Effects of Nd-YAG Laser iridotomy on anterior segment measurements in pigment dispersion syndrome and ocular hypertension.

PURPOSE: To compare the anterior segment optical coherence tomography (AS-OCT) measurements of eyes with pigment dispersion syndrome (PDS) and ocular hypertension (OHT) before and after neodymium:yttrium-aluminum-garnet (Nd:YAG) laser peripheral iridotomy (LPI). METHODS: A total of 23 eyes of 23 patients with PDS and OHT with features of PDS were included in this retrospective study. All of the eyes with PDS and OHT were examined by AS-OCT before and after Nd:YAG LPI. Anterior chamber depth, angle opening distance 500, angle opening distance 750, trabecular iris space 500, trabecular iris space 750 and scleral spur angle, iris bowing and iris shape were measured with AS-OCT by the same examiner. RESULTS: The differences in all parameters before and after Nd:YAG LPI were statistically significant. Iris configuration was concave in all eyes prior to iridotomy. After Nd:YAG laser iridotomy, the iris configuration became convex in 7 eyes, flat in 9 eyes and remained concave in 7 eyes. CONCLUSION: Nd:YAG laser peripheral iridotomy is an effective method for reversing the iris concavity and iris bowing in pigment dispersion syndrome.

Short and long term outcomes after small-incision lenticule extraction: A tertiary referral centre experience.

PURPOSE: The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE). METHODS: Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded. RESULTS: Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected. CONCLUSION: This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.

Analysis of retinal microvasculature in Fuchs' uveitis syndrome. Retinal microvasculature in Fuchs' uveitis.

PURPOSE: The objective of this study is to quantitatively analyse the foveal microvasculature in eyes with Fuchs' Uveitic Syndrome (FUS), or Fuchs' Heterochromic Iridocyclitis (FHI), by Optical coherence tomography angiography (OCTA). METHODS: Thirty patients with FUS and 30 healthy volunteer patients (control group) were enrolled in the study. Vascular density (VD) in the superior and deep capillary plexuses (SCP, DCP) were reported and compared between eyes with FUS (FU), fellow eyes (FE) and the control group. RESULTS: Foveal VD and parafoveal VDs in all quadrants of the SCP were significantly lower in the FU group than the FE group and normal eyes (P<0.05). Foveal VDs in the DCP were similar between the three groups (P>0.05); however, parafoveal VDs in all quadrants of the DCP were significantly lower in the FU group than in the FE and control eyes (P<0.05). Foveal and parafoveal VDs in both the SCP and DCP were similar between fellow eyes and the control group. CONCLUSION: Fuchs' Uveitic Syndrome (Fuchs' Heterochromic Iridocyclitis) affects not only the anterior uvea and vitreous but also the retinal microvasculature. Analysis by OCT-A may enable us to understand the extent of this disease.

Rate of hypotony and intraocular pressure fluctuation immediately after intravitreal dexamethasone implantation in vitrectomized eyes.

PURPOSE: To observe the rate of hypotony and intraocular pressure (IOP) fluctuations immediately following intravitreal dexamethasone implantation in vitrectomized eyes. METHODS: The study included previously vitrectomized eyes scheduled to receive intravitreal dexamethasone implants. IOP measurements were performed at minute 1, minute 10, hour 1, hour 2, hour 3 and day 1. The primary outcome measure of the study was the rate of hypotony at the various time points, while the secondary outcome measure was the IOP profile over time. RESULTS: A total of 26 eyes were enrolled in the study. Immediately following the injection, 11 (42.3%) of the eyes exhibited an IOP<6mm Hg. Hypotony was observed in one eye (3.8%) at hour 3 and day 1. After the immediate IOP reduction, IOP recovered rapidly and showed a peak at hour 1, with 5 eyes (19.2%) exhibiting IOP levels ≥25mmHg and 1 eye (3.8%) ≥30mm Hg. Aside from the eye with persistent hypotony resulting in a choroidal effusion, no other complication was observed. CONCLUSIONS: Injection of dexamethasone implants in vitrectomized eyes resulted in immediate IOP reduction. Hypotony showed a short, self-limited course in the majority of eyes. In the presence of additional risk factors for wound incompetency, regular follow-up in the early post-injection period appears to be needed.

