AIM： To analyze the effect of steep meridian small incision phacoemulsification cataract surgery on anterior,posterior and total corneal wavefront aberration.· METHODS： Steep meridian small incision phacoemulsi...AIM： To analyze the effect of steep meridian small incision phacoemulsification cataract surgery on anterior,posterior and total corneal wavefront aberration.· METHODS： Steep meridian small incision phacoemulsification cataract surgery was performed in age-related cataract patients which were divided into three groups according to the incision site： 12 o＇clock, 9o＇clock and between 9 and 12 o＇clock（BENT） incision groups. The preoperative and 3-month postoperative root mean square（RMS） values of anterior, posterior and total corneal wavefront aberration including coma,spherical aberration, and total higher-order aberrations（HOAs）, were measured by Pentacam scheimpflug imaging. The mean preoperative and postoperative corneal wavefront aberrations were documented.·RESULTS： Total corneal aberration and total lower-order aberrations decreased significantly in three groups after operation. RMS value of total HOAs decreased significantly postoperatively in the 12 o＇clock incision group（P 〈0.001）. Corneal spherical aberration was statistically significantly lower after steep meridian small incision phacoemulsification cataract surgery in BENT incision group（P 〈0.05） and Pearson correlation analysisindicated that spherical aberration changes had no significant relationship with total astigmatism changes in all three corneal incision location.·CONCLUSION： Corneal incision of phacoemulsification cataract surgery can affect corneal wavefront aberration.The 12 o＇clock corneal incision eliminated more HOAs and the spherical aberrations decreased in BENT incision group obviously when we selected steep meridian small incision. Cataract lens replacement using wavefront-corrected intraocular lens combined with optimized corneal incision site would improve ocular aberration results.展开更多
Objective:To assess the 10-year incidence of retinal vein occlusion(RVO)and its predictors in an older population.Methods:The Blue Mountains Eye Study examined 3654 residents aged 49 years and older(82.4% response)fro...Objective:To assess the 10-year incidence of retinal vein occlusion(RVO)and its predictors in an older population.Methods:The Blue Mountains Eye Study examined 3654 residents aged 49 years and older(82.4% response)from 1992 to 1994,reexamined 2335 residents(75.1% of survivors)from 1997 to 1999,and reexamined 1952 residents(75.6% of survivors)from 2002 to 2004.Incident RVO was assessed from stereoscopic retinal photographs.Kaplan-Meier cumulative 10-year incidence was calculated.Results:After excluding 47 residents with RVO at baseline and 171 residents with no photographs at either followup examination,2346 residents were considered at risk of developing RVO.The cumulative 10-year incidence of RVO was 1.6%.Age was significantly associated with the incidence of RVO(P=.03,Mantel-Haenszel χ 2 test for trend).Factors predicting the incidence of RVO included mean arterial blood pressure(age-adjusted odds ratio OR,1.41 per 10-mm Hg increase),ocular perfusion pressure(OR,1.71 per 10-mm Hg increase),obesity(OR,2.16),and presence of retinal arteriolar wall signs(focal narrowing:OR,3.37;arteriovenous nicking:OR,4.09;and opacification:OR,4.89).Conclusions:Older age(≥ 70 years),increasing mean arterial blood pressure,and atherosclerotic retinal vessel signs were significant predictors of incident RVO.展开更多
PURPOSE: The effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema from central retinal vein occlusion (CRVO) was investigated. DESIGN: A noncomparative, prospective, interven...PURPOSE: The effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema from central retinal vein occlusion (CRVO) was investigated. DESIGN: A noncomparative, prospective, interventional case series. METHODS: In a clinical practice, 18 patients were enrolled with nonischemic CRVO and cystoid macular edema. Two milligrams of triamcinolone acetonide were injected into the vitreous of only one eye from each patient. The outcome measures were 1-mm mean central retinal thickness on optical coherence tomography and visual acuity. RESULTS: Mean duration of symptoms before surgery was 2 months (SD, 1.3 months). Ten patients required repeated injections for recurrent cystoidmacular edema (mean,1.8 injections). Mean visual acuity significantly improved from 20/300 to 20/166 (P=.007) at 1 month, 20/100 (P=.0005) at 2 months, 20/130 (P=.007) at 3 months, and 20/150 (P=.02) at 6 months but deteriorated again to 20/270 (not significant) at 12 months. There was a significant improvement in retinal thickness from presentation 518 μm, to 363 μm (P=.03) at 1 month, 304 μm (P=.04) at 2 months, and 353 μm (P=.01) at 3 months but not from presentation at 6 months (mean, 383 μm) and 12 months (mean, 406 μm). Eleven patients suffered intraocular pressure rises requiring intervention. Intravitreal triamcinolone acetonide did not prevent collateral circulation formation, which was seen in 10 patients. CONCLUSION: Intravitreal corticosteroid injection is very effective in reversing cystoid macular edema and improving visual acuity in recent-onset nonischemic CRVO in the first 6 months, but this is unfortunately not sustained at 1 year.展开更多
