 Janet L. Davis. All rights reserved. The Ocular Surface Chemical Burns Tue, 01 Jul 2014 09:10:00 +0000 Ocular chemical burns are common and serious ocular emergencies that require immediate and intensive evaluation and care. The victims of such incidents are usually young, and therefore loss of vision and disfigurement could dramatically affect their lives. The clinical course can be divided into immediate, acute, early, and late reparative phases. The degree of limbal, corneal, and conjunctival involvement at the time of injury is critically associated with prognosis. The treatment starts with simple but vision saving steps and is continued with complicated surgical procedures later in the course of the disease. The goal of treatment is to restore the normal ocular surface anatomy and function. Limbal stem cell transplantation, amniotic membrane transplantation, and ultimately keratoprosthesis may be indicated depending on the patients’ needs. Medi Eslani, Alireza Baradaran-Rafii, Asadolah Movahedan, and Ali R. Djalilian Copyright © 2014 Medi Eslani et al. All rights reserved. Anatomical Outcome of Vitreoretinal Surgery Using Temporary Keratoprosthesis and Replacement of the Trephined Corneal Button for Severe Open Globe Injuries: One-Year Result Tue, 01 Jul 2014 07:57:01 +0000 In this case series of 74 patients with coexisting vitreoretinal injury and severe corneal opacification, after temporary keratoprosthesis (TKP) assisted pars plana vitrectomy (PPV), an allograft corneal transplant was not performed at the same time; instead, the patient’s trephined corneal button was sutured back. One year after the surgery, if intraocular pressure of the injured eyes was above 8 mmHg, removing silicone oil was attempted, and penetrating keratoplasty could be performed. Finally, 10 eyes (13.5%) were enucleated due to atrophia bulbi; 46 eyes (62.2%) were silicone-oil sustained; 15 eyes (20.3%) were anatomically restored; and 3 eyes (4.0%) experienced recurrent retinal detachment. These figures only demonstrate a small percentage of the injured eyes in our series, which have PKP indications. It is a practical option to suture back the patient’s trephined cornea following a TKP assisted PPV; keratoplasty was reserved for selected cases. Hui-Jin Chen, Chang-Guan Wang, Hong-Liang Dou, Xue-Feng Feng, Kang Feng, Yun-Tao Hu, Yi-Min Xu, and Zhi-Zhong Ma Copyright © 2014 Hui-Jin Chen et al. All rights reserved. Big Bubble Deep Anterior Lamellar Keratoplasty for Management of Deep Fungal Keratitis Tue, 01 Jul 2014 06:48:48 +0000 Objective. To evaluate the therapeutic effect of big bubble deep anterior lamellar keratoplasty (DALK) in patients with deep fungal keratitis. Methods. Consecutive patients who had DALK for deep fungal keratitis at Shandong Eye Hospital between July 2011 and December 2012 were included. In all patients, the infiltration depth was more than 4/5ths of the corneal thickness. DALK surgery was performed with bare Descemet membrane (DM) using the big bubble technique. Corrected distance visual acuity (CDVA), graft status, and intraoperative and postoperative complications were monitored. Results. Big bubble DALK was performed in 23 patients (23 eyes). Intraoperative perforation of the DM occurred in two eyes (8.7%) during stromal dissection. The patients received lamellar keratoplasty with an air bubble injected into the anterior chamber. Double anterior chamber formed in 3 eyes (13.0%). Mean CDVA of the patients without cataract, amblyopia, and fungal recurrence was improved from preoperative HM/20 cm−1.0 (LogMAR) to (LogMAR) at the last followup (). Fungal recurrence was found in two patients (8.7%). Corneal stromal graft rejection was noted in one patient (4.3%). Conclusions. DALK using the big bubble technique seems to be effective and safe in the treatment of deep fungal keratitis unresponsive to medication. Hua Gao, Peng Song, Jose J. Echegaray, Yanni Jia, Suxia Li, Man Du, Victor L. Perez, and Weiyun Shi Copyright © 2014 Hua Gao et al. All rights reserved. Combined Tractional and Rhegmatogenous Retinal Detachment in Proliferative Diabetic Retinopathy in the Anti-VEGF Era Wed, 25 Jun 2014 07:39:42 +0000 Purpose. To investigate the clinical features, surgical outcomes, and prognostic factors of combined rhegmatogenous and tractional detachment (combined RD) in proliferative diabetic retinopathy (PDR) in recent years. Methods. Medical records of PDR and combined RD treated with vitrectomy from 2008 to 2013 were retrospectively reviewed. Results. A total of 57 eyes from 49 patients were included. Nine eyes had received panretinal photocoagulation (PRP) and 7 eyes had intravitreal bevacizumab (IVB) within 3 months before RD developed. Thirty-eight eyes (66.7%) had ≧3 sites of broad adhesion of fibrovascular