[Long-term Follow-up After Cryocoagulation in Preterm Newborns from Northern Greece with Retinopathy of Prematurity: Three Year Results]. / Langzeit-Follow-up nach Exokryokoagulation bei Frühgeborenenretinopathie in Nordgriechenland: 3-Jahres-Ergebnisse.

BACKGROUND: This is a retrospective study of the efficacy of treatment of neonates (NN) with exocryocoagulation retinopathy of prematurity (ROP) with respect to morphology of the retina and visual function. MATERIALS AND METHODS: Out of a total of 3103 neonates, 304 (9.8%) had a ROP. 66 of these were treated. All neonates were observed for 3 years after this treatment. When the patients suffered retinal ablation or dragging of the macula, the treatment was rated as unsuccessful. Best corrected grid visual acuity and best corrected visual acuity were assessed with Lea symbols and Kay pictures. RESULTS: The 66 treated neonates (132 eyes) had a gestation age of less than 28 weeks and weight at birth of < 1280 g. 28 neonates exhibited ROP and the rest in zone 2. Among these 66 neonates, 64 (128 eyes) exhibited improved vision. 37 neonates (74 eyes) also exhibited morphological improvement. Only one neonate developed retinal detachment. CONCLUSION: Early treatment with cryopexia of neonates with ROP can improve vision and stabilise the retina.

Rare Persistent Corneal Infection by Phoma sp. - A Case Report.

We report a case of severe Phoma sp. corneal infection in a middle-aged, otherwise healthy, female patient who was using a soft contact lens. This is the first time that such an infection has been reported in Greece. Our case demonstrates the clinical difficulties and management challenges presented by these recalcitrant corneal infections. Management steps included corneal grafting, vitrectomy, and intravitreal antibiotics.

Genetic Aspects of Keratoconus: A Literature Review Exploring Potential Genetic Contributions and Possible Genetic Relationships with Comorbidities.

INTRODUCTION: Keratoconus (KC) is a complex, genetically heterogeneous, multifactorial degenerative disorder that is accompanied by corneal ectasia which usually progresses asymmetrically. With an incidence of approximately 1 per 2000 and 2 cases per 100,000 population presenting annually, KC follows an autosomal recessive or dominant pattern of inheritance and is, apparently, associated with genes that interact with environmental, genetic, and/or other factors. This is an important consideration in refractive surgery in the case of familial KC, given the association of KC with other genetic disorders and the imbalance between dizygotic twins. The present review attempts to identify the genetic loci contributing to the different KC clinical presentations and relate them to the common genetically determined comorbidities associated with KC. METHODS: The PubMed, MEDLINE, Google Scholar, and GeneCards databases were screened for KC-related articles published in English between January 2006 and November 2017. Keyword combinations of "keratoconus," "risk factor(s)," "genetics," "genes," "genetic association(s)," and "cornea" were used. In total, 217 articles were retrieved and analyzed, with greater weight placed on the more recent literature. Further bibliographic research based on the 217 articles revealed another 124 relevant articles that were included in this review. Using the reviewed literature, an attempt was made to correlate genes and genetic risk factors with KC characteristics and genetically related comorbidities associated with KC based on genome-wide association studies, family-based linkage analysis, and candidate-gene approaches. RESULTS: An association matrix between known KC-related genes and KC symptoms and/or clinical signs together with an association matrix between identified KC genes and genetically related KC comorbidities/syndromes were constructed. CONCLUSION: Twenty-four genes were identified as potential contributors to KC and 49 KC-related comorbidities/syndromes were found. More than 85% of the known KC-related genes are involved in glaucoma, Down syndrome, connective tissue disorders, endothelial dystrophy, posterior polymorphous corneal dystrophy, and cataract.

Effect of Conus Eccentricity on Visual Outcomes After Intracorneal Ring Segments Implantation in Keratoconus.

