Outcomes of cataract surgery in eyes with ocular melanoma treated with iodine-125 brachytherapy.

PURPOSE: To evaluate visual and surgical outcomes of cataract surgery in eyes with a history of iodine-125 (I125) brachytherapy for ocular melanoma. SETTING: Department of Ophthalmology, David Geffen School of Medicine at UCLA and the Stein Eye Institute, Los Angeles, California, USA. DESIGN: Retrospective case series. METHODS: Patients with ocular melanoma treated by I125 brachytherapy who subsequently had cataract surgery were evaluated. The recorded data included tumor size, location, preoperative ocular comorbidities, corrected distance visual acuity (CDVA), operative complications, and brachytherapy-related maculopathy before and after surgery. RESULTS: Thirty-two eyes of 32 patients were included. The mean age at the time of cataract surgery was 66.1 years. The median follow-up was 53.5 months. There were no intraoperative complications. Eighteen eyes (56.3%) had a history of preoperative radiation retinopathy, 10 involving the macula. Between 2 weeks and 4 weeks postoperatively, 22 eyes (68.8%) had an improvement in CDVA (≥2 lines). Seven of 10 eyes that failed to improve had radiation maculopathy. By the last follow-up examination, 13 eyes (40.6%) had improved CDVA, 9 eyes (28.1%) were worse (≥2 lines), and 10 eyes (31.3%) were unchanged (within ±1 line). Of 15 eyes that lost CDVA gains achieved between 2 weeks and 4 weeks postoperatively, 9 eyes had new-onset or worsening maculopathy. Cataract surgery had no effect on local tumor control or distant metastasis. CONCLUSIONS: Cataract surgery after I125 brachytherapy for ocular melanoma improved CDVA in most eyes during the immediate postoperative period. Gains were often lost with further follow-up. Progression of radiation maculopathy was primarily responsible for subsequent visual decline.

A sample predictive model for intraocular pressure following laser in situ keratomileusis for myopia and an "intraocular pressure constant".

PURPOSE: To describe a sample predictive model for intraocular pressure (IOP) following laser in situ keratomileusis (LASIK) for myopia and an IOP constant. METHODS: The records of patients that underwent LASIK for myopia and myopic astigmatism via WaveLight Allegretto Wave Eye-Q 400 Hz excimer laser and Hansatome XP microkeratome were retrospectively reviewed. Patients with no systemic or ocular disease other than myopia or myopic astigmatism were included in the study. Preoperative and postoperative month 1 data and intraoperative data were used to build the predictive model for IOP after LASIK. The IOP constant was calculated by subtracting the predicted IOP from preoperative IOP. The paired samples t test, Pearson's correlation analysis, curve estimation analysis, and linear regression analysis were used to evaluate the study data. RESULTS: The study included 425 eyes in 214 patients with a mean age of 32 ± 7.8 years. Mean spherical equivalent of the attempted correction (SE-ac) was -3.7 ± 1.7 diopters. Mean post-LASIK decrease in IOP was 4.6 ± 2.3 mmHg. The difference between preoperative and postoperative IOP was statistically significant (P < 0.001). SE-ac, preoperative IOP, and central corneal thickness had highly significant effects on postoperative IOP, based on linear regression analysis (P < 0.001 and R 2 = 0.043, P < 0.001 and R 2 = 0.370, and P < 0.001 and R 2 = 0.132, respectively). Regression model was created (F = 127.733, P < 0.001), and the adjusted R 2 value was 0.548. CONCLUSIONS: Evaluation of IOP after LASIK is important in myopic patients. The present study described a practical formula for predicting the true IOP with the aid of an IOP constant value in myopic eyes following LASIK.

A Technique to Reduce Incidence of Opaque Bubble Layer Formation During LASIK Flap Creation Using the VisuMax Femtosecond Laser.

