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Optical coherence tomography angiography: Technical principles and clinical applications in ophthalmology
Ahmed M Hagag, Simon S Gao, Yali Jia, David Huang
July-September 2017, 7(3):115-129
DOI:10.4103/tjo.tjo_31_17  PMID:28966909
Optical coherence tomography angiography (OCTA) is a functional extension of OCT that provides information on retinal and choroidal circulations without the need for dye injections. With the recent development of high-speed OCT systems and efficient algorithms, OCTA has become clinically feasible. In this review article, we discuss the technical principles of OCTA, including image processing and artifacts, and its clinical applications in ophthalmology. We summarize recent studies which qualitatively or quantitatively assess disease presentation, progression, and/or response to treatment.
  20 3,304 675
Traumatic optic neuropathy—Clinical features and management issues
Patrick Yu-Wai-Man
January-March 2015, 5(1):3-8
DOI:10.1016/j.tjo.2015.01.003  PMID:26052483
Traumatic optic neuropathy (TON) is an uncommon cause of visual loss following blunt or penetrating head trauma, but the consequences can be devastating, especially in cases with bilateral optic nerve involvement. Although the majority of patients are young adult males, about 20% of cases occur during childhood. A diagnosis of TON is usually straightforward based on the clinical history and examination findings indicative of an optic neuropathy. However, the assessment can be difficult when the patient’s mental status is impaired owing to severe trauma. TON frequently results in profound loss of central vision, and the final visual outcome is largely dictated by the patient’s baseline visual acuities. Other poor prognostic factors include loss of consciousness, no improvement in vision after 48 hours, the absence of visual evoked responses, and evidence of optic canal fractures on neuroimaging. The management of TON remains controversial. Some clinicians favor observation alone, whereas others opt to intervene with systemic steroids, surgical decompression of the optic canal, or both. The evidence base for these various treatment options is weak, and the routine use of high-dose steroids or surgery in TON is not without any attendant risks. There is a relatively high rate of spontaneous visual recovery among patients managed conservatively, and the possible adverse effects of intervention therefore need to be even more carefully considered in the balance.
  13 1,187 146
Prevalence of general binocular dysfunctions among rural schoolchildren in South Korea
Jung Un Jang, Inn-Jee Park
October-December 2015, 5(4):177-181
DOI:10.1016/j.tjo.2015.07.005  PMID:29018694
Background/Purpose: To assess the prevalence of nonstrabismic accommodative and vergence dysfunc tions among primary schoolchildren in Hampyeong, a rural area of South Korea. Methods: Five hundred and eighty-nine primary schoolchildren, 8–13 years old, were each given a thorough eye examination, including binocular-vision testing, near point of convergence, horizontal phoria measurement by von Graefe, and negative and positive vergence amplitudes with prism bar, to determine any form of accommodative or vergence dysfunctions. Results: Of the 589 participants examined, 168 (28.5%) primary schoolchildren presented some form of nonstrabismic accommodative or vergence dysfunctions. The prevalence of accommodative dysfunctions and vergence dysfunctions was 13.2% and 9%, respectively. Convergence insufficiency (10.3%) was more prevalent than convergence excess (1.9%), and accommodative insufficiency (5.3%) was more prevalent than accommodative excess (1.2%). Conclusion: This study suggests that nonstrabismic accommodative and vergence dysfunctions are prevalent in the rural area of South Korean primary schoolchildren, and convergence insufficiency was the most prevalent.
  9 1,232 121
Severe ocular complications following facial calcium hydroxylapatite injections: Two case reports
Yun-Han Hsieh, Chao-Wen Lin, Jen-Shang Huang, Po-Ting Yeh
January-March 2015, 5(1):36-39
DOI:10.1016/j.tjo.2014.03.009  PMID:29018663
Dermal soft-tissue augmentation using a filler is a technique widely used for facial cosmetic enhancement. However, potential complications following facial cosmetic injections have heightened the possibility of iatrogenic visual loss. We report two cases of severe ocular complications after nasal cosmetic enhancement. Both cases had poor visual outcomes in spite of emergency management. The second patient is a rare case with bilateral anterior ischemic optic neuropathy after dermal soft-tissue augmentation. The visual outcome was correlated with the location and the extent of the arterial embolization. Unfortunately, there is still no standard treatment protocol for vision-threatening complications. Clinicians should always keep in mind that embolic arterial occlusion may occur after augmentation.
