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1.
Cornea ; 38(9): 1154-1160, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31394554

RESUMO

PURPOSE: This study aimed to predict the best-corrected visual acuity (BCVA) based on swept-source optical coherence tomography (SS-OCT) parameters in eyes with keratoconus. METHODS: We retrospectively reviewed 135 eyes of 135 patients with keratoconus (mean age: 31.9 ± 12.4 years). The average keratometry value and BCVA (logarithm of the minimal angle of resolution [Snellen]) were 48.68 ± 5.44 diopter and 0.20 ± 0.36 (20/25), respectively. Eleven parameters were calculated using SS-OCT. Apart from the corneal height and elevation, all the other parameters were calculated from both anterior and posterior corneal OCT data. The patients were divided into 2 groups, 1 for creating the prediction equation (prediction group, 86 eyes) and another for verifying the equation (verification group, 49 eyes). In the former, individual correlations between the BCVA and SS-OCT parameters were analyzed. A stepwise multiple regression analysis was performed with the BCVA as a dependent variable and SS-OCT parameters as independent variables. After its creation, the accuracy of the prediction equation was verified in the verification group. RESULTS: All the parameters, except for age and total corneal cylinder, showed statistically significant correlations with BCVA (P < 0.0001). Using the stepwise multiple regression analysis, we selected 2 explanatory variables: root mean square of anterior corneal elevation (standardized regression coefficient: 1.221; P < 0.0001) and total coma aberration (standardized regression coefficient: -0.575; P = 0.001; adjusted R = 0.546). The prediction was correct in 84.6% of the eyes within ±1 line of Snellen BCVA. CONCLUSIONS: Using the equation we derived from SS-OCT parameters is a promising method to predict visual function in patients with keratoconus.


Assuntos
Córnea/fisiopatologia , Topografia da Córnea/métodos , Ceratocone/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Adulto , Feminino , Humanos , Ceratocone/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto Jovem
2.
BMC Ophthalmol ; 19(1): 183, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412813

RESUMO

BACKGROUND: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL). METHODS: This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10-0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months. RESULTS: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health. CONCLUSIONS: Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia. TRIAL REGISTRATION: UMIN000021220 . Registered 10 September 2015. UMIN Clinical Trials Registry.


Assuntos
Percepção de Profundidade/fisiologia , Membrana Epirretiniana/cirurgia , Qualidade de Vida , Acuidade Visual/fisiologia , Vitrectomia/métodos , Idoso , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica
3.
Asia Pac J Ophthalmol (Phila) ; 8(4): 285-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397676

RESUMO

PURPOSE: The aim was to study the visual performance of a new refractive extended depth of focus (EDOF) intraocular lens (IOL). DESIGN: Prospective, comparative study. METHODS: Consenting patients with age-related cataract willing for bilateral cataract surgery within 2 weeks were implanted with the Supraphob EDOF IOL and those willing for 1 eye surgery were implanted with a monofocal IOL. The uncorrected and best-corrected distance, intermediate and near visual acuity, and contrast sensitivity were evaluated at 1 and 3 months postoperatively. We also inquired about glare, halos, difficulties in night driving, requirement for spectacles, and overall satisfaction with vision. RESULTS: The Supraphob EDOF group (n = 72 eyes) and the monofocal IOL group (n = 54 eyes) were comparable with respect to all preoperative parameters including biometry, visual acuity, and cataract status. The mean age of participants was 58.4 ±â€Š10.6 years. Both groups had similar distance vision but the EDOF group had significantly better intermediate (0.2 ±â€Š0.2 logMAR vs 0.75 ±â€Š0.19 logMAR, P < 0.001) and near vision (median = N6 vs N12, P < 0.001) compared to the monofocal group at 3 months. The contrast sensitivity was similar in both groups. Patients in the EDOF IOL group had much greater satisfaction for intermediate and near vision. Less than 10% patients reported glare, halos, and difficulty in driving at night in the EDOF group. CONCLUSIONS: The Supraphob EDOF IOL was effective in improving the distance, intermediate and near vision in majority of patients, and retained good contrast sensitivity with most patients reporting excellent satisfaction.


