Long-term results of micropulse laser trabeculoplasty with 577-nm yellow wavelength in patients with uncontrolled primary open-angle glaucoma and pseudoexfoliation glaucoma

Our aim was to evaluate the long-term results of micropulse laser trabeculoplasty (MLT) with 577-nm yellow wavelength in the treatment of glaucoma. We reviewed the medical records of 51 patients (51 eyes) with uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma who underwent 180° MLT for the first time. The success of MLT was defined as an IOP reduction of ≥ 20% and IOP < 21 mmHg after treatment. If the number of medications was increased or further laser trabeculoplasty or glaucoma surgery was required after treatment, the case was considered unsuccessful. The mean duration of patient follow-up was 18.39 ± 12.17 months (range 3-52 months). Patients included in the study used 2-4 types of antiglaucoma eye drops (mean 3.43 ± 0.7). The mean number of MLT spots was 65.54 ± 6.19, and the mean energy level was 750.98 ± 101.73 mJ. The decrease in intraocular pressure compared to baseline measurements was: 16.72 ± 11.87%, 15.07 ± 13.76%, 12.63 ± 14.29%, 16.66 ± 19.32%, and 16.75 ± 19.78% during follow-up at 3, 6, 12, 24, and 36-48 months. Successful response was achieved in 35.41%, 36.95%, 34.21%, 40%, 41.17%, and 42.85% of patients during 3, 6, 12, 18, 24, and 36-48 months of follow-ups, respectively. Of the 51 eyes studied, 12 patients (23.5%) underwent post-MLT glaucoma surgery, and 7 patients (13.7%) had cataract surgery, whose follow-up data were subsequently censored. The reduction of intraocular pressure showed a significant correlation with baseline intraocular pressure, while age and laser power showed no correlation (p > 0.05). MLT is a novel treatment option for patients with glaucoma with favorable long-term outcomes and a good safety profile.

Success of hydrocone (TORIS-K) soft contact lens for keratoconus and traumatic keratopathy

Objective:

To present success of Toris-K contact lenses in keratoconus and traumatic keratopathy with irregular corneal surface.

Methods:

Toris-K contact lenses were used to treat 7 eyes of 4 patients with traumatic keratopathy (Case 1) or keratoconus (Case 2, Case 3, and Case 4). All cases had a complete eye examination before the contact lens application. The case with traumatic keratopathy was a 32-year-old male who had corneal penetrating injury due to hobnail strike 23 months ago. The other 3 keratoconus cases were females at the age of 14, 16 and 22 years old. They had high myopia and irregular astigmatism due to keratoconus. All patients refused using rigid gas permeable contact lens because of intolerance. Toris-K contact lenses were fitted on all eyes. All patients were followed-up for 28 months with a complete ophthalmic examination and corneal topography every two months.

Results:

Improvement of BCVA of the cases was remarkable. All cases were comfortable with their Toris-K contact lenses for 28 months. There was no significant distortion on the lenses during follow-up period.

Conclusion:

Toris-K lenses may be an effective alternative treatment option for the patients with keratoconus and traumatic keratopathy, especially who cannot tolerate rigid gas permeable contact lenses.

Evaluation of the impact of persistent subepithelial corneal infiltrations on the visual performance and corneal optical quality after epidemic keratoconjunctivitis

PURPOSE

Aim was to measure the effect of persistent subepithelial corneal infiltrates (SEIs) after epidemic keratoconjunctivitis (EKC) on visual performance and corneal optical quality.

METHODS

We examined 53 patients divided into two groups. Patients with previous EKC constituted the study group (Group 1, n: 27). Healthy age matched subjects constituted the control group (Group 2, n: 26). Study group was subdivided into eyes with SEI (Group 1A, 40 eyes) and healthy fellow eyes (Group 1B, 14 eyes). Patients were submitted to a complete examination including high- and low-contrast visual acuities (HCVA, LCVA), corneal topography and aberrometry.

