Secondary piggyback implantation versus IOL exchange for symptomatic pseudophakic residual ametropia.

BACKGROUND: To evaluate the safety and efficacy of implanting a secondary IOL in comparison with IOL exchange to correct residual spherical refractive error after cataract surgery. METHOD: This prospective case series included 23 pseudophakic eyes of 23 patients. They were divided into two groups: group I included 12 eyes for whom secondary piggyback IOL implantation in the ciliary sulcus was done, and group II included 11 eyes for whom IOL exchange was done. The mean follow up was 18 ± 4.2 months and 20 ± 3.6 months in groups I and II respectively. The visual and refractive outcomes were evaluated, and any intraoperative or postoperative complications was recorded. RESULTS: The mean spherical equivalent in group I (secondary piggyback implantation), was reduced from -6.2 ± 2.2 diopters preoperatively to -0.28 ± 0.59D postoperatively in myopic eyes and from 4.79 ± 1.02D to 0.03 ± 0.74D in hyperopic eyes. Ninety-two percent of eyes were within ±0.5D of intended correction. In group II (IOL exchange), the mean SE was reduced from -5.88 ± 3.1D preoperatively to 0.16 ± 1.09 D postoperatively in myopic eyes and from 5.05 ± 0.93D preoperatively to 0.11 ± 0.69D postoperatively in hyperopic eyes. Eighty-two percent of eyes had postoperative SE within ± 0.5D of the intended correction. UCVA improved significantly in both groups. Rupture of the posterior capsule occurred in one eye in group II. Only one eye in group II lost one line of BCVA. CONCLUSION: Secondary piggyback implantation in the ciliary sulcus is an effective, safe, and easy treatment for a pseudophakic ametropia.

Retinal vessel diameters: Can they predict future risk of infertility in patients with varicocele?

OBJECTIVE: The objective of this study was to assess the relationship between retinal vessel diameters, such as retinal arteriolar diameter, retinal venular diameter, and arteriolar/venular ratio (AVR), as clinical parameters of fertility in varicocele patients. MATERIALS AND METHODS: Sixty-eight (68) infertile varicocele men with abnormal semen parameters and sixty-one (61) varicocele normozoospermic men were included in the study. Moreover, fifty-eight (58) healthy normozoospermic men without varicocele were enrolled as a control group. For each participant, retinal vascular diameters were measured from the digital retinal photographs as a central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and AVR. In addition, hormones (total testosterone and FSH), and semen parameters were assessed and correlated with retinal vessel diameters. RESULTS: The mean CRAE, CRVE, and AVR values were 147.8 ± 15.8 µm, 198.3 ± 39.3 µm, and 0.61 ± 0.01 in infertile varicocele patients, respectively. Significant difference of CRAE, CRVE, and AVR were found when comparing infertile varicocele patients with both varicocele and control normozoospermic male groups (p = 0.01, p = 0.006, and p = 0.007; respectively). Larger retinal venular caliber and smaller AVR ratio showed a significant inverse correlation with both sperm parameters and hormones (total testosterone and FSH) (p < 0.05). No significant correlations were found between CRAE with both sperm parameters and hormonal values (total testosterone and FSH) (p > 0.05). CONCLUSIONS: Infertile patients with varicocele showed a significant relationship with the retinal vascular diameter (CRVE and AVR ratio). This finding supports recommendation for regular eye examinations in the varicocele population.

Endothelin-1 and nitric oxide levels in patients with glaucoma.

