Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 9 Articles
Riboflavin/UVA cross-linking is a technique introduced in the past decades for the treatment of keratoconus, keratectasia, and\ninfectious keratitis. Its efficacy and safety have been investigatedwith clinical and laboratory studies since its first clinical application\nby Wollensak for the treatment of keratoconus. Although its complications are encountered during clinical practice, such as\ninfection inducing risk, minimal invasion merits a further investigation on its future application in clinical practice. Recently,\ncollagen cross-linking in sclera shows a promising prospect. In present study, we summarized the representative studies describing\nthe clinical and laboratory application of collagen cross-linking published in past decades and provided our opinion on the positive\nand negative results of cross-linking in the treatment of ophthalmic disorders....
Purpose. To report a case of acute hydrops in a 10-year-old child with advanced keratoconus. Case Presentation. A ten-year-old boy\ndiagnosed as having right eye (RE) infectious keratitis, not responding to antimicrobial therapy, was referred to our hospital.The\ndiagnosis of infectious keratitis was established onemonth prior to his presentation following an episode of acute cornealwhitening,\npain, and drop in visual acuity. Topical fortified antibiotics followed by topical antiviral therapy were used with no improvement.\nSlit lamp examination showed significant corneal protrusion with edema surrounding a rupture inDescemet�s membrane in the RE.\nThe diagnosis of acute corneal hydrops from advanced keratoconus was highly suspected and confirmed with corneal topography.\nConclusion. Although a relatively rare disease at the age of 10 years, keratoconus can be rapidly progressive in the pediatric group.\nKeratoconus should always be considered in the differential diagnosis of progressive vision loss in this age group....
Objective. Compare glaucoma medication costs between the United States (USA) and Canada. Methods. We modelled glaucoma\nbrand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously\nreported bottle overfill rates, drops per mL, and wastage adjustment.We also calculated real wholesale price changes from 2006 to\n2013 based on theAverageWholesale Price (USA) and theOntarioDrug Benefit Price (Canada). Results.US brand name medication\ncosts were on average 4x more than Canadian medication costs (range: 1.9xââ?¬â??6.9x), averaging a cost difference of $859 annually. US\ngeneric costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from\n2006 to 2013 more than Canadian prices (US range: 29%ââ?¬â??349%; Canadian range: 9%ââ?¬â??16%). US generic wholesale prices increased\nmodestly (US range: ?23%ââ?¬â??58%), and Canadian wholesale prices decreased (Canadian range: ?38%ââ?¬â??0%). Conclusions. US brand\nnameglaucomamedications aremore expensive thanCanadian medications, though generic costs are similar (with somevariation).\nThe real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest,\nwith real prices actually decreasing in Canada....
Purpose.The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with\ncanalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has\nbeen studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal\ndacryocystorhinostomy (EE-DCR) combined with a modified canalicular repair. Postoperative observations included slit lamp,\nfluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6ââ?¬â??18 months\nof postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and\noccasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and\nnormal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial\nand the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them\nhad a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12), and\nanatomical success rate is 75% (9/12). Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient\nmethod for the management of dacryocystitis with canalicular obstruction....
Purpose. This study examined the association between the severity of visual field defects and the prevalence of motor vehicle\ncollisions (MVCs) in subjects with primary open-angle glaucoma (POAG). Methods. This is a cross-sectional study. Japanese\npatients who have had driver�s licence between 40 and 85 years of age were screened for eligibility. Participants answered a\nquestionnaire about MVCs experienced during the previous 5 years. Subjects with POAG were classified as having mild,moderate,\nor severe visual field defect. We evaluated associations between the severity of POAG and the prevalence of MVCs by logistic\nregression models. Results.The prevalence of MVCs was significantly associated with the severity of POAG categorized by worse\neye MD (control: 30/187 = 16.0%; mild POAG: 17/92 = 18.5%; moderate POAG: 14/60 = 23.3%; severe POAG: 14/47 = 29.8%;\n???? = 0.025, Cochran-Armitage trend test). Compared to the control group, the adjusted OR for MVC prevalence in subjects with\nmild, moderate, or severe POAG in the worse eye was 1.07 (95% CI: 0.55 to 2.10), 1.44 (95% CI: 0.68 to 3.08), and 2.28 (95% CI: 1.07\nto 4.88). Conclusions.There is a significant association between the severity of glaucoma in the worse eye MD and the prevalence\nof MVCs....
