Aim: To report the outcomes of internal revision with bleb needling in cases of failing blebs with the internal sclerostomy blocked by iris tissue. Methods: Prospective study of 26 eyes of 26 patients with failing blebs where target IOP was not achieved with 2 anti-glaucoma drugs and sclerostomy was blocked by iris (confirmed on gonioscopy). Patients were divided into 3 groups depending on the time from the first surgery- early (<3 months), intermediate (4-12 months) and late (>1 year). Patients underwent internal revision with bleb needling with either 5-Fluorouracil (5-FU) or Mitomycin C (MMC) Results: 26 eyes of 26 patients were included in the study. Mean age was 51.35±14.5 years. Time from the filtration surgery was early in 3, intermediate in 5 and late in 18 eyes. Mean IOP reduction at 3 months was 32±18% with maximum reduction in early group (40%). Mean IOP decreased from 24.5±3.4 mmHg to 16.2±4.3 mmHg in 5-FU group (12 patients) and 27.4±9 mmHg to 18.2±6.6 mmHg in MMC group (14 patients). Self-limiting complications were hyphema in 2 patients and subconjunctival haemorrhage in 1 patient. Conclusion: Internal revision with bleb needling is a safe and effective procedure for reviving failing blebs.
Diabetes has been recognized by the World Health Organization (WHO) as a noncommunicable, chronic disease and a 21st century epidemic. Diabetic retinopathy (DR) is one of the three leading causes of blindness among the working-age population aged 20 to 74 years. Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and the impact of DME on quality of life is very significant. Currently, first-line treatment recommendations for center-involved DME (CI-DME) include intravitreal anti-VEGF injections on a monthly or bimonthly regimen. It is essential to understand the burden that treatment regimens have on patients, as well as on healthcare systems. The most significant improvement to the regimen would be to have fewer injections and monitoring visits while maintaining satisfactory vision outcomes. A lower number of intravitreal injections could optimize disease outcomes by improving patient compliance. This article discusses novel agents targeting alternative pathways and mechanisms involved in the pathogenesis of DME, as well as high-dose drugs and novel approaches to treatment regimens aimed at extending treatment intervals, decreasing treatment burden, and increasing treatment efficacy. This knowledge will enhance the selection of treatments, thereby improving patient compliance with therapy and optimizing healthcare system resources.
Purpose: The long-term success of pterygium surgery is subject to treatment of the limbal stem cell defect. The purpose of this study is to present an alternative method to conjunctival autografting in patients with large pterygia and consequently a large limbal stem cell defect. Methods: 38 Patients with primary nasal pterygium of more than 5 mm limbal involvement were selected for the procedure. Simple limbal epithelial transplantation with human amniotic membrane graft placement over the bare sclera after pterygium excision was done. Patients were followed-up for a period of 12 months. Results: From post-operative day 7, patients had significant improvement in complaints and ocular surface morphology. We reported only one case of graft failure which was a consequence of patient’s non-compliance with post-operative medications and follow-up. Conclusion: Focal-simple limbal epithelial transplantation is an effective alternative to conjunctival limbal autografting in patients with large pterygia where preservation of virgin conjunctiva is prudent for future ocular surgeries.
Objectives: To investigate pressure related ocular parameters (intraocular pressure (IOP), estimated trans-lamina cribrosa pressure difference (TLPD) and ocular perfusion pressure (OPP) in Caucasian patients with primary open angle glaucoma (POAG) and control subjects. Methods: This is an observational cross-section study that included 57 subjects (27 patients with open-angle glaucoma and 30 healthy control subjects). All subjects underwent ophthalmic and systemic measurements in order to evaluate pressure related ocular parameters – IOP (mmHg), OPP (mmHg), and TLPD (mmHg) based on established formulas. The differences in the IOP, OPP and TLPD values between patients with POAG and control subjects were evaluated. Results: Intraocular pressure and TLPD were significantly higher in patients with glaucoma (mean IOP= 18.93 ± 4.53 mmHg; TLPD= 9.47 ± 5.02 mmHg), than in control subjects (IOP= 16.47 ± 2.60 mmHg; TLPD= 6.82 ± 3.60 mmHg) (p=0.017 and p=0.025 respectively). In univariate logistic progression, IOP and TLPD were significant predictors for POAG. Conclusion: Our results suggest that in addition to IOP, TLPD is also significantly higher in Caucasian patients with POAG than in control subjects and both parameters are significant predictors of POAG. This suggests that TLPD may have a role in the pathogenesis of POAG.