AIMS: To investigate the levels of endothelin-1 (ET-1) and nitric oxide (NO) in the aqueous humor and plasma of human eyes with different types of glaucoma: primary open-angle glaucoma (POAG) and chronic closed-angle glaucoma (CCAG). METHODS: Patients were classified into 3 groups: group I comprised 35 patients with POAG, group II comprised 25 patients with CCAG, and 30 patients with senile cataract (group III) were used as a control group. Aqueous humor and corresponding plasma were analyzed for ET-1 and NO concentrations by enzyme-linked immunosorbent assay. A Bonferroni correction for multiple comparisons was performed. RESULTS: There was no significant difference in plasma levels of either ET-1 or NO metabolites between the groups studied. ET-1 and NO were significantly elevated in the aqueous humor of patients with CCAG and POAG compared to the corresponding value in patients with cataract (p < 0.001). ET-1 and NO concentrations in the aqueous humor were more marked in CCAG than in POAG. NO levels were correlated with ET-1 in the aqueous humor of patients with glaucoma (p < 0.001). CONCLUSIONS: Increased concentrations of ET-1 and NO in aqueous humor may be useful with POAG and CCAG. In addition, ET-1 and NO may have useful metabolite levels in the aqueous humor of POAG and CCAG patients as a result of glaucoma damage and may not be a cause of it.

Erythropoietin and soluble CD44 levels in patients with primary open-angle glaucoma.

PURPOSE: To investigate the levels of erythropoietin (EPO) and soluble CD44 (sCD44) in the aqueous and plasma of human eyes with primary open-angle glaucoma (POAG), and to correlate their concentration with severity of glaucoma. METHODS: A total of 30 patients with POAG and 25 patients with senile cataract (control group) of matched age and gender were included in the study prospectively. Aqueous samples were obtained by paracentesis from glaucoma and cataract patients who were undergoing elective surgery. Aqueous and corresponding plasma samples were analysed for EPO and sCD44 concentrations by enzyme-linked immunosorbent assay. RESULTS: The EPO and sCD44 levels were significantly higher in aqueous of POAG patients with respect to the comparative group of cataract patients (P < 0.001). No significant difference in the levels of EPO and sCD44 in plasma of POAG and cataract patients. A high positive correlation was found between EPO and sCD44 in aqueous of POAG patients (P < 0.001). Significant correlation was found between EPO or sCD44 levels and severity of visual field loss in mild and moderate stages (P < 0.001). CONCLUSION: Increased levels of aqueous EPO and sCD44 may be associated with POAG. In addition, EPO and sCD44 may be useful proteins levels in aqueous of POAG patients as a result of glaucoma damage and not a cause. EPO and sCD44 concentrations in aqueous are a possible biomarkers for visual field loss in patients with POAG.

Ghrelin Levels in Patients With Primary Open-Angle Glaucoma.

PURPOSE: This study was aimed to assess the levels of ghrelin in aqueous humor and plasma of human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with the severity of glaucoma. DESIGN: This was a case-control, prospective study. METHODS: Fifty patients with POAG and 35 patients with senile nonpathologic cataract (control group) were enrolled in the study prospectively. Aqueous humor samples were obtained by paracentesis from patients with glaucoma and cataract who underwent elective surgery. Aqueous humor and corresponding plasma samples were analyzed for ghrelin concentrations by radioimmunoassay diagnostic kits assay. RESULTS: Ghrelin levels were significantly lower in aqueous humor of patients with POAG with respect to the comparative group of patients with cataract (P < 0.001). There was no significant difference in the levels of ghrelin in the plasma of patients with POAG and that of patients with cataract. A positive correlation was found between plasma/aqueous humor ghrelin concentration in patients with POAG versus the control group (P < 0.001). No significant correlation was found between the levels of ghrelin and the severity of visual field loss. CONCLUSIONS: Lower levels of aqueous humor ghrelin may be associated with POAG and may be a consequence of glaucomatous damage.

Outcome of a Single Intravitreal Bevacizumab Injection on the Visual Acuity and Course of Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy.

