Ocular Malformations with Presumable Intraocular Calcification.

This is a case of ocular malformations with presumable intraocular calcification based on computed tomography (CT) imaging, magnetic resonance imaging (MRI) and ocular ultrasound (US) findings. The authors presented the clinical, imaging and pathological findings of this case. Intraocular calcification is the most important finding in retinoblastoma, which requires aggressive management. It is important to distinguish it from other intraocular lesions, especially intraocular calcified hematoma.

Performance of optical coherence tomography for distinguishing between normal eyes, glaucoma suspect and glaucomatous eyes.

OBJECTIVE: Evaluate the diagnostic performance of spectral-domain optical coherence tomography (OCT) parameters to distinguish between healthy, glaucoma suspect, and glaucomatous eyes. MATERIAL AND METHOD: Forty-eight eyes of glaucoma, 48 glaucoma suspect eyes, and 35 healthy eyes were included. The circumpapillary and macular retinal nerve fiber layer (RNFL) thickness were measured using the Cirrus OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA). One-way analysis of variance was used to compare the different parameters among groups. Calculating areas under receiver operating characteristic (AROC) curves evaluated the discriminating power of each parameter RESULTS: The average circumpapillary RNFL thickness in normal, glaucoma suspects, and glaucomatous eyes were 100.31 +/- 7.69 microm, 90.27 +/- 9.22 microm, and 71.40 +/- 13.08 microm, respectively (p < 0.001). The largest AROC curve among the circumpapillary parameters was the inferior quadrant thickness (0.974, p < 0.001). The macular volume had the largest AROC curves (0.898, p < 0.001) of all macular parameters. For glaucoma suspect eyes versus early glaucomatous eyes, the best value of circumpapillary parameters was inferior quadrant thickness (0.835, p < 0.001). Among the macular parameters, the best value was the macular cube volume (0.766, p < 0.001). CONCLUSION: Circumpapillary parameters have better diagnostic performance than macular parameters especially the inferior quadrant thickness that has the best discriminating power

Neovascular glaucoma: a retrospective review of 5-year experience in Songklanagarind Hospital.

OBJECTIVE: To review causes, treatment modalities, and success of neovascular glaucoma treatment in the past five years at Songklanagarind Hospital. MATERIAL AND METHOD: Neovascular glaucoma of any causes between February 2005 and January 2010 were retrospectively reviewed. The patients were divided into six major treatment subgroups. A medical treatment group, an intraocular bevacizumab injection group (IOB), a trabeculectomy with mitomycin C group, a trabeculectomy with mitomycin C plus adjunctive intraocular bevacizumab injection group, a glaucoma drainage device group, and a transscleral cyclophotocoagulation group. All treatment outcomes were compared and classified as success or failure according to the specific criteria. RESULTS: One hundred and sixty-six eyes were reviewed. The mean age at the time of diagnosis was 60 +/- 16 years and the average follow-up duration was 21 +/- 18 months. The most common etiology was central retinal vein occlusion (47%) followed by proliferative diabetic retinopathy (42%) and ocular ischemic syndrome (5%). The mean pressure was reduced from 38.1 +/- 12.5 mmHg at baseline to 17.8 +/- 12.3 mmHg at the final visit. After treatment, visual acuity was worse, remained stable, and improved in 45%, 37%, and 18% of the patients, respectively. In the trabeculectomy with mitomycin C plus intraocular bevacizumab injection group 54% of eyes were classified as a complete success, which was significantly higher than the other groups (p < 0.001). Although filtering surgeries with adjunctive bevacizumab showed no benefit over standard filtering surgeries in terms of VA change, pressure reduction, and success criteria but complications were found to be less in eyes treated with adjuvant bevacizumab. CONCLUSION: Key factors are treatment of the underlying disease responsible for ischemic triggers and treatment of the increased intra-ocular pressure. Even treatment with bevacizumab cannot increase the success rate but this seems to reduce the surgical complications.

