Journal of Ophthalmic and Vision Research
Volume:8 Issue: 4, Oct-Dec 2013

To report the outcomes of transscleral diode laser photocoagulation for treatment of type 1 prethreshold retinopathy of prematurity (ROP). In this prospective interventional case series, 139 eyes of 73 infants with type 1 prethreshold ROP underwent transscleral diode laser photocoagulation of the avascular retina under topical anesthesia without making a conjunctival incision. Supplemental transpupillary diode laser photocoagulation was used for zone 1 ROP in one eye. All patients were followed for 6 months. Main outcome measures were regression of ROP, incidence of unfavorable outcomes and adverse effects. At the end of follow-up, neovascularization regressed completely in all eyes and no eye developed an unfavorable outcome. Repeated laser therapy was performed employing the same technique in 3 eyes (2.3%). Ocular adverse effects were minor including mild conjunctival injection and edema in all patients, small conjunctival lacerations in 12 eyes (8.7%), minor self-limited vitreous hemorrhage in 2 eyes (1.4%) and mild self-limited hyphema in one eye (0.7%). Transscleral diode laser photocoagulation is a safe and effective treatment option for type 1 prethreshold ROP. This technique can be performed under topical anesthesia.

To screen the microarray expression of CDH1, ECM1, EIF1B, FXR1, HTR2B, ID2, LMCD1, LTA4H, MTUS1, RAB31, ROBO1, and SATB1 genes which are predictive of primary uveal melanoma metastasis, and NFKB2, PTPN18, MTSS1, GADD45B, SNCG, HHIP, IL12B, CDK4, RPLP0, RPS17, RPS12 genes that are differentially expressed in metastatic uveal melanoma in normal whole human blood and tissues prone to metastatic involvement by uveal melanoma. We screened the GeneNote and GNF BioGPS databases for microarray analysis of genes predictive of primary uveal melanoma metastasis and those differentially expressed in metastatic uveal melanoma in normal whole blood, liver, lung and skin. Microarray analysis showed expression of all 22 genes in normal whole blood, liver, lung and skin, which are the most common sites of metastases. In the GNF BioGPS database, data for expression of the HHIP gene in normal whole blood and skin was not complete. Microarray analysis of genes predicting systemic metastasis of uveal melanoma and genes differentially expressed in metastatic uveal melanoma may not be used as a biomarker for metastasis in whole blood, liver, lung, and skin. Their expression in tissues prone to metastasis may suggest that they play a role in tropism of uveal melanoma metastasis to these tissues.

To describe the demographic pattern of congenital cataract surgery at a referral ophthalmology center in Iran and to evaluate any possible difference between the genders. Subjects aged 15 years or less scheduled for cataract surgery were enrolled in this cross-sectional study. Data was retrieved from the electronic medical records according to the ICD-10 coding system. Age and proportion of operations by sex were the main parameters of interest. We employed analysis of covariance to compare age at surgery and logistic regression to obtain the trend for the number of cataract procedures in boys and girls. Overall, 314 congenital cataract procedures were performed during the study period, 55 (17.5%) of which were related to second eye surgery. Operated eyes belonged to male subjects in 172 (54.8%) cases and female subjects in 142 (45.2%) cases. Mean age at operation for both first and second eyes was 3.2±3.0 years overall, and 3.1±2.9 versus 3.4±3.0 years in girls and boys, respectively (P= 0.62). Surgery was performed before one year of age in 33.2% and before 5 years in 75% of cases. Among patients undergoing second eye surgery, girls presented significantly later than boys (at 4.2±3.3 vs. 2.6±1.7 years, P= 0.012). The rate of congenital/infantile cataract surgery in boys was almost 10% higher than girls. We observed a significant difference only regarding age at second eye surgery which comprised 17.5% of all operations. One third and two thirds of the procedures were performed under the age of one and five years, respectively.

To devise and evaluate a screening algorithm for glaucoma in clinical settings. Screening included examination of the optic disc for vertical cupping (equal or more than 0.4) and asymmetry (equal or more than 0.15), Goldmann applanation tonometry (equal or more than 21 mmHg, adjusted or unadjusted for central corneal thickness), and automated perimetry. In the diagnostic step, retinal nerve fiber layer imaging was performed using scanning laser polarimetry. Performance of the screening protocol was assessed in an eye hospital-based program in which 124 non-physician personnel aged 40 years or above were examined. A single ophthalmologist carried out the examinations and in equivocal cases, a glaucoma subspecialist''s opinion was sought. Glaucoma was diagnosed in six cases (prevalence 4.8%; 95% confidence interval, 0.01-0.09) of whom five were new. The likelihood of making a definite diagnosis of glaucoma for those who were screened positively was 8.5 times higher than the estimated baseline risk for the reference population; the positive predictive value of the screening protocol was 30%. Screening excluded 80% of the initial population. Application of a formal screening protocol (such as our algorithm or its equivalent) in clinical settings can be helpful in detecting new cases of glaucoma. Preliminary performance assessment of the algorithm showed its applicability and effectiveness in detecting glaucoma among subjects without any visual complaint.

