Ophthalmic Injuries After the Port of Beirut Blast-One of Largest Nonnuclear Explosions in History.

IMPORTANCE: A review of the injury patterns, treatment strategies, and responding physicians' experience during the Port of Beirut blast may help guide future ophthalmic disaster response plans. OBJECTIVE: To present the ophthalmic injuries and difficulties encountered as a result of the Port of Beirut blast on August 4, 2020. DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical record review of all patients who presented to the emergency department and 13 ophthalmology outpatient clinics at the American University of Beirut Medical Center for treatment of ophthalmic injuries sustained from the explosion in Port of Beirut, Beirut, Lebanon, from August 4 to the end of November 2020. Patients were identified from emergency records, outpatient records, and operative reports. MAIN OUTCOMES AND MEASURES: Types of ocular injuries, final best-corrected visual acuity, and need for surgical intervention were evaluated. Visual acuity was measured with correction based on noncycloplegic refraction using the Snellen medical record. EXPOSURES: Ocular or ocular adnexal injuries sustained from the Port of Beirut explosion. RESULTS: A total of 39 blast survivors with ocular injuries were included in this study. Twenty-two patients presented with ocular injuries on the day of the blast, and 17 patients presented within the following 3 months to the ophthalmology clinics for a total of 48 eyes of 39 patients were treated secondary to the blast. Thirty-five patients (89.6%) were adults, and 24 (61.5%) were female. A total of 21 patients (53.8%) required surgical intervention, more than half of which were urgently requested on the same day of presentation (14 [35.9%]). Most eye injuries were caused by debris and shrapnel from shattered glass leading to surface injury (26 [54.2%]), eyelid lacerations (20 [41.6%]), orbital fractures (14 [29.2%]), brow lacerations (10 [20.8%]), hyphema (9 [18.8%]), open globe injuries (10 [20.8%]), and other global injuries. Only 7 injured eyes (14.5%) had a final best-corrected visual acuity of less than 20/200, including all 4 open globe injuries with primary no light perception (8.3%) requiring enucleation or evisceration. CONCLUSIONS AND RELEVANCE: In the aftermath of the Port of Beirut explosion, a review of the ophthalmic injuries showed a predominance of shrapnel-based injuries, many of which had a delayed presentation owing to the strain placed on health care services. Reverting to basic approaches was necessary in the context of a malfunctioning electronic medical record system.

Nontraumatic Epithelial Ingrowth 15 Years Post Laser In Situ Keratomileusis.

Purpose. Epithelial ingrowth occurring many years after primary Laser in Situ Keratomileusis (LASIK) without a preceding traumatic event is very rare. Case Report. We describe the case of a 61-year-old woman with epithelial ingrowth in her right eye 15 years after primary LASIK. She presented with right eye redness, pain, and decreased vision and denied any preceding trauma. An epithelial cells' tract was visible on Optical Coherence Tomography. Conservative treatment lead to the stabilization of the epithelial nests. Discussion. Epithelial ingrowth can occur many years after LASIK and may be due to a microtrauma to the edge of the flap.

Long-term outcomes of Ahmed tube implantation in pediatric glaucoma after multiple surgeries.

PURPOSE: To report success of Ahmed glaucoma valve (AGV) implantation in eyes with pediatric glaucoma and subconjunctival scarring from previous surgeries. METHODS: A retrospective review of pediatric glaucoma patients who underwent AGV implantation after ≥ 2 previous surgeries with conjunctival scarring. Preoperative and postoperative parameters were recorded to study success, defined as intraocular pressure (IOP) < 22 mmHg with or without medications and without serious complications. RESULTS: Eleven eyes of 10 patients were included, and the mean age was 12.7 years. Diagnoses included primary childhood glaucoma, aphakic glaucoma, and anterior segment anomalies. Mean number of prior ocular surgeries was 3.3 (± 1.3). Final mean IOP was 17.5 (± 4.3) mmHg, significantly different from the preoperative mean of 24.8 (± 6.8) mmHg, p = 0.01. Mean number of anti-glaucoma medications also decreased significantly from 2.8 (± 1.5) to 1.4 (± 1.5), p = 0.02. The success rate was 82% at a mean follow-up of 51.6 (± 10.8) months. Complications were minor and transient. CONCLUSION: Subconjunctival scarring did not increase the risk of failure of tube shunt surgery.

