Topography changes and endothelial cell loss after temporal 1.8 mm coaxial microincision cataract surgery (MICS)

INTRODUCTION. The purpose of this paper was to determine surgically-induced changes both in corneal topographic parameters and in endothelial cell loss after coaxial microincision cataract surgery (MICS) through temporal 1.8 mm incision. MATERIALS AND METHODS. Evaluation was performed in forty eyes of thirty patients who underwent cataract sur­gery. Topographic parameters including corneal astigmatism, surface regularity index (SRI), and surface asymmetry index (SAI) were estimated preoperatively and at one week, four weeks, and eight weeks after surgery. A specular microscope was also used for the measurement of the corneal endothelial density (cells/mm2). The surgically-induced astigmatism (SIA) was calculated by means of vector analysis using Alpins’ method. RESULTS. Eight weeks after surgery the final mean value of SIA was 0.42 D and the differences in topographic parameters such as corneal astigmatism, SRI, and SAI were not statistically significant. Also, the decrease in endothelial cell density eight weeks after surgery was 6.02%. CONCLUSIONS. The changes in SIA and topographic parameters after temporal coaxial 1.8 mm MICS are minimal throughout an eight-week follow up period

Characteristic Needle-Shaped Pattern Seen on OCT in a Patient with Ocular Amyloidosis

This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published version, accepted version (12 month embargo

Living-related limbal allograft transplantation for bilateral stem cell deficiency in a patient with bilateral chemical burn

INTRODUCTION. The purpose of this paper was to report the long-term outcome of a living-related limbal allograft transplantation followed by penetrating keratoplasty in a patient with severe bilateral stem cell deficiency. MATERIALS AND METHODS. A 50-year-old woman presented with extensive bilateral stem cell deficiency secondary to ocular acid burn on both eyes. Visual acuity was counting fingers at 30 cm on the right eye and counting fingers at 1 m Snellen line on the left. Limbal allograft transplantation on the right eye from a first-degree living-related relative was performed. The recipient was prepared by removing the abnormal corneal epithelium and vascularised pannus of the right eye under general anaesthesia. Two limbal allografts (mean length of 2–3 corresponding anatomic posi­tions on the recipient). Postoperatively, the host received systemic immunosuppression (steroids and cyclosporine). RESULTS. The cornea of the right eye achieved reepithelialisation within two weeks after surgery, followed by re­duction in vascularity in eight weeks time. After one year of regular follow up, the corneal surface remained stable whereas the stroma was opaque and the vision was low. Therefore, the patient underwent penetrating keratoplasty on the same eye. After the surgery the corneal graft was clear and the visual acuity on the right eye improved to 20/50 Snellen line. No graft rejection occurred after a five-year follow-up. CONCLUSION. Living-related limbal allograft transplantation is a good alternative option in cases of total bilateral stem cell deficiency whenever a conjunctival limbal autograft transplantation is not possible

Phototherapeutic keratectomy for the treatment of dense subepithelial infiltrates after epidemic keratoconjunctivitis

This is a case report of a patient who developed dense subepithelial corneal infiltrates after epidemic keratoconjunctivitis and was treated with phototherapeutic keratectomy (PTK). The purpose of this case report is to explain the surgical technique and the results of PTK procedure

Partial transepithelial topography-guided PRK combined with corneal collagen crosslinking in patients with keratoconus

