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PURPOSE: To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment. METHODS: Twenty eyes of 20 keratoconus patients who underwent DALK surgery using the big-bubble technique after CXL treatment between January 2011 and September 2015 were retrospectively reviewed. All patients completed 3 years follow-up. Intraoperative and postoperative complications were recorded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), maximum keratometry, keratometric astigmatism and endothelial cell density (ECD) were analysed. RESULTS: The mean interval between CXL and DALK surgery was 47.5 ± 24.0 months (mean ± SD). DALK was completed in all eyes. Big-bubble was successfully achieved in 16 eyes (80%), and manual dissection was performed in four eyes (20%). Microperforation occurred in three eyes (15%). Postoperatively, persistent epithelial defect occurred in three eyes (15%). The mean UCVA and mean BSCVA values were significantly improved preoperatively to all postoperative visits (p < 0.001). UCVA was 20/100 or lower in all eyes preoperatively and 20/100 or better in 18 eyes (80%) at 3 years; BSCVA was 20/40 or better in all eyes (100%) and 20/20 or better in three eyes (15%), and keratometric astigmatism was lower than 4 dioptres in 14 eyes (70%) at 3 years. The mean ECD loss was 6.3 ± 4.4% at 1 year, 9.0 ± 6.3% at 2 years and 11.2 ± 7.4% at 3 years. CONCLUSION: Previous CXL treatment in keratoconus patients did not cause a negative impact on the visual, refractive and surgical outcomes of DALK surgery using the big-bubble technique. DALK surgery seems to be a safe and effective surgical approach in these patients.
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Colágeno/farmacología , Córnea/patología , Topografía de la Córnea/métodos , Reactivos de Enlaces Cruzados/farmacología , Queratocono/terapia , Queratoplastia Penetrante/métodos , Fotoquimioterapia/métodos , Adolescente , Adulto , Córnea/efectos de los fármacos , Córnea/cirugía , Femenino , Estudios de Seguimiento , Humanos , Queratocono/diagnóstico , Masculino , Refracción Ocular , Estudios Retrospectivos , Factores de Tiempo , Agudeza Visual , Adulto JovenRESUMEN
BACKGROUND: To evaluate the effect of intracameral lidocaine anesthesia on macular thickness and macular ganglion cell-inner plexiform layer (GC-IPL) thickness following uneventful phacoemusification in healthy subjects. METHODS: This is a prospective, randomized and double- masked study. One hundred eyes of 74 consecutive patients were randomized to receive intracameral preservative-free lidocaine 1 % (intracameral lidocaine group) or intracameral injection of balanced salt solution (sham injection group) at the time of the phacoemulsification surgery. Preoperative and postoperative macular thickness analyses with spectral domain optical coherence tomography (SD-ODT) were performed and the results between the two groups were compared. RESULTS: Postoperatively, both the central foveal thickness (CFT) and the thickness of perifoveal macula were significantly improved in both groups (p < 0.001). There was no statistically significant difference between CFT and the inner and outer macular zone thicknesses of the two groups at any follow-up time. In both groups, GC-IPL thickness was significantly increased at the first week and first month visits (p < 0.001). There was no statistically significant difference between GC-IPL thickness measurements of the two groups at any follow-up time. CONCLUSION: The current study demonstrated that supplementary intracameral lidocaine 1 % did not cause more macular thickening than the intracameral sham injection during a follow-up period of 3 months. The present study also showed a tendency for a transient increase in high definition SD-OCT-based GC-IPL thickness measurements within a few months following cataract surgery under both intracameral lidocaine anesthesia and intracameral sham injection.