PURPOSE: To identify risk factors for opaque bubble layer (OBL) formation and compare the incidence of OBL using a cone modification technique versus the original technique for LASIK flap creation using the VisuMax laser (Carl Zeiss Meditec, Jena, Germany). METHODS: This retrospective study examined videos of flap creation using the VisuMax laser to identify OBL occurrence. Eyes were divided into three groups: eyes where OBL occurred using the original technique (OBL group), eyes where OBL did not occur using the original technique (no OBL group), and eyes in which the cone modification technique was used for LASIK flap creation (larger flap diameter) (cone modification technique group). Preoperative measurements including simulated keratometry (flat and steep) values, white-to-white distance (WTW), pachymetry, patient age and gender, amount of correction, flap parameters, energy setting, corneal hysteresis, and corneal resistance factor were analyzed to identify parameters with statistical difference between the OBL and no OBL groups. Incidence of OBL was compared between the original and cone modification techniques. RESULTS: OBL incidence was significantly lower with the cone modification technique (7.6%; 7 of 92 eyes) than with the original technique (28.8%; 34 of 118 eyes) (Fisher's exact test, P = .0009). Factors identified with a significant difference between eyes with and without OBL using the original technique were: corneal thickness (OBL: 561.2 µm, no OBL: 549.6 µm, P = .0132), WTW diameter (OBL: 11.6 mm, no OBL: 11.9 mm, P = .0048), corneal resistance factor (OBL: 10.4 mm Hg, no OBL: 9.6 mm Hg, P = 0.0329), and corneal astigmatism (OBL: 0.80 diopter, no OBL: 1.00 diopter, P = .0472) CONCLUSIONS: Less astigmatic, thicker, denser, and smaller corneas increased the risk of OBL using the original technique for flap creation. The cone modification technique was associated with lower risk of OBL formation, even in eyes with significant risk factors for OBL using the original technique. [J Refract Surg. 2017;33(9):584-590.].

An 11-Year Review of Keratoplasty in a Tertiary Referral Center in Turkey: Changing Surgical Techniques for Similar Indications.

OBJECTIVES: Study aims to evaluate the indications and surgical techniques for corneal transplantation and to report changes in trends for preferred keratoplasty surgical techniques. METHODS: Clinical records of 815 consecutive corneal transplantations between January 1, 2004 and December 31, 2014 in Haydarpasa Numune Training and Research Hospital Eye Clinic were analyzed and classified into seven broad groups according to indications. Main outcome measures were change of leading indications and trends for surgical techniques. RESULTS: Leading indications for keratoplasty were keratoconus (KCN) (27.7%), bullous keratopathy (BK) (23%), postinfectious corneal scars (13.5%), regrafts (13.1%), corneal dystrophies (12.1%), and noninfectious corneal scars (5.4%). Regrafts were the only indication with a significantly increasing trend (P<0.01). Since the introduction of lamellar keratoplasty (LK) techniques including deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK), there was a significant increasing trend in number and percentage of both LK techniques (DALK; P=0.001 and P=0.007, and DSAEK; P<0.001 and P<0.001, respectively) and a significant corresponding decline in the percentage of penetrating keratoplasty (PK) (P<0.01). Similarly, DALK and DSAEK replaced PK as the preferred surgical technique for KCN and BK indications, (P=0.007 and P=0.01, respectively). Although PK was the most common surgical technique over the 11-year period (54.7%), both anterior and posterior LK techniques showed an emerging trend as the procedures of choice when indicated. CONCLUSIONS: No major shift was observed in the clinical indications for corneal transplantation over the previous 11 years, except for regrafts. Lamellar keratoplasty techniques largely overtook the PK technique, but PK was still the overall preferred technique in the era when both LK techniques were used.

Characterization of the Corneal Subbasal Nerve Plexus in Limbal Stem Cell Deficiency.