  8 964 72
The epidemiology of patients with pterygium in southern taiwanese adults: The Chiayi survey☆
Ching-Lung Chen, Chien-Hsiung Lai, Pei-Lun Wu, Pei-Chang Wu, Tsung-Hsien Chou, Hsu-Huei Weng
April-June 2013, 3(2):58-61
Purpose: To investigate patients with pterygium in different geographic regions and the associated risk factors in southern Taiwan. Methods: A clinical observation survey was conducted in Chiayi County, a rural area in southern Taiwan. The subjects aged 40 years and above underwent complete ocular examinations. Associated risks factors were evaluated, including gender, age, occupations, smoking, and geographical living regions by univariant and multivariant logistic regression analysis. Results: A total of 2197 participants (790 male, 36.0%) from 44 different villages were evaluated. In these, 554 participants (25.2%) have either unilateral or bilateral pterygium. Age is associated with the percentage of pterygium, and those aged between 60 and 69 had the highest percentage of 30.1% (p < 0.0001). The gender effect was higher among men than women (OR = 1.31, 95% CI: 1.08–1.60, p = 0.006). The percentage of pterygium lived in plain, seaside, and mountainous areas were 22.6%, 32.6%, and 14.5% respectively. Geographical regions also showed that seaside area had the highest percentage of pterygium (seaside area OR = 1.65, 95% CI: 1.35-2.03, and mountainous area OR = 0.58,95% CI: 0.35-0.95 compared with plain areas). Primary outdoor workers and residents with smoking history had relative higher risk for pterygium (OR = 1.47, 95% CI: 1.17-1.86; OR = 1.36, 95% CI: 1.02-1.83). Conclusions: The percentage of pterygium in southern Taiwan is about 25.2% among adults aged over 40 years in this survey. It is significantly higher in the age of 50 or more and in residents living in villages along the seaside than those living in the mountainous and the plain areas.
  7 874 54
Rod metabolic demand drives progression in retinopathies
Michael K Lin, Soo Hyun Kim, Lijuan Zhang, Yi-Ting Tsai, Stephen H Tsang
July-September 2015, 5(3):105-108
DOI:10.1016/j.tjo.2015.06.002  PMID:29018679
Various factors are thought to cause the development and progression of disease in macular degeneration, diabetic retinopathy, and retinitis pigmentosa. Some of the deleterious processes include oxidative stress, hypoxia, metabolic derangement, genetics, and vasculopathy. In this review, we present a unified theory for the pathophysiology of several retinopathies based on the unique and intense metabolism of rod photoreceptors.
  7 1,133 91
Serum components and clinical efficacies of autologous serum eye drops in dry eye patients with active and inactive Sjogren syndrome
I-Hsin Ma, Lily Wei Chen, Wen-Hui Tu, Chia-Ju Lu, Chien-Jung Huang, Wei-Li Chen
October-December 2017, 7(4):213-220
DOI:10.4103/tjo.tjo_102_17  PMID:29296554
PURPOSE: Autologous serum eye drops are considered safe and efficient for the treatment of various ocular surface disorders, including dry eye diseases (DED) caused by the primary and secondary Sjogren syndrome (SS). However, the serum components in patients of SS may be different from those of normal patients and can thus lead to unpredictable therapeutic effects. This study divided the SS patients into active and inactive types based on the erythrocyte sedimentation rate and the presence or absence of active rheumatoid arthritis. METHODS: We compared the serum components of these two groups with standard and multiplex enzyme linked immunosorbent assay arrays and predicted the therapeutic effects of topical autologous serum for the treatment of DED with ocular surface disease index (OSDI) and Oxford Schema scale (OSS). RESULTS: Hyaluronic acid and transforming growth factor b1 levels were significantly higher in the active SS group compared to the inactive SS group (P < 0.01), whereas epidermal growth factors, insulin growth factor 1, and fibroblast growth factor b had no significant differences between these two groups. Active SS group had significantly higher expressions of interleukin (IL) 1 beta, IL 6, and tumor necrosis factor alpha compared to inactive SS patients (P < 0.05). There were no statistical differences in therapeutic effects between these two groups, as measured with the OSDI or OSS. CONCLUSION: Dividing the Sjogren dry eye patients into active and inactive groups may appear as a reasonable method to predict the quality of autologous serum eye drops, but there seems to be no significant predictability to the therapeutic effects.
