D. Díaz-Valle

Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract

Aims To evaluate the mid-term efficacy and safety of the GTS-400-iStent combined with phacoemulsification in patients with cataract and open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods Prospective, non-comparative, uncontrolled, interventional case series study. Subjects underwent phacoemulsification and two GTS-400 implantation. Efficacy outcomes: intraocular pressure (IOP) and antiglaucoma medications. Safety outcomes: complications, best-corrected visual acuity and endothelial cell count (ECC). Follow-up was 1 year. Results 20 patients were enrolled (mean age: 75.1±8.6 years). Mean medicated baseline IOP was 19.95±3.71 mm Hg and 26±3.11 mm Hg without medication. Mean final IOP was 16.75±2.24, determining a final IOP decrease of 35.68% (9.42±3 mm Hg; p<0.001), from baseline washout IOP. Mean number of medications fell from 1.3±0.66 to 0.3±0.57 (P<0.001). 75% of patients were off medications at one year. Mean ECC decreased from 2289.64±393.5 cells/mm2 to 1986.95±520.58 cells/mm2. Conclusions Combined cataract surgery with implantation of GTS-400-iStent seems to be an effective and safe procedure.

Endothelial morphological and functional evaluation after cataract surgery.

Purpose To assess endothelial barrier function, morphological appearance and corneal thickness three months after cataract surgery in order to evaluate intraoperative endothelial damage. Methods Endothelial permeability was examined by fluorophotometry, and contact specular microscopy and corneal pachymetry measurements were made in 40 patients (40 eyes) with senile, non-complicated cataracts one month before and three months after cataract surgery. Twenty eyes underwent uneventful phacoemulsification (Group 1) and 20 uneventful extracapsular cataract extraction (ECCE) with continous curvilinear capsulotomy (Group 2). Results were analyzed using the two-tailed Students t test, analysis of variance, and multifactorial and regression analysis. Results There was a significant postoperative increase in endothelial permeability in both groups (p<0.001), but no real differences between the postoperative values (p=0.07). Mean cell loss was 15.2% in ECCE and 18.3% in phacoemulsification (p=0.4). There was a significant linear correlation between ultrasound time, cell loss and functional damage. Postoperative pachymetric measurements were not significant. Conclusions Endothelial response showed no differences between the surgical techniques. Endothelial barrier function remained disturbed in spite of the apparent morphological stabilization. Corneal pachymetry is not useful for assessing postoperative endothelial changes.

Intravitreal bevacizumab (Avastin®) for radiation retinopathy neovascularization

patients with Leber’s hereditary optic neuropathy harbouring the mitochondrial DNA G11778A mutation. Ophthalmic Res 35: 224–231. Kakiuchi-Matsumoto T, Isashiki Y, Ohba N, Kimura K, Sonoda S & Unoki K (2001): Cytochrome P450 1B1 gene mutations in Japanese patients with primary congenital glaucoma. Am J Ophthalmol 131: 345– 350. Marquardt A, Stohr H, Passmore LA, Kramer F, Rivera A & Weber BH (1998): Mutations in a novel gene, VMD2, encoding a protein of unknown properties cause juvenile-onset vitelliform macular dystrophy (Best’s disease). Hum Mol Genet 7: 1517– 1525. Sarfarazi M & Stoilov I (2000): Molecular genetics of primary congenital glaucoma. Eye 14: 422–428. Thompson JG, Gibson TJ, Plewniak F, Jeanmougin F & Higgins DG (1997): The clustal_x–Windows interface: flexible strategies for multiple sequence alignment aided by quality analysis tools. Nucl Acids Res 25: 4876–4882.

Assessment of lower tear meniscus measurements obtained with Keratograph and agreement with Fourier-domain optical-coherence tomography

Aims To compare intraobserver repeatability and interobserver and intersession reproducibility of lower tear meniscus height measurements (LTMH) obtained with the new Keratograph 5M and a Fourier-domain optical-coherence tomography (OCT; Spectralis OCT) and to assess the agreement between the two devices. Methods This is a observational cross-sectional study. Thirty eyes of 30 normal subjects were randomly imaged twice with both devices in our setting. Two examiners randomly made LTMH measurements using the devices. To assess intraobserver repeatability and interobserver and intersession reproducibility within-subject SD (Sw), test–retest repeatability, coefficient of variation (CoV) and intraclass correlation coefficients (ICCs) were calculated. Agreement between both devices was also determined. Results Average LMTH for Keratograph was 235.46±57.61u2005μm, whereas the mean LTMH measured by OCT was 245.84±67.18u2005μm. Intraobserver repeatability and interobserver and intersession reproducibility were moderate with Keratograph (CoV ≥0.16%, ≥0.19%, ≥0.17% and ICC ≤0.83, ≤0.76, ≤0.83, respectively) and high for the Spectralis OCT (CoV ≤0.13%, ≤0.12%, ≤0.11% and ICC ≥0.9, ≥0.92, ≥0.92, respectively). No statistically significant difference was detected in mean LMTH measurements made with both devices, although correlation was low (CoV 0.25%, ICC 0.55). Conclusions Spectralis OCT LTMH measurements were more reliable than the new Keratograph data. Agreement between the devices was poor.

Effect of pharmacologic pupil dilation on OLCR optical biometry measurements for IOL predictions.

