Andreas Diagourtas

Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study.

Purpose:  To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP).

Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma

Purpose: To study acquired color vision and visual field defects in patients with ocular hypertension (OH) and early glaucoma. Methods: In a prospective study we evaluated 99 eyes of 56 patients with OH without visual field defects and no hereditary color deficiencies, followed up for 4 to 6 years (mean = 4.7 ± 0.6 years). Color vision defects were studied using a special computer program for Farnsworth–Munsell 100 hue test and visual field tests were performed with Humphrey analyzer using program 30–2. Both tests were repeated every six months. Results: In fifty-six eyes, glaucomatous defects were observed during the follow-up period. There was a statistically significant difference in total error score (TES) between eyes that eventually developed glaucoma (157.89 ± 31.79) and OH eyes (75.51 ± 31.57) at the first examination (t value 12.816, p < 0.001). At the same time visual field indices were within normal limits in both groups. In the glaucomatous eyes the earliest statistical significant change in TES was identified at the first year of follow-up and was −20.62 ± 2.75 (t value 9.08, p < 0.001) while in OH eyes was −2.11 ± 4.36 (t value 1.1, p = 0.276). Pearson’s coefficient was high in all examinations and showed a direct correlation between TES and mean deviation and corrected pattern standard deviation in both groups. Conclusion: Quantitative analysis of color vision defects provides the possibility of follow-up and can prove a useful means for detecting early glaucomatous changes in patients with normal visual fields.

Lens-induced glaucoma in the elderly

Lens-induced glaucoma comprises a number of different glaucomatous processes occurring in the elderly that share in common the role of the crystalline lens in the mechanism of increase in intraocular pressure. We will review the anatomic predisposing factors, their physiology, signs and symptoms, and therapeutic approach. We will consider two studies and discuss the visual results and risk factors associated with these pathologic conditions.

Visual field examination method using virtual reality glasses compared with the Humphrey perimeter

Purpose To present a visual field examination method using virtual reality glasses and evaluate the reliability of the method by comparing the results with those of the Humphrey perimeter. Materials and methods Virtual reality glasses, a smartphone with a 6 inch display, and software that implements a fast-threshold 3 dB step staircase algorithm for the central 24° of visual field (52 points) were used to test 20 eyes of 10 patients, who were tested in a random and consecutive order as they appeared in our glaucoma department. The results were compared with those obtained from the same patients using the Humphrey perimeter. Results High correlation coefficient (r=0.808, P<0.0001) was found between the virtual reality visual field test and the Humphrey perimeter visual field. Conclusion Visual field examination results using virtual reality glasses have a high correlation with the Humphrey perimeter allowing the method to be suitable for probable clinical use.

Phacoemulsification in a patient with small pupil and a large iris cyst.

Purpose Peripheral iris cysts are generally asymptomatic and nonprogressive. They are usually located in the inferotemporal quadrant of the anterior segment, most commonly in the iridociliary sulcus. We report our management strategy in a patient with small pupil and a large iris cyst. Method Retrospective, case report. Results A 65-year-old man was referred, reporting blurred vision OS. Best-corrected visual acuity (BCVA) was 6/12 OD and 6/48 OS. Anterior chamber (AC) examination OS revealed an iris cyst protruding inferotemporally occupying almost one-third of AC volume. Intraocular pressure (IOP) was 32 mmHg OS and 19 mmHg OD. Aspiration with a 27-G cannula, without cyst resection, was performed. Phacoemulsification and intraocular lens implantation were uneventful. The BCVA improved to 6/9 1 week postoperatively and to 6/6 a month later. In the first postoperative visit, IOP dropped to 16 mmHg. The cyst was significantly decreased in size. Six months postoperatively, BCVA remained unchanged while AC examination revealed that the cyst remained in place with no signs of enlargement. Conclusions In this case, cyst aspiration was elected as a treatment procedure that led to significant decrease in size. This management option, combined with an uncomplicated cataract extraction procedure, resulted in an excellent visual and a positive anatomic outcome.

Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation.