Interocular symmetry in macular choroidal thickness in children.

Objective. To report interocular differences in choroidal thickness in children using spectral domain optical coherence tomography (SD-OCT) and correlate findings with biometric data. Methods. This observational cross-sectional study included 91 (182 eyes) healthy children aged 6 to 17 years with no ocular abnormality except refractive error. After a comprehensive eye exam and axial length measurement, high definition macular scans were performed using SD-OCT. Two observers manually measured the choroidal thickness at the foveal center and at 1500 µm nasally, temporally, inferiorly, and superiorly. Interocular differences were computed; correlations with age, gender, refractive error, and axial length were performed. Results. Mean age was 10.40 ± 3.17 years; mean axial length and refractive error values were similar between fellow eyes. There was excellent correlation between the two observers' measurements. No significant interocular differences were observed at any location. There was only a trend for right eyes to have higher values in all thicknesses, except the superior thickness. Most of the choroidal thickness measurements correlated positively with spherical equivalent but not with axial length, age, or gender. Conclusion. Choroidal thickness measurements in children as performed using SD-OCT revealed a high level of interobserver agreement and consistent interocular symmetry. Values correlated positively with spherical equivalent refraction.

Spectral domain optical coherence tomography in children: normative data and biometric correlations.

BACKGROUND: The aim was to report normative values of retinal nerve fiber layer (RNFL) and macular parameters in children using spectral domain optical coherence tomography (OCT) and to perform correlations with age, refractive error and axial length. METHODS: This was an observational cross-sectional study recruiting 113 healthy children aged 6 to 17 years with no ocular abnormality except refractive error. After a comprehensive eye examination and axial length measurement, RNFL and macular thickness measurements were performed using the Cirrus OCT machine. Main outcome measures were macular volume, macular thickness and RNFL thickness values as well as their correlations with age, refractive error and axial length. Right eyes of all subjects were selected for analysis. RESULTS: One hundred and eight children were included in the study, 65 females and 43 males. Mean age was 10.7+/-3.1 years, average spherical equivalent refraction (SE) was -0.02+/-1.77(-4.25 to +5.00) diopters and average axial length was 23.5+/-1.0 (21.5 to 25.8)mm. Mean RNFL thickness was 95.6+/-8.7 µm, average macular thickness was 279.6+/-12.5 µm, central macular thickness was 249.1+/-20.2 µm, and mean macular volume was 10.1+/-0.5 mm(3). Central macular thickness values were significantly higher in males (p < 0.001). RNFL measurements did not correlate with age but did show a positive correlation with SE. All macular parameters were consistently positively correlated with age and most of them were positively correlated with SE. When controlling for axial length, only the macular inner circle thickness was positively correlated with age. CONCLUSIONS: Using Cirrus OCT, normative RNFL and macular parameters in healthy children below 18 years of age were established; measurements varied by age and gender.

Interocular symmetry in retinal and optic nerve parameters in children as measured by spectral domain optical coherence tomography.