Variations of Intraocular Pressure Measured by Goldmann Applanation Tonometer, Tono-Pen, iCare Rebound Tonometer, and Pascal Dynamic Contour Tonometer in Patients With Corneal Edema After Phacoemulsification.

PRCIS: Edematous corneas had lower Goldmann applanation tonometer (GAT) intraocular pressure (IOP) compared with other tonometers. A significant, mild negative correlation between central corneal thickness (CCT) and GAT IOP was found in a group of significant edematous corneas with CCT increases of >100 µm. PURPOSE: To compare the IOP that was randomly obtained with the GAT, Tono-Pen, iCare, and Pascal dynamic contour tonometer in patients with corneal edema after phacoemulsification. MATERIALS AND METHODS: Corneal edema was quantified by CCT measurement. The agreement between IOP measurements assessed by different instruments was evaluated using Bland-Altman plots. The relationship between CCT and IOP was investigated using the coefficient of correlation. The CCT and IOP were compared between the periods of postsurgical edema and after its resolution. RESULTS: The mean age of 60 patients was 75.9±7.8 years. CCT increased significantly after surgery, by an average of 96.1±39.9 µm (P<0.001). Relative to the IOPs measured with the GAT in edematous eyes: the mean difference in Tono-Pen IOPs was 4.7 mm Hg; 95% limits of agreement (LOA), -0.3 to 9.6 mm Hg. For iCare, was 2.3 mm Hg; 95% LOA, -2.2 to 6.8 mm Hg. For Pascal dynamic contour tonometer, was 3.0 mm Hg; 95% LOA, -0.4 to 6.5 mm Hg. Edematous corneas had significantly lower GAT IOP than Tono-Pen IOP; 12.3±3.2 versus 16.9±3.1 (P=0.02). Pearson correlation coefficients (r) showed a high correlation between the 4 tonometers in eyes without edema. There was a significant, mild negative correlation between CCT and GAT IOP (r=-0.25, P=0.02) in a group of significant edematous corneas with CCT increases of >100 µm: GAT IOP decreased by 3.1 mm Hg for every 10-µm increase in CCT. CONCLUSIONS: IOP readings with GAT tended to be lower than those obtained with the other tonometers, especially the Tono-Pen. GAT IOP readings in cases of severe corneal edema should be interpreted with caution.

Bilateral septic cavernous sinus thrombosis following the masticator and parapharyngeal space infection from the odontogenic origin: a case report.

Neglect of odontogenic infections can have serious consequences. If they spread through fascial planes and intracranially they can cause an abscess, orbital cellulitis, and eventually cavernous sinus thrombosis. The authors report a case of rapid progressive bilateral orbital cellulitis and cavernous sinus thrombosis that originated from dental caries. Septic cavernous sinus thrombosis is a medical emergency. Early recognition and prompt treatments direct to the underlying sources of infection are crucial. Broad-spectrum intravenous antibiotics are the mainstay of treatment to reduce morbidity and mortality from this lethal condition. Management should be based on early diagnosis and prompt management with intravenous broad-spectrum antibiotics and surgical intervention.

Clinical Characteristics and Prognostic Factors of Visual Outcomes in Childhood Glaucoma.

