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   2016| April-June  | Volume 6 | Issue 2  
    Online since May 14, 2016

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Needle decompression in a patient with vision-threatening orbital emphysema
Che-Yu Lin, Chieh-Chih Tsai, Shu-Ching Kao, Hui-Chuan Kau, Fenq-Lih Lee
April-June 2016, 6(2):93-95
DOI:10.1016/j.tjo.2015.02.003  PMID:29018719
Orbital emphysema is a condition resulting from trapping of air in loose subcutaneous or orbital tissues from the paranasal sinuses. This condition commonly seen in patients with a history of periorbital trauma or surgery, especially following sneezing or nose blowing. It usually has a benign and self-limited course. However, the entrapped orbital air can cause a substantial increase in pressure with restricted ocular motility or vascular compromise and become severe enough to cause visual impairment. We herein present the case of a patient who developed severe orbital emphysema after blunt trauma followed by sneezing and was successfully treated with needle decompression of intraorbital air. Emergency needle decompression resulted in an improvement in vision and intraocular pressure.
  1,180 76 3
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.
  1,035 155 7
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.
  1,031 83 4
Eradicating trachoma: The experience in Taiwan
David Hui-Kang Ma
April-June 2016, 6(2):53-54
DOI:10.1016/j.tjo.2016.04.005  PMID:29018711
  941 57 -
Retinoblastoma in Mongolia: Clinical characteristics and survival from 1987 to 2014
Tsengelmaa Chuluunbat, Baasankhuu Jamiyanjav, Baylag Munkhuu, Uranchimeg Bazarsad, Altankhuu Molom, Ling-Yuh Kao, Wei-Chi Wu
April-June 2016, 6(2):79-84
DOI:10.1016/j.tjo.2016.04.004  PMID:29018716
Background/Purpose: This study aims to describe the clinical characteristics and treatment outcome of retinoblastoma in Mongolian children. Methods: Data of all children diagnosed with retinoblastoma at the National Center for Maternal and Child Health of Mongolia from 1987 to January 2014 were reviewed retrospectively. The ICRB classification was used. Survival characteristics of the cohort were analyzed. Results: Retinoblastoma was diagnosed in 79 eyes of 64 cases during the study period. Median age of diagnosis was 24.5 ± 15.8 months. There were no differences in sex ratio, and 15 cases (23%) were bilateral. Forty-three (67%) patients were from rural areas. The more frequent clinical presentations were leukocoria in 50 (78%) patients, strabismus in 24 (38%) patients, and glaucoma in 21 (33%) patients. Sixty-one (95%) patients were diagnosed with Classification D or worse when presented to us. Due to late diagnosis in the majority of cases, unilateral and bilateral enucleations were performed in 48 (61%) eyes and 24 (30%) eyes, respectively; exenteration was done in three (4%) eyes. Fifty-two (81%) patients received chemotherapy and 13 (8.3%) patients underwent external beam radiation after enucleation. At the time of last follow-up, 52 (81%) patients were alive, five (8%) patients were dead, and seven (11%) patients had lost to follow-up or unknown vital status. The mean follow-up period was 121.5 months (range, 12–360 months). In five cases with immunohistochemistry analysis in the eye specimen, neuron-specific enolase-, Ki-67 protein-, and B-cell lymphoma 2-positive cells were found in all five (100%) cases and Rb protein was detected in three (60%) cases. Conclusion: Retinoblastoma in Mongolia is frequently diagnosed at late stages and has a poor outcome. These data show the importance of early pediatric eye examinations and better treatment of retino-blastoma in children younger than 3 years in Mongolia.
  808 67 -
Ipsilateral rotational autokeratoplasty for central corneal scar: An alternative to penetrating keratoplasty
Wei-Shan Tsao, Yuan-Chieh Lee
April-June 2016, 6(2):89-92
DOI:10.1016/j.tjo.2015.07.007  PMID:29018718
A 49-year-old woman was referred to our clinic for penetrating keratoplasty. A central corneal scar involving the visual axis with high irregular astigmatism up to 15.8 D was noted. Because the scar was located mostly in the central cornea, ipsilateral rotational autokeratoplasty was suggested and performed. An 8.5-mm punch was used to trephine the cornea eccentrically and superiorly intentionally. The trephined corneal button was then rotated 150° to relocate the scar to the temporal upper part of the cornea. The graft was soon clear with a normal curvature centrally. The astigmatism was −0.5 D, the visual acuity was 20/40, and the endothelial cell loss was 2.66% 2 years after the operation. A rotational autograft carries no risk of immunological complications such as rejection associated with allografts and has lower endothelial cell loss rate. It can be an effective alternative to standard penetrating keratoplasty for some patients with central corneal scars.
  813 61 -
Clinical characters and treatments of retinal vasoproliferative tumors
Yi-Ming Huang, Shih-Jen Chen
April-June 2016, 6(2):85-88
DOI:10.1016/j.tjo.2016.04.003  PMID:29018717
Retinal vasoproliferative tumors (VPT) are uncommon benign vascular tumors. They mostly occur in healthy patients, but may be associated with other chorioretinal diseases. Here we report four patients with VPT at a referral center from 2006 to 2015. Three patients denied any past history and one had a history of retinal detachment surgery. VPT-related complications included epiretinal membrane (ERM) (n = 2), cystoids macular edema (n = 1), and lamellar hole combined with dense cataract, rigid anterior capsule and vitreous opacity (n = 1). Treatments for VPT and comorbidities included vitrectomy (VT) and membrane peeling with tumor resection (n = 2), a combined treatment of photodynamic therapy (PDT) and intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) (n = 2). Tumor shrinkage was achieved in both patients treated with PDT and IVI of anti-VEGF injection. The other two patients with ERM were successfully treated with VT and tumor resection. Visual acuity improved at least two lines in three patients, and one patient had decreased vision due to cataract formation after VT. Pathology of the resected tumor in one case revealed massive gliosis with positive stain of vascular endothelial cells and glial fibrillary acidic protein stain. Yet the peeled membrane was acellular. Possible beneficial treatments for VPT and comorbidities include PDT combined with IVI of anti-VEGF, or VT and membrane peeling with tumor resection.
