The Ayounkon project: visual impairment, eye diseases and unmet eye care needs in the Syrian refugee population and the hosting community in Lebanon.

AIM: To report on the distribution of eye diseases, aetiologies of severe visual impairment/blindness (SVI/BL) and unmet eye care needs of the Syrian refugee population and the Lebanese host community. METHODS: This retrospective study analysed the data of patients that were examined during the Ayounkon project -an eye health care project offering medical and surgical treatment for Syrian refugees and Lebanese host community in the Bekaa Valley in Lebanon. The project took place in three different primary health care centres and involved cooperation between several NGOs and ophthalmologists working on a voluntary basis. Data was analysed for distribution of eye diseases and aetiologies responsible for monocular and binocular SVI/BL. RESULTS: A total of 2067 patients were included, 677 were children < 18 years. The most frequent pathologies were ocular allergy (10%), and cataract (7.4%). 158 patients (7.6%) were referred for surgery. Glasses were prescribed for 1103 patients (53.4%), of whom 242 (21.9%) were children of school age. SVI/BL was found in 276 patients (13%). The condition was bilateral in 116 patients (42%). SVI/BL was significantly more frequent in the Syrian population than in the Lebanese (186 patients, 14.8% versus 86 patients, 11.3%; p = 0.04). The main causes for SVI/BL were cataract, keratoconus/corneal decompensation and amblyopia. CONCLUSION: The Syrian refugee population and the Lebanese host community have a high prevalence of ophthalmic pathologies and SVI/BL. Visual impairment is more prevalent in the refugee population. Our findings underscore the importance of targeted interventions and access to eye care services for these populations.

Distribution and causes of blindness and severe visual impairment in children at a tertiary referral centre in Rwanda.

AIM: To determine the prevalence and the causes of severe visual impairment and blindness (SVI/BL) in children at a tertiary referral centre in Rwanda. METHODS: In this retrospective study, files of all patients <18 years presenting during the year 2019 at the Kabgayi Eye Unit in Rwanda with SVI/BL (presenting visual acuity of <6/60 Snellen or lack of preferential looking behaviour) in at least one eye were analysed for age, sex, laterality, province of origin and cause of SVI/BL. Causes were categorised according to WHO standard classification. RESULTS: Out of 3939 children presenting to the clinic, 428 (10.9%) had SVI/BL in at least one eye. 165 (4.2%) patients had bilateral and 263 (6.7%) had unilateral condition. Of patients with BL/SVI, 36.7% were below the age of 6 years. In bilateral BL/SVI, the main causes were cataract (18%), refractive error (18%), keratoconus (13%), congenital eye anomaly (9%), glaucoma (8%), cortical blindness (8%) and retinoblastoma (6%). In unilateral BL/SVI it was trauma (46%), cataract (8%), keratoconus (8%), infectious corneal disease (7%) and retinoblastoma (7%). In preschool children, retinopathy of prematurity accounted for 7% of bilateral BL/SVI. Avoidable BL/SVI accounted for 87% of all cases. CONCLUSION: The high number of avoidable causes for SVI/BL may be reduced through several cost-effective ways.

Gigahertz Detection Rates and Dynamic Photon-Number Resolution with Superconducting Nanowire Arrays.

Superconducting nanowire single-photon detectors (SNSPDs) have enabled the realization of several quantum optics technologies thanks to their high system detection efficiency (SDE), low dark counts, and fast recovery time. However, the widespread use of linear optical quantum computing, quasi-deterministic single-photon sources, and quantum repeaters requires even faster detectors that can also distinguish between different photon-number states. Here, we present an SNSPD array composed of 14 independent pixels, achieving an SDE of 90% in the telecommunications band. By reading each pixel of the array independently, we show detection of telecommunication photons at 1.5 GHz with 45% absolute SDE. We exploit the dynamic photon-number resolution of the array to demonstrate accurate state reconstruction for a wide range of light inputs, including operation with long-duration light pulses, as obtained with some cavity-based sources. We show two-photon and three-photon fidelities of 74% and 57%, respectively, which represent state-of-the-art results for fiber-coupled SNSPDs.

