Georgios D. Panos

Effect of ranibizumab on serous and vascular pigment epithelial detachments associated with exudative age-related macular degeneration.

Purpose To report the effect of intravitreal ranibizumab therapy for serous and vascular pigment epithelial detachments (PED) associated with choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD). Methods In a prospective study, best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were collected for 62 eyes of 62 patients, with serous or vascular PED associated with CNV secondary to AMD. Intravitreal ranibizumab 0.5 mg was administered with a loading phase of three consecutive monthly injections, followed by monthly review with further treatment, as indicated according to the retreatment criteria of the PrONTO study. The change in visual acuity and PED height from baseline to month 12 after the first injection was determined. Results Sixty-one eyes of 61 patients (one of the patients developed retinal pigment epithelial tear and was excluded from the study) were assessed at the 12-month follow-up examination. There were two types of PED, including vascular PED in 32 patients (Group A) and serous PED (Group B) in 29 patients. The mean improvement of mean BCVA from baseline to 12 months was 0.09 logMAR (Logarithm of the Minimum Angle of Resolution) in Group A and 0.13 logMAR in Group B. Both groups showed significant improvement of the mean BCVA 12 months after the first injection compared with the baseline value (P < 0.05). In relation to the PED height, the mean decrease of mean PED height from baseline to 12 months was 135 μm in Group A and 180 μm in Group B. Both groups showed significant reduction of the PED height during the follow-up period (P < 0.01). The PED anatomical response to ranibizumab was not correlated with the BCVA improvement in any of the groups. Apart from one patient who developed pigment epithelial tear no other complications were documented. Conclusion Ranibizumab is an effective and safe treatment for improving vision in patients with serous and vascular PED, although the anatomical response of the PED to ranibizumab may not correlate directly with the visual outcome.

Transepithelial Corneal Cross-linking Using an Enhanced Riboflavin Solution.

PURPOSE To assess the efficacy of a modified high concentration riboflavin solution containing benzalkonium chloride 0.01% for transepithelial corneal cross-linking (CXL). METHODS In this prospective, interventional multicenter cohort study, 26 eyes of 26 patients with documented progressive keratoconus who underwent transepithelial CXL were included. Follow-up at 6 and 12 months postoperatively included slit-lamp examination, uncorrected and corrected distance visual acuity (logMAR), maximum keratometry (Kmax), and corneal pachymetry (corneal thinnest point) as determined by Scheimpflug imaging. Statistical analysis was performed using repeated measures analysis of variance and the Friedman test for parametric and non-parametric data, respectively. P values less than .05 were considered significant. RESULTS Kmax did not change significantly at postoperative months 6 and 12. Changes in corneal thinnest point did not change postoperatively over 12 months. Uncorrected and corrected distance visual acuity did not change postoperatively. Progression (defined by an increase in Kmax greater than 1.00 diopter occurred in 46% of eyes at 12 months. Corneal epithelial defects were observed in 46% of the patients and marked punctate corneal epitheliopathy/loose epithelium in 23% of the patients in the immediate postoperative period. No corneal infection, sterile infiltrates, or haze were observed. CONCLUSIONS Transepithelial CXL with an enhanced riboflavin solution did not effectively halt progression of keratoconus. Significant epithelium damage was evident in the immediate postoperative period. [J Refract Surg. 2016;32(6):372-377.].

Efficacy of autologous platelets in macular hole surgery

The introduction of optical coherence tomography has allowed accurate measurement of the size of macular holes. A retrospective consecutive review was performed of 21 patients undergoing macular hole repair with vitrectomy, gas tamponade, and autologous platelet injection and we assessed the effect of macular hole parameters on anatomic and functional outcomes. We looked at the demographic features, final visual outcome, and anatomical closure. Twenty-one patients were included in the study. They underwent routine vitrectomy with gas tamponade (C3F8) and injection of autologous platelets. All patients were advised to maintain a facedown posture for 2 weeks. Anatomical closure was confirmed in all cases and 20 out of 21 of patients had improved postoperative visual acuity by two or more lines. In our series, the macular hole dimensions did not have much effect on the final results. The use of autologous platelets and strict facedown posture seems to be the deciding factor in good anatomical and visual outcome irrespective of macular hole dimensions.