A 54-year-old woman with a history of type 2 diabetes presented with concern for sudden eye pain, photophobia, and redness of the eye. History, physical examination and comprehensive lab tests, yielded a diagnosis of corneal keratopathy. She responded poorly to the initial management of moxifloxacin 5% and homatropine 2%. A multi-faceted approach involving strict glycemic control and antibiotic therapy was then adopted. Through dietary management and pharmacotherapy, the patient’s clinical disposition improved, highlighting the importance of glycemic control when managing diabetic keratopathy.
Hereditary retinal dystrophies (HRDs) represent a wide group of chronic and hereditary disorders affecting the retina, which constitute an important source of disability. Among inherited retinal dystrophies, retinitis pigmentosa (RP) represents the most genetically and clinically heterogeneous group. X-linked forms (OMIM 26800), the most severe subtypes of this disease, account for about 15% of RP cases. RPGR, one of the most X-linked RP involved genes, involved in ciliogenesis, microtubule organization and regulation of transport in primary cilia, presents a splicing variant, called exon ORF15, which represents a mutational hot spot in a huge number of patients. The most challenge peculiarity of exon ORF15 is its repetitive nature, especially of guanine (G)-rich sequences, that makes it very difficult to screen. Thus, we investigate the possible molecular causes that determine such difficulties by an in-silico approach, evaluating the possibility that, due to its nature, exon ORF15 could show a G-quadruplex structure. All the three algorithms exploited confirmed the possibility that several G-quadruplex could be folded in RPGR exon ORF15, providing new insights towards a better sequencing approach to RPGR diagnostic screening.
Introduction: Ocular manifestations are frequent during primary Sjögren's syndrome (PSS) and largely dominated by the signs of xerophthalmia. The extra-glandular ocular involvement is, on the contrary, exceptional and unusual. We are reporting an original case of bilateral posterior uveitis with retinitis inaugural of PSS. Case report: A 48-year-old Tunisian woman, with no notable pathological history, was explored for progressive decline in visual acuity, bilateral visual blur, and moderate eye pain. The examination noted a visual acuity at 6/10 on the left and 5/10 on the right, without redness of the eyes or irritative signs. The anterior segment of both eyes was normal. Ophthalmologic exam (slit lamp, fundus, and retinal angiography) revealed bilateral, non-granulomatous posterior uveitis associated with retinitis and retinal vasculitis. Further investigations concluded to PSS and treatment with intravenous pulse methylprednisolone followed by oral prednisone was introduced. The evolution was rapidly favorable and ophthalmological exam with eye fundus was totally normal at two months. Conclusion: PSS remains an exceptional and unusual cause of uveitis. It is therefore appropriate to evoke it in front of any uveitis that does not prove itself, especially if recidivating.
Feminine, 42 years old. Car accident, 1 week after intensive therapy, presented dyplopie with severe orbital fracture. Besides right nasal bones fracture with internal canthal ligament section, enophtalmos and low ocular muscles herniaetion and haemathome into right maxilar sinus, Any calvary bone fracture.
Malignant arterial hypertension is a serious cardiovascular disorder with fatal consequences if untreated. Ocular morbidity includes severe visual impairment and even blindness. A case of malignant hypertension is reported, which had features of purtcher’s retinopathy. The Keith Wagner Barker classification is used to describe the severity of hypertensive retinopathy changes in the retina. This classification may be inadequate in the context of malignant hypertension where the systemic hypertension is due to a secondary cause.
