Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 7 Articles
Background: The exact pathogenetic mechanisms of Coats� disease remain unknown. In this report, we show two\ncases of Coats� disease that achieved a favorable prognosis with the combined treatment of intravitreal\nbevacizumab (IVB) injection prior to photocoagulation, although both initially resisted photocoagulation therapy.\nCase presentations: Case 1 was a 15-year-old boy with initial visual acuity of 0.4 OD. At the temporal retina,\naneurysms and abnormal telangiectatic vessels were observed. Hard exudates and an exudative retinal detachment\nextended to the fovea. He was diagnosed as having Coats� disease at stage 3A and we performed laser\nphotocoagulation as an initial approach to treat peripheral aneurysms and telangiectatic vessels. After the\ntreatment, the exudative retinal detachment was eased and visual acuity improved to 1.0; however, recurrence\noccurred after 5 months. The exudative change was resistant against laser photocoagulation therapy and we\ntherefore added IVB as an adjuvant before photocoagulation. Fourteen days after IVB injection phased laser\nphotocoagulation was given to cover the abnormal capillaries, aneurysms and the leakage area spotted in FA.\nA good prognosis was obtained with decreased exudation and improved visual acuity.\nCase 2 was an 11-year-old boy with decreased visual acuity of 0.15 OS at the initial visit. Hard exudates, retinal\nedema and serous retinal detachment were seen at the macula and peripheral retina. Fluorescein angiography\nrevealed telangiectatic capillaries at the temporal retina. Our diagnosis was Coats� disease at stage 3A. Extensive\nphotocoagulation was performed as an initial treatment to the lesion. However, the exudative change was\nsevere and resistant against the photocoagulation treatment. Therefore, we added IVB as an adjuvant before\nphotocoagulation. Exudative change in the retina seemed to be eased 7 days after IVB injection, therefore, phased\nlaser phototherapy was added to cover the abnormal capillaries. After the combination therapy, exudative change\nwas remarkably ameliorated and better visual acuity was achieved.\nConclusion: Bevacizumab is considered an effective adjuvant for Coats� disease with exudative change resistant to\nretinal photocoagulation therapy....
Background: To report the optical coherence tomographic (OCT) findings in 4 eyes before and after a\nspontaneous resolution of a myopic traction maculopathy (MTM).\nMethod: Retrospective review of medical records including history, examination findings, fundus details, and\nfinding of spectral-domain OCT (Cirrus HD-OCT, Carl Zeiss Meditec, Spectralis, Heidelberg Engineering, Heidelberg)\nfindings in 4 eyes with a spontaneous resolution of MTM.\nResults: A release of the vitreofoveal traction was detected by OCT in 3 eyes before the resolution of the MTM. A\nvitreofoveal separation in one eye and an increase in the length of a vitreous strand from the macula in two eyes\nindicated a reduction in the traction. In 2 eyes, an internal limiting membrane (ILM) detachment was seen by OCT\nas a membrane above the wrinkled inner retina at the perifoveal lesion, and a flattening of the ILM and inner retina\nwas detected after the resolution. The detached ILM was shifted centrifugally on the macula and disappeared with\nthe flattening of the adjacent retina which suggests that the release of tangential traction was caused by the\ndehiscence of ILM possibly at the proximal edges of the ILM detachment.\nConclusion: Releasing a vitreofoveal traction and flattening of the detached ILM may be signs of spontaneous\nresolution of a MTM. Vitrectomy is not required when these signs are detected....
Background: Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or\nreduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to\ndetermine whether education and support was beneficial and cost-effective in improving adherence with glaucoma\ntherapy.\nMethods: A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted.\nPatients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached.\nParticipants were randomised into two groups and adherence was measured over 8 months, using an electronic\nmonitoring device (Travalert�® dosing aid, TDA). The control group received standard clinical care, and the intervention\ngroup received a novel glaucoma education and motivational support package using behaviour change counselling.\nCost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence.\nResults: Two hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in\nmean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8%\n(CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage\nintraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the\nintervention group (p = 0.45). Participants in the intervention group were more satisfied with information about\nglaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51\n(CI, 7.72, 9.30). The mean intervention cost per patient was GB�£10.35 (less than US$16) and not cost-effective.\nConclusions: Adherence with travoprost was high and not further increased by the intervention. Nevertheless, the\nstudy demonstrated that provision of information, tailored to the individual, was inexpensive and able to achieve high\npatient satisfaction with respect to information about glaucoma medication. Measurement of adherence remains\nproblematic since awareness of study participation may cause a change in participant behaviour....
Background: Few reports have described the ophthalmic complications that occur after maxillary orthognathic\nsurgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe\n2 cases of loss of reflex tearing after maxillary orthognathic surgery.\nCase presentation: Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and\nirritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing\nin 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients.\nConclusions: The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured\nduring Le Fort osteotomy....
