Ioannis Halkiadakis

Course of Macular Edema in Uveitis under Medical Treatment

Objective: To describe the response of uveitic macular edema to various treatment methods using optical coherence tomography (OCT). Methods: This is a prospective study of consecutive uveitis patients with macular edema in at least one eye. The patients received medical treatment. Best corrected Snellen Visual Acuity (BCVA) and tomographic features of the macula, including macular thickness measurement, were obtained at one, three, six, and 12 months after commencing treatment. Results: Eighty-one eyes of 58 patients were analyzed. Complete resolution of macular edema occurred in 38 eyes (47%). The average BCVA was 20/34 logarithm of minimum angle of resolution (-logMAR, 0.2 ± 0.3) upon study entry and 20/27 (-logMAR, 0.13 ± 0.29) upon study completion. The difference was statistically significant (p = 0.04). The corresponding mean retinal thickness at the central fovea was 319 ± 150 μm at the beginning of the study compared to 241 ± 125 μm at 12 months (p < 0.001). A weak but statistically significant correlation between the reduction of macular thickness and the improvement of BCVA (r = 0.3, p = 0.01) was found. Thirteen of the 43 eyes (30%) with persistent macular edema had a more than 15% reduction of macular thickness compared to baseline, whereas 10 eyes (23, 3%) had a more than 15% increase in macular thickness. Statistical analysis indicated that the presence of an epiretinal membrane and an OCT pattern of diffuse macular edema was a significant factor associated with medical treatment failure. Conclusion: This study demonstrates the overall favorable visual prognosis of uveitic macular edema under medical treatment. The presence of an epiretinal membrane is an important factor associated with medical treatment failure.

Comparison of dynamic contour tonometry with Goldmann applanation tonometry in glaucoma practice.

Purpose:  To compare intraocular pressure (IOP) readings taken using dynamic contour tonometry (DCT) with IOP readings taken with Goldmann applanation tonometry (GAT) in eyes with glaucoma or ocular hypertension.

Intravenous Pulse Methylprednisolone Therapy for Acute Treatment of Serpiginous Choroiditis

Purpose: To evaluate the safety and efficacy of high-dose intravenous steroid therapy (HDIST) for the acute treatment of vision-threatening serpiginous choroiditis. Methods: Retrospective review of the records of five patients with serpiginous choroiditis who were treated with HDIST (1 g methylprednisolone for three days) in addition to their standard immunosuppressive treatment. The visual acuities and improvement of ocular signs after HDIST were evaluated. Results: Twelve episodes of macula-threatening choroiditis in five patients with serpiginous choroiditis were treated during a seven-year period. All patients responded to HDIST with evidence of a decrease in intraocular inflammation immediately after and complete restoration of visual acuity within 10 days of commencing treatment. In one patient, medical intervention was required because of gastric distress. During the follow-up, three out of five patients experienced new attacks and two patients developed subretinal neovascularization. Conclusion: HDIST is effective in controlling severe vision-threatening serpiginous choroiditis and in improving visual function in a short period of time. However, the effect of this treatment in long-term disease control is uncertain.

Comparison of optical coherence tomography and scanning laser polarimetry in glaucoma, ocular hypertension, and suspected glaucoma.

BACKGROUND AND OBJECTIVE To compare the performance of the newest generation optical coherence topography (OCT) and scanning laser polarimetry with variable corneal compensation (SLP-VCC) in eyes with glaucoma, ocular hypertension, and suspected glaucoma. PATIENTS AND METHODS One eye each of 84 patients (30 with glaucoma, 26 with suspected glaucoma, and 28 with ocular hypertension) was included in the study. Retinal nerve fiber layer (RNFL) thickness was measured with both technologies and thickness parameters were compared in the three groups of eyes. The correspondence of RNFL thickness measurements with visual field function was also studied. RESULTS Average OCT-RNFL thickness was found to have a statistically significant difference between patients with glaucoma and either suspected glaucoma or ocular hypertension. A statistically significant correlation between the average RNFL thicknesses measured by the two different technologies was shown only in the glaucoma group. A significant correlation with visual field mean deviation was found for superior average RNFL thickness as measured by SLP and for nerve fiber indicator and average and inferior average RNFL thickness as measured by OCT in glaucomatous eyes. Regression analysis indicated nerve fiber indicator to be the most valuable factor in predicting mean deviation. CONCLUSION RNFL thickness measurements obtained with OCT and SLP-VCC correlate well only in eyes with more advanced glaucomatous damage. The nerve fiber indicator parameter derived by SLP correlated best with mean deviation.

Study of patients with ocular hypertension with scanning laser polarimetry and short-wavelength automatic perimetry.

