Phototherapeutic keratectomy (PTK) for treatment of recurrent corneal erosion: Correlation between etiology and prognosis - prospective longitudinal study.

BACKGROUND: To evaluate and compare the efficacy of phototherapeutic keratectomy (PTK) for recurrent corneal erosion (RCE) caused by trauma, map-dot-fingerprint dystrophy (MDF) or instances without an established cause. METHODS: Single center prospective longitudinal study. Between January 2003 and November 2006 we treated 89 eyes of 82 patients with PTK. All patients presented with refractory RCE caused either by trauma, MDF or with no established cause. During follow-up (until May 2013), patients, treating ophthalmologists and/or family doctors were interviewed about the patients' state of health, recurrence of pain, the necessity of further treatments or the occurrence of complications. Five patients died or were lost during follow-up and were thus excluded from the analysis. Freedom of recurrence was estimated using logistic regression analysis using indicator variates for the following three etiologic groups: trauma (55 eyes), MDF (29 eyes) and idiopathic (no established cause; 5 eyes). RESULTS: Overall 89 eyes of 82 patients were followed-up. Average follow-up among failures and non-failures was 51.56 months (standard deviation (SD) 21.22, range 24 to 91) and 95.25 months (SD 15.99, range 35 to 137 months), respectively. Fifty-seven percent were female and the average age at first PTK was 45.3 years (range: 23 to 70 years). During follow-up, there were 25 recurrences and 15 of these patients received a re-PTK. Compared to patients with a traumatic cause of epithelial erosions, the likelihood of experiencing a recurrence was higher in patients with MDF [odds ratio (OR) 5.48; 95 % confidence interval (CI) 1.93 to 15.59; p = 0.001]; the OR was 8.81 (95 % CI 1.27 to 61.32; p = 0.028) for patients with an idiopathic cause. CONCLUSIONS: In view of the available evidence, we want to raise the awareness of those managing patients with MDF and idiopathic causes that, in order to control the disease, recurrent PTK treatments are expected to be necessary more often than in cases of traumatic RCE.

Corneal limbal marking in the treatment of myopic astigmatism with the excimer laser.

PURPOSE: To determine whether preoperative marking of the limbal cornea improves treatment of myopic astigmatism with the excimer laser. METHODS: Retrospective study on 108 eyes with myopic astigmatism that underwent LASIK or laser epithelial keratomileusis (LASEK) with the Technolas 217 (Bausch & Lomb) excimer laser. Preoperative limbal marking was performed in 47 eyes (marked group). The 12-month results were used for refractive and visual analysis. RESULTS: The achieved cylinder reduction, spherical reduction, and refractive predictability were similar for the marked and unmarked groups in the overall study collective, in the LASIK and LASEK subgroup analysis, and in a higher astigmatism (> 1.25 diopters) subgroup analysis. Limbal marking showed no influence on the refractive results, and vector analysis showed no significant difference in angle of error among groups. CONCLUSIONS: Corneal limbal marking failed to improve the refractive outcome in LASIK and LASEK for myopic astigmatism.

Mutation of solute carrier SLC16A12 associates with a syndrome combining juvenile cataract with microcornea and renal glucosuria.

Unobstructed vision requires a particular refractive index of the lens, a measure based on the organization of the structural proteins within the differentiated lens cells. To ensure an intact lens structure, homeostasis within the lens cells is indispensable. Alterations of the lens structure result in opacity and lead to cataract. Renal glucosuria is defined by elevated glucose level in the urine without hyperglycemia and without evidence of morphological renal anomalies. In a Swiss family with autosomal dominant juvenile cataract, microcornea, and renal glucosuria, we have identified a nonsense mutation in a member of the carboxylic acid transporter family SLC16. The underlying gene defect in SLC16A12 resides within a 3 cM region on chromosome 10q23.13 defined by linkage mapping of this phenotype. We found tissue-specific variability of SLC16A12 transcript levels in control samples, with high expression in the eye and kidney, the two organs affected by this syndrome. This report demonstrates biological relevance of this solute carrier. We hypothesize that SLC16A12 is important for lens and kidney homeostasis and discuss its potential role in age-related cataract.

Combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in severe proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVE: To evaluate the results of combined vitrectomies and intraocular lens implantations in cases of proliferative diabetic retinopathy. PATIENTS AND METHODS: Data from procedures on 117 eyes (91 patients) undergoing combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation for the complications of proliferative diabetic retinopathy were analyzed retrospectively. Follow-up ranged from 8 to 64 months (median = 25 months). RESULTS: Retinal tears were the most frequent intraoperative problems (19%). Limited postoperative fibrin formation occurred in 22% of eyes. Within 6 months, 7% developed glaucoma and 2% showed new anterior segment rubeosis. Overall, 10% underwent secondary surgical procedures as follows: lavage for hemorrhage (n = 3), silicone oil exchange after 7 days for focal rebleeding (n = 1), silicone oil surgery for retinal detachment after gas resorption (n = 1), and lavage for late vitreous hemorrhage (7 to 13 months) (n = 4). Half of the secondary procedures were necessitated within 3 months of the original surgery. CONCLUSIONS: Combined surgery in proliferative diabetic retinopathy is safe and effective. It should be considered when lens opacities are either present or likely to develop soon.

A novel complex mutation event in the peripherin/RDS gene in a family with retinal pattern dystrophy.