Assuntos
Sensibilidades de Contraste/fisiologia , Percepção de Profundidade/fisiologia , Lentes Intraoculares , Facoemulsificação , Acuidade Visual/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Desenho de Prótese
4.
Asia Pac J Ophthalmol (Phila) ; 8(4): 335-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403494

RESUMO

AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a 1-piece aspheric hydrophobic presbyopia-correcting intraocular lens (IOL) launched in 2015. Unlike traditional trifocal IOLs that usually have an intermediate focal point of 80 cm, the PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs. This review provides an overview of the clinical performance of the PanOptix IOL and discusses it in the context of other commercially available trifocal IOLs, FineVision Micro F (PhysIOL, Liege, Belgium), the AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) and the extended depth of focus IOL, TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA). A literature search was performed in the PubMed database to identify studies that have assessed the visual and other clinical outcomes with the PanOptix IOL. In total, 12 studies were included in this review article. Overall, the clinical evidence suggests that in general good visual outcomes, along with a high degree of spectacle independence, are achieved in patients implanted with the PanOptix, FineVision, AT LISA and Symfony IOLs. However, every MIOL has its benefits and limitations, which along with patient's needs and clinical conditions are important factors to consider while selecting an IOL to achieve best possible post-operative outcomes.


Assuntos
Lentes Intraoculares , Satisfação do Paciente , Pseudofacia/cirurgia , Refração Ocular/fisiologia , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Humanos , Facoemulsificação , Desenho de Prótese , Pseudofacia/fisiopatologia
5.
BMC Ophthalmol ; 19(1): 160, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345183

RESUMO

PURPOSE: Central serous chorioretinopathy (CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors-for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment-were also assessed. MATERIALS AND METHODS: The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/- 10.5) with chronic central serous chorioretinopathy (mean duration 18.9 months SD +/- 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. RESULTS: Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. CONCLUSION: Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.


Assuntos
Coriorretinopatia Serosa Central/fisiopatologia , Retina/patologia , Transtornos da Visão/etiologia , Acuidade Visual/fisiologia , Coriorretinopatia Serosa Central/complicações , Coriorretinopatia Serosa Central/diagnóstico , Corioide/patologia , Doença Crônica , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia
6.
BMC Ophthalmol ; 19(1): 159, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345188

RESUMO

BACKGROUND: The Ehlers-Danlos syndromes are a heterogenous group of diseases that cause connective tissue defects. At present, there are no published reports focusing upon the neuro-ophthalmic symptoms that might occur in EDS patients after mild traumatic brain injury. The demographics and clinical course of seven patients with subclinical EDS and mild traumatic brain injury are presented. CASE PRESENTATION: This series describes patients with Ehlers Danlos Syndrome whose diagnosis was discovered in a neuro-ophthalmic clinic for brain injury. Patient demographics and neuro-ophthalmological symptoms are presented. CONCLUSIONS: Patients with subclinical EDS and brain injury may experience a slower, less complete recovery course. Heightened awareness of undiagnosed or underlying Ehlers Danlos Syndrome is important for patients and providers.


Assuntos
Concussão Encefálica/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Recuperação de Função Fisiológica , Transtornos da Visão/etiologia , Acuidade Visual/fisiologia , Adulto , Idoso , Concussão Encefálica/diagnóstico , Síndrome de Ehlers-Danlos/complicações , Feminino , Humanos , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Adulto Jovem
7.
BMC Ophthalmol ; 19(1): 161, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349817

RESUMO

BACKGROUND: Persistent hyperplastic primary vitreous (PHPV) is a rare congenital developmental ocular disorder caused by incomplete regression of the embryonic hyaloid vasculature. Here we report a case of nonsurgical unilateral anterior PHPV that was managed by amblyopia treatment and resulted in an improvement of visual acuity and regression of the fetal vasculature. CASE PRESENTATION: A three-year-old girl was diagnosed with unilateral anterior PHPV in the left eye, manifested with posterior pole cataract, posterior capsule opacification, tunica vasculosa lentis, and a floating hyaloid artery connected to the retrolental mass. The plaque was not large enough to fill the pupil, and conservative management along with amblyopia treatment was conducted. Nineteen months later, the visual acuity in the affected eye improved from 20/100 to 20/50 with correction, and the fetal vasculature regressed gradually and finally into a nonperfusion ghost vessel. CONCLUSIONS: In PHPV-affected children, regression of the fetal vasculature may be observed, and conservative management and amblyopia treatment may be helpful for visual improvement.


