Unilateral Spontaneous Descemet Membrane Rupture in a Case With Megalophthalmos.

OBJECTIVE: To report a case of unilateral spontaneous descemet membrane rupture associated with megalophthalmos. METHODS: A case report of a 23-year-old woman with blurred vision of the right eye for 6 months due to spontaneous descemet membrane rupture associated with megalophthalmos is described. Slit-lamp examination demonstrated corneal edema and suggestion of a descemet membrane rupture in the right eye. RESULTS: Anterior segment optical coherence tomography verified the presence of a ruptured descemet membrane separated from the nasal posterior cornea along with corneal edema and intraepithelial cystic lesions. With A-scan ultrasonography, axial lengths were 32 and 28 mm in OD and OS, respectively. Indirect gonioscopy demonstrated a wide iridocorneal angle and a ciliary body band, bilaterally. Corneal pachymetry measurements were performed with Pentacam HR Scheimpflug topography which measured the central corneal thickness 360 µ in OD and 300 µ in OS. CONCLUSIONS: Megalophthalmos and spontaneous descemet membrane rupture are rare conditions. To the best literature knowledge, this is the first report of descemet membrane rupture in megalophthalmos.

Assessment of anterior chamber parameters after cataract surgery by Galilei dual Scheimpflug analyzer.

OBJECTIVE: To quantify the difference between anterior chamber parameters determined by the Galilei dual Scheimpflug analyzer after uneventful cataract surgery in normotensive eyes. METHODS: In this study, 39 eyes of 30 patients (11 men and 19 women) who had uneventful cataract surgery with phacoemulsification were evaluated preoperatively, and at 1 month postoperatively with the Galilei. We investigated the measurements including anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), and the 3-, 5-, and 7-mm corneal thickness (CT) preoperatively and postoperatively. RESULTS: The differences between ACD (P=0.01), ACA (P=0.07), ACV (P=0.01), and 7-mm CT (P=0.01), and intraocular pressure (P=0.03) were statistically significant after the first month of phacoemulsification. However, the differences between CCT (P=0.60), 3-mm CT (P=0.75), and 5-mm (P=0.17) CT were not statistically significant. CONCLUSIONS: After the first month of cataract surgery, a significant increase was observed in ACD, ACV, ACA, and 7-mm CT parameters, which were practically determined by a new noncontact Scheimpflug imagining system.

The activities of paraoxonase, xanthine oxidase, adenosine deaminase and the level of nitrite in pseudoexfoliation syndrome.

AIM: Our purpose was to investigate the possible roles of nitrite levels and the activity of paraoxonase (PON), xanthine oxidase (XO) and adenosine deaminase (ADA) in the pathogenesis of pseudoexfoliation (PEX) syndrome. METHODS: Serum samples were taken from 43 patients with PEX and 41 control subjects. The serum PON, XO and ADA activities and nitrite levels were assayed by spectrophotometric methods. RESULTS: The PON, ADA and XO activities and nitrite levels (means +/- standard deviation) were 81.72 +/- 42.56 U/ml, 19.75 +/- 5.72 U/l, 0.16 +/- 0.09 U/l and 94.23 +/- 27.72 micromol/l in the PEX group, respectively. In the control group, the PON, ADA and XO activities and the nitrite levels were 111.02 +/- 43.51 U/ml, 15.21 +/- 3.93 U/l, 0.13 +/- 0.06 U/l and 61.96 +/- 19.05 micromol/l, respectively. The serum PON activity was significantly lower in the PEX group when compared with the control group. The serum XO and ADA activities and nitrite levels were significantly higher in the patients with PEX when compared with the control subjects. CONCLUSION: Decreased PON (an antioxidant enzyme) activity as well as increased ADA and XO activities and nitrite levels indicate that oxidative stress is increased and purine metabolism is altered in PEX syndrome.

Evaluation of Aqueous Endocan and Endostatin Levels in Patients With Pseudoexfoliation Syndrome.

