Late ophthalmological manifestations in patients with subarachnoid hemorrhage and coiling of cerebral aneurysm

Late ocular manifestations of aneurysmal subarachnoid hemorrhage (SAH) have not been previously investigated except for one study which demonstrated that one half of patients subjected to aneurysm clipping suffer from symptoms of visual pathway impairment. We assessed ophthalmological status of patients after 1–4.5 years from SAH and aneurysm embolization to identify predictors of damage to the visual pathways. Complete ophthalmological examination, static perimetry, and visual evoked potentials (VEPs) were performed in 74 patients (26 men, 48 women, aged 19–76 years), who constituted a consecutive sample of 129 patients treated with aneurysm embolization in the years 2008–2010. The following independent variables: sex, age, time from SAH to embolization, size and site of aneurysm, score in Glasgow Coma Scale, Glasgow Outcome Scale, Hunt-Hess and Fisher scales were subject to univariate and multivariate statistical analyses to study their influence on the ocular outcome. 40 patients (54%) demonstrated visual field defects appearing as multiple peripheral foci and constricted field, affecting both eyes. Among these subjects, 12 patients had severe defects in the visual field, 20 had deterioration in VEPs, and 9 had decreased visual acuity. Older age and high score in Hunt-Hess and Fisher scales were identified as predictors for visual field defects and disturbances in VEPs. More than half of the survivors of SAH and aneurysm embolization suffer from a permanent defect in visual function. Damage of visual pathway correlates with severity of SAH and older age of patients

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: First clinical experience

Background and purpose Recently, a transconjunctival, endoscope-assisted (TEA) approach to the medial intra-orbital space was developed based on cadaver preparations, with an ultimate goal of minimizing disturbances of the anatomic structures of the orbit. However, no report on clinical validation of this promising technique was published thus far. We present our experiences with the TEA approach in two patients. Material and methods In emergency conditions, we approached the lateral retrobulbar space of a 42-year-old male through a 180° incision close to the corneal limbus; a scrap of metal, which had perforated the globe and resided at its posterior wall, was removed endoscopically. Moreover, we used the TEA approach to remove a tumor from the upper intraconal space in a 63-year-old woman. Results In both patients the surgical goal was achieved with no muscle transection and without additional morbidity and complications. Conclusions Our experiences with TEA approach suggest that the procedure is clinically feasible, produces no co-morbidity and yields good functional and cosmetic results. As a result, the whole circumference of the retrobulbar space can be conveniently explored

Injection of methylprednisolone directly into the extraocular muscles of eyes with disturbed motility secondary to Graves’ opthalmopathy. Preliminary report

Celem pracy była próba oceny skuteczności podaży bursztynianu 6-α-metyloprednizolonu do zmienionych chorobowo mięśni okoruchowych w oczach z zabu-rzeniami ruchomości, spowodowanymi oftalmopatią tarczycową. Materiał i metody. Do badań zakwalifikowano 4 chorych, w tym 1 kobietę i 3 mężczyzn, w wieku: 60, 43, 42 i 64 lata, ze stopniem aktywności klinicznej choroby (CAS) równym 4. Średni czas trwania oftalmopatii tarczycowej wynosił 2,1 lat (0,16-5,5). W doborze chorych kierowano się zakresem upośledzenia ruchomości oczu w płaszczyźnie poziomej oraz zmianami echograficznymi, ograniczonymi do izolowanych mięśni okoruchowych (prostych dolnych). Każdemu badanemu podawano do brzuśca mięśnia prostego dolnego zajętego oka 20 mg 6-α-metyloprednizolonu, w jednym przypadku iniekcję przeprowadzono w obu oczach. Wyniki. Uzyskano zmniejszenie ciśnienia wewnątrzgałkowego w pozycji wtórnej, z mierną poprawą ruchomości gałek ocznych i zwiększeniem obszaru wodzenia, wolnego od dwojenia. Wnioski. Poprawa, odczuwana przez chorych, jest najlepszym dowodem skuteczności podaży 6-α-metyloprednizolonu do zmienionych mięśni okoruchowych w wybranych przypadkach zaburzenia ruchomości, spowodowanych oftalmopatią tarczycową.Aim of the study was to estimate the efficacy of 6-α-methylprednisolone injection into involved extraocular muscles in eyes with motility disturbances caused by endocrine ophthalmopathy. Material and methods. For further evaluation we qualified 4 patients, 1 female and 3 males, aged: 60, 43, 42 and 64 years, with clinical activity score equal 4, with duration of Graves’ ophthalmopathy of mean 2.1 years (0.16-5.5). Included were patients with movement restrictions in vertical plane and echographic findings of isolated extraocular muscle involvement (inferior rectus). Each of the patients received 20 mg 6-α-methylprednisolone into the muscle belly of inferior rectus, in one case injection was done in both eyes. Results. In all cases we were able to archive lessening of the intraocular pressure in secondary position, with slight improvement in ocular motility and bigger range of duction free of diplopia. Conclusions. Visual function improvement found by the patients is the best evidence for application of 6-α-methylprednisolone into the extraocular muscles of patients with motility disturbances secondary to endocrine ophthalmopathy

Improvement of the Safety Profile of Canaloplasty and Phacocanaloplasty: A Review of Complications and Their Management