Fast single-photon detectors and real-time key distillation enable high secret-key-rate quantum key distribution systems.

Quantum key distribution has emerged as the most viable scheme to guarantee information security in the presence of large-scale quantum computers and, thanks to the continuous progress made in the past 20 years, it is now commercially available. However, the secret key rates remain limited to just over 10 Mbps due to several bottlenecks on the receiver side. Here we present a custom multipixel superconducting nanowire single-photon detector that is designed to guarantee high count rates and precise timing discrimination. Leveraging the performance of the detector and coupling it to fast acquisition and real-time key distillation electronics, we remove two major roadblocks and achieve a considerable increase of the secret key rates with respect to the state of the art. In combination with a simple 2.5-GHz clocked time-bin quantum key distribution system, we can generate secret keys at a rate of 64 Mbps over a distance of 10.0 km and at a rate of 3.0 Mbps over a distance of 102.4 km with real-time key distillation.

Surgical removal of submacular choroidal neovessels in children: Outcome and literature review.

PURPOSE: To report on the outcome of surgical submacular choroidal neovascular membrane (CNV) removal in children and to perform a comprehensive review of literature concerning this intervention in children. METHODS: In this retrospective, noncomparative, interventional case series, we included 8 eyes of 7 consecutive children with subfoveal choroidal neovascularization treated by pars plana vitrectomy (PPV) and CNV removal. Main outcome measures were visual acuity and complications. RESULTS: Mean age at surgery was 8.6 ± 5.2 years (range: 2-16). Two out of 8 eyes were idiopathic. Corrected-distance visual acuity (CDVA) improved from 1.01 ± 0.45logMAR (range:0.3-1.5) at presentation to 0.60 ± 0.37 (range:0-1) at last follow-up (p = 0.03). Mean follow-up was 3.9 ± 3.9 years. Six eyes received at least one intravitreal injection of bevacizumab prior to surgery. Recurrence occurred in one eye with Best's disease.Literature review revealed a total of 42 cases with the most frequent etiologies being Presumed ocular histoplasmosis syndrome (POHS) and idiopathic CNV. Considering all cases together, mean CDVA improved from 1.00 ± 0.37logMAR to 0.52 ± 0.42 (p < 0.01). CNV recurrence occurred in 11 eyes (22.0%), 7 of which had an inflammatory etiology. Other complications included pigment epithelium tear, atrophy and retinal tear. CONCLUSION: Surgical removal of CNV is a viable, effective and safe option in children with persistent submacular neovascular membranes.

Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial.

AIM AND OBJECTIVE: Evaluate the short-term safety and efficacy of dexmedetomidine (0.0055%) drops on intraocular pressure (IOP) in healthy eyes. MATERIALS AND METHODS: In this randomized controlled trial, patients with normal eye exams were randomly assigned to receive, in a randomly selected eye, one drop of either balanced salt solution (BSS) or dexmedetomidine (0.0055%). Goldmann applanation tonometry was performed at baseline and then 30 minutes, 4 hours, and 24 hours after drop instillation. RESULTS: Forty-nine eyes of 49 normal volunteers were enrolled in the study, with 21 eyes (group I) receiving BSS and 28 (group II) dexmedetomidine. Both groups were comparable at baseline as far as age and IOP (p = 0.55 for both parameters). Intraocular pressure significantly decreased from baseline in group II at 30 minutes and 4 hours (p = 0.001 and 0.05, respectively). Maximum IOP decrease was obtained at 30 minutes after dexmedetomidine instillation, with a 9% decrease from baseline (mean decrease: 1.15 mm Hg). The percentage of IOP decrease was significantly higher in group II at 30 minutes compared with group I (9 vs 1.1%; p = 0.05). No side effects were recorded. CONCLUSION: In this pilot study, dexmedetomidine 0.0055% drops have shown good safety and efficacy in lowering IOP in normal healthy volunteers with no history of glaucoma. This medication has a short onset of action, with a 10% reduction of IOP occurring 30 minutes post-instillation. TRIAL REGISTRATION NUMBER: NCT03690622. HOW TO CITE THIS ARTICLE: Fakhoury H, Abdelmassih Y, El-Khoury S, et al. The Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial. J Curr Glaucoma Pract 2021;15(2):58-63.