Congenital oculomotor apraxia, also known as Cogan´s syndrome [Cogan-type congenital ocular motor apraxia (COMA, OMIM 257550)], is a rare hereditary disease that affects the eye insofar as it cannot make horizontal movements voluntary. Of unknown etiology, it was described by Cogan in 1952 and, classically considered as a sporadic disease with autosomal dominant inheritance in some cases, and as an indicator of partial metabolic alterations or defects of neurological development in others. We present a newborn with 6q21q22.1 microdeletion, result of gestation after in vitro fertilization, which clinically manifests movement disorders including ataxia and characteristic clinical picture of Cogan´s syndrome (oculomotor apraxia); highlighting microcephaly and peculiar phenotype characterized by small eyes, sparse hair, broad nasal root with epicanthus and hypoplasia of nasal wings. Cerebral ultrasound showed Cysts of the Subependymal. Germinal Matrix. The 6q deletions are infrequent, with around 100 cases described, associated with variable phenotypes, including dysmorphic features, growth retardation, upper limb malformations, and Prader-Willi (PW)-like features; and few of them studied with high resolution cytogenetic techniques. Recently, in the study of three patients (one with ataxia and two with movement disorders), the 6q22.1 region has been proposed as critical (including the MARCKS, HDAC2, and HS3ST5 genes), a region that is also affected in our patient, and correlated with the ataxia phenotype, as the most outstanding data. So, from these results, the genetic heterogeneity of Cogan syndrome is inferred. In this article we also review the bibliography related to oculomotor apraxia associated with other movement disorders such as ataxia.
Background: Treatments administered after a corneal burn injury can have long term implications on wound healing. Initial treatments can include the administration of lubricants, anti inflammatories, and antibiotic eye drops, many of which contain phosphate buffered saline (PBS) as a vehicle. As a result, the purpose of this study was to observe the effects of the commonly used PBS ophthalmic drop vehicle on corneal alkali burns over 30 days when treated 4X daily for the first 14 days. Materials and Methods: Corneal alkali burns 5.5 mm in diameter were created on 10 anesthetized, male New Zealand White rabbits Animals (5) with corneal wounds were treated with PBS 4X daily or left untreated (5). Control animals (5) were not wounded, but were treated with PBS drops 4X daily. Corneal alkali burns were created by centrally placing NaOH (1N) soaked filter paper onto the cornea for 30 seconds. After removal of the filter paper, the surface of the eye was immediately debrided with a Weck-Cel® sponge and irrigated with 15 ml of sterile buffered salt solution (BSS). At days 0, 3, 7, 14 and 30 post-chemical alkali burn creation, eyes were evaluated by white light imaging and fluorescein staining. On days 14 and 30, corneal thickness was assessed via optical coherence tomography (OCT). Results: A significant decrease in fluorescein staining indicating a significant increase in wound healing was observed on day 7 (P< 0.05) in the PBS treatment group when compared to the non-treated corneal alkali burns. A significant increase in fluorescein staining or decrease in wound healing was observed on day 30 (P< 0.0005) in the PBS treatment group when compared to non-treated corneal alkali burns. White light imaging and OCT results, respectively, showed no significant differences in corneal opacity or corneal swelling between treatment groups at any time point. Conclusions: This study suggests that the treatment of corneal alkali burns with ophthalmic solutions containing PBS may impact wound closure while having no significant effect on corneal opacity or corneal swelling.