To explore functional visual recovery after retinal reattachment surgery employing full-field electroretinography (ffERG). In this case series, scotopic and photopic ffERGs were compared 2 days before, and 1, 3 and 6 months after successful scleral buckling for total rhegmatogenous retinal detachment (RRD). Main outcome measures were changes in ERG a-and b-wave amplitudes postoperatively. Twenty eyes of 20 patients including 14 male and 6 female subjects with mean age of 34.7±8.2 (range, 23 to 50) years were enrolled. Preoperatively, mean a-wave amplitude in the maximal combined response was 27.5±11.7 µ V which was increased to 110.7±41.9 (P < 0.001), 175.7±53.1 (p < 0.001) and 174.6±51.4 (P < 0.001) µ V at 1, 3 and 6 months, respectively. Mean preoperative a-wave amplitude of the cone ERG response was 2.1±0.8 µ V, which was increased to 2.2±0.9 (P = 0.03), 5.1±1.7 (P < 0.001) and 5.3±1.6 (P < 0.001) µ V at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude in the maximal combined response was 97.6±28.9 µ V which was increased to 179.2±44.9 (P < 0.001), 264.2±56.3 (P < 0.001) and 267.8±54.2 (P < 0.001) µ V at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude of the cone ERG response was 2.9±0.9 µ V which was increased to 3±0.9 (P = 0.32), 9.9±1.9 (P < 0.001) and 9.8±1.9 (P < 0.001) µ V at 1, 3 and 6 months, respectively. After retinal reattachment surgery, photoreceptor and visual function show parallel improvement. The scotopic ERG response recovered faster than the photopic response. Incomplete recovery of ERG parameters indicates that photoreceptor cell damage in retinal detachment is not completely reversible.

To report the clinical features of eyes with intraretinal foreign bodies (IRFBs) and to evaluate the results of surgical management in these eyes. Hospital records of 34 eyes of 33 patients with IRFBs were reviewed. All eyes underwent pars plana vitrectomy to remove the foreign bodies using intraocular forceps or by magnetic extraction. All patients were male with mean age of 28±12.3 years and were followed for a mean period of 24.5±2.3 months. The IRFBs were ferromagnetic in 29 (85.3%) cases and were removed using an external magnet in 13 eyes (38.4%) or intraocular forceps in 21 eyes (61.6%). Laser photocoagulation was performed around the IRFB prior to surgery in 7 (20.6%) eyes. Macular pucker and scars developed in 8 (23.5%) eyes and retinal breaks posterior to the sclerotomy were formed in 12 eyes (35.3%) postoperatively. Final visual acuity was 20/40 or better in 12 (35.3%) eyes and 20/200 or better in 23 (67.7%) eyes. Final visual acuity of 20/200 or better had no significant relationship with the site, size, or type of the IRFB or with the interval from trauma to surgery. Despite the complexity of surgical management of IRFBs, anatomic and visual outcomes of vitreoretinal surgery in these cases are generally good. The appropriate route of removal may be determined by the type, size, and site of the IRFB. Removal of magnetic IRFBs using external magnets versus intraocular forceps seems to entail comparable results.

To evaluate the effect of intravitreal injection of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) combined with intravitreal bevacizumab (IVB) on refractory diabetic macular edema (DME). This prospective, interventional case series included 15 eyes of 15 patients with DME unresponsive to previous IVB injections. Eligible eyes underwent intravitreal injection of 0.025 mg Fasudil and 1.25 mg bevacizumab. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated before and 4 weeks after treatment. Mean age was 64.6±7.3 (range, 49-79) years and mean number of previous IVB injections was 2.8. Mean pre-injection BCVA was 0.84±0.35 LogMAR, which was improved to 0.49±0.29 LogMAR four weeks after intervention (P=0.003). Mean CMT was decreased from 448±123? m before treatment, to 347±76? m at four weeks (P=0.001); no adverse event was observed during the study period. Intravitreal ROCK inhibitors seem to entail structural and visual benefits in eyes with DME refractory to IVB monotherapy.