RESULTS

The mean interval between epidemic conjunctivitis and examination was 7.25 ± 5.63 months. Mean number of corneal infiltrates was 17.30 ± 14.38. The mean HCVA and LCVA were significantly lower in the eyes with SEI than fellow eyes and control group (p = 0.001). LCVA value was also worse in the fellow eyes when compared to control (p = 0.048). Corneal topography values were significantly higher in the eyes with SEI from both fellow eyes and control group. During corneal aberrometry, the mean root mean square value of spheric aberration, irregular astigmatism and total aberration were significantly higher in SEI group when compared to fellow eyes and control group (p < 0.05). Total aberrations were higher than control subjects in the fellow eyes. Trefoil aberration was higher in SEI group only when compared to control subjects, while there was no significant difference in coma aberration values between the groups (p > 0.05).

CONCLUSION

Results of this study suggested that visual performance is compromised in patients with EKC by aberrations and changes in topographic variables.

Confocal scanning laser tomography of the optic nerve head on the patients with Alzheimer's disease compared to glaucoma and control

The purpose of this study was to evaluate optic nerve head (ONH) differences of the patients with Alzheimer's disease (AD) measured by confocal scanning laser tomography [Heidelberg Retina Tomograph (HRT) III] and compare with glaucoma and control subjects. Eighty-four patients were enrolled into the study: 44 eyes of 24 patients with mild to moderate AD (Group 1), 68 eyes of 35 patients with glaucoma (Group 2), and 49 eyes of 25 heathy volunteers as a control (Group 3). A complete ophthalmologic examination as well as a confocal scanning laser ophthalmoscopic assessment with HRT III were performed on all patients. Mean values of the ONH topographic parameters such as rim area (RA), rim volume (RV), height variation contour, linear cup/disc ratio, cup shape measure, and retinal nerve fiber layer (RNFL) were recorded. Mean values of RNFL thickness was 0.23 ± 0.07 in AD, 0.22 ± 0.09 in glaucoma and 0.24 ± 0.07 in the control group (p = 0.323). RA and RV were significantly lower, and linear C/D ratio was significantly higher in the glaucoma group when compared to AD and control (p < 0.05). There was no statistically significant difference between AD and control for the optic disc parameters tested (p > 0.05). We observed a negative correlation of the age with RNFL in all of the groups (p < 0.005). Age was the most important parameter affecting RNFL. Our results suggest that HRT does not demonstrate ONH differences between AD and control group, while it successfully differentiates glaucoma from AD and control cases of older age.

Success of ranibizumab in central serous chorioretinopathy resistant to bevacizumab

PURPOSE

To present effectiveness of intravitreal ranibizumab (IVR) injection for central serous chorioretinopathy (CSC), resistant to intravitreal bevacizumab (IVB) injection.

METHODS

Files of the patients who had the diagnosis of CSC between 2005 and 2013 were reviewed retrospectively. Eighty-five eyes of 81 patients' files have been investigated. Ten eyes of 10 patients that were resistant to IVB, with no history of photodynamic therapy, were included in to this study. Demographic details, best-corrected visual acuity (BCVA), and central macular thickness (CMT) were studied to analyze the effectiveness of IVR.

RESULTS

The mean age of the patients was 38.8 years (SD=4.7 years). The mean follow-up time after first IVR injection was 7.9 months (SD=1.5 months). The mean number of IVB and IVR injections was 2.0 (SD=0.7) and 1.3 (SD=0.4), respectively. The mean CMT before IVR injection was 392.4 μm (SD=66.3) and decreased to 194.1 μm (SD=9.3, P<0.001) at the last visit. The mean BCVA before IVR injection was 0.50 logMAR (SD=0.23) and improved to 0.05 logMAR (SD=0.06, P<0.001) at the last visit. In all cases after IVR injection, the subretinal fluid almost resolved completely, and leakage disappeared in fundus fluorescein angiography.

CONCLUSION

Ranibizumab might be a promising option for the patients with CSC, resistant to bevacizumab in acute or early chronic stage.

Unilateral morning glory optic disc anomaly in a case with Down syndrome

BACKGROUND

This case is unique because it is the first reported case of Down syndrome with morning glory optic disc anomaly in literature.

CASE PRESENTATION

A 15-year-old girl with features of Down syndrome presented to the Clinic of Ophthalmology for a regular ophthalmologic examination. Her best corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. The fundus examination revealed findings compatible with unilateral morning glory optic disc anomaly in the right eye. The patient underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings.

