Role of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor treatment in age-related macular degeneration.

PURPOSE: The aim of this study was to determine the effect of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor injection. METHODS: Sixty-one eyes with age-related macular degeneration that had received intravitreal bevacizumab or ranibizumab injections were retrospectively reviewed. The vitreomacular interface was evaluated, and eyes were grouped according to the presence of posterior vitreous detachment (Group 1, n = 25) or vitreomacular adhesion (Group 2, n = 36). All patients received three loading doses of intravitreal anti-vascular endothelial growth factor injections at monthly intervals, and subsequently, pro re nata regimen was performed. Best-corrected visual acuity and central foveal thickness measurement at follow-up were evaluated. The development of posterior vitreous detachment during the follow-up was also reported. RESULTS: The best-corrected visual acuity changes at each visit compared with baseline were significantly better in Group 1 (P = 0.01, 0.02, 0.02, 0.009, 0.009, respectively at third, sixth, ninth, 12th month, and last visit). When best-corrected visual acuity was classified according to the change in visual acuity of 10 letters or more, the rate of improved or stable best-corrected visual acuity was greater in Group 1 (P = 0.02). During the follow-up, 5 eyes (14.3%) developed posterior vitreous detachment. CONCLUSION: Vitreomacular adhesion seems to have an adverse effect on the visual prognosis of anti-vascular endothelial growth factor treatment for age-related macular degeneration.

Toxic optic neuropathies.

PURPOSE OF REVIEW: Many causes of toxic optic neuropathy have been described to date and novel causes of toxicity are continuously being added to the current literature. The pathophysiological basis for the toxicity or a direct causal relationship is yet to be determined for many of these agents. This review highlights the reports made over the last year about the commonly reported agents, with emphasis on the mechanisms of toxicity. RECENT FINDINGS: Mitochondria of retinal ganglion cells and papillomacular bundle in particular could be the common target of many causes of toxic optic neuropathy, if not all. Agents or their metabolites responsible for the toxicity seem to interfere with the oxidative phosphorylation in mitochondria, causing a buildup of reactive oxidation species, energy depletion, oxidative stress, and activation of apoptosis. SUMMARY: Further data are still necessary to understand how some of the usual suspects cause damage to the optic nerve or whether they indeed cause damage or not. A basic algorithm, as proposed, could be a useful addition to discriminate the novel causes of toxic optic neuropathy. VIDEO ABSTRACT: See the Supplemental Digital Content 1 (http://links.lww.com/COOP/A11).

Comparison of sutures and cyanoacrylate tissue adhesives for wound repair in a rat model of corneal laceration.

AIMS: The aim of the present study was to evaluate the cicatricial repair of a corneal artificial perforation in rats with 10-0 nylon suture, N-butyl-2-cyanoacrylate (NBCA) adhesive, or NBCA + methacryloxysulfolane (NBCA-MS) adhesive through microscopic and histological assays. METHODS: Twenty Wistar rats were randomly divided into 4 groups each containing 5 rats: (1) control group (corneal trauma without suturing and tissue adhesives), (2) suture group, (3) NBCA group and (4) NBCA-MS group. A central full-thickness 2-mm laceration was performed in the left eyes of the studied rats in all 4 groups. The presence of corneal edema, corneal neovascularization and tissue adhesive/suture were evaluated. On the 21st day, the rats were sacrificed and histological examination was performed to determine irregularity of corneal layers, superficial epithelization, polymorphonuclear leucocytes and neovascularization. RESULTS: Tissue adhesives were as effective as suturing in closing full-thickness corneal wounds and no difference in postoperative healing was observed clinically. As for the histological results, suture-treated eyes had persistent corneal irregularity that can limit visual acuity and may also lead to astigmatism. CONCLUSIONS: The use of tissue adhesives constitutes a viable alternative clinical procedure to conventional sutures. Possible influences on astigmatism are hypothetical, as no objective measure of astigmatism was performed in the test animals.

Cup-to-disc ratio in patients with idiopathic intracranial hypertension is smaller than that in normal subjects.