PURPOSE: To quantify the changes in the subbasal nerve plexus in patients with limbal stem cell deficiency (LSCD) using in vivo laser scanning confocal microscopy. METHODS: In this retrospective cross-sectional comparative study, confocal images of 51 eyes of 37 patients with LSCD collected between 2010 and 2015 by the Heidelberg Retina Tomograph III Rostock Corneal Module Confocal Microscope were analyzed. Two independent observers evaluated the scans of the central cornea. Seventeen normal eyes of 13 subjects served as controls. Total subbasal nerve density (SND), density of long nerves (ie, nerves 200 µm or longer), and the degree of tortuosity were quantified. RESULTS: The mean (±SD) total SND and long nerve density were 48.0 ± 34.2 and 9.7 ± 10.9 nerves/mm, respectively, in all eyes with LSCD and 97.3 ± 29.9 and 35.3 ± 25.3 nerves/mm, respectively, in eyes of the control group (P < 0.001 for both comparisons). Compared with SND in control subjects, SND was reduced by 34.9% in the early stage, 54.0% in the intermediate stage, and 73.5% in the late stage of LSCD. The degrees of nerve tortuosity were significantly greater in patients with LSCD than in control subjects and differed among the early, intermediate, and late stages of LSCD. Reductions in total SND and long nerve density were positively correlated with the severity of LSCD. CONCLUSIONS: Reductions in total SND and long nerve density were accompanied by increases in nerve tortuosity in eyes with LSCD. These parameters could be used as quantifiable measures of LSCD severity.

Subfoveal choroidal thickness changes after intravitreal bevacizumab therapy for central serous chorioretinopathy.

PURPOSE:: To evaluate subfoveal choroidal thickness (SFCT) changes after intravitreal bevacizumab (IVB) therapy for central serous chorioretinopathy (CSC) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). METHODS:: In this retrospective study, we assessed the medical records of patients with CSC who received IVB (IVB group) or who were observed without intervention (control group). SFCT was measured using EDI-OCT. The main outcome measure was the change in SFCT. RESULTS:: Twenty-one eyes were included in the IVB group and 16 eyes were included in the control group. All patients showed resolution of neurosensory detachment and improvement in vision. In the IVB group, the mean SFCT was 315 µm at baseline, which decreased to 296 µm at the most recent visit. In the control group, the mean SFCT was 307 µm at baseline, which decreased to 266 µm at the most recent visit. Although there was a significant decrease in the mean SFCT for the control group, the decrease was not significant for the IVB group (41 vs 19 µm, p=0.003 vs p=0.071). CONCLUSIONS:: SFCT decreased in both groups with remission of the disease. However, the decrease was significantly greater in the control group. In terms of anatomic and functional outcomes, IVB injection is not promising.

Subfoveal choroidal thickness changes after intravitreal bevacizumab therapy for central serous chorioretinopathy / Alterações da espessura subfoveal coroide após terapia com bevacizumab para coriorretinopatia serosa central

ABSTRACT Purpose: To evaluate subfoveal choroidal thickness (SFCT) changes after intravitreal bevacizumab (IVB) therapy for central serous chorioretinopathy (CSC) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Methods: In this retrospective study, we assessed the medical records of patients with CSC who received IVB (IVB group) or who were observed without intervention (control group). SFCT was measured using EDI-OCT. The main outcome measure was the change in SFCT. Results: Twenty-one eyes were included in the IVB group and 16 eyes were included in the control group. All patients showed resolution of neurosensory detachment and improvement in vision. In the IVB group, the mean SFCT was 315 μm at baseline, which decreased to 296 μm at the most recent visit. In the control group, the mean SFCT was 307 μm at baseline, which decreased to 266 μm at the most recent visit. Although there was a significant decrease in the mean SFCT for the control group, the decrease was not significant for the IVB group (41 vs 19 μm, p=0.003 vs p=0.071). Conclusions: SFCT decreased in both groups with remission of the disease. However, the decrease was significantly greater in the control group. In terms of anatomic and functional outcomes, IVB injection is not promising.