PURPOSE: The purpose of the present study was to evaluate the aqueous humor endocan and endostatin levels in patients with pseudoexfoliation (PEX) syndrome and to compare the results with healthy individuals. MATERIALS AND METHODS: Twenty nine cataract patients with PEX syndrome (PEX group) and 32 cataract patients without PEX syndrome (control group) were enrolled in the study. Endocan and endostatin were measured in the aqueous humor of the PEX and control groups by enzyme-linked immunosorbent assay. RESULTS: There was no difference between the PEX and control groups in terms of age (P=0.721) and sex (P=0.902). The aqueous levels of endocan in patients with PEX (26.39±5.80 pg/mL) was significantly higher than in the control group (11.42±2.44 pg/mL) (P=0.039). The aqueous levels of endostatin was 12.00±1.35 ng/mL in the PEX group and 14.22±3.31 ng/mL in the control group, however, the difference was not statistically significant (P=0.41). CONCLUSIONS: The findings of the present study could suggest that the increased levels of aqueous endocan may be related to pathogenesis of PEX. However, levels of aqueous endostatin did not show any significant difference in PEX.

Inhibitory effects of topical thymoquinone on corneal neovascularization.

PURPOSE: Thymoquinone, one of the biologically active components of black seed oil, has anti-inflammatory and antioxidant properties. We aimed to study the effect of thymoquinone on corneal neovascularization in rats and to compare its efficacy with that of triamcinolone acetonide. METHODS: Chemical cauterization of the cornea was performed with silver nitrate/potassium nitrate sticks in 40 eyes in 40 rats. An examiner blinded to the experiments scored the intensity of the cauterization. Topical instillation of thymoquinone 0.1%, thymoquinone 0.4%, and triamcinolone acetonide was continued for 7 days. The inhibitory effects of the drugs on corneal neovascularization were tested and compared with each other and with controls with a computer program that evaluates percent areas of cornea covered by neovascularization. RESULTS: The means of percent area of corneal neovascularization in the thymoquinone 0.1%, thymoquinone 0.4%, triamcinolone acetonide, and control groups were 60.1%, 45%, 46%, and 72%, respectively. The inhibitory effect of thymoquinone 0.4% was found to be equal to that of triamcinolone acetonide (P = 0.87). The thymoquinone 0.4% and triamcinolone groups were different from the thymoquinone 0.1% and control groups (P < 0.05). There was also a significant difference between the percent area of corneal neovascularization in the thymoquinone 0.1% group and that of the controls (P < 0.05). The mean burn stimulus intensities were not different among the groups (P = 0.54). CONCLUSIONS: Thymoquinone was shown to have an inhibitory effect, comparable with that of triamcinolone, on corneal neovascularization in this rat model. However, thymoquinone decreased corneal neovascularization in a dose-dependent manner.

Lack of association between pseudoexfoliation syndrome and manganese superoxide dismutase polymorphism.

PURPOSE: The aim of this clinical study was to investigate the possible association between manganese superoxide dismutase (Mn-SOD) enzyme polymorphism in the mitochondrial targeting sequence and pseudoexfoliation syndrome. METHODS: Ala (GTT) or Val (GCT) polymorphism in the signal peptide of Mn-SOD gene was evaluated using a primer pair to amplify a 107-bp fragment followed by digestion with restriction enzyme NgoM IV. RESULTS: The frequencies of Ala-9 and Val-9 variants and genotypes of Mn-SOD were similar in the controls and pseudoexfoliation syndrome patients. CONCLUSIONS: These results suggest no major modifying role for the Mn-SOD gene polymorphism in patients with pseudoexfoliation syndrome.

Corneal curvature and central corneal thickness in eyes with pseudoexfoliation syndrome.

BACKGROUND: Previous studies have reported different central corneal thickness (CCT) values in eyes with pseudoexfoliation syndrome (PXS). There has been no report about corneal curvature (CC) in PXS eyes. The aim of this study was to investigate the CCT together with the CC in PXS eyes with and without glaucoma. METHODS: The CC (simulated keratometry 1 [SimK1], SimK2, and mean K) and CCT were prospectively studied by rotating a Scheimpflug camera in 72 PXS eyes and comparing them with 65 normal eyes. RESULTS: In all PXS eyes, the mean K was significantly steeper than in control eyes (44.1 [SD 1.5] diopters (D) vs. 43.2 [SD 2.0] D, p = 0.04). When PXS eyes were subcategorized, the mean K was significantly steeper in both normotensive PXS eyes (44.6 [SD 1.6] D) and pseudoexfoliation glaucoma (PEXG) eyes (44.0 [SD 1.2] D) than normal eyes (43.2 [SD 2.0] D) (p = 0.001 and 0.02, respectively). In all PXS eyes, the mean CCT (546.4 [SD 39.6] microm) was not significantly different than the control eyes (542.9 [SD 32.2] microm) (p = 0.56). When PXS eyes were subcategorized, however, the CCT was significantly thinner in normotensive PXS eyes and significantly thicker in PEXG eyes. INTERPRETATION: It appears that PEXG eyes have a significantly steeper CC and higher CCT than normal eyes. This could be of clinical significance because overestimation of true intraocular pressure may then occur in these eyes.