Abstract Purpose: To evaluate the effect of a single intravitreal 1.25 mg/0.05 ml bevacizumab (IVB) (Avastin, Genentech) injection on the visual outcome and both intraoperative and postoperative course of pars plana vitrectomy (PPV) in proliferative diabetic retinopathy. Study Design: Prospective case-control interventional comparative study. Methods: One hundred patients (100 eyes) were divided into two groups: Group I had undergone PPV with preoperactive IVB (50 patients), and Group II had undergone PPV without IVB (50 patients). Best corrected visual acuity (BCVA), intraoperative and postoperative complications were compared between both groups. Patients were followed-up for one year. Results: After one year, there was a highly statistically significant difference in the mean BCVA, as it was (0.146 ± 0.103) in Group I and 0.069 ± 0.049 in Group II with (p < 0.001), while mean bleeding frequency in Group I was 0.7 ± 0.78 times/case with range between 0 and 2 bleeding attacks/case and mean bleeding frequency in Group II was 3.12 ± 1.31times/case with range between 3 and 6 bleeding attacks/case and the difference was statistically significant as (p < 0.001). Diathermy was used in Group I in 15 patients only with mean frequency of 0.3 ± 0.46 times/case with range between 0 and 1 attack/case; while diathermy was used in all cases in Group II with mean frequency of 2.4 ± 1.06 times/case with range between 1 to 4 times/case and this difference was also statistically significant as p < 0.001. Postoperative vitreous hemorrhage developed in 3 eyes (6%) in Group I and 15 eyes (30%) in Group II and this difference was statistically significant (p < 0.003). All the other intraoperative and postoperative complications were reduced in Group I, but with no statistically significant difference between both groups. Conclusions: The use of intravitreal bevacizumab before pars plana vitrectomy is beneficial in improving visual outcome, minimizing the incidence of intraoperative bleeding and reducing the need for intraoperative diathermy.

Can opposite clear corneal incisions have a role with post-laser in situ keratomileusis astigmatism?

PURPOSE: To evaluate the astigmatic correcting effect of paired opposite clear corneal incisions (OCCIs) on the steep axis in patients with residual astigmatism after laser in situ keratomileusis (LASIK) MATERIALS AND METHODS: Thirty-one eyes of 24 patients with a mean age of 28.4 years ±2.46 (range, 19-36 years) were recruited for the study. Inclusion criteria included residual astigmatism of ≥1.5 diopter (D) after LASIK with inadequate residual stromal bed thickness that precluded ablation. The cohort was divided into two groups; group I (with astigmatism ranging from -1.5 D to -2.5 D) and group II (with astigmatism > -2.5 D). The steep axis was marked prior to surgery. Paired three-step self-sealing opposite clear corneal incisions were performed 1-mm anterior to the limbus on the steep axis with 3.2-mm keratome for group I and 4.1 mm for group II. Patients were examined 1 day, 1 week, 1 month, 3 months and 6 months, postoperatively. Visual acuity, refraction, keratometry, and corneal topography were evaluated preoperatively and postoperatively. Analysis of the difference between groups was performed with the Student t-test. P<0.05 was considered statistically significant. RESULTS: The mean uncorrected visual acuity (UCVA) improved from 0.35±0.13 (range, 0.1-0.6) to 0.78±0.19 (range, 0.5-1) in group I and from 0.26±0.19 (range, 0.1-0.5) to 0.7±0.18 (range, 0.4-1) in group II. The increase in UCVA was statistically significant in both groups (P=0.001, both cases). The mean preoperative and postoperative keratometric astigmatism in group I was 2.0±0.48 D (range, 1.5-2.5 D) and 0.8±0.37 D (range, 0.1-1.4 D), respectively. The decrease in keratometric astigmatism was highly statistically significant in group II (P=0.001.). Mean surgically induced astigmatic reduction by vector analysis was 1.47±0.85 D and 2.21±0.97 D in groups I and II respectively. There were no incision-related complications. CONCLUSIONS: Paired OCCIs were predictable and effective in correcting post-LASIK astigmatism and required no extra surgical skill or expensive instruments. OCCIs are especially useful in eyes with insufficient corneal thickness for LASIK retreatment.

One-Haptic Fixation of Posterior Chamber Intraocular Lenses without Scleral Flaps.