proliferation (FVP). Thirty-three eyes (57.9%) showed active FVP. Thirty-four eyes (59.6%) had extent of RD involving 3 or 4 quadrants. The primary reattachment rate was 93.0%, and the final visual acuity (VA) improved by more than 3 lines in 80.7% of eyes. Neovascular glaucoma occurred in 4 eyes postoperatively. Poor preoperative VA, severe vitreoretinal adhesion, and broad extent of RD had significant correlation with poor visual outcomes. Conclusion. PRP or IVB might play a role in provoking combined RD. The anatomical and functional success rates of surgery were high. Poor preoperative VA and severe proliferations predicted poor visual outcomes. Ya-Jui Hsu, Yi-Ting Hsieh, Po-Ting Yeh, Jehn-Yu Huang, and Chung-May Yang Copyright © 2014 Ya-Jui Hsu et al. All rights reserved. A Cornea Substitute Derived from Fish Scale: 6-Month Followup on Rabbit Model Tue, 24 Jun 2014 12:13:27 +0000 A fish scale-derived cornea substitute (Biocornea) is proposed as an alternative for human donor corneal tissue. We adopt a regenerative medicine approach to design a primary alternative to the use of fish scale for restoring sight by corneal replacement. Biocornea with corneal multilayer arrangement collagen was implanted to rabbits by pocket implantation. Our study demonstrated the safety and detailed morphologic and physiologic results from the 6 months of followup of rabbit model. In the peripheral Biocornea, the collagen fibrils were arranged in reticular fashion. Slit lamp examination showed that haze and an ulcer were not observed in all groups at 3 months postoperatively while all corneas with Biocornea were clear at both 3 months and 6 months postoperatively. The interface of Biocornea and stromal tissue were filled successfully and without observable immune cells at postoperative day 180. Moreover, the Biocornea was not dissolved and degenerated but remained transparent and showed no apparent fragmentation. Our study demonstrated that the Biocornea derived from fish scale as a good substitute had high biocompatibility and support function after a long-term evaluation. This revealed that the new approach of using Biocornea may yield an ideal artificial cornea substitute for long-term inlay placement. Fei Yuan, Liyan Wang, Chien-Chen Lin, Cheng-Hung Chou, and Lei Li Copyright © 2014 Fei Yuan et al. All rights reserved. The Influence of Prior Hyperthyroidism on Euthyroid Graves’ Ophthalmopathy Sun, 22 Jun 2014 06:26:25 +0000 Background. To investigate the influence of previous exposure to elevated thyroid hormones in euthyroid Graves’ ophthalmopathy. Design. Retrospective, observational case series in university setting Median follow-up of 1 year with ranges of 0,8–7,6 years. Study performance of 10 years. Participants. We reviewed the clinical records of 731 Graves’ ophthalmopathy patients. There were 88 (12%) patients with onset of Graves’ ophthalmopathy during euthyroidism: 37 (5%) patients had ophthalmopathy without known history of thyroid dysfunction (group A) and 51 patients (6%) had onset of ophthalmopathy 6 months or more euthyroid after completion of antithyroid therapy (group B). Main Outcome Measures. Graves’ ophthalmopathy was graded using the EUGOGO severity criteria. Unilaterality was investigated. TSH receptor antibody and thyroid peroxidase antibody were measured as markers of Graves’ disease. Results. Group A had more often a normal ocular motility (46%) and less proptosis ( mm) compared to group B (22%,  mm) ( and 0.028, resp.). TSH receptor antibody was more frequently elevated in group B (94%) than in group A (17%) . Conclusion. Patients with euthyroid Graves’ ophthalmopathy present more often with ocular muscle restriction and proptosis when previously exposed to elevated thyroid hormones. Karolien Termote, Brigitte Decallonne, and Ilse Mombaerts Copyright © 2014 Karolien Termote et al. All rights reserved. Systemic Endothelial Function in Primary Open-Angle Glaucoma Wed, 18 Jun 2014 07:41:19 +0000 Objective. We aimed to assess peripheral vascular endothelial function in open-angle glaucoma (POAG) by measuring flow-mediated dilatation (FMD). Materials and Methods. The study included 20 cases with POAG (group 1, mean age years) and 30 healthy individuals (group 2, mean age years). In all cases, responses of endothelial function were assessed by a cardiologist through measurement of FMD following brachial artery occlusion. Results. Mean percent of FMD, an indicator of endothelial function, was found to be in group 1 and in group 2 (). Conclusion. No impairment in systemic vascular function of cases with POAG suggests that POAG could be a local disorder rather than being a component of systemic disease. Mustafa Atas, Hasan Basri Arifoglu, Arzu Seyhan Karatepe Hashas, Bahadır Sarli, Suleyman