Mature cataracts increase risk of capsular complications in manual small-incision cataract surgery of pseudoexfoliative eyes.

BACKGROUND: To evaluate rates of intraoperative posterior capsule complications in manual small-incision cataract surgery of eyes with and without pseudoexfoliation syndrome in terms of cataract maturity level. METHODS: We identified patients who had undergone manual small-incision cataract surgery between January 1997 and October 2003 from a review of patient charts. Preoperative data collected were cataract maturity level, best corrected visual acuity, and intraoperative posterior capsule complications as documented in the surgical report, namely (1) posterior capsule rupture or zonulolysis, or both, and (2) vitreous loss. RESULTS: Two hundred and twenty-five eyes of 187 patients met the study criteria, of which 99 eyes had pseudoexfoliation syndrome (group 1) and 126 did not (group 2). Intraoperative posterior capsule complications occurred in 18 eyes (18%) in group 1 and 7 eyes (5.5%) in group 2 (difference was significant at p=0.003). The rate of capsular complications was significantly higher in both groups for eyes with preoperative visual acuity worse than 20/200 than for eyes with 20/200 or better. The number of eyes with visual acuity worse than 20/200 (counting fingers, hand motion, or light perception) was 70 (70%) in group 1 and 63 (50%) in group 2. Mature or brunescent cataract occurred in 49.5% of group 1 eyes and 26% of group 2 eyes. INTERPRETATION: In manual small-incision cataract surgery, pseudoexfoliation syndrome has an increased intraoperative posterior capsule complication rate that increases as the level of cataract maturity increases and the preoperative visual acuity decreases.

Oxidative stress and protein oxidation in pseudoexfoliation syndrome.

PURPOSE: To investigate the oxidant/antioxidant status and protein oxidation in pseudoexfoliation syndrome. METHODS: The activity of serum superoxide dismutase (SOD) and the levels of serum malondialdehyde (MDA) and protein carbonyl (PC) were measured in 50 patients with pseudoexfoliation (PEX) and in 55 healthy controls. RESULTS: There was significant difference in the SOD activity in PEX group compared with the control group (p < 0.001). In addition, MDA and PC levels were significantly higher in patients than in the controls (p < 0.001). CONCLUSIONS: Decrease in SOD activity and the higher levels of MDA and PC indicate increased oxidative stress. Our results suggest a possible role of oxidative stress in pathology of PEX syndrome.

Myopic shift from the predicted refraction after sulcus fixation of PMMA posterior chamber intraocular lenses.

BACKGROUND: To evaluate the refractive results of sulcus-fixated polymethylmethacrylate (PMMA) posterior chamber intraocular lenses (PC IOLs) after cataract surgery with and without posterior capsule complications. METHODS: The charts of patients who had undergone cataract surgery were reviewed, and eyes that had received sulcus-fixated PMMA PC IOLs were included in the study. Postoperative refraction, predicted postoperative refraction for in-the-bag IOL with the same diopter, intraoperative posterior capsular complications and vitrectomy, axial eye length, incision type (corneal or scleral), and surgery type were recorded and analyzed. The difference between actual postoperative refraction and predicted refraction for the in-the-bag lens was calculated for each patient. RESULTS: Of 143 patients (84 men and 59 women), 162 eyes with a sulcus-fixated posterior chamber intraocular lens were investigated. Mean age was 63.7 +/- 12.1 years. A mean myopic shift of -1.02 +/- 0.96 D from the predicted in-the-bag refraction was found. There were no significant differences between eyes with or without vitreous loss-vitrectomy (p = 0.8), eyes with scleral or corneal incisions (p = 0.11), and eyes having phacoemulsification or extracapsular cataract extraction (p = 0.93). In terms of axial length, there were no significant differences between long, normal, or short eyes (p = 0.85). INTERPRETATION: Sulcus fixation of a PMMA IOL originally planned for in-the-bag fixation caused approximately -1.00 D myopic shift in this study. We recommend that when sulcus fixation is necessary PMMA IOL power should be approximately 1.25 to 1.50 D less than the power for in-the-bag fixation. Axial length, incision type, vitreous loss and use of vitrectomy, and type of the surgery do not appear to alter the postoperative refraction significantly in eyes with sulcus fixation.

