Differences between Goldmann Applanation Tonometry and Dynamic Contour Tonometry following Trabeculectomy

Background. To evaluate differences between Goldmann Applanation Tonometry (GAT) and Dynamic Controur Tonometry (DCT) following trabeculectomy. Methods. Thirty eight glaucomatous eyes with a history of trabeculectomy (Trabeculectomy group, TG), 20 eyes without a history of trabeculectomy but with a history of latanoprost use (Latanoprost group, LG), and 19 nonglaucomatous eyes (Control group, CG) were included. GAT-IOP, DCT-IOP, the difference between them (dIOP), the central corneal thickness (CCT), the axial length (AL), and the depth of the anterior chamber (ACD) were measured. Results. dIOP was significantly higher in TG (5.19 mmHg) than in LG (4.01 mmHg) and CG (1.98 mmHg). Correlations between AL and dIOP were statistically significant in both TG and LG but not in CG whereas correlations between dIOP and other clinical parameters examined were statistically not significant in all groups. Conclusions. The significantly higher dIOP in TG implies that the bio-mechanical properties of the ocular walls are altered following trabeculectomy

Corneal Topography With Upper Eyelid Platinum Chain Implantation Using the Pretarsal Fixation Technique

Purpose: To determine the effect of upper eyelid platinum chain implantation, with the pretarsal fixation technique, on corneal astigmatism. Methods: This is a prospective, cohort study. Fifteen eyes of 15 patients underwent upper eyelid platinum chain implantation, with the pretarsal fixation technique, for facial nerve palsy. Information recorded included patient demographics, etiology for facial palsy, weight of the implant, time from onset of paresis to upper eyelid platinum chain implantation, associated surgical procedures, and preoperative and postoperative corneal topography measurements. Results: Of the 15 patients studied, 10 were male and five were female. The mean age was 55.9 ± 13.8 years (range, 33–87 years). The most common etiology for facial palsy was acoustic neuroma. The weight of the implant ranged from 0.6 to 1.6gr (median 1.2gr). The time from onset of paresis to upper eyelid platinum chain implantation varied from 1 week to 3 months (median 1 month). Four patients had an associated procedure to correct the effect of paralytic ectropion. There was no statistically significant difference in with the rule astigmatism before and after platinum chain implantation. Conclusions: Upper eyelid platinum chain implantation, with the pretarsal fixation technique, does not appear to cause significant change in corneal astigmatism. This is contrary to data for pretarsal gold weight implantation, which does induce significant with the rule astigmatism

Corneal Topography With Upper Eyelid Platinum Chain Implantation Using the Pretarsal Fixation Technique

Purpose: To determine the effect of upper eyelid platinum chain implantation, with the pretarsal fixation technique, on corneal astigmatism. Methods: This is a prospective, cohort study. Fifteen eyes of 15 patients underwent upper eyelid platinum chain implantation, with the pretarsal fixation technique, for facial nerve palsy. Information recorded included patient demographics, etiology for facial palsy, weight of the implant, time from onset of paresis to upper eyelid platinum chain implantation, associated surgical procedures, and preoperative and postoperative corneal topography measurements. Results: Of the 15 patients studied, 10 were male and five were female. The mean age was 55.9 ± 13.8 years (range, 33–87 years). The most common etiology for facial palsy was acoustic neuroma. The weight of the implant ranged from 0.6 to 1.6gr (median 1.2gr). The time from onset of paresis to upper eyelid platinum chain implantation varied from 1 week to 3 months (median 1 month). Four patients had an associated procedure to correct the effect of paralytic ectropion. There was no statistically significant difference in with the rule astigmatism before and after platinum chain implantation. Conclusions: Upper eyelid platinum chain implantation, with the pretarsal fixation technique, does not appear to cause significant change in corneal astigmatism. This is contrary to data for pretarsal gold weight implantation, which does induce significant with the rule astigmatism

Ocular and eyelid surgical anatomy in Georg Bartisch's "Ophthalmodouleia"