Legacy of Syriac-Aramaic Scholars in Transmitting Neurosurgical Knowledge Between Antiquity and the Middle Ages.

The link between ancient Greek medicine and the Arabic translation period in the 9th century cannot be understood without studying the contributions of Syriac scholars. With their mastery of Greek and the related Semitic languages of Syriac and Arabic, they initiated a scientific translation process with methods that prevail to this day. In this paper, we reviewed Hunayn Ibn Isshaq's Ten Treatises on the Eye to elucidate the original contributions of the Syriac physicians to the field of neurologic surgery. We analyzed the oldest known diagram of orbital anatomy along with Hunayn's genuine ideas on the optic nerve anatomy and pathology, optic chiasm, afferent pupillary reflex, and papilledema and venous congestion. We also reviewed the neurosurgical elements found in the Syriac Book of Medicines including the thought process in localizing neurologic deficits based on clinical experience and anatomic dissections and the earliest recorded description of brachial plexus pathology.

Comparison of the Automated Pattern-Noise (PANO) Glaucoma Test with the HFA, an FDT Stimulus, and the Fundus Area Cup-to-disk Ratio.

AIM AND OBJECTIVE: To compare the results of a new automated glaucoma test-Pattern-Noise (PANO)-to the Humphrey Visual Field Analyzer-II (HFA), the fundus area cup-to-disk ratio (CDR), and a frequency doubling technology (FDT) stimulus. MATERIALS AND METHODS: This was a prospective study performed in the West-Region of Cameroon. Two hundred and nineteen eyes of 122 adult patients were included with a clinical suspicion of normal-tension or primary open-angle glaucoma and no other major ocular pathology. Eyes were examined with PANO, HFA (24-2 SITA standard), and FDT-stimulus in a randomized order followed by clinical assessment of the CDR. RESULTS: Parametric correlation of the mean contrast threshold of PANO with the mean contrast threshold of FDT-stimulus, total deviation of HFA, and area CDR was 0.94, -0.85, and 0.62, respectively (p < 0.001 for all values). Spatial distribution of sensitivity thresholds is highly correlated (p < 0.001) at all points in the visual field between PANO and HFA. With cut-off values of 3 ± 1 dB for HFA mean deviation and 4 ± 1 for PANO mean contrast threshold and after eliminating borderline cases, PANO's sensitivity was 95% and specificity 60%. The mean patient age was 45.2 ± 15.8 years. Mean thresholds of PANO and FDT-stimulus decreased with increasing age. Mean examination time was 7.1 ± 1.8 minutes for PANO, 5.9 ± 1.3 minutes for HFA, and 4.7 ± 1.3 minutes for FDT-stimulus. The mean percentage of false-positives per examination was 4.95% for PANO, 4.62% (p = 0.025) for FDT-stimulus, and 2.10% for HFA. CONCLUSION: The results showed that PANO was successful in suspecting the presence of glaucoma. Pattern-Noise examination led to findings that were significantly correlated to HFA, FDT stimulus, and area CDR. Some patterns of defect were also correlated. Furthermore, PANO showed a reasonable examination time and error rate. CLINICAL SIGNIFICANCE: Affordable and robust visual field devices are lacking in large parts of the developing world. Comparing them to established methods is a prerequisite to their clinical use. HOW TO CITE THIS ARTICLE: Hannen T, El-Khoury S, Patel R, et al. Comparison of the Automated Pattern-Noise (PANO) Glaucoma Test with the HFA, an FDT Stimulus, and the Fundus Area Cup-to-disk Ratio. J Curr Glaucoma Pract 2021;15(3):132-138.

The Effect of Age on Corneal Topographic Indices, Keratometry and Visual Acuity After Combined Intrastromal Corneal Ring Segment (ICRS) Implantation and Corneal Crosslinking.