  6 2,294 336
Development of vitreomacular interface abnormality in patients with diabetic macular edema
Chun-Kai Chang, Cheng-Kuo Cheng, Chyi-Huey Bai, Chi-Hsien Peng, Chao-Chien Hu
July-September 2012, 2(3):93-98
Purpose: To report the prevalence of vitreomacular interface abnormality (VMIA) and the incidence of the development of VMIA in patients with diabetic macular edema (DME). Factors associated with the development of VMIA were also investigated. Methods: This is a retrospective observational study. Patients with DME who were followed for at least 6 months were reviewed. Ophthalmoscopic examination, fundus photography, fluorescein angiography, and optical coherence tomography were used to detect DME and VMIA. Results: A total of 244 eyes in 180 patients were found to have DME at the initial visit, of these, 16 eyes (6.56%) were also diagnosed with VMIA. Ninety-six eyes in 76 patients with DME who did not receive an intravitreal operation or medications were included in the follow-up study. VMIA developed in 8 eyes (8.33%) over a mean follow-up duration of 22.63 months, which corresponded to a calculated annual incidence of 4.42%. The mean time from the initial visit to the detection of VMIA was 19 months, older age was found to be a risk factor for the development of VMIA. The occurrence of VMIA was associated with worsening visual acuity and a thicker central retinal thickness on the final visit. Conclusion: This study reveals the prevalence of VMIA on the initial visit and the incidence and risk factors associated with the occurrence of VMIA in patients with DME. This study also found that the occurrence of VMIA was significantly associated with poor visual outcomes and worsened macular edema at the end of the observation period.
  6 868 63
Effects of ranibizumab on very low birth weight infants with stage 3 retinopathy of prematurity: A preliminary report☆
Chun-Ju Lin, San-Ni Chen, Chien-Chi Tseng, Yao-Chung Chang, Jiunn-Feng Hwang
October-December 2012, 2(4):136-139
Background/Purpose: To report the effects of ranibizumab on very low birth weight (VLBW) infants with retinopathy of prematurity (ROP). Methods: A retrospective, noncomparative, consecutive, interventional case series was conducted. Patients with stage 3 ROP were identified and evaluated from August 2011 to February 2012. All patients with ROP received one intravitreal ranibizumab injection (0.25 mg/0.025 mL) under topical anesthesia as the initial treatment. Main outcome measures: Regression of ROP and the complications associated with the intravitreal ranibizumab injection. Results: A total of 23 eyes of 12 patients (four boys and eight girls) were included in this study. All of the patients had a history of supplemental oxygen and mechanical ventilation use. The mean gestational age was 26.33 ± 2.06 weeks (range: 24–30 weeks), and the mean birth weight was 821.58 ± 297.63 g (range: 507–1480 g). The mean postmenstrual age during the intravitreal administration of ranibizumab injection was 35.08 ± 2.07 weeks (range: 32–39 weeks), and the mean follow-up period was 5.83 ± 1.64 months (range: 3–8 months). All eyes received one intravitreal ranibizumab injection (0.25 mg/ 0.025 mL) as the primary therapy. None of the eyes needed conventional laser photocoagulation or cryotherapy as adjuvant therapy and no systemic complications were noted. No cataracts, endophthalmitis, or retinal detachment occurred postoperatively. Preretinal hemorrhages were found in four eyes of three patients (17.39%), but all were absorbed without sequelae. Conclusion: Intravitreal ranibizumab injections seem to be effective and well tolerated in VLBW infants with stage 3 ROP. Only self-limited preretinal hemorrhages were noted, and no short-term systemic or major ocular side effects were identified.