Purpose. To assess visual results and complications of a modified technique of posterior chamber intraocular lenses (PC IOLs) in aphakic eyes without scleral flaps. Methods. Modified one-haptic scleral fixation was performed in one eye each of 25 patients with aphakia and insufficient capsule support. Follow-up period was six months. Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), and postoperative complications. Results. The study included 15 males and 10 females. The preoperative best-corrected visual acuity (BCVA) ranged from 5/60 to 6/9. The operation time ranged from 25 to 45 minutes (mean 35.25 ± 5.34 min). Anterior vitrectomy was performed in 12 cases (48%). There was no major IOL decentration. The final BCVA ranged from 6/36 to 6/9. Seven cases (28%) showed postoperative glaucoma, five cases (20%) had temporary hypotony, and hyphema in 2 eyes (8%). No cases of suture erosion, postoperative endophthalmitis, retinal detachment, or IOL dislocation were detected. Conclusion. This technique of one-haptic scleral fixation of posterior chamber IOLs is a good choice in presence of insufficient capsule support. It reduces the operation time, achieves the IOL stability, and minimizes postoperative suture-related complications.

Evaluation of collagen crosslinking in keratoconus eyes with Kera intracorneal ring implantation.

PURPOSE: To assess the outcome of collagen crosslinking (CXL) in keratoconus eyes after implantation of Kera intracorneal ring segments. PATIENTS AND METHODS: Twenty-one eyes of 13 patients with mild to moderate degree of keratoconus were included in this study. All eyes had uneventful surgery for Kera intracorneal ring segment implantation followed by collagen CXL treatment after at least 3 months of the implantation. Inclusion criteria were absence of corneal scarring and corneal thickness higher than 400 mm. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent and cylinder refraction, and the mean keratometric (K) values were evaluated preoperatively and postoperatively. RESULTS: The mean age was 21.36 ± 4.46 years (range 16-28). Mean time between implantation of Kera ring and CXL was 4.56 ± 3.2 months. The mean baseline UCVA and BCVA were 0.05 ± 0.02 and 0.18 ± 0.1, respectively; after Kera ring, the mean UCVA and BCVA were 0.23 ± 0.17 and 0.39 ± 0.18 (p=0.000), respectively. Collagen CXL after Kera ring resulted in an additional change in UCVA and BCVA to become 0.23 ± 0.17 (p=0.951) and 0.41 ± 0.18 (p=0.08), respectively. Also, CXL results in an additional change in spherical equivalent, cylindrical, and mean keratometric values. The decrease in spherical equivalent, cylindrical, and mean keratometric value was 2.8 D (p<0.05), 2.1 D (p<0.05), and 2.5 D (p<0.05), respectively, after Kera ring treatment. An additional decrease of 0.11 D (p>0.05), 0.01 D (p>0.05), and 0.09 D (p>0.05) was obtained after CXL in each respective parameter. CONCLUSIONS: Collagen CXL has an additive effect after Kera ring implantation and may be considered as an enhancement/stabilizing procedure.

Homocysteine and hydroxyproline levels in patients with primary open-angle glaucoma.

AIM: To assess the levels of homocysteine (Hcy) and hydroxyproline (Hyp) in aqueous humor and plasma of human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with the severity of glaucoma. METHODS: Fifty patients with POAG and 35 patients with senile cataract (control group) were enrolled in the study prospectively. Aqueous humor samples were obtained by paracentesis from glaucoma and cataract patients who were undergoing elective surgery. Aqueous humor and corresponding plasma samples were analyzed for Hcy and Hyp concentrations by high-performance liquid chromatography and spectrometry, respectively. RESULTS: Hcy and Hyp levels were significantly higher in aqueous humor of POAG patients with respect to the comparative group of cataract patients (p < 0.001). No significant difference in the levels of Hcy and Hyp in plasma of POAG and cataract patients. A positive correlation was found between Hcy and Hyp in aqueous humor of POAG patients (p < 0.001). No significant correlation was found between either Hcy or Hyp levels and the severity of visual field loss. CONCLUSION: Increased levels of aqueous humor Hcy and Hyp may be associated with POAG. In addition, Hcy and Hyp may be useful protein levels in aqueous humor of POAG patients as a consequence of glaucomatous damage.

