Journal of Ophthalmic and Vision Research
Volume:7 Issue: 4, Oct-Dec 2012

To investigate the efficacy of normobaric oxygen (NBO) therapy for treatment of scleral ischemia or melt. This prospective interventional case series includes 9 eyes of 8 patients with scleral ischemia or melt of diverse etiologies. Following the failure of conventional medical and/or surgical therapy to improve ischemia or upon clinical deterioration، NBO was initiated. All patients received 100% NBO at flow rate of 10 liters/minute by face mask for 1 hour، twice daily until complete vascularization of ischemic areas. Main outcome measures were improvement of scleral ischemia and healing of conjunctival epithelial defects. NBO therapy led to epithelialization and vascularization of the ischemic sclera in all eyes; the repair process began 3-4 days after NBO had been initiated and was completed in 18. 1±4. 7 (range، 10-25) days. All patients remained stable over a 9-month follow-up period. NBO therapy seems effective for treatment of scleral ischemia or melt، and hence can be considered as a non-invasive alternative to surgical intervention in these conditions.

To report the outcomes of two different surgical techniques for the repair of late onset bleb leakage following trabeculectomy. This retrospective study includes 21 eyes of 20 patients with prior trabeculectomy and late-onset bleb leaks; 14 eyes underwent excision of the filtering bleb together with conjunctival advancement while in the other 7 eyes the bleb was retained but de-epithelialized before conjunctival advancement. Success was defined as resolution of leakage with no need for additional glaucoma surgery together with intraocular pressure (IOP) of 5-21 mmHg. Complete and qualified success was considered when the above mentioned was achieved without or with glaucoma medications, respectively. Mean duration of follow-up was 20.3±14.4 months. No significant difference was observed between the two groups in terms of complete, qualified and overall success rates (P>0.05), however more antiglaucoma medications were necessary in the bleb excision group (P=0.02). Both surgical techniques of bleb repair were comparably effective, however the bleb de-epithelialization technique was associated with less need for glaucoma medications after the procedure.

To explore changes in central macular thickness (CMT) after a two-month period of glaucoma therapy with topical latanoprost after uneventful phacoemulsification. Forty-one eyes of 31 patients with primary open angle or pseudoexfoliative glaucoma who required glaucoma medications after cataract surgery were prospectively enrolled. All eyes had undergone uneventful phacoemulsification with intraocular lens implantation at least 4 months before initiation of latanoprost. After a complete ophthalmic examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 2 months, and clinical examinations were repeated one and two months afterwards; OCT and FA were repeated after 2 months. Outcome measures were CMT and loss of more than 2 lines of best corrected visual acuity (BCVA). Mean patient age was 71.6±7.8 years. Intraocular pressure decreased from 21.5±3.4 mmHg to 14.4±2.6 mmHg (p0.05 for all comparisons). Topical use of latanoprost later than 4 months after uncomplicated cataract surgery does not seem to predispose to increased macular thickness or CME and may safely be used in this setting.

To investigate the correlation between diabetic retinopathy severity and blood flow parameters in the central retinal artery (CRA) and internal carotid artery (ICA). This comparative study included 40 eyes of 20 patients with asymmetric diabetic retinopathy. Twelve subjects had asymmetric diabetic macular edema while eight patients had proliferative diabetic retinopathy (PDR) in one eye and non-proliferative diabetic retinopathy (NPDR) in the fellow eye. Bilateral color Doppler imaging (CDI) of the CRA and ICA was performed to determine resistance index (RI) and peak systolic velocity (PSV). RI and PSV values were compared between eyes with higher grades of macular edema (> 2 grades of difference with the fellow eye) and fellow eyes with less severe macular edema، as well as between eyes with PDR and fellow eyes with NPDR. Mean RI of the CRA in eyes with higher grades of macular edema was 0. 78±0. 11 as compared to 0. 69±0. 08 in fellow eyes with less severe macular edema (P=0. 012)، while PSV of the CRA was 58. 83±18. 93 cm/s in eyes with higher grades of macular edema versus 59. 75±11. 83 cm/s in fellow eyes with less severe macular edema (P=1. 00). Mean PSV of the ICA was 55±23. 94 cm/s in eyes with PDR and 69. 25±34. 30 cm/s in eyes with NPDR (P=0. 008) while mean RI of the ICA was 0. 81±0. 13 in eyes with PDR and 0. 76±0. 12 in eyes with NPDR (P=1. 00). Evaluation of RI in the CRA and PSV in the ICA by CDI in diabetic patients may identify eyes at risk of more severe macular edema and PDR.

To investigate the effect of simultaneously performed fluorescein angiography (FA) on full-field electroretinography (ffERG) parameters. Scotopic and photopic ffERG were performed immediately and 60 minutes after conventional FA in patients with retinal photoreceptor disorders; a-and b-wave amplitudes were compared between recordings obtained at the two time intervals in each patient. Ten eyes of five (3 male and 2 female) patients with mean age of 19.6±3.8 (range, 15-25) years were studied. Intravenous fluorescein administration caused an immediate reduction in ERG waves which was most prominent in rod and maximal combined responses. Mean a-wave amplitude in maximal combined response, rod response and cone response ERGs was 46.0±18.8, 8.0±7.0 and 5.1±2.0? v immediately after FA which was increased to 79.0±30.0, 21.5± 22.5 and 6.5±2.4? v 60 minutes afterwards, respectively (P)

To report non-organic visual loss (NOVL) following cataract surgery with multifocal intraocular lens (IOL) implantation. After reviewing consecutive cases of NOVL diagnosed by a single neuro-ophthalmologist over a one year period, two patients reported herein attributed their visual symptoms to cataract surgery and multifocal IOL implantation. In both patients variability was noted in visual function and kinetic perimetry demonstrated non-organic visual field loss. Initially, refractive surgeons considered lens exchange, which was avoided after neuro-ophthalmic evaluation in both cases. This report should alert cataract and refractive surgeons to the possibility of NOVL as an explanation for dissatisfaction after cataract surgery with multifocal IOL implantation.

