Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange

Changing from bevacizumab to ranibizumab in age-related macular degeneration. Is it safe?

Dimitrios A Karagiannis1, Ioannis D Ladas2, Efstratios Parikakis1, Ilias Georgalas2, Athanasios Kotsolis2, Giorgos Amariotakis1, Vasileios Soumplis1, Panagiotis Mitropoulos11Ophthalmiatrio Eye Hospital of Athens, Athens, Greece; 2First Department of Ophthalmology, Medical School of Athens University, General Hospital of Athens, Athens, GreeceObjective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in age-related macular degeneration (AMD).Design: Retrospective case series.Participants and methods: We retrospectively reviewed the records of 34 patients (36 eyes) who were treated with monthly injections of intravitreal bevacizumab for six months and then switched to monthly injections of ranibizumab for 12 months. Best-corrected visual acuity measurements (BCVA), contact lens biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography were performed at the baseline examination and then monthly. Chi-square test was used for statistical analysis.Results: Following bevacizumab treatment, retinal thickness decreased (P = 0.033) while BCVA improved (P = 0.040). Changing from bevacizumab to ranibizumab resulted in a transient decrease in BCVA (P = 0.045) and an increase in retinal thickness (P = 0.042). In addition, three eyes presented with a large subretinal hemorrhage. However, final retinal thickness was better than the initial thickness and the value following the bevacizumab course. No major ocular or systemic side effects were noted.Conclusions: Ranibizumab was clinically effective in the long term but the change of treatment from bevacizumab to a half-size molecule with less half-life in the vitreous such as ranibizumab contributed to a transient “instability” in the eye which may have triggered the large subretinal hemorrhage. There is insufficient experience reported in the literature in switching from one agent to another. A prospective study with controls is necessary to determine whether it is safe to change from one medication to another.Keywords: age-related macular degeneration, bevacizumab, ranibizumab, subretinal hemorrhag

Axial eye length measurements pre- and post- laser-assisted in situ keratomileusis using the IOL Master: a pilot study

Spyridon E Chalkiadakis, Georgios A Amariotakis, Efstratios A Parikakis, Vasileios G PeponisAthens Eye Hospital, 2nd Eye Clinic, Athens, GreecePurpose: A preliminary study in order to test the accuracy of the IOL Master in detecting axial eye length changes after laser-assisted in situ keratomileusis and to correlate the findings with the theoretical ablation depth.Methods: Pre- and postoperative axial eye length measurements were performed in 10 consecutive eyes that underwent laser-assisted in situ keratomileusis with the Alcon Ladar Vision excimer laser to treat myopic refractive errors ranging from -2.50 to -8.00 diopters of spherical equivalent (mean: -5.23 ± 1.30 D).Results: The preoperative axial eye length measurements ranged from 24.53 mm to 27.78 mm (mean: 25.80 ± 1.01 mm) and from 24.57 mm to 27.57 mm (mean: 25.68 ± 0.93 mm) 1 month after the operation. Preoperative and 1-month postoperative data showed a statistically significant difference (P <0.05).Conclusions: The IOL Master showed a decrease in the axial eye length measurements that was bigger than the theoretical ablation depth and did not correlate well with it. Such data need to be confirmed by a larger cohort of patients.Keywords: ablation, biometry, coherence, excimer, interferometry, keratomileusis, lase

Chronic Postoperative Endophthalmitis Caused by Actinomyces meyeri

We report a female patient who developed chronic endophthalmitis after an uneventful cataract surgery. Cultures of aqueous humor and a vitreous sample showed positivity for Actinomyces meyeri. Intense anterior segment inflammation and a less evident impairment of the patient’s posterior segment led us to treat her vigorously with pars plana vitrectomy combined with intraocular and topical antibiotics. The patient achieved a good recovery of vision without the need to remove the intraocular lens and to add systemic drugs. To the best of our knowledge, this is the first reported case of an intraocular infection caused by A. meyeri after small-incision clear corneal phacoemulsification

Acute Zonal Occult Outer Retinopathy with Atypical Findings

Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electrophysiology findings. Case Presentation. A 23-year-old-female presented with visual acuity deterioration in her right eye accompanied by photopsia bilaterally. Corrected distance visual acuity at presentation was 20/50 in the right eye and 20/20 in the left eye. Fundus examination was unremarkable. Visual field (VF) testing revealed a large scotoma. Pattern and full-field electroretinograms (PERG and ERG) revealed macular involvement associated with generalized retinal dysfunction. Electrooculogram (EOG) light rise and the Arden ratio were within normal limits bilaterally. The patient was diagnosed with AZOOR due to clinical findings, visual field defect, and ERG findings. Conclusion. This is a case of AZOOR with characteristic VF defects and clinical symptoms presenting with atypical EOG findings