Assuntos
Tratamento Conservador/métodos , Vítreo Primário Hiperplásico Persistente/diagnóstico , Recuperação de Função Fisiológica , Acuidade Visual/fisiologia , Corpo Vítreo/anormalidades , Pré-Escolar , Progressão da Doença , Óculos , Feminino , Seguimentos , Humanos , Vítreo Primário Hiperplásico Persistente/fisiopatologia , Vítreo Primário Hiperplásico Persistente/terapia , Privação Sensorial , Corpo Vítreo/diagnóstico por imagem
8.
BMC Ophthalmol ; 19(1): 163, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357966

RESUMO

BACKGROUND: Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation. CASE PRESENTATION: A 71-year-old woman presented with Fuchs' endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient's visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6 months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15 months of follow-up, with a clear and well-attached graft. CONCLUSION: Reorientation of an upside down DMEK graft was successful even 4 weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6 months and 15 months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6 months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft.


Assuntos
Córnea/patologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Distrofia Endotelial de Fuchs/cirurgia , Rejeição de Enxerto/prevenção & controle , Coleta de Tecidos e Órgãos/métodos , Acuidade Visual/fisiologia , Idoso , Córnea/cirurgia , Feminino , Seguimentos , Distrofia Endotelial de Fuchs/diagnóstico , Sobrevivência de Enxerto , Humanos , Fatores de Tempo , Tomografia de Coerência Óptica
9.
Cornea ; 38(8): 951-954, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276458

RESUMO

PURPOSE: To describe the outcomes of tuck-in tenon patch graft (TPG) in the management of corneal perforation up to 5-mm size. METHODS: Thirty-one cases of sterile corneal perforation (3-5 mm) underwent autologous TPG. The technique included, freshening of the edges, measuring the size of defect, creating a 360-degree stromal pocket around the perforation margin, harvesting the tenon graft followed by tucking into the stromal pocket, and application of cyanoacrylate glue or suturing the graft using 10-0 monofilament nylon suture. The main outcome measure was rate of healing (percentage of cases healed). RESULTS: The mean age was 52.3 ± 8.9 years with 22 male and 9 female patients. The various etiologies of corneal perforation included trauma (n = 10), neurotrophic keratitis (n = 11), and peripheral ulcerative keratitis (n = 10). The mean size of corneal perforation was 4.2 ± 0.6 mm (range 3-5 mm). The mean duration of epithelial healing was 25.7 ± 6.7 days. Best-corrected visual acuity improved from 1.8 ± 0.4 to 1.2 ± 0.4 logarithm of the minimum angle of resolution units at 4 weeks after surgery (P ≤ 0.01). Twenty-seven (87.1%) cases healed with formation of a leucomatous scar at 16.9 ± 2.7 weeks, whereas 4 cases had a flat anterior chamber. In three-fourths of the cases, a corneal graft was performed. In one case, graft resuturing was performed for post-op aqueous leak, which healed with the formation of a corneo-iridic scar. CONCLUSIONS: TPG is a safe, simple, inexpensive, and an effective technique for the management of corneal perforations. The advantages include the autologous nature of the graft, cost effectiveness, and easy availability.


Assuntos
Perfuração da Córnea/cirurgia , Úlcera da Córnea/cirurgia , Cápsula de Tenon/transplante , Adulto , Idoso , Perfuração da Córnea/fisiopatologia , Úlcera da Córnea/fisiopatologia , Cianoacrilatos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Adesivos Teciduais/uso terapêutico , Transplante Autólogo , Acuidade Visual/fisiologia , Cicatrização/fisiologia
10.
Cornea ; 38(8): 955-958, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276459