Georg Bartisch, a 16th century barber surgeon, published in 1583 his treatise entitled "Ophthalmodouleia" (Greek term meaning eye service), a work in German to promote ophthalmology for his countrymen barber surgeons. He did not have an academic education nor knew classical languages, he had used a triplet in terminology by using German, Hellenic and Latin nomination in his anatomical descriptions. Various accurate illustrations and a peculiar system of presentation with flap to liken an in-depth presentation were demonstrated to add prestige in his work. This raises concerns for another medical surgeon to have helped for this publication. Bartisch innovative approaches introduced various surgical tools. Cataract surgery was the epitome of his work. Anatomy of both the eye and the eyelids was there for only to serve the operation. Religion, magic and Galenic views presented barriers for Bartisch's scientific development. However, he is considered as the patron of German School of Ophthalmology

Case Report Transient Anisocoria after Corneal Collagen Cross-Linking

properly cited. Purpose. To report a case with transient anisocoria after corneal collagen cross-linking (CXL). Methods. Case report. Results. A 24-year-old male underwent corneal collagen cross-linking (CXL) in his right eye for keratoconus. At the end of the procedure, the pupil of the treated eye was irregular and dilated, while the pupil of the fellow eye was round, regular, and reactive (anisocoria). The following day, pupils were round, regular, and reactive in both eyes. Conclusion. Anisocoria may be a transient and innocuous complication after CXL. A possible cause for this complication might be the anesthetic drops used before and during the surgical procedure or/and the ultraviolet A irradiation during the treatment

Transient Anisocoria after Corneal Collagen Cross-Linking

Purpose. To report a case with transient anisocoria after corneal collagen cross-linking (CXL). Methods. Case report. Results. A 24-year-old male underwent corneal collagen cross-linking (CXL) in his right eye for keratoconus. At the end of the procedure, the pupil of the treated eye was irregular and dilated, while the pupil of the fellow eye was round, regular, and reactive (anisocoria). The following day, pupils were round, regular, and reactive in both eyes. Conclusion. Anisocoria may be a transient and innocuous complication after CXL. A possible cause for this complication might be the anesthetic drops used before and during the surgical procedure or/and the ultraviolet A irradiation during the treatment

Non-Invasive Ocular Rigidity Measurement: A Differential Tonometry Approach

Purpose: Taking into account the fact that Goldmann applanation tonometry (GAT) geometrically deforms the corneal apex and displaces volume from the anterior segment whereas Dynamic Contour Tonometry (DCT) does not, we aimed at developing an algorithm for the calculation of ocular rigidity (OR) based on the differences in pressure and volume between deformed and non-deformed status according to the general Friedenwald principle of differential tonometry. Methods: To avoid deviations of GAT IOP from true IOP in eyes with corneas different from the “calibration cornea” we applied the previously described Orssengo-Pye algorithm to calculate an error coefficient “C/B”. To test the feasibility of the proposed model, we calculated the OR coefficient (r) in 17 cataract surgery candidates (9 males and 8 females). Results: The calculated r according to our model (mean ± SD, range) was 0.0174 ± 0.010 (0.0123–0.022) mmHg/μL. A negative statistically significant correlation between axial length and r was detected whereas correlations between r and other biometric parameters examined were statistically not significant. Conclusions: The proposed method may prove a valid non-invasive tool for the measurement method of OR, which could help in introducing OR in the decision-making of the routine clinical practice