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Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Mácula Lútea/anatomía & histología , Facoemulsificación , Células Bipolares de la Retina/citología , Células Ganglionares de la Retina/citología , Anciano , Anciano de 80 o más Años , Cámara Anterior/efectos de los fármacos , Método Doble Ciego , Femenino , Humanos , Inyecciones Intraoculares , Implantación de Lentes Intraoculares , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To evaluate the efficacy and safety of oral azithromycin treatment combined with topical antibiotic and anti-inflammatory agents in pediatric patients with chronic severe bilateral blepharokeratoconjunctivitis. METHODS: Patients younger than 14 years with chronic and severe bilateral blepharokeratoconjunctivitis were reviewed retrospectively. Consecutive patients receiving oral azithromycin treatment were included. All patients received oral azithromycin (5 mg/kg/single dose daily) for at least 4 weeks combined with topical antibiotic and anti-inflammatory agents. Before and after the treatment, clinical symptoms were noted, and corneal and conjunctival fluorescein staining and corneal neovascularization were graded. Meibomian gland secretion and meibomian gland plugging were also assessed. All patients completed at least 3 months of follow-up after completion of the oral azithromycin treatment. Patients' clinical data at the time of diagnosis and last follow-up visit were statistically compared. RESULTS: Twenty-nine children (58 eyes, mean age of 6.51 years) were included. The mean time of oral azithromycin use was 5.87 weeks (range: 4 to 10 weeks). Clinical symptoms and signs and visual acuity were significantly improved after treatment. The mean fluorescein staining and corneal neovascularization grades and meibomian gland secretion and meibomian gland plugging scores also improved after treatment (P < .001). Eyelid distortion or fornix shortening was not observed. At the last follow-up visit, all patients were stable with treatment only with daily eyelid hygiene, topical cyclosporine, and artificial tears. CONCLUSIONS: Long-term, low-dose oral azithromycin combined with topical antibiotic and anti-inflammatory agents is an effective treatment option for pediatric patients with chronic severe bilateral blepharokeratoconjunctivitis. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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PURPOSE: To describe a technique for the fixation of intraocular lenses or capsular tension rings through the ciliary sulcus or pars plana. METHODS: This alternative technique allows burial of the knot and the free suture ends within the sclera, without using a scleral flap or pocket or even a conjunctival opening. RESULTS: No suture exposure has occurred with the use of the suture burial technique in approximately 25 eyes in 4 years. Additional benefits include less patient discomfort and an improved anatomic and cosmetic outcome starting from the first postoperative day. CONCLUSIONS: This technique causes minimal tissue damage and scarring with almost no postoperative discomfort.
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Conjuntiva/fisiología , Implantación de Lentes Intraoculares/métodos , Esclerótica/cirugía , Técnicas de Sutura , HumanosRESUMEN
BACKGROUND: To evaluate the 3-year clinical outcomes after toric implantable collamer lens (ICL) implantation for the management of moderate to high myopic astigmatism. METHODS: Thirty-four eyes of 20 patients who underwent toric ICL implantation were reviewed. All eyes completed 3-year follow-up. Uncorrected (UDVA) and corrected (CDVA) distance LogMAR visual acuities, refraction, endothelial cell density (ECD), and surgical complications were evaluated. Vectorial analysis of astigmatic correction was also done. RESULTS: A significant improvement in UDVA, CDVA, manifest spherical and cylindrical refraction was observed at 1 week and remained stable after 3 years. Twenty-six eyes (76.5%) gained lines of CDVA, and two eyes (5.9%) showed a loss of 1 line of CDVA. The spherical equivalent (SE) was within ±0.50 D of emmetropia in 18 eyes (52.9%) and within ±1.00 D in 28 eyes (82.4%). Differences between target-induced astigmatism (TIA) and surgically-induced astigmatism (SIA) were statistically significant (p < 0.01), and a trend to undercorrection of the refractive astigmatism was present after 3 years. The magnitude of flattening effect (FE) was found to be significantly lower than the magnitude of TIA (p < 0.01). The magnitude of the torque vector was always positive, with a value below 0.50 D in all cases. No vision-threatening complications were observed during the follow-up. CONCLUSION: Toric ICL implantation is an effective and safe surgical option that provides a relatively predictable and stable refractive correction of myopic astigmatism. Further improvements are needed to minimize the degree of undercorrection.