Multimodal imaging based biomarkers predictive of early and late response to anti-VEGFs during the first year of treatment for neovascular age-related macular degeneration.

PURPOSE: To evaluate baseline predictive markers of early and late anatomical response to anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD). METHODS: The records of the nAMD patients who underwent intravitreal ranibizumab or aflibercept treatment, received the 3 monthly loading doses, and completed a follow-up period of 12 months were included retrospectively. The anatomical treatment response at month 3 (early) and between month 3 and 12 (late) was classified as good, intermediate or poor. Baseline demographic, fluorescein angiography, and optical coherence tomography findings were compared among the three groups. RESULTS: One hundred and ten eyes (74.3%) showed good, 18 (12.2%) showed intermediate and 20 (13.5%) showed poor anatomical response at month 3, and 114 eyes (77.0%) showed good, 27 (18.2%) showed intermediate and 7 (4.7%) showed poor anatomical response between month 3 and month 12. Of the evaluated parameters, drug type (better in aflibercept), showed a statistically significant difference in regards to anatomical outcomes at both the early and late periods (P=0.02 and P=0.03). The greatest linear dimension of choroidal neovascularization (CNV) and presence of peaked pigment epithelial detachment (PED) were important factors for early anatomical anti-VEGF treatment response. CONCLUSION: Larger CNV and the presence of a peaked PED appeared to be associated with a good early response, and the drug type seemed to be associated with both early and late poor anatomical response of anti-VEGF treatment in nAMD patients. Aflibercept appears to be more effective than ranibizumab in regards to the percentage of patients with better anatomical response in both the early and late treatment periods.

Clinical and imaging findings of pattern dystrophy subtypes; Diagnostic errors and unnecessary treatment in clinical practice.

PURPOSE: To evaluate the clinical and multimodal imaging findings of various pattern dystrophy (PD) subtypes and report the initial misdiagnosis rate of PD patients resulting in unnecessary treatment in actual clinical practice. METHODS: Retrospective, observational study. Forty eyes of 24 patients with PD were included. The distribution of PD subtypes, optical coherence tomography (OCT) and fundus autofluorescence (FAF) findings, initial misdiagnoses, revised diagnoses, duration between misdiagnosis and revised diagnosis, and unnecessary treatments administered were evaluated over this time-period. RESULTS: Twenty-eight eyes (70%) showed adult-onset foveomacular vitelliform dystrophy, 6 eyes (15%) showed butterfly PD (BPD), 4 eyes (10%) showed reticular PD, and 2 eyes (5%) showed PD simulating fundus flavimaculatus and BPD mixed type PD. Most of the patients showed various types of hyperreflective material in the subretinal space on OCT, and hyperautofluorescence on FAF imaging. Eighteen eyes (45%) had a true PD diagnosis initially, whereas 22 (55%) of them were misdiagnosed as age-related macular degeneration, central serous chorioretinopathy, or non-specific RPE change. The mean duration between the initial and revised diagnosis was 18.7±16.8 months. In addition, 5 eyes in the misdiagnosed group underwent intravitreal anti-vascular endothelial growth factor treatment during this period. CONCLUSION: Pattern dystrophies are a heterogeneous group of macular disorders which may mimic several macular diseases. By knowing the multimodal imaging findings, especially the distinctive FAF findings of the PDs, we may easily diagnose the disease and save our patients from unnecessary treatments.

Changes in pupil size following panretinal retinal photocoagulation: conventional laser vs pattern scan laser (PASCAL).