Purpose The aim of this study was to compare the results of phacoemulsification through a small pupil using minimal iris manipulation versus phacoemulsification through a well-dilated pupil. Methods This prospective randomized control (comparative) study comprised 78 patients (group I) with a maximally dilated pupil size of ≤4.00 mm and 45 patients (group II) with dilated pupil size of ≥7.00 mm. In group I patients, only viscodilation and minimal push-and-pull iris stretching with two collar-button iris-retractor hooks were utilized without iris manipulation. Phacoemulsification was performed by two senior surgeons and the technique used consisted of either stop and chop or quick chop, infusion/aspiration of lens cortex, capsular bag refill with ocular viscoelastic devices, and implantation of an acrylic foldable intraocular lens. Patients were examined on the first day and 1 month postoperatively. Results Forty-six eyes of group I patients had pseudoexfoliation syndrome, eleven eyes had previous glaucoma surgery, 14 eyes had angle-closure or open-angle glaucoma, and seven eyes had posterior synechiae with iritis. In group I patients, the mean pupil size measured under an operating microscope was 3.2 mm preoperatively, 4.3 mm after viscoelastic and mechanical pupil dilation, and 4.1 mm at the end of a surgical procedure. Rupture of the zonular fibers occurred in six patients of group I and the intraocular lens was implanted in the sulcus. Small iris-sphincter rupture and small hemorrhages occurred in four eyes during pupillary manipulation, but they were not evident at the end of the surgery. In group II patients, no intraoperative complications occurred. Signs of significant corneal edema and iritis were observed more frequently in group I eyes (26 eyes and 20 eyes, respectively) on the first postoperative day in comparison with group II eyes (ten eyes and six eyes, respectively). Intraocular pressure was <20 mmHg in all eyes of both groups. One month postoperatively, the pupil was round and reactive to light, the anterior chamber was quiet, and the cornea was clear in all eyes. The best-corrected visual acuity on Snellen chart was 20/40 (Monoyer’s scale) or better in both groups. Conclusion Phacoemulsification through a small pupil using minimal iris manipulation can be safe and exhibits the same results as those obtained with phacoemulsification through normal pupils.

Trabeculectomy with Healaflow versus Trabeculectomy for the Treatment of Glaucoma: A Case-Control Study

Purpose. To compare the outcomes of trabeculectomy with and without Healaflow (Anteis S.A, Geneva, Switzerland), a high molecular weight viscoelastic gel, in patients requiring glaucoma surgery. Methods. This was a retrospective, comparative, interventional case-control study. Forty patients formed two matched study groups and were analyzed (trabeculectomy alone (control) versus trabeculectomy with Healaflow (study)). Results. The postoperative levels of mean IOP were statistically significantly lower (P < 0.05) than preoperatively in both groups, for all time intervals. There was no statistical difference, at the end of the follow-up period, between the two groups in the mean values of the IOP (14.9 ± 3.2 mmHg for the study group versus 14.8 ± 3.3 mmHg for the control group). The number of antiglaucoma drugs used in the study group was reduced from a preoperative mean of 3.4 ± 0.75 to a 6-month postoperative mean of 0.6 ± 0.8 (P < 0.001) and in the control group from 3.6 ± 0.59 to 0.55 ± 0.9 (P < 0.001). Conclusions. Although trabeculectomy with Healaflow appears to be a safe procedure, we failed to identify any significant advantages in the use of Healaflow when compared with trabeculectomy alone, at the end of the 6-month follow-up period.

Cortical blindness due to bilateral embolism: a rare complication of cardiac catheterisation