Background: Many efforts have been invested in slowing progression of myopia. Among the methods, atropine\nadministration and orthokeratology (OK) are most widely used. This study analyzed the efficacy of atropine and OK\nlens in controlling myopia progression and elongation of axial length.\nMethods: This retrospective study included 105 patients (210 eyes) who wore OK lenses and 105 patients (210 eyes)\nwho applied 0.125% atropine every night during the 3 following period. Student t-test, linear regression analysis,\nrepeated measure ANOVA, and Pearsonâ��s correlation coefficient were used for statistical analysis.\nResults: The change in axial length per year was 0.28 �± 0.08 mm, 0.30 �± 0.09 mm, and 0.27 �± 0.10 mm in the OK lens\ngroup, and 0.38 �± 0.09 mm, 0.37 �± 0.12 mm, and 0.36 �± 0.08 mm in the atropine group for years 1, 2, and 3,\nrespectively. Linear regression analysis revealed an increase in myopia of 0.28 D and 0.34 D per year, and an increase in\naxial length of 0.28 mm and 0.37 mm per year in the OK lens and atropine groups, respectively. Repeated measure\nANOVA showed significant differences in myopia (p = 0.001) and axial length (p < 0.001) between the atropine and OK\nlens groups; in astigmatism, there was no significant difference in these parameters (p = 0.320). Comparison of\nincreases in axial length in relation to baseline myopia showed significant correlations both in the OK lens group\n(Pearsonâ��s correlation coefficient, r = 0.259; p < 0.001) and atropine group (r = 0.169; p = 0.014). High myopia patients\nbenefited more from both OK lenses and atropine than did low myopia patients. The correlation of baseline myopia\nand myopia progression was stronger in the OK lens group then in the atropine group.\nConclusions: OK lens is a useful method for controlling myopia progression even in high myopia patients....
Background: The baseline data pertaining to the national epidemiological survey of infectious keratitis remain\nscarce in China, and currently there is no corneal blindness control strategy developed by the nation.\nMethods: Geographically defined cluster sampling was used to randomly select a cross-section of residents from\nrepresentative urban and rural populations in Hubei Province. Participants were selected from village registers,\nfollowed by door-to-door household visits. The assessment items included a structured interview, visual acuity\ntesting, external eye examination, and anterior segment examination using slit lamp. Causes and sequelae of\ncorneal disease were identified according to uniform customized protocol.\nResults: The prevalence of presenting corneal diseases was 0.8% (211/26 305), while the prevalence of infectious\nkeratitis was 0.148% (39/26 305). The prevalences of viral, bacterial, and fungal keratitis were 0.065, 0.068, and\n0.015%, respectively. There were no significant differences found between the prevalences of viral (accounting for\n43.6%) and bacterial (accounting for 46.2%) corneal ulcers. cases of Acanthamoeba keratitis were not found.\nInfectious keratitis was the leading cause of corneal blindness (85.7%), and the prevalence of blindness in at least\none eye resulting from infected corneas was 0.091% (95% CI: 0.067-0.127%).\nConclusions: Viral and bacterial mechanisms constitute the most important risk factors for infectious corneal ulcers\nin Central China. To reduce the rate and severity of infectious keratitis, he public health care policy should be\nfocused on designing cost-effective strategies and operational programs for the prevention and prompt treatment\nof infectious corneal ulcers....
Background: The aim of this study was to compare the efficacy and tolerability of trabeculectomies performed\nwith and without releasable sutures in the treatment of patients with uncontrolled glaucoma.\nMethods: A comprehensive literature meta-analysis was performed, comparing trabeculectomies performed with and\nwithout releasable sutures. The primary efficacy measure was the weighted mean difference (WMD) in percentage\nintraocular pressure reduction (IOPR%) at the follow-up end point. The secondary efficacy measure was the risk\nratio (RR) for complete and qualified success rates of trabeculectomy at the follow-up end point. Trabeculectomy\ntolerability estimates were measured by the RR for adverse events. All the outcomes were reported with a 95%\nconfidence interval (CI).\nResults: The WMD of the IOPR% from baseline was -4.56 (range -9.24ââ?¬â??0.12) when trabeculectomies without\nreleasable sutures were compared with trabeculectomies with releasable sutures. Trabeculectomies with releasable\nsutures were associated with numerically greater, but nonsignificant, efficacy in terms of lowered IOP compared with\ntrabeculectomies without releasable sutures. The complete and qualified success rate of the two surgical procedures\nwere comparable, with RRs of 0.92 (range 0.80ââ?¬â??1.04) and 0.99 (range 0.89ââ?¬â??1.11), respectively, at the follow-up endpoints.\nTrabeculectomies without releasable sutures were associated with a significantly higher frequency of hypotony and flat\nanterior chambers than trabeculectomies with releasable sutures, with pooled RRs of 4.04 (range 1.88ââ?¬â??8.68) and 2.57\n(range 1.25ââ?¬â??5.30), respectively.\nConclusion: Although the two surgical procedures resulted in equivalent efficacy in IOP control, the trabeculectomies\nperformed with releasable sutures were better tolerated than those without releasable sutures....
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