Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Autologous Advanced Tenon Grafting Combined with Conjunctival Flap in Scleromalacia after Pterygium Excision Thu, 23 Apr 2015 06:12:45 +0000 Purpose. To evaluate the efficacy of autologous tenon grafting combined with conjunctival flap as a treatment for scleromalacia or scleral thinning after pterygium excision without any additional donor graft tissue. Methods. Twenty-six cases underwent autologous advanced tenon grafting combined with sliding or rotating conjunctival flap for scleromalacia after pterygium surgery ranging from 2 years to 30 years. The extent of scleral defect measured from 2.0 mm to 6.8 mm in diameter. The cosmetic outcome was defined as complete resolution of scleromalacia or completely conjunctival reepithelialization and firm adhesion between subtenon and scleral tissue over scleral thinning without significant complications. Results. All cases achieved the covering of conjunctival and tenon or subtenon tissue over scleromalacia or scleral thinning with this procedure. Preoperative pain, inflammation, and choroidal exposure disappeared after surgery. Immediate postoperative complications, such as large wound dehiscence or reopening of the scleral wound, did not occur in any of the patients. There were no significant clinical complications during the mean postoperative follow-up period of 14.17 months in all cases. Conclusions. We obtained excellent outcome with fewer complications after autologous advanced tenon graft and conjunctival flap, without an additional donor graft, in scleromalacia or scleral thinning caused by previous pterygium excision. Jong Soo Lee, Min Kyu Shin, Jong Ho Park, Young Min Park, and Margaret Song Copyright © 2015 Jong Soo Lee et al. All rights reserved. Thickness Mapping of Eleven Retinal Layers Segmented Using the Diffusion Maps Method in Normal Eyes Sun, 19 Apr 2015 08:12:50 +0000 This study was conducted to determine the thickness map of eleven retinal layers in normal subjects by spectral domain optical coherence tomography (SD-OCT) and evaluate their association with sex and age. Mean regional retinal thickness of 11 retinal layers was obtained by automatic three-dimensional diffusion map based method in 112 normal eyes of 76 Iranian subjects. We applied our previously reported 3D intraretinal fast layer segmentation which does not require edge-based image information but rather relies on regional image texture. The thickness maps are compared among 9 macular sectors within 3 concentric circles as defined by ETDRS. The thickness map of central foveal area in layers 1, 3, and 4 displayed the minimum thickness. Maximum thickness was observed in nasal to the fovea of layer 1 and in a circular pattern in the parafoveal retinal area of layers 2, 3, and 4 and in central foveal area of layer 6. Temporal and inferior quadrants of the total retinal thickness and most of other quadrants of layer 1 were significantly greater in the men than in the women. Surrounding eight sectors of total retinal thickness and a limited number of sectors in layers 1 and 4 significantly correlated with age. Raheleh Kafieh, Hossein Rabbani, Fedra Hajizadeh, Michael D. Abramoff, and Milan Sonka Copyright © 2015 Raheleh Kafieh et al. All rights reserved. Fusional Vergence Detected by Prism Bar and Synoptophore in Chinese Childhood Intermittent Exotropia Tue, 14 Apr 2015 14:33:49 +0000 Purpose. To measure the changes in fusional vergence in Chinese children with intermittent exotropia (IXT) and the association with the control of IXT. Methods. Ninety-two patients with IXT (8–15 years old) were compared with 86 controls. Exodeviation control was evaluated using the Revised Newcastle Control Score. Angle of deviation was measured using prism and alternate cover testing at distance and near. Fusional vergence was measured using prism bar and synoptophore. This study was registered with ChiCTR-RCC-13003920. Results. Using prism bar, convergence break points were lower whereas divergence break points were higher in children with IXT at distance () and near () compared with controls. There was no significant difference in mean divergence amplitudes between the two groups when testing using a synoptophore (). In children with IXT, the distance between recovery point and break point in both convergence (distance: ; near: ) and divergence (distance: ; near: ) was larger than controls when detected by prism bar and synoptophore (convergence: ; divergence: ). Conclusions. Children with IXT have reduced convergence amplitudes as detected by both prism bar and synoptophore. Tao Fu, Jing Wang, Moran Levin, Qing Su, Dongguo Li, and Junfa Li Copyright © 2015 Tao Fu et al. All rights reserved. Incidence and Outcomes of Anterior Chamber Gas Bubble during Femtosecond Flap Creation for Laser-Assisted In Situ Keratomileusis Tue, 14 Apr 2015 06:43:57 +0000 Purpose. To report the incidence and outcomes of anterior chamber gas bubble formation during femtosecond laser flap creation for laser-assisted in situ keratomileusis (LASIK). Methods. The charts of 2,886 consecutive eyes that underwent femtosecond LASIK from May 2011 through August 2014 were retrospectively reviewed. The incidence, preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed in subjects developing anterior chamber gas bubble formation during the procedure. Results. A total of 4 cases (0.14%) developed anterior chamber gas bubble formation during femtosecond laser flap creation. In all four cases, the excimer laser was unable to successfully track the pupil immediately following the anterior chamber bubble formation, temporarily postponing the completion of the procedure. There was an ethnicity predilection of anterior chamber gas formation toward Asians (). An uncorrected visual acuity of 20/20 was ultimately achieved in all four cases without further complications. Conclusions. Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK is an uncommon event that typically results in a delay in treatment completion; nevertheless, it does influence final positive visual outcome. Sloan W. Rush, Philip Cofoid, and Ryan B. Rush Copyright © 2015 Sloan W. Rush et al. All rights reserved. Comparison of Two Different Scheimpflug Devices in the Detection of Keratoconus, Regular Astigmatism, and Healthy Corneas Tue, 14 Apr 2015 06:06:43 +0000 Aim. The aim of this study was to determine the intra- and interobserver variability of two Scheimpflug based camera systems, Pentacam and Sirius. In addition, the comparability of the measurements was tested in healthy subjects, subjects with regular astigmatism, and keratoconus patients. Methods. Intra- and interobserver variability were assessed in 20 healthy corneas. Pachymetry values were also compared with ultrasound pachymetry as a reference measurement. To detect possible differences between the two devices, 82 eyes with clinically established keratoconus, 30 eyes with regular astigmatism (>1.5 D), and 60 eyes without corneal pathologies were included in this prospective study. Results. Pachymetry and keratometry showed good intra- and interobserver variability for both devices. Pachymetry values obtained with the Sirius system ( μm) were significantly higher compared to the Pentacam system ( μm, ) and to ultrasound pachymetry ( μm, ). Significant interdevice differences were found regarding the majority of the detected keratometry parameters. Conclusions. Both devices show almost perfect reproducibility in healthy subjects. However, pachymetry and keratometry values of the two devices should not be used interchangeably. David Finis, Bernhard Ralla, Maria Karbe, Maria Borrelli, Stefan Schrader, and Gerd Geerling Copyright © 2015 David Finis et al. All rights reserved. Association of Birth Parameters with Refractive Status in a Sample of Caucasian Children Aged 4–17 Years Thu, 09 Apr 2015 16:08:07 +0000 Purpose. To investigate the association of birth parameters with refractive status in different age groups of Caucasian children. Materials and Methods. This cross-sectional study included 564 eyes of 282 children aged 4 to 17 years. All children underwent complete ophthalmologic examination. The children were divided into three groups according to their refractive status (emmetropia,myopia, and hyperopia), ages (4–7, 8-9, 10–12, and 13–17), and appropriateness for gestational age, respectively. Results. The mean age of the children was (age range 4–17 years). The mean spheric equivalent was (range: (−10.0)–(+10.0) diopters). The mean birth weight and gestational age were grams (750–5000 grams) and weeks (25–42 weeks). According to multinominal logistic regression analysis, children with myopia were more likely to have higher birth weights than emmetropic children (OR: 1.0, 95% CI: 1.000–1.001, and ). The hypermetropes were found to be significantly small for gestational age between 13 and 17 years of age. Conclusion. Birth weight and appropriateness for gestational age as birth parameters may have an impact on development of all types of refractive errors. The hypermetropic children tended to be small for gestational age. Berna Akova-Budak, Sertaç Argun Kıvanç, and Osman Okan Olcaysü Copyright © 2015 Berna Akova-Budak et al. All rights reserved. Comparison of Two Anesthetic Methods for Intravitreal Ozurdex Injection Thu, 09 Apr 2015 11:13:42 +0000 Purpose. To determine whether subconjunctival lidocaine injection maintains additional anesthetic effect during intravitreal Ozurdex injection. Methods. 63 patients who were diagnosed as central or branch retinal vein occlusion and planned to receive Ozurdex injection for macular edema were prospectively included in the study. The patients were randomized into one of the two anesthetic groups. The first group received topical proparacaine drop and lidocaine applied pledget. The second group received subconjunctival lidocaine injection in addition to the anesthetics in group 1. Results. Mean pain score was in group 1 and 1.71 ± 2.09 in group 2 (). Mean subconjunctival hemorrhage grade was in group 1 and in group 2 (). There was no relationship between the amount of subconjunctival hemorrhage and pain score of the patients. Conclusions. There was no difference in pain scores between the two anesthetic methods. The addition of subconjunctival lidocaine injection offered no advantage in pain relief compared to lidocaine-applied pledgets. V. Levent Karabaş, Berna Özkan, Çiğdem Akdağ Koçer, Özgül Altıntaş, Dilara Pirhan, and Nurşen Yüksel Copyright © 2015 V. Levent Karabaş et al. All rights reserved. Endoscopic Endonasal Dacryocystorhinostomy Combined with Canaliculus Repair for the Management of Dacryocystitis with Canalicular Obstruction Wed, 08 Apr 2015 09:47:32 +0000 Purpose. The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with canalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has been studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy (EE-DCR) combined with a modified canalicular repair. Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6–18 months of postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and occasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and normal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial and the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them had a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12), and anatomical success rate is 75% (9/12). Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient method for the management of dacryocystitis with canalicular obstruction. Yunhai Tu, Zhenbin Qian, Jiao Zhang, Wencan Wu, and Tianlin Xiao Copyright © 2015 Yunhai Tu et al. All rights reserved. A Review of Collagen Cross-Linking in Cornea and Sclera Thu, 02 Apr 2015 10:10:37 +0000 Riboflavin/UVA cross-linking is a technique introduced in the past decades for the treatment of keratoconus, keratectasia, and infectious keratitis. Its efficacy and safety have been investigated with clinical and laboratory studies since its first clinical application by Wollensak for the treatment of keratoconus. Although its complications are encountered during clinical practice, such as infection inducing risk, minimal invasion merits a further investigation on its future application in clinical practice. Recently, collagen cross-linking in sclera shows a promising prospect. In present study, we summarized the representative studies describing the clinical and laboratory application of collagen cross-linking published in past decades and provided our opinion on the positive and negative results of cross-linking in the treatment of ophthalmic disorders. Xiao Zhang, Xiang-chen Tao, Jian Zhang, Zhi-wei Li, Yan-yun Xu, Yu-meng Wang, Chun-xiao Zhang, and Guo-ying Mu Copyright © 2015 Xiao Zhang et al. All rights reserved. Comparison of United States and Canadian Glaucoma Medication Costs and Price Change from 2006 to 2013 Wed, 01 Apr 2015 11:31:11 +0000 Objective. Compare glaucoma medication costs between the United States (USA) and Canada. Methods. We modelled glaucoma brand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously reported bottle overfill rates, drops per mL, and wastage adjustment. We also calculated real wholesale price changes from 2006 to 2013 based on the Average Wholesale Price (USA) and the Ontario Drug Benefit Price (Canada). Results. US brand name medication costs were on average 4x more than Canadian medication costs (range: 1.9x–6.9x), averaging a cost difference of $859 annually. US generic costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from 2006 to 2013 more than Canadian prices (US range: 29%–349%; Canadian range: 9%–16%). US generic wholesale prices increased modestly (US range: −23%–58%), and Canadian wholesale prices decreased (Canadian range: −38%–0%). Conclusions. US brand name glaucoma medications are more expensive than Canadian medications, though generic costs are similar (with some variation). The real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest, with real prices actually decreasing in Canada. Matthew B. Schlenker, Graham E. Trope, and Yvonne M. Buys Copyright © 2015 Matthew B. Schlenker et al. All rights reserved. Glaucomatous Visual Field Defect Severity and the Prevalence of Motor Vehicle Collisions in Japanese: A Hospital/Clinic-Based Cross-Sectional Study Wed, 01 Apr 2015 07:27:23 +0000 Purpose. This study examined the association between the severity of visual field defects and the prevalence of motor vehicle collisions (MVCs) in subjects with primary open-angle glaucoma (POAG). Methods. This is a cross-sectional study. Japanese patients who have had driver’s licence between 40 and 85 years of age were screened for eligibility. Participants answered a questionnaire about MVCs experienced during the previous 5 years. Subjects with POAG were classified as having mild, moderate, or severe visual field defect. We evaluated associations between the severity of POAG and the prevalence of MVCs by logistic regression models. Results. The prevalence of MVCs was significantly associated with the severity of POAG categorized by worse eye MD (control: 30/187 = 16.0%; mild POAG: 17/92 = 18.5%; moderate POAG: 14/60 = 23.3%; severe POAG: 14/47 = 29.8%; , Cochran-Armitage trend test). Compared to the control group, the adjusted OR for MVC prevalence in subjects with mild, moderate, or severe POAG in the worse eye was 1.07 (95% CI: 0.55 to 2.10), 1.44 (95% CI: 0.68 to 3.08), and 2.28 (95% CI: 1.07 to 4.88). Conclusions. There