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Astigmatismo/cirugía , Implantación de Lentes Intraoculares , Miopía/cirugía , Lentes Intraoculares Fáquicas , Adolescente , Adulto , Recuento de Células , Topografía de la Córnea , Endotelio Corneal/patología , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias , Masculino , Refracción Ocular/fisiología , Tonometría Ocular , Resultado del Tratamiento , Agudeza Visual/fisiología , Adulto JovenRESUMEN
Objectives: We aimed to investigate the short- and long-term static and dynamic pupillary responses of patients recovered from coronavirus disease-19 (COVID-19) using quantitative infrared pupillography. Methods: This study included patients who recovered from COVID-19 (Group 1) and age- and gender-matched controls (Group 2). A detailed ophthalmic examination was performed at 1 month and 6 months after the diagnosis of COVID-19. Photopic, mesopic, and scotopic pupil diameters (PDs) were measured using a quantitative infrared pupillography which was integrated into Scheimpflug/Placido photography-based topography system. PDs at 0, 2nd, 4th, and 6th seconds, and average pupil dilation speeds at 2nd, 4th, 6th, and 8th seconds were recorded. Results: Eighty-six eyes of 86 patients (Group 1: n=42; Group 2: n=44) were included. While the mean photopic, mesopic, and scotopic PDs were significantly larger in the COVID-19 group than the control group in the 1st month (p=0.035, p=0.017, p=0.018, respectively), no statistically significant difference was found in the 6th month. Besides, average pupil dilation speeds and PDs at the 0, 2nd, 4th, and 6th seconds were not statistically significantly different between the two groups in the 1st month and 6th month. Conclusion: PDs were significantly larger in COVID-19 patients in all light intensities in the 1st month after COVID-19. However, pupillary dilation was transient, and no significant difference was found in the 6th month. We suggest that the transient pupillary dilation may be secondary to the autonomic nervous system dysfunction and/or optic nerve and visual pathways alterations following COVID-19.
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PURPOSE: To provide an overview of the visual outcomes after pediatric refractive surgery in anisometropic amblyopia and to analyze the relationship of these outcomes with age and type of refractive surgery. METHODS: Systematic searches in PubMed, Embase, and Web of Science databases without data restrictions and a search by surveillance of the literature regarding pediatric refractive surgery were performed. Only studies reporting individual data of pediatric cases (age 1 to 17 years) undergoing photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), and LASIK were included. A total of 15 articles including data from a total of 213 amblyopic eyes were considered: LASIK in 95 eyes and surface ablation in 118 eyes. Changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) were investigated as well as their relation with age and ablation type. RESULTS: A significant increase in logMAR UDVA and CDVA was found in the overall sample of amblyopic eyes after surgery (P<.001). A significant correlation was found between age and preoperative CDVA (r=0.34, P<.001) as well as between age and the change in CDVA after surgery (r=-0.38, P<.001). The change in UDVA was significantly superior for eyes undergoing surface ablation compared to those undergoing LASIK (P=.04). Corneal haze was the predominant complication, which was reported in 5.3% of LASIK cases and 8.5% of surface ablation cases. CONCLUSIONS: Laser refractive surgery is an effective option for improving the visual acuity in children with an amblyopic eye in association with anisometropia.