Research on the methods used to achieve persistent and safe control of intraocular pressure resulted in the implementation of novel surgical procedures, such as canaloplasty and phacocanaloplasty. Herein, we review the literature focused on the safety profile of canaloplasty and phacocanaloplasty and the management of related complications. The aim of canaloplasty is to restore the natural aqueous outflow. This goal is achieved via a surgical procedure that involves viscocanalostomy with catheterisation of Schlemm’s canal (360°) and placement of a circumferential suture that tensions the canal walls. This improves Schlemm’s canal drainage, choroidoscleral flow, and subconjunctival filtration. The efficacy of canaloplasty for reducing the intraocular pressure is similar to those of trabeculectomy with mitomycin C and deep sclerectomy augmented with an implant and mitomycin C. However, canaloplasty is associated with a lower complication rate than those conventional techniques. Novel microsurgical techniques for the treatment of glaucoma are unlikely to replace the conventional methods. However, these new techniques offer alternatives, especially for patients who have an early indication for surgical intervention. Nevertheless, canaloplasty is associated with the expectations of efficient, safe, and modern surgical treatment

Evaluation of the Endothelial Cell Density and the Central Corneal Thickness in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

. Purpose. Evaluation of central corneal thickness (CCT) and endothelial cell density (ECD) in patients with senile cataract and coexisting pseudoexfoliation (PEX) syndrome with glaucoma (PEXG) and without glaucoma using specular microscopy. Participants and Methods. The study included 122 patients (217 eyes). In this group of patients we identified 133 eyes with PEX syndrome (65 with glaucoma, 68 without glaucoma) and 84 eyes without PEX syndrome. ECD and CCT were measured in each eye by specular microscopy. Results. ECD in eyes with PEX syndrome without glaucoma (2297 ± 359 cell/mm 2 ) and in eyes with PEXG (2241 ± 363 cell/mm 2 ) was lower than in the control group (2503 ± 262 cell/mm 2 ) ( < 0.001). CCT in eyes with PEXG (508.2 ± 32.6 m) was thinner than in eyes with PEX syndrome without glaucoma (529.7 ± 30.3 m) and control group (527.7 ± 29.4 m) ( < 0.001). Conclusions. This research shows that in eyes with PEX syndrome, both with and without glaucoma, ECD was statistically significantly lower than in the control group. In patients with PEXG, CCT was statistically significantly thinner than in the PEX syndrome and control group

Evaluation of the Endothelial Cell Density and the Central Corneal Thickness in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

Purpose. Evaluation of central corneal thickness (CCT) and endothelial cell density (ECD) in patients with senile cataract and coexisting pseudoexfoliation (PEX) syndrome with glaucoma (PEXG) and without glaucoma using specular microscopy. Participants and Methods. The study included 122 patients (217 eyes). In this group of patients we identified 133 eyes with PEX syndrome (65 with glaucoma, 68 without glaucoma) and 84 eyes without PEX syndrome. ECD and CCT were measured in each eye by specular microscopy. Results. ECD in eyes with PEX syndrome without glaucoma (2297 ± 359 cell/mm2) and in eyes with PEXG (2241 ± 363 cell/mm2) was lower than in the control group (2503 ± 262 cell/mm2) (P<0.001). CCT in eyes with PEXG (508.2 ± 32.6 μm) was thinner than in eyes with PEX syndrome without glaucoma (529.7 ± 30.3 μm) and control group (527.7 ± 29.4 μm) (P<0.001). Conclusions. This research shows that in eyes with PEX syndrome, both with and without glaucoma, ECD was statistically significantly lower than in the control group. In patients with PEXG, CCT was statistically significantly thinner than in the PEX syndrome and control group

An Approach to Automatic Hard Exudate Detection in Retina Color Images by a Telemedicine System Based on the d-Eye Sensor and Image Processing Algorithms

Hard exudates are one of the most characteristic and dangerous signs of diabetic retinopathy. They can be marked during the routine ophthalmological examination and seen in color fundus photographs (i.e., using a fundus camera). The purpose of this paper is to introduce an algorithm that can extract pathological changes (i.e., hard exudates) in diabetic retinopathy. This was a retrospective, nonrandomized study. A total of 100 photos were included in the analysis&#8212;50 sick and 50 normal eyes. Small lesions in diabetic retinopathy could be automatically diagnosed by the system with an accuracy of 98%. During the experiments, the authors used classical image processing methods such as binarization or median filtration, and data was read from the d-Eye sensor. Sixty-seven patients (39 females and 28 males with ages ranging between 50 and 64) were examined. The results have shown that the proposed solution accuracy level equals 98%. Moreover, the algorithm returns correct classification decisions for high quality images and low quality samples. Furthermore, we consider taking retina photos using mobile phones rather than fundus cameras, which is more practical. The paper presents an innovative approach. The results are introduced and the algorithm is described

Seven-year evaluation of idiopathic multiple retinal pigment epithelium detachments

Objective: To analyze a 7-year natural history of idiopathic multiple retinal pigment epithelium (RPE) detachment based on optical coherence tomography (OCT) images. Methods: Case report. SD-OCT imaging (Topcon 3D OCT-1000).Results: A 55-year-old female presented with three foci of pigment epithelium detachment (PED) in her left eye. Her past ophthalmic and medical history was uneventful. The patient’s visual acuity in both eyes was 1.0 throughout the follow-up period. Fluorescein angiography images are shown. Corresponding OCT scans illustrate natural history of the PED foci and retinal structure of the left eye. PED number, location, shape, size and morphology were analyzed. Initially, the dimensions of PEDs were stable, but then a tendency to fluctuate or flatten was observed. Eventually, the lesions have resolved completely. Apart from the detachments, no other structural abnormalities of the retina were found. No PEDs, but sub-, para- and perifoveal RPE protrusions and defects were detected in the right eye.Conclusions: In the hereby presented case:1. OCT proved to be suitable for diagnosis and monitoring of multiple PEDs. 2. Multiple idiopathic PEDs without involvement of the fovea were asymptomatic and regressed spontaneously. As such, they did not require any treatment. However, they were monitored due to potential risk for choroidal neovascularization or serous retinal detachment