BACKGROUND/AIMS: To report interocular differences in retinal nerve fibre layer (RNFL), optic nerve head and macular parameters in children using spectral domain optical coherence tomography (SD-OCT). METHODS: This was an observational cross-sectional study including 108 healthy children aged 6-17 years with no ocular abnormality except refractive error. After a comprehensive eye exam and axial length measurement, RNFL, optic nerve and macular thickness measurements were performed using the Cirrus OCT machine. Right and left eyes were compared and interocular differences were computed. Subjects were also divided into two groups based on age (under or over 10 years of age). Main outcome measures were interocular differences and their correlations with age and gender. RESULTS: The study included 108 children, mean age 10.7 ± 3.1 years; significant interocular differences were observed in both macular and RNFL parameters. The macular thickness analysis revealed interocular differences in the outer nasal and outer inferior quadrants, with left eyes displaying larger values. With respect to RNFL parameters, right eyes displayed thicker nasal and temporal quadrants, and inferior clock hours; left eyes had a thicker superior quadrant. The older age group (>10 years) had more pronounced variation in interocular differences compared with the younger group with less mature visual systems. CONCLUSIONS: Normal variation in interocular symmetry exists. Our results can contribute to establishing a standard reference for interocular differences in OCT parameters in children aged 6-17 years using the Cirrus device.

A comparison between tube surgery, ND:YAG laser and diode laser cyclophotocoagulation in the management of refractory glaucoma.

PURPOSE: To compare the results of intraocular pressure (IOP) reduction by 3 treatment modalities, (a) glaucoma tube implants, (b) noncontact YAG laser cyclophotocoagulation (cycloYAG), and (c) contact transscleral diode laser cyclophotocoagulation (cyclodiode), in cases of advanced glaucoma refractory to alternative treatments. METHODS: A consecutive group of 45 eyes that received cycloYAG were matched against two control groups of patients who had received tube surgery or cyclodiode, each control group having been derived from a database of patients. RESULTS: Mean pretreatment IOP improved from 41.3, 38.6, and 32.0 mmHg for the tube, cycloYAG, and cyclodiode groups, respectively, to 16.4, 22.1, and 19.3 mmHg, respectively. Treatment success was achieved in 78%, 69%, and 71% of the tube, cycloYAG, and cyclodiode groups, respectively. Visual acuity deteriorated 2 or more Snellen lines in 16%, 7%, and 9% of the patients in the tube, cycloYAG, and cyclodiode groups, respectively. Complications included retinal detachment, hypotony, and phthisis. CONCLUSIONS: All 3 methods provided acceptable IOP lowering in the short and medium term. Control of IOP was best in patients receiving tube surgery. Cyclodiode and cycloYAG treatments were similarly effective in lowering IOP. Tube surgery was associated with a greater incidence of sight threatening complications.

Abnormal binocular vision: monocular diplopia of physical origin: two case reports. Its relationship to the physiology and arrangement of the visual directions of the retinal areas; binocular triplopia.

BACKGROUND AND PURPOSE: Monocular diplopia is an infrequent but disabling complication following laser peripheral iridotomy, or following cataract surgery. Our purpose is to clarify the intraocular mechanism of monocular diplopia (and binocular triplopia) of physical origin and its relation to the physiology and arrangement of the visual directions of the retinal areas in each eye. CASE REPORTS: This is a report of one patient who developed monocular diplopia following an "exposed" laser peripheral iridotomy, and of a second patient who developed monocular diplopia due to a swollen opacified central posterior capsule following cataract surgery. CONCLUSION: Monocular diplopia of physical origin results from stimulation, by an object of regard, of two separate retinal areas that have two different visual directions due to optical ocular pathology.

The distribution of visual field defects per quadrant in standard automated perimetry as compared to frequency doubling technology perimetry.

To test the ability of frequency doubling technology (FDT) perimetry to reveal defects in the same field quadrants as detected by standard automated perimetry (SAP). Ninety-two eyes with open-angle glaucoma and documented visual field defects by threshold SAP (Octopus Dynamic strategy) also underwent threshold FDT testing after successfully passing the FDT screening test. All eyes revealed varying stages of SAP defects while only 80 revealed FDT damage: 31:21 eyes in the early field loss stage, 36:35 in the moderate field loss stage, and 25:24 in the severe field loss stage in SAP versus FDT, respectively. SAP was able to detect abnormalities in 74 and 79% of the superotemporal, and inferotemporal quadrants, respectively, while the corresponding FDT figures were 70 and 69% for the same quadrants (P < 0.05 each). With regards to the nasal hemifield, SAP detected defects in 73 and 81% of the superonasal and inferonasal quadrants, respectively, compared to 69 and 66% for FDT (P < 0.001 each). The test duration per individual eye was significantly shorter with FDT than with SAP (P < 0.05). As well as the already established lower sensitivity of FDT compared to SAP, this study also demonstrated the significantly poorer ability of FDT in detecting the same field quadrant defects, especially in the early stages of glaucomatous damage.

Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: the second year of a prospective study.

PURPOSE: To demonstrate the efficacy of intravitreal bevacizumab for treatment of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, nonrandomized clinical study. METHODS: Fifty-one patients (51 eyes) with subfoveal choroidal neovascularization (CNV) resulting from AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. These patients had already completed 12 months of follow-up. The criteria for reinjection were presence of fluid in the macula, increased central retinal thickness (CRT) of at least 100 microm, loss of at least 5 letters of vision associated with increased fluid in the macula, new classic CNV, or new macular hemorrhage. The main outcome measure was the proportion of eyes losing fewer than 15 letters of vision after 12 months. RESULTS: Fifty-one patients (51 eyes) completed the additional 12 months. Mean visual acuity improved from 45.7 letters at baseline to 54.3 letters at 24 months (P = .001), and 47 eyes (92.2%) lost fewer than 15 letters. Mean CRT decreased from 327.4 microm at baseline to 246.6 mum at 24 months (P < .001). A mean of 1.5 injections were administered over the course of the second year. No serious ocular or systemic side effects were noted. CONCLUSIONS: Eyes with neovascular AMD treated with intravitreal bevacizumab over 2 years had significant anatomic and functional improvement compared with baseline. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.

Modified phototherapeutic keratectomy technique for the treatment of elevated corneal opacities.

A simple modification to the existing phototherapeutic keratectomy techniques to treat elevated corneal opacities is described for a case of severe bilateral macular dystrophy. After epithelial removal, a single drop of carboxymethylcellulose sodium 1.0% was applied centrally on the cornea. A spatula drawn smoothly stretched the drop in all directions without breaking its surface tension until the tip of the highest corneal elevation was seen. Large-diameter phototherapeutic keratectomy for 30-micron ablation was applied. This process was repeated several times, with decreasing amounts of tissue ablation as needed. Postoperative slit-lamp biomicroscopy revealed a smooth corneal surface with no elevated corneal opacities. The patient reported significant improvement with tearing and photophobia. This simple modification from painting to stretching the masking agent, thus transforming it to an ablatable mask, allowed for an effective and practical treatment of elevated corneal opacities. Carboxymethylcellulose sodium 1.0% is nontoxic, biocompatible, and requires no incubation or solidification time.

Intravitreal triamcinolone acetonide: Pattern of secondary intraocular pressure rise and possible risk factors.

PURPOSE: To determine the pattern of increase in intraocular pressure (IOP) following intravitreal triamcinolone acetonide (IVTA) and identify possible risk factors associated with this rise in IOP. METHODS: We carried out a retrospective review of records for 185 patients (226 eyes) who received 4 mg of IVTA at the American University of Beirut Medical Center and Hotel Dieu de France eye clinics between 2003 and 2005 RESULTS: Mean follow-up was 8.17 months (range 6 to 24 months). The mean number of IVTA injections per eye was 1.31 +/- 0.69. The mean IOP increased after the first IVTA injection from 15.04 +/- 3.18 mmHg at baseline to a mean maximum of 17.20 +/- 5.75 mmHg (p < 0.0001, paired t-test) at month 3 of follow-up with a return to mean baseline IOP (15.49 +/- 4.79 mmHg) at month 12. Fifty nine of 226 eyes showed IOP higher than 21 mmHg during follow-up. Nine eyes started to have IOP greater than 21 mmHg, 6 to 12 months after a single injection. Intraocular pressure lowering medications were started when IOP exceeded 25 mmHg in 15 of the 226 eyes studied. No risk factors have been found to predict this IOP rise CONCLUSIONS: IOP elevation can occur in a significant number of eyes receiving 4 mg of IVTA. This phenomenon seems to be transient and a small number of eyes required treatment during this period. Eyes that received IVTA need to be monitored for IOP changes especially during the first 3 months, but the IOP may still rise 6 months and even 12 months after a single injection. This study did not show any risk factor that may predict this IOP rise.

Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: a one-year prospective study.

PURPOSE: To investigate the efficacy of intravitreal bevacizumab for treatment of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, nonrandomized clinical study. METHODS: Sixty patients (60 eyes) with subfoveal choroidal neovascular membrane (CNV) attributable to AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. All lesion types were included except for retinal angiomatous proliferation. In the initial treatment phase, intravitreal bevacizumab (2.5 mg/0.1 ml) was given at baseline, and then two additional monthly injections were given if the macula was not dry on optical coherence tomography. The criteria for re-injection after the induction phase were presence of new fluid in the macula, increased central retinal thickness (CRT) at least 100 microm, loss of at least five letters of vision with increased fluid in the macula, new classic CNV or new macular hemorrhages. Main outcome measure was the proportion of eyes losing <15 letters of vision after 12 months. RESULTS: Fifty-one patients (51 eyes) completed the 12 months. Mean visual acuity improved from 45.7 letters at baseline to 53.1 letters at 12 months (P = .004), and 47 eyes (92.2%) lost <15 letters. Mean CRT decreased from 327.4 microm at baseline to 227.8 microm at 12 months (P < .001). A mean of 3.4 injections were given over the course of the study, and no ocular or systemic side-effects were noted. CONCLUSION: Eyes with neovascular AMD treated with intravitreal bevacizumab over 12 months had significant anatomical and functional improvement. Further studies need to confirm the long-term efficacy of this treatment.

Corneal light shield as a delivery system for standardized application of mitomycin C in excimer surface ablation.

PURPOSE: To develop a simple, reproducible method of applying intraoperative mitomycin C (MMC) in excimer surface ablation surgery. METHODS: A two-part protocol was developed to study several properties of corneal light shields. Part A tested the amount of MMC (0.2 mg/mL) absorbed, expansion dimension attained, and amount released to filter paper. Part B examined in vitro release of MMC to a photorefractive keratectomy (PRK)-treated enucleated pig eye. RESULTS: Mean MMC absorbed by corneal light shields was 63.7 +/- 5.0 mg (range: 57.4 to 72.8 mg); coefficient of variability was 7.8%. Expansion diameter and thickness were constant at 9.0 mm and 1.1 mm, respectively. Mean solution released to filter paper was 55.4 +/- 3.9 mg (range: 51.3 to 63.5 mg); coefficient of variability was 7.1%. Mean solution transferred to the PRK-treated pig eye was 2.3 +/- 0.7 mg (range: 1.1 to 3.5 mg); coefficient of variability was 33%. CONCLUSIONS: Mitomycin C contact surface area, amount absorbed, and amount released by each corneal light shield were reproducible. Uniform dimensions theoretically provide uniform distribution of MMC. This method may allow standardization of intraoperative MMC application in excimer surface ablation.

Intravitreal bevacizumab vs verteporfin photodynamic therapy for neovascular age-related macular degeneration.

