Arie Marcovich

Age-related Macular Degeneration after Extracapsular Cataract Extraction with Intraocular Lens Implantation

PURPOSEnTo evaluate the course of age-related maculopathy after cataract surgery.nnnMETHODSnIncluded were 47 patients with bilateral, symmetric, early age-related macular degeneration (AMD), documented by fluorescein angiography, who underwent extracapsular cataract extraction with intraocular lens implantation in one eye. The fellow eye served as the control. The patients were retrospectively reviewed or prospectively followed.nnnRESULTSnWet AMD developed in nine eyes (19.1%) that were treated with surgery compared with two fellow eyes (4.3%). It was detected within 3 months of surgery in four (44.4%) of the nine affected eyes and within 6 to 12 months of surgery in four other eyes (44.4%). Progression to wet AMD occurred significantly more often in men than in women (P < 0.05). Soft drusen were found as a significant ocular risk factor (P < 0.05). The final visual outcome was poor in all eyes with such progression.nnnCONCLUSIONSnIn this study, progression of AMD occurred more often in the surgical eyes compared with the fellow eyes. However, the reasons for the progression of AMD after cataract surgery are still uncertain. Further prospective studies are needed to investigate this observation.

Angiogenesis in pterygium: Morphometric and immunohistochemical study

Objective. To evaluate the role of angiogenesis in the pathogenesis of pterygium by comparing the expression of von-Willebrand factor (vWF) and vascular endothelial growth factor (VEGF) in pterygium, and in normal superior bulbar conjunctiva. Methods. 23 human samples from pterygium and the superior bulbar conjunctiva were stained using rabbit anti-vWF and anti-VEGF antibodies. The density of vWF and VEGF positive vessels, VEGF staining intensity and the number of VEGF positive stromal, epithelial and vascular endothelial cells were evaluated. Results. Pterygium specimens had higher average vWF and VEGF positive microvascular counts per high power field (P = 0.0012), higher average VEGF staining intensity scores in epithelial, stromal and endothelial cells (p < 0.0001) and higher VEGF positive cell counts (P < 0.0001) than normal conjuctiva. Conclusions. Over-expression of VEGF in pterygium tissue, together with the abundance of vWF-stained new vessels, may support previous suggestions that angiogenesis may play a role in the formation of pterygium.

Development of exudative age-related macular degeneration after cataract surgery

The macular status of patients with findings consistent with early dry age-related macular degeneration (AMD) who underwent an extracapsular cataract extraction with intraocular lens implantation was evaluated by fundoscopy and fluorescent angiography pre-operatively and during the first post-operative year. Five patients who developed the exudative form of AMD, and who represent the problems arising when treating patients with AMD and cataract, are described. Patients who received laser photocoagulation responded with recurrent choroidal neovascularisation. We suggest that patients with signs of age-related changes scheduled for cataract surgery should undergo a thorough pre- and post-operative assessment of their retinal status.

Corneal collagen cross-linking for the treatment of progressive keratoconus: 3-year prospective outcome

OBJECTIVEnTo assess the long-term effects of treatment of progressive keratoconus with ultraviolet A-riboflavin collagen cross-linking (CXL).nnnDESIGNnThis was a prospective clinical study.nnnPARTICIPANTSnSeventeen eyes of 17 patients with progressive keratoconus were treated with CXL.nnnMETHODSnPatients were examined preoperatively, at week 1, months 1, 3, 6, 9, 12, 24, and 36 after treatment. We assessed uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), refraction, biomicroscopy and fundus appearance, intraocular pressure, endothelial cell density (ECD), corneal topography, minimal corneal thickness (MCT), macular optical coherence tomography, axial length, and corneal biomechanics with the ocular response analyzer.nnnRESULTSnComparing the 36-month time point results with pretreatment values, we found that UCVA and BSCVA were unchanged. Steepest meridian keratometry (D) and mean cylinder (D) did not show significant change compared with pretreatment values but showed a slight increase as compared with the 24-month time point (53.9 vs 51.7 vs 52.5, and 10.5 vs 8.1 vs 9.2 before, at 24 months, and at 36 months, respectively). Axial length (mm) showed an elongation trend throughout the follow-up period (24.56 vs 24.61 [p = 0.04] vs 24.71 [p = 0.05], before, at 24 months, and at 36 months, respectively). No significant change was observed in ECD, corneal hysteresis and corneal resistance factor, MCT, or foveal thickness.nnnCONCLUSIONSnThree-year results after CXL show stable visual acuity, stable corneal thickness, and stable corneal biomechanical parameters. The decreasing trend in keratometry values that was observed during the first 2 years after CXL was no longer evident. Longer follow-up is needed to decide whether it is a first sign of loss of achieved stability and resumption of keratoconus progression.