  756 81 -
Trachoma in Asia—A disappearing scourge
Hugh R Taylor
April-June 2016, 6(2):55-57
DOI:10.1016/j.tjo.2016.04.002  PMID:29018712
Trachoma is an ancient blinding eye disease. With improvements in hygiene and living conditions and development of targeted strategies by the World Health Organization, trachoma is being progressively eliminated. Great progress is being seen in Asian countries, many of which are becoming trachoma free.
  727 64 -
Methicillin-resistant Staphylococcus aureus buckle infection complicated by endophthalmitis and presumed choroidal abscess in a patient with ulcerative colitis
Kuan-I Wu, Kwan-Rong Liu, Hsiang-Wen Chien
April-June 2016, 6(2):98-100
DOI:10.1016/j.tjo.2015.07.002  PMID:29018721
This patient presented with excessive pain, lid swelling, erythema, heat and limitations of extraocular movement (OD) nine days after a scleral buckle (SB) and pneumopexy surgery. Complicated buckle infection with endophthalmitis was impressed. Bacterial culture yielded methicillin-resistant Staphylo-coccus aureus. A choroidal abscess was identified 1 week after the episode. Complete visual recovery from hand motion to 20/30 (OD) was achieved with buckle removal, subconjunctival and intravitreal antibiotics. Endophthalmitis and choroidal abscess formation after SB surgery is extremely rare. Host factors including ulcerative colitis may play a role in causing the severe buckle infection of this patient.
  711 56 1
Deep vein thrombosis due to continuous prone positioning after retinal detachment surgery
Chih-Ping Wang, Evelyn Jou-Chen Huang, Chien-Neng Kuo, Chien-Hsiung Lai
April-June 2016, 6(2):96-97
DOI:10.1016/j.tjo.2015.05.002  PMID:29018720
In March 2014, a 56-year-old woman without previous underlying disease underwent encircling scleral buckling, 20-gauge pars plana vitrectomy, cryotherapy around a retinal tear, and gas-fluid exchange with 15% perfluoropropane flush for upper rhegmatogenous retinal detachment of the left eye. However, she developed progressive left leg swelling, pain, warmth, and redness, associated with difficulty in elevating her left leg after continuously maintaining a prone head position when either lying down or sitting for 2 days. When she arrived at the emergency room, she had an elevated D-dimer level. After undergoing Doppler ultrasound imaging, she was diagnosed as having deep vein thrombosis of the left leg. She received anticoagulation therapy with enoxaparin and warfarin overlapping for 7 days. The edema, pain, and paresthesia of her left leg were relieved. However, because of the risk of bleeding with anti-coagulation drug usage, the patient needed to be monitored for 6 months. Prone positioning for gas tamponade is important for anatomic and functional success in retinal detachment surgery; however, timely walking and rest between periods of continuous prone positioning should be encouraged to prevent deep vein thrombosis and other impaired circulation-related complications.
  692 46 2
Reducing intraocular-pressure spike after intravitreal-bevacizumab injection with ocular decompression using a sterile cotton swab soaked in proparacaine 0.5%: A quasi-experimental study
Naveed A Qureshi, Hassan Mansoor, Sabihuddin Ahmad, Sarah Zafar, Muhammad Asif
April-June 2016, 6(2):75-78
DOI:10.1016/j.tjo.2015.12.003  PMID:29018715
Background/Purpose: The study was conducted to determine the effect of preinjection ocular decompression by a cotton swab soaked in local anesthetic on the immediate postinjection rise in intraocular pressure (IOP) after intravitreal bevacizumab (IVB). Methods: A nonrandomized, quasi-experimental interventional study was conducted at Al-Shifa Trust Eye Hospital, Pakistan, from August 1, 2013 to July 31, 2014. One hundred (n = 100) patients receiving 0.05-mL IVB injection for the first time were assigned to two preinjection anesthetic methods: one with ocular decompression using a sterile cotton swab soaked in proparacaine 0.5%, and the other without ocular decompression using proparacaine 0.5% eyedrops. The IOP was recorded in the eye receiving IVB at three time intervals: Time 1 (preinjection), Time 2 (immediately after injection), and Time 3 (30 minutes after injection). Results: There was a significant difference in the mean IOP change (between Time 1 and Time 2) for the group injected with ocular decompression [M = 1.00, standard deviation (SD) = 1.47] and the group injected without ocular decompression (M = 5.00, SD = 2.38; t (68) = 9.761, p < 0.001). There was also a significant difference in the mean IOP change (between Time 1 and Time 3) for the group injected with ocular decompression (M = 0.428, SD = 1.58) and the group injected without ocular decompression (M = 4.318, SD = 3.34; t (58) = 7.111, p < 0.001). Conclusion: Patients receiving IVB injections with ocular-decompression soaking in proparacaine 0.5% experience significantly lower postinjection IOP spike, and that too for a considerably shorter duration as compared to those receiving IVB without ocular decompression.
  697 40 1