Visual outcome following extracapsular cataract extraction in mature cataracts with pseudoexfoliation syndrome: a retrospective study

To report the best corrected visual acuity, at the end of one year, in 33 patients [35 eyes], who underwent extracapsular cataract extraction [ECCE] with posterior chamber intraocular lens implantation [PC-IOL] for mature and hypermature cataracts, with pseudoexfoliation [PEX]. Retrospective, non-comparative, single-institutional [Sultan Qaboos University Hospital] study. Thirty-three patients with mature and hypermature cataracts, with PEX operated upon between January 2007 and December 2008, by one surgeon [AM]. Retrospective study of thirty-three patients [35 eyes] with mature and hypermature cataracts, with ocular PEX, evaluating the visual outcome at the end of 12 months following ECCE with PC-IOL. Thirty eyes [85.71%] showed improvement in the best corrected visual acuity [BCVA] ranging from 0.2 to 1.0 Snellen lines. Four eyes [11.43%] had unchanged BCVA from the baseline. There were no intraoperative complications in any patient. One eye [2.86%] that did not improve developed retinal detachment at three months follow-up, and was referred to the Vireoretinal Unit and follow-up has been lost. Extracapsular cataract extraction is a safe and effective technique in eyes with mature and hypermature cataracts with PEX

Optical coherence tomography: clinical applications in medical practice

Optical Coherence Tomography [OCT] is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer

Confoscan: an ideal therapeutic aid and screening tool in acanthamoeba keratitis

Although present worldwide, Acanthamoeba keratitis [AK] is a rare condition. It is a protozoal infection of the eye that is generally caused by wearing contaminated contact lenses or lens solutions. Confoscan and confocal scanning laser tomography [CSLT] are in vivo noninvasive diagnostic tools which provide high definition images of corneal microstructures. Laser in situ keratomileusis [LASIK] is a very common refractive surgery. We report a case series in which the first patient had contact lens induced Acanthamoeba keratitis with corneal epitheliopathy that was unresponsive to conservative treatment. Epithelial debridement was performed based on confoscan findings which confirmed the presence of Acanthamoeba cysts. Subsequently, the cornea re-epithelialized over two days. Another patient had CSLT prior to the LASIK which showed stromal cyst-like structures suggestive of Acanthamoeba keratitis. Four months after medical therapy, repeat CSLT was negative for Acanthamoeba cysts. Third patient was diagnosed with Acanthamoeba infection after undergoing lamellar keratoplasty. CSLT should be used as a screening procedure prior to any corneal refractive surgery to detect and treat protozoal and other infections preoperatively

Sebaceous gland carcinoma of the eyelid

Sebaceous gland carcinoma, commonly arises in the periocular area, is an uncommon condition. It represents 1-5.5% of eyelid malignancies and is considered to be the third most common eyelid malignancy after basal cell and squamous cell carcinomas, although few reports placed this tumor as second most common after basal cell carcinoma. It usually affects elderly women and characterized by high rate of local recurrence, regional, and distant metastases. A delay in diagnosis, which can be attributed primarily to ability of this tumor to masquerade as more benign conditions, often leads to inappropriate management with increased morbidity and mortality rates. In this study, the authors discuss key elements of the primary disease and therapeutic options available to treat such devastating problem

Total levator aponeurosis resection for primary congenital ptosis with very poor levator function

This study was designed to evaluate the effectiveness of total levator aponeurosis resection in patients with very poor levator function secondary to primary congenital ptosis. A retrospective, noncomparative single-institutional study was designed. Seven patients with very poor levator function secondary to primary congenital ptosis operated between May 2008 and May 2010 by one surgeon [AM]. A retrospective study of seven patients with congenital ptosis evaluating eyelid elevation following total levator aponeurosis resection. End result is improvement of the eyelid elevation. Total levator aponeurosis resection is easy and effective tool in elevating the eyelid in patients with very poor levator function secondary to primary congenital ptosis

Culture negative confoscan positive acanthamoeba keratitis: a relentless course

Acanthamoeba keratitis is a protozoal infection of the eye, mainly due to the use of non-sterile solutions, like saline for disinfecting contact lenses. We report a case where delay in the diagnosis of acanthamoeba keratitis due to inadequate laboratory investigations and clinical management led to an excruciatingly painful course of the disease. The importance of non-invasive imaging techniques of confocal microscopy in the diagnosis of acanthamoeba keratitis, in the absence of positive culture reports, is highlighted in this case

Bacterial keratitis: perspective on epidemiology, clinico-pathogenesis, diagnosis and treatment

Bacterial keratitis is an acute or chronic, transient or recurrent infection of the cornea with varying predilection for anatomical and topographical parts of the cornea like marginal or central. It is a potentially sight-threatening corneal infection in humans that is generally found in eyes with predisposing elements, the most common of which is contact lens wear. The epidemiological data reveals the universal occurrence of this disease. With advances in the understanding of its pathogenesis, laboratory investigations like immunohistochemistry, fluorescent microscopy, enzyme immunoassays and molecular biology, and the availability of fourth generation antibiotics, the overall visual outcome in bacterial keratitis has improved with time. Particular attention should be given to this condition as it can progress very rapidly with complete corneal destruction occurring within 24-48 hours. Early diagnosis, which is primarily clinical and substantiated largely by microbiological data, and prompt treatment are needed to minimise the possibility of permanent visual loss and reduce structural damage to the cornea

Bevacizumab therapy for macular edema in central retinal vein occlusion: long-term results

There is no proven effective treatment for vision loss in central retinal vein occlusion [CRVO]. Bevacizumab has been reported in small series with limited follow-up, to have a positive effect in reducing cystoid macular edema [CME] and improving vision in CRVO. To report long-term results with the use of bevacizumab in CRVO. Prospective interventional case series included 15 patients, serially evaluated with best corrected visual acuity [BCVA], optical coherence tomography [OCT], fluorescein angiography, and tonometry. Results were statistically analyzed. Mean follow-up was 12 +/- 3.6 months [range, 6?18 months]; mean number of injections was 2.2 [range, 1?4] per patient. Statistically significant reduction of macular thickness [P < 0.001] was seen at six weeks [mean, 346 micro]; three months [mean, 353 micro]; six months [mean, 348 micro]; and final follow-up [mean, 342 micro]. Significant BCVA improvement was seen at six weeks [mean, 0.27 logMAR], three months [mean, 0.3 logMAR], three months [0.15 logMAR], and final follow-up [mean, 0.21 logMAR] [P = 0.009]. Also, 73.3% patients had BCVA improvement at the last follow-up. Intravitreal bevacizumab is an effective treatment option for CME in CRVO patients. Reinjections at appropriate timing, based on the OCT findings, are important for better visual outcome

Unilateral retinitis pigmentosa with hypoplastic tilted disc in other eye

A case of a 32-year-old woman showing pigmentary degeneration of the retina in one eye associated with a hypoplastic tilted disc in fellow eye is presented. Clinical examinations of the patient were performed in order to rule out the various causes which are known to produce fundoscopic features that mimic retinitis pigmentosa. Since these investigations were all negative, the fundus changes were interpreted as a unilateral retinitis pigmentosa. Four years later, the patient was re-examined and the findings were reconfirmed. An association of unilateral retinitis pigmentosa and hypoplastic tilted disc in the other eye can be regarded as exceptional. The possibility of a correlation of the pathogenetic mechanism involved in the development of both conditions is discussed