RESUMO Objetivo: Avaliar as alterações da espessura da coroide subfoveal (SFCT) após terapia com bevacizumab (IVB) para coriorretinopatia serosa central (CSC) usando tomografia de coerência óptica de domínio espectral com profundidade aprimorada (EDI-OCT). Métodos: Neste estudo retrospectivo, foram avaliados prontuários de pacientes com CSC que receberam IVB (grupo IVB) ou que foram apenas observados, sem intervenção (grupo controle). SFCT foi medido por meio de EDI-OCT. O desfecho principal avaliado foi a mudança na SFCT. Resultados: Houve 21 olhos no grupo IVB e 16 olhos no grupo de controle. Todos os pacientes apresentaram resolução de descolamento neurossensorial e melhora na visão. No grupo IVB, a SFCT media foi 315 μm no início e diminuiu para 296 μm na visita mais recente. No grupo controle, a SFCT média foi 307 μm no início e diminuiu para 266 μm na visita mais recente. Embora tenha havido uma diminuição significativa na SFCT média para o grupo controle, a diminuição não foi significativa para o grupo IVB (41 μm contra 19 μm, p=0.003 vs p=0.071). Conclusões: A SFCT diminuiu em ambos os grupos após a remissão da doença. Contudo, a diminuição foi significativamente maior no grupo de controle. Em termos de resultados anatômicos e funcionais, a injeção de IVB não foi promissora.

Long-Term Outcomes of the Boston Type I Keratoprosthesis in the Management of Corneal Limbal Stem Cell Deficiency.

PURPOSE: To report the long-term outcomes of the Boston type I keratoprosthesis (KPro) in the management of limbal stem cell deficiency (LSCD). METHODS: Retrospective review of KPro procedures performed by a single surgeon from May 1, 2004, to January 1, 2015. RESULTS: One hundred seventy-three KPro procedures were performed in 149 eyes, including 68 in 54 eyes with LSCD. Glaucoma (48% vs. 82%, P < 0.0001) and a history of ≥2 keratoplasties (39% vs. 79%, P < 0.0001) were significantly less common in eyes with LSCD. Preoperative corrected distance visual acuity was ≥20/200 in 7% of eyes with LSCD and 9% of eyes without LSCD. A significantly greater percentage of eyes with LSCD had CDVA ≥ 20/200 at each of the first 5 years after surgery. The only postoperative complication more common in eyes with LSCD compared with eyes without was persistent corneal epithelial defect (50% vs. 28%, P = 0.013), although the associated secondary complications sterile corneal necrosis (22% vs. 11%, P = 0.059) and corneal infiltrate (20% vs. 10%, P = 0.08) were twice as common in eyes with LSCD. Despite this, the retention failure rates in eyes with and without LSCD were similar (0.089/eye-yr vs. 0.071/eye-yr; P = 0.53). CONCLUSIONS: Boston type I keratoprosthesis implantation results in a significant improvement in CDVA in the majority of eyes with LSCD through 5 years after surgery, with better visual outcomes than eyes without LSCD. Although several postoperative complications are more common in LSCD, sight-threatening complications such as endophthalmitis and retinal detachment are not. Additionally, there is no difference in the retention failure rate in eyes with and without LSCD, although a larger number of procedures with longer follow-up will be needed to determine retention outcomes more than 5 years after surgery.

Intravitreal Bevacizumab for Treatment of Central Serous Chorioretinopathy.

PURPOSE: To compare the outcomes of treatment with intravitreal bevacizumab (IVB) versus observation in central serous chorioretinopathy (CSCR). METHODS: In a retrospective comparative study, records of 45 patients with CSCR were reviewed. Twenty-two patients received IVB (1.25 mg/0.05 ml) while 23 subjects were observed. All subjects underwent measurement of best corrected visual acuity (BCVA) and intraocular pressure (IOP), dilated fundus examination and optical coherence tomography (OCT) imaging at baseline and follow up visits. Outcome measures included central macular thickness (CMT) and BCVA in logarithm of minimum angle of resolution (logMAR) notations. RESULTS: Mean age was 44.1 ± 9.3 (range: 24 to 64) years and mean follow-up period was 10.4 ± 11.2 (range: 3 to 43; median: 6) months. All patients demonstrated resolution of neurosensory detachment and improvement in visual acuity. At final visit, there was no significant difference in mean CMT between the IVB and observation groups (275 vs 284 µm, P> 0.05). Mean baseline logMAR visual acuity was 0.38 ± 0.24 in the IVB group which improved to 0.24 ± 0.31 at final follow-up (P = 0.011); mean baseline logMAR visual acuity was 0.42 ± 0.28 in the observation group and improved to 0.12 ± 0.18 (P = 0.001). Visual improvement was more marked in the observation group (0.30 vs 0.14 logMAR, P< 0.05) and mean final visual acuity was also significantly better (P = 0.05). CONCLUSION: There was no significant difference between IVB injection and observation in terms of anatomical outcomes of treatment for CSCR. In terms of visual outcomes, observation was superior to IVB injection.