We aimed to assess age-related changes in corneal topographic indices, keratometry and visual acuity after sequential intracorneal ring segment implantation (ICRS) and crosslinking (CXL). This was a retrospective matched case-control series including 26 eyes of patients ≤18 years as cases and 26 eyes of adult patients as controls. All eyes received ICRS+CXL for progressive keratoconus. Eyes were matched regarding the keratoconus parameters and the treatment (type, number and thickness of ICRS). Data was analyzed for refractive and topographic values (uncorrected and corrected distance visual acuity (UDVA; CDVA) sphere; cylinder; spherical equivalent; maximum keratometry (Kmax); flat keratometry (Kflat); steep keratometry (Ksteep); all 7 pentacam topographic indices) preoperatively and one year postoperatively. Preoperatively, there was no significant difference for any refractive, clinical or topographic parameters between the groups except for index of vertical asymmetry. After one year, children had a significantly higher improvement in Ksteep (3.05D) than adults (2.10D; P=0.036) and a trend to significance for Kflat (2.7D compared to 1.78D, respectively; P=0.081). UDVA improved by 4.3 ETDRS lines in children compared to 3.3 ETDRS lines in adults and CDVA improved by 1.7 ETDRS lines in children compared to 1.2 ETDRS lines in adults, but with no statistical significance. The effects on keratometry indicated that corneal response after ICRS and CXL for keratoconus is more pronounced in young patients than adults. This assumption is also supported by functional improvement and by the fact that a few eyes (5) of some very young patients (<13years) showed highly remarkable improvements after surgery (higher than any adult eye).

Outcome and risk factors of vitreoretinal surgery in pediatric patients with familial exudative vitreoretinopathy.

PURPOSE: To evaluate the outcome for vitreoretinal surgery in children with familial exudative vitreoretinopathy (FEVR) and to evaluate the risk factors associated with failure. METHODS: This is a retrospective interventional case series of 43 consecutive eyes (34 patients) with vitreoretinal surgery for FEVR. Ocular status prior to intervention and at last follow-up and all surgical steps were recorded. Follow-up time was at least 6 months. Main outcome measure was surgical failure (defined as one of the following: (1) deterioration of visual acuity and stage, (2) persistence or development of total retinal detachment, (3) phthisis). RESULTS: After a mean follow-up of 3.3 ± 3.4 years (median 2.3; 0.5-15.7 years), surgery was successful in 30 eyes (70%) and failed in 13 eyes (30%). Twenty-one eyes (49%) improved, 13 (30%) remained stable, and 9 (21%) deteriorated. Postoperatively, stages and VA improved significantly (p = 0.001; p = 0.04, respectively). Surgical failure was only observed on patients with stages 4 and 5. Mean macular thickness decreased significantly in eyes (stages 2 and 3) with tractional epiretinal membrane. CONCLUSION: Eyes with tractional epiretinal membrane in stages 2 and 3 seem to benefit from vitrectomy and membrane peeling with a positive risk-benefit profile. Advanced stages have a low success rate and limited functional improvement, but in selected cases, surgery seems beneficial.

Corrigendum to "Under-the-Flap Crosslinking and LASIK in Early Ectasia with Hyperopic Refractive Error".

[This corrects the article DOI: 10.1155/2018/4342984.].

Therapeutic Challenges and Prognosis of Descemet's Membrane Endothelial Keratoplasty in Herpes Simplex Eye Disease.

