SDOCT thickness measurements of various retinal layers in patients with autosomal dominant optic atrophy due to OPA1 mutations.

PURPOSE: To specify thickness values of various retinal layers on macular spectral domain Optical Coherence Tomography (SDOCT) scans in patients with autosomal dominant optic atrophy (ADOA) compared to healthy controls. METHODS: SDOCT volume scans of 7 patients with ADOA (OPA-1 mutation) and 14 healthy controls were quantitatively analyzed using manual grading software. Mean thickness values for the ETDRS grid subfields 5-8 were calculated for the spaces neurosensory retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), a combined space of inner plexiform layer/outer plexiform layer/inner nuclear layer (IPL+INL+OPL), and a combined space of outer nuclear layer/photoreceptor layers (ONL+PL). RESULTS: ADOA patients showed statistically significant lower retinal thickness values than controls (P < 0.01). RNFL (P < 0.001) and GCL thicknesses (P < 0.001) were significantly lower in ADOA patients. There was no difference in IPL+INL+OPL and in ONL+PL thickness. CONCLUSION: Manual subanalysis of macular SDOCT volume scans allowed detailed subanalysis of various retinal layers. Not only RNFL but also GCL thicknesses are reduced in the macular area of ADOA patients whereas subjacent layers are not involved. Together with clinical findings, macular SDOCT helps to identify patients with suspicion for hereditary optic neuropathy before genetic analysis confirms the diagnosis.

Kestenbaum procedure with combined muscle resection and tucking for nystagmus-related head turn.

BACKGROUND: Literature has dealt extensively with dose-effect relations for recess-resect procedures for correction of horizontal nystagmus-related head turn. However, muscle tucking procedures have some advantages compared to resection procedures. Aim of this study was to evaluate dose-effect relations of Kestenbaum surgery with symmetrical combined recession and tucking (instead of resection) of the horizontal rectus muscles for the reduction of a nystagmus-related head turn. METHODS: In a retrospective study, clinical findings of 42 patients who consecutively underwent treatment in our institution between 2000 and 2011 were investigated. The patients were aged 4-57 years (median age 6 years). For all patients, surgery aimed to correct a horizontal head turn (to the right: 18 patients) due to infantile nystagmus. The head turn was measured with a goniometer with the patient fixing the smallest age-appropriate target distinguishable for the patient. RESULTS: The median absolute head turn before surgery was 30° (min. 15°, max. 45°). The four horizontal rectus muscles were recessed or tucked between 5.5 and 10 mm, median 9 mm. All four muscles were recessed or tucked for the same amount. At the first postoperative day, the median dose-effect relation was 1.88° reduction of head turn per millimeter surgery on one eye (min. 0.5°/mm, max. 3.2°/mm). The median head turn was 0° (min. -20°, max. 15°). Surgery was considered successful in 88% of the patients with a reduction of the head turn to max. 10°. Data of 36 patients were available for the long-term postoperative period (median 1.5 years; min. 6 weeks, max. 11 years). The median head turn was 10° (min. -16°, max. 30°). The median dose-effect relation was reduced to 1.35°/mm per eye (min. 0°/mm, max. 2.9°/mm). Surgery was considered successful in 72 % of the patients with a reduction of the head turn to max. 10°. Three patients showed an overcorrection with a head turn of 8°, 15° and 16° to the other side. A squint has not been induced. CONCLUSIONS: The dose-effect relation for Kestenbaum surgery with symmetrical combined recession and tucking of the horizontal rectus muscles is comparable to the dose-effect relation reported by other authors for symmetrical combined recession and resection.

Rebound, applanation, and dynamic contour tonometry in pathologic corneas.