  6 828 62
Immunosuppressive therapy for eye diseases: Effectiveness, safety, side effects and their prevention
Dana M Hornbeak, Jennifer E Thorne
October-December 2015, 5(4):156-163
DOI:10.1016/j.tjo.2015.03.004  PMID:29018691
Ocular inflammation is a significant cause of ocular morbidity and visual impairment. Topical, periocular, intraocular, and systemic corticosteroids are highly effective for treating appropriate forms of ocular inflammation. However, their use may be constrained by local and/or systemic side effects, especially if long-term therapy is required. As a result, immunosuppressive agents increasingly have been used to manage ocular inflammation alongside or in place of corticosteroids. The four categories of agents used today are antimetabolites [primarily methotrexate, mycophenolate mofetil (MMF), and azathioprine]; T-cell inhibitors (usually cyclosporine, less often tacrolimus or sirolimus); alkylating agents (cyclophos-phamide and chlorambucil); and biologic agents [tumor necrosis factor (TNF) inhibitors, lymphocyte inhibitors, and interleukin inhibitors]. The primary goals of immunosuppressive therapy are (1) to control inflammation when corticosteroids fail to do so; (2) to prevent corticosteroid-induced toxicity when the necessary corticosteroid dosage exceeds the desired or safe level (corticosteroid sparing); and (3) to treat specific high-risk uveitis syndromes known to respond poorly to corticosteroids alone. Growing evidence shows the effectiveness of immunosuppressive drugs in achieving these goals, as well as improved visual function, prevention of ocular complications, and in some cases even disease remission. However, these agents also have side effects, which must be considered in each patient's management. In this report, we summarize the effectiveness and safety of immunosuppressive drug therapy utilized in the treatment of ocular inflammatory diseases.
  6 1,079 143
Impact of swept source optical coherence tomography on ophthalmology
Shoji Kishi
April-June 2016, 6(2):58-68
DOI:10.1016/j.tjo.2015.09.002  PMID:29018713
Swept source optical coherence tomography (SS-OCT) was introduced in clinical practice in 2012. Because of its deeper penetration and faster acquisition time, SS-OCT has the ability to visualize choroid, vitreous, and retinal structures behind dense preretinal hemorrhages. Swept source optical coherence tomography has positively influenced and hugely contributed to the research of the vitreous body. It is the first ophthalmic diagnostic technology to demonstrate the entire structure of the posterior pre-cortical vitreous pocket (PPVP) in vivo. The roles of the PPVP in physiological posterior vitreous detachment and vitreoretinal interface disorders have now been elucidated. The presence of a connecting channel between the PPVP and Cloquet’s canal suggests that the aqueous humor drains into the premacular space. Deeper penetration of SS-OCT has made it possible to view the choroid. It also has an important role in central serous chorioretinopathy and uveitis. We have also been able to treat Harada disease by monitoring the choroidal thickness by SS-OCT.
  6 981 148
Chiasmal optic neuritis: A report of three cases
Shih-Yun Lee, An-Guor Wang, May-Yung Yen
April-June 2012, 2(2):68-72
Chiasmal optic neuritis (ON), a rare condition that affects the optic chiasm, is mostly associated with inflammatory demyelinating disorders and may be the initial manifestation of multiple sclerosis (MS). Here, we reported three cases of MS with chiasmal optic neuritis. The clinical manifestations, neuro-imaging results, and visual prognosis were evaluated in each patient. Routine eye examinations and auxiliary examinations, including Ishihara color plate, determination of the visual field (VF), and magnetic resonance imaging (MRI) of the optic nerve and chiasm, were performed. All patients presented with reduced VA and VF defects. The abnormal enhancement of the optic chiasm was clearly demonstrated on MRI. Two patients recovered after the systemic administration of steroids, but the other patient only partially recovered. In conclusion, although it is rare, chiasmal ON should be considered in patients who develop bitemporal hemianopia. MRI is the modality of choice for accurate diagnosis. Early diagnosis and proper treatment are mandatory for the restoration of restore visual function.