Μοριακή γενετική ανάλυση σε ιστούς οφθαλμικού πτερυγίου

Ophthalmic pterygium is a fibrovascular lesion of the corneoscleral junction, usually displaying progressive growth. It can threaten vision by extending to the central cornea. Pathogenesis remains unknown, although a relationship with environmental factors, such as solar light, has been established. Treatment is mainly surgical. The tendency to grow, the frequent postoperative recurrence as well as laboratory findings have led to the assumption that pterygium is a neoplastic condition. Furthermore, potentially oncogenic viruses, such as HPV and HSV have been detected in pterygia. Loss of Heterozygosity (LOH) implies the involvement of tumor-suppressor genes in pathological conditions. LOH can be detected with microsatellite DNA markers, amplified with polymerase chain reaction (PCR) in paired pathological and peripheral blood specimens. The present study investigated the incidence of LOH, in selected loci, as well as the presence of HPV and HSV in pterygia. Moreover, evaluation of the possible correlation of the findings with clinical and epidemiological information was carried out. Fifty pterygia and respective phenotypically normal conjunctival samples, together with peripheral blood samples were included. Samples were obtained from patients treated at the Ophthalmological Clinic of the University Hospital of Crete. A slit lamp examination was performed and an ophthalmological and medical history was recorded for each patient. PCR was employed to amplify 20 microsatellite markers located at regions 17p, 17q, 13q, 9p, 9q and 3p. HSV and HPV detection and typing were also performed with PCR. The highest incidence of LOH was observed at regions 9p (48% of specimens) and 17q (42% of specimens). No conjunctival specimen displayed LOH. HSV and HPV were detected in 22% and 24% of pterygium specimens respectively, while both HSV and HPV in 6% of specimens. No conjunctival specimen displayed HSV, while HPV was detected in 8%. All HSV-positive specimens displayed HSV-1, while all HPV-positive specimens displayed HPV-18. LOH at regions 9q31-33 and 3p22-21.3 was higher among patients living at higher altitudes and among those with a history of chronic conjunctivitis respectively. LOH incidence at region 9q31-33 was also higher among younger patients. Postoperative recurrence correlated with LOH at 9q and with the simultaneous presence of HPV and HSV. The detection of LOH at the examined loci, supports the concept that pterygium is a neoplastic condition and implies that it is genetically determined. The fact that the incidence of LOH at region 9q was higher among recurrent pterygia and correlated, especially at 9q31-33, with recognized risk factors such as young age and altitude of residence (which is related to exposure to ultraviolet irradiation), implies a possible prognostic value of LOH at this region for postoperative recurrence. Moreover, the correlation of the simultaneous presence of HPV and HSV with postoperative recurrence suggests that antiviral therapy in selected cases could play a role in the management of recurrent pterygiaΤο οφθαλμικό πτερύγιο είναι ινοαγγειακή βλάβη του σκληροκερατείου ορίου, που μπορεί να παρουσιάσει προοδευτική αύξηση σε μέγεθος και να απειλήσει την όραση με κατάληψη του κεντρικού κερατοειδή. Η αιτιοπαθογένεια παραμένει σε μεγάλο βαθμό αδιευκρίνιστη, αν και έχει διαπιστωθεί στενή συσχέτιση με περιβαλλοντικούς ερεθισμούς, όπως το ηλιακό φως. Η αντιμετώπιση είναι κυρίως χειρουργική. Η τάση για προοδευτική αύξηση του μεγέθους, η συχνή μετεγχειρητική υποτροπή αλλά και ορισμένα εργαστηριακά δεδομένα, οδήγησαν στην υπόθεση ότι ενδεχομένως αντιπροσωπεύει νεοπλασματική επεξεργασία. Εξάλλου, έχει αναφερθεί η ανίχνευση διαφόρων δυνητικά ογκογόνων ιών σε οφθαλμικά πτερύγια, όπως ο ιός των θηλωμάτων (ΗPV) και ο ιός του απλού έρπητα (HSV). Η απώλεια ετεροζυγωτίας (LOH) υποδηλώνει εμπλοκή ογκο-κατασταλτικών γονιδίων σε μια παθολογική