INTRODUCTION. The aim of this study is to identify the visual outcome and possible complications of partial transepithelial topography-guided PRK combined with collagen crosslinking in patients with keratoconus. MATERIALS AND METHODS. Twenty eyes (20 patients) were treated with partial transepithelial topography-guided PRK combined with collagen crosslinking. Patients were evaluated preoperatively for best spectacle corrected visual acuity (BSCVA), clinical signs of keratoconus via slit lamp examination, and Scheimpflug-generated corneal topography. All eyes were treated with Amaris 750s Excimer Laser and KXL system. RESULTS . Mean BCVA was improved from 20/100 to 20/25, postoperatively. Mean flat K was 46.8 ± 0.14 D preoperatively and was reduced to 45.2 ± 0.7 D postoperatively. Mean steep K was reduced from 50.2 ± 0.10 D to 47 ± 0.6 D. Total corneal astigmatism was 4.5 ± 0.14 D and decreased to 2.5 ± 0.10 D postoperatively. Average thinnest pachymetry was reduced from 465 ± 9.9 μm to 416 ± 11.3 μm. Total RMS (corneal aberrations) was 15.5 ± 7.4μm and was significantly reduced to 5.5 ± 2 μm. CONCLUSIONS. Partial transepithelial topography-guided PRK combined with collagen crosslinking can benefit patients fitting the criteria for such a procedure, by stabilising their cornea as well as improving their BSCVA.

Evaluating the safety and efficacy of photorefractive keratectomy combined with corneal collagen crosslinking for the treatment of myopia and myopic astigmatism

INTRODUCTION. The purpose of the study was to evaluate the safety and efficacy of photorefractive keratectomy (PRK) combined with corneal collagen crosslinking (CXL) in patients with potential risk of developing postoperative ectasia, who were not good candidates for LASIK. MATERIALS AND METHODS. Twenty eyes were treated with transepithelial PRK combined with CXL. Patients were evaluated preoperatively for best corrected visual acuity (BCVA), refraction, keratometry, topography, and endothelial cell count. All eyes were treated with Amaris 750s Excimer Laser and KXL system for 90 seconds at 30 mW/cm2. RESULTS. Mean BCVA was improved from 0.0075 ± 0.08 logMAR to 0.025 ± 0.05 logMAR postoperatively. Average keratometry reduced from 44.9 ± 1.9 D to 39.8 ± 3.9 D. Mean minimal corneal thickness reduced from 504 ± 16.7 μm to 405 ± 41 μm. None of the cases developed regression, corneal ectasia, or corneal haze. CONCLUSIONS. Photorefractive keratectomy combined with high-fluence corneal collagen crosslinking (PRK XTRA) appears to be a safe and effective treatment for patients who are not good candidates for LASIK

Pseudotumor Cerebri in a Child with Idiopathic Growth Hormone Insufficiency Two Months after Initiation of Recombinant Human Growth Hormone Treatment

Purpose. To report a rare case of pseudotumor cerebri (PTC) in a child two months after receiving treatment with recombinant human growth hormone (rhGH) and to emphasize the need of close collaboration between ophthalmologists and pediatric endocrinologists in monitoring children receiving rhGH. Methods. A 12-year-old boy with congenital hypothyroidism started treatment with rhGH on a dose of 1,5 mg/daily IM (4.5 IU daily). Eight weeks later, he was complaining of severe headache without any other accompanying symptoms. The child was further investigated with computed tomography scan and lumbar puncture. Results. Computed tomography scan showed normal ventricular size and lumbar puncture revealed an elevated opening pressure of 360 mm H2O. RhGH was discontinued and acetazolamide 250 mg per os twice daily was initiated. Eight weeks later, the papilledema was resolved. Conclusions. There appears to be a causal relationship between the initiation of treatment with rhGH and the development of PTC. All children receiving rhGH should have a complete ophthalmological examination if they report headache or visual disturbances shortly after the treatment. Discontinuation of rhGH and initiation of treatment with acetazolamide may be needed and regular follow-up examinations by an ophthalmologist should be recommended

Multimodal analysis in symptomatic MIDD-associated retinopathy. A case report and literature review