PURPOSE: To determine the prognostic factors for poor visual outcomes in childhood glaucoma. METHODS: The medical records of patients with childhood glaucoma diagnosed at age 4 years or younger who were treated surgically from 2002 to 2019 at Songklanagarind Hospital, Hatyai, Thailand, were retrospectively reviewed. Glaucoma subtypes, clinical characteristics, final visual acuity, and etiology of visual impairment were recorded. The generalized estimating equation for logistic regression analysis was used to determine prognostic factors for final visual acuity of worse than 20/200. RESULTS: Forty-five eyes of 31 patients were included (33.3% had primary glaucoma and 66.7% had secondary glaucoma). At the final visit (mean: 6.8 years), 20.5% had good visual acuity (20/50 or better), 15.9% had fair visual acuity (worse than 20/50 to 20/200), and 63.6% had poor visual acuity (worse than 20/200). The major cause of visual impairment (worse than 20/50) was deprivation amblyopia. Prognostic factors for poor final visual acuity (worse than 20/200) were secondary glaucoma, age at diagnosis of younger than 3 months, and interval to surgery of more than 3 months. Eyes with a final visual acuity of better than 20/200 had higher mean intraocular pressure preoperatively that tended to increase postoperatively and every visit afterward compared to the other group. CONCLUSIONS: Two-thirds of eyes with childhood glaucoma ended up with poor final vision. Early surgery to control intraocular pressure, along with amblyopia treatment, should be considered to prevent poor visual outcome. The prognostic factors for poor visual outcome can contribute to parental advice and planning of patient care. [J Pediatr Ophthalmol Strabismus. 2020;57(5):283-291.].

Intraoperator repeatability and interoperator reproducibility in the ultrasonic pachymetry measurements of central corneal thickness.

OBJECTIVE: To assess the repeatability and reproducibility of central corneal thickness (CCT) measurement by the commercial available ultrasonic pachymeter in Songklanagarind Hospital. MATERIAL AND METHOD: Seventy eyes underwent two sessions of CCT measurements, each session consisting of two CCT measurements, performed by two different operators. The mean and standard deviation of the mean differences were calculated. The interoperator repeatability and interoperator reproducibility were calculated by means of intraclass correlation coefficient (ICC). Agreement was analyzed by means of Bland-Altman plots. RESULTS: The mean CCT for 70 eyes was 537.61 +/- 26.66 mm. The intraoperator repeatability study of the first operator, the mean difference between the repeated measurements was 0.49 mm. The ICC was 0.985 (p < 0.001). For the second operator, the mean difference between the repeated measurements was 0.57 mm. The ICC was 0.935 (p < 0.001). A Bland-Altman plot of both operators showed narrow limits of agreement with respect to CCT for both operators. The mean measurement difference between operator was 0.96 mm and the ICC for reproducibility study was 0.979 (p < 0.01). The Bland-Altman plot showed narrow limits of agreement with respect to CCT. CONCLUSION: The measurement of CCT using the ultrasonic pachymeter is highly repeatable and reproducible.

The effects of selective laser trabeculoplasty and travoprost on circadian intraocular pressure fluctuations: A randomized clinical trial.

BACKGROUND: To compare the effect of selective laser trabeculoplasty (SLT) and travoprost on 24-hour IOP fluctuations in primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: Sixty eyes were included. Sixteen and 14 eyes of POAG patients were randomized to receive 360° SLT or 0.004% travoprost, respectively. Fourteen and 16 eyes of NTG patients were randomized to receive either SLT or travoprost, respectively. The 24-hour IOP data were collected before treatment and 6 to 8 weeks after treatment. IOP was measured at 2 hours intervals in the sitting position during daytime (9 AM to 7 PM) and in the supine position during nighttime (9 PM to 7 AM). Main outcome measure was the percentage of eyes that achieved posttreatment 24-hour IOP fluctuations <3 mm Hg. Success in fluctuation reduction was defined as at least a 50% reduction in these fluctuations. RESULTS: Fifty-eight eyes were analyzed. Overall, eyes in the SLT and the travoprost groups achieved a significant reduction in IOP compared with the baseline IOP values (-3.7 mm Hg [P = 0.002] vs -4.1 mm Hg [P < 0.001], respectively). There was no significant difference in IOP reduction in both groups according to type of glaucoma. During the diurnal period, 100% of POAG eyes in the travoprost group achieved posttreatment IOP fluctuations <3 mm Hg, and 87% of eyes in the SLT group achieved the same level of fluctuations (P < 0.001). Ninety-six percent of NTG eyes in the travoprost group, and 82% of eyes in the SLT group had IOP fluctuations <3 mm Hg (P = 0.01). Success in fluctuation reduction was 75% and 92% for the SLT and travoprost groups, respectively (P = 0.005). The effect of travoprost on IOP reduction in POAG and NTG patients was significant both during the daytime and the nighttime, while the SLT's effect was significant only during the nighttime. CONCLUSIONS: Both travoprost and SLT can significantly reduce the IOP in patients with POAG and NTG. Based on habitual positions, travoprost better controls IOP fluctuations than SLT, especially during the daytime.