PURPOSE: To describe the functional outcome, postoperative complications, and complication management of Descemet's membrane endothelial keratoplasty (DMEK) in corneal decompensation secondary to Herpes simplex eye disease (HED). METHODS: This retrospective interventional case series included 17 eyes that received DMEK for endothelial decompensation secondary to HED. Complete ophthalmological examination, including corrected-distance visual acuity (CDVA), anterior segment slit-lamp, and optical coherence tomography assessment, were performed preoperatively and postoperatively at regular follow-up intervals. Visual outcome and complication rates were compared with those of 72 consecutive eyes that received DMEK for Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) during the same period. RESULTS: Mean follow-up time was 11.1 ± 5.9 months (range 6-27). CDVA improved from 1.16 ± 0.46 logMAR to 0.62 ± 0.44 logMAR (P = 0.001). Corneal pachymetry significantly decreased from 695 ± 53 µm at day 1 to 569 ± 88 µm at 2 months (P < 0.001). Postoperative complications occurred in 12 eyes, including primary graft failure (12%), endotheliitis (29%), corneal ulcers (35%), and cystoid macular edema (18%). Most complications occurred shortly after surgery, with a median delay of 2.5 months. In comparison, the complication rates for DMEK in FECD and PBK were significantly lower (no graft failure, P = 0.005; no endotheliitis, P < 0.001; no corneal ulcers, P < 0.001 and 3% cystoid macular edema, P = 0.046). CONCLUSIONS: DMEK surgery significantly improved CDVA in patients with endothelial decompensation due to HED. The rate of postoperative complications was higher than for FECD and PBK. Close follow-up is mandatory and the rate of postoperative inflammatory events suggests that patients should be kept on high doses of oral valacyclovir.

Artificial chamber and 3D printed iris: a new wet lab model for teaching Descemet's membrane endothelial keratoplasty.

PURPOSE: To describe a new wet lab model of Descemet membrane endothelial keratoplasty (DMEK) using human corneas mounted on an artificial anterior chamber with an artificial iris and to compare the performance time and scores between beginners and experienced anterior segment surgeons. METHODS: Corneas were mounted on an artificial chamber. To simulate an anterior chamber and to avoid loosing the graft into the tubing, a 3D printed iris was added. Each DMEK procedure required only one cornea for graft preparation, insertion, orientation, unfolding and centration. Ten human research corneas were used for training purposes. Intraoperative OCT was only used to validate the different steps of the procedure. Operators were divided into two groups, two beginners and three experienced DMEK surgeons. RESULTS: All DMEK procedures were successfully performed. Descemet's tears were frequent but harvesting was successful in all procedures. All combinations of graft unfolding techniques were possible. Experienced surgeons performed statistically better then beginners with faster harvesting (12.8 versus 28.2 min; p = 0.02) and insertion (13.5 versus 20.8 min; p = 0.05) times and better performance score (94 versus 52; p = 0.03). CONCLUSION: This DMEK wet lab model offers a close to reality, feasible, resource-sparing and valid teaching technique that permits to perform all DMEK surgical steps. It also offers the possibility of varying the surgical difficulty by changing the anterior chamber depth.

Under-the-Flap Crosslinking and LASIK in Early Ectasia with Hyperopic Refractive Error.

PURPOSE: To present safety, efficacy, and early results of a new combinational treatment for early corneal ectasia with hyperopic refractive error aimed to reinstate emmetropia and stabilize cornea. METHOD: This is a retrospective case series. All surgeries were performed at the Beirut Eye Specialist Hospital, Lebanon. Surgical procedure consisted of (1) lifting flap (post-LASIK ectasia)/creation of corneal flap (keratoconus), (2) application of excimer laser ablation to correct refractive error, (3) loose repositioning of flap, (4) under-the-flap irrigation with riboflavin 0.1% dextran solution, and (5) application of UVA light. RESULTS: A total of 7 eyes (4 patients; mean age 24.25 years; all male) were included. 2 patients had early keratoconus, and 2 patients had early post-LASIK ectasia. Pretreatment vs. last postoperative follow-up visit (mean 11.25 months; range 6-15 months) UDVA (logMAR), spherical equivalent (SE) (D), astigmatism (D), and central pachymetry (µm) were 0.35 ± 0.18 vs. 0.05 ± 0.07, p=0.017; -0.81 ± 0.67 vs. -0.46 ± 0.57, p=0.078; 2.46 ± 0.53 vs. 0.68 ± 0.28, p=0.018; and 547 ± 58 vs. 536 ± 49, p=0.07, respectively. In all eyes, BCVA was 0.1 logMAR or better before and after treatment. No eye showed a decrease in BCVA. Two eyes of one patient had an epithelial ingrowth, which was removed in one case. Follow-up results showed no major complications and no progression of corneal ectasia. CONCLUSION: Early results showed that under-the-flap CXL with excimer laser correction is an effective treatment for early hyperopic keratectasia, with the advantage of rapid recovery, postoperative corneal stability, and no epithelial healing complications. The procedure seems to bear a risk for postoperative epithelial growth into the flap interface.