PURPOSE: To investigate the potential impact of cone eccentricity on visual outcomes after Keraring (Mediphacos, Belo Horizonte, Brazil) implantation for keratoconus. METHODS: Nineteen eyes from 19 patients with keratoconus who underwent femtosecond laser-assisted Keraring implantation for keratoconus were included in this retrospective study. Uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), keratometric readings, central corneal thickness, maximum keratometric distance from corneal apex (DKmax), corneal thinnest point from corneal apex (DTh), and coma were evaluated preoperatively and 6 months after the Keraring implantation. DKmax and DTh were used as metrics reflecting the eccentricity of the cone. RESULTS: UDVA, CDVA, keratometric readings, and coma improved at 6 months postoperatively. However, there was no correlation between DKmax or DTh and visual outcomes at 6 months postoperatively. CONCLUSIONS: The data did not show any impact of the cone eccentricity on visual outcomes after Keraring implantation for keratoconus at 6 months postoperatively. [J Refract Surg. 2018;34(3):196-200.].

Full-thickness macular hole associated with congenital simple hamartoma of retinal pigment epithelium (CSHRPE).

PURPOSE: To report a unique case of congenital simple hamartoma of retinal pigment epithelium (CSHRPE) associated with full-thickness macular hole (FTMH). METHODS: A 14-year-old female with a previous diagnosis of simple hamartoma of retinal pigment epithelium in the left eye presented with a 3-week onset of reduced visual acuity in the same eye. Complete ophthalmological examination with spectral domain ocular coherence tomography (SD-OCT) and autofluorescence imaging was carried out. Results were compared with the last 4-year follow-up data. RESULTS: On examination, visual acuity in the left eye was counting fingers compared to 20/100 documented in the last follow-up. Fundoscopy revealed a nodular, heavily pigmented, circumscribed foveal mass, with 0.5 mm basal diameter and 1.1 mm thickness corresponding to the simple RPE hamartoma. Although the latter remained unchanged throughout the follow-up period, a new lesion at the inferior edge of the hamartoma was noted. SD-OCT confirmed the presence of a FTMH with no evidence of associated epiretinal membrane, vitreomacular traction or posterior vitreous detachment. After explaining the risks and benefits of vitrectomy for FTMH, the patient declined surgery. CONCLUSIONS: CSHRPE may have associated features such as feeding vessels, retinal surface wrinkling, pigmented vitreous cells, retinal exudation and vitreoretinal adhesion. The case presented herein broadens the clinical spectrum of CSHRPE and emphasizes that despite the benign nature of the lesion, which remains stable without growth, visual loss may occur, attributable to foveal traction and development of FTMH. We postulate that protrusion of the tumor into the vitreous cavity results in tissue stretching and development of anteroposterior and tangential forces which may lead to development of macular hole.

Contact Lenses for Keratoconus- Current Practice.

BACKGROUND: Keratoconus is a chronic, bilateral, usuallly asymmetrical, non-inflammatory, ectatic disorder, being characterized by progressive steepening, thinning and apical scarring of the cornea. Initially, the patient is asymptomatic, but the visual acuity gradually decreases, resulting in significant vision loss due to the development of irregular astigmatism, myopia, corneal thinning and scarring. The classic treatment of visual rehabilitation in keratoconus is based on spectacles and contact lenses (CLs). OBJECTIVE: To summarize the types of CLs used in the treatment of keratoconus. This is literature review of several important published articles focusing on the visual rehabilitation in keratoconus with CLs. METHOD: Gas permeable (GP) CLs have been found to achieve better best corrected visual acuity than spectacles, eliminating 3rd-order coma root-mean-square (RMS) error, 3rd-order RMS, and higher-order RMS. However, they have implicated in reduction of corneal basal epithelial cell and anterior stromal keratocyte densities. Soft CLs seem to provide greater comfort and lower cost, but the low oxygen permeability (if the lens is not a silicone hydrogel), and the inability to mask moderate to severe irregular astigmatism are the main disadvantages of them. On the other hand, scleral CLs ensure stable platforms, which eliminate high-order aberrations and provide good centration and visual acuity. Their main disadvantages include the difficulties in application and removal of these lenses along with corneal flattening and swelling. RESULT: The modern hybrid CLs are indicated in cases of poor centration, poor stability or intolerance with GP lenses. Finally, piggyback CL systems effectively ameliorate visual acuity, but they have been related to corneal neovascularization and giant papillary conjunctivitis. CONCLUSION: CLs seem to rehabilitate visual performance, diminishing the power of the cylinder and the high-order aberrations. The final choice of CLs is based on their special features, the subsequent corneal changes and the patient's needs.

Disc swelling in abetalipoproteinemia: a novel feature of Bassen-Kornzweig syndrome.

