Μελέτη της ενδοφθάλμιας πίεσης με την Dynamic Contour Tonometry και την Goldmann Applanation Tonometry σε σχέση με το πάχος και την καμπυλότητα του κερατοειδούς.

Σκοπός : Σκοπός της μελέτης ήταν η ανάλυση της συσχέτισης του κεντρικού πάχους κερατοειδούς και της ακτίνας καμπυλότητας του κερατοειδούς με τις μετρήσεις ενδοφθάλμιας πίεσης με το τονόμετρο Goldmann και τo τονόμετρο Pascal . Μέθοδος : Προοπτική μελέτη 185 οφθαλμών από 97 ασθενείς, οι οποίοι υπεβλήθησαν σε μέτρηση ενδοφθάλμιας πίεσης με τονόμετρο Goldmann και τονόμετρο Pascal στο τμήμα Γλαυκώματος της 1ης Πανεπιστημιακής κλινικής Αθηνών του Νοσοκομείου Γεννηματάς. Η μέτρηση του πάχους του κερατοειδούς έγινε με υπερηχητική παχυμετρία και η μέτρηση της καμπυλότητας με την Orbscan τοπογραφία. Αποτελέσματα: Η μέση ενδοφθάλμια πίεση μετρούμενη με τη DCT ήταν 17,21 mmHg και μετρούμενη με τη GAT 13,23. H μέση διαφορά μεταξύ GAT και DCT ήταν 3,88 mmHg . Το μέσο πάχος κερατοειδούς ήταν 522,78 μm και η μέση καμπυλότητα 43,89 διοπτρίες. Συμπέρασμα : H ενδοφθάλμια πίεση μετρούμενη με τη GAT ήταν μικρότερη σε σχέση με τη DCT, και η διαφορά αυξανόταν σε λεπτούς κερατοειδείς. Κερατοειδείς με χαμηλά κερατομετρικά επηρέασαν περισσότερο τις τιμές μετρούμενες με GAT σε σχέση με τις τιμές μετρούμενες με DCT.Purpose : To assess the influence of central corneal thickness and corneal curvature in tonometry measurements taken by Goldmann applanation tonometry (GAT) and Pascal Dynamic Contour Tonometry (DCT). Methods: Prospective study of 185 eyes from 97 subjects, attending outpatient ophthalmology appointments, who underwent intraocular pressure measurements by Goldmann applanation tonometer (GAT) and Pascal Dynamic contour tonometer (DCT). Central corneal thickness (cct) and corneal curvature were obtained using ultrasound pachymetry and orbscan topography respectively. All measurements carried out among males and females during the period 2009 to 2012. Apart from the usual descriptive and exploratory data analysis, linear correlation coefficients were estimated, multiple scatter plots were produced and one-way analysis of variance was performed. Results: Mean IOP measurements obtained were 17,21 ± 4,10mmHg by DCT and 13,23 ± 4,07 mmHg by GAT. Mean difference between the GAT and DCT measurements was 3,88 ±2,8 mmHg. Mean CCT and Corneal curvature were 522,78 ± 52 μm and 43,83 ± 2,9823 Diopters respectively. Conclusions: Intraocular pressure measured by GAT was consistently lower when compared with DCT, and this difference was greatest with thinner CCT. Flat corneas seem to influence GAT readings compared to DCT

Optical Coherence Tomography Angiography: Employing a Novel Technique for Investigation in Vogt-Koyanagi-Harada Disease

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease and describe the imaging findings by means of optical coherence tomography angiography (OCTA). Methods: Medical and ophthalmological history, ophthalmological examination, laboratory evaluation, B-scan ultrasonography, fluorescein and indocyanine angiography, and optical coherence tomography (OCT) were performed at baseline, as well as OCTA. Results: A 50-year-old healthy female presented with decreased vision in both eyes. A Topcon DRI OCT Triton Plus swept source OCT system was used to visualize and evaluate the retinal and choroidal vascular plexus. Patchy and confluent dark areas in the superficial and deep retinal capillary plexus and choriocapillaris corresponded to areas of hypoperfusion, analyzed as areas of ischemia. Conclusions and Importance: VKH disease is characterized by ocular, neurological, and integumentary findings in its complete form. We present a case of incomplete disease in a 50-year-old female evaluated by means of OCTA which is a novel technique that provides depth-resolved images of the retina and choroidal microvasculature without dye injection that allows better visualization and detailed evaluation of the retinal and choroidal vascular plexus

Treatment of anterior corneal scarring, following DSAEK graft failure, with combined graft exchange and phototherapeutic keratectomy