PurposeTo evaluate and compare the possible changes in pupil size subsequent to panretinal laser photocoagulation (PRP) via conventional laser and pattern scan laser (PASCAL).Patients and methodsForty eyes of 40 patients with diabetic retinopathy were included. 20 eyes had a PRP via conventional laser and formed Group 1. 20 eyes had a PRP via PASCAL laser and formed Group 2. The participants underwent standard ophthalmologic examination at baseline. Automated infrared pupillometry were performed at baseline and month 1.ResultsThe mean pupillary measurements (mm) for Group 1 (in the order photopic, mesopic, and scotopic conditions) were 2.88±0.34, 3.38±0.40, and 3.95±0.38, and changed to 3.64±0.42, 4.18±0.42, and 4.58±0.48, respectively. There was significant increase in pupil size at month 1 (P<0.001, P<0.001, and P<0.00, respectively). For Group 2, they were 2.90±0.38, 3.43±0.36, and 3.90±0.40, and changed to 3.18±0.42, 3.74±0.36, and 4.10±0.38, respectively. There was significant increase in pupil size at month 1 (P=0.018, P=0.014, and P=0.014, respectively). The pupil size increased significantly in both groups in all illumination conditions.ConclusionWe have demonstrated via automated infrared pupillary measurements that PRP may significantly increase pupil size whether it is performed with conventional laser or PASCAL laser.

The time of resolution and the rate of recurrence in acute central serous chorioretinopathy following spontaneous resolution and low-fluence photodynamic therapy: a case-control study.

PurposeTo evaluate the resolution time and the recurrence rate of acute central serous chorioretinopathy (CSC) after spontaneous resolution and low-fluence photodynamic therapy (PDT).MethodsCase-control study: The CSC patients who were admitted to our clinic for the first time were included. No treatment was given during the first 6 months. Patients were treated with PDT after 6 months from the initial signs of the disease, if they did not show any sign of resolution. The patients who showed a significant decrease in subretinal fluid after month 6 were not scheduled for PDT. The primary outcomes were the resolution time and the recurrence rate after the first episode. Secondary outcome measures were the change in BCVA and CRT during the follow up.ResultsA total of 77 consecutive eyes of 77 patients were included, 41 eyes (53.2%) with spontaneously resolved CSC and 36 eyes (46.8%) with PDT-treated CSC. The initial resolution time was 4.1±3.2 months in spontaneous resolution group, and 8.1±0.8 months in PDT group, respectively (P<0.001). The recurrence rate was 51.2% in spontaneous resolution group, and 25% in PDT group (P=0.01). The change in BCVA from baseline to the last follow-up visit was statistically significant in both groups (P=0.002, P=0.003, respectively). The change in CRT from baseline to the last follow up was also statistically significant in both groups (P=0.002, P=0.003, respectively).ConclusionsThe recurrence rate of acute CSC was lower in PDT-treated patients than the spontaneously resolved patients.

The role of indocyanine green angiography imaging in further differential diagnosis of patients with nAMD who are morphologically poor responders to ranibizumab in a real-life setting.

PurposeTo evaluate the neovascular age-related macular degeneration (nAMD) in patients who were morphologically poor responders to intravitreal ranibizumab (IVR) treatment using indocyanine green angiography (ICGA) for further investigation.MethodsThis was a cross-sectional, retrospective study. The patients with an initial diagnosis of nAMD who made through the clinical examination, optical coherence tomography, and fluorescein angiography imaging, and were treated with at least three monthly IVR injections that resulted with a morphological poor response, were included. ICGA was obtained from the patients and evaluated in regard to differential diagnosis of other macular diseases, which might mimic nAMD.ResultsThe study included 132 eyes of 117 patients. The mean age was 67.4±9.4 years. After ICGA imaging, 13 eyes (9.8%) were diagnosed as true nAMD, 74 eyes (56.1%) as polypoidal choroidal vasculopathy (PCV), 35 eyes (26.5%) as chronic central serous chorioretinopathy (CSC), 3 eyes (2.3%) as retinal angiomatous proliferation (RAP), 3 eyes (2.3%) as choroidal neovascularization secondary to CSC, 2 eyes (1.5%) as adult-onset vitelliform macular dystrophy, and 2 eyes (1.5%) as drusenoid pigment epithelial detachment with vitelliform material, respectively. The duration between the initial diagnosis and the revised diagnosis was 15.6±10.5 months in the non-AMD group, and the mean injection number of these patients was 6.6±4.4.ConclusionsMost of the nAMD patients who were thought to be morphologically poor responders to IVR were diagnosed as having non-AMD diseases via ICGA. A detailed differential diagnostic work-up is needed before considering these patients as poor responders.