To describe the polymorphic expression of Stargardt disease in a large Tunisian family with clinical intra- and interfamilial variation of the condition. Twelve subjects from two related families with autosomal recessive Stargardt disease were enrolled. A detailed clinical examination including visual acuity and visual field measurement, fundus photography, fluorescein angiography, electroretinography (ERG) and color vision testing was performed for all subjects. The youngest child from family A manifested typical Stargardt disease while her two brothers presented with Stargardt disease-fundus flavimaculatus (STGD-FFM) and her two sisters demonstrated a peculiar phenotype overlapping Stargardt disease and cone-rod dystrophy; their phenotypic manifestation corresponded well with ERG groups I, II and III, respectively. This uncommon occurrence of an age-related decline in ERG amplitude and worsening of fundus changes is suggestive of a grading pattern in Stargardt disease. Their two cousins in family B, displayed the STGD-FFM phenotype. Despite clinically similar STGD-FFM patterns in both families, age of onset and progression of the phenotype in family B differed from family A. This is the first report on phenotypic variation of Stargardt disease in a large Tunisian family. Regarding phenotype and severity of visual symptoms, family A demonstrated Stargardt disease at various stages of progression. In addition, STGDFFM appeared to be an independent clinical entity in family B. These findings imply that further parameters are required to classify Stargardt''s disease.

Graft versus host disease (GVHD) is a common complication of allogeneic stem cell transplantation (allo-SCT). Ocular GVHD develops in approximately 40-60% of patients following allo-SCT and its most common clinical manifestations include keratoconjunctivitis sicca and cicatricial conjunctivitis. Ocular GVHD may lead to severe ocular surface disease, which can significantly diminish quality of life and restrict daily activities. It is thus important to monitor the condition closely since with timely diagnosis, irreversible damage can be avoided. The current review will focus on updated information regarding ocular GVHD.

Polypoidal choroidal vasculopathy (PCV) is a retinal disease involving the choroidal vasculature characterized by the presence of polypoidal lesions with or without branching vascular network best seen on indocyanine green angiography (ICGA). Clinical features of PCV include recurrent subretinal hemorrhage; serosanguineous pigment epithelial detachment, subretinal exudation and serous retinal detachment. PCV is more prevalent among Asians and Blacks as compared to Caucasians and has been found to account for 25 to 50% of cases of presumed neovascular age-related macular degeneration in Asian patients. Treatment is indicated in patients with symptomatic PCV due to potentially irreversible visual loss. Various treatment modalities for symptomatic PCV have been described in the literature, including thermal laser photocoagulation, ICGA-guided photodynamic therapy (PDT) with verteporfin, anti-vascular endothelial growth factor (VEGF) therapy, and combined PDT and anti-VEGF therapy. This review aims to provide an update on the therapeutic options for PCV, with particular reference to recent studies published in the past two years.

To report a case of recurrent idiopathic frosted branch angiitis (FBA) successfully treated with adalimumab. Case Report: A 14-year-old otherwise healthy boy was referred to the uveitis clinic for bilateral panuveitis with diffuse retinal vascular sheathing and severe macular edema. Extensive work-up including aqueous sampling for detection of viral causes was inconclusive. Two years ago، a similar episode had been treated with oral prednisolone، however it was complicated by adverse psychiatric effects. The progressive course of the condition mandated considering other therapeutic measures; Adalimumab was chosen based on its purported efficacy for treatment of childhood uveitis and a favorable safety profile. The patient responded dramatically to a single subcutaneous injection of adalimumab without any side effect during and after injection. The therapeutic effect was rapid and relatively long-lasting. To the best of our knowledge، this is the first case of idiopathic FBA treated successfully with adalimumab without adjunctive steroid therapy.

To report a case of granular cell tumor as a rare orbital pathology. Case report: A 50-year-old female presented with a 4-year history of diplopia, right ocular displacement and a firm nontender mass in her right lower lid. Computed tomography (CT) scan of the orbit disclosed a well-defined mass in the right inferior orbit involving the right inferior rectus. Subtotal excision of the mass was performed, and histopathologic and immunohistochemical studies revealed granular cell tumor. Subsequently, the tumor recurred and exenteration was required as multiple sessions of radiotherapy failed to prevent the residual tumor from growing. Granular cell tumor, though very rare in the orbit, should be considered in patients with orbital masses especially in cases with involvement of the inferior rectus muscle. Infiltrative tumors may be impossible to completely resect and can rapidly recur following surgery.

To report a patient who was referred for orbital cellulitis but was finally diagnosed with acute leukemia. Case Report: A 17-year-old boy presented with fever, periorbital erythema and swelling mimicking periorbital cellulitis. He underwent empiric antibiotic therapy. Complete blood counts revealed leukocytosis with a predominance of immature blast cells. Bone marrow aspiration confirmed the diagnosis of acute myelogenous leukemia. Chemotherapy was initiated resulting in resolution of signs and symptoms. Acute leukemia may mimic periorbital cellulitis and must be considered in the differential diagnosis.

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