  5 924 58
Scleral contact lenses for visual rehabilitation in keratoconus and irregular astigmatism after refractive surgery
Hua-Lin Lo, Shu-I Yeh, Huey-Chuan Cheng
April-June 2014, 4(2):73-76
This study aims to report our experience of using fluid-ventilated, gas-permeable scleral contact lenses (SCLs) for visual rehabilitation of patients with keratoconus and irregular astigmatism after refractive surgery. This is a noncomparative interventional case series reporting eight consecutive patients fitted with SCLs because of irregular astigmatism following the failure of other optical corrections. Retrospective chart review and data analysis included age, sex, etiology prior to lens fitting, visual outcomes, follow-up time, and complications. Twelve eyes of eight patients were studied. All eyes were fitted with SCLs due to unsatisfactory vision with spectacle correction or other contact lens modalities. Five eyes had keratoconus and seven had irregular corneas post refractive surgery. The mean follow-up period was 14.4 ± 1.3 months (range 11–17 months). The mean age was 32.63 ± 7.68 years (range 18–48 years). The average steepest keratometry(Kmax) of our series was 49.56 ± 12.2 D. The mean refractive astigmatism was 5.50 ± 5.3 D. The mean best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution improved from 0.71 ± 0.50 (range 0.10–1.40) to 0.05 ± 0.07 (range 0.00–0.15) after SCL fitting (p < 0.001). All reported eyes achieved significant improvement in the BCVA with SCL fitting. None of the patients discontinued to wear SCLs. SCLs should be considered lenses of choice in irregular corneas refractory to conventional optical correction.
  5 1,013 64
Smartphone fundoscopy for retinopathy of prematurity
Shan-Jiun Lin, Chung-May Yang, Po-Ting Yeh, Tzyy-Chang Ho
April-June 2014, 4(2):82-85
Purpose: The utility of digital fundus images in retinopathy of prematurity (ROP) screening has been established. A smartphone can be a device available to most ophthalmologists to capture digital fundus photographs. In this study, fundus images were captured with original camera settings for ROP documentation. Methods: The examination was performed under topical anesthesia. An assistant held a glass stick against the eye movement if infants moved their eyes too frequently. A hand-held smartphone and a 30D lens were used to record the fundus in video mode. A continuous flash was turned on to provide almost constant coaxial illumination. Fundus photographs were captured from the video film. Results: Fundus photographs can be captured successfully with a smartphone and a 30D lens under original camera settings. Conclusion: Fundus photographs of acceptable diagnostic quality can be obtained in ROP patients conveniently and inexpensively using a portable hand-held smartphone. It might be a useful tool in documentation, education, consultation, and telemedicine in ROP.
  5 998 69
Recent progress in the diagnosis and treatment of primary vitreoretinal lymphoma
Min Zhou, Gezhi Xu
October-December 2016, 6(4):170-176
DOI:10.1016/j.tjo.2016.05.002  PMID:29018736
Primary vitreoretinal lymphoma (PVRL) was previously termed primary intraocular lymphoma. PVRL is a potentially fatal intraocular malignancy, and 65–90% of PVRL cases eventually involve the central nervous system (CNS). The incidence of PVRL has been rising in both immunocompromised and immuno-competent populations worldwide. PVRL frequently masquerades as chronic uveitis. Advanced auxiliary examinations, such as optical coherence tomography and fundus autofluorescence have been applied in the diagnosis of PVRL. Histology and immunohistochemistry in combination with molecular tests and interleukin-10 analysis have been demonstrated as reliable in diagnosing PVRL. Despite early initiation of treatment, mortality is high with PVRL associated with CNS involvement and relapses are common. The use of systemic chemotherapy has not been proven to prevent CNS involvement; however, local therapies including intravitreal injections of methotrexate and/or rituximab and low-dose radiotherapy to the eye, has shown to be extremely effective in controlling intraocular lymphoma with encouraging results.