Connective tissue growth factor and tissue inhibitor of matrix metalloproteinase-2 in patients with exfoliative glaucoma.

PURPOSE: To investigate the aqueous humor levels of connective tissue growth factor (CTGF), matrix metalloprotinease-2 (MMP-2), and tissue inhibitor of matrix metalloprotinease-2 (TIMP-2) in human eyes with exfoliative glaucoma, primary open-angle glaucoma, and senile cataract patients. PATIENTS AND METHODS: This was a prospective, comparative study. Sixty patients with glaucomas and 25 patients with senile cataract of matched age and gender were enrolled in this study. Patients were classified into three groups: group I comprised 30 patients with exfoliative glaucoma (XFG), group II comprised 30 patients with primary open-angle glaucoma (POAG), and group III comprised 25 patients with senile cataract (controls). Aqueous humor samples were obtained by paracentesis at the time of elective surgery for glaucomatous and cataractous patients. CTGF, MMP-2, and TIMP-2 were measured in aqueous humor by specific enzyme linked immunosorbent assay (ELISA) kits, and total aqueous humor protein content was assessed by the Lowry method. RESULTS: There were significant increases in aqueous humor levels of CTGF and TIMP-2 in XFG patients compared to the corresponding values of POAG patients or controls. The MMP-2 aqueous humor level was significantly increased in the XFG patients when compared with controls (P < 0.001). Moreover, the total protein level in the aqueous humor of eyes of the XFG patients was significantly higher than in POAG patients or controls (P < 0.001). A positive correlation was found between CTGF and MMP-2 in aqueous humor samples of XFG patients (P < 0.001). CONCLUSION: Increased levels of aqueous humor of CTGF and TIMP-2 may promote the abnormal extracellular matrix accumulation and may be involved in the pathogenesis of XFG.

Pentosidine and N-carboxymethyl-lysine: biomarkers for type 2 diabetic retinopathy.

PURPOSE: Advanced glycation end products (AGEs) accumulation may result from chronic hyperglycemia promoting generation and onset of microangiopathy. The aim of this study was to investigate the association between diabetic retinopathy (DR) and levels of AGEs, pentosidine, and N-carboxymethyl-lysine (CML) in aqueous humor and serum of human patients and their role in predicting the progression of DR. METHODS: Ninety patients with type 2 diabetes mellitus and 30 nondiabetic patients underwent cataract surgery. The diabetic group was divided into 3 subgroups: 35 patients with mild nonproliferative diabetic retinopathy (mild NPDR), 30 patients with severe nonproliferative diabetic retinopathy (severe NPDR), and 25 patients with proliferative diabetic retinopathy (PDR). In the samples, pentosidine was measured by high-performance liquid chromatography and CML using a competitive enzyme-linked immunosorbent assay. RESULTS: Serum levels of pentosidine and CML were significantly increased in patients with type 2 diabetes compared to nondiabetic controls (p<0.001). In diabetic patients, serum pentosidine and CML levels were significantly higher in patients who had PDR than in those with mild NPDR or severe NPDR (both p<0.001). A significant difference was found between aqueous humor CML levels in diabetic and nondiabetic patients and increased along with progression of DR. Significant correlations existed between serum pentosidine and aqueous CML in severe NPDR and PDR (p<0.001). CONCLUSIONS: In patients with type 2 DM, serum levels of pentosidine and CML are related to severity of retinopathy. In addition, aqueous humor level of CML increased along with progression of DR. Pentosidine and CML can be used as biochemical markers of glycoxidation and related to onset or progression of DR.

Wavefront-optimized ablation versus topography-guided customized ablation in myopic LASIK: comparative study of higher order aberrations.