is a significant association between the severity of glaucoma in the worse eye MD and the prevalence of MVCs. Takeshi Ono, Kenya Yuki, Ryo Asaoka, Keisuke Kouyama, Takayuki Abe, Sachiko Tanabe, Kazumi Fukagawa, Miki Uchino, Masaru Shimoyama, Yoko Ozawa, Naoki Ozeki, Daisuke Shiba, and Kazuo Tsubota Copyright © 2015 Takeshi Ono et al. All rights reserved. Short Term Outcome of Anterior Lamellar Reposition in Treating Trachomatous Trichiasis Tue, 31 Mar 2015 09:58:14 +0000 Purpose. To evaluate the outcome of anterior lamellar reposition (ALR) in treating trachomatous trichiasis. Methods. Patients with trachomatous trichiasis or entropion with short tarsus were treated by ALR between February 2009 and November 2013. This included splitting of the lid margin behind the aberrant lash line to separate the lid lamellae. The anterior lamella was recessed and fixated using 4/0 silk sutures. The extra lashes and their routes were excised. Sutures were removed by the 3rd week and patients completed 6 months of follow-up. Recurrence of ≤5 lashes was treated by electrolysis. Results. The study included 752 eyelids (445 patients; 58.4% females, 41.6% males), mean age 53.2 ± 6.9 y. 179 (25.1%) lids had entropion while 287 (64.5%) patients had corneal affection. By the third week, 2.66% lid had trichiasis while 30.8% had no rubbing lashes. By the 6th month, 14.9% of lids showed recurrence while 66.1% were completely cured (CI = 0.63–0.69) and 19% had partial success (CI = 0.16–0.21). Abnormal lid appearance persisted in 2.66% and 12.9% required another surgery. Conclusion. ALR is a good option for treating trachomatous trichiasis especially without cicatricial entropion. Excision of dysplastic lashes is thought to augment the surgical outcome. Rania A. Ahmed and Sameh H. Abdelbaky Copyright © 2015 Rania A. Ahmed and Sameh H. Abdelbaky. All rights reserved. Dry Eye and Corneal Langerhans Cells in Systemic Lupus Erythematosus Sun, 29 Mar 2015 11:38:46 +0000 Purpose. Investigation of dry eye and corneal Langerhans cells (LCs) in systemic lupus erythematosus (SLE). Methods. Prospective consecutive case series of 27 SLE patients and 27 control subjects. Dry eye was evaluated by lid-parallel conjunctival folds (LIPCOF), Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) questionnaire. In vivo investigation of corneal LCs density and morphology (LCM) was performed with confocal corneal microscopy (Heidelberg Retina Tomograph with Rostock Cornea Module). Results. Tear production and stability were pathological in SLE subjects compared to control (Schirmer: 8.45 ± 9.82 mm/5 min versus 11.67 ± 3.21 mm/5 min; TBUT: 6.86 ± 3.53 s versus 11.09 ± 3.37 s). OSDI was significantly greater in SLE patients (25.95 ± 17.92) than in controls (11.06 ± 7.18). Central LC density was greater in SLE patients (43.08 ± 48.67 cell/mm2) than in controls (20.57 ± 21.04 cell/mm2). There was no difference in the peripheral LC density (124.78 ± 165.39 versus 78.00 ± 39.51 cell/mm2). LCM was higher in SLE patients in the centre (1.43 ± 0.79) and in the periphery (2.89 ± 0.42) compared to controls (centre: 1.00 ± 0.69, periphery: 2.35 ± 0.54). Conclusions. Significant changes in dry eye parameters and marked increase of central LCs could be demonstrated in SLE patients. SLE alters not only the LC density but also the morphology, modifies corneal homeostasis, and might contribute to the development of dry eye. Miklós D. Resch, László Marsovszky, János Németh, Márta Bocskai, László Kovács, and Attila Balog Copyright © 2015 Miklós D. Resch et al. All rights reserved. Joint Effect of CFH and ARMS2/HTRA1 Polymorphisms on Neovascular Age-Related Macular Degeneration in Chinese Population Wed, 25 Mar 2015 09:22:07 +0000 Purpose. The etiology of neovascular age-related macular degeneration (nAMD) cannot be completely explained by identified environmental risk factors or single-locus gene variants. This study was to explore the potential interactions among gene variants on nAMD in Chinese population. Methods. 43 SNPs located in different genes were genotyped in 932 Chinese individuals (464 nAMD patients and 468 controls). We explored the potential interactions among gene variants using generalized multifactor dimensionality reduction (GMDR) algorithm and the method to measure the departure from the additivity model. Results. The joint effect that involved CFH rs1061170 and HTRA1 rs3793917 was shown statistically significant (P < 0.001) with the highest cross-validation consistency (10/10) and the best testing balanced accuracy (64.50%). In addition, based on the method to measure the departure from the additivity model, the synergy index (S) was 2.63 (1.09–6.38) and the attributable proportion due to interaction (AP) was 55.7% (21.4%–89.9%), which suggested that a common pathway may exist for these genes for nAMD. Those who carried CC for rs3793917 and TC/CC for rs1061170 were at the highest risk of nAMD (OR: 9.76, 95% CI: 4.65–20.51). Conclusions. Evidence that the joint effect that involved CFH and ARMS2/HTRA1 may contribute to the risk of neovascular AMD in Chinese population was obtained. Kai Fang, Pei Gao, Jun Tian, Xueying