Intraocular Pressure Changes in Non-Glaucomatous Patients Receiving Intravitreal Anti-Vascular Endothelial Growth Factor Agents.

PURPOSE: To study the prevalence of sustained intraocular pressure (IOP) elevation associated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. METHODS: Prospective comparative study. Non-glaucomatous patients scheduled to receive intravitreal injection of anti-VEGF therapy were recruited from an outpatient eye clinic, Songklanagarind Hospital between April 2013 and March 2014. The IOP was measured by Goldmann applanation tonometer before and at 1 hour, 1 week, 1 month, 3 months, and 6 months after injection. The IOP was compared using the repeated measures analysis. Sustained IOP elevation was defined as either an IOP > 21 mmHg or an increase from baseline ≥ 5 mmHg on two consecutive visits. RESULTS: Seventy eyes of 54 patients met the inclusion criteria. The most common diagnosis was diabetic macular edema (48%). The mean IOP ± standard deviation (SD) before treatment was 13.7 ± 2.8 mmHg. The means ± SDs after treatment at 1 hour, 1 week, 1 month, 3 months, and 6 months were 11.3 ± 2.6, 13.7 ± 3.6, 14.1 ± 3.3, 14.0 ± 2.3, and 13.7 ± 2.4 mmHg, respectively. A mean of IOP difference at 1 hour postinjection and at baseline was -2.36 ± 2.5 mmHg (P < 0.001). Four of 70 treated eyes (5.7%) developed sustained IOP elevation (IOP ≥ 5 mmHg from baseline on two consecutive visits). The IOP returned to baseline levels after 1 month, in three eyes. One eye had sustained IOP elevation at 3 and 6 months follow-up. Thereafter, IOP returned to baseline level. There was no need of anti-glaucoma medication. CONCLUSIONS: After receiving intravitreal injection of anti-VEGF agent, a small proportion of non-glaucomatous eyes developed a sustained IOP elevation without requiring IOP-lowering treatment. At 1 hour postinjection, there was a significant reduction of the mean IOP compared with the baseline level.

Efficacy of Adjunctive Subconjunctival Bevacizumab on the Outcomes of Primary Trabeculectomy With Mitomycin C: A Prospective Randomized Placebo-controlled Trial.

PURPOSE: To evaluate the efficacy of subconjunctival bevacizumab (ScB) as adjuvant therapy to primary trabeculectomy with mitomycin C (MMC) in primary open-angle glaucoma. MATERIALS AND METHODS: Forty-six eyes of primary open-angle glaucoma patients were randomized to receive ScB (1.25 mg/0.05 mL) injections (the MMC+ScB group) at the end of the operations, or sham-treated controls (the MMC group). Intraocular pressure (IOP) was the primary outcome and secondary outcomes included bleb appearance, visual acuity, number of medications, complications, and proportion of eyes achieving successful outcomes at the 12-month follow-up. RESULTS: Of 39 eyes, 20 eyes from the MMC+ScB group, and 19 eyes from the MMC group completed the follow-up. The mean postoperative IOP was 15.5±4.1 mm Hg in the MMC+ScB group (P<0.01; 40% reduction), and 14.7±4.3 mm Hg in the MMC group (P<0.01; 44% reduction). The differences in IOPs, at all follow-up visits, were not significant (P>0.05). The mean bleb vascularity score, at 1 month, in the MMC+ScB group was lower than the MMC group (1.55±0.51 vs. 2.26±0.6, respectively, P=0.01), but was not retained at follow-ups. The success rates at 12 months after surgery were 85% in the MMC+ScB group and 89.5% in the MMC group (P=0.53). The cumulative probabilities of surgical success were 80% and 73.7% in the MMC+ScB and in the MMC group, respectively (P=0.52). CONCLUSION: Single adjunctive ScB injection did not appear to have an additive benefit on outcomes of MMC trabeculectomy, in terms of IOPs and success rates.