Surgical outcome of coaxial phacoemulsification with torsional ultrasound after a 2.4 mm versus 3.2 mm clear corneal temporal incision.

PURPOSE: This study aimed to evaluate and compare outcomes of phacoemulsification surgery with purely torsional ultrasound in coaxial small incision procedures. METHODS: This study was a prospective observational series of 50 eyes of 50 patients with age-related cataracts. There were two groups each with 25 eyes. Group 1 eyes were treated with microcoaxial phacoemulsification using a 2.4 mm temporal clear corneal incision; group 2 eyes were treated with phacoemulsification using a 3.2 mm temporal clear corneal incision. Both groups underwent a standardised surgical procedure using purely torsional ultrasound. Outcome measures were best corrected visual acuity, percentage increase in postoperative corneal thickness, and surgically-induced astigmatism assessed at day 1, week 1, month 1 and month 3 postoperatively. RESULTS: Both groups were comparable with respect to age, cataract grading and intraoperative parameters such as cumulative dissipated energy and irrigation volume. The only statistically significant outcome difference was surgically induced astigmatism at postoperative day 1 (higher in group 2). Intraoperative and early postoperative complications were similar in both groups. CONCLUSIONS: Coaxial phacoemulsification with purely torsional ultrasound produced satisfactory results for 2.4 mm and 3.2 mm incisions. There were no differences in outcomes between groups.

Topical apraclonidine to diagnose Bernard-Horner syndrome.

This study aimed at developing through three clinical cases, the usefulness of topical apraclonidine 0.5% to confirm a diagnosis of Bernard-Horner syndrome. Pupil diameter measurements were performed in indoor, bright and dim light successively. Apraclonidine 0.5% was then applied topically to both eyes, and pupils were observed at 30 and 60 minutes. Apraclonidine demonstrated denervation hypersensitivity in all three cases. Anisocoria was reversed in two cases and corrected in the third case. Although the cocaine test should still be considered as the gold standard for BHS diagnosis, apraclonidine seems to be a useful drug to confirm clinically diagnosed Bernard-Horner syndrome

Comparison of sulcus implantation of single-piece hydrophilic foldable acrylic and polymethylmethacrylate intraocular lenses in eyes with posterior capsule tear during phacoemulsification surgery.

PURPOSE: To compare the results of sulcus implantation of acrylic and poly(methylmethacrylate) (PMMA) intraocular lens (IOL) in eyes with posterior capsule tear during phacoemulsification surgery. METHODS: In all eyes a posterior capsule tear developed during phacoemulsification surgery and an IOL to the ciliary sulcus was implanted primarily. A total of 89 eyes of 88 patients received hydrophilic foldable acrylic IOL (acrylic group). A total of 72 eyes of 72 patients received PMMA IOL (PMMA group). The mean age was 67.1 years and 68.1 years and postoperative follow-up period was 19.2 months and 17.9 months in acrylic and PMMA groups, respectively. RESULTS: Temporary corneal edema appeared in 33 eyes and 26 eyes, elevation of intraocular pressure in 17 eyes and 12 eyes, anterior chamber inflammatory reaction in 5 eyes and 5 eyes, clinical cystoid macular edema in 7 eyes and 12 eyes, and decentered IOL in 4 eyes and 3 eyes in acrylic and PMMA groups, respectively. Late postoperative endophthalmitis developed in two eyes of the PMMA group. Rhegmatogenous retinal detachment developed in one eye in each group. Final best-corrected visual acuities were 5/10 and above in 73 eyes (82.02%) in the acrylic group and 5/10 and above in 42 eyes (58.33%) in the PMMA group. Postoperative final induced astigmatism was 0.5+/-0.5 D (SD) in the acrylic group and 1.11+/-0.65 D (SD) in the PMMA group (p=0.0001) (independent samples t-test). CONCLUSIONS: Increased astigmatism is more frequently seen in the PMMA group. The implantation of foldable acrylic IOL in the sulcus after posterior capsule tear maintains the advantages of small incision surgery.