Purpose To determine the possible influence of pupil dilation on intraocular lens (IOL) power predictions made using optical biometry with Lenstar LS 900® (Haag-Streit AG, Koeniz, Switzerland). Methods A total of 72 eyes of 72 patients scheduled to undergo cataract surgery were prospectively examined using the optical low-coherence reflectometry (OLCR) optical biometer before and after pupil dilation with tropicamide 1%. The measurements made were axial length, central corneal thickness, anterior chamber depth (ACD), lens thickness, mean keratometry, corneal diameter (CD), and pupil diameter. Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between the 2 measurement modes (with and without dilation) was assessed by calculating intraclass correlation coefficients (ICC) and constructing Bland-Altman plots. Results The mean age of the patients was 74.71 ± 7.53 years (range 56–90). Among the variables determined, only ACD varied significantly according to pupil dilation (p<0.001). The ICC data revealed excellent intraobserver correlation between measurements made with and without dilation, except for CD. The IOL power predictions were unmodified. Conclusions The use of pupil dilation does not seem to influence measurements and IOL predictions made using this OLCR optical biometer.

Simultaneous optic and vestibulocochlear syphilitic neuropathy in a patient with HIV infection

BackgroundThe purpose of this report is to present a case of optic and vestibulocochlear neuropathy as a manifestation of concurrent HIV and syphilis coinfection. This is an interventional case report of a 37-year-old man who complained of blurry central vision in his left eye and hearing loss in his left ear over the past 2u2009weeks.FindingsVisual acuity was 20/20 in both eyes, and the anterior segment was normal in both eyes without relative afferent pupillary defect. Fundoscopy revealed swelling of the left optic disc. Optic coherence tomography and the Heidelberg retina tomograph confirmed and quantified the oedema of the left optic disc. An audiometry showed a left sensorineural deafness. Serological examinations disclosed confirmed HIV and syphilis infection. Magnetic resonance imaging of the brain showed no abnormalities. Properly treated with intravenous penicillin, the lesions resolved.ConclusionsSimultaneous optic and auditive involvement can be the first manifestation of syphilitic and HIV coinfection. To our knowledge, this report is the first to describe the rare occurrence of syphilitic optic neuritis and ipsilateral affectation of the vestibulocochlear nerve.

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer

PURPOSEnTo determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700©; Carl Zeiss Meditec, Jena, Germany).nnnPROCEDURESnEighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots.nnnRESULTSnMean patient age was 75.17±7.54 years (range: 57-92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation.nnnCONCLUSIONSnThe use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700© measurements. However, it does not affect mean IOL power calculation.

The role of tocilizumab in the treatment of inflammatory diseases of the eye and orbit: A useful alternative

PURPOSEnWith uveitis being one of the leading causes of blindness worldwide, biological therapies have arisen as an option for the treatment of refractory cases based on good results shown in clinical practice. The goal of this study is to provide a systematic review of current knowledge of the role and possible uses of tocilizumab in the field of ophthalmology.nnnMATERIALS AND METHODSnWe performed a search for records reporting the use of tocilizumab for various diseases in MEDLINE (PubMed and OVID). We conducted an analysis of several individual studies and their reported individual patient data (82 eyes of 45 patients) published from 2011 to 2017.nnnCONCLUSIONSnTocilizumab may prove to be an effective choice for the treatment of a variety of ocular conditions such as refractory uveitis, inflammatory macular edema, vitreo-retinal tumors and thyroid orbitopathy, leading to control of the inflammation in these patients. Further studies need to be conducted to establish its safety and efficacy.

Fibrin glue conjunctival autograft for primary pterygium: Overall outcomes and outcomes in expert versus trainee ophthalmologists

INTRODUCTIONnTo determine outcomes of conjunctival autograft attached with fibrin glue (FG) for primary pterygium, and compare these outcomes in expert versus closely supervised trainee ophthalmologists.nnnMETHODSnThis was a retrospective, comparative, non-randomized, interventional study. Patients were recruited among those with primary nasal pterygium undergoing FG conjunctival autograft. Surgery was performed by expert (136 eyes) or closely supervised trainee (128 eyes) ophthalmologists. Mean follow-up was 7.82±8.23months. Main outcome measures were recurrence rate, reoperation rate and complications.nnnRESULTSnThe study sample comprised 264 eyes of 225 patients. Participants were of mean age 47.09±12.89years; 46.7% were male, 28.4% Caucasian and 70.5% Hispanic. Recurrence was recorded in 6.4%: 5.9% in the expert group and 7% in the trainee group (P=0.704) and reoperation in 1.9%: 0.7% and 3.1% (P=0.202), respectively. Both groups showed similar rates of complications such as transient graft edema, graft dehiscence, hematoma or ocular hypertension. Reoperation was slightly more frequent in patients younger than 40years (P=0.064).nnnCONCLUSIONSnGood outcomes were observed for FG conjunctival autografting in primary pterygium surgery, with no differences recorded between supervised trainee and expert surgeons. Our findings suggest the need to supervise pterygium surgeries during training.

Expulsive total iridodialysis through microincision phacoemulsification wound

Two weeks after microincision cataract surgery, a 74-year old patient was seen in our center for pain and visual acuity (VA) loss after blunt orbital trauma. He presented with VA of light perception and localized pain. Slit lamp examination revealed total hyphema (Fig. 1), negative Seidel sign, eyelid swelling and intraocular pressure (IOP) of 38 mmHg. Echography ruled out retinal detachment or involvement of the intraocular lens (IOL) and orbital CT scan showed fractures of the inferior and nasal wall of the orbit without muscle involvement. The patient was treated with acetazolamide 250 mg, potassium supplements, timolol + brimonidine, atropine and dexamethasone drops. After several follow up visits that allowed for progressive weaning of medications, the work-up showed complete resolution of the hyphema, revealing a 360◦ absence of the iris and blood debris inside the corneal incision (Fig. 2). The IOL, lens capsule, Zinn’s zonules and ciliary processes were all intact (Figs. 3, 4). The VA reached 0.4 Snellen and the IOP was 12 mmHg. Several hypotheses have been proposed to explain the few cases found in the literature [1—9]. They include