Results of combined phacoemulsification and trabeculectomy with mitomycin C in pseudoexfoliation versus non-pseudoexfoliation glaucoma

BackgroundThis study was conducted to evaluate the rate of intraoperative and postoperative complications and the outcome of combined phacoemulsification (phaco) with posterior chamber (PC) intraocular lens (IOL) and trabeculectomy in patients with pseudoexfoliation (PXF) versus non-pseudoexfoliation (non-PXF) glaucoma.MethodsOne hundred and four eyes of 88 patients with combined phaco, PC IOL and trabeculectomy with mitomycin C (MMC) were included in the study. MMC 0.02% was applied for 1xa0min in all cases. Main outcome measures were rate of intraoperative and postoperative complications, intraocular pressure (IOP) and visual acuity (VA). Success rates were determined via Kaplan–Meier survival analysis. Surgical success for both groups was defined as IOP being less than 21xa0mmHg with no treatment or less than 16 with one topical pressure-reducing agent allowed.ResultsThe PXF group included 55 (52.9%) eyes and the non-PXF group 49 (47.1%) eyes. Transition to extracapsular cataract extraction (ECCE) occurred in 12.7% of the PXF group, and in 6.1% of the non-PXF group (P=0.16). The occurrence of vitreous loss did not differ significantly between the groups. Patients of both groups had a significant IOP reduction after surgery (P=0.0001). At the end of postoperative follow-up, the success rate approached 83.6% in the PXF group and 83.7% in the non-PXF group. The most common postoperative complications were hyphema (14.5%) in the PXF group and fibrin (14.3%) in the non-PXF group.ConclusionsAlthough transition to ECCE was more frequent in the PXF than in the non-PXF group, there was no significant difference in the rate of complications between PXF and non-PXF eyes.

Linear deposits on the surfaces of intraocular lenses implanted through a hexagonal cartridge which mimic scratches/cracks on the lenses.

Aim: To describe unique linear deposits on the surface of posterior chamber intraocular lenses (IOLs) occurring after implantation through a hexagonal cartridge. Methods: Five ACR6D SE IOLs (Corneal Laboratories, Pringy, France) were injected/implanted through hexagonal cartridges. Two of these were injected into a petri dish and the remaining three were inserted into the evacuated capsular bag of cadaver eyes. In addition, three other ACR6D SE IOLs were injected into a petri dish through round cartridges. The latter served as controls. Results: All lenses that were injected/implanted through the hexagonal cartridges demonstrated linear deposits on the posterior surface of the IOL optic component. The IOLs that were injected through the round cartridges had no deposits. All the hexagonal cartridges showed signs of internal cracking. None of the round cartridges were cracked. Conclusion: Implantation of at least one IOL model, the ACR6D SE IOL, through a hexagonal cartridge can result in linear deposits on the posterior optical surface of the IOL. The shape of the cartridge appears to be a significant factor in causing the depositions.

Outcome of posterior capsulotomy in late capsular block syndrome with posterior capsular opacification

Background:u2002 To examine the results of neodymium:yttrium‐aluminium‐garnet (Nd:YAG) laser posterior capsulotomy in eyes with late or previously unrecognized capsular block syndrome (CBS) presenting with deterioration of vision owing to posterior capsular opacification (PCO).

The course of surface deposits on a hydrophilic acrylic intraocular lens after implantation through a hexagonal cartridge

Aim: To evaluate the outcome of surface deposits that occurred during implantation of hydrophylic acrylic intraocular lenses (IOLs) through a hexagonal cartridge. Methods: Surface deposits were observed on the posterior surface of the ACR6D SE IOLs that were injected through a hexagonal cartridge filled with sodium hyaluronate 1%. All the patients were examined 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. The location of the deposits was recorded and photographed. The patients were questioned about blurred vision, glare or halos. Results: Linear or curly deposits were detected on the posterior surface of the IOL in six patients. In four patients, the deposits were peripheral and were observed 1 week postoperatively. In two patients, the deposits were noticed immediately after implantation. In one eye, they were misinterpreted as a crack in the IOL’s optic and were left in the eye. In the second patient the deposits were removed immediately after implantation with forceps. The deposits that were left after implantation (five eyes) did not resolve during 1 year of follow-up. None of the eyes developed abnormal inflammatory reaction. In three eyes the best-corrected visual acuity (BCVA) was 6/6. In the other three eyes the BCVA was 6/12. None of the patients experienced any visual disturbance. Conclusions: Implantation of the ACR6D SE IOL through a hexagonal cartridge can lead to the formation of deposits on the posterior surface of the lens. The deposits do not resolve and may resemble a crack in the IOL. The deposits left on the IOL had no clinical relevance in our patients.