RESUMO

PURPOSE: To describe the clinical features, risk factors, and treatment outcomes after supratarsal injection of triamcinolone for vernal keratoconjunctivitis (VKC). METHODS: A retrospective review of all patients treated with supratarsal triamcinolone for VKC between February 2002 and May 2017 at the Royal Victoria Eye and Ear Hospital and Our Lady's Children Hospital Crumlin, Dublin, Ireland, was performed. RESULTS: Twenty-five patients, 46 eyes, and 145 injections were included for analysis. The mean age at first injection was 9.1 ± 5.7 years. Ninety-six percent of the patients were male. A seasonal variation was noted, with 59 injections (41%) of triamcinolone administered for acute and refractive cases of VKC in the summer compared with 35 (24%), 35 (24%), and 16 (11%) in the spring, autumn, and winter months, respectively. The most common presenting complaint was red eye, which was seen in all cases. Hay fever (64%) was the most common associated systemic disease. Each eye required, on average, 3.2 injections (range 1-9 injections), and the mean duration from the onset of symptoms to final treatment was 3.03 years (range 0-7.9 years). The mean presenting and final visual acuities were 0.33 and 0.11 logarithm of the minimum angle of resolution, respectively (P < 0.0001). During our study period, no patient experienced intraocular pressure rise requiring treatment, development of lenticular opacity, or ptosis after supratarsal injection of triamcinolone. CONCLUSIONS: In this case series, supratarsal triamcinolone was used in cases of VKC in which topical medications had failed to control the disease process. All patients reported improvement after treatment. There were no cases of intraocular pressure rise, lenticular opacity, or ptosis development after treatment.


Assuntos
Conjuntivite Alérgica/tratamento farmacológico , Pálpebras/efeitos dos fármacos , Glucocorticoides/uso terapêutico , Triancinolona Acetonida/uso terapêutico , Adolescente , Criança , Pré-Escolar , Conjuntivite Alérgica/fisiopatologia , Feminino , Glucocorticoides/efeitos adversos , Humanos , Lactente , Injeções , Irlanda , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Triancinolona Acetonida/efeitos adversos , Acuidade Visual/fisiologia , Adulto Jovem
11.
Cornea ; 38(8): 1043-1048, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276462

RESUMO

PURPOSE: To describe a new surgical option for the treatment of acute corneal hydrops in keratoconus and to present the first results. METHODS: This is a retrospective analysis of 3 patients who presented to our clinic with a massive corneal hydrops in acute keratoconus and were treated by mini-Descemet membrane endothelial keratoplasty (DMEK). According to the size and the shape of the gap in the patient's Descemet membrane (DM), 1 DMEK graft was trephined with a round 5-mm punch. The other grafts were trimmed with a razor blade to a width of about 3 mm and a length adjusted to the length of the defect of the recipients' DM. The graft was inserted with a regular intraocular lens shooter. Correct unfolding of the graft was controlled by using intraoperative optical coherence tomography. At the end of the surgery, the graft was attached to the posterior corneal surface by a small air bubble. Thereafter, the complete anterior chamber was filled with 20% SF6 gas. RESULTS: All 3 patients (age 32 ± 3 years on average) showed a rapid increase in uncorrected visual acuity from the logarithm of the minimum angle of resolution (LogMAR) 1.66 (±0.46) before mini-DMEK to the LogMAR 1.2 (±0.3) within 6 to 8 weeks after mini-DMEK. The thickest corneal point within the edematous cornea decreased in all 3 patients (1088 ± 280 µm before surgery vs. 630 ± 38 µm 1 week after surgery). One mini-DMEK failed in a first attempt. In this patient, the recipient DM was under strong tension and showed a pronounced dehiscence. Therefore, a small part of the recipient's DM around the preexisting gap in DM was removed before a second mini-DMEK graft was placed successfully. The other 2 patients developed partial graft detachment within 1 to 2 weeks after surgery. However, the corneas of these patients were dehydrated to physiological levels after mini-DMEK, and despite partial detachment, there was no relapse of the hydrops. CONCLUSIONS: Mini-DMEK could be helpful in patients with larger defects and detachments of DM in very ectatic corneas in the acute phase of corneal hydrops in acute keratoconus. These patients may not be successfully treated by intracameral gas application alone or in combination with pre-Descemetal sutures. Further investigations are needed to identify factors helping to decide on the best surgical approach in hydrops in acute keratoconus.