BACKGROUND: A small cup-to-disc (C:D) ratio is an established risk factor for nonarteritic anterior ischemic optic neuropathy. We sought to determine if a small C:D ratio was present in patients with idiopathic intracranial hypertension (IIH) as a potential risk factor for visual loss in that disorder. METHODS: We performed a retrospective review of 52 charts of patients diagnosed with IIH at Michigan State University from 1990 to 2003. Twenty-eight patients (55 eyes) met diagnostic inclusion criteria and had undergone fundus photography of sufficient quality to allow assessment of the C:D ratio after optic disc edema had become minimal or resolved. C:D ratio was measured from the digitized photographs. The data were placed into rank order categories (0.1 unit intervals) and compared to published normative C:D data. RESULTS: The average vertical C:D ratio was 0.143 (SD 0.061) in the right eye and 0.127 (SD 0.056) in the left eye. The average horizontal C:D ratio was 0.145 (SD 0.053) in the right eye and 0.133 (SD 0.053) in the left eye. The IIH group rank distribution data were compared to published normative C:D ratio data (chi-square test). In each case, the IIH population had a statistically significantly smaller C:D ratio (P < 0.0001) compared to normal subjects. CONCLUSIONS: The C:D ratio in our IIH population was smaller than that in published control populations. A small C:D ratio may lower the threshold for developing optic disc edema from ischemia, increased intracranial pressure, or other mechanisms. Additional studies are needed to confirm these findings.

Prevalence of pinguecula and pterygium in patients with thyroid orbitopathy.

PURPOSE: To determine the prevalence of pinguecula and pterygium in patients with thyroid orbitopathy (TO) and to evaluate its correlation with clinical findings. METHODS: All patients underwent a thorough ophthalmic examination, including tear function analysis using tear film breakup time (BUT) measurement. For patients with TO, lid retraction, Hertel exophthalmometry, and clinical activity scores were also measured. All patients were evaluated for the presence of pinguecula and pterygium. RESULTS: The groups were age (P = 0.15) and gender matched (P = 0.2). The prevalence of pinguecula was significantly higher in group 1 (196 patients, 98%) than in group 2 (23 patients, 46%) and group 3 (64 patients, 32%) (P < 0.001). In group 1, lid retraction was significantly correlated with pinguecula prevalence (P < 0.001), whereas there was no correlation between pinguecula prevalence and BUT values (P = 0.624), clinical activity score levels (P = 0.325), or exophthalmometer findings (P = 0.155) In groups 2 and 3, pinguecula was seen more frequently in patients with subnormal BUT measurements (P < 0.001). Pterygium was seen at very low rates in all groups and analysis could not be performed. CONCLUSIONS: Pinguecula was seen more frequently in patients with TO than in both control groups. Lid retraction was the only clinical factor determined with significant impact on the prevalence of pinguecula in patients with TO. Impaired tear function did not influence pinguecula prevalence in patients with TO, in contrast to both control groups. Increased exposure to UV light because of lid retraction may be the major underlying causative factor on pinguecula prevalence in patients with TO, compared with tear dysfunction in both control groups.

Takayasu's disease and secondary ocular ischemic syndrome.

Takayasu's, or "pulseless," disease is a rare, idiopathic, chronic granulomatous vasculitis that affects large arterial blood vessels. Ocular manifestations occur as a consequence of obliteration of the carotid artery, and ocular ischemia may develop. A 14-year-old girl with progressive visual loss and ocular ischemic syndrome secondary to Takayasu's disease is described.

The impact of Nd:YAG capsulotomy on foveal thickness measurement by optical coherence tomography.

BACKGROUND AND OBJECTIVE: To measure the foveal thickness change after Nd:YAG laser capsulotomy by optical coherence tomography (OCT). PATIENTS AND METHODS: Fifty-four eyes of 54 patients who had posterior capsule opacification underwent Nd:YAG laser capsulotomy. OCT of the foveal region was performed preoperatively and postoperatively (on days 1 and 7 and months 1, 3, 6, and 12). The preoperative and postoperative measurements were compared. RESULTS: The foveal thickness did not significantly change in the first year after laser treatment. Cystoid macular edema developed in only 1 patient (2%). Patient age and gender, time between surgery and laser capsulotomy, total laser shots, total laser energy, or mean laser energy per shot did not affect the foveal thickness. CONCLUSION: Foveal thickness does not change in the first year after Nd:YAG laser capsulotomy, as determined by OCT.

Vitrectorhexis versus forceps capsulorhexis for anterior and posterior capsulotomy in congenital cataract surgery.

PURPOSE: To compare the results of anterior and posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. METHODS: Twenty-eight eyes with congenital cataract were included in the study. The anterior and posterior continuous curvilinear capsulorhexes were created using microforceps in 17 eyes or through a vitrector in 11 eyes. RESULTS: Corneal edema (P = .56) and anterior chamber flare (P = 1.0) were comparable in both groups. In addition, the time for optical axis clarity was also similar between the groups (P = .98). CONCLUSION: The current results suggest that the use of both techniques appears to be equally safe and effective for the achievement of anterior and posterior capsulorhexis.

Late onset optic neuropathy in methylmalonic and propionic acidemia.