We report the good outcome of combined intravitreal aflibercept injection and photodynamic treatment in a case with fundus\nflavimaculatus (FFM) and unilateral subretinal neovascularmembrane (SRNM).A57-year-oldmanwithFFMand unilateral SRNM\nwho was treated with two consecutive ranibizumab injections with no improvement at another institution was referred to us. He\nwas treated successfully with three aflibercept injections three months apart and a single photodynamic treatment performed a\nweek after the initial aflibercept injection. Six weeks after the last aflibercept injection visual acuity was improved and submacular\nexudation exhibited dramatic resolution with a moderate degree of residual scarring. SRNM formation is rarely observed in eyes\nwith FFM and a satisfactory outcome can be achieved with a proper treatment....
Purpose. To describe a case of 3 refractive procedures performed in one eye over 2 decades. Methods. Case report. Results. A 41-\nyear-old patient presented for refractive surgery evaluation. His ocular history includes bilateral radial keratotomy performed 21\nyears ago for moderate myopia: spherical equivalence of ?4.25D bilaterally. Postoperative uncorrected visual acuity (UCVA) was\n20/30; however, over time he developed a hyperopic shift and UCVA decreased to 20/40 in the right eye.Thus, laser-assisted in situ\nkeratomileusis (LASIK) was performed at an outside institution 6.5 years later, and the patient had initial improvement of UCVA to\n20/25. Due to a change in refractive error, the patient underwent uneventful astigmatic keratotomy 13 years after LASIK in the right\neye, and 1.5 years after surgery best-corrected visual acuity was 20/25 with manifest refraction of ?1.00 + 5.50 Ã?â?? 134?. Conclusion.\nWe report the outcomes and natural refractive progression in a patient who underwent three corneal refractive procedures over\ntwo decades. This case underlines the difficulties of long-term management of post-RK hyperopia and astigmatism...
Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal\ncollagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and\natopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and\ncyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum\nantimicrobic therapy. Results.The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic\ntherapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures\nwas unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in\nhalting keratoconus� progression. However, this procedure is not devoid of infectious complications, due to known risk factors\nand/or poor patients� hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with\nkeratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity\nwith atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days\nafter surgery and the imposition of strict personal hygiene rules are strongly recommended....
Purpose. To evaluate the outcome of anterior lamellar reposition (ALR) in treating trachomatous trichiasis. Methods. Patients with\ntrachomatous trichiasis or entropion with short tarsus were treated by ALR between February 2009 and November 2013. This\nincluded splitting of the lid margin behind the aberrant lash line to separate the lid lamellae. The anterior lamella was recessed\nand fixated using 4/0 silk sutures. The extra lashes and their routes were excised. Sutures were removed by the 3rd week and\npatients completed 6 months of follow-up. Recurrence of ?5 lashes was treated by electrolysis. Results. The study included 752\neyelids (445 patients; 58.4% females, 41.6% males), mean age 53.2 Ã?± 6.9 y. 179 (25.1%) lids had entropion while 287 (64.5%) patients\nhad corneal affection. By the third week, 2.66% lid had trichiasis while 30.8% had no rubbing lashes. By the 6th month, 14.9% of lids\nshowed recurrence while 66.1% were completely cured (CI = 0.63ââ?¬â??0.69) and 19% had partial success (CI = 0.16ââ?¬â??0.21). Abnormal\nlid appearance persisted in 2.66% and 12.9% required another surgery. Conclusion. ALR is a good option for treating trachomatous\ntrichiasis especially without cicatricial entropion. Excision of dysplastic lashes is thought to augment the surgical outcome....
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