To evaluate refractive state in children with unilateral congenital nasolacrimal duct obstruction (NLDO). This descriptive cross-sectional study includes consecutive children with unilateral congenital NLDO. Examination under anesthesia was performed to perform cycloplegic refraction and was followed by appropriate intervention in each patient. Refractive errors of the involved and sound fellow eyes were compared. Ninety-four children with mean age of 25.4±20.4 months (range, 6 months to 10 years) were enrolled from May 2007 to January 2010. Based on spherical equivalent refractive error, hyperopia was more common in the affected eyes, however this difference failed to reach statistical significance (P=0.5). Anisometropia more and less than 0.5 diopters (D) was present in 25% and 43% of patients respectively. Interocular difference was significant in terms of spherical refractive error and spherical equivalent (P=0.003) but not cylindrical refractive error. When the comparison was limited to hyperopic eyes, the interocular difference became more significant in terms of spherical refractive error and spherical equivalent (P)

Retinal vasculature related pathologies account for a large proportion of global blindness. Choroidal neovascularization accompanying age-related macular degeneration is the largest cause of blindness in people over the age of 65 years، proliferative diabetic retinopathy is the main cause of acquired blindness in working adults، and retinopathy of prematurity (ROP) is the leading cause of acquired blindness in children. Given the great success in treating the first category of these conditions with anti-vascular endothelial growth factor (anti-VEGF) therapy، there is understandably considerable interest to employ this strategy to other retinal vascular disorders. Anti-VEGF therapy may not be the optimal course of action، as it may compromise neuronal survival; this is of particular concern when treating ROP where retinal neurogenesis is still not complete. Moreover، retinal neovascularization is preceded by alterations in the vascular wall extracellular matrix with concomitant reduction in mural cell adhesion. This produces vascular instability followed by the pathobiologic process of neovascularization. Thus، stabilizing mural cell-matrix interactions would be a prudent alternative for controlling retinal vascular pathologies. In this review، we will summarize the development of retinal angiogenesis focusing on the role of cell-matrix interaction in each step of the process. Our goal is to identify potential targets for regulating and maintaining normal vascular development and function.

To report the recurrence of keratoconus 49 months after deep anterior lamellar keratoplasty (DALK). Case Report: A 21-year-old man with history of bilateral keratoconus who had undergone DALK in his right eye, presented with gradual visual loss 49 months after corneal transplantation. Slit lamp biomicroscopy revealed graft ectasia together with Vogt''s striae in the posterior stroma and corneal topography demonstrated inferior steepening. With a diagnosis of recurrent keratoconus in the graft, the patient underwent penetrating keratoplasty (PK) and histopathological examination confirmed the diagnosis of keratoconus in the graft. Similar to PK, keratoconus can recur in the transplanted cornea after DALK. However, the time interval from transplantation to recurrence seems to be much shorter in DALK grafts.

To report the effectiveness of indocyanine green mediated photothrombosis (IMP) combined with high dose (4 mg/0.16 ml) intravitreal bevacizumab (IVB) as adjunctive therapy for management of isolated choroidal metastasis from breast cancer. This retrospective interventional case report includes three eyes of two patients with choroidal metastasis from breast cancer. Both patients were submitted to one session of IMP combined with high dose IVB as adjuvant local therapy to systemic chemotherapy. Main outcome measures were tumor response, and fluorescein angiography (FA), optical coherence tomography (OCT), and visual acuity (VA) results. The first patient was a 47-year-old woman who had undergone radical mastectomy, chemotherapy and radiotherapy 7 years earlier and the second patient was a 70-year-old woman managed with chemotherapy and radiotherapy 16 years before presentation. There was no evidence of systemic metastasis in either case and both suffered from gradually blurred vision. The first patient presented with a unilateral choroidal lesion whereas the second case had bilateral unifocal choroidal lesions which was symptomatic in only one eye. Clinical examination, ultrasonography, FA, and OCT revealed accompanying exudative retinal detachment in all three eyes. OCT 3 to 5 weeks after combined therapy demonstrated complete resolution of subretinal fluid and improved VA in two eyes. Combined IMP and high-dose IVB seems to be an effective adjunctive treatment to systemic chemotherapy for management of isolated choroidal metastasis from breast cancer.

Proliferative vitreoretinopathy (PVR) is a frequent condition following complex retinal detachments or trauma, and subretinal PVR is a common cause of retinal redetachment. Subretinal PVR removal is challenging and may require creating multiple or large retinotomies, making manipulation of the retina difficult and sometimes hazardous. We propose a novel surgical technique that may facilitate subretinal removal of PVR. After peripheral retinotomy of 180 degrees or greater, perfluorocarbon liquid (PFCL) is carefully introduced into the subretinal space as a single bubble which provides space to perform the maneuvers. The PFCL serves as a second hand which folds the retina over, thereby allowing better visualization for safer and easier subretinal PVR removal. PFCL in then removed by direct aspiration as a single bubble while still under balanced salt solution, taking advantage of its high surface tension which prevents leaving bubbles behind. The described technique allows adequate exposure of the subretinal space for proper dissection of difficult-to-reach subretinal PVR. We applied this technique in five patients with chronic retinal detachment, extensive subretinal PVR and poor visual potential. The utilization of subretinal PFCL can assist dissection of subretinal PVR and may be useful in eyes with complicated retinal detachment and poor visual prognosis.