Assaf Kratz

Burkitt's lymphoma presenting as oculomotor palsy in an HIV-positive patient

Purpose To report a case of Burkitts lymphoma (BL) in an HIV-positive patient presenting as complete third nerve palsy. Methods Interventional case report. A 34-year-old man presented with headache, left eye pain, diplopia, and complete ptosis of several hours’ duration. Left eye examination disclosed complete third nerve palsy with pupillary involvement. Significant hepatomegalia was noted at physical examination and computed tomography (CT) scan of the abdomen showed multiple solid lesions. Results Liver biopsy was consistent with Burkitts lymphoma. Bone marrow biopsy was normal. Brain imaging was normal. Work-up also revealed positivity for human immunodeficiency virus. Chemotherapy treatment was started. Two months later, ocular motility examination was normal. Conclusions Although BL affects the central nervous system very rarely, BL should be considered in any immunosuppressed patient presenting with diplopia or ophthalmoparesis.

Eye injuries due to tractor wheel explosion: report of two cases

CASE REPORT We describe 2 patients who sustained eye injuries when tractor wheels exploded while being inflated. Descriptions of ocular involvement from such accidents are rare in the literature. One of our patients experienced severe eye trauma requiring enucleation. In the second case, despite trauma to both eyes, 20/20 vision was recovered. COMMENTS Injuries from exploding tires are compared to those seen in the context of air-bag deployment, and safety recommendations are discussed.

Optic nerve head assessment: comparison of Cirrus optic coherence tomography and Heidelberg Retinal Tomograph 3

The purpose of this study was to analyse the relationship between optic nerve head (ONH) parameters measured by spectral domain optical coherence tomography and confocal scanning laser ophthalmoscope.

Pars Plana Vitrectomy Versus Combined Pars Plana Vitrectomy–Scleral Buckle for Secondary Repair of Retinal Detachment

BACKGROUND AND OBJECTIVE To investigate the optimal technique for repairing recurrent rhegmatogenous retinal detachments. PATIENTS AND METHODS A 2-year retrospective review of recurrent rhegmatogenous retinal detachments by 23-gauge pars plana vitrectomy (PPV) or combined 23-gauge PPV with encircling scleral buckling was performed. The primary outcome was anatomical success. The secondary outcome was the likelihood of achieving a final best corrected visual acuity of 6/12 or better at 6-month follow-up. RESULTS Anatomical success was achieved in 65.2% (95% CI, 53.4% to 75.4%) of the PPV group versus 74.3% (95% CI, 57.9% to 85.8%) of the PPV-scleral buckling group with one additional procedure (not statistically significant). There was no significant difference in the likelihood of achieving a final acuity of at least 6/12 between groups at 6-month follow-up. CONCLUSION The results of our study do not demonstrate a superiority of method of primary repair, or of one method of secondary repair, over another.

The effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations

OBJECTIVE To assess the effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations. STUDY DESIGN Retrospective comparative study. PARTICIPANTS Twenty-four eyes of 24 consecutive pseudophakic patients with symptomatic PCO, who presented for Nd:YAG laser posterior capsulotomy at our clinic, were included in this study. METHODS The wave front aberrations of the entire optical path of 24 pseudophakic eyes of 24 patients before, and 1 month after, Nd:YAG laser posterior capsulotomy were measured using the Nidek Optical Path Difference (OPD) scan aberrometer. Total, tilt, and high-order aberrations, and total coma, total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were analyzed statistically. Secondary measures included changes in visual acuity and refraction, and repeatability of wave front measurements in the fellow eye. RESULTS Before Nd:YAG laser posterior capsulotomy, the total higher-order aberrations root mean-square (RMS) wave front aberration was 2.08 (SD 2.20) microm, with total trefoil being a major contributor at 1.19 (SD 1.15) microm. One month after the procedure, significant decreases in total, tilt, and high-order aberrations, and total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were noted (p< 0.05). No significant changes in total coma aberrations were found (p > 0.05). Additionally, significant improvement in visual acuity without significant change in refraction was observed. No statistically significant differences were detected in any of the RMS values of wave front measurements taken 1 month later in the fellow eye. CONCLUSIONS Nd:YAG laser posterior capsulotomy causes significant decrease in ocular wave front aberrations measured using the Nidek-OPD scan aberrometer, which can account for a better optical quality after the procedure. Further research to examine the impact of wave front aberrations in visual function after Nd:YAG laser posterior capsulotomy is needed.

Retinal nerve fibre layer imaging: comparison of Cirrus optical coherence tomography and Heidelberg retinal tomograph 3.

The purpose of this study was to analyze the relationship between retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography and confocal scanning laser ophthalmoscope.

Planned posterior assisted levitation in severe subluxated cataract: surgical technique and clinical results.

We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

A Novel Method for Laser Suture Lysis Using Multispot Laser System

Although often uncomplicated, the current technique for laser suture lysis after filtration surgery requires patient cooperation and appropriate care taken by the surgeon. In cases with suboptimal cooperation, steadying the 50-µm laser aiming beam exactly over a thin 10-0 nylon suture, can be exhausting, difficult for both the patient and the surgeon; it may prove to be ineffective or even precipitate complications. We describe a novel method for laser suture lysis using a multispot laser system, which requires less patient cooperation and surgeon skills and yields excellent results.