Effect of Tafluprost 0.0015% on Central Corneal Thickness in Patients With Primary Open-angle Glaucoma

Abstract Purpose: To evaluate the effect of tafluprost on the central corneal thickness (CCT) in patients with primary open-angle glaucoma (POAG). Methods: This was a prospective study and included 100 eyes of 54 patients with POAG. All patients received tafluprost 0.0015% (Saflutan®) once daily in one or both eyes. CCT was measured by using noncontact pachymetry prior to the treatment and after 6 and 12 months. Results: Mean CCT of all treated eyes (n = 100) was 547.79 ± 29.48 μm at baseline, 535.61 ± 26.54 μm after 6 months and 533.55 ± 26.45 μm after 12 months (Student’s t test, p < 0.0001). Ninety-three percent of all treated eyes showed a decrease of CCT. CCT reduction was more significant within the first six months of the treatment period (Student’s t test, p < 0.0001). After 12 months, a CCT reduction >25 μm occurred in 5% of all treated eyes. There was a significant positive correlation between the magnitude of corneal thinning and the initial CCT (Pearson, r = 0.49, p < 0.0001) but not between the magnitude of corneal thinning and intraocular pressure (IOP) reduction (Pearson, r = 0.145, p = 0.15). Discussion: Long-term use of tafluprost may decrease the CCT in patients with POAG. Consequently, clinicians must be aware of prolongated CCT variations that may arise throughout the follow-up period for proper IOP targeting and management.

Corneal topographical and biomechanical variations associated with hypothyroidism.

There is increasing evidence that hormonal influences may play a key role in the pathogenesis of corneal ectasia.1,2 Furthermore, transitory corneal topographical variations due to hormonal influences during pregnancy have been recently reported.3 We highlight a case of corneal topographic fluctuations associated with exacerbated hypothyroidism. A 47-year-old woman without medical history was referred for ophthalmic evaluation by an optician because of progressive loss of corrected distance visual acuity in March 2012. Corrected distance visual acuity was 6/10 in the right eye and 6/10 in the left eye. Objective refraction was -3.0/-3.0/15° in the right eye and -1.0/-5.5/170° in the left eye. Slit-lamp examination and fundus examination revealed normal findings bilaterally. Maximal keratometry (Kmax) readings were 49.7 diopters (D) in the right eye and 51.0 D in the left eye, as evaluated by Scheimpflug imaging (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany). Corneal thickness was 552 μm in the right eye and 542 μm in the left eye. Although Kmax was above normal, there was no indication in other Pentacam parameters that the patient was suffering from mild/forme fruste keratoconus and her cornea appeared entirely normal. Moreover, the patient provided the results of her corneal topographic evaluation performed 10 years ago in another hospital, which showed Kmax values were 46.0 D in the right eye and 46.5 D in the left eye and corneal thickness was 538 μm in the right eye and 530 μm in the left eye. The patient also complained of fatigue, anorexia, and mild depression during the past 6 months, but she did not consult any physician for these symptoms. Laboratory investigation showed a high concentration of thyroid-stimulating hormone in plasma (4.3 mUI/L), thereby confirming the diagnosis of hypothyroidism in this patient. The patient was referred to a physician for management of her hypothyroidism and her glasses were adjusted to her actual refractive values, providing corrected distance visual acuity of 10/10 bilaterally. Under thyroxine supplementation therapy, we observed a gradual reduction of the Kmax values and normalization of the thyroid-stimulating hormone plasma concentration. The fluctuations of the Kmax and corneal pachymetry measurements are depicted in Figure 1. Interestingly, measurement of corneal hysteresis and corneal resistance factor with the Ocular Response Analyzer (Reichert, Inc., Depew, New York) revealed significant worsening of the cornea on presentation, which improved after subsequent treatment with thyroxine supplementation (Figure 1). The implication of thyroid hormones in corneal physiology is increasingly being investigated. Conrad et al. reported the presence of thyroxin receptors alpha and beta in the chicken cornea,4 whereas our research group has recently documented in vitro the expression of thyroxine receptors in human cornea (unpublished data). Interestingly, a case of keratoconus progression with development of acute corneal hydrops induced by hypothyroxinemia has been reported during pregnancy.5 Hypothyroidism occurs mostly in middle-aged women with a prevalence of 0.6 to 12 per 1,000