Assuntos
Edema da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Ceratocone/cirurgia , Doença Aguda , Adulto , Edema da Córnea/complicações , Edema da Córnea/diagnóstico por imagem , Feminino , Humanos , Ceratocone/complicações , Ceratocone/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Prevenção Secundária , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
12.
Semin Ophthalmol ; 34(5): 359-364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257965

RESUMO

To evaluate the factors affecting the amount of myopic regression after laser refractive surgery for high myopia, we retrospectively reviewed medical records of 1591 eyes with high myopia treated by laser in situ keratomileusis or laser-assisted subepithelial keratectomy at Shandong Eye Hospital between January 2008 and December 2012. Thirty-five eyes suffering a postoperative myopic shift of manifest spherical equivalent (MSE) of 0.25 diopter (D) or greater were included in this study. The mean refractive error was -9.34 ± 1.89 D before surgery, and the mean regression was -1.22 ± 0.70 D. Correlation analysis and multiple regression analysis were performed to assess the factors that were associated with the refractive regression. The age displayed a negative correlation with the diopter of regression (R = -0.404, P = .016), while the optical zone diameter had a positive correlation with it (R = 0.406, P = .016). Explanatory variables relevant to the diopter of regression were age (partial regression coefficient B = -0.045, P = .016) and optical zone diameter (partial regression coefficient B = 0.979, P = .014). Advanced-age patients with small optical zones were more predisposed to a larger amplitude of regression after laser refractive surgery for high myopia.


Assuntos
Ceratectomia Subepitelial Assistida por Laser , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia Degenerativa/cirurgia , Adulto , Feminino , Humanos , Masculino , Miopia Degenerativa/fisiopatologia , Refração Ocular/fisiologia , Análise de Regressão , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto Jovem
13.
Semin Ophthalmol ; 34(6): 436-441, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31309849

RESUMO

Purpose: To evaluate the efficacy and safety of oral eplerenone in cases of central serous chorioretinopathy (CSCR) refractory to photodynamic therapy (PDT). Methods: 19 patients with chronic CSCR and persistent subretinal fluid (SRF) were treated with oral eplerenone for 6 months, starting at a dose of 25 mg/day for 4 weeks and then 50 mg/day for 5 months. All patients underwent visual acuity measurement and optical coherence tomography (OCT), while fluorescein angiography was also performed at baseline, before treatment. Resolution of SRF, changes in retinal thickness and BCVA changes at month 6 and 12 post-treatment initiation were assessed. In addition, creatinine and electrolyte test was done on each patient every month for potential complications. Results: Two out of 19 cases were excluded, since one presented with hyperkaliemia 15 days after eplerenone intake and one with skin rash one day after the treatment initiation. At month 12, 88.2% of patients exhibited visual acuity improvement and 76.4% SRF resolution, while in 11.8% of patients SRF remained stable. Conclusions: This study has shown that eplerenone is safe and effective in cases of chronic CSCR, refractory to previous PDT.


Assuntos
Coriorretinopatia Serosa Central/tratamento farmacológico , Eplerenona/administração & dosagem , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Acuidade Visual/fisiologia , Administração Oral , Adulto , Coriorretinopatia Serosa Central/diagnóstico , Coriorretinopatia Serosa Central/fisiopatologia , Corioide/patologia , Doença Crônica , Relação Dose-Resposta a Droga , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/administração & dosagem , Estudos Prospectivos , Retina/patologia , Tomografia de Coerência Óptica , Resultado do Tratamento
14.
BMC Ophthalmol ; 19(1): 151, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315595

RESUMO

BACKGROUND: To measure the decentration following SMILE in eyes with high myopic astigmatism and investigate its impact on visual quality. METHODS: The prospective study was conducted to analyze patients who underwent SMILE for correction of myopia and myopic astigmatism ≥2.5D (high astigmatism group, HA) at the ophthalmology department, Eye and ENT hospital, Shanghai, China.. Patients with myopic astigmatism < 1.5D served as controls (low astigmatism group, LA). Decentration was measured using a Scheimpflug camera with a difference map of the tangential curvature at 12 months postoperatively. Also the associations between decentration from the coaxial sighted corneal light reflex (CSCLR) and the visual outcomes, correction efficacy of astigmatism, wavefront aberrations and objective scatter index (OSI) were analyzed. RESULTS: No significant differences were observed in the decentered distance between HA and LA in either eyes (OD: HA: 0.18 ± 0.10 mm, LA: 0.20 ± 0.14 mm, P = 0.659; OS: HA: 0.22 ± 0.11 mm, LA: 0.20 ± 0.11 mm, P = 0.637). The analysis across the three levels of decentration (< 0.1 mm, 0.1-0.2 mm, and > 0.2 mm) showed no significant association between decentration and visual outcomes of predictability, efficiency, safety, MTF cutoff, OSI, SR and OVs in both groups. Also no significant association was observed between decentration and postoperative astigmatism in either group. A significant relationship between the magnitude of decentration and induced coma and spherical aberration was observed in HA. CONCLUSIONS: The amount of decentration between HA and LA groups showed no differences. Decentration > 0.20 mm from CSCLR resulted in greater induction of coma and SA after SMILE in eyes with HA.