Evaluation of Subfoveal Choroidal Thickness in Internal Carotid Artery Stenosis.

Purpose. To evaluate the relationship between internal carotid artery (ICA) stenosis and subfoveal choroidal thickness (SFCT) in the elderly population. Methods. A total of 42 eyes of 21 patients with more than 70% ICA stenosis (Group 1) on one side and less than 70% stenosis (Group 2) on the other side were recruited for this study. ICA stenosis was diagnosed using both the B-mode and Doppler ultrasound. The two groups were compared in terms of the percentage of stenosis, SFCT measurements, intraocular pressure, ocular perfusion pressure, refractive error, and peak systolic velocity. Eyes were examined with the RTVue-100 OCT device by the EDI-OCT technique. Results. The mean age of the patients was 71.9 ± 10.8 years. The mean percentage of ICA stenosis was 74 ± 4.9% in Group 1 and 47.5 ± 7.7% in Group 2. The mean SFCT was 231.9 ± 44.6 µm in Group 1 and 216.2 ± 46.8 µm in Group 2, which was significantly lower (P = 0.028). A statistically significant positive correlation was found between the percentage of internal carotid artery stenosis and SFCT (r = 0896, P = 0.001). Conclusions. Compensatory SFCT increase can be seen in ipsilateral internal carotid artery stenosis greater than 70%.

Suprachoroidal hemorrhage during femtosecond laser assisted cataract surgery.

PURPOSE: To describe a case of suprachoroidal hemorrhage that occurred during femtosecond laser assisted cataract surgery (FLACS). OBSERVATIONS: A 67-year-old woman with high myopia underwent FLACS. Following two unsuccessful attempts at docking due to interface air bubbles, the third attempt was successful. Laser treatment and cataract surgery proceeded uneventfully until intraocular lens (IOL) implantation. While positioning the IOL within the capsular bag, the anterior chamber began to shallow, intraocular pressure became high by palpation, and the optic of the IOL prolapsed partially out of the bag. A segmental suprachoroidal hemorrhage was identified in the superior peripheral retina by intraoperative indirect ophthalmoscopy. Following an hour of waiting in the recovery room, the anterior chamber deepened and the intraocular pressure was low enough to position the IOL centrally within the bag. Her subsequent postoperative course was uneventful. CONCLUSIONS AND IMPORTANCE: To our knowledge, this is the first report of suprachoroidal hemorrhage during FLACS. We speculate that repeated sudden drops in intraocular pressure associated with multiple undockings triggered the suprachoroidal hemorrhage in this case.

Acute retinal pigment epitheliitis: spectral domain optical coherence tomography, fluorescein angiography, and autofluorescence findings.

A 17-year-old presented with central and paracentral scotomas in his right eye for one week. There was no remarkable medical or ocular history. Blood analyses were within normal range. At presentation both eyes' best-corrected visual acuities were 20/20. Slit-lamp examination result was normal. Fundus examination revealed yellow-white hypopigmented areas in the macula. Fluorescein angiography (FA) showed hypofluorescence surrounded by ring of hyperfluorescence. Fundus autofluorescence (FAF) was slightly increased. Spectral domain optical coherence tomography (SD-OCT) showed disruption of IS/OS junction with expansion of abnormal hyperreflectivity from retinal pigment epithelium to the outer nuclear layer (ONL). One month later fundus examination showed disappearance of the lesions. FA revealed transmission hyperfluorescence. FAF showed increased autofluorescence and pigment clumping. Hyperreflective band in SD-OCT disappeared. Loss of photoreceptor segment layers was observed in some of the macular lesions. The diagnosis of acute retinal pigment epitheliitis can be challenging after disappearance of fundus findings. FA, FAF, and SD-OCT are important tests for diagnosis after resolution of the disease.

