Nikolas G Ziakas

Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study

Aim: To determine the long term intraocular pressure (IOP) response to phacoemulsification in patients with and without exfoliation syndrome (XFS). Methods: Prospective, multicentre, cohort study with the following inclusion criteria: age over 50 years, open iridocorneal angle, and cataract. Two groups were enrolled: those with XFS and those without. The main outcome was mean IOP reduction 2 years after phacoemulsification cataract extraction (PCE). Univariate and multivariate analyses were performed. Results: 183 patients were enrolled, 71 with and 112 without XFS. There were 29 patients with glaucoma in both groups. Mean baseline IOP was higher in XFS compared to control eyes (17.60 (SD 3.23) mm Hg v 16.08 (3.18) mm Hg, p = 0.002). Overall IOP reduction was significantly greater in the XFS group at the 2 year time point (−1.85 mm Hg v −0.62 mm Hg in the controls (p = 0.0037)). Multivariate analysis demonstrated that the IOP lowering effect in the XFS group may be related to irrigation volume at the time of surgery. In the subgroup analyses IOP lowering was significantly greater in the XFS and XFG patients than in controls without glaucoma, and POAG controls, respectively. The percentage of patients with a postoperative IOP spike was similar and relatively high in both XFS and control groups (34% v 25%; p = 0.54). Conclusion: IOP decreases more in patients with XFS following PCE compared to control eyes without XFS. This effect is more pronounced in glaucoma patients and persists for at least 2 years.

Clinical and laboratory study of rosacea in northern Greece

Background  Numerous factors have been implicated in the pathogenesis of rosacea, which remains obscure.

A study of heredity as a risk factor in strabismus

Aims Inheritance is recognised to have a part in the aetiology of strabismus but previous studies have not adequately distinguished between different types of strabismus leading to wide variations in reported findings. The aim of this study was to investigate the importance of heredity in different types of strabismus.Methods The parents of children attending for treatment of strabismus over a one-month period were interviewed to identify relatives with a history of strabismus. A complete three-generation pedigree was established for 96 index cases who were classified into four groups: infantile esotropia (26 cases), accommodative esotropia (49 cases), anisometropic esotropia (15 cases), and exotropia (six cases).Results Forty-three of a total of 165 (26.1%) first degree relatives of patients with hypermetropic accommodative esotropia were affected. In contrast, 15 of a total of 101 (14.9%) first degree relatives of patients with infantile esotropia, eight of a total of 66 (12.1%) first degree relatives of patients with anisometropic esotropia, and one of a total of 25 (4%) first degree relatives of patients with exotropia were affected. Analysing the data using logistic regression with a random term for family showed a significantly higher proportion of affected first degree relatives in the accommodative group than in any of the other three diagnostic groups.Conclusion A history of strabismus appears to be more common in hypermetropic accommodative esotropia than in infantile esotropia, anisometropic esotropia or exotropia. More detailed investigation of the role of heredity in the aetiology of accommodative esotropia is needed.

Eclipse burns: a prospective study of solar retinopathy following the 1999 solar eclipse

Looking at the sun can cause focal burns to the retina. We prospectively followed up all patients who presented to Eye Casualty of Leicester Royal Infirmary having observed the solar eclipse of August, 1999. 45 patients attended, of whom 20 had visual symptoms and five had visible changes in the retina; four patients were still symptomatic after 7 months.

Clinical and laboratory study of ocular rosacea in northern Greece.

Background  The prevalence of ophthalmic involvement in rosacea is probably higher than previously presumed and varies considerably among several studies.

Cryopreserved amniotic membrane transplantation for the management of symptomatic bullous keratopathy.

Background:  To report the results of cryopreserved human amniotic membrane transplantation for the management of symptomatic bullous keratopathy.

Endogenous group G Streptococcus endophthalmitis following a dental procedure

Purpose To report a case of bilateral endogenous endophthalmitis due to group G Streptococcus after a dental procedure. METHODS Case report of a 69-year-old woman who presented with pain, decreased vision, bilateral uveitis, and a unilateral hypopyon 1 week after treatment for an abscessed tooth. Results Bilateral endophthalmitis was diagnosed, and group G Streptococcus was cultured from the vitreous samples. CONCLUSIONS To our knowledge, this is the second reported case of endogenous endophthalmitis following a dental procedure. Furthermore, it was due to group G Streptococcus, which is a rare cause of this condition.

Kaposi's Sarcoma of the Bulbar Conjunctiva in an Immunocompetent Patient.

Kaposi’s sarcoma is an uncommon endothelial malignant tumor, first described by Moricz Kaposi in 1872. It is commonly encountered in patients with acquired immunodeficiency syndrome (AIDS), immunosuppression or organ transplantation. Conjunctival Kaposi’s sarcoma is a rare tumor, mostly in patients with AIDS. We present a selected case with a superior bulbar conjunctival lesion in a patient who is HIV negative and immunocompetent, with an unremarkable general medical history. The lesion was surgically excised with no adjunctive treatment, and histological examination confirmed the diagnosis. There was no recurrence or metastasis 5 years after surgery.

Does the use of trypan blue during phacoemulsification affect the intraocular pressure

OBJECTIVE The purpose of the study was to evaluate the effect of trypan blue on intraocular pressure (IOP) after small-incision cataract surgery. DESIGN Prospective, randomized study. PARTICIPANTS Fifteen patients (30 eyes) with bilateral, dense, age-related cataracts. METHODS Patients with glaucoma, ocular hypertension, exfoliation, pigment dispersion syndrome, history of uveitis, recent use of topical or systemic steroids, and previous ocular surgery were excluded. The patients were randomly assigned to receive trypan blue during cataract surgery for enhancing capsulorrhexis in 1 of their eyes, while in the other eye, trypan blue was not used. Cataract surgery was performed in an identical fashion in both eyes, with a sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The same viscoelastic (sodium hyaluronate) was used in all cases and was thoroughly aspirated at the end of the procedure. All patients received a single dose of 250 mg acetazolamide 8 hours after surgery. No other antiglaucomatous agent was used during surgery or postoperatively. The intraocular pressure (IOP) was measured preoperatively and at 24 hours, 1 week, 1 month, and 3 months postoperatively. RESULTS IOP values were similar in both groups at all 4 postoperative measurements. There was no statistically significant difference in postoperative IOP values between the eyes in which trypan blue was used and the control eyes. CONCLUSIONS The use of trypan blue during small-incision cataract surgery does not have any effect on IOP during the immediate and early postoperative period.

Visual Impairment in Children With Acute Nontraumatic Coma

PURPOSE To determine the incidence and severity of visual impairment in children following acute nontraumatic coma. METHODS An 18-month prospective epidemiologic study of acute nontraumatic coma was undertaken in the former Northern NHS Region of England. Children aged >1 month and <16 years were included in the study if they had a Glasgow Coma Score of < or = 12 for >6 hours or if they died within 6 hours of the onset of decreased levels of consciousness. For survivors, ophthalmologic assessments were performed 6 weeks and 12 months after presentation. RESULTS Two hundred eighty-seven children were included in the study, of whom 127 died. Of the 137 examined survivors, 35 had visual abnormalities suspected by the examining neurologist during the ophthalmic assessment. Of these, visual impairment was confirmed in 10 children at the 6-week assessment by the pediatric ophthalmologist. At the 1 2-month assessment, visual impairment remained stable in 9 children and improved in 1. CONCLUSION In this study, 6.6% of children surviving acute nontraumatic coma had visual impairment that persisted at the 12-month follow-up examination. Incidence of visual impairment in acute nontraumatic coma is 0.97 per 100,000 children per year.