  5 1,426 207
The diagnostic challenge of evaluating papilledema in the pediatric patient
Brandon McCafferty, Collin M McClelland, Michael S Lee
January-March 2017, 7(1):15-21
DOI:10.4103/tjo.tjo_17_17  PMID:29018749
Pseudopapilledema is a fairly common finding in ophthalmic practice, and in many cases, the diagnosis is straightforward. However, an accurate diagnosis can challenge the most seasoned clinicians, and missing true papilledema can result in life-threatening or vision-threatening consequences. In this review, we describe the clinical findings and a diagnostic algorithm to distinguish pseudopapilledema and papilledema in the pediatric patients. We also describe the clinical evaluation once a diagnosis of papilledema has been established.
  5 4,956 526
Management of macular edema due to central retinal vein occlusion – The role of aflibercept
William Rhoades, Drew Dickson, Quan Dong Nguyen, Diana V Do
April-June 2017, 7(2):70-76
DOI:10.4103/tjo.tjo_9_17  PMID:29018760
Central retinal vein occlusion (CRVO) can cause vision loss. The pathogenesis of CRVO involves a thrombus formation leading to increased retinal capillary pressure, increased vascular permeability, and possibly retinal neovascularization. Vision loss due to CRVO is commonly caused by macular edema. Multiple treatment modalities have been used to treat macular edema. Currently, the most common therapy used is intravitreal inhibition of vascular endothelial growth factor (VEGF). The three most widely used agents are aflibercept, bevacizumab, and ranibizumab and they are effective at blocking VEGF. In addition, intraocular steroids can be used to treat macular edema. This review will briefly cover the treatment options and discuss in greater detail the efficacy and safety of aflibercept.
  5 1,994 360
Multifocal intraocular lenses: Types, outcomes, complications and how to solve them
Liberdade C Salerno, Mauro C Tiveron, Jorge L Alió
October-December 2017, 7(4):179-184
DOI:10.4103/tjo.tjo_19_17  PMID:29296549
The multifocal intraocular lenses (IOLs) available are often able to restore visual function and allow spectacle independence after their implantation with great levels of patient satisfaction. The factors associated with the postoperatory success include the careful selection of the patient, the knowledge about the IOLs' design, and their visual performance added to the proper surgical technique and management of possible complications as demonstrated by the evidence available.
  5 4,633 823
Amantadine-related corneal edema and endothelial cell loss: Four case reports
Chia Ching Lin, Chieh Yin Cheng, Pei Shin Hu, Chang Ping Lin, Shiuh Liang Hsu
July-September 2014, 4(3):137-140
Amantadine is widely used in treating influenza A, hepatitis, Parkinson’s disease, and fatigue in multiple sclerosis. In the past, only a few case reports have demonstrated that amantadine is associated with corneal edema, endothelial dysfunction, and other corneal comorbidity. We herein present four cases with reversible corneal edema and endothelial loss after taking amantadine, including two cases with delayed presentation of corneal edema after use of amantadine for 18 months and 12 months.
  4 918 46
Bilateral optic neuritis related to chronic inflammatory demyelinating polyneuropathy
Kui-Yueh Lin, I-Hua Wang, Jieh-Ren Jou, Hai-Jui Chu, William Wei, Shwu-Huey Lee, Szu-Yuan Lin
January-March 2015, 5(1):40-43
DOI:10.1016/j.tjo.2014.04.002  PMID:29018664
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that mainly affects the peripheral nervous system; however, the central nervous system has also been involved in rare cases. Herein, we describe the case of a 33-year-old man with CIDP who presented with progressively blurred vision and pain with eye movement in both eyes for 1 month. Ocular examination revealed reduced visual acuities of 0.15 (oculus unitas or OU) and unremarkable fundi (OU). Furthermore, bitemporal visual field defects and prolonged visually evoked potentials were evident. Brain magnetic resonance imaging revealed nothing remarkable along the optic nerve and chiasm. These findings were compatible with the diagnosis of bilateral optic neuritis. The patient’s symptoms and visual acuity improved after 5 days of intravenous (IV) corticosteroid pulse therapy, which was subsequently replaced by oral prednisolone therapy with a tapering schedule. The patient’s visual acuity returned to 1.0 (OU) 6 months after treatment. However, bilateral optic neuritis recurred in 7 months while the patient was on oral pred-nisolone and azathioprine. IV corticosteroid pulse therapy was subsequently reinitiated and the patient’s visual acuity returned gradually to 1.0 (OU). Bilateral optic neuritis is a rare manifestation of CIDP. It responded well to IV corticosteroid therapy in our case.