Purpose: To evaluate long-term refractive, aberrometric and anatomical results of surface ablation plus corneal PTK-style smoothing for myopia greater than –7.00 D. Methods: One-hundred-and-fourteen eyes of 69 patients (mean age: 37.7 ± 8.3 years) underwent PRK with the NIDEK EC-5000 excimer laser (NIDEK Co. Ltd., Gamagori, Japan) using multiple optical zones ranging in diameter from 4.89 mm to 7.0 mm, and transition zones (TZ) that were at least 3 mm wider than the optical zones (OZ). A cross-cylinder technique was used for treating astigmatism greater than 0.50 D. All eyes underwent a phototherapeutic keratectomy (PTK) smoothing technique using masking fluid. The Student’s t-test was used to determine a statistically significant change after surgery. A p value less than 0.05 was considered statistically significant. Results: Preoperative corrected distance visual acuity (CDVA) was 0.88 ± 0.16 with –9.53 ± 1.18 D cycloplegic spherical equivalent (SE). Preoperative corneal pachymetry was 560.4 ± 30.1 µ. Three years after surgery uncorrected visual acuity (UCVA) was 0.79 ± 0.26, CDVA was 0.92 ± 0.19 with –0.56 ± 0.90 D SE. Mean corneal haze was highest 1 month after surgery (0.58 ± 0.35), then progressively decreased to 0.11 ± 0.32 by 3 months postoperatively. Following year one, refraction and corneal curvature remained stable. There were no cases of keractasia to date. There was no hyperopic induction due to PTK. Two eyes required retreatment due to undercorrection. Total wavefront error did not change significantly, while astigmatism decreased and coma increased (both with p< 0.001). Conclusion: Surface ablation for the treatment of high myopia using PTK smoothing with a masking fluid was safe and effective. Wide optical and transition zones prevented induction of spherical aberration and the incorporation of the smoothing technique created a regular corneal surface with regular healing and trace to no haze after surgery.
Background and Objective: To compare the pain perceived by patients undergoing argon laser panretinal photocoagulation treatment for proliferative diabetic retinopathy under slit lamp delivery after topical anaesthesia and indirect ophthalmoscope laser delivery after peribulbar anaesthesia. Study design/ Patient and Methods: Prospective, multicentre non-randomised, study. Forty-six eyes of 46 patients with proliferative diabetic retinopathy were treated either by slit lamp delivery using topical anaesthesia (Group A) or indirect ophthalmoscope laser panretinal photocoagulation after peribulbar anaesthesia (Group B). Patients in both the categories were divided into two subgroups, one receiving pan retinal photocoagulation for the first time (A1 & B1) and the second group receiving laser treatment for the second or subsequent time (A2 & B2). The primary outcome measure was eye pain perceived during the laser treatment and pain within 48 hours following laser treatment. Patients graded the pain from (0-10) on a visual analogue scale. Secondary outcome measure included the need for oral analgesia within 48 hours following the laser procedure. Results: Overall panretinal photocoagulation treatment under peribulbar anaesthesia is more comfortable than topical anaesthesia (p<0.001), but pain within 48 hours following the laser procedure was similar in the two groups (p=0.118). Panretinal photocoagulation for the first time with peribulbar injection was more comfortable than topical anaesthesia (p=0.001), but both the groups perceived similar pain 48 hours following the laser procedure (p=0.571). Subsequent laser treatment is again more comfortable under peribulbar anaesthesia (p<0.001) and is also more comfortable than topical anaesthesia causing less pain 48 hours following laser treatment (p=0.004). Conclusion: Peribulbar anaesthesia does not abolish pain completely, but definitely made argon laser panretinal photocoagulation treatment more comfortable for patients. Panretinal photocoagulation under topical anaesthesia is painful and this pain may persist for up to 48 hours. Peribulbar anaesthesia is not entirely effective in controlling pain during the first 48 hours following laser treatment in those patients undergoing laser application for the first time. Patients need to be counselled regarding pain following panretinal photocoagulation treatment and the need for oral analgesia.
Purpose: To evaluate the efficacy of new formula of the PTK calculated with the head-limbus-distance (=height) and limbal base length of the pterygium and ablation thickness on the anterior corneal curvature and visual acuity, associated with autologous conjuntival implant in patients with primary (Group A)and secondary(Group B) pterygium. Setting: This study was developed in the Department of Ophthalmology, Maggiore Hospital of Bologna. Design: Prospective non randomized study was conducted in 18 eyes of 18 subjects (9 eyes primary and 9 eyes with recurrent pterygium) operated with a dedicated PTK program. Methods: All patients signed informed consent before the start of the research. BCVA (Best Corrected Visual Acuity), mean refractive error (ME) and topographic astigmatism and recurrence of pterygium was followed. Mean follow up was 18.67 ± 6.13 months Min: 12 Max: 24 months. Results: Mean post-operative BCVA increased at 3-24 months compared with pre-op BCVA (p= 0.003). Mean post-op BCVA improved independent of the optical zone involvement in the pre-op (p= 0.845). Mean Pre-op astigmatism (Group A): was: 0,97 ± 2,7 (MIN: -2,8 Max: +5). Mean pre-op Astigmatism (Group B) :-0,33 ± 1,98 (MIN: -3 Max:+4). Astigmatism reduction in the group A: 0 D; Group B: -0,1D ± 0,74D MIN: -1 Max: +1. No statistically difference at 24 months from two groups in BCVA (p=0,59), Sf ( P=0,7), ME(p=0,7), astigmatism ( p=0,96) ANOVA. Recurrence of pterygium was: 0%. Conclusions: The dedicated programme of PTK was shown to be safe and effective for the treatment of the pterygium. BCVA can be improved by providing a smooth corneal surface in cases of optical zone involvement.