CONCLUSION

This case report emphasizes the importance of ophthalmic screening-examinations in Down children to rule out any vision relevant pathology.

Central retinal artery occlusion in association with fibromuscular dysplasia

A 14 year-old female, whose chief complaint was severe vision loss in the right eye for 2 days, presented to the Clinic of Ophthalmology of Fatih Sultan Mehmet Education and Research Hospital. The patient had been attending follow-up visits for 4 years, following a diagnosis of fibromuscular dysplasia by the Clinic of Pediatrics. The patient underwent a complete ophthalmo-logic, angiographic, hematologic, and systemic evaluation. Fundus fluorescein angiography was performed immediately, because of the cherry-red spot sign in the macula of the right eye. Fundus fluorescein angiography revealed evidence of marked stasis of the retinal arterial circulation in the right eye. Best corrected visual acuity was 20/400 in the right eye and 20/20 in the left eye.

High Dk piggyback contact lens system for contact lens-intolerant keratoconus patients

BACKGROUND

The aim of the study was to examine the clinical success of high Dk (oxygen permeability) piggyback contact lens (PBCL) systems for the correction of contact lens intolerant keratoconus patients.

METHODS

Sixteen patients (29 eyes) who were not able to wear gas-permeable rigid lenses were included in this study. Hyper Dk silicone hydrogel (oxygen transmissibility or Dk/t = 150 units) and fluorosilicone methacrylate copolymer (Dk/t = 100 units) lenses were chosen as the PBCL systems. The clinical examinations included visual acuity and corneal observation by biomicroscopy, keratometer reading, and fluorescein staining before and after fitting the PBCL system.

RESULTS

INDICATIONS FOR USING PBCL SYSTEM WERE: lens stabilization and comfort, improving comfort, and adding protection to the cone. Visual acuities increased significantly in all of the patients compared with spectacles (P = 0). Improvement in visual acuity compared with rigid lenses alone was recorded in 89.7% of eyes and no alteration of the visual acuity was observed in 10.3% of the eyes. Wearing time of PBCL systems for most of the patients was limited time (mean 6 months, range 3-12 months); thereafter they tolerated rigid lenses alone except for 2 patients.

CONCLUSION

The PBCL system is a safe and effective method to provide centering and corneal protection against mechanical trauma by the rigid lenses for keratoconus patients and may increase contact lens tolerance.

Success rates in the correction of astigmatism with toric and spherical soft contact lens fittings

Objectives:

To evaluate success rates in the correction of astigmatism with toric and spherical soft contact lens fitting.

Methods:

30 patients with soft toric lenses having more than 1.25 D of corneal astigmatism (25 eyes; Group A) or having 0.75–1.25 D of corneal astigmatism (22 eyes; Group B) and 30 patients with soft spheric lenses having 0.75–1.25 D of corneal astigmatism (28 eyes; Group C) or less than 0.75 D of corneal astigmatism (23 eyes; Group D) were included in the study. Corrected and uncorrected monocular visual acuity measurement with logMAR, biomicroscopic properties, autorefractometry and corneal topography were performed for all patients immediately before and at least 20 minutes after the application of contact lenses. Success of contact lens fitting was evaluated by three parameters: astigmatic neutralization, visual success, and retinal deviation.

Results:

After soft toric lens application, spheric dioptres, cylindric and keratometric astigmatism, and retinal deviation decreased significantly in Groups A and B (P < 0.05). In Group C, spheric dioptres and retinal deviation decreased (P < 0.05), while cylindric and keratometric astigmatism did not change significantly (P > 0.05). In Group D, spheric dioptres, retinal deviation, and cylindric astigmatism decreased (P < 0.05). Keratometric astigmatism did not change significantly (P > 0.05) and astigmatic neutralization even increased.

Conclusions:

Visual acuity and residual spherical equivalent refraction remained between tolerable limits with the use of toric and spheric contact lenses. Spherical lenses failed to mask corneal toricity during topography, while toric lenses caused central neutralization and decrease in corneal cylinder in low and moderate astigmatic eyes.