Effects of polyquaternium- and benzalkonium-chloride-preserved travoprost on ocular surfaces: an impression cytology study.

PURPOSE: To compare the toxicity effect of polyquaternium (PQ) and benzalkonium chloride (BAK) preservation of travoprost on the ocular surface. METHODS: This prospective study included 44 eyes of 44 patients with newly diagnosed glaucoma. Twenty-two patients used PQ-preserved travoprost (PQ group) and 22 patients used BAK-preserved travoprost (BAK group). To investigate the effect on the ocular surface, conjunctival impression cytology (IC) was performed at baseline and the 1- and 6-month follow-up visits. Additionally, the ocular surface disease index (OSDI) questionnaire, Schirmer I test, and tear break-up time (TBUT) measurement were administered at baseline, and at 1-, 3-, and 6-month follow-up visits. RESULTS: While both groups showed statistically significant IC grade increases at 1 and 6 months when compared with baseline measurements, IC grades were significantly higher for patients using PQ-preserved travoprost compared with patients using BAK-preserved travoprost. The Schirmer I test and TBUT scores were not statistically significant between group 1 and BAK group at baseline and at 1-, 3-, and 6-month visits (P>0.05). OSDI scores did not statistically differ at baseline and the 1-month measurements between the 2 groups (P>0.05), but the 3- and 6-month OSDI scores were significantly higher for BAK group (P=0.001). Differences in OSDI and Schirmer I test scores were statistically significant at 1, 3, and 6 months in both groups as compared with baseline values (P<0.05). Statistically significant differences in the TBUT scores were seen for both groups at 3 and 6 months, while BAK group, but not PQ group, had insignificant score differences at 1 month as compared with baseline values of PQ group (P=0.083). CONCLUSION: PQ-preserved travoprost was found to be safer and better-tolerated than BAK-preserved travoprost. PQ-preserved travoprost provided better ocular surface comfort, and therefore a better patient experience, which would likely result in higher treatment compliance.

Quantitative analysis of macular thickness following uneventful and complicated cataract surgery.

PURPOSE: To compare change of macular thickness after uneventful cataract surgery and after cataract surgery complicated with vitreous loss, using optic coherence tomography (OCT). METHODS: Twenty eyes of 20 patients who underwent cataract surgery complicated with posterior capsular tear participated in this retrospective study (Group 2). The fellow eyes of those patients who underwent uneventful cataract surgery served as the control group (Group 1). Best spectacle-corrected visual acuity (BCVA), refraction, keratometry, axial length measurement, intraocular lens power calculation, intraocular pressure, and biomicroscopic and posterior segment examinations were done preoperatively. BCVA was evaluated at the postoperative 1st day, 1st week, 1st month, and 3rd month. Macular thickness and volumetric measurements with OCT with MM5 protocol were conducted at the postoperative 3rd month. RESULTS: Logarithm of the minimum angle of resolution BCVA of Group 1 was significantly better than Group 2 at all intervals (P < 0.05). Foveal, parafoveal (superior and temporal), and perifoveal (superior and temporal) macular thickness measurements were significantly higher in Group 2 at month 3 (P < 0.05). Foveal volume was also significantly higher in Group 2 when compared with Group 1 (P < 0.05). In Group 2, two eyes (10%) were diagnosed with clinically significant cystoid macular edema at the 1-month visit. CONCLUSION: Macular thickness was found to be significantly high in eyes undergoing complicated cataract surgery (with posterior capsular tear) when compared with uneventful cataract surgeries of fellow eyes.

Vitiligo in a Patient Treated with Interferon Alpha-2a for Behçet's Disease.

Behçet's disease (BD) and vitiligo are diseases of unknown etiology. Interferon (IFN) alpha therapy is commonly used in Behçet uveitis. Interferon treatment in various diseases have also been observed causing certain autoimmune diseases such as vitiligo because of its immunomodulatory activity. The association between IFN therapy and vitiligo has been reported in the literature. We report a 21-year-old man with BD in whom vitiligo occurred during IFN treatment. To the best of our knowledge, this is the first reported case of such an association.