Qin, Wenzhen Yu, Juan Li, Qing Chen, Lvzhen Huang, Dafang Chen, Yonghua Hu, and Xiaoxin Li Copyright © 2015 Kai Fang et al. All rights reserved. Comparative Analysis of Anterior Segment Parameters in Normal and Keratoconus Eyes Generated by Scheimpflug Tomography Tue, 24 Mar 2015 12:33:45 +0000 Purpose. To assess and compare the anterior and posterior corneal surface parameters, keratoconus indices, thickness profile data, and data from enhanced elevation maps of keratoconic and normal corneas with the Pentacam Scheimpflug corneal tomography and to determine the sensitivity and specificity of these parameters in discriminating keratoconus from normal eyes. Methods. The study included 656 keratoconus eyes and 515 healthy eyes with a mean age of and years, respectively. Forty parameters obtained from the Pentacam tomography were assessed by the receiver operating characteristic curve analysis for their efficiency. Results. Receiver operating characteristic curve analyses showed excellent predictive accuracy (area under the curve, ranging from 0.914 to 0.972) for 21 of the 40 parameters evaluated. Among all parameters indices of vertical asymmetry, keratoconus index, front elevation at thinnest location, back elevation at thinnest location, Ambrósio Relational Thickness (ARTmax), deviation of average pachymetric progression, deviation of ARTmax, and total deviation showed excellent (>90%) sensitivity and specificity in addition to excellent area under the receiver operating characteristic curve (AUROC). Conclusions. Parameters derived from the topometric and Belin-Ambrósio enhanced ectasia display maps very effectively discriminate keratoconus from normal corneas with excellent sensitivity and specificity. Faik Orucoglu and Ebru Toker Copyright © 2015 Faik Orucoglu and Ebru Toker. All rights reserved. Current Concepts and Future Developments of Corneal Cross-Linking Tue, 24 Mar 2015 11:59:23 +0000 Suphi Taneri, Elias Jarade, John A. Kanellopoulos, and David Muller Copyright © 2015 Suphi Taneri et al. All rights reserved. The Aging Eye Tue, 24 Mar 2015 09:06:15 +0000 Suddhasil Mookherjee, Ashima Bhattacharjee, and Mainak Sengupta Copyright © 2015 Suddhasil Mookherjee et al. All rights reserved. Comparison of Physiologic versus Pharmacologic Mydriasis on Anterior Chamber Angle Measurements Using Spectral Domain Optical Coherence Tomography Mon, 23 Mar 2015 11:26:06 +0000 Purpose. To compare the effects of physiologic versus pharmacologic pupil dilation on anterior chamber angle (ACA) measurements obtained with spectral domain optical coherence tomography (SD-OCT). Methods. Forty eyes from 20 healthy, phakic individuals with open angles underwent anterior segment OCT imaging under 3 pupillary states: (1) pupil constricted under standard room lighting, (2) physiologic mydriasis in a darkened room, and (3) postpharmacologic mydriasis. Inferior angle Schwalbe’s line-angle opening distance (SL-AOD) and SL-trabecular-iris-space area (SL-TISA) were computed for each eye and pupillary condition by masked, certified Reading Center graders using customized grading software. Results. SL-AOD and SL-TISA under pupillary constriction to room light were  mm and  mm2, respectively; decreased to  mm and  mm2  , respectively, under physiologic mydriasis; and increased to  mm and  mm2   under pharmacologic mydriasis compared to baseline. Conclusions. Using SD-OCT imaging, pharmacologic mydriasis yielded the widest angle opening, whereas physiologic mydriasis yielded the most angle narrowing in normal individuals with open iridocorneal angles. Accounting for the state of the pupil and standardizing the lighting condition would appear to be of importance for future studies of the angle. Anna I. Dastiridou, Xiaojing Pan, ZhouYuan Zhang, Kenneth M. Marion, Brian A. Francis, Srinivas R. Sadda, and Vikas Chopra Copyright © 2015 Anna I. Dastiridou et al. All rights reserved. The Impact of Unilateral or Bilateral Cataract Surgery on Visual Acuity and Life Quality of Elderly Patients Sun, 22 Mar 2015 11:00:51 +0000 In the current study, the CLVQOL was used to assess VRQOL before unilateral or bilateral cataract surgery and at the end of the follow-up period in order to determine the greater beneficial mode of surgery for patients, if one of the two surgical methods is more beneficial over the other. The patients were classified as receiving unilateral (group A) and bilateral cataract surgery (group B). There were no significant differences between groups A and B before the operation in terms of life quality scores, binocular weighted average LogMAR BCVA, age, educational level, gender, systematic and ocular comorbidities, and the complications of the operation. It was shown that visual acuity improved more significantly with bilateral cataract surgery than with unilateral surgery in elderly patients with a high preoperative disease burden in Shanghai city. However, the improvement in life quality was not different in patients receiving either bilateral or unilateral cataract surgery. Lei Zuo, Haidong Zou, Xinfeng Fei, Weiqi Xu, and Jianhong Zhang Copyright © 2015 Lei Zuo et al. All rights reserved. Association between