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Ambliopía/cirugía , Revisión por Pares/métodos , Procedimientos Quirúrgicos Refractivos/métodos , Niño , Humanos , Refracción Ocular , Resultado del TratamientoRESUMEN
PURPOSE: To report the anatomical and visual results in patients diagnosed as having retinal pigment epithelium (RPE) tears after receiving ranibizumab injections. METHODS: Eyes diagnosed as having RPE tears with a minimum 6-month follow-up were retrospectively evaluated. Each eye was treated with at least three doses of ranibizumab at monthly intervals. Best-corrected visual acuity (BCVA), anterior segment findings, intraocular pressure, and fundus examination results were evaluated during control visits. Color fundus photography, fundus fluorescein angiographies, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) images were obtained. The height of pigment epithelial detachment (PED) was measured by SD-OCT. RESULTS: Twelve eyes with RPE tears were studied. Nine eyes (75%) developed RPE tears during ranibizumab injections for choroidal neovascularization (eight eyes with vascularized PED and one eye with choroidal osteoma), and tears occurred in three eyes before any injections. The median number of ranibizumab injections after diagnosis of RPE tears was 3 (min 2, max 5). In the most recent follow-up visit, there was no statistically significant correlation between the grade of RPE and logMAR of BCVA (p>0.05, r=0.112). Eight of twelve eyes had PED, and seven of these had irregular PED contours before injection therapy. The mean PED height was 447 ± 122 µm. CONCLUSIONS: In this series, RPE tears developed mostly after intravitreal anti-VEGF injections for vascularized PED. Increased vertical height and irregular contours of the PEDs can be risk factors for the formation of RPE tears. The continuation of anti-VEGF therapy after tear formation is beneficial for vision improvement in eyes with RPE tears.
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Inhibidores de la Angiogénesis/administración & dosificación , Degeneración Macular/tratamiento farmacológico , Ranibizumab/administración & dosificación , Desprendimiento de Retina/tratamiento farmacológico , Epitelio Pigmentado de la Retina/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/efectos adversos , Neovascularización Coroidal/tratamiento farmacológico , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Presión Intraocular/fisiología , Inyecciones Intravítreas/métodos , Degeneración Macular/diagnóstico , Masculino , Persona de Mediana Edad , Ranibizumab/efectos adversos , Desprendimiento de Retina/inducido químicamente , Desprendimiento de Retina/diagnóstico , Epitelio Pigmentado de la Retina/fisiopatología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacosRESUMEN
BACKGROUND: To evaluate the effects of selective α1A-adrenoceptor antagonist tamsulosin hydrochloride on choroidal thickness using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). METHODS: This is a prospective observational study including 29 eyes of 29 patients with newly diagnosed benign prostatic hyperplasia. Choroidal thickness and retrobulbar ocular blood flow measurements were performed at baseline and after 3 months of treatment. Results were analyzed by the masked observer. RESULTS: The mean subfoveal choroidal thickness (275.8-291.9 µm) and thicknesses 750 µm nasal (257.9-270.4 µm) and 750 µm temporal (262.4-277.0 µm) to the fovea were significantly increased after 3 months of treatment (p < 0.001). No statistically significant change was found in retrobulbar ocular blood flow. CONCLUSIONS: Tamsulosin causes a significant increase in EDI-OCT-based choroidal thickness measurements. This increase might be associated with choroidal vasodilation in consequence of blockade of sympathetic α1A-adrenoceptors, which is critical for the maintenance of vascular tone and resistance in the choroidal vascular architecture. This should be kept in mind when choroidal disease and its response to treatment are followed by EDI-OCT imaging.