A 58-year-old male hypertensive patient, who was a moderate smoker and had undergone uncomplicated coronary angiography with no pathologic findings two years earlier, was admitted to the cardiology department. Coronary angiography and angioplasty of the right coronary artery were performed with anticoagulation and using a modern non-ionic, lowosmolar contrast agent (Iobitridol). One day later, the patient complained of blurred vision in both eyes. On subsequent neurologic examination, no deficit was diagnosed. Urgent computed tomographic (CT) scan showed no acute pathologic findings. The following day, he was referred to the ophthalmologist, as he was still complaining of visual impairment. Visual acuities were 6/6 OU. There was no afferent pupillary defect and no nystagmus but confrontation field testing was not performed. Fundoscopy revealed normal optic nerves and maculae and the patient was discharged. He continued complaining of visual disturbances and four days later was referred to us for advice. A SITA-Standard 30-2threshold visual field test with excellent reliability indices revealed a bilateral homonymous hemianopia with macular sparing (Figure 1). Additionally, a second contrast enhanced CT-scan was performed because magnetic resonance imaging could not be performed due to the presence of the coronary stent. The contrast enhanced CT-scan showed bilateral mesial occipital lobe infarcts and non-homogeneous, lowdensity regions symmetrically distributed, in both occipital lobes, indicating ischaemic type defects of the posterior circulation secondary to a thromboembolic event. A week later, a new visual field test was performed and showed a small improvement of the patient’s hemianopia with enlargement of the central region. No further visual improvement was noted after six months. DISCUSSION

Acute ocular pain during magnetic resonance imaging due to retained intraocular metallic foreign body: the role of ultrasonography and ultrasound biomicroscopy in diagnosis and management of this condition

PurposeTo report the case of a 65-year-old metalworker with no known history of ocular trauma, who suffered from intense ocular pain during magnetic resonance imaging (MRI) of the brain, due to a retained intraocular metallic foreign body (IOFB).Case reportMeticulous ophthalmological examination was inconclusive. An IOFB was confirmed with X-ray scan, whereas its exact localization was enabled by means of ultrasonography and ultrasound biomicroscopy (UBM).ConclusionsDespite appropriate screening protocols, MRI-related ocular complications might occur in the presence of a hidden metallic IOFB. Clinical detection of ocular foreign bodies can sometimes be challenging. Ultrasonography and UBM are valuable adjuncts for the accurate localization, especially of small or hidden particles.SOMMARIOScopo dello studioPresentare il caso clinico di un operaio metallurgico, di 65 anni, con anamnesi negativa per traumi oculari, che durante un esame di Risonanza Magnetica (MRI) del capo ha avvertito intenso dolore oculare a causa di un corpo estraneo ritenuto.Caso clinicoL’esame oftalmologico di routine è stato inconclusivo. La presenza di un corpo estraneo intraoculare è stata documentata con una radiografia (RX) delle orbite, mentre la sua esatta localizzazione e’ stata resa possibile dall’ ecografia oculare (US) e dalla biomicroscopia ad ultrasuoni (UBM).ConclusioniNonostante protocolli di screening adeguati, complicazioni oculari in corso di MRI possono verificarsi in presenza di un corpo estraneo oculare non noto. L’ esatta localizzazione di un corpo estraneo intraoculare talvolta può essere laboriosa e inconclusiva. US e UBM oculare sono metodiche di ausilio per la localizzazione accurata di corpi estranei, soprattutto di piccole dimensioni.

Optical Coherence Tomography Angiography: Employing a Novel Technique for Investigation in Vogt-Koyanagi-Harada Disease

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease and describe the imaging findings by means of optical coherence tomography angiography (OCTA). Methods: Medical and ophthalmological history, ophthalmological examination, laboratory evaluation, B-scan ultrasonography, fluorescein and indocyanine angiography, and optical coherence tomography (OCT) were performed at baseline, as well as OCTA. Results: A 50-year-old healthy female presented with decreased vision in both eyes. A Topcon DRI OCT Triton Plus swept source OCT system was used to visualize and evaluate the retinal and choroidal vascular plexus. Patchy and confluent dark areas in the superficial and deep retinal capillary plexus and choriocapillaris corresponded to areas of hypoperfusion, analyzed as areas of ischemia. Conclusions and Importance: VKH disease is characterized by ocular, neurological, and integumentary findings in its complete form. We present a case of incomplete disease in a 50-year-old female evaluated by means of OCTA which is a novel technique that provides depth-resolved images of the retina and choroidal microvasculature without dye injection that allows better visualization and detailed evaluation of the retinal and choroidal vascular plexus.