PURPOSE: To report a complex mutation in the peripherin/RDS gene found in a family in whom retinal pattern dystrophy is segregating as an autosomal dominant trait. METHODS: Clinical data were collected from family members of a large Swiss family affected by autosomal dominant retinal pattern dystrophy. Single strand conformation polymorphism (SSCP) analysis of the candidate gene peripherin/RDS and subsequent sequencing of the first exon were performed. RESULTS: Pattern dystrophy of the retina was suspected in 18 family members aged 30 years or older. Assuming a homogeneous phenotype, the candidate locus peripherin/RDS was investigated. SSCP analysis of the first exon of the peripherin/RDS gene showed an aberrant pattern in 18 affected individuals. Direct sequencing of polymerase chain reaction products detected a complex mutation, del265-268GCCA ins AGGGCC, leading to a stop codon at amino acid position 99. CONCLUSION: To our knowledge, we report the first complex mutation in the peripherin/RDS gene as the cause of a mild macular phenotype, supporting the importance of molecular diagnosis in genetic counseling.

Diagnosis and management of bilateral posterior lenticonus in 7 members of the same family.

PURPOSE: To report on the occurrence of monosymptomatic bilateral posterior lenticonus in 7 members of the same family and discuss the diagnoses and methods of management. SETTING: Eye Clinic, Cantonal Hospital, Lucerne, Switzerland. METHODS: Two sisters were found to suffer from bilateral posterior lenticonus. The 3 sons of the elder sister and the 2 daughters of the younger sister all presented with bilateral posterior lenticonus. A cataract operation or a clear lens extraction with intraocular lens implantation was performed in 4 of the 7 patients. RESULTS: The disorder was found to be inherited and to follow a pattern of autosomal dominance. Visual acuity improved to 20/20 in all operated eyes. CONCLUSION: This may be the largest group in 1 family presenting with bilateral posterior lenticonus described to date. Treatment of posterior lenticonus, if necessary, can be successfully managed as an ordinary cataract.

Glare sensitivity and optical side effects 1 year after photorefractive keratectomy and laser in situ keratomileusis.

PURPOSE: To compare the outcome of low-contrast visual acuity and glare sensitivity after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Cantonal Hospital of Lucerne, Lucerne, Switzerland. METHODS: In this prospective study, patients selected PRK or LASIK after the advantages and disadvantages of both had been described. Snellen visual acuity and disability glare were measured with the Berkeley glare test preoperatively and 1 year postoperatively. At the 1-year follow-up, haze was graded and patients had to assess their quality of vision subjectively. RESULTS: One-year follow-up of 58 patients in the PRK group and 64 patients in the LASIK group was achieved. In both groups, the mean uncorrected visual acuity was 20/32 (P =.63) and the mean best corrected visual acuity, 20/20 with no statistically significant difference (P =.20). There were no preoperative or postoperative differences between the 2 groups in low-contrast visual acuity under 4 glare conditions. At 1 year, LASIK eyes had significantly lower postoperative haze scores than PRK eyes (P =.0013). The number of eyes with visually moderate and disturbing halos or disturbances in night vision did not differ considerably between the groups (P =.88). CONCLUSIONS: Efficacy outcomes were generally similar in the PRK and LASIK groups. Both achieved good objective and subjective results after treatment with a second-generation excimer laser.

[Pars plana vitrectomy for pseudophakic retinal detachment]. / Primäre Pars-plana-Vitrektomie zur Behandlung der Pseudophakieamotio - eine retrospektive Studie über 129 Fälle.

BACKGROUND: Pars plana vitrectomy, usually without additional buckling procedures, is the first choice for repair of pseudophakic retinal detachment at the Lucerne Eye Hospital. PATIENTS AND METHODS: In a retrospective study we analyzed a consecutive series of 129 eyes (122 patients) treated for pseudophakic retinal detachment. All underwent a primary pars plana vitrectomy. 97 % had retrobulbar anaesthesia. SF6 was used in 93 %, Si-oil in 7 %. An additional encircling band was placed in 5 %. Mean age was 65 years (24 - 92, +/- 13). Minimal follow-up was 8 months (8 - 66, median 25). RESULTS: Mean duration of surgery was 90 minutes (50 - 140, +/- 15). Severe PVR grade C was present in 17 %. Breaks in the inferior part of the retina were found in 52 % - the localisation had no influence on the anatomical or functional outcome. A difference between preoperative and intraoperative findings was noted in 46 % (missed breaks or lattice degenerations etc.). For general medical reasons, Si-oil was not removed in 4 eyes. Complete reattachment after the first operation was achieved in overall 91 % (oil-left eyes were considered as failure); in 95 %, if the oil-left eyes were excluded from the study; in 93 %, if the eyes with encircling band were not counted; in 95 % without encircling-band and oil-left eyes; in 93 % without PVR-C cases; 95 % without encircling-band/oil-left/PVR-C eyes. Median final visual acuity was 1.0, if the macula was not detached preoperatively and 0.8, if the macula was detached. Intraocular pressure problems (> 30 mm Hg < 12 h and/or > 25 mm Hg > 36 h) were noted in 28 %. Prophylactic or therapeutic antiglaucomatous medication was applied in 58 %. 14 % showed a transient fibrin reaction in the anterior segment. Refraction and ocular motility were not influenced by the surgery. CONCLUSION: Primary vitrectomy for pseudophakic retinal detachment is safe and effective. Transient elevation of the intraocular pressure is a frequent postoperative complication.