Preoperative spectral-domain optical coherence tomography in patients having cataract surgery.

PURPOSE: To evaluate the role and cost-effectiveness of preoperative spectral-domain optical coherence tomography (SD-OCT) in patients having cataract surgery. SETTING: Fondation Opthalmologique Adolphe de Rothschild, Paris, France. DESIGN: Retrospective case series. METHODS: All patients who had cataract surgery had macular and retinal nerve fiber layer SD-OCT preoperatively. A complete ophthalmologic examination was performed, including corrected near (CNVA) and corrected distance visual acuities, intraocular pressure (IOP), and a fundus examination. RESULTS: The study comprised 245 patients (401 eyes) with a mean age of 73.5 years ± 9.81 and a mean IOP of 15.6 ± 3.04 mm Hg. Of 107 eyes (26.7%) with abnormal macular SD-OCT, 70 eyes were judged normal on fundus examination. The most frequent anomalies were age-related macular degeneration and epiretinal membrane. Age over 70 years and CNVA worse than Parinaud 2 were associated with higher rate of abnormal macular SD-OCT (odds ratio, 2.76 and 2.28, respectively). Fifty-seven eyes (14.2%) had abnormal retinal nerve fiber layer SD-OCT, 30% of them with no history of glaucoma and no detected anomaly on fundus examination. Age over 70 years and a history of glaucoma were associated with a higher rate of retinal nerve fiber layer anomalies. CONCLUSIONS: Preoperative SD-OCT scanning was significantly more effective in detecting anomalies in patients having cataract surgery than fundus examination. Older age and CNVA worse than Parinaud 2 were associated with higher rates of abnormal macular SD-OCT. Older age and a history of glaucoma were associated with higher abnormal retinal nerve fiber layer anomaly rates.

ENDOILLUMINATION-ASSISTED MODIFIED SCLERAL BUCKLING.

PURPOSE: To assess the anatomical and functional outcomes in addition to complications for endoillumination-assisted modified scleral buckling surgery using a noncontact Oculus BIOM wide-angle viewing system in patients with primary rhegmatogenous retinal detachment. METHODS: This is an interventional prospective noncomparative case series. Consecutive patients listed for scleral buckle surgery for primary rhegmatogenous retinal detachment were enrolled over an 18-month period and followed up for 1 year. The study cohort consisted of 25 patients (25 eyes) of which 23 patients (23 eyes) completed the 1-year follow-up. Scleral buckling surgery was done with a 23-gauge endoillumination probe, which was inserted through a pars plana sclerotomy. The primary outcome measure was anatomical success rate with one surgery assessed at the 6-month and the 1-year follow-up. Secondary outcome measures included final visual acuity, number of surgeries required, and complication rates such as entry site break, posterior vitreous detachment, endophthalmitis, and cataract. RESULTS: At 1 year, anatomical success with one surgery was achieved in 20 patients (87%). One patient required two additional vitreoretinal surgeries and 2 patients required three additional surgeries. All patients had a flat retina at 1 year with silicone oil present in one eye. Mean best-corrected visual acuity improved by six ETDRS lines, from 1.03 ± 0.83 logarithm of the minimum angle of resolution (20/200) preoperatively to 0.40 ± 0.47 logarithm of the minimum angle of resolution (20/50) at 1 year. No entry site breaks were detected, and posterior vitreous detachment developed in six patients (26%). No cases of endophthalmitis or cataract progression were reported. CONCLUSION: Endoillumination-assisted modified scleral buckling surgery combined with a noncontact wide-angle viewing system can provide good anatomical and functional outcomes with many advantages and a low complication rate.

Pattern noise (PANO): a new automated functional glaucoma test.

