Surgical Management of Epiretinal Membrane

Epiretinal membranes (ERMs) are contractile membranes that occur on the inner surface of the retina and can lead to significant visual impairment when located at the central retina. Recent advances in vitreoretinal surgery have greatly improved the safety and efficacy of microsurgical intervention at the retinal surface level. Today, vitrectomy and membrane peels are considered the treatment of choice for most patients with ERMs that create significant visual symptoms. Nevertheless, possible complications such as accelerated cataract formation, recurrence of ERM and retinal detachment may withhold the choice of surgical intervention. Additionally, in some cases, simple observation may be advised. In view of surgery, controversies regarding techniques such as those related to an internal limiting membrane peel and the use of dye still exist. In this chapter, we cover current surgical techniques for ERM removal, their expected results, possible complications, as well as a guide for possible case selection

Possible Poecilogony Due to Discontinuous Multifactorial Inheritance in Some Mediterranean Species of Raphitoma (Mollusca, Conoidea, Raphitomidae)

At least 10 pairs of similar, most probably closely related, species of Raphitoma are often sampled in the same Mediterranean localities. In each pair, one member bears a planktotrophic protoconch and the other a lecithotrophic one. We propose that the phenomenon may be attributed to a simple gene that functions in conjunction with others and environmental factors to exhibit a discontinuous multifactorial inheritance leading to poecilogony. Below a threshold, the animals may produce fewer and larger germ cells, giving rise to fewer and larger eggs and large lecithotrophic embryos with large paucispiral protoconch I, while above that threshold, more and smaller germ cells leading to smaller eggs and to planktotrophic larvae with small protoconch I and large multispiral protoconch II. Preliminary measurements are in support of our hypothesis. Analysis of mitochondrial DNA markers as well as interbreeding experiments could bring an end to the existing confusion

Transepithelial Phototherapeutic Keratectomy Using a 213-nm Solid-State Laser System Followed by Corneal Collagen Cross-Linking with Riboflavin and UVA Irradiation

Purpose. To present a case of a keratoconic patient who underwent epithelial removal with transepithelial phototherapeutic keratectomy (t-PTK) using a 213-nm solid-state laser system followed by corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) irradiation. Methods. Case report. Results. A twenty-four-year-old male with keratoconus underwent CXL treatment after epithelial removal with t-PTK using a solid-state laser system. No intra- or early postoperative complications were found. One month postoperatively, uncorrected visual acuity (UCVA) improved from 20/63 to 20/32 while best spectacle- corrected visual acuity (BSCVA) improved from 20/40 to 20/25. Corneal topography revealed a significant improvement which remained stable during the six-month followup period. Conclusions. Epithelial removal with t-PTK before CXL could improve patient's visual outcome

Clinical Study Long Term Followup of Photorefractive Keratectomy with Adjuvant Use of Mitomycin C

properly cited. Purpose. To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC). Methods. This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval. Results. Mean preoperative spherical equivalent (SEQ) was −6.03 ± 1.87 D (diopters) and reduced to −0.09 ± 0.53 D at the last postoperative examination. Mean followup was 44.73 ± 18.24 months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was 2658 ± 153 cells/mm 2 . Conclusions. PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery

Update on Simultaneous Topo-guided Photorefractive Keratectomy Immediately Followed by Corneal Collagen Cross-linking for Treatment of Progressive Keratoconus

ABSTRACT Corneal collagen cross-linking (CXL) is a safe and effective technique for the management of corneal ecstatic disorders. It has been proven that CXL is effectual in stopping the progression of keratoconus quasi ‘freezing’ the cornea and in many cases avoiding corneal transplantation. Nevertheless, patients’ basic problem, which is the deterioration of their vision due to irregular astigmatism, remains. CXL combined with topography-guided photorefractive keratectomy (PRK) has been developed in order to achieve an important goal. To offer patients stability of their disorder and at the same time to assist them in achieving a functional vision by improving topographic outcomes. This article discusses update on this new combination therapy in the form of topo-guided PRK immediately followed by CXL as one-step procedure for treatment of progressive keratoconus. How to cite this article Kankariya V, Kymionis G, Kontadakis G, Yoo S. Update on Simultaneous Topo-guided Photorefractive Keratectomy Immediately Followed by Corneal Collagen Cross- linking for Treatment of Progressive Keratoconus. Int J Kerat Ect Cor Dis 2012;1(3):185-189

The family Raphitomidae (Mollusca: Gastropoda: Conoidea) in the Greek Seas with the description of two new species

Abstract Background The Raphitomidae family in the Mediterranean Sea is under revision. Accordingly, new data are of taxonomic and comparative relevance. In this study, new material from the Hellenic Seas is presented. Results The Raphitomidae fauna of Greece was collected and investigated during the period from October 2008 to February 2018. Thirty-five (35) species were identified and their status was compared with existing checklists and other collections. This effort revealed two new Raphitoma species, and one new record for the Mediterranean Sea. Also from the present collection, four species are new records for the East Mediterranean, 10 for the Hellenic fauna and six are reported for second time. The main identification characteristics and baseline ecological information are given and discussed. Conclusions By this report, the Hellenic Raphitomidae biodiversity is enriched by 10 new records, out of which, two are new species, one is new record for the Mediterranean Sea, and four for the East basin

Wavelike Interface Opacities After Descemet-Stripping Automated Endothelial Keratoplasty: 7-Year Follow-up

To report a case of wavelike interface opacities in a patient who underwent Descemet-stripping automated endothelial keratoplasty (DSAEK) and was managed conservatively over the course of 7 years. A 65-year-old woman underwent DSAEK for pseudophakic bullous keratopathy. Textural wavelike opacities were noted in the graft-host interface 6 days postoperatively without evidence of anterior segment inflammation. The patient's vision was also initially limited by the presence of cystoid macular edema (CME). Six months postoperatively, CME had resolved but the patient's vision failed to improve better than 20/80 because of the persistent dense interface opacities. The patient refused to undergo graft exchange despite a suboptimal visual result and she therefore was observed over time. The interface opacities started to regress and her visual acuity improved to 20/30 by 9 months postoperatively. The opacities became gradually less prominent over the next few years, and at 7 years postoperatively, her best-corrected vision was 20/25. In this case, observation of this post-DSAEK complication rather than surgical intervention resulted in a favorable long-term visual outcome

Nonorganic visual loss in a child due to school bullying

Purpose: To describe a case of a child with nonorganic visual loss due to school bullying. Observations: An eight-year-old boy presented with bilateral painless vision loss for a few days. His best corrected visual acuity (BCVA) was 20/200 in the right eye and 20/140 in the left eye. Color vision was normal. Fundoscopy, visual fields, electroretinography, electrooculography and visual evoked potentials were within normal limits. A nonorganic (psychogenic) cause of visual loss was suspected. A conversation with his parents and school teachers revealed that he was undergoing intense school bullying. Discussion between the boy and his parents and teachers' awareness helped in relieving the boy's stress. After two weeks BCVA was 20/20 bilaterally. Conclusions and importance: School bullying is a potential cause of nonorganic vision loss in children. Correct diagnosis, and support by the parents and teachers might rapidly alleviate the symptoms