OBJECTIVE: To compare verteporfin photodynamic therapy (PDT) with intravitreal bevacizumab for management of choroidal neovascularization (CNV) associated with age-related macular degeneration. METHODS: Patients with predominantly classic CNV were prospectively randomized to receive standard PDT or intravitreal bevacizumab injections (2.5 mg). Best-corrected visual acuity (BCVA) measured by Snellen charts, central retinal thickness by optical coherence tomography, and greatest linear dimension of the CNV by fluorescein angiography were compared between the groups at baseline and at 3 and 6 months. Main outcome measures were stability or improvement in BCVA, decrease in central retinal thickness, and stability in greatest linear dimension. RESULTS: Mean baseline BCVA, central retinal thickness, and greatest linear dimension were not statistically different between the bevacizumab (n = 32) and PDT (n = 30) groups. Mean central retinal thickness was significantly better at 3 and 6 months in the bevacizumab group vs the PDT group (P = .04 and P = .002, respectively). At 3 months, mean BCVA and greatest linear dimension were not significantly different between the 2 groups. At 6 months, mean BCVA and greatest linear dimension were significantly better in the bevacizumab group (P < .001 and P = .02, respectively). CONCLUSION: During 6 months, intravitreal bevacizumab was superior to PDT in controlling predominantly classic CNV in age-related macular degeneration. Additional randomized clinical trials are necessary to determine if this benefit will remain with longer follow-up.

Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration.

PURPOSE: To investigate the efficacy and safety of intravitreal bevacizumab for managing choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). DESIGN: Prospective interventional case series. METHODS: Seventeen eyes of 17 patients with subfoveal CNV due to AMD participated in this study at the American University of Beirut Ophthalmology Clinics. All patients had failed, refused, or were not eligible for photodynamic therapy. All eyes received a baseline eye examination, which included best-corrected visual acuity (BCVA), dilated fundus examination, ocular coherence tomography (OCT) imaging, and fluorescein angiography. An intravitreal injection of bevacizumab (2.5 mg/0.1 ml) was given at baseline and followed by two additional injections at four-week intervals. BCVA, OCT, and fluorescein angiography were repeated four weeks after each injection. Main outcome measures were improvement in BCVA and central retinal thickness (CRT). RESULTS: Mean baseline BCVA was 20/252 (median 20/200), and baseline CRT was 362 microm (median 350 microm). Improvement in VA and CRT occurred by the fourth week. At 12 weeks, mean BCVA was 20/76 (P < .001) and median BCVA was 20/50 (P < .001). Both mean and median CRT decreased to 211 microm (P < .001). Thirteen (76%) of 17 eyes had total resolution of subretinal fluid, and four eyes (24%) had BCVA better than 20/50. No systemic or ocular side effects were noted at any time. CONCLUSION: Eyes with CNV due to AMD treated with intravitreal bevacizumab had marked anatomic and visual improvement. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.

Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation fluoroquinolone.

OBJECTIVE: To report a patient with Mycobacterium chelonae keratitis after LASIK and discuss therapeutic measures. DESIGN: Interventional case report and literature review. INTERVENTION: A healthy, 25-year-old man presented 6 weeks after LASIK with infectious keratitis in the left eye. Scrapings were obtained from the central stromal bed after lifting the flap and inoculated on culture media. MAIN OUTCOME MEASURES: Response to medical treatment. RESULTS: Mycobacterium chelonae was identified from stromal bed scrapings. The protracted course of the infection necessitated surgical debridement and flap amputation with slow and suboptimal response to prolonged (14 weeks) treatment with topical amikacin 3.3%, clarithromycin 1%, and levofloxacin 0.5%. The substitution of levofloxacin 0.5% with gatifloxacin 0.3% resulted in closure of the epithelial defect within 1 week and resolution of the infiltrates in 3 weeks. The combined regimen of gatifloxacin 0.3%, amikacin 3.3%, and clarithromycin 1% was continued for a total of 4 months. The patient remains infection free 1 year after stopping all antibiotics. CONCLUSION: Treatment of post-LASIK nontuberculous mycobacteria remains a challenge. Institution of combination therapy including fortified amikacin, clarithromycin 1%, and a fourth-generation fluoroquinolone appeared to be beneficial in this patient.

Panretinal photocoagulation and intravitreal triamcinolone acetonide for the management of proliferative diabetic retinopathy with macular edema.