Aims: To compare and correlate retinal nerve fiber layer (RNFL) measurements obtained by scanning laser polarimetry (SLP) with defects detected by short-wavelength automatic perimetry (SWAP) in eyes with ocular hypertension (OHT). Methods: SLP and SWAP were performed in 96 eyes of 48 consecutive patients with OHT. Results: Twenty-five eyes (26%) had SWAP visual field defects. Twenty-seven eyes (28.1%) had abnormal RNFL evaluation defined by the GDx neural network (‘number’ >29). Fourteen eyes of 10 patients (14.5%) had abnormal RNFL evaluation and SWAP visual field defects. RNFL thickness measurements were significantly reduced in eyes with abnormal SWAP. A weak but statistically significant correlation between the ‘number’ and pattern standard deviation (r = 0.3, p = 0.006) and the corrected pattern standard deviation (r = 0.3, p = 0.007) in SWAP was found. Areas of abnormal RNFL thickness corresponded to the localization of the SWAP visual field defects in corrected pattern deviation plots in 10 of the 14 eyes with defects in both tests. Conclusions: SWAP visual field defects frequently coexist and correspond with abnormalities of RNFL detected by SLP in eyes with OHT. In certain eyes, however, the two methods detect different glaucoma properties.

Relationship between short-wavelength automatic perimetry and Heidelberg retina tomograph parameters in eyes with ocular hypertension.

AIM To compare and correlate optic nerve head parameters obtained by Heidelberg retina tomograph (HRT) with short-wavelength automatic perimetry (SWAP) indices in eyes with ocular hypertension (OHT). METHODS One hundred and forty-six patients with OHT included in the present study. All subjects had reliable SWAP and HRT measurements performed within a 2wk period. The eyes were classified as normal/abnormal according to visual field criteria and Moorfields regression analysis (MRA). Correlations between visual field indices and HRT parameters were analyzed using Pearson correlation coefficient (r). RESULTS Twenty-nine eyes (19.9%) had SWAP defects. Twenty-nine eyes (19.9%) were classified as abnormal according to global MRA. Six eyes (4.1%) had abnormal global MRA and SWAP defects. The k statistic is 0.116 (P=0.12) indicating a very poor agreement between the methods. No statistical significant correlation between HRT and SWAP parameters was detected. CONCLUSION SWAP defects may coexist with abnormalities of optic disc detected by HRT in eyes with OHT. In most eyes, however, the two methods detect different glaucoma properties.

Causes and management of small pupil in patients with cataract

BACKGROUND: The purpose of the study was to present the causes and management of small pupil (<6 mm) in Greek patients with cataract. METHODS: About 1144 consecutive patients with cataract comprised the study group. The pupil size was measured after maximal dilation by means of Rosenbaum cards and Colvard pupillometer. Dilation regimen included phenylephrine 10%, tropicamide 1%, cyclopentolate 1%, and ketorolac trometamol 0.5% administered 3 times at 5 min intervals starting 1 h before surgery. The presence of possible risk factors for small pupil was recorded. The need of additional maneuvers and devices to dilate the pupil during cataract surgery was examined, and the complication rate in cases with small pupils was recorded. RESULTS: Small pupil was observed in 78 out of 1144 eyes (6.8%, 95% confidence interval = 5.2%–8.8%). Nine eyes had pupil size <4 mm (0.78%) preoperatively. Six cases (0.52%) developed intraoperative pupillary miosis. The major cause of small pupil was pseudoexfoliation (PEX) in 47.4% (37/78) of patients. No significant associations were observed regarding age, gender, history of diabetes mellitus, the maturity of cataract, and phacodonesis. Techniques for small pupil management included pupil stretching in 14 cases (17.9%), use of iris hooks in 6 cases (7.7%), iris sphincter cuts in 2 cases (2.6%), and placement of a Malyugin Ring in 4 cases (5.1%). Seven eyes (9%) with small pupil had capsular rupture versus 16 eyes (1.5%) with normal dilation (P < 0.001). CONCLUSIONS: Small pupil is not very common in Greek population, is mostly caused by PEX, and it is associated with increased complication rate.

Effect of Glaucoma Medication in Tear Film Osmolarity of Patients Without Symptoms of Ocular Discomfort

PURPOSE To evaluate tear film osmolarity in patients with no symptoms of ocular discomfort treated with intraocular pressure (IOP)-lowering medication and compare it with tear film osmolarity of controls. METHODS This was a cross-sectional study of 61 patients with glaucoma or ocular hypertension (study group) and 32 age-matched normals (control group). Neither group of patients reported ocular discomfort. Tear film osmolarity was measured with the TearLab Osmolarity System (TearLab Corp, San Diego, CA), and results were compared between groups. Correlation of osmolarity with parameters associated with medication use (time, number of medications, and number of instillations) was assessed. RESULTS Mean age of the patients in the medication group was 71±10.18 years and in the control group was 69±10.23 years (P=0.247). In the medication group, the tear film osmolarity was 295.56±12.54 mOsms/L and in the control group, it was 294.84±14.73 mOsms/L (P=0.807). Regarding the percentage of patients with tear film hyperosmolarity (osmolarity≥316 mOsms/L), in the group of normal patients, 3 had osmolarity more than or equal to the selected cutoff value (9.3%) and in the medication group, 7 patients (8.2%). Difference of the percentage between groups was not statistically significant (P=0.999, chi-square test). Tear film osmolarity in the medication group was not correlated to any of the parameters related to treatment. CONCLUSIONS Patients treated with IOP-lowering medication do not exhibit tear film hyperosmolarity as long as they do not report symptoms of ocular discomfort.