Correlation between visual function and refractive, topographic, pachymetric and aberrometric data in eyes with keratoconus.

AIM: To analyze the relationship between two visual functions and refractive, topographic, pachymetric and aberrometric indicators in eyes with keratoconus. METHODS: Corrected distance visual acuity (CDVA), and letter contrast sensitivity (CS) were correlated with refraction, corneal topography, pachymetry, and total corneal wavefront data prospectively in 71 eyes with keratoconus. The topographic indices assessed were simulated keratometry for the flattest and steepest meridians (SimK1 and SimK2), posterior steeper K (Ks), elevation value in best-fit sphere (BFS) maps, squared eccentricity (Є(2)), aspheric asymmetric index (AAI), pachymetry, thickness progression index (TPI), the amount of pachymetric decentralization (APD), and GalileiTM-keratoconus indices. RESULTS: The mean CDVA (expressed as logMAR) were 0.25±0.21. The mean CS was 1.25±0.46. The spherical refraction correlated well with CDVA (r=-0.526, P<0.001). From topographic indices, SRI correlated with CS (r=-0.695), and IAI with CS (r=-0.672) (P<0.001 for all). Root mean square (RMS) was 4.3±1.81 µm, spherical aberration (SA) was -0.4±0.67 µm, vertical and horizontal coma were -2.1±1.47 and -0.4±0.72 µm. All wavefront data (except horizontal coma), AAI, Є(2) and maximum BFS correlated significantly with the visual function (P≤0.001 for all). CONCLUSION: In this study, CS is more affected than CDVA as a visual function. The quantity and quality of vision is significantly correlated with well-known and new topographic indices. There is not a significant correlation between visual function and pachymetric parameters. The significantly correlated indices can be used in staging keratoconus and to follow the outcome of a treatment.

Efficacy of Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma.

PURPOSE: In this prospective study, we aimed to investigate the success and safety of a modified 360-degree suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma (XFG). PATIENTS AND METHODS: The modified 360-degree ST was performed on 15 eyes of 15 patients with XFG resistant to maximal topical treatment. In 6 patients, ST was combined with phacoemulsification. Main outcome measures were the surgical success rate, mean postoperative intraocular pressure (IOP), the number of antiglaucoma medications, and the operative complications. RESULTS: The mean follow-up period was 8 months (range 6 to 12 mo). Baseline IOP decreased from 27.53±9.38 mm Hg on 3.26±0.70 medications to 12.86±2.72 mm Hg (P=0.01) on 0.20±0.56 medications (P=0.01) at 6 months postoperatively accounting for a 52.82% reduction. The complete and qualified success rates were 77% and 100%, respectively, at the sixth month. The entire circumference of the Schlemm canal was successfully opened in all cases. Hyphema (in all cases), intraoperative iris prolapse (in 3 cases), transient elevation of the IOP (in 1 case), posterior synechia (in 2 phakic cases), and peripheral anterior synechia (in 1 case) were noted. There was not a trend for lower IOP after combined phacomodified 360-degree ST in this small group. CONCLUSIONS: The modified 360-degree ST appears to be a valuable option for the surgical treatment of XFG. Future studies are needed to explore the remote side effects and the long-term effects of this procedure on IOP.

Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma: 12-Month Results.