Ophthalmic Timolol and Hospitalisation for Bradycardia Sun, 22 Mar 2015 08:53:05 +0000 Introduction. Ophthalmic timolol, a topical nonselective beta-blocker, has the potential to be absorbed systemically which may cause adverse cardiovascular effects. This study was conducted to determine whether initiation of ophthalmic timolol was associated with an increased risk of hospitalisation for bradycardia. Materials and Methods. A self-controlled case-series study was undertaken in patients who were hospitalised for bradycardia and were exposed to timolol. Person-time after timolol initiation was partitioned into risk periods: 1–30 days, 31–180 days, and >180 days. A 30-day risk period prior to initiating timolol was also included. All remaining time was considered unexposed. Results. There were 6,373 patients with at least one hospitalisation for bradycardia during the study period; 267 were exposed to timolol. Risk of bradycardia was significantly increased in the 31–180 days after timolol initiation (incidence rate ratio (IRR) = 1.93; 95% confidence interval (CI) 1.00–1.87). No increased risk was observed in the first 30 days or beyond 180 days of continuous exposure (IRR = 1.40; 95% CI 0.87–2.26 and IRR = 1.21; 95% CI 0.64–2.31, resp.). Conclusion. Bradycardia is a potential adverse event following timolol initiation. Practitioners should consider patient history before choosing a glaucoma regime and closely monitor patients after treatment initiation with topical nonselective beta-blocker eye drops. Nicole L. Pratt, Emmae N. Ramsay, Lisa M. Kalisch Ellett, Tuan A. Nguyen, and Elizabeth E. Roughead Copyright © 2015 Nicole L. Pratt et al. All rights reserved. Safety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up Thu, 19 Mar 2015 09:20:48 +0000 Purpose. To evaluate the long-term safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. Methods. This was a retrospective study of 30 eyes (19 patients), with progressive keratoconus, who underwent sequential CXL followed by Visian toric ICL implantation after 6 months. Results. At baseline, 6 eyes had stage I, 14 eyes stage II, and 10 eyes stage III keratoconus graded by Amsler-Krumeich classification. At 6 months after CXL, only K (steep) and K (max) decreased significantly from baseline, with no change in visual acuity or refraction. Flattening in keratometric readings was stable thereafter. There was significant improvement in mean uncorrected distance visual acuity (1.57 ± 0.56 to 0.17 ± 0.06 logMAR, ) and mean corrected distance visual acuity (0.17 ± 0.08 to 0.11 ± 0.05 logMAR, ) at 12 months after ICL implantation that was maintained at the 2-year follow-up. Mean cylinder power and mean spherical equivalent (SE) also decreased significantly after ICL implantation. A small hyperopic shift in SE (+0.25 D) was observed at 2 years that did not alter visual outcomes. Conclusions. Visian toric ICL implantation following CXL is an effective option for improving visual acuity in patients with keratoconus up to 2 years. Rafic Antonios, Ali Dirani, Ali Fadlallah, Elias Chelala, Adib Hamade, Carole Cherfane, and Elias Jarade Copyright © 2015 Rafic Antonios et al. All rights reserved. Rate of Corneal Collagen Crosslinking Redo in Private Practice: Risk Factors and Safety Thu, 19 Mar 2015 09:03:59 +0000 Objective. To report the rate of progression of keratectasia after primary crosslinking (CXL) and evaluate the safety and efficiency of CXL redo. Materials and Methods. We conducted a retrospective analysis of the patients who underwent CXL between 2010 and 2013 at the Beirut Eye Specialist Hospital, Lebanon. Progression of keratectasia was based on the presence of an increase in maximum keratometry of 1.00 D, a change in the map difference between two consecutive topographies of 1.00 D, a deterioration of visual acuity, or any change in the refraction. Primary and redo CXL were done using the same protocol. Results. Among the 221 eyes of 130 patients who underwent CXL, 7 eyes (3.17%) of five patients met the criteria of progression. All patients reported a history of allergic conjunctivitis and eye rubbing and progressed within 9 to 48 months. No complications were noted and all patients were stable 1 year after CXL redo. Conclusion. Allergic conjunctivitis and eye rubbing were the only risk factors associated with keratoconus progression after CXL. A close followup is thus mandatory, even years after the procedure. CXL redo seems to be a safe and efficient technique to halt the progression after a primary CXL. Joelle Antoun, Elise Slim, Rami el Hachem, Elias Chelala, Elyse Jabbour, Georges Cherfan, and Elias F. Jarade Copyright © 2015 Joelle Antoun et al. All rights reserved. The Relationship between Estimated Glomerular Filtration Rate and Diabetic Retinopathy Wed, 18 Mar 2015 07:09:15 +0000 Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness in working-aged people. Several studies have suggested that glomerular filtration rate (GFR) was correlated with DR. This is a hospital-based study and the aim of it was to examine the relationship between the GFR and DR in patients with type 2 diabetes mellitus (T2DM). We used CKD-EPI