Assuntos
Astigmatismo/cirurgia , Cirurgia da Córnea a Laser/métodos , Miopia Degenerativa/cirurgia , Procedimentos Cirúrgicos Refrativos/métodos , Acuidade Visual/fisiologia , Astigmatismo/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Lasers de Excimer/uso terapêutico , Masculino , Estudos Prospectivos , Adulto Jovem
15.
Digit J Ophthalmol ; 25(2): 21-25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327933

RESUMO

Purpose: To determine whether signs and symptoms of ocular surface disease improve after placement of a self-retained, cryopreserved amniotic membrane (CAM) in patients with Sjögren syndrome (SS). Methods: The medical records of SS patients who received a self-retained CAM implant (Prokera or Prokera Slim; TissueTech Inc, Doral, FL) for the treatment of ocular surface disease between August 2012 and August 2016 at a single, large academic institution were reviewed retrospectively. Visual acuity, results of slit-lamp examination of the cornea and conjunctiva, and dry eye symptoms, were evaluated before and after CAM insertion. Results: A total of 6 eyes of 6 patients (all female; mean age, 62.5 ± 13.0 years [range, 49-86 years]) were included. All patients were on topical medications at the time of the study and had signs of ocular surface dryness. There were reductions in corneal and/or conjunctival staining in 5 eyes (83%) after the CAM dissolved. All patients who completed therapy (5/5) experienced a relapse in their signs and symptoms within 1 month of removal of the CAM, with an average time to relapse of 24.6 days. Mean follow-up time was 54.5 days. Foreign body sensation and blurred vision were the most common complaints associated with the CAM implant. Conclusions: In this small case series, self-retained CAM implantation was found to be beneficial in SS patients with ocular surface disease that is refractory to standard therapies; however, we found that the effects were temporary. Future larger studies are needed to confirm these benefits.


Assuntos
Âmnio/transplante , Síndrome de Sjogren/terapia , Idoso , Idoso de 80 Anos ou mais , Túnica Conjuntiva/patologia , Córnea/patologia , Criopreservação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Sjogren/fisiopatologia , Acuidade Visual/fisiologia
16.
Orv Hetil ; 160(27): 1064-1069, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31264468

RESUMO

Introduction: Idiopathic strabismus sursoadductorius is characterized by an overaction of the inferior oblique (IO) muscle, with elevation of the eye in adduction. This can result in chronic headache, eye pain, diplopia and abnormal head posture. Aim: Presentation of clinical results after graded recession of inferior oblique overaction (IOOA) in strabismus sursoadductorius. Method: During a period of 6 years (2012-2017) we performed a dosed transposition of IO muscle in 53 patients in the Department of Ophthalmology of the Semmelweis University and analyzed the clinical results retrospectively. The mean age was 12.8, min-max: 2-51 years. The transposition of the muscle (8 mm, 10 mm or maximal) was performed because of IOOA and was planned depending on the vertical deviation (VD) in maximal adduction. In case of maximal transposition, the insertion of IO was placed under the lateral part of the lower rectus muscle. We evaluated the squint angle in five positions of gaze preoperatively and postoperative 1 week, 1 month and 3-6 months. We examined best corrected visual acuity, binocular vision and complications after surgery. Results: Postoperatively 25 patients had acceptable stereopsis (Titmus 5). Visual acuity remained stable after surgery in all cases. The VD measured in maximal adduction changed with a decrease of 7.5° when 8 mm transposition was performed, and changed with a decrease to 12°, when maximal recession was performed. The mean reduction of VD was 17.8 prism dioptres (PD) after 1 week (p<0.01), 20.5 PD after 1 month and remained stable during a follow-up of 3-6 months. Conclusion: Graded recession of inferior oblique muscle is a suitable proposed procedure in patients with marked strabismus sursoadductorius. The rates of functional under- or overcorrection or other complications are low. Orv Hetil. 2019; 160(27): 1064-1069.


