Current Issue : April - June Volume : 2020 Issue Number : 2 Articles : 8 Articles
Background: To report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer\nanterior segment manipulations in eyes lacking sufficient capsular support.\nMethods: Eyes from 14 patients who underwent 27-gauge needle-guided intrascleral IOL fixation with built-in 8â??0\nabsorbable sutures were studied. The 8-0 absorbable sutures were inserted into 27-gauge round needles and used\nto create sclerotomies at the 4 oâ??clock and 10 oâ??clock positions under the scleral flap. The sutures were used to tie\nknots at the end of each haptic and guide haptic externalization through the sclerotomy. After externalization, a\nsufficient flange was created at the end of each haptic and fixed under the scleral flaps. The best corrected visual\nacuity (BCVA), corneal endothelial cell density (ECD), IOL tilt and decentration, previous surgery history, and\ncomplications were determined.\nResults: Fourteen cases were analyzed. The majority of eyes exhibited an improvement in the BCVA after surgery.\nWhen comparing the last follow-up to preoperative visual acuity, the mean change in BCVA was + 26.32 letters\n(p = 0.011). Postoperative complications included postoperative hypotony in 3 eyes, ocular hypertension in 2 eyes.\nNo cases of postoperative cystoid macular edema (CME), vitreous hemorrhage (VH), IOL dislocation, or\nendophthalmitis were observed.\nConclusions: The 27-gauge needle-guided intrascleral IOL fixation technique with built-in 8â??0 absorbable sutures is\neasy to perform with fewer anterior chamber manipulations and achieves both anatomical and optical stability....
Background: Anterior high-resolution optical coherence tomography (HR-OCT) is a novel non-invasive in vivo\nimaging modality that can assist in the diagnosis and management of various ophthalmic pathologies. The\nimplementation of diagnosing ocular surface lesions has been explored in previous studies, successfully revealing\nspecific signs in some ocular lesions. This case report aims to exhibit a case of corneal squamous hyperplasia\ndiagnosed via anterior HR-OCT, prior to surgical intervention.\nCase presentation: A 69 year-old male had blurred vision and foreign body sensation OD for several weeks. A\nrapidly-grown corneal mass was presented, showing an appearance of a grayish flesh-colored mass with elastic\ntexture. Large vessels supplying the mass were also found. Anterior HR-OCT was performed, and the results\nsuggested the lesion be benign hyperplasia. Superficial keratectomy was done, and the pathologic report showed\nmild-appearing epithelial squamous hyperplasia, which confirmed the analysis via anterior HR-OCT.\nConclusion: In the categorization by Nanji, et al. of corneal surface diseases using anterior OCT, the comparative\nepithelial thickness (normal range: 47-68 microm); inferior border obscuration of epithelium (normal or benign inferior\nborder: no shadowing); reflectivity of epithelial layer (normal: not hyper-reflective); abrupt transition (normal: no\nhorizontally abrupt transition); and sub-epithelium analysis vary between benign and malignant lesions (normal:\ndemarcated anterior to Bowmanâ??s layer), and the differences are systemically sorted. We applied all these\ncharacteristics to our patient as guidance, and the measurement results indicated the lesion be a benign lesion,\nwhich is consistent with the tissue pathology. Anterior HR-OCT is overall a non-invasive and timely method capable\nof assisting the diagnosis of ocular surface disease, predicting the qualities of a lesion, and determining the followup\ntreatment plan....
Objective : To describe the dissection protocol for the pig head to obtain the\norbital tissue, as well as a simple setup for ophthalmic surgical wetlabs.\nMethods and Analysis : A descriptive study. The pig head dissection was\nperformed at the abattoir for convenience. The orbital tissue thus obtained\nwas used to set up the wetlab workstation. Results : A cost-effective, low\ntechnology, affordable set-up for ophthalmic surgical wetlab protocol was\ndeveloped. High resolution photographs of the procedure were taken and\nwere presented for ease of description. The dissection protocol was test-run at\nan ophthalmic surgical training workshop. Conclusions : The porcine orbit\nand the wetlab setup were available and affordable. The dissection in the abattoir\nis easy and reproducible. The orbit was used instead of the enucleated\nglobe and this ensures stability throughout surgical practice sessions....