Background: To present a method, alternative to penetrating keratoplasty, for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure. Case presentation: A 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of pseudophakic bullous keratopathy, presented with long-standing corneal oedema and anterior corneal scarring. A significant improvement in corrected distance visual acuity was demonstrated, as corneal clarity was restored following graft exchange and phototherapeutic keratectomy (PTK). Conclusions: The combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft

Surgical management of spontaneous, late-onset Descemet membrane detachment after penetrating keratoplasty for keratoconus: a case report

Abstract Background To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty. Case presentation A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus. Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue, accompanied by corneal graft oedema. Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema. We proceeded with a full-thickness, partially circumferential incision in the graft-host junction, followed by repositioning and re-suturing of the graft in place, and intracameral air injection in order to achieve reattachment of Descemet membrane. Conclusions Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment

Treatment of anterior corneal scarring, following DSAEK graft failure, with combined graft exchange and phototherapeutic keratectomy

Abstract Background To present a method, alternative to penetrating keratoplasty, for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure. Case presentation A 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of pseudophakic bullous keratopathy, presented with long-standing corneal oedema and anterior corneal scarring. A significant improvement in corrected distance visual acuity was demonstrated, as corneal clarity was restored following graft exchange and phototherapeutic keratectomy (PTK). Conclusions The combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft

Surgical management of spontaneous, late-onset Descemet membrane detachment after penetrating keratoplasty for keratoconus: a case report

Background: To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty. Case presentation: A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus. Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue, accompanied by corneal graft oedema. Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema. We proceeded with a full-thickness, partially circumferential incision in the graft-host junction, followed by repositioning and re-suturing of the graft in place, and intracameral air injection in order to achieve reattachment of Descemet membrane. Conclusions: Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment

Early anti-VEGF treatment for hemorrhagic occlusive retinal vasculitis as a complication of cataract surgery

Abstract Background We report a case of hemorrhagic occlusive retinal vasculitis (HORV) after prophylactic intracameral vancomycin use during an uneventful cataract surgery treated with early anti-VEGF treatment. Case presentation A 51-year-old female underwent uneventful cataract surgery with prophylactic intracameral vancomycin during the procedure. On the seventh post-operative-day, she presented with sudden painful, visual loss. Fundus examination revealed peripheral hemorrhagic retinal vasculitis. She received anti-VEGF therapy to prevent further vision loss and retinal neovascularization due to extensive retinal ischemia. At the 6-month follow-up visit, visual acuity was 20/20 with no sign of neovascularization. Conclusions Postoperative HORV is a devastating condition that can occur after otherwise uncomplicated cataract surgery. The nature of this rare condition remains unknown. Early anti-VEGF administration seems to demonstrate favorable results

Early anti-VEGF treatment for hemorrhagic occlusive retinal vasculitis as a complication of cataract surgery

Background: We report a case of hemorrhagic occlusive retinal vasculitis (HORV) after prophylactic intracameral vancomycin use during an uneventful cataract surgery treated with early anti-VEGF treatment. Case presentation: A 51-year-old female underwent uneventful cataract surgery with prophylactic intracameral vancomycin during the procedure. On the seventh post-operative-day, she presented with sudden painful, visual loss. Fundus examination revealed peripheral hemorrhagic retinal vasculitis. She received anti-VEGF therapy to prevent further vision loss and retinal neovascularization due to extensive retinal ischemia. At the 6-month followup visit, visual acuity was 20/20 with no sign of neovascularization. Conclusions: Postoperative HORV is a devastating condition that can occur after otherwise uncomplicated cataract surgery. The nature of this rare condition remains unknown. Early anti-VEGF administration seems to demonstrate favorable results

Optical Coherence Tomography Angiography of Foveal Neovascularization in Diabetic Retinopathy

Purpose: To report a case of foveal neovascularization in a patient with proliferative diabetic retinopathy as seen on optical coherence tomography angiography (OCT-A). Methods: Multimodal imaging was used for diagnostic investigation. Patient: A 61-year-old male with a 16-year history of insulin-dependent diabetes mellitus was referred to our medical retina department for examination and management. Meticulous fundus examination and multimodal imaging revealed proliferative diabetic retinopathy lesions, including neovascularization located in the foveal area. Results: OCT-A allowed us to detect the neovascular lesion, confirm that it originated from perifoveal capillaries, estimate its retinal depth, and evaluate the vessel blood flow in multiple layers. Conclusion: To the best of our knowledge this is the first report of OCT-A imaging of foveal neovascularization in diabetic retinopathy. OCT-A is a very useful examination for the diagnostic investigation of patients with diabetic retinopathy