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Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Coroides/patología , Hiperplasia Prostática/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Tomografía de Coherencia Óptica , Administración Oral , Anciano , Velocidad del Flujo Sanguíneo , Coroides/irrigación sanguínea , Arterias Ciliares/fisiología , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/fisiología , Tamaño de los Órganos , Estudios Prospectivos , Hiperplasia Prostática/fisiopatología , Flujo Sanguíneo Regional , Arteria Retiniana/fisiología , Tamsulosina , Ultrasonografía Doppler en ColorRESUMEN
BACKGROUND: To evaluate the effects of sub-conjunctivally applied interleukin-6 receptor (IL-6R) antibody (tocilizumab) on alkali burn induced corneal neovascularization (CNV) in rats. METHODS: Alkali burn induced corneal neovascularization was created in 24 right eyes of 24 rats. The rats were then randomized into 2 groups. Group 1 received sub-conjunctival injection of 4 mg/0.2 ml tocilizumab and Group 2 received sub-conjunctival injection of 0.2 ml normal saline at the 5th day of alkali burn. The corneal surface area invaded with neovascular vessels were calculated on photographs. The rats were sacrificed and the corneas were excised at the15th day. The corneal specimens were stained with hemotoxylin-eosin to evaluate tissue morphology and with Willebrand factor (vWF) to evaluate microvascular structures immunohistochemically. Vascular endothelial growth factor (VEGF) expression was analyzed by ELISA. RESULTS: The percent area of CNV was 26.9% in Group 1 and 56.5% in Group 2 (p < 0.001). The histological evaluation showed that the corneal structures were not visibly altered by sub-conjuntival tocilizumab injection. Group 1 showed significantly lower corneal inflammation score than Group 2 (p < 0.001). The number of vessels stained with vWF were significantly higher in Group 2 than Group 1 (15.23 and 5.46, respectively; p < 0.001). ELISA analyses showed that corneal VEGF levels were significantly lower in Group 1 compared to Group 2 (p = 0.013) CONCLUSION: The present data demonstrated first time the beneficial effects of sub-conjunctival tocilizumab on decreasing CNV in alkali burn model of the rat cornea. Further studies are warranted to confirm these findings for the clinical application.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Quemaduras Químicas/tratamiento farmacológico , Conjuntiva/efectos de los fármacos , Neovascularización de la Córnea/tratamiento farmacológico , Quemaduras Oculares/inducido químicamente , Animales , Quemaduras Químicas/metabolismo , Quemaduras Químicas/patología , Neovascularización de la Córnea/metabolismo , Neovascularización de la Córnea/patología , Modelos Animales de Enfermedad , Ensayo de Inmunoadsorción Enzimática , Quemaduras Oculares/metabolismo , Quemaduras Oculares/patología , Inyecciones Intraoculares , Masculino , Ratas , Ratas Sprague-Dawley , Receptores de Interleucina-6/inmunología , Hidróxido de Sodio , Factor A de Crecimiento Endotelial Vascular/metabolismo , Cicatrización de Heridas/efectos de los fármacosRESUMEN
AIM: To investigate the association of serum glucocorticoid kinase gene-1 (SGK-1) DNA variants with chronic central serous chorioretinopathy (CSC). METHODS: We enrolled 32 eyes of 32 patients who were diagnosed with chronic CSC and composed 32 normal eyes as a control group. Peripheral blood was used for DNA extraction and polymerase chain reaction (PCR) amplification. SGK1 gene was sequenced by using BigDye(®) Terminator v3.1 cycle sequencing KIT (Applied Biosystems, Foster City, CA, USA). The SGK1 gene and its variants were investigated in CSC patient group and control group. RESULTS: We identified a new polymorphism M32V in two person in the patient group (Minor allele frequency (MAF)=0.009) on the region of 1-60 amino acids. The rs1057293 was located in the encoder region of the SGK 1 gene but not associated with CSC (P=0.68). An intrinsic rs1743966 is also not associated (P=0.28). CONCLUSIONS: The new polymorphism M32V is located on the region of 1-60 amino acids which is necessary for localization to the mitochondria in CSC patient. This mutation is probably important for the energy metabolism and plays an important role in the cellular response to hyperosmotic stress and other stress stimuli. Both rs1057293 and rs1743966 are not associated with CSC.
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AIM: To investigate the effects of selenium in rat retinal ischemia reperfusion (IR) model and compare pre-treatment and post-treatment use. METHODS: Selenium pre-treatment group (n=8) was treated with intraperitoneal (i.p.) selenium 0.5 mg/kg for 7d and terminated 24h after the IR injury. Selenium post-treatment group (n=8) was treated with i.p. selenium 0.5 mg/kg for 7d after the IR injury with termination at the end of the 7d period. Sham group (n=8) received i.p. saline injections identical to the selenium volume for 7d with termination 24h after the IR injury. Control group (n=8) received no intervention. Main outcome measures were retina superoxide dismutase (SOD), glutathione (GSH), total antioxidant status (TAS), malondialdehyde (MDA), DNA fragmentation levels, and immunohistological apoptosis evaluation. RESULTS: Compared to the Sham group, selenium pre-treatment had a statistical difference in all parameters except SOD. Post-treatment selenium also resulted in statistical differences in all parameters except the MDA levels. When comparing selenium groups, the pre-treatment selenium group had a statistically higher success in reduction of markers of cell damage such as MDA and DNA fragmentation. In contrast, the post-selenium treatment group had resulted in statistically higher levels of GSH. Histologically both selenium groups succeeded to limit retinal thickening and apoptosis. Pre-treatment use was statistically more successful in decreasing apoptosis in ganglion cell layer compared to post-treatment use. CONCLUSION: Selenium was successful in retinal protection in IR injuries. Pre-treatment efficacy was superior in terms of prevention of tissue damage and apoptosis.