PURPOSE: We aimed to evaluate the 12-month results of a modified 360-degree suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma (XFG). PATIENTS AND METHODS: The modified 360-degree ST was performed on 20 eyes of 20 consecutive patients with XFG resistant to maximal topical treatment. In 8 patients, ST was combined with phacoemulsification. The main outcome measures were the surgical success rate, the mean postoperative intraocular pressure (IOP), the number of antiglaucoma medications, and the operative complications. RESULTS: The baseline IOP (26.55 ± 8.91) and medications (3.15 ± 0.81) decreased significantly to 10.90 ± 2.73 mm Hg and 0.30 ± 0.80, respectively, at 12 months postoperatively (P<0.001). The magnitude of IOP reduction was 58.9%. Complete and qualified success rates were 68.4% and 94.7%, respectively. The entire circumference of Schlemm's canal was opened successfully in all cases. Hyphema, perforation of the trabeculodesmetic window, posterior synechia, peripheral anterior synechia, and a transient elevation of the IOP were noted. The results are comparable to our 6-month results and other previously published results for circumferential trabeculotomy. CONCLUSIONS: The modified 360-degree ST provides a feasible choice in patients with XFG with a reasonable rate of complications. The 12-month success rates are promising. It can also be combined effectively with the current cataract surgery.

Corneal melanosis successfully treated using topical mitomycin-C and alcohol corneal epitheliectomy: a 3-year follow-up case report.

We report a case of primary acquired corneal melanosis without atypia associated with corneal haze in a patient with a history of limbal malignant melanoma and the effect of mitomycin-C. A 75-year-old woman with a history of limbal malignant melanoma presented with loss of vision in right eye. Corneal examination showed a patchy melanotic pigmentation with a central haze. Topical mitomycin-C improved visual acuity and corneal haze. However, the pigmented lesions persisted, and they were removed with alcohol corneal epitheliectomy. Histopathological examination demonstrated primary acquired melanosis without atypia. The lesions were successfully removed, and there were no recurrences during the follow-up period of 36 months. The association of conjunctival and corneal melanosis without atypia is a rare condition. In addition, co-existence of central corneal haze and melanosis may decrease visual acuity. Topical mitomycin-C and alcohol corneal epitheliectomy can be useful treatments in this condition.

Repeatability and Reproducibility of Anterior Segment Measurements in Normal Eyes Using Dual Scheimpflug Analyzer.

OBJECTIVES: To assess the repeatability and reproducibility of anterior segment measurements including aberrometric measurements provided by a dual Scheimpflug analyzer (Galilei) system in normal eyes. MATERIALS AND METHODS: Three repeated consecutive measurements were taken by two independent examiners. The following were evaluated: total corneal power and posterior corneal power, corneal higher-order wavefront aberrations (6.0 mm pupil), pachymetry at the central, paracentral, and peripheral zones, and anterior chamber depth (ACD). Repeatability was assessed by calculating the within-subject standard deviation, precision, repeatability, and intraclass correlation coefficient (ICC). Bland-Altman analysis was used for assessing reproducibility. RESULTS: Thirty eyes of 30 patients were included. The best ICC values were for corneal pachymetry and ACD. For both observers, acceptable ICC was also achieved for the other parameters, the only exceptions being posterior corneal astigmatism and total high order aberration. The 95% LoA (Limits of Agreement) values for all measurements showed small variability between the two examiners. CONCLUSION: The Galilei system provided reliable measurements of anterior segment parameters. Therefore, the instrument can be confidently used for routine clinical use and research purposes.

Lenticular astigmatism in tilted disc syndrome.