Assuntos
Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular , Acuidade Visual/fisiologia , Adulto Jovem
17.
Eur J Ophthalmol ; 29(1_suppl): 22-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282196

RESUMO

INTRODUCTION: Phaco-antigenic glaucoma occurs in less than 1% of cataract surgeries. Managing this rare complication is challenging, especially when there are few documented cases reported. We describe the challenges of managing a case of bilateral phaco-antigenic glaucoma following uncomplicated cataract surgery requiring viscocanalostomy. CASE DESCRIPTION: An 82-year-old atopic lady presented with a 2-day history of painful injected right eye. She was 4 days post left and 8 days post right uncomplicated cataract surgery. On examination, the anterior chambers were deep with no hypopyon. Intraocular pressure was raised at 38 mmHg in the right eye and 24 mmHg in the left eye initially. However, intraocular pressure remained uncontrolled despite maximum medical treatment; she attended A + E six times within 11 days with intraocular pressures of up to 48 mmHg in the right eye and 46 mmHg in the left eye. A vitreous biopsy was reported negative for infective organisms. Eventually, bilateral viscocanalostomies were performed and vision improved to 0.24 logMAR in both eyes with intraocular pressures of 8 mmHg in the right eye and 10 mmHg in the left eye. CONCLUSION: We present a rare presentation of phaco-antigenic glaucoma following an uncomplicated cataract surgical procedure with good results following timely intervention.


Assuntos
Autoantígenos/sangue , Extração de Catarata , Glaucoma/etiologia , Cristalino/imunologia , Complicações Pós-Operatórias , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Feminino , Glaucoma/tratamento farmacológico , Glaucoma/imunologia , Humanos , Pressão Intraocular/fisiologia , Tonometria Ocular , Acuidade Visual/fisiologia
18.
Eur J Ophthalmol ; 29(1_suppl): 27-31, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282209

RESUMO

PURPOSE: To describe the diagnostic complexities of a patient with acute zonal occult outer retinopathy. CASE REPORT: A healthy female presented with acute bilateral visual field loss and photopsia. On initial examination, her visual acuity, colour vision, fundus examination and fluorescein angiography were normal. Fundus autofluorescence, however, revealed scattered hyperautofluorescence in both eyes and electrodiagnostic tests were abnormal. A differential diagnosis including acute zonal occult outer retinopathy was postulated and serology requested. The patient's past medical history included both breast and endometrial cancer and raised the possibility of cancer-associated retinopathy. A normal full-body positron emission tomography scan, negative antibodies for cancer-associated retinopathy and abnormal electroretinogram led to a diagnosis of acute zonal occult outer retinopathy. CONCLUSION: It has been more than 20 years since Gass first described the syndrome of acute zonal occult outer retinopathy. Typically affecting young, healthy females, acute zonal occult outer retinopathy is characterised by photopsia, minimal fundoscopic changes and electroretinographic abnormalities. Visual field loss is permanent and often associated with slow-progressing degeneration of the retinal pigment epithelial cells. Retinal photoreceptor dysfunction is an uncommon and unrecognised cause of acute visual loss. Acute zonal occult outer retinopathy should be considered as a differential diagnosis in those patients with deceptively normal fundal examinations, abnormal electroretinograms and visual field loss.