The cationic antimicrobial protein of 37 kDa (CAP37) mediates proliferation, migration, and adhesion of human corneal epithelial cells and promotes corneal re-epithelialization in mouse. The purpose of this study was to investigate the cytokine profile following abrasion of the corneal epithelium, and to identify the cytokines modulated by topical treatment with CAP37 to determine the mechanism by which CAP37 contributes to the recruitment of inflammatory cells and healing of the cornea. The corneal epithelium in mouse eyes was removed and wounds were treated with a saline vehicle or human recombinant CAP37. Wounds were visualized with fluoresce in staining at 0, 16, 24 and 48 h. Mouse corneas were excised at 0, 6, 16, 24 and 48 h post corneal abrasion. The excised corneas were analyzed by immunohistochemistry for re-epithelialization and infiltration of inflammatory cells while the expression profiles of thirty-two cytokines were investigated by multiplex analysis. Results corroborating previous studies showed accelerated wound closure in corneas treated with CAP37 compared to those treated with the saline vehicle. Immunohistochemistry revealed less neutrophil infiltration in CAP37-treated corneas when compared to controls at 24 h. By 48 h post-wounding, histological analysis revealed more staining for neutrophils than the staining observed in the controls. Modulation of cytokine expression occurred for the majority of the cytokines tested at the time of corneal abrasion, during re-epithelialization, and/or by CAP37 treatment. Cytokines monocyte chemoattractant protein-1 (MCP-1) and regulated on activation, normal T cell expressed and secreted (RANTES) were induced during re-epithelialization, at the early 16 h time point. Interleukin 6 (IL-6), leukemia inhibitory factor (LIF), granulocyte colony-stimulating factor (G-CSF), IL-12p70, macrophage inflammatory protein 1 beta (MIP-1β), and interferon gamma-induced protein 10 (IP-10) were induced at 24 h and unchanged during CAP37 treatment. By contrast, IL-15, monokine induced by gamma interferon (MIG), keratinocyte-derived cytokine (KC), tumor necrosis factor alpha (TNF-α), MIP-1α, IL-1β, and macrophage colony-stimulating factor (M-CSF) were modulated by CAP37 treatment. In general, CAP37 appeared to decrease pro-inflammatory cytokines at 24 h and increase them at 48 h when compared to the control group. These data demonstrate that CAP37 modulates the production of cytokines in the cornea and suggest that limiting the number of neutrophils recruited during the early inflammatory phase may support corneal re-epithelialization.