PURPOSE: To investigate intravitreal triamcinolone acetonide (IVTA) as an adjunctive therapy to panretinal photocoagulation (PRP) in patients with both high-risk proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). METHODS: Thirty-five eyes diagnosed with both high-risk PDR and CSME underwent PRP and a single injection of 4 mg of IVTA (IVTA group). Visual, anatomic, and fluorescein angiographic changes were documented. Any complications resulting from the combined procedure were noted. These data were compared retrospectively to 35 eyes that underwent grid laser treatment to the macula followed 2 weeks later by PRP (laser group). Main outcome measures included change in best-corrected visual acuity, improvement in macular edema (clinical or angiographic), and control of the neovascular disease. RESULTS: Mean follow-up was 9.6 months for the IVTA group and 11.9 months for the laser group. Mean pretreatment best-corrected visual acuity was 20/286 in the IVTA group and 20/282 in the laser group (P = 0.80). After 9 months of follow-up, visual acuity was 20/80 in the IVTA group versus 20/156 in the laser group (P = 0.007). Thirty-four percent of eyes in the IVTA group had final vision of 20/40 or better versus 11% in the laser group (P = 0.044). At 9 months follow-up, 84% of IVTA eyes had complete resolution of macular edema versus 46% of laser eyes (P = 0.002). Three eyes in the IVTA group had recurrence of macular edema after 6 months and required reinjection of IVTA. Elevation in intraocular pressure occurred in eight eyes in the IVTA group and responded to topical therapy. Cataract progression was observed in nine eyes in the IVTA group. CONCLUSIONS: The addition of intravitreal triamcinolone acetonide to PRP in the management of patients with both PDR and CSME seems promising. Further study is needed to assess the effect of this combined treatment.

Plasma thymulin and nerve growth factor levels in patients with primary open angle glaucoma and elevated intraocular pressure.

BACKGROUND: The objective was to measure the plasma concentrations of thymulin and nerve growth factor (NGF) in a group of patients with primary open angle glaucoma (POAG) and compare them with age- and sex-matched normal controls. METHODS: Twenty-eight patients newly diagnosed with POAG who were not undergoing treatment were compared with the same number of age- and sex-matched healthy controls. Blood samples were drawn into heparinized tubes and plasma samples were collected for the determination of the concentrations of thymulin and NGF, using specific enzyme-linked immunosorbent assay (ELISA). The Student's t test was used to perform the necessary statistical analysis of the results. RESULTS: Seventeen women and 11 men were enrolled in each of the two groups (study and control), with a mean age of 63.7 (SD 10.3) years in the former and 63.3 (SD 9.6) years in the latter. There was a highly significant (p<0.001) elevation in the thymulin levels in POAG patients compared with the control group. However, no significant difference was observed when comparing the plasma NGF levels. CONCLUSION: This is the first report to measure plasma thymulin levels in glaucoma patients. The significant results point the possible role of this immunomodulator in the pathogenesis of primary open angle glaucoma. The potential role of NGF seems to be less likely. These findings warrant further investigation.

LASIK for high myopic astigmatism resulting from perforating ocular injury.

PURPOSE: To present a case of successful treatment of high myopic astigmatism after a perforating injury with significant corneal laceration and pupil ectopia using excimer LASIK. METHODS: A 30-year-old man presented for treatment of high myopic astigmatism in his right eye resulting from perforating ocular trauma, which occurred 8 years prior to presentation. The corneoscleral wound repair was performed with posterior chamber intraocular lens implantation. Uncorrected visual acuity (UCVA) in the right eye was counting fingers at 1 m, best corrected to 20/30 with -7.00 + 5.00 x 110. Visual acuity in the left eye was 20/20 with -1.5 D. The patient was unable to tolerate spectacles and contact lenses because of asthenopia and high astigmatism, respectively. As an alternative, LASIK with the Allegretto Wave excimer laser was performed. RESULTS: Three months postoperatively, UCVA was 20/25 in the right eye and 20/15 in the left eye. CONCLUSIONS: This case indicates that LASIK can be a useful surgical method for correcting high myopic astigmatism resulting from ocular trauma with significant corneoscleral laceration.