Comparison of corneal endothelial cell density estimated with 2 noncontact specular microscopes.

Purpose To assess the repeatability of endothelial cell density (ECD) measurements by the EM-935 endothelial microscope and their agreement with those of the Konan-Noncon Robo SP 6000 (Noncon Robo) specular microscope. Methods We assessed the agreement between automated and semiautomated methods of analysis of the EM-935 and the Noncon Robo by measuring ECD in 40 eyes of 20 healthy subjects and calculating the 95% limits of agreement (LoA) and plotting Bland-Altman graphs. We then evaluated the repeatability of both the methods of the EM-935 by calculating the intraclass correlation coefficients (ICC) and coefficient of variation (CV). Results The mean ECD of the 40 eyes was 2531±244 cells/mm2 for Noncon Robo and 2483±159 cells/mm2 for EM-935-Automated. The difference between these 2 methods was not statistically significant. The mean ECD for EM-935-semiautomated was 2635±190 cells/mm2 and was statistically significantly higher than the 2 other methods (p<0.001). The 95% LoA were −435 to 339 cells/mm2 for the Noncon Robo and EM-935-Automated, −230 to 438 cells/mm2 for the Noncon Robo and EM-935-semiautomated, and −347 to 43 cells/mm2 for the EM-935-Automated and EM-935-semiautomated. Repeatability was better for EM-935-semiautomated method compared with automated method as expressed by ICC (95% CI) of 0.80 (0.52–0.95) vs 0.50 (0.09–0.84) and coefficient of variation of 2.43% vs 2.85%, respectively. Conclusions The EM-935 specular microscope showed better repeatability for the semiautomated mode compared with the automated mode. Although measurement agreement with the Noncon Robo was somewhat better for the semiautomated mode, agreement was only moderate for both methods. This leads us to recommend that these instruments should not be used interchangeably.

Self-inflicted (factitious) conjunctivitis

PURPOSEnTo describe the diagnosis and management of self-inflicted factitious conjunctivitis in conscripted soldiers.nnnDESIGNnProspective, noncomparative, consecutive case series.nnnPARTICIPANTSnSeventeen conscripted soldiers.nnnMETHODSnSoldiers with chronic conjunctivitis (>3 weeks) were referred by ophthalmologists, and cases of shorter duration were referred by primary-care physicians. All cases underwent thorough ophthalmic and systemic history and examination, as well as questioning regarding their military units, military duties, and social background. Exclusion criteria were any condition that may cause conjunctivitis. Inferior fornix specimen microscopy and culture and eye photography were performed in most cases. In cases suspected of self-inflicted conjunctivitis all medication, besides lubricant drops, was stopped. Underlying psychosocial problems were investigated and managed. Cases were followed for at least 3 months after resolution of the conjunctivitis, at which point the diagnosis was confirmed, and the case entered the analysis.nnnMAIN OUTCOME MEASURESnResolution of the conjunctivitis.nnnRESULTSnSeventeen consecutive cases of self-inflicted conjunctivitis, 8 of long duration and 9 of short duration, were studied. All cases demonstrated inconsistent clinical findings. The ocular signs most suggestive of self-inflicted conjunctivitis were purulent discharge purposely left on the lashes and periorbital skin, discharge more severe than in conjunctival hyperemia, less conjunctival chemosis than in hyperemia, mainly inferior conjunctival involvement, and an uninvolved cornea. Five of the 8 chronic cases had significant underlying psychologic or social problems. Their conjunctivitis resolved only after their underlying problems were addressed. Two cases admitted introducing freshly scraped dental plaque into the lower conjunctival sac. In the remaining 15 the similarity of the clinical findings suggested that a similar method was used.nnnCONCLUSIONSnIn the context of a subject standing to gain by assuming the sick role and after exclusion of ocular pathology, self-inflicted conjunctivitis can be reliably diagnosed by noting the characteristic clinical profile. Effective management includes addressing the underlying psychologic and social problems.