Introduction: At present anti-inflammatory therapy of patients with dry eye disease is based mainly on glucocorticoids' instillations. In spite of the fact that dexamethasone in officinal dosage (0.1%) has a marked local anti-inflammatory effect, its wide use is limited by the presence of a destructive process in the cornea. Taking this into account, the authors developed a drug containing 0.01% dexamethasone phosphate in combinations with 6% polyvinylpyrolidone and 1.5-5.5% dextrose solution. Objective: To study the impact of the developed medication on the inflammatory process dynamics in the tissues of the eye surface in patients with dry eye disease of various etiology. Materials and Methods: The material of this study was based on the results of the examination and treatment of 25 volunteers (50 eyes) with corneal-conjunctival xerosis developed on the background of 7 cases of meibomian blepharitis (14 eyes), 8 cases of perimenopause (16 eyes), and 10 cases of Sjögren's syndrome (20 eyes). All patients used the developed medication in the form of eye drops 3-4 times daily on the background of tear replacement therapy. Prior to the therapy and on day 28 of the study the following parameters were assessed, lower tear meniscus index, precorneal tear film production, stability and osmolarity, staining of eye surface epithelium with sodium fluoresce in solution, as well as bengal rose and lissamine green. The quantity of cytokines was determined in the tear fluid and blood plasma with ELISA method: interleukins-1β, 2, 4, 6, 8, 10, 17A, interleukin 1 receptor antagonist, TNF α, interferons α and γ. Besides, all the subjects were asked to fill in a questionnaire to evaluate subjective signs of the ocular surface epithelium xerosis or Ocular Surface Disease Index (OSDI). Results: By day 28 of the study statistically valid increase of the tear meniscus index, precorneal tear film stability, main and total tear production and decrease of tear film osmolarity were observed. Besides, the staining degree of the ocular surface epithelium with bengal rose and lissamine green (van Bijsterv?ld scale) and with sodium fluoresce in (Oxford scale) decreased. Also, the positive dynamics of the objective parameters of the ocular surface epithelium is confirmed by the subjects' patients evaluation of their quality of life. Conclusion: The results of the study performed prove the high clinical efficiency of the developed medication that has a marked local anti-inflammatory effect in the therapy of dry eye disease of various etiology.
Objective: To evaluate the efficacy of a computer simulated visual field test (Simfield) as a screening tool for glaucoma. Design/Participants/Methods: 36 glaucoma or glaucoma suspect patients (53 eyes) from one ophthalmology clinic between October 2013 and May 2014 used the Simfield program within six months of a reliable performance on a 24-2 SITA standard Humphrey Visual Field Analyzer Exam. The exam measured threshold values at the same 54 points as the 24-2 SITA standard software as well as false positives, false negatives, and fixation losses. Two glaucoma specialists and one general ophthalmologist analyzed the Simfield results in masked fashion and determined whether there was evidence of a glaucomatous defect in any of the 4 quadrants of each field. These results were compared to the corresponding HFA tests to determine sensitivity and specificity. Results: The sensitivity of Simfield ranged from 51-76% and the specificity was 67-88%. In a sub analysis that eliminated mild defects, defined as defects in a field with mean deviation < 7.0, sensitivity improved to 75-91% and specificity was 69-91%. The average false positive rate was 5.2%, the average false negative rate was 3.7%, and the average fixation loss rate was 27.7%. Conclusions: Simfield is an effective test for identifying moderate to severe glaucomatous visual field loss and can be accessed from any home computer. While the cost to detect glaucoma in one patient using current screening methods is estimated at $1000, Simfield can be used for free anywhere that a computer is available.
This is a progressive demostration of severe damage to right orbit with bursting right eye. In this article we performed the treatment with enucleation and immediate reconstruction of orbital socket with blowout fracture with autologous implant of ear cartilage and series of reconstructive surgeries with the result to three years of accident.
Although aging is natural and acceptable process by most people, it has become a major problem with increased life expectancy and socio-cultural levels. The eyelid protects eyes from dryness, environmental exposure and trauma. It is important that the eyelid is to be robust and in the proper position for eye health.
Ophthalmic cysticercosis due to larval Taenia solium infestation in eye is one of the common preventable causes of acquired blindness particularly in the tropics. Though haematogenously disseminated oncospheres of this parasite can lodge in any tissue or body parts in human, there is a known predilection for brain, skeletal muscle and eye where they develop into metacestode larvae or cysticerci. However a number of cases have been reported having solitary cysticercosis only in eye without affecting brain and/or skeletal muscles. It is not clear to understand the exact route of entry into eye, the timing and environmental circumstances that produce ocular invasion without affecting other tissues. In this article, we have highlighted on the possibility of an alternate non-haematogenous route of transmission of infection particularly affecting eye or its adnexa in T. solium endemic tropical developing countries with poor sanitation practice, and deficient environmental monitoring system. Experimental infection studies might be helpful to prove the hypothesis on direct inoculation with T. solium eggs causing larval infestation in eye.