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Bone marrow-derived multiple myeloma is a type of plasma cell tumor that may be associated with ocular complications. A 52-year-old male patient was admitted to our eye clinic with the complaint of sudden visual loss and a visual acuity of 20/50 in the right eye and 20/800 in the left eye. Fundus examination revealed common flame-shaped hemorrhages, venous dilatation and tortuosity, Roth spots, serous macular detachment, and yellow macular deposits in both eyes. Evaluation with fundus fluorescein angiography, fundus autofluorescence, and spectral-domain optical coherence tomography resulted in suspicion of hyperviscosity retinopathy and referral to the hematology clinic. After hematology consultation confirmed a diagnosis of multiple myeloma, chemotherapy and plasmapheresis were initiated. Four months after presentation, best-corrected visual acuity was 20/20 in both eyes and improvement in hyperviscosity retinopathy, serous macular detachment, and yellow macular deposits was observed.
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PURPOSE: To compare the efficacy of intravitreal ranibizumab and bevacizumab treatment for type 1 retinopathy of prematurity (ROP). METHODS: 36 eyes of 20 patients with type 1 ROP who received anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections between August 2011 and February 2013 were retrospectively evaluated. Fifteen eyes of 8 patients received 0.25 mg ranibizumab (group 1), and 21 eyes of 12 patients received 0.625 mg bevacizumab (group 2). Eyes were examined by indirect ophthalmoscopy on the first day, third day, first week, and first month and as required after injections. Laser photocoagulation was performed in cases with progression of ROP. RESULTS: The mean gestation time was 26.2 ± 2.7 weeks in group 1 patients and 27.1 ± 2.5 weeks in group 2 patients. No statistical difference in the time of gestation was observed between the two groups. The mean follow-up period was 20 ± 4.5 months. Laser photocoagulation was performed in 6 of 15 eyes from group 1 and 2 of 21 eyes from group 2. No eyes developed retinal detachment during the follow-up period. CONCLUSION: Ranibizumab and bevacizumab showed an efficacy in the treatment of type 1 ROP. The incidence of disease relapse was higher in eyes which received ranibizumab. Further randomized, controlled clinical trials are required to compare the efficacy of ranibizumab and bevacizumab.
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Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Ranibizumab/uso terapéutico , Retinopatía de la Prematuridad/tratamiento farmacológico , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Lactante , Inyecciones Intravítreas , Coagulación con Láser , Masculino , Recurrencia , Retinopatía de la Prematuridad/cirugía , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: The current study aimed to investigate short- and long-term postoperative ocular refractive effects of medial rectus recession on the involved eye and to describe the detectable effects in detail by the results of vector analysis. METHODS: Data of patients in whom medial rectus recession was performed between 2010 and 2012 were retrospectively evaluated. The study included 52 eyes of 32 patients. Patients with a history of previous ocular surgery, congenital or progressive corneal disease, familial or acquired posterior segment disease, glaucoma, a history of ocular trauma, or any neurological or systemic disease were excluded. Best-corrected and uncorrected visual acuities and refraction examination findings of the patients were recorded before the surgery and at the postoperative first month and first year. A vector analysis program was used to analyze surgically induced astigmatism. RESULTS: Significant myopic shift and astigmatic change were determined in the spherical equivalent refraction in the early postoperative period (first month); however, these changes disappeared in the long term (at the postoperative first year). A positive correlation was not observed between the amount of surgical recession and the results of ophthalmic examination at the postoperative first month and first year. CONCLUSIONS: Only postoperative first month spherical equivalent showed a positive correlation with the amount of surgical recession; however, this correlation disappeared at the postoperative first year.