[Treatment of diabetic macular edema with intravitreal triamcinolone acetonide injection: functional and anatomical outcomes]. / Traitement de l'oedème maculaire diabétique par injection intravitréenne d'acétonide de triamcinolone: conséquences fonctionnelles et anatomiques.

PURPOSE: This prospective study aimed to investigate the effectiveness and safety of intravitreal triamcinolone acetonide (TA) injection in diabetic macular edema unresponsive to an initial argon laser photocoagulation procedure. MATERIAL: and methods: Fifty-six eyes of fifty patients were included in this study. All the eyes had refractory and clinically significant diabetic macular edema with a central macular thickness (CMT) greater than 300 microm. All the eyes were injected 4 mg/0.1 ml TA intravitreally. The main outcome parameters were best corrected visual acuity (BCVA) and CMT. Elevation of intraocular pressure (IOP) and other potential complications were monitored carefully. All the patients were followed at least 9 months. RESULTS: Preinjection mean BCVA was 0.128+/-0.11 and statistically significant improvement in BCVA started in the 1st week and was observed during the first 6 months of the follow-up period. BCVA reached 0.289+/-0.19 at the 2nd month and decreased gradually to 0.169+/-0.1 at the 9th month. However, clinically significant improvement after TA injection in BCVA (> or =0.2) was observed in 50%, 67.8%, 67.8%, 28.5%, and 12.5% of the eyes in the 1st, 2nd, 3rd, 6th, and 9th months, respectively. The central macular thickness measured by OCT, which was reduced by 45% at the 3rd month, returned nearly to its initial level at the 9th month. High IOP was observed in 35.7% of eyes and appeared between the 1st week and the 2nd month. Other complications were cataract development and progression (7.1%), pseudoendophthalmitis (3.56%), and bacterial endophthalmitis (1.78%). CONCLUSION: Intravitreal TA injection is a relatively safe and beneficial therapeutic method for intractable diabetic macular edema. The recurrence of edema warrants reinjections, even though the risk of complication is higher, especially infectious endophthalmitis, which might be devastating. Further studies should be conducted with newer, slow corticosteroid release methods such as intravitreal devices in the treatment of diabetic macular edema.

[Calcification of hydrophilic acrylic intraocular lenses: clinical and pathological aspects]. / Calcification postopératoire des lentilles intraoculaires acryliques hydrophiles: aspects cliniques et pathologiques.

PURPOSE: The aim of this study was to evaluate the clinical aspects of ten eyes with calcified hydrophilic acrylic intraocular lenses and pathological data obtained from seven explanted lenses. MATERIAL AND METHODS: Forty-seven eyes of 40 patients received the same implant in the first 6-month period of 2001. Ten eyes showed intraocular lens opacification detected 6-18 months after the operation: seven lenses were explanted and three were left in place because they were not causing a decrease in visual acuity or glare at light. Five of ten eyes were diabetic. The explanted lenses were examined under the light microscope and the electron microscope. The elemental analysis of the lens surfaces was made by energy dispersive spectrometry. RESULTS: The light microscopy showed an irregular surface covered by a gray-white opacity. The electron microscopy detected multiple granulations on the front and back surfaces of the lenses including some portions of the haptics. The size and density of these granulations were smaller on the back surface. The energy dispersive spectrometry showed the presence of calcium and phosphate on both surfaces. The spikes of calcium and phosphate were smaller for the back surface of the lenses. DISCUSSION: Calcification was predominantly seen on the surfaces that were in contact with aqueous not covered with anterior capsule. Half (5/10) of the cases were diabetic even though 18% of all patients receiving this lens were diabetic. The presence of diabetes is very common in other series. These data suggest the role of a metabolic factor influencing the milieu of the lens in this calcification process. CONCLUSION: Calcification of the hydrophilic acrylic lenses is a relatively serious complication, but the conditions leading to its appearance and the physiopathology have not yet been fully elucidated. The surgeon should be very careful in the choice of the intraocular lens to implant, and even more so if the patient is diabetic.