PURPOSE: To evaluate whether an abnormal optic disc shape in patients with tilted disc syndrome (TDS) is associated with an abnormal configuration of the crystalline lens measured as lenticular astigmatism. SETTING: Department of Ophthalmology, Inönü University Medical Faculty, Turgut Ozal Medical Center, Malatya, Turkey. METHODS: This cross-sectional masked case-control study comprised 32 eyes of 32 patients with established TDS (13 men, 19 women; mean age 21.31 years +/- 7.05 [SD]) and 20 age- and sex-matched healthy control subjects (8 men, 12 women; mean age 22.65 +/- 7.11 years) with a comparable amount of myopic astigmatism (spherical equivalent) without TDS. The optic disc was morphometrically analyzed by planimetric evaluation of optic disc photographs. The total refractive and keratometric corneal astigmatism was obtained, and lenticular astigmatism was calculated by vector analysis. The Mann-Whitney U test was used for statistical analysis; 1 eye of each patient was evaluated in both groups. A P value less than 0.05 was considered statistically significant. RESULTS: The mean spherical equivalent refraction was comparable in TDS patients (-4.73 +/- 1.12 diopters [D]) and controls (-4.28 +/- 1.29 D) (P =.210). The mean total astigmatism was higher in TDS patients (-2.96 +/- 1.04 D) than in the controls (-2.51 +/- 1.09 D), but the difference was not significant (P =.151). The mean corneal astigmatism was comparable in TDS patients (-2.07 +/- 0.83 D) and controls (-2.28 +/- 0.87 D) (P =.454), but the calculated mean lenticular astigmatism was significantly higher in TDS patients (-1.31 +/- 0.98 D and -0.20 +/- 0.35 D, respectively) (P <.001). Twenty-nine of 32 TDS patients (90.6%) had lenticular astigmatism; in 16 (50%), it was greater than -1.00 D. Lenticular astigmatism was present in 7 controls (35%); in 2 (10%), it was greater than -1.00 D. The mean keratometry was significantly higher in TDS patients (43.84 +/- 1.06 D) than in the controls (42.75 +/- 1.45 D) (P =.011). CONCLUSIONS: Clinically significant lenticular astigmatism was present in TDS patients. If an abnormal optic disc shape is found on ophthalmoscopy, lenticular astigmatism as well as corneal astigmatism should be carefully evaluated to prevent an unsatisfactory refractive outcome, especially in refractive surgery candidates.

Hammer-chisel technique in endoscopic dacryocystorhinostomy.

We performed a prospective evaluation of endoscopic hammer-chisel dacryocystorhinostomy (DCR) procedures on 62 eyes of 44 patients (40 female and 4 male) with chronic epiphora or dacryocystitis (26 unilateral and 18 bilateral). The technique included chisel removal of bone over the lacrimal sac. The follow-up period was 12 to 54 months (mean, 28 months), and the patients' ages ranged from 17 to 67 years (mean, 35.5 years). The success rate of the consecutive endoscopic hammer-chisel DCR procedures was 87%. During operation, 8 patients had mild mucosal hemorrhage, which did not prevent the successful completion of the operation. Excellent patient tolerance was observed, with minimal morbidity and no major complications. As compared to the external approach, endoscopic hammer-chisel DCR is less traumatic, is less time-consuming, and is practical and cosmetically convenient, with minimal perioperative and postoperative complications. It also allows the simultaneous correction of any intranasal disease. It requires minimal instrumentation and is a relatively easy and fast technique.

Comparison of visual quality between aspheric and spherical IOLs.

PURPOSE: To determine if aspheric intraocular lens (IOL) implantation produces the same degree of postoperative ocular aberration and contrast sensitivity as spherical IOL implantation. METHODS: In this randomized prospective comparative study, 60 eyes of 30 cataract surgery patients were randomly assigned to receive a spherical IOL (Rayner 620H) in one eye and an aspheric IOL (Rayner 920H) in the contralateral eye. All patients were examined at 1 month postoperatively. Primary outcomes of contrast sensitivity and ocular wavefront higher order aberrations (HOAs) were assessed. RESULTS: Aspheric IOLs (median total HOAs 0.26 root mean square [RMS]; range 0.13-0.82 RMS) produced significantly lower total HOAs than spherical IOLs (median total HOAs 0.34 RMS; range 0.18-1.08 RMS; p<0.05). Contrast sensitivity was significantly better with aspheric IOLs (median contrast sensitivity 1.8 log units; range 1.35-1.8 log units) than with spherical IOLs (median contrast sensitivity 1.65 log units; range 1.35-1.8 log units; p<0.05). CONCLUSIONS: When compared with a structurally (platform and material) similar spherical IOL (Rayner 620H), aspheric IOLs (Rayner 920H) appear to significantly reduce HOAs and yield better levels of contrast sensitivity under photopic conditions.

Cystoid macular edema associated with juvenile idiopathic arthritis resolved by a dexamethasone intravitreal implant.

Uveitis, glaucoma, and cystoid macular edema frequently develop in patients with juvenile idiopathic arthritis. The authors describe a case of cystoid macular edema associated with juvenile idiopathic arthritis that had not responded to intravitreal triamcinolone acetonide and bevacizumab but improved significantly following intravitreal injection with a dexamethasone 0.7 mg implant.