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Astigmatismo/etiología , Miopía/etiología , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Complicaciones Posoperatorias , Estrabismo/cirugía , Adolescente , Adulto , Astigmatismo/fisiopatología , Niño , Preescolar , Femenino , Humanos , Masculino , Miopía/fisiopatología , Refracción Ocular , Estudios Retrospectivos , Visión Binocular/fisiología , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To analyze the outcomes of traumatic wound dehiscence after deep anterior lamellar keratoplasty (DALK). DESIGN: Retrospective and interventional case series. SETTING: Single hospital. PATIENTS: A total of 338 consecutive cases were reviewed. Eleven eyes that had wound dehiscence related to ocular trauma were included. MAIN OUTCOME MEASURES: Incidence and causes, best-corrected visual acuity (BCVA), and endothelial cell density were evaluated. Complications and secondary surgeries were recorded. RESULTS: Seven patients were male (63.6%) and 4 patients were female (36.4%), with a mean age of 30.6 years (range, 24-40 years). The incidence of wound dehiscence was 3.2% (11/338). The mean interval between the initial DALK procedure and wound dehiscence was 9.45 months (range, 2-16 months). The mean follow-up time was 6 years. The most common trauma was a fist blow injury (36.3%). Descemet membrane perforation was observed in 8 eyes (72.7%); lens damage and vitreous prolapse occurred in 2 eyes (18.1%). The final BCVA was 0.51 and was maintained in 4 eyes (36.3%). At the final visit, 10 grafts (90.9%) were clear. The mean endothelial cell loss was 55.8% between before DALK and last visit. CONCLUSION: Although the intact Descemet membrane protects against dehiscing traumas after DALK, a relative weakness at the graft-host junction tends to persist and a severe deforming force may result in graft dehiscence. This case series indicates that despite the fact that the visual results following the repair are acceptable, corneal endothelium seems to be subjected to severe damage, which puts graft survival chances at risk in the long term.
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Trasplante de Córnea , Lesiones Oculares/etiología , Complicaciones Posoperatorias , Dehiscencia de la Herida Operatoria/etiología , Heridas no Penetrantes/etiología , Adulto , Recuento de Células , Enfermedades de la Córnea/cirugía , Pérdida de Celulas Endoteliales de la Córnea , Lámina Limitante Posterior/lesiones , Endotelio Corneal/patología , Oftalmopatías/etiología , Lesiones Oculares/epidemiología , Lesiones Oculares/cirugía , Femenino , Humanos , Incidencia , Cristalino/lesiones , Masculino , Prolapso , Estudios Retrospectivos , Dehiscencia de la Herida Operatoria/epidemiología , Dehiscencia de la Herida Operatoria/cirugía , Resultado del Tratamiento , Agudeza Visual/fisiología , Cuerpo Vítreo/patología , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/cirugía , Adulto JovenRESUMEN
PURPOSE: To compare the visual and refractive results in eyes with advanced keratoconus having deep anterior lamellar keratoplasty (DALK) with those having intrastromal corneal ring segment (ICRS) implantation. SETTING: Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey. DESIGN: Comparative case series. METHODS: Records of advanced keratoconus patients with a clear central cornea and contact lens intolerance who had DALK or ICRS implantation were reviewed. Preoperatively and after 24 months, the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and Orbscan II keratometry (K) readings in the 2 groups were comparable. RESULTS: The DALK group comprised 36 eyes and the ICRS group, 30 eyes. Both groups had a statistically significant increase in UDVA and CDVA from preoperatively to 24 months postoperatively (P<.001). The DALK group had a statistically significantly greater improvement in UDVA and CDVA than the ICRS group 24 months postoperatively (P<.001). The improvement in spherical equivalent (SE) refractive error, manifest sphere, and manifest cylinder was statistically significant in both groups (P<.001). The mean reduction in SE and manifest cylinder were significantly greater in the DALK group (P<.05). The postoperative reduction in the maximum and minimum K values was statistically significant in both groups (P<.001); the mean reduction in K values was significantly greater in the DALK group (P<.001). CONCLUSION: Although DALK provided greater improvement in visual acuity and refractive errors in advanced keratoconus cases, ICRS implantation may be an alternative treatment with satisfactory outcomes and less visual impact.
