Lymphocytic reaction to ultraviolet radiation on rabbit conjunctiva

We examined the clinical and histological effects of controlled UV radiation on the conjunctiva and cornea of rabbit eyes by duration of exposure (0.5-4 hours daily for 5 consecutive days). Longer UV exposure (day 1-day 5) was associated with increased conjunctival redness, corneal erosion, edema and opacity. This study shows that UV irradiation leads to clinical and histological changes which may reflect an immune reaction to damaged epithelial cells.

Buttonholes During LASIK: Etiology and Outcome

PURPOSE

To report the clinical features and outcome of eyes with flap buttonhole during LASIK.

METHODS

A retrospective review was performed to identify eyes that developed flap buttonhole during Hansatome microkeratome translation. Pre-, intra-, and postoperative data were obtained to identify factors predictive of buttonhole.

RESULTS

Five patients with buttonhole were identified from June 2001 through September 2002 (5 [0.06%] eyes of 7672 primary LASIK procedures). Mean patient age was 49.2 +/- 11.3 years (range: 37 to 66 years). Mean preoperative spherical equivalent refraction was 4.92 +/- 2.90 diopters (D) (range: -2.25 to -9.50 D). Mean keratometry was 45.59 +/- 1.15 D (range: 43.90 to 47.60 D). All 5 flap buttonholes occurred in the second of 2 consecutively treated eyes (P = .03). Buttonhole occurred in 2 (0.26%) of 778 eyes where the 160-microm microkeratome plate was used, and 3 (0.06%) of 4350 eyes where the 180-microm plate was used (P = .16). Two eyes received laser ablation at the time of buttonhole formation. In the untreated cases, the buttonhole flap itself caused a myopic spherical change of -0.50 D and 0.70 D of astigmatism. One of 5 eyes lost 2 lines of best spectacle-corrected visual acuity; this eye received laser ablation immediately after buttonhole formation.

CONCLUSIONS

Buttonholes are significantly more likely to occur in the second of two consecutively treated eyes. A new blade for the second eye when the flap in the first eye appears to be thin should be considered. Caution should be exercised when considering laser ablation immediately following buttonhole formation.

Asymmetric keratoconus attributed to eye rubbing

PURPOSE

To report a series of cases with asymmetric keratoconus attributed to eye rubbing, discuss its pathogenesis, and review the literature.

METHODS

Case reports and literature review.

RESULTS

A careful history obtained from 5 patients with asymmetric keratoconus revealed habitual eye rubbing of the more severely affected eye.

CONCLUSIONS

Trauma, such as occurs with habitual eye rubbing, plays a role in the pathogenesis of keratoconus.

Repositioning the Laser in situ Keratomileusis Flap at the Slit Lamp

PURPOSE

To describe the indications and technique for repositioning the laser in situ keratomileusis (LASIK) flap at the slit lamp.

METHODS

We present a description of patients with striae or slippage of the flap who had repositioning of the flap at the slit lamp.

RESULTS

Indications for repositioning at the slit lamp are mostly flap striae. However, it can also be done for a displaced flap and small amounts of debridement. This procedure is not recommended for taking cultures, irrigation of diffuse lamellar keratitis, suturing the flap, or epithelial ingrowth. Repositioning the flap is done by finding the edge of the flap with the cannula, lifting the flap, sweeping the cannula to release the entire wound, and infusing balanced salt solution under the entire flap. We did not encounter infection or recurrent epithelial erosion in these patients.

CONCLUSIONS

Repositioning the LASIK flap at the slit lamp was effective and safe in the treatment of striae or flap slippage. It saved time, money, and, anxiety for the patient.

Retinal microangiopathies overlying pigment epithelial detachment in age-related macular degeneration

PURPOSE

To evaluate alterations in the retinal vasculature overlying pigment epithelial detachments (PED) in exudative age-related macular degeneration (ARMD) using indocyanine green and fluorescein angiography.

METHODS

Forty-one patients (41 eyes) with a clinical diagnosis of exudative ARMD with PED underwent simultaneous fluorescein and indocyanine green angiography, also under high (10 degrees ) magnification. Vascular abnormalities in the retina were compared between patients with vascularized (n = 34, group 1) and nonvascularized (n = 7, group 2) PED on indocyanine green angiography and correlated with the size of the PED and the presence of serous retinal detachment.

RESULTS

In all, 67 vascular abnormalities were found by indocyanine green angiography and only 22 by fluorescein angiography; this finding was statistically significant (P < 0.0001). The finding of retinal vasculopathy (32 patients in group 1 and two patients in group 2) was directly correlated with the presence of choroidal neovascularizations (P = 0.002). There was also a direct correlation between the presence of choroidal neovascularization and size of the PED (P = 0.03). The number of retinal vascular findings was not significantly correlated with serous elevation of the retina.