Demircan, Ayse Ozkose, and Altan Goktas Copyright © 2014 Mustafa Atas et al. All rights reserved. The Frequency of Exfoliation Syndrome in the Central Anatolia Region of Turkey Tue, 17 Jun 2014 11:30:52 +0000 Aim. The aim of this study was to investigate the frequency of exfoliation syndrome in the Central Anatolia region of Turkey and to evaluate its relationship with cardiovascular and ocular diseases. Methods. Patients over the age of 45 years who presented to the clinic were included in the study. All cases underwent a comprehensive ophthalmology examination. Exfoliation syndrome was diagnosed with the presence of exfoliative material on the lens anterior capsule or iris on slit lamp examination. The patients were divided into two groups as the exfoliation syndrome group and nonexfoliation syndrome group according to the presence of exfoliative material. Results. Exfoliative material was found in one or both eyes of 212 of the 2103 patients (10.1%) evaluated within the scope of the study. A significant relationship was found between exfoliation syndrome and increasing age and male gender. A significant relationship was found between exfoliation syndrome and glaucoma, cataracts, age-related macular degeneration, and phacodonesis. While no relationship was found between exfoliation syndrome and hypertension or diabetes mellitus, a significant relationship was found with coronary artery disease. Conclusion. The unilateral or bilateral exfoliation syndrome frequency was 10.1% in this hospital-based study. A statistically significant relationship was found between exfoliation syndrome and advancing age, gender, and coronary artery disease. Raşit Kılıç, Hafize Sezer, Sebile Ü. Çomçalı, Serdar Bayraktar, Gökay Göktolga, Yasin Çakmak, Abdi B. Çetin, and Tongabay Cumurcu Copyright © 2014 Raşit Kılıç et al. All rights reserved. Examining the Choroid in Ocular Inflammation: A Focus on Enhanced Depth Imaging Mon, 16 Jun 2014 00:00:00 +0000 The choroid is the vascular layer that supplies the outer retina and is involved in the pathogenesis of several ocular conditions including choroidal tumors, age related macular degeneration, central serous chorioretinopathy, diabetic retinopathy, and uveitis. Nevertheless, difficulties in the visualization of the choroid have limited our understanding of its exact role in ocular pathology. Enhanced depth imaging optical coherent topography (EDI-OCT) is a novel, noninvasive technique that is used to evaluate choroidal thickness and morphology in these diseases. The technique provides detailed objective in vivo visualization of the choroid and can be used to characterize posterior segment inflammatory disorders, monitor disease activity, and evaluate efficacy of treatment. In this review we summarize the current application of this technique in ocular inflammatory disorders and highlight its utility as an additional tool in monitoring choroidal involvement in ocular inflammation. Abeir Baltmr, Sue Lightman, and Oren Tomkins-Netzer Copyright © 2014 Abeir Baltmr et al. All rights reserved. Clinical, Radiological, Microbiological, and Histopathological Aspects of Acquired Dacryocystoceles Wed, 11 Jun 2014 11:44:22 +0000 Purpose. The aim of this study is to investigate the etiology and the clinical, microbiological, histopathological, and radiological findings of acquired dacryocystoceles. Methods. In this retrospective study, we reviewed the clinical records of 10 eyes of 8 patients with dacryocystoceles who underwent external dacryocystorhinostomy (DCR) surgery. Etiology, presenting symptoms and radiological findings as well as microbiological and histopathological assessment results and outcome were analyzed. Results. The records of 8 patients with dacryocystoceles were included in this study. In the histopathological evaluations of the samples collected from the lacrimal sac wall, chronic inflammation was found in all biopsied samples and fibrosis was observed in two histopathological evaluations. Computerized tomography (CT) imaging showed fluid collection separated from adjacent tissues by a thin rim, corresponding to dacryocystoceles in the sac. In the microbiological culture examination of samples collected from the fluid within the cyst, no bacterial growth in 5 eyes, gram-negative bacillus growth in 3 eyes, and gram-positive cocci growth in 2 eyes were found. Conclusions. Acquired dacryocystoceles were observed extremely rarely and a definite pathogenic agent could not be identified in any of the cases, either microbiologically or histologically, whereas chronic inflammation was detected in all cases in our study. Selam Yekta Sendul, Sonmez Cinar, Halil Hüseyin Çağatay, Mehmet Demir, Burcu Dirim, and Dilek Guven Copyright © 2014 Selam Yekta Sendul et al. All rights reserved.