  4 711 45
Spontaneous suprachoroidal hemorrhage: Case report and review of the literature
Shu-Fang Hsiao, Min-Hsiu Shih, Fu-Chin Huang
January-March 2016, 6(1):36-41
DOI:10.1016/j.tjo.2014.10.008  PMID:29018708
We present the clinical course, management, and final outcome of spontaneous suprachoroidal hemorrhage (SSCH) in an age-related macular degeneration (AMD) patient—a 64-year-old male receiving antiplatelet therapy who developed SSCH during the Valsalva maneuver. In addition to our case study, we discuss the results of a systemic review of the literature and reference lists of retrieved studies published from January 2001 to December 2013. Among a total of 31 patients (32 eyes), acute secondary glaucoma was a complication in 87.5% of the cases, and over half of the cases (20 eyes, 62.5%) received surgery. Twenty cases (64.5%) were characterized by systemic hypertension (HTN), followed by cardiovascular or cerebral vascular disease in 17 cases (54.8%). The Valsalva maneuver was performed in five cases (16.1%) prior to the episode. Twenty-three cases (74.2%) had abnormal hemostasis, including use of anticoagulants or thrombolytic agents (18 cases), chronic renal failure (CRF, 5 cases), and blood dyscrasia (3 cases). AMD was the most common (17 eyes of 16 patients, 53.1%) ocular disease. Visual acuity was classified as hand motion (HM) or worse in 20 eyes (of 28 eyes, 71.4%) at initial presentation and in 24 eyes (of 30 eyes, 80%) upon final examination. Anticoagulated patients with AMD should be informed of the risk of intraocular hemorrhage. Medical therapy usually fails in the treatment of glaucoma. Surgical intervention provides an option for the purpose of pain relief. Even so, the final visual prognosis is usually poor.
  4 823 81
Iris-claw versus posterior chamber fixation intraocular lens implantation in pediatric traumatic cataract☆
V Kavitha, Preethi Balasubramanian, Mallikarjun M Heralgi
April-June 2016, 6(2):69-74
DOI:10.1016/j.tjo.2016.04.001  PMID:29018714
Aim: This study aims to compare visual outcomes and complications of iris-fixated (claw) intraocular lens (IFIOL) implantation with those of posterior chamber intraocular lens (PCIOL) implantation in children with traumatic cataract. Settings and design: Retrospective observational clinical audit. Materials and methods: A total of 50 pediatric traumatic cataract cases that underwent lens removal and IOL implantation (IFIOL or PCIOL) with or without corneal or corneoscleral tear repair between January 2009 and December 2013 were analyzed. After meeting the eligibility criteria, their pre- and postoperative visual outcomes and complication rates were recorded. Data were analyzed descriptively. Results: Out of 50 children, IFIOL and PCIOL implantations were performed in one eye of each of 25 children. Their mean age was 11 ± 4 years (range 4–18 years). Primary (cataract removal with lens implantation) and secondary (corneal tear repair followed by cataract removal with lens implantation) procedures were performed in 19 (76%) and six (24%) children in the IFIOL group and in 21 (84%) and four (16%) children in the PCIOL group, respectively. There was an improvement in best corrected visual acuity postimplantation in both the IFIOL and the PCIOL group, and no significant difference in the logarithm of the minimum angle of resolution of best corrected visual acuity was observed between the two groups over 36 months. Only three eyes in the IFIOL group developed complications: one eye developed secondary glaucoma, one disenclavation of IOL haptic, and one cystoid macular edema. Conclusion: Both IFIOL and PCIOL implantations have good visual outcomes and minimal postoperative complications; therefore, IFIOL can be used as an alternative to PCIOL in children with traumatic cataract with inadequate capsular support.