Assuntos
Retina/fisiopatologia , Escotoma/diagnóstico , Diagnóstico Diferencial , Eletrorretinografia , Feminino , Angiofluoresceinografia/métodos , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Retina/diagnóstico por imagem , Escotoma/tratamento farmacológico , Escotoma/fisiopatologia , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
19.
J Pediatr Ophthalmol Strabismus ; 56(4): 234-237, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322713

RESUMO

PURPOSE: To evaluate the ability of the PDI Check (PDI Check LLC, Anchorage, AK) near vision screening game to assess monocular acuity, stereopsis, suppression, and color. METHODS: Children and adults consented to perform the PDI Check Quick Screening game following conventional near testing of patched Rosenbaum acuity, Titmus Fly stereo, Worth 4-dot, and Ishihara color. Time to complete each test and preferred method were recorded. RESULTS: A total of 77 patients (5 to 63 years old) attempted all tests. There was a positive correlation between the PDI Check and conventional tests for all visual tasks. Using previously determined instrument referral criteria, sensitivity/specificity was determined for right acuity (67%/91%), left acuity (55%/94%), stereopsis (87%/95%), red-green color (80%/99%), and ocular suppression (58%/98%). Screening time was 202 ± 96 versus 99 ± 42 seconds for the PDI Check and the game was preferred by 87%. CONCLUSIONS: The PDI Check provided a valid assessment of near vision in less than half the time of conventional testing without patches or goggles. This Quick Screening version may help eye technicians and physicians with time efficiency in the frequent task of near visual assessment. [J Pediatr Ophthalmol Strabismus. 2019;56(4):234-237.].


Assuntos
Percepção de Profundidade/fisiologia , Estrabismo/diagnóstico , Jogos de Vídeo , Seleção Visual/instrumentação , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Privação Sensorial , Estrabismo/fisiopatologia , Adulto Jovem
20.
Cornea ; 38(8): 1049-1057, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169612

RESUMO

PURPOSE: To evaluate the safety, efficacy, and stability of topography-guided partial PRK combined with corneal cross-linking (CXL) (the Athens Protocol [AP]) in pediatric patients with keratoconus over a 4-year follow-up period. METHODS: This prospective study included 39 keratoconic eyes of 21 patients younger than 18 years with clinical and imaging evidence of keratoconus progression. Partial topography-guided excimer laser ablation in conjunction with high-fluence CXL was performed in all patients according to the AP. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, endothelial cell density, topography, and tomography using both Scheimpflug and optical coherence tomography (OCT) were evaluated for 4 years postoperatively. RESULTS: At 4 years postoperative, there was significant improvement in mean uncorrected distance visual acuity from 0.51 ± 0.31 (decimal) to 0.65 ± 0.26 (decimal; P < 0.05). Mean corrected distance visual acuity improved from 0.71 ± 0.22 (decimal) preoperatively to 0.81 ± 0.19 (decimal; P < 0.05), respectively. Mean flat keratometry (K1) and mean steep keratometry (K2) readings reduced from 44.95 ± 3.71 D and 49.32 ± 5.05 D, respectively, preoperatively to 43.14 ± 2.95 D and 46.28 ± 4.87 D, respectively, (P < 0.05) at 4 years. The mean anterior maximum keratometry (Kmax) reading reduced from 56.81 ± 2.94 D preoperatively to 48.11 ± 3.17 D at 48 months. The mean index of height decentration was 0.105 ± 0.054 µm preoperatively and 0.049 ± 0.024 (P < 0.05) at 4 years postoperative. Mean preoperative corneal thickness at the thinnest point was 436.7 ± 42.6 µm preoperatively, 392.50 ± 45.68 µm at 12 months postoperative, and 418.42 ± 17.01 µm at 4-year follow-up. Late-onset deep corneal haze, a potential intrinsic complication of this technique in pediatric patients, was encountered in 2 cases at least 1 year after the procedure. CONCLUSIONS: Long-term results of the AP seem to be safe and effective in pediatric patients, with marked improvement in visual function and keratometric symmetry indices.


Assuntos
Reagentes para Ligações Cruzadas , Ceratocone/terapia , Fotoquimioterapia/métodos , Ceratectomia Fotorrefrativa/métodos , Cirurgia Assistida por Computador/métodos , Adolescente , Criança , Protocolos Clínicos , Colágeno/metabolismo , Terapia Combinada , Substância Própria/metabolismo , Topografia da Córnea/métodos , Feminino , Humanos , Ceratocone/tratamento farmacológico , Ceratocone/metabolismo , Ceratocone/cirurgia , Masculino , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Refração Ocular/fisiologia , Riboflavina/uso terapêutico , Tomografia de Coerência Óptica , Raios Ultravioleta , Acuidade Visual/fisiologia
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