CONCLUSIONS

Retinal vasculopathies may be observed in eyes with PED and are detectable by indocyanine green and fluorescein angiography.

Posterior chamber intraocular lens implantation after capsular tear: ultrasound biomicroscopy evaluation

PURPOSE

To evaluate by ultrasound biomicroscopy (UBM) the exact position of a posterior chamber intraocular lens (PC IOL) implanted above a posterior capsule tear and to correlate the findings with the outcomes and complication rate.

SETTING

Department of Ophthalmology, Rabin Medical Center, Petah Tiqva, Israel.

METHODS

In a retrospective noncomparative case series, 36 patients (36 eyes) who had extracapsular cataract extraction (ECCE) complicated by capsular tear were evaluated. In all cases, a PC IOL was implanted above the remnant of the capsule without suturing. Ultrasound biomicroscopy was performed to study the exact position of the optic and haptic. The outcomes and complication rate were determined from patient examinations performed during a follow-up of 1 to 6 years.

RESULTS

Optic tilt was found in 20 of 36 patients (56%). In 17 patients (47%), both haptics were located in the sulcus. In 15 patients (42%), 1 haptic was observed in the sulcus and 1 in the bag or elsewhere. No correlation was found between the position of the optic and the location of the haptics. Minimal postoperative complications were observed, and only 1 patient required another surgery for a dislocated IOL.

CONCLUSION

By UBM, half the patients had optic tilt and more than half the IOLs were not implanted in the sulcus, the intended location.

Keratoconus and mitral valve prolapse

PURPOSE

To investigate the prevalence of keratoconus in patients with mitral valve prolapse (MVP).

METHODS

Videokeratography was performed in 36 patients (72 eyes) with an echocardiographic diagnosis of MVP, and were compared with 25 controls. All participants underwent slit-lamp examination and completed a medical questionnaire about joint hypermobility, arthralgia, asthma, and allergic reactions.

RESULTS

Keratoconus was found in eight eyes (11. 1%) (P =.056) of eight patients (22.2%) (P =.049) in the MVP group and in one eye (2%) of one patient (4%) in the control group. The keratoconus was unilateral and asymptomatic in all cases. Conjunctival papillae were statistical significant higher in the MVP group (P =.015). A statistically significant intergroup difference existed in the presence of an allergic reaction (P =.001), but not in arthralgia, hypermobility of joints, or asthma.

CONCLUSION

A borderline important association of MVP with keratoconus and with allergy exists. Patients with mitral valve prolapse complaining of poor vision should be suspected of having keratoconus.

Analgesic effect of topical sodium diclofenac 0.1% drops during retinal laser photocoagulation

AIMS

To evaluate the analgesic effect of topical sodium diclofenac 0.1% during retinal laser photocoagulation.

METHODS

87 patients, 45 with proliferative diabetic retinopathy treated with two sessions of panretinal photocoagulation (group A), and 42 patients with non-proliferative diabetic retinopathy who underwent grid treatment of the posterior pole (19 bilaterally) (group B). Sodium diclofenac 0.1% or sodium chloride 0.9% drops were topically applied 30-135 minutes before laser treatment in a masked fashion. Patients who had two sessions were given the alternate drug in the second one. Pain level was evaluated immediately after laser treatment with the visual analogue scale (VAS). The results were statistically analysed.

RESULTS

Patients in group A reported pain in 85/90 sessions (94%). The average pain level was 44.2% with sodium diclofenac 0.1% drops and 53.1% with sodium chloride 0.9% drops (p = 0.011 by paired t test). Patients in group B reported pain in only 16/60 sessions (26. 7%), and the pain level ranged from 10% to 60% regardless of the kind of drops used. There was no correlation in either group between level of pain and time interval from application of the drops to laser treatment (30-135 minutes) or average energy level used (100-500 mW).

CONCLUSION

Sodium diclofenac 0.1% is useful for pain reduction and should be applied before panretinal photocoagulation.

Simultaneous indocyanine green and fluorescein angiography in retinal pigment epithelium tear using the confocal scanning laser ophthalmoscope

PURPOSE

To describe the indocyanine green angiographic pattern of retinal pigment epithelium tears in the setting of age-related macular degeneration compared with the fluorescein angiographic features.

METHODS

Twelve consecutive patients (12 eyes) with a retinal pigment epithelium tear underwent simultaneous indocyanine green angiography and fluorescein angiography with the confocal scanning laser ophthalmoscope. The findings for the two modes were compared.

RESULTS

Choroidal neovascular membrane was evident beneath the rolled retinal pigment epithelium on indocyanine green angiograms in 11(92%) of 12 eyes: a focal neovascular membrane was apparent in five (42%) of 12 eyes, whereas a plaque neovascular membrane was seen in six (50%) of 12 eyes. In comparison, fluorescein angiography demonstrated late leakage as a result of occult choroidal neovascular membrane in nine (82%) of 11 eyes but no well-defined choroidal neovascular membrane.