PURPOSE: To compare the practicability of using an Icare rebound tonometer (RT) versus a Goldmann applanation tonometer (GAT) or a Pascal dynamic contour tonometer (DCT) for measuring intraocular pressure (IOP) in patients with corneal abnormalities and, furthermore, to study the influence of central corneal thickness, corneal diameter, corneal radius, and axial length. METHODS: One hundred seventy-one pathologic eyes with corneal abnormalities and 26 nonpathologic control eyes of 99 patients were included. Pathologic corneas were divided into subgroups: previous keratoplasty, keratoconus, corneal scars, corneal dystrophies, and bullous keratopathy. RESULTS: Although IOP was successfully measured using the RT in all pathologic eyes, successful measurement of IOP was only possible in 98.2% when using the GAT and in 73.1% with the DCT. Mean IOP for all enrolled eyes was 12.7 ± 4.1 mm Hg for RT, 15.5 ± 4.4 mm Hg for GAT, and 16.3 ± 4.1 mm Hg for DCT. The mean difference between RT and GAT was ≤ 1 mm Hg (≤ 2 mm Hg) [≤ 3 mm Hg] in 23.4% (41.8%) [62.0%] of cases. Correlation analysis showed a moderate correlation between RT and GAT (r = 0.566; P < 0.001) and between RT and DCT (r = 0.364; P < 0.001). Bland-Altman analysis revealed a bias between RT and GAT and between RT and DCT of -2.8 and -3.8 mm Hg, with limits of agreement of -10.5 to 4.9 mm Hg and -12.2 to 4.6 mm Hg, respectively. CONCLUSION: In pathologic corneas, IOP was difficult to obtain with GAT and DCT, whereas RT was able to determine IOP in all pathologic corneas. RT significantly underestimated IOP in all groups in relation to GAT and DCT. The agreement between the methods was clinically acceptable in corneal dystrophy and keratoconus but poor in eyes after keratoplasty.

Biodegradable implant for tissue repair after glaucoma drainage device surgery.

AIM/BACKGROUND: To report a novel technique using biodegradable material to cover exposed glaucoma tube shunts. METHODS: A case report of a single patient who underwent drainage tube shunt surgery with the Baerveldt drainage device for intractable glaucoma. Four months post operation the tube became exposed through necrosis of the overlying scleral flap and conjunctiva. The defect was repaired by fixation of the tube to the sclera, with a slice of an ologen implant as a patch, covered by the adjacent conjunctiva. The patient was followed over a period of 1 year after the surgery. RESULTS: Successful, lasting closure of the conjunctival defect was achieved without any side effects or complications. CONCLUSIONS: Erosion of the drainage tube after shunt surgery is a potentially serious problem. It can be successfully managed using a biodegradable implant as a patch before closing the conjunctiva.

Effect of a capsular tension ring on refractive outcomes in eyes with high myopia.

PURPOSE: To evaluate the effect of capsular tension ring (CTR) implantation on refractive outcomes in patients with high myopia. SETTING: University of Cologne, Department of Ophthalmology, Cologne, Germany. DESIGN: Comparative case series. METHODS: The refractive outcomes in myopic eyes were compared between phacoemulsification and IOL implantation with a CTR (CTR group) and without a CTR (control group). Optical biometry (IOLMaster) was obtained. The power of the IOL was used to calculate the predicted postoperative spherical equivalent using the Haigis and SRK/T formulas. The main outcome measures were the mean error and mean absolute error of the refractive prediction error. RESULTS: The mean axial length was 29.1 mm (range 26.5 to 34.1 mm) in the CTR group and 28.2 mm (range 25.6 to 31.1 mm) in the control group. There was no statistically significant difference in the mean absolute refractive prediction error between the CTR group and the control group with the Haigis formula (P = .921) or SRK/T formula (P = .693). However, there was lower variance in the absolute refractive prediction error in the CTR group with both formulas (P = .014 and P = .027, respectively). Intragroup differences between formulas were not statistically significant (CTR, P = .069; control P = .551). CONCLUSIONS: Implantation of a CTR had no consistent effect on refractive outcomes compared with routine phacoemulsification in highly myopic eyes. There was a tendency toward higher precision in outcomes with a CTR. Results indicate IOL power calculation does not have to be changed when a CTR is used.