equation to estimate GFR and SPSS 19.0 and EmpowerStats software to assess their relationship. Among the 1613 participants (aged 54.75 ± 12.19 years), 550 (34.1%) patients suffered from DR. The multivariate analysis revealed that the risk factors for DR include age (, OR = 0.940), duration of diabetes (, OR = 1.163), hemoglobin A1c (, OR = 1.224), systolic blood pressure (, OR = 1.032), diastolic blood pressure (, OR = 0.953), high density lipoprotein cholesterol (, OR = 3.884), and eGFR (, OR = 0.973). Through stratified analysis and saturation effect analysis, our data suggests that eGFR of 99.4 mL/min or lower might imply the early stage of DR in diabetic patients. Thus, the evaluation of eGFR has clinical significance for the early diagnosis of DR. Jingyang Wu, Jin Geng, Limin Liu, Weiping Teng, Lei Liu, and Lei Chen Copyright © 2015 Jingyang Wu et al. All rights reserved. Surgical Outcome of Medial Rectus Resection in Recurrent Exotropia: A Novel Surgical Formula Tue, 17 Mar 2015 09:37:18 +0000 Purpose. To evaluate the surgical outcomes of unilateral or bilateral medial rectus (MR) muscle resection for recurrent exotropia after bilateral lateral rectus (BLR) muscle recession based on a novel surgical formula. Methods. Forty-one consecutive patients with unilateral or bilateral MR muscle resection for recurrent exotropia after BLR muscle recession were included in this retrospective study. All surgeries were performed according to the formula: 1.0 mm MR muscle resection for every 5 prism dioptres (PD) of exotropia, with an addition of 0.5 mm to each MR muscle operated on. Results. The mean recurrent exotropia distant deviation was 28 PD ± 11.2 (range 14 to 55 PD). Overall at postoperative 1 month, 36 (88%) achieved successful outcomes, 4 (10%) had undercorrection, and 1 (2%) had overcorrection. At postoperative 6 months, 29 (71%) achieved successful outcomes, 12 (29%) had undercorrection, and none had overcorrection. Subgroup analysis showed no statistically significant difference in success rates between unilateral and bilateral MR groups. Conclusion. Unilateral or bilateral MR muscle resection using our surgical formula is a safe and effective method for calculating the amount of MR resection in moderate to large angle recurrent exotropia, with a low overcorrection rate. Abbie Sheung-Wan Luk, Jason Cheuk-Sing Yam, Henry Hing-Wai Lau, Wilson Wai-Kuen Yip, and Alvin Lerrmann Young Copyright © 2015 Abbie Sheung-Wan Luk et al. All rights reserved. Intraocular Lens Opacification following Intracameral Injection of Recombinant Tissue Plasminogen Activator to Treat Inflammatory Membranes after Cataract Surgery Mon, 16 Mar 2015 08:58:41 +0000 Purpose. To report 7 cases of intraocular lens (IOL) opacification following treatment of postoperative anterior chamber fibrin with recombinant tissue plasminogen activator (rtPA) after cataract surgery. Methods. Retrospective case series of 7 eyes in 7 patients who developed IOL opacification after receiving rtPA for anterior chamber inflammatory membrane formation resulting from phacoemulsification cataract surgery. Three explanted IOLs were investigated with light microscopy, histochemical analysis, scanning electron microscopy, and X-ray spectrometry. Results. All patients underwent uncomplicated cataract surgery and posterior chamber hydrophilic IOL implantation. Anterior chamber inflammatory membranes developed between 1 and 4 weeks of surgery and were treated with intracameral rtPA. IOL opacification was noted between 4 weeks and 6 years after rtPA treatment with reduced visual acuity, and IOL exchange was carried out in 3 patients. Light microscopy evaluation revealed diffuse fine granular deposits on the anterior surface/subsurface of IOL optic that stained positive for calcium salts. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS) confirmed the presence of calcium and phosphate on the IOL. Conclusions. Intracameral rtPA, though rapidly effective in the treatment of anterior chamber inflammatory membranes following cataract surgery, may be associated with IOL opacification. Simon S. M. Fung, Evripidis Sykakis, Niaz M. Islam, Hadi J. Zambarakji, Ramin Khoramnia, Gerd U. Auffarth, and Dipak N. Parmar Copyright © 2015 Simon S. M. Fung et al. All rights reserved. Decreased Perifoveal Sensitivity Detected by Microperimetry in Patients Using Hydroxychloroquine and without Visual Field and Fundoscopic Anomalies Thu, 12 Mar 2015 13:57:28 +0000 Purpose. To evaluate the usefulness of microperimetry in the early detection of the ocular anomalies associated with the use of hydroxychloroquine. Methods. Prospective comparative case series study comprising 14 healthy eyes of 7 patients (group A) and 14 eyes of 7 patients under treatment with hydroxychloroquine for the treatment of rheumatologic diseases and without fundoscopic or perimetric anomalies (group B). A comprehensive ophthalmological examination including microperimetry (MP) and spectral-domain optical coherence tomography was performed in both groups. Results. No significant differences were found in mean MP foveal sensitivity between groups . However, mean MP overall sensitivity