BACKGROUND AND OBJECTIVE: To compare the outcomes of wavefront-optimized ablation and topography-guided ablation in fellow eyes of patients undergoing laser in situ keratomileusis (LASIK) for myopia. PATIENTS AND METHODS: This prospective study included 84 patients who underwent LASIK in both eyes: wavefront-optimized ablation in one eye (group I) and topography-guided ablation in the fellow eye (group II). The Moria2 microkeratome with a 110 single-use head (Moria, Antony, France) was used to create a superior hinged flap and the Allegretto Wave Excimer Laser (Alcon/Wavelight Light Laser Technologie GmbH, Erlangen, Germany) for photoablation. The Allegretto wave analyzer was used to measure the ocular aberrations before and 6 months after LASIK. Refractive visual outcomes and ocular aberration changes were compared between the two treatment modalities. RESULTS: Six months postoperatively, the mean uncorrected visual acuity of group II was statistically better than that of group I (P = .02). Seventy percent of group I and 83% of group II achieved a postoperative spherical equivalent refraction of ±0.5 diopters. The postoperative total root-mean-square of higher order aberrations (HOAs) of group II was smaller than that of group I, but the difference was not statistically significant (P = .51). There was a decrease in most of the individual terms of HOAs in group II, but it was only statistically significant in Z(3) (-1) (P = .04). The reverse occurred in group I, where most of the individual terms of HOAs increased, but it was not statistically significant. Significant improvement was only noted in Z(5) (3) (P = .05) and Z(5) (5) (P = .04). CONCLUSION: Both wavefront-optimized ablation and topography-guided ablation provided good refractive results, but the latter induced fewer HOAs.

Correlation of central corneal thickness and optic nerve head topography in patients with primary open-angle glaucoma.

PURPOSE: To evaluate whether changes in optic nerve head topography and visual field in patients with primary open-angle (POAG) are related to central corneal thickness (CCT). MATERIALS AND METHODS: Eighty eyes of 50 patients with POAG underwent ophthalmic examination; optic nerve head imaging with the Heidelberg Retina Tomography II (HRT II), ultrasound corneal pachymetry, and visual field evaluation with the Humphrey visual field analyser (program 24-2). Correlation between CCT, age, gender, family history of glaucoma, visual acuity, intraocular pressure (IOP), optic disc surface area, vertical and horizontal cup: disc ratios, neuroretinal rim area, mean deviation of visual field, and number of glaucoma medications was analyzed. Patients were divided into a thin CCT group <540 µm or a thick CCT group >540 µm. Pearson correlation was used for correlation coefficient and a P value of <0.05 was considered statistically significant. RESULTS: THIN CCT WAS SIGNIFICANTLY CORRELATED WITH VERTICAL AND HORIZONTAL CUP: disc ratios, neuroretinal rim area loss, and smaller optic disc surface area (r=0.043, r=0.021, r=0.036, and 0.031 respectively). Thin CCT was also significantly associated with worsened mean deviation of visual field, and increased number of glaucoma medications (r=0.065 and r=0.423). Patients with positive family history correlated with with greater vertical cup: disc ratio, and more glaucoma medications but this was not statistically significant. CONCLUSIONS: In patients with POAG those with thinner CCT are likely to develop greater glaucomatous optic nerve and visual field damages than those with a thicker CCT.

Accuracy of intraocular lens power calculation in high myopia.