Purpose: To present results of contemporary multimodal ophthalmic imaging in a case of maternally inherited diabetes and deafness (MIDD) and a literature review of MIDD.Methods: A case of a 47-year-old female with diabetes mellitus, severe insulin resistance, familial lipodystrohy, deafness and increasing problems with vision is reported. A full ophthalmic examination was done, including best corrected visual acuity (BCVA, LogMAR), funduscopy, and imaging studies: optical coherence tomography (OCT), OCT angiography (OCT-A), fundus autofloresence (FAF), visual fields (HVF) 10-2 , electrophysiology (EP) and genetic testing were performed. Literature available on the topic was reviewed. Results: BCVA was 0.06 LogMAR in the right eye and 0.1 LogMAR in the left. Funduscopy revealed atrophy (AT) and pigmentary changes but no diabetic retinopathy. HVF confirmed corresponding defects.The imaging and diagnostic tests showed the following abnormalities: FAF: hypoautofluoresence in areas of AT and mottled appearance in the macular and peripapillary area; OCT: attenuation of outer retinal layers and retinal pigment epithelium (RPE) in the AT; OCT-A: thinning of the deep capillary plexus and choriocapillaris; EP: abnormalities on full field electroretinogram (ERG), 30 Hz flicker and single cone flash response; multifocal ERG: reduced responses; genetic testing: A-to-G transition mutation at position 3243 of the mitochondrial genome, typical for MIDD.After one year OCT ganglion cell analysis showed loss of thickness.Conclusions: Genetic testing should be considered in diabetic patients with pigmentary retinopathy. Imaging studies and diagnostic testing showed structural and functional retinal changes, confined to the macula and progressive in nature

A Review of Aflibercept Treatment for Macular Disease

Aflibercept is a fully human recombinant fusion protein that includes the second domain of human VEGF receptor 1 and the third domain of human VEGF receptor 2. Despite the important role played by VEGF in maintaining the physiological condition of the retina under normal conditions, dysregulation of VEGF can result in pathological alterations including hyperpermeability of the retinal capillaries and migration and proliferation of retinal endothelial cells. Over the years, a number of studies have evaluated the use of intravitreal aflibercept in different retinal diseases. In this review, we aim to summarize the scientific evidence and recommendations for use of intravitreal aflibercept in neovascular age-related macular degeneration, diabetic macular oedema, macular oedema associated with retinal vein occlusion, and myopic choroidal neovascularization.RD&E staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted.Not permitte

Characteristic optical coherence tomography findings in patients with primary vitreoretinal lymphoma::a novel aid to early diagnosis

BACKGROUND: The diagnosis of primary vitreoretinal lymphoma (PVRL) poses significant difficulties; presenting features are non-specific and confirmation usually necessitates invasive vitreoretinal biopsy. Diagnosis is often delayed, resulting in increased morbidity and mortality. Non-invasive imaging modalities such as spectral domain optical coherence tomography (SD-OCT) offer simple and rapid aids to diagnosis. We present characteristic SD-OCT images of patients with biopsy-positive PVRL and propose a number of typical features, which we believe are useful in identifying these lesions at an early stage. METHODS: Medical records of all patients attending Moorfields Eye Hospital between April 2010 and April 2016 with biopsy-positive PVRL were reviewed. Pretreatment SD-OCT images were collected for all eyes and were reviewed independently by two researchers for features suggestive of PVRL. RESULTS: Pretreatment SD-OCT images of 32 eyes of 22 patients with biopsy-proven PVRL were reviewed. Observed features included hyper-reflective subretinal infiltrates (17/32), hyper-reflective infiltration in inner retinal layers (6/32), retinal pigment epithelium (RPE) undulation (5/32), clumps of vitreous cells (5/32) and sub-RPE deposits (3/32). Of these, the hyper-reflective subretinal infiltrates have an appearance unique to PVRL, with features not seen in other diseases. CONCLUSION: We have identified a range of SD-OCT features, which we believe to be consistent with a diagnosis of PVRL. We propose that the observation of hyper-reflective subretinal infiltrates as described is highly suggestive of PVRL. This case series further demonstrates the utility of SD-OCT as a non-invasive and rapid aid to diagnosis, which may improve both visual outcomes and survival of patients with intraocular malignancies such as PVRL