Background: To evaluate 5-year outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy and\ncombination therapy of anti-VEGF agents and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy\n(PCV) in a real-world Chinese population.\nMethods: Retrospective study. Fifty-three eyes of 46 patients with subtype 1 and 2 PCV followed up for at least 60\nmonths were grouped into three regimens: anti-VEGF monotherapy, PDT combining with anti-VEGF therapy initially,\nand PDT combining with deferred anti-VEGF therapy. Main outcome measure was best-corrected visual acuity\n(BCVA) using logarithm of minimal angle of resolution (logMAR).\nResults: The mean BCVA of eyes with subtype 1 PCV (n = 28) deteriorated from 0.69 logMAR at baseline to 1.25\nlogMAR at months 60 (P = 0.001), while the mean BCVA of eyes with subtype 2 PCV (n = 25) sustained stable from\n0.62 logMAR at baseline to 0.57 at months 60 (P = 0.654). No significant differences of visual outcomes were found\nbetween the 3 treatment regimens for subtype 1 PCV. Anti-VEGF monotherapy and initial combination treatment\nhad better visual outcomes in eyes with subtype 2 PCV than deferred combination group during part of follow-up\nsignificantly. Initial combination group needed a less number of PDT than deferred combination group (P < 0.001).\nConclusions: Compared with subtype 1 PCV, subtype 2 PCV has a more favorable visual outcome in real world. All\nthe regimens presented unfavorable visual outcomes for subtype 1 PCV. Anti-VEGF monotherapy and initial\ncombination therapy should be superior to deferred combination therapy in the long-term management of\nsubtype 2 PCV. Prospective randomized studies of larger size are needed to determine the long-term efficacy and\nsafety of various treatment for PCV in real world....
Background: To evaluate the efficacy of micro-incision vitrectomy surgery (MIVS) using Lumera and Resight noncontact\nsutureless wide-angle viewing systems (WAVS) for primary rhegmatogenous retinal detachment (RRD), and\nto analyze the anatomical and visual outcomes.\nMethods: The retrospective, non-comparative, interventional case series reported here was conducted from June\n2014 through November 2016. Enrolled patients presented with primary RRD and received MIVS with/without\ncryopexy by one surgeon using the Lumera and Resight non-contact sutureless WAVS. All patients were followedup\nfor a minimum of 12 months. Variables collected included patient demographics, best-corrected visual acuity,\nand macular status. The number and position of retinal break(s), and the use of cryopexy, were also recorded.\nOutcome measures included operative time, single-operation anatomical success rate, final anatomical success rate,\nrecurrent rate, postoperative best-corrected visual acuity, and surgical complications. The end points were operative\ntime, anatomical outcome, and functional outcome.\nResults: In total, 110 eyes from 110 patients (68 men and 42 women) were treated. Of these, 103 (93%) eyes were\nreattached after primary vitrectomy. One hundred ten eyes (100%) reached final anatomical success. The mean\noperative time was 50.55 min. Multivariate analyses were performed with best model selection principle based on\ngeneral linear model by Akaike Information Criteria for detecting possible factors related to operation time, and\nwith multivariate logistic regression analysis for revealing probable clinical parameters which might influence the\nanatomical outcome after first operation and final visual outcome. Intraoperative cryopexy and multiple breaks\nincreased operative time significantly. More favorable BCVA was significantly correlated with shorter operation time\nand the preoperative macula-on status. Multivariate logistic regression on the group of patients who have received\nthe cataract surgery revealed that the pre-operative BCVA is a significant factor which can predict the visual outcome\nafter MIVS.\nConclusions: The outcome of primary RRD repaired by MIVS using the Lumera and Resight sutureless WAVS was not\ninferior to any other published method. This instrument combination resulted in a relatively rapid and comfortable\nprocedure without serious postoperative complications. Cryopexy and multiple breaks affected operative time significantly.\nShorter operative times and preoperative macula-on status are associated with better final visual outcomes....