was significantly higher in group A ( dB versus group B,  dB; ). Significantly higher sensitivity values were obtained in group A in comparison to group B for the three eccentric loci evaluated . Conclusion. Microperimetry seems to be a useful tool for the early detection of retinal damage in patients treated with hydroxychloroquine. A. Molina-Martín, D. P. Piñero, and R. J. Pérez-Cambrodí Copyright © 2015 A. Molina-Martín et al. All rights reserved. Attenuating Photostress and Glare Disability in Pseudophakic Patients through the Addition of a Short-Wave Absorbing Filter Mon, 09 Mar 2015 12:46:47 +0000 To evaluate the effects of filtering short wavelength light on visual performance under intense light conditions among pseudophakic patients previously implanted with a clear intraocular lens (IOL). This was a patient-masked, randomized crossover study conducted at 6 clinical sites in the United States between September 2013 and January 2014. One hundred fifty-four bilaterally pseudophakic patients were recruited. Photostress recovery time and glare disability thresholds were measured with clip-on blue-light-filtering and placebo (clear; no blue-light filtration) glasses worn over patients’ habitual correction. Photostress recovery time was quantified as the time necessary to regain sight of a grating target after intense light exposure. Glare disability threshold was assessed as the intensity of a white-light annulus necessary to obscure a central target. The order of filter used and test eye were randomized across patients. Photostress recovery time and glare disability thresholds were significantly improved (both ) when patients used blue-light-filtering glasses compared with clear, nonfiltering glasses. Compared with a nonfiltering placebo, adding a clip-on blue-absorbing filter to the glasses of pseudophakic patients implanted with clear IOLs significantly increased their ability to cope with glare and to recover normal viewing after an intensive photostress. This result implies that IOL designs with blue-light-filtering characteristics may be beneficial under intense light conditions. Billy R. Hammond Copyright © 2015 Billy R. Hammond. All rights reserved. Advances in Retinal Therapeutics Mon, 09 Mar 2015 06:53:52 +0000 Petros E. Carvounis, Thomas A. Albini, Andrew J. Barkmeier, and Miltiadis Tsilimbaris Copyright © 2015 Petros E. Carvounis et al. All rights reserved. The Role of Eye Movement Driven Attention in Functional Strabismic Amblyopia Mon, 09 Mar 2015 06:40:40 +0000 Strabismic amblyopia “blunt vision” is a developmental anomaly that affects binocular vision and results in lowered visual acuity. Strabismus is a term for a misalignment of the visual axes and is usually characterized by impaired ability of the strabismic eye to take up fixation. Such impaired fixation is usually a function of the temporally and spatially impaired binocular eye movements that normally underlie binocular shifts in visual attention. In this review, we discuss how abnormal eye movement function in children with misaligned eyes influences the development of normal binocular visual attention and results in deficits in visual function such as depth perception. We also discuss how eye movement function deficits in adult amblyopia patients can also lead to other abnormalities in visual perception. Finally, we examine how the nonamblyopic eye of an amblyope is also affected in strabismic amblyopia. Hao Wang, Sheila Gillard Crewther, and Zheng Qin Yin Copyright © 2015 Hao Wang et al. All rights reserved. Prognostic Factors of Early Morphological Response to Treatment with Ranibizumab in Patients with Wet Age-Related Macular Degeneration Wed, 04 Mar 2015 09:28:06 +0000 Aim. To assess the significance of age, gender, baseline best corrected visual acuity, baseline macula thickness, and type and size of choroidal neovascularization in early morphological therapeutic response to ranibizumab treatment in patients with the wet form of age-related macular degeneration. Methods. From 09/2008 to 06/2013 we evaluated 1153 newly diagnosed, treatment-naïve patients treated with ranibizumab. Based on the morphological findings in the macula following the initial 3 injections of ranibizumab, the patients were divided into two groups based on active and inactive choroidal neovascularization. Results. After the initial 3 injections of ranibizumab, we examined the sample of 841 eyes with active CNV and 312 eyes with inactive CNV. In the inactive group, we found a statistically higher proportion of occult CNV () and lower incidence of CNV greater than 5DA () compared with the active group. We found no statistically significant difference in age, gender, baseline best corrected visual acuity, or baseline macula thickness between the inactive and active groups. Conclusion. Occult CNV and CNV smaller than 5DA are optimistic factors for a better morphological therapeutic response at the beginning of ranibizumab treatment. Oldřich Chrapek, Jiří Jarkovský, Martin Šín, Jan Studnička, Petr Kolář, Barbora Jirková, Ladislav Dušek, Šárka Pitrová, and Jiří Řehák Copyright © 2015 Oldřich Chrapek et al. All rights reserved.