CONCLUSIONS

Indocyanine green angiography is superior to fluorescein angiography for imaging choroidal neovascularization in cases of retinal pigment epithelium tear and may serve as an important adjunct to indocyanine green-guided laser treatment in selected cases.

Corneal topographic changes after retinal and vitreous surgery

PURPOSE

To investigate the topographic changes in the cornea after retinal and vitreous operations.

DESIGN

Observational prospective case series.

PARTICIPANTS

The study population included 46 patients after vitreoretinal surgery: 11 underwent pneumatic retinopexy, 10 underwent vitrectomy, and 25 underwent scleral buckling procedure.

METHODS

The corneal topography was measured by videokeratography with the absolute program and evaluated statistically by a quantitative comparative method, which was developed for this study, for the whole and the central cornea.

MAIN OUTCOME MEASURES

The corneal topographic changes were measured in diopters (D), evaluating and comparing the preoperative and postoperative measurements.

RESULTS

None of the operative procedures changed the shape of the whole cornea. Vitrectomy induced radial steepening of the central cornea 1.2 to 1.6 D, corresponding to the scleral sutures. Central steepening (average, 2.2 D) was also noted in the first week after circular buckling, but it flattened (average, 1.4 D) after 1 to 3 months. When an additional radial or circumferential buckling element was added to the circular buckle, steepening of the entire cornea and radial steepening of the central cornea (average, 0.6-0.8 D) occurred in the first week and flattened or returned to baseline after 1 to 3 months. There was no correlation between the location of the additional buckling element and the corneal topographic change.

CONCLUSIONS

Corneal videokeratography is a useful tool for evaluating the postoperative corneal curvature. It showed that vitreoretinal surgery alters the shape of the cornea when buckling or scleral sutures are used, but pneumatic retinopexy does not.

[Kimura's disease and angiolymphoid hyperplasia with eosinophilia-- on disease with different expressions?]

Kimura's disease is a rare angiolymphoid proliferative disorder of soft tissue characterized by subcutaneous swelling and a predilection for the head and neck. There are usually enlarged regional lymph nodes, eosinophilia and elevated sedimentation rate and IgE levels. A 26-year-old women with subcutaneous masses in the submandibular area is reported. The diagnosis of Kimura's disease versus angiolymphoid hyperplasia is discussed.

Extracapsular cataract extraction and intraocular lens implantation in eyes filled with silicone oil

Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed in five phakic eyes filled with silicone oil following vitreoretinal surgery. Silicone oil migration was prevented during surgery using an anterior chamber maintaining system and a self-sealed corneoscleral tunnel incision. The posterior capsule opacified within 3 months in all patients, and neodymium:YAG capsulotomy or surgical discission was performed in a diamond-shaped pattern. No silicone-related complications were found, including silicone oil migration into the anterior chamber. There were no difficulties visualizing the peripheral retina during funduscopy.

Intraocular intrusion of sutures after retinal detachment buckling surgery

BACKGROUND

Intraocular intrusion of tight encircling silicone band is a major complication of retinal detachment surgery leading to subretinal and vitreous hemorrhage, retinal detachment, and phthisis bulbi. Intrusion of the sutures into the eye has only been reported as an adjunct to buckle intrusion.

METHODS

Seven patients (9 eyes) are presented in whom intrusion of sutures occurred as a late complication of retinal detachment surgery using the extrascleral buckling technique. Their complications and treatments are discussed.

RESULTS

Eleven anchoring sutures were observed under the retina and two sutures penetrated into vitreous cavity. In five eyes (55.5%), small subretinal or vitreous hemorrhages were noted and in one of them perforation with total detachment occurred. In four eyes, no complications were detected. In four eyes, the silicone band was cut and left in place and the hemorrhages were spontaneously absorbed. The perforated eye underwent replacement of the silicone band with a wide silicone sponge, followed by vitrectomy and silicone oil injection.

CONCLUSIONS

Intrusion of sutures into the eye can rarely be seen years after retinal detachment surgery and usually do not require surgical intervention. When hemorrhage occurs, cutting of the silicone band only, with no attempt to remove the band or the sutures, is recommended.

An attempt at prevention of obesity in infancy

A study of The Prudent Diet in early infancy was undertaken in a test group of 80 infants as an attempt to prevent overweight in a private practice setting. This group was compared with another group of 50 infants born in 1964 who were fed the standard infant diet then in use. Although an incidence of 34.1% overweight was present in the comparison group as compared with 25% in the diet group at age 3 months, by age 3 years the comparison still showed a 25.5% prevalence of overweight as compared with the study group with a significantly lower incidence of only 1.28%. These results require confirmation from other investigators, as well as long-term follow-up observation of patients before one could consider recommending such a diet for widespread use.