Visual outcomes of Femto-LASIK for correction of residual refractive error after corneal graft

To evaluate the outcomes of the Femto-LASIK method in the treatment of refractive errors following penetrating keratoplasty (PK) at the Persian Eye Clinic, Isfahan, Iran In a prospective, non-comparative case series, 34 consecutive symptomatic eyes of 34 patients after corneal graft, were operated on. Tissue-saving (TS) Femto-LASIK (n = 16), and Zyoptix Personalized Treatment Advanced (PTA) Femto-LASIK (n = 18) were performed using the Bausch & Lomb Technolas 217z excimer laser and Zyoptic algorithm. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, contrast sensitivity, and HOAs were evaluated preoperatively and 12 months after enhancement treatment. At 12 months, the mean preoperative myopic spherical equivalent refraction (SE) decreased from -6.50 +/- 2.8 D to -1.6 +/- 1.8 D, and mean hyperopic SE from +3.2 +/- 2.20 D to 0.37 +/- 1.2 D. The safety index was 1.42 (1.2 in the TS group and 1.5 in the PTA group). In the TS group, 100 % of eyes achieved 20/80 or better UCVA and 50 %, 20/40 or better and in the PTA group, 100 % of eyes achieved 20/80 or better UCVA and 77.7 %, 20/40 or better. The efficacy index was 1.08 (0.9 in TS group and 1.21 in the PTA group). Patients obtained statistically significant lower values of root mean square (RMS) of HOAs with spherical aberrations (p < 0.05). Femto-LASIK method with Zyoptic programs after PK was safe, effective, and predictable for correction of spherical and cylindrical components of the refractive error

Visual outcomes of topography-guided excimer laser surgery for treatment of patients with irregular astigmatism

The aim of this study was to evaluate the efficacy, safety, and predictability of topography-guided treatments to enhance refractive status following other corneal surgical procedures. In a prospective case series study, 28 consecutive eyes of 26 patients with irregular astigmatism after radial keratotomy, corneal transplant, small hyperopic and myopic excimer laser optical zones, and corneal scars were operated. Laser-assisted in situ keratomileusis (LASIK) (n = 8) and photorefractive keratectomy (PRK) (n = 20) were performed using the ALLEGRETTO WAVE excimer laser and topography-guided customized ablation treatment software. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest and cycloplegic refraction, and corneal topography with asphericity were analyzed in 12 months follow-up. Uncorrected visual acuity (UCVA) changed from 0.2 +/- 0.2 or (20/100 +/- 20/100) to 0.51 +/- 0.31 or (20/40 +/- 20/60) in the LASIK group (P = 0.01) and from 0.34 +/- 0.16 or (20/60 +/- 20/120) to 0.5 +/- 0.23 or (20/40 +/- 20/80) in the PRK group (P = 0.01). Refractive cylinder decreased from -3.2 +/- 0.84 diopters (D) to -2.06 +/- 0.42 D in the LASIK group (P = 0.07) and from -2.25 +/- 0.39 D to -1.5 +/- 0.23 D in the PRK group (P = 0.008). Best corrected visual acuity did not change significantly in either group. Topography-guided treatment is effective in correcting the irregular astigmatism after refractive surgery. Topography-guided PRK can significantly reduce irregular astigmatism and increase the UCVA and BCVA

Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran

Toxoplasmosis is the most common cause of posterior uveitis in the world. This study described the clinical characteristics and visual outcome of 193 patients with ocular toxoplasmosis at Feiz Hospital (Isfahan, Iran) during the last six years. The setting and design used was a retrospective non-comparative observational case series. In this study, 193 patients with ocular toxoplasmosis (111 female, 82 male) were enrolled. The distribution of symptoms and fundoscopic findings were studied. The most-reported chief complaint was blurred vision in 96 (184 patients) and floaters in 13.47 (25 patients) of cases and most frequent clinical manifestations were chorioretinitis 98.48 (190 patients), macular scars 50.7 (98 patients), and atrophic optic papilla two (1.03 ) patients. Primary retinal lesions were observed in 16 (8.2 ) and combination of active lesions and old retinochoroidal scars in 177 (91.7 ) of the patients. Retinal detachment occurred in 11 (5.69 ) patients. Bilateral involvement was found in 27 of patients. Blindness was 0.05 after treatment. Recurrence rate was 14.5 . In conclusion, ocular toxoplasmosis substantially varies among patients with different age, gender, site of lesion and other factors. Suddenly blurred vision, floater, and pain could be caused by Toxoplasma gondii. Flashing, may necessitate a more precise peripheral fundus examination. © 2012 Springer Science+Business Media B.V

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in unrecognised early pregnancy

The use of intravitreal vascular endothelial growth factor (VEGF) inhibitor medications has widened considerably to include indications affecting females of reproductive age. Our patient was inadvertently exposed to bevacizumab within the first trimester when placental growth and fetal organogenesis take place and patient suffered pregnancy loss. There is insufficient information to suggest that such use is safe, nor is there definitive evidence to suggest that it causes harm. We advise that ophthalmologists discuss pregnancy with women of childbearing age undergoing intraocular anti-VEGF injections and in pregnant woman counselling is needed to explain the potential risks and benefits

Postlaminectomy lumbar pseudomeningocele with nerve root entrapment: a case report with review of literature

Pseudomeningocele is a rare but well-recognized complication of lumbar surgery. Most of the patients tolerate the presence of the cyst well, however, some present with back pain and spinal claudication, presumably due to neural compression. We report a case who presented with radicular symptoms and signs after disk surgery. The cause of his pain was nerve root herniation into large pseudomeningocele. The diagnosis was made by magnetic resonance imaging. The patient underwent surgery for the pseudomeningocele with reduction in the nerve root into the dural canal and primary closure of the dural defect. Postoperative results were gratifying

Association of invasive breast carcinoma and multicentric high grade astrocytoma: a case report with a review.