Gradenigo's syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report.

INTRODUCTION: Gradenigo's syndrome is nowadays a rare condition characterized by a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens nerve palsy. Most cases are caused by medial extension of acute otitis media into a pneumatized petrous apex and surgical drainage is usually the treatment of choice. We present a case highlighting the pathological mechanism of this disease, demonstrate rare radiological findings associated with this patient, and showcase successful medical treatment without surgical intervention. CASE PRESENTATION: A 63-year-old Thai man presented with complete Gradenigo triad as a complication of chronic otomastoiditis in spite of clinical history of previous radical mastoidectomy and a nonpneumatization of the petrous apex. Magnetic resonance imaging showed abnormal prominent enhancement at the roof of his right temporal bone, and the dura overlying the floor of right middle cranial fossa and right cavernous sinus. Magnetic resonance imaging also detected right petrous apicitis. With the use of intravenous antibiotics and topical antibiotic eardrops, recovery was observed within 5 days with complete resolution within 2 months. CONCLUSIONS: Although there is little evidence to support the use of medical therapy in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome following chronic otitis media in a patient who underwent previous radical mastoidectomy.

Glaucoma tube imaging using anterior segment optical coherence tomography in patients with opaque cornea.

PURPOSE: Anterior segment optical coherence tomography (AS-OCT) was used to diagnose Ahmed tube tip patency in patients with opaque corneas after corneal transplantation and tube shortening. MATERIALS AND METHODS: Noncomparative observational case series: 3 consecutive patients with nonvisualized tubes and uncontrolled intraocular pressure after corneal transplantation underwent AS-OCT to determine tube tip patency. RESULTS: In each case, AS-OCT allowed for imaging of the tube position, wall passage, and osteum patency that could not be visualized on gonioscopy. Two of 3 tubes were found to be nonpatent. CONCLUSIONS: High-resolution noncontact cross-sectional AS-OCT images provide information on tube position and patency in the presence of opaque media after corneal transplantation, assisting with clinical decision-making.

Intraocular pressure monitoring post intravitreal steroids: a systematic review.

The use of intravitreal (IVT) corticosteroids for treatment of posterior segment diseases has increased significantly over the last decade. A commonly recognized complication of IVT steroids is secondary ocular hypertension (OHT) that can occur immediately secondary to direct intraocular volume increase or weeks to months later as a result of increased outflow resistance. We performed a meta-analysis and found 32% (95% confidence interval, 28.2-36.3) of individuals developed OHT following 4 mg IVT triamcinolone, 66% (50.2-78.8) and 79% (72.2-84.5) following 0.59 and 2.1 mg fluocinolone implant, respectively, and 11% (6.4-17.9) and 15% (9.2-24.3) following 0.35 and 0.7 mg dexamethasone implant, respectively. Risk factors included pre-existing glaucoma, higher baseline intraocular pressure (IOP), younger age, OHT following previous injection, uveitis, higher steroid dosage, and fluocinolone implant. Most cases of OHT can be controlled medically; up to 45% following fluocinolone implant require surgery, however. We suggest a protocol to monitor IOP after IVT steroid injection/implantation that includes checking IOP within 30 minutes after injection, followed by 1 week after IVT triamcinolone and 2 weeks after implant insertion, then every 2 weeks for the first month and monthly for up to 6 months after IVT triamcinolone and dexamethasone implantation and 9 months after fluocinolone implantation.