PURPOSE: To describe 3 cases of late-onset bilateral optic neuropathy with visual dysfunction in patients with organic acidemia. DESIGN: Retrospective case series. METHODS: A total of 3 subjects, a 16-year-old male with methylmalonic acidemia (MMA), a 21-year-old male with MMA, and a 20-year-old female with propionic acidemia (PA), are included in this series. Comparison of the patients' clinical course, ophthalmologic exam, and testing are discussed. The outcome measures include visual acuity (VA), fundus appearance, visual fields, brain imaging, and genetic testing. RESULTS: All 3 subjects had late-onset severe bilateral VA loss with bilateral optic nerve pallor, central or cecocentral scotomas on visual field testing, and negative diagnostic workups for other causes of bilateral optic neuropathy. CONCLUSIONS: Patients with organic acidemia may develop late-onset bilateral optic neuropathy with visual dysfunction despite lifelong propiogenic amino acid restriction and dietary supplementation.

Prospective comparison of two suturing techniques of amniotic membrane transplantation for symptomatic bullous keratopathy.

PURPOSE: To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK). DESIGN: Randomized, double-blind controlled clinical trial. METHODS: setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups. RESULTS: The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046). CONCLUSIONS: The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.

Ocular complications in 2 cases with porphyria.

PURPOSE: We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT). METHODS: Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU. RESULTS: Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment. CONCLUSIONS: Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions.

Postoperative endophthalmitis caused by Bacillus cereus and Chlamydia trachomatis.

PURPOSE: To describe the clinical manifestations and outcomes in 4 patients with endophthalmitis caused by Bacillus cereus and Chlamydia trachomatis. SETTING: Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey. METHODS: Four patients who had cataract extraction and intraocular lens implantation with phacoemulsification at a secondary eye-care center presented with endophthalmitis. Cultures and direct fluorescein assay (DFA) were performed on vitreous aspirates from all patients. RESULTS: Cultures were positive for B cereus and DFAs were positive for C trachomatis in all patients. Despite timely intervention, at the end of follow-up, 1 patient had 20/200 visual acuity and another, counting fingers at 3 m. Phthisis bulbi developed in the 2 other patients. CONCLUSION: The course of infection with B cereus and C trachomatis poses a potential threat, especially because of the limited data on treatment of endophthalmitis secondary to C trachomatis.

Mitomycin C and conjunctival autograft for recurrent pterygium.

PURPOSE: To observe the efficiency of intraoperative low-dose Mitomycin-C combined with conjunctival autograft in the treatment of recurrent pterygium. METHODS: Fifteen eyes with recurrent pterygium were included in this study. The mean age of the patients was 51.6 +/- 11.4 (9 men, 6 women). All patients underwent excision of the pterygium tissue and subconjunctival fibrous tissue with a no cautery approach. 0.2 mg/ml Mitomycin-C (0.02%) was applied for 3 min. Conjunctival autograft was obtained from the superotemporal bulbar conjunctiva of the same eye. Eyes were followed for a mean period of 21.0 +/- 9.1 months. RESULTS: Recurrence was seen in two eyes (13.3%) during the follow-up period. The only complication seen was graft edema (two eyes; 13.3%) which healed after pressure patching. Graft necrosis, scleral melting or failure of revascularization was not noted. CONCLUSION: Intraoperative application of 0.2 mg/ml Mitomycin-C combined with conjunctival autograft reduces recurrence in recurrent pterygium cases, with minimal complications.

The ratio of square wave jerk rates to blink rates distinguishes progressive supranuclear palsy from Parkinson disease.

BACKGROUND: Distinguishing progressive supranuclear palsy (PSP) from Parkinson disease (PD) may be difficult, particularly in the early stages, because the characteristic vertical supranuclear eye movement abnormalities of PSP may be absent or delayed until late in the course of the disease. In this study we investigated the usefulness of comparing the square wave jerk rate (SWJR) and blink rate (BR) in the differentiation of these two disorders. METHODS: We studied 10 patients with PD (PD group) and 5 patients with PSP (PSP group) who met published diagnostic criteria. The SWJR and BR were measured from video recordings and were used to calculate a ratio (SWJR:BR). RESULTS: The PSP group exhibited a significantly higher SWJR, higher SWJR:BR, and lower BR than did the PD group. No patient with PSP exhibited a SWJR:BR of < 3; however, one patient with PD had a SWJR:BR of 5.3, creating overlap between the two groups. CONCLUSIONS: The SWJR:BR is a simple and reasonably useful clinical measure to distinguish established PSP from PD. Determining the value of this measure in differentiating early PSP from PD requires a prospective study.