Evaluating the Ectasia Risk Score System in Cancelled Laser In Situ Keratomileusis Candidates

Purpose: To evaluate the ectasia risk score system in cancelled laser in situ keratomileusis (LASIK) candidates at an academic hospital. Methods: LASIK candidates who had been cancelled by a surgeon considering the patient age, preoperative central corneal thickness, residual stromal bed thickness, or preoperative manifest refraction spherical equivalent were retrospectively reviewed, and their Randleman ectasia risk score system score was calculated. Results: The mean ectasia score of 194 eyes (97 patients) was 4.5 ± 2.67; 40 (20.6%), 46 (23.7%), and 108 (55.7%) eyes were classified as low-, moderate-, and high-risk eyes, respectively. The topography was abnormal in 69% of the patients. The mean manifest refraction spherical equivalent, central corneal thickness, and estimated residual stromal bed thickness were 4 (+0.50 to –15.50) diopters, 520 (439 to 608) μm, and 312.38 (61.5 to 424.12) μm, respectively. The main cause of cancellation in low- and moderate-risk patients (86 eyes) was the presence of unstable refractive error in the past year. Conclusion: Although promising, some other criteria, such as stable refraction, should be added to this scoring system to achieve greater practicality since a main cause of cancelling LASIK candidates in this study was the presence of unstable refraction

Ahmed Glaucoma Valve with Adjunctive Amniotic Membrane for Refractory Glaucoma

Purpose: To evaluate the efficacy and safety of Ahmed Glaucoma Valve (AGV) implantation with adjunctive use of preserved amniotic membrane for surgical management of refractory glaucoma. Methods: Seven patients (5 female subjects) with refractory glaucoma were included in the study. An AGV (model FP7) was implanted in the usual manner and was covered with two layers of cryopreserved human amniotic membrane. Intraocular pressure (IOP) and number of glaucoma medications before and after surgery, and complications were evaluated. Results: Mean duration of follow-up was 16.8±4.6 months. Mean preoperative IOP was 31.7±4.4 mmHg which was reduced to 17.7±6.1 mmHg at final follow-up (P=0.01, Wilcoxon U test). Although the number of topical medications was also reduced (mean decrease of 0.85 drops), this decrease was not significant (P=0.10, Wilcoxon U test). None of the eyes developed encapsulation after surgery; only one case was complicated by posterior migration of the implant resulting in failure. Conclusion: Glaucoma shunt surgery using the AGV with adjunctive amniotic membrane seems to be a safe and effective procedure which may reduce the risk of bleb encapsulation in refractory glaucomas

The Applications of Cone-Beam Computed Tomography in Endodontics: A Review of Literature

By producing undistorted three-dimensional images of the area under examination, cone-beam computed tomography (CBCT) systems have met many of the limitations of conventional radiography. These systems produce images with small field of view at low radiation doses with adequate spatial resolution that are suitable for many applications in endodontics from diagnosis to treatment and follow-up. This review article comprehensively assembles all the data from literature regarding the potential applications of CBCT in endodontics

Dilemma of Retained Intraorbital Fragment of Pencil

Juvenile injuries by intraorbital foreign body in extremities are common and usually trivial (1) but they may lead to debilitating sequels in the head and neck. Because of their availability in comparison to other sources of trauma, accidental injuries may occur while children play with their friends. Injuries by pencils are special types of intraorbital foreign body, the final outcome of which is dependent to concurrent injuries of the ocular and also neurologic structure and comorbiditie. Orbital injury requires comprehensive evaluation, especially in child victims when there is not sufficient information regarding trauma mechanism and the intraorbital foreign body should be ruled out before any closure of wounds, as shown in the sample case presented here. In school age children with a history of falling, intraorbital fragments of pencils should be kept in mind. Preoperative information about the true number and exact location of retained fragments is paramount for an appropriate management. When there is high suspicion for retained foreign body, further detailed studies with CT and if needed MR scans and in selected cases plain X- ray are very helpful

Susac's Syndrome in a 27-Year-Old Female

A 27-year-old woman was referred by the neurologist for ophthalmic examination. She had a history of headache, visual loss in her right eye, four-limb paresthesia, and behavioral changes over the previous 10 months. The patient complained of tinnitus and hearing loss for two weeks. The patient was initially diagnosed with multiple sclerosis, but auditory and retinal involvement (small branch retinal artery occlusion in fluorescein angiography) raised the possibility of Susac's syndrome