PURPOSE: To study the accuracy of different recent intraocular lens (IOL) calculation formulas in predicting a target postoperative refraction ± 1.0D (Diopters) in patients with long eyes (axial length ≥ 26.0 mm) undergoing phacoemulsification. MATERIALS AND METHODS: This study comprised 127 eyes of 87 patients who presented with cataract and axial eye length ≥ 26 mm. Before phacoemulsification and IOL implantation; axial length measurement using immersion ultrasound A-scan technique, and autokeratometry with or without computerized corneal topography for K readings were done. The IOL power was calculated using four formulas, namely the SRK-T, Hoffer-Q, Holladay-2, and Haigis formulas. Four months after surgery, refraction was done. Differences between actual postoperative refraction and assumed target refraction using the different formulas were analyzed. P < 0.05 was considered statistically significant. RESULTS: In all 127 eyes, the mean axial length was 31.71 mm (range, 26.06-37.11 mm) and the mean K was 44.68 D (range, 40.05-55.14D). The mean preoperative spherical equivalent (SE) was -17.52D (range, -12.25 to -30.50D). After surgery, the mean spherical equivalent was -0.8 ± 0.83D (range, +1.25 to -3.75D). The mean postoperative refractive SE when implanting a plus power IOLs was -0.3 ± 0.51D (P < 0.001) while the mean postoperative refractive SE when implanting a minus power IOLs was +1.21 ± 0.11D denoting a highly significant tendency toward hyperopia (P < 0.001). Concerning the minus power group, most postoperative refractive error was within +1.0 to +2.0D in the actual implanted IOL and in all other formula calculated IOL power. However, Haigis formula showed the least deviation while SRK-T and other formulas showed a greater tendency toward hyperopia. CONCLUSIONS: In eyes with high axial myopia, the performance of SRK-T, Hoffer-Q, Holladay-2 and Haigis formulas are comparable in low plus-powered IOL implantation. Haigis formula is the best formula when minus power IOL is implanted.

Graves opthalmopathy and psychoendocrinopathies.

PURPOSE: To assess the psychiatric and endocrinological changes in patients with Graves ophthalmopathy (GO). DESIGN: A prospective, controlled, University Hospital based study SUBJECTS AND METHODS: The current study comprised 60 patients diagnosed with GO at Mansoura Ophthalmic Center. Thirty five patients of them with moderate to severe GO formed the study group and twenty five patients with negligible to very mild GO formed the control group in the euthyroid state. The study group was further subdivided based on their predominant clinical signs into a proptosis subgroup and a muscle restriction subgroup. Psychiatric changes were assessed with the Middlesex Hospital Questionnaire (MHQ). Biochemical analyses included serum-free thyroxine and thyroid-stimulating hormone (TSH) concentrations, TSH receptor antibody (TRAb) activity and anti-thyroglobulin particle agglutination (TGPA) and antithyroid microsomal particle agglutination (MCPA). RESULTS: The proptosis group reported significantly higher scores on anxiety, depression, and phobia than the muscle restriction group (P<0.0001). The proptosis and muscle restriction subgroups reported significantly higher scores on all subscales compared to the control group (P<0.05). The scale scores of depression and phobia showed a positive correlation with scores of anxiety (P<0.0001). The serum TRAb activity showed a significant correlation with anxiety, phobia and hysteria (P<0.0001). CONCLUSION: The psychiatric aspect of GO should be evaluated during routine follow-up and should be considered when making management decisions. Thyroid specific antibodies may be useful in confirming the diagnosis of GO.

Oxidative stress markers in patients with primary open-angle glaucoma.

PURPOSE: To investigate the levels of antioxidant enzymes catalase (CAT), glutathione peroxidase (GPO), superoxide dismutase (SOD), and malondialdehyde (MDA) in human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with severity of glaucoma. DESIGN: A prospective cases control study. PATIENTS AND METHODS: Thirty patients with primary open-angle glaucoma and twenty-five patients with senile cataracts of matched age and gender were included in the study prospectively. Aqueous humor samples were obtained by paracentesis at the time of elective surgery for glaucomatous and cataractous patients. Aqueous humor were analyzed for CAT, GPO, SOD, and MDA status. RESULTS: GPO, SOD, and MDA enzyme levels revealed a high significant increase in aqueous humor of POAG patients with respect to the comparative group of cataract patients (P < 0.001). No significant difference in the activity of CAT enzyme in aqueous humor of POAG and cataract patient (P = 0.201). Significant correlation was found between the MDA enzyme level and severe visual field loss (P < 0.001) in POAG patients. CONCLUSION: Increased levels of aqueous humor GPO, SOD, and MDA may be associated with POAG. In addition, they may be useful antioxidant enzyme levels in aqueous humor of POAG patients as a result of glaucoma disease and not a cause.