  4 976 80
Short break-up time type dry eye has potential ocular surface abnormalities
Yoshiyuki Ichihashi, Takeshi Ide, Minako Kaido, Reiko Ishida, Shin Hatou, Kazuo Tsubota
April-June 2015, 5(2):68-71
DOI:10.1016/j.tjo.2015.02.004  PMID:29018670
Purpose: To describe a case series in which corneal fluorescein staining (CFS) development occurred in short break-up time (s-BUT) dry eyes after a short period during prolonged opening of the eye. Methods: The study was designed as a clinical case series. Ocular surface evaluations were performed on 13 individuals with s-BUT dry eye. Tear function examinations included Schirmer’s test and BUT evaluation. Results: In all 13 cases, the BUT was short, but the tear quantity was not so bad. In all cases, CFS developed following a single eye opening, and the staining was observed at sites that showed as dark spots. In several cases, the CFS disappeared later. Conclusion: In this study, we demonstrated that CFS could develop following a single eye opening. Based on our findings, CFS is a dynamic phenomenon rather than a stable indicator of ocular surface abnormalities. Moreover, s-BUT dry eye has the potential to show ocular surface abnormalities.
  4 702 54
Complex genetics of familial exudative vitreoretinopathy and related pediatric retinal detachments
Hiroyuki Kondo
April-June 2015, 5(2):56-62
DOI:10.1016/j.tjo.2015.04.002  PMID:29018668
Familial exudative vitreoretinopathy (FEVR) is a hereditary vitreoretinal disorder that can cause various types of retinal detachments. The abnormalities in eyes with FEVR are caused by poor vascularization in the peripheral retina. The genetics of FEVR is highly heterogeneous, and mutations in the genes for Wnt signaling and a transcription factor have been reported to be responsible for FEVR. These factors have been shown to be the regulators of the pathophysiological pathways of retinal vascular development. Studies conducted to identify the causative genes of FEVR have uncovered a diverse and complex relationship between FEVR and other diseases; for example, Norrie disease, a Mendelian-inherited disease; retinopathy of prematurity, a multifactorial genetic disease; and Coats disease, a nongenetic disease, associated with pediatric retinal detachments.
  4 872 106
Current concepts and cutting-edge techniques in myopic macular surgeries
Yasushi Ikuno
October-December 2014, 4(4):147-151
Myopic foveoschisis and macular hole with a retinal detachment are two major diseases associated with posterior staphyloma that are specific to high myopia. The pathogenesis is a combination of various types of traction from the vitreous cortex, epiretinal membrane (ERM), internal limiting membrane (ILM), and microvessels. Foveoschisis typically starts with retinoschisis, and a retinal detachment subsequently develops as a result of traction on the inner retina. The stress on the fovea eventually opens a small hole and leads to retinal detachment from a macular hole; thus, both are closely related. These two pathologies can be treated with vitrectomy. A foveal detachment is the best indication for surgery because of the greatest visual improvement. The routine surgical procedures are vitreous cortex removal with triamcinolone acetonide, ERM peeling, ILM peeling stained with Brilliant Blue G, and gas tamponade. The necessity for ILM peeling and gas tamponade for myopic foveoschisis remains controversial. A postoperative macular hole is a severe complication in foveoschisis, and a photoreceptor inner/outer segment defect seen on optical coherence tomography images obtained preoperatively is a risk factor for macular hole. A foveal nonpeeling can be considered to avoid foveal trauma. The inverted ILM peeling technique is a new option to enhance macular hole closure. Both techniques seem to enhance retinal restoration; however, the visual benefit has not been confirmed. A long-shaft forceps facilitates precise maneuvers. Vitrectomy for highly myopic macular diseases remains challenging; however, an understanding of the pathogeneses and innovations in vitreous surgical instruments and techniques will facilitate safer surgeries.
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* Source: CrossRef