PURPOSE: Abetalipoproteinemia is a very rare disease with multisystemic manifestations. METHODS: Retrospective, case report. RESULTS: We report a 9-year-old girl with a history of Bassen-Kornzweig syndrome diagnosed at the age of 3. The patient was referred to us by the pediatricians for ocular assessment. During the examination, an atypical pigmentary retinopathy and bilateral swelling of the optic discs were observed, with no consequences to her visual acuity. CONCLUSIONS: Ophthalmic manifestations in Bassen-Kornzweig syndrome are not uncommon. We describe, for the first time, bilateral swelling of the optic discs, a sign that appears directly associated with abetalipoproteinemia.

A serious refractive multifocal intraocular lens complication in Meniere's disease.

PURPOSE: To report an unfortunate case of patient selection for multifocal intraocular lens (MIOL) implantation. METHODS: Interventional case report. RESULTS: A 69-year-old woman with bilateral corticonuclear cataract underwent uneventful phacoemulsification with diffractive MIOL implantation within 1 week. She reported no previous medical history. A few days later she had persisting dizziness and experienced extreme photic phenomena, which progressively deteriorated. After intensive conversation, we discovered that our patient had a medical history of Meniere's disease. Bilateral intraocular lens exchange surgery was performed. One week after monofocal intraocular lens implantation, the patient was satisfied with the final visual outcome and did not report any visual complaints. CONCLUSIONS: Retinocortical processing of visual information is impaired in patients with peripheral vestibular disorders such as Meniere's disease. Therefore, these patients are probably not good candidates for MIOL implantation, which requires an intact sensory system with rigorous visuovestibular interaction.

Visual function and visual perception in cerebral palsied children.

PURPOSE: To investigate visual function and perception in cerebral palsied (CP) children. METHODS: A total of 105 congenitally CP children (aged 6-15 years), without severe mental retardation, were classified into three groups: those with spastic quadriplegia, spastic diplegia and spastic hemiplegia. Data collected included patient history, IQ, refraction, far and near visual acuity, position of the eyes and eye movements, visual fields, colour perception, stereoacuity, slit lamp and fundoscopic examinations, and evaluation of visual perception. The results were compared with a control group from the general paediatric population. RESULTS: The IQ of the CP children ranged between 70 and 100. A total of 59% of them had best corrected distance visual acuity <6/6, with 25.5% <6/9. Near visual acuity was also reduced (70.1% scored <6/6 and 38.4% scored <6/9). Incidence of refractive errors was higher than in the control group (hypermetropia in 43.8% of the eyes, myopia 16.19% and astigmatism 40.9%) as was the incidence of strabismus (26.7% esotropic and 27.6% exotropic). In visual field testing, 80.95% of CP children were normal. A total of 94.28% had normal colour perception and 89.52% were free of ocular pathology. Stereopsis was abnormal or absent in 85.71% of the cases. Visual perception was markedly reduced: in 57.14% of the cases it was less than or equal to that of 6-year-old children; in 26.66% equal to that of 6- to 7.5-year-old children, and in 16.2% of the cases greater than or equal to that of 7.5-year-old children. CONCLUSIONS: In the absence of severe mental retardation, CP children have deficient visual skills. It is suggested that the poor visual skills of CP children are a separate, identifiable factor compounding the adverse effects of mental retardation.

Visual function and execution of microsaccades related to reading skills, in cerebral palsied children.

This article investigates the ability of cerebral palsied (CP) children to execute microsaccades. One-hundred and five congenitally CP school aged children (6 to 15 years old), without severe mental retardation, were classified into three groups: those with spastic quadriplegi, spastic diplegics, and spastic hemiplegics on the basis of: (1) patient anamnesis, (2) IQ estimation, (3) evaluation of the microsaccadic skills with the Developmental Eye Movement test (DEM). Their performance in these tests was compared with a control group from the general pediatric population. IQ of the CP children ranged between 70 and 100; the microsaccadic skills were severely affected: only 19% of the CP children had normal function, 20.9% of the CP children appeared with a pure oculomotor problem, 32.4% of the CP children had a visual-perceptual problem, and 27.7% of the CP children had a combined oculomotor and visual perceptual problem. CP children, in the absence of severe mental retardation, have disturbed visual skills and visual perception that usually leads to reading difficulties. It is also suggested that microsaccadic skills of CP children is an identifiable factor compounding the adverse effects of mental retardation on reading skills.