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Sustancia Propia/cirugía , Trasplante de Córnea/métodos , Queratocono/cirugía , Prótesis e Implantes , Implantación de Prótesis/métodos , Adolescente , Adulto , Niño , Topografía de la Córnea , Humanos , Queratocono/fisiopatología , Persona de Mediana Edad , Refracción Ocular/fisiología , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus. MATERIALS AND METHODS: Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter. RESULTS: Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P<0.001). Mean ECD loss rate at four years was 47.82% in Group A and 21.62% in Group B (P<0.001). Mean annual ECD loss rate was calculated 14.12% per year in Group A and 5.78% per year in Group B. In the PK group, increase in mean CCT was 15.60% in two years and 15.03% in four years, while in the DALK group, mean CCT increased by 8.05% in two years and 9.31% in four years. CONCLUSIONS: As the majority of ectatic disorders such as keratoconus occur in young people, long-term endothelial cell survival following treatment with keratoplasty is essential for the long-term visual ability. Our finding that corneal endothelial cell loss in the DALK group occurs at a slower rate than in the PK group suggests DALK as a safer alternative to PK in these selected patients.
Asunto(s)
Endotelio Corneal/patología , Queratocono/cirugía , Queratoplastia Penetrante/métodos , Adolescente , Adulto , Endotelio Corneal/cirugía , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Queratocono/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia. MATERIALS AND METHODS: Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of -11.70 ± 3.77 diopters (D; range -5.50 to -17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry. RESULTS: After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in 17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA. CONCLUSION: The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.
Asunto(s)
Endotelio Corneal/cirugía , Iris/cirugía , Miopía/cirugía , Lentes Intraoculares Fáquicas , Refracción Ocular , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Miopía/fisiopatología , Satisfacción del Paciente , Estudios Prospectivos , Diseño de Prótesis , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To compare the results of penetrating keratoplasty (PK) in a series of congenital hereditary endothelial dystrophy (CHED) patients operated at amblyogenic years and at later ages. METHODS: Records of 65 eyes of 35 CHED patients who underwent PK were reviewed retrospectively. Visual results and graft clarity rates were compared between patients operated after (group 1) and before (group 2) 12 years of age. Results were also compared between eyes with and without nystagmus. RESULTS: Group 1 consisted of 47 eyes (24 patients), whereas group 2 consisted of 18 eyes (11 patients). Thirteen patients (54%) in group 1 and 10 patients (91%) in group 2 had nystagmus. Mean ages at surgery were 26.4 and 7.6 years in group 1 and group 2, respectively. Mean follow-up period was 101.0 months in group 1 and 59.7 months in group 2. Group 1 cases had better graft clarity rates than group 2 cases (P = 0.023). Postoperative best-corrected visual acuities (BCVAs) were 20/80 or better in 39 eyes of group 1 (83%) and in 5 eyes of group 2 (28%). Visual outcomes were found significantly better in group 1 cases (P < 0.001). In group 1, 76% of eyes with nystagmus and 91% of eyes without nystagmus had BCVAs of 20/80 or better. In group 1, both preoperative and postoperative BCVAs were found significantly better in eyes without nystagmus (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Delayed keratoplasty seems to offer better graft outcomes and visual prognosis to CHED patients, even in the presence of nystagmus.