Evaluation of the role of timolol 0.1% gel in myopic regression after laser in situ keratomileusis.

PURPOSE: To evaluate the efficacy of the concomitant administration of antiglaucoma medications namely timolol 0.1% gel in cases with myopic regression after myopic laser in situ keratomileusis (LASIK). DESIGN: Prospective observational clinical trial. SUBJECTS AND METHODS: Ninty five eyes of 75 patients were included in this study prospectively. The mean myopic regression was -1.29 ± 0.83 diopters (range -0.5 to -4.62) after myopic LASIK. The eyes were divided into two groups: 50 eyes administrated timolol 0.1% gel once daily for 12 months (treated group), and 45 eyes were age matched (control group). We assessed the amounts of myopic regression in terms of changes in the refraction (spherical equivalent and astigmatism), intraocular pressure (IOP), pachymetry and the refractive power of the cornea measurements for all participants. RESULTS: The refractive error and visual acuity were similar between the two groups at baseline. The treated group had an improvement in spherical equivalent significantly from -1.29 ± 0.83 to -0.94 ± 1.07 diopters (P = 0.012). Astigmatism was changed from -0.94 ± 0.53 to -0.86 ± 0.60 diopters but this change was not statistically significant (P = 0.20). The IOP was decreased significantly from 12.6 ± 1.9 to 9.0 ± 1.1 mm Hg (P < 0.001). Central corneal thickness was changed from 425.6 ± 19.86 to 429 ± 18.1 µm but not statistically significant (P = 0.56). The central corneal power decreased significantly from 37.2 ± 1.8 to 36.4 ± 1.3 diopters (P < 0.05). CONCLUSION: Timolol 0.1% gel was effective for reduction and improvement of myopic regression especially the spherical errors after myopic LASIK.

MRI in diagnosis of orbital masses.

PURPOSE: To evaluate the role of diffusion-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy in diagnosis of different orbital masses and their advantages over conventional magnetic resonance imaging. METHODS: The study included 32 patients presenting with proptosis. Every patient was subjected to a clinical examination; conventional MRI "T1 weighted, T2 weighted, and post-contrast T1 weighted if needed;" diffusion-weighted MRI; and proton magnetic resonance spectroscopy. Orbitotomy was performed, the orbital mass was excised, and histopathological examination was performed. RESULTS: Diffusion-weighted MRI can be used to differentiate between benign lesions and malignant tumors in 75% of cases; however, overlap occurred in 25% of cases with benign tumors showing restricted diffusion while proton magnetic resonance spectroscopy could differentiate between benign and malignant tumors in 93.7% of cases. CONCLUSION: Diffusion-weighted MRI and proton magnetic resonance spectroscopy increased the accuracy of diagnosis of orbital masses through giving in vivo tissue characterization; with magnetic resonance spectroscopy being more accurate.

Intravitreal bevacizumab (avastin) as an adjuvant treatment in cases of neovascular glaucoma.

PURPOSE: To evaluate the effect of intravitreal bevacizumab (avastin) injection in cases of neovascular glaucoma. STUDY DESIGN: Clinical case series. MATERIALS AND METHODS: Sixteen eyes of 16 patients with rubeosis iridis and secondary glaucoma were administered intravitreal injection of bevacizumab (2.5 mg). The patients were followed for 2 months. RESULTS: We noted partial or complete regression of iris neovascularization 1 week after injection of bevacizumab. Reproliferation of new vessels was detected in 25% of the cases after 2 months. The mean intraocular pressure (IOP) before injection was 28+/- 9.3 mm Hg under topical ss-blocker and systemic acetazolamide. One week after injection, the IOP decreased to 21.7+/- 11.5 mm Hg (5 cases without anti-glaucoma drugs, 6 cases with topical ss-blocker and 5 cases with both topical ss-blocker and systemic acetazolamide). CONCLUSION: Intravitreal bevacizumab (avastin) injection leads to regression of iris neovascularization with subsequent drop of IOP in eyes with neovascular glaucoma.