PURPOSE: To present a newly developed visual field device (pattern noise: PANO) designed to be sensitive to glaucoma defects, cost-effective, material-practical and easy to repair and therefore particularly suited for low-income countries, where glaucoma can be highly prevalent (e.g. sub-Saharan Africa). METHODS: This is primarily a descriptive paper, but it also includes a prospective matched case-control pilot study. Hardware, stimulus, target configuration, testing strategy and result sheet are described. The main outcome measure is the contrast level (range 2-64). Targets are composed of bright/dark pixels flickering with 18 Hz and have a size of 5°. Pixel size is approximated to the hill of vision. Average luminance of targets is constant and equals background luminance.The study was performed in the West Region in Cameroon. Twenty eyes of 20 newly presenting patients with glaucomatous optic disc cupping on funduscopy were compared with 20 eyes of 20 normal patients matched in age and laterality of eye. RESULTS: Mean age was 32.9 ± 18.8 years for glaucoma patients and 32.2 ± 15.6 years for healthy subjects. Mean contrast threshold was significantly higher in eyes with abnormal disc (16.2 ± 14.3 vs. 4.4 ± 0.8, P = 0.002). Correlation of mean contrast thresholds and cup-to-disc ratio was significant (r = 0.59; P = 0.006). Average examination time was significantly longer for glaucoma eyes compared to healthy eyes (8.2 vs. 6.1 min, P < 0.001), whereas error rate did not differ (4.8 ± 2.5% vs. 4.1 ± 1.8%, P = 0.33). CONCLUSION: PANO demonstrated visual field defects in patients with glaucomatous optic disc. Defects correlated significantly with glaucomatous optic nerve head morphological alterations. Healthy eyes obtained normal results. More studies are needed to establish PANO.

Acute Angle-closure Glaucoma as a First Presentation of Coats' Disease: A Case Report.

PURPOSE: The purpose of this study was to report an unusual first manifestation of Coats' disease presenting as an acute angle-closure glaucoma attack in an adult patient. PATIENTS AND METHODS: A 37-year-old African woman presented to the emergency department with severe headache, ocular pain, and no light perception in the left eye. The left pupil was middilated and nonreactive, and the intraocular pressure (IOP) by applanation tonometry was 47 mm Hg. Slit-lamp examination revealed anterior subcapsular opacification (glaukomflecken), posterior synechiae, and total angle closure with iris bombé. A fundus examination revealed macular exudation, inferior vascular dilation, and tortuosity with peripheral telangiectasia and macroaneurysms, in addition to partial exudative retinal detachment involving the macula. On the basis of these findings, Coats' disease was diagnosed. RESULTS: The patient was treated with antiglaucoma medications and laser peripheral iridotomy to control the IOP, which had decreased to 21 mm Hg the following day. Diode laser transscleral cyclophotocoagulation was performed to further decrease the IOP. After completing a 360 degree laser, the IOP decreased to 8 mm Hg and then stabilized around 12 mm Hg. The vision remained no light perception; however, the patient felt major symptomatic relief. CONCLUSIONS: The present case describes acute angle-closure glaucoma as an initial presentation of Coats' disease in adults. Clinicians should be aware that this unique presentation in Coats' disease can occur even without retinal detachment.

Central island formation after cataract surgery in a laser in situ keratomileusis eye: New etiology.

We report a case of central corneal steepness formation after cataract surgery in a post-laser in situ keratomileusis (LASIK) eye. A 51-year-old woman with traumatic cataract and a history of myopic LASIK surgery had uneventful phacoemulsification cataract surgery. Postoperatively, the corneal topography difference map showed a central island formation of 2.1 diopters (D) compared with the preoperative level, which correlated with a clinical myopic shift of 2.00 D from the targeted emmetropia. At 4 months, most of the central island had resolved spontaneously. At 15 months, topography returned to preoperative levels. We speculate that wound hydration in the flap interface during surgery resulted in a pond-like fluid accumulation in the center of the cornea, resulting in a myopic refractive shift. We report this case because of the high probability that this phenomenon could be confounded by an erroneous intraocular lens (IOL) calculation and the potential for a serious iatrogenic complication from a premature IOL exchange or touch-up procedure.