Background: To report a case of Purtscher-like retinopathy (PUR) and the optical coherence tomography (OCT) and\nOCT angiography (OCT-A) findings before and after treatment.\nCase presentation: A 65-year-old male presented with acute onset of vision loss for 2 weeks. Fundus examination\nrevealed cotton-wool spots, retinal haemorrhage, and Purtscher flecken spread around the optic disc in the right\neye. He was diagnosed with Purtscher-like retinopathy because he lacked any traumatic medical history. OCT\npresented some band-like hyperreflective lesions at the inner nuclear layer, which are indicative of paracentral acute\nmiddle maculopathy (PAMM). OCT-A revealed apparent reduction in blood flow signal at the deep retina and\nchoriocapillaris layers with a honeycomb-like hypointense signal pattern. After 3 months of follow-up, OCT revealed\nresolution of retinal oedema, but PAMM lesions remained visible. Based on OCT-A, the honeycomb-like pattern\nturned into a homogeneous reduction in blood flow with small patches of hypointense signal areas in the\nchoriocapillaris.\nConclusion: This case presented a new OCT-A sign in PUR with a honeycomb-like hypointense signal at the\nchoriocapillaris layer, indicating the involvement and ischaemia of the choroid during the pathological process....
Purpose: Fixed-combination medication to treat glaucoma can reduce intraocular\npressure (IOP) without negative effects of concomitant medication.\nTafluprost/timolol fixed-combination ophthalmic solution (TTFC) has been\nreported to show similar effectiveness in lowering IOP, compared with concomitant\nuse of its component drugs, tafluprost and timolol. However, the\ndifference in IOP-lowering effects between TTFC and concomitant use of tafluprost\nand gel-forming timolol is unknown. Hence, we conducted this switching\nstudy from tafluprost and gel-forming timolol to TTFC in glaucoma patients\nundergoing multi-drug therapy. Design: Multi-center, open-label, interventional\nclinical study. Methods: Twenty-eight patients (28 eyes; safety\nanalysis set) with primary open-angle glaucoma and ocular hypertension,\nwho had completed the 4-week-concomitant phase of tafluprost and\ngel-forming timolol, were treated for 8 weeks with TTFC. IOP, adherence,\nocular surface safety, and the usability of ophthalmic solution were compared\nbefore and after switching. This study was approved by the ethics committees\nof Kitasato University Hospital and all other study sites. All patients provided\nwritten informed consent to participate. Results: IOP at 8 weeks after switching\nwas significantly lower than before switching (P = 0.0001) in the efficacy\nanalysis set (n = 24). The self-reported adherence rate remained high after\nswitching; moreover, there was no meaningful change in ocular surface safety.\nPatient questionnaires regarding usability of medication revealed that\n85.7% of patients preferred their instillation prescription after switching, including\nTTFC. Among the safety analysis set (n = 28), no adverse events were\nreported in relation to the study drug. Conclusion: TTFC showed greater\nIOP reduction than concomitant therapy. Thus, TTFC may be a better option\nin glaucoma patients than concomitant therapy....
Background: Visual impairment occurred as an infrequent form of chemotherapeutic toxicity and was often\nunderestimated despite of several reports. We described a case of acute unilateral visual impairment after one cycle\nof intravenous chemotherapy of a normal dose, aiming at raising attention to chemotherapy-induced ocular\ntoxicity.\nCase presentation: The patient developed a progressive vision loss in the right eye during the chemotherapy.\nAfter one cycle of intravenous chemotherapy, her visual acuity decreased by 0.6 in the right eye (VOD = 0.4)\ncompared to the previous value of 1.0 (VOD = 1.0). No evidence of ocular infiltration was observed from the\ncerebral magnetic resonance imaging (MRI). During her follow-up period, we documented the ophthalmologic\nexaminations including visual acuity, visual field (VF), visual evoked potential (VEP), electroretinogram (ERG), fundus\nphotograph (FP), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). Ophthalmoscope\nexamination and fundus photograph showed optic disc edema, fuzzy boundary and linear hemorrhages in her\nright eye. Fundus fluorescein angiography (FFA) revealed capillary underdevelopment at the nasal and superior\ntemporal area of the optic disc in the early phase and capillary fluorescein leakage in the late phase. The result of\nVEP test suggested the impaired function of the optic nerve. Thus, a diagnosis of nonarteritic anterior ischemic\noptic neuropathy (NAION) was made by the ophthalmologist according to these results. The patient was prescribed\nprednisone combined with neuroprotective drugs, which did not work. After the cessation of chemotherapy, her\nimpaired vision gradually recovered.\nConclusions: This is the first reported case of acute visual impairment in a patient who underwent chemotherapy\nof a normal dose. It is indicated that while receiving benefits from chemotherapy, cancer patients simultaneously\nsuffer from the risk of vision loss....
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