Breast cancer is the most common cancer in women. Multicentric gliomas are uncommon lesions of the central nervous system (CNS) with an unprecise rate of occurrence that diffusely infiltrate large portions of the brain. High grade astrocytoma is the most agressive form of gliomas and often has a distinct neuroimaging pattern with a poor prognosis. We report a case of a 29-year-old woman patient with primary breast carcinoma and high grade astrocytoma subsequently developed. The woman was treated by mastectomy and 20 months post-diagnosis of the cancer she exhibited a transient facial paralysis. Magnetic resonance imaging (MRI) revealed two cranial masses suspicious of metastasis. A complete tumor removal from the brain was performed. On histological examination, this tumor was a high grade astrocytoma

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in patient during pregnancy

Purpose: To report the clinical course of a woman treated with intravitreal bevacizumab during pregnancy. Case report: A 27-year-old female with poorly controlled diabetes and a history of two previous miscarriage was referred to our hospital with sudden deterioration in visual acuity (VA) in her right eye. Ocular findings revealed severe Proliferative Diabetic Retinopathy (PDR) complicated with preretinal hemorrhages in her right eye, and after maximal Panretinal Photocoagulation (PRP) bilaterally, she was treated with intravitreal injection of bevacizumab (IVB) into the right eye. Twenty four hours after the bevacizumab injection, she reported vaginal bleeding, and ultrasound confirmed a 12-week pregnancy of which the patient was unaware. The patient suffered from pregnancy loss. Conclusion: Use of intravitreal anti-VEGF by pregnant woman may only be justified if the potential benefit outweighs the potential risk to the fetus and only if clearly needed. Intravitreal bevacizumab during pregnancy in women with a history of miscarriage should be used with caution

Ocular toxoplasmosis and retinal detachment: five case reports

BACKGROUND: Ocular toxoplasmosis is a potentially blinding cause of posterior uveitis. Retinal detachment is rare complication of ocular toxoplasmosis. AIM: To report the clinical course and prognosis of retinal breaks and detachments occurring in patients with ocular toxoplasmosis. PATIENTS AND METHODS: This study was a retrospective, non-comparative case series of five patients with ocular toxoplasmosis who had consulted us with retinal detachment. RESULTS: All of the participants had retinal detachment after severe and treatment resistant toxoplasmic retinochoroiditis, leaving one of them with decreased visual acuity to light perception in spite of treatment and final visual acuity was 20/100 or better in four patients. CONCLUSIONS: The functional prognosis for the patients with retinal detachment was poor. Careful retinal examination in ocular toxoplasmosis is warranted, especially in patients with severe intraocular inflammation

Association of retinopathy and intima media thickness of common carotid artery in type 2 diabetic patients

Background: This study was carried out in order to evaluate the relationship between retinopathy and carotid intima-media thickness (CIMT). Materials and Methods: In a cross-sectional study, 154 diabetic patients who had a history of diabetic disease were evaluated in two equal groups of 77 patients with and without retinopathy, respectively. CIMT was evaluated in all of the patients. Results: Mean age of the patients was 59.65 +/- 9.37 years. Mean CIMT of all patients was 0.84 +/- 0.18. CIMT of patients with retinopathy was significantly greater than patients without retinopathy (P < 0.001). CIMT also correlated with age, duration of diabetes, systolic blood pressure, blood urea nitrogen, and serum creatinine. Conclusion: CIMT may be used as a simple, available and noninvasive method for screening of macro and microvascular complication of diabetic patients

Retinal findings of COVID-19 patients using ocular coherence tomography angiography two to three months after infection: Ocular appearance recovered COVID-19 patient

Purpose: The aim of this study was to evaluate the ocular disorders in COVID-19 patients, two to three months after infection. Methods: In this cross-sectional, historically controlled study, fifty-one COVID-19 patients were compared with thirty-seven age, and gender-matched healthy individuals. After complete ophthalmological examination, all participants underwent peripapillary and macular optical coherence tomography, and optical coherence tomography angiography (OCTA) measurements (OptoVue Inc, Freemont, CA, USA). Results: The time between the initial onset of symptoms, and ophthalmologic examination was 63.31±15.21 (40�95 days). Ophthalmic examination of all the recovered COVID-19 patients was within normal range. None of the peripapillary and macular OCTA parameters were significantly different between the two groups with pairwise comparisons, but after adjusting for age, gender, axial length, and signal strength index (SSI), recovered COVID-19 eyes showed a significant increase in peripapillary retinal nerve fiber (RNFL) thickness, superficial, and deep macular vessel densities in parafoveal and perifoveal regions compared with healthy control eyes (p<= 0.05). Inner retinal thickness overall is higher in recovered COVID-19 eyes compared to healthy eyes after adjustment. Conclusion: Patients with moderate-intensity SARS-CoV-2 pneumonia had altered peripapillary and macular vessel density compared to healthy subjects. Further investigation is warranted to analyze the correlation of these changes with disease severity as well as evolution of these changes over time