Ranibizumab for the treatment of degenerative ocular conditions

Degenerative ocular conditions, such as age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and myopic degeneration, have become a major public health problem and a leading cause of blindness in developed countries. Anti-vascular endothelial growth factor (VEGF) drugs seem to be an effective and safe treatment for these conditions. Ranibizumab, a humanized monoclonal antibody antigen-binding fragment, which inhibits all biologically active isoforms of VEGF-A, is still the gold standard treatment for the majority of these pathological entities. In this review, we present the results of the most important clinical trials concerning the efficacy and safety of ranibizumab for the treatment of degenerative ocular conditions.

Macular hole formation after toxoplasmic retinochoroiditis

A 56-year-old female patient presented with toxoplasmic retinochoroiditis (TR) in the right eye. Optical coherence tomography revealed a full-thickness macular hole (MH) in the affected eye. Fluorescence angiography and indocyanine green-angiography disclosed focal choroidal ischaemia in the area of inflammation. Heidelberg retinal flowmetry confirmed the significant hypoperfusion in this area. Proper medication was administered. Ophthalmological examination 4 weeks later revealed an improvement of the clinical findings without visual restoration. This case supports the clinical hypothesis that retinochoroidal ischaemia due to TR may induce the development of MH, indicating that patients with TR may have a certain risk for MH formation.

Idiopathic macular epiretinal membrane surgery with simultaneous internal limiting membrane peeling. The experience of the Fribourg Eye Clinic.

PURPOSE To evaluate the visual and anatomical outcomes following idiopathic macular epiretinal membrane (ERM) removal. METHODS A retrospective study of 30 eyes operated for idiopathic ERM was conducted. Pars plana vitrectomy was combined with ERM removal and indocyanine green (ICG) assisted internal limiting membrane (ILM) peeling. RESULTS Mean preoperative best corrected visual acuity (BCVA) was 0.4 logMAR (0.4 in decimal units), whereas mean postoperative BCVA was 0.26 logMAR (0.6 in decimal units). Mean preoperative foveal thickness was 392 μm, whereas mean postoperative foveal thickness was 305 μm. A statistically significant difference was observed between preoperative and postoperative BCVA (p <0.001, Students t-test). Optical coherence tomography (OCT) measurement of postoperative foveal thickness revealed a significant decrease in thickness (p <0.0001, Students t-test), however, no correlation was observed between postoperative BCVA and postoperative foveal thickness (Pearsons correlation coefficient, r = 0.228; p = 0.22). CONCLUSIONS Although significant visual acuity improvement and anatomical recovery was detected after idiopathic ERM removal, full restoration of foveal thickness was not achieved in the majority of cases.

Comparative Study of Refractive Errors, Strabismus, Microsaccades, and Visual Perception Between Preterm and Full-Term Children With Infantile Cerebral Palsy

The purpose of this study was to examine the refractive status, orthoptic status and visual perception in a group of preterm and another of full-term children with cerebral palsy, in order to investigate whether prematurity has an effect on the development of refractive errors and binocular disorders. A hundred school-aged children, 70 preterm and 30 full-term, with congenital cerebral palsy were examined. Differences for hypermetropia, myopia, and emmetropia were not statistically significant between the 2 groups. Astigmatism was significantly increased in the preterm group. The orthoptic status was similar for both groups. Visual perception was markedly reduced in both groups, but the differences were not significant. In conclusion, children with cerebral palsy have impaired visual skills, leading to reading difficulties. The presence of prematurity does not appear to represent an additional risk factor for the development of refractive errors and binocular disorders.

Pellucid marginal degeneration and keratoconus; Differential diagnosis by corneal topography

or conjunctival ballooning, as is sometimes seen after peribulbar blocks. As seen in the figure, the conjunctival bleeding itself may present as a small blob with a diameter of nearly 1mm. In cases in which the hemorrhage becomes even larger, accuracy will decrease. As a rule of thumb, for an eye with a normal corneal diameter, an uncertainty of 1 mm at the limbus will result in an uncertainty of 10 degrees in defining the steep meridian. We believe this is too much when using toric IOLs.dOliver Findl, MD, MBA