κατάσταση. Για την ανίχνευσή της χρησιμοποιούνται γενετικοί δείκτες μικροδορυφορικού DNA, που ενισχύονται με τη μέθοδο της αλυσιδωτής αντίδρασης με πολυμεράση (PCR), τόσο σε δείγματα από παθολογικές καταστάσεις, όσο και σε αντίστοιχα δείγματα περιφερικού αίματος. Με την παρούσα εργασία επιχειρείται η διερεύνηση της παρουσίας LOH στo πτερύγιο, η ανίχνευση των ιών HPV και HSV αλλά και η συσχέτιση των ευρημάτων με κλινικοεπιδημιολογικά δεδομένα των ασθενών. Εξετάστηκαν 50 δείγματα πτερυγίων ασθενών της Οφθαλμολογικής Κλινικής του Πανεπιστημιακού Νοσοκομείου Ηρακλείου και αντίστοιχα δείγματα περιφερικού αίματος και φαινοτυπικά υγιούς επιπεφυκότα. Προηγήθηκε οφθαλμολογική εξέταση και καταγραφή στοιχείων από το ιατρικό και οφθαλμολογικό ιστορικό των ασθενών. Ενισχύθηκαν συνολικά 20 μικροδορυφορικοί δείκτες στις χρωμοσωμικές περιοχές 17p, 17q, 13q, 9p, 9q και 3p. Eπίσης διερευνήθηκε με PCR η παρουσία των ιών HPV και HSV και στις περιπτώσεις θετικών δειγμάτων έγινε τυποποίηση στελεχών των ιών. Η υψηλότερη συχνότητα LOH παρατηρήθηκε στις περιοχές 9p (48% των δειγμάτων) και 17q (42%). Σε καμία περίπτωση δεν παρατηρήθηκε LOH σε δείγμα φυσιολογικού επιπεφυκότα. Σε 22% των δειγμάτων πτερυγίου ανιχνεύτηκε HSV και σε 24% HPV. Ο HSV δεν ανιχνεύτηκε σε δείγματα φυσιολογικού επιπεφυκότα ενώ ο ΗPV ανιχνεύτηκε σε 8% των δειγμάτων αυτών. Σε 3 περιπτώσεις ανιχνεύτηκαν στα ίδια δείγματα οι ιοί HPV και HSV. Σε όλα τα δείγματα που βρέθηκαν θετικά για τον ιό HSV ανιχνεύτηκε ο τύπος HSV-1, ενώ σε όλα τα θετικά δείγματα για HPV βρέθηκε ο HPV-18. Η συχνότητα LOH στις περιοχές 9q31-33 και 3p22-21.3 ήταν υψηλότερη σε άτομα με μεγαλύτερο υψόμετρο διαβίωσης και ιστορικό χρόνιας επιπεφυκίτιδας αντίστοιχα. Η συχνότητα LOH στην περιοχή 9q31-33 ήταν επίσης υψηλότερη σε νεότερα άτομα. Η μετεγχειρητική υποτροπή συσχετίστηκε με την ταυτόχρονη παρουσία των ιών HPV και HSV καθώς και με την παρουσία LOH στην περιοχή 9q. H ανίχνευση LOH στους εξετασθέντες δείκτες, ενισχύει την υπόθεση ότι το οφθαλμικό πτερύγιο είναι νεοπλασματική κατάσταση και υποδηλώνει ότι πιθανώς ελέγχεται γονιδιακά. Το γεγονός ότι η συχνότητα LOH στην περιοχή 9q ήταν υψηλότερη σε υποτροπιάζοντα πτερύγια και συσχετίστηκε, ιδίως στην περιοχή 9q31-33, με γνωστούς παράγοντες κινδύνου όπως η νεαρή ηλικία και το υψόμετρο του τόπου διαβίωσης (που συνδέεται με την έκθεση στην υπεριώδη ακτινοβολία), υποδηλώνει πιθανή προγνωστική αξία της LOH στην παραπάνω περιοχή για μετεγχειρητική υποτροπή. Εξάλλου, η συσχέτιση της ταυτόχρονης παρουσίας HPV και HSV με τη μετεγχειρητική υποτροπή υποδηλώνει ότι επιλεκτική αντιική θεραπεία μπορεί ενδεχομένως να έχει κάποια θέση στη θεραπευτική του πτερυγίου

INTRA-SCLERAL PARATHALAMUS IMPLANT: EFFICACY AND SAFETY IN RABBIT EYES

Purpose: A variety of anti-glaucomatous shunt designs have been proposed so far. This study evaluates the feasibility of a novel shunt design, the intra-scleral parathalamus implant (IPI), in a rabbit eye model. Methods: Ten healthy albino rabbits were included. Measurements of the IOP, using TonoPenXL, as well as ocular rigidity (OR) and aqueous outflow facility (AO), using a previously described methodology, were performed in both eyes of each animal. Subsequently, the IPI was implanted at the left eye of all animals whereas the right eye served as control. Measurements of IOP were repeated at weekly intervals for 2 months postoperatively whereas measurements of OR and AO were repeated at the 1st and 2nd postoperative week. Results: The IOP decreased significantly whereas the AO increased significantly postoperatively at the operated eyes. A significant postoperative decrease in OR was also recorded at the operated eyes. Respective differences at the fellow eyes were statistically not significant. Two animals developed postoperative complications and were excluded from follow-up. Conclusions: Results imply that the implantation of the IPI is feasible in rabbit eyes with significant favorable effects on the IOP, AO and OR