Purpose: To investigate the visual prognosis of amblyopia associated with anisomyopia and myelinated nerve fibers. Design: Retrospective noncomparative case series. Methods: Twelve children with amblyopia associated w...Purpose: To investigate the visual prognosis of amblyopia associated with anisomyopia and myelinated nerve fibers. Design: Retrospective noncomparative case series. Methods: Twelve children with amblyopia associated with anisomyopia and myelinated nerve fibers were treated with spectacle correction after cycloplegic refraction and occlusion therapy for amblyopia. Their visual acuity was measured at each visit to the clinic. The patients were divided into three groups according to their final visual acuity, and statistical analyses were performed to evaluate the differences among these groups in terms of the initial age, spherical equivalent, anisometropia, the area of myelination, final age, and follow- up period. Results: The mean refractive error of the 12 children in spherical equivalents was- 8.16 diopters (range- 1.50 to approximately- 13.00 diopters). The mean age at the initiation of therapy was4.2 years (range 2.1 to 8.6) and the mean follow- up period was 2.6 years (range 0.5 to5.1). After the occlusion treatment, visual acuity improved to 20/30 in four patients, and to 20/60 in one patient. In the remaining six patients, visual acuity remained at 20/200 or worse. The amount of anisometropia and the area of myelination were significantly different between the group with a final visual acuity of 20/40 or better and the group with a final visual acuity of worse than 20/200. Conclusion: The visual acuity of about one third of the amblyopes with myelinated nerve fibers improved to 20/30. The prognostic factors for the visual improvement were the amount of anisometropia and the area of myelination.展开更多
Background: Corneal ectasia is a serious complication after laser in situ keratomileusis(LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, t...Background: Corneal ectasia is a serious complication after laser in situ keratomileusis(LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation(PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN~ IIz(Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN~ IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.Results: There was no statistical difference between the mean best-fit sphere(BFS) pre-LASIK and 6 years postop(P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm(range, 12 to-31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent(ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK.展开更多
Background:To report the clinical features of surgically induced scleral staphyloma and investigate the management.Methods:Retrospective uncontrolled study.Results:A full ophthalmological evaluation of surgically indu...Background:To report the clinical features of surgically induced scleral staphyloma and investigate the management.Methods:Retrospective uncontrolled study.Results:A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed.The first patient was a 3-year-old young girl underwent corneal dermoid resection.The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C(MMC).The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery.All patients performed allogeneic sclera patch graft.In the at least half a year follow-up,the best corrected visual acuity(BCVA)of all the four patients were no worse than that of preoperative.Ocular symptoms disappeared,including eye pain,foreign body sensation,and so on.Unfortunately,the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month.Conclusions:Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid,pterygium,and cataract surgery.Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma.However sclera rejection and dissolution should be considered postoperatively.展开更多
Purpose. To ascertain the therapeutic effect of periocular corticosteroids in diabetic papillopathy. Methods. Prospec-tively, five consecutive adult-onset diabetic patients with symptomatic diabetic papillopathy under...Purpose. To ascertain the therapeutic effect of periocular corticosteroids in diabetic papillopathy. Methods. Prospec-tively, five consecutive adult-onset diabetic patients with symptomatic diabetic papillopathy underwent visual fields and fluorescein angiography before and after superonasal subtenon injection of corticosteroids. Results. The median duration of papillopathy was 2.5 weeks by ophthalmoscopy and 3 weeks by fluorescein angiography. The median recovery time of best-spectacle-corrected visual acuity was 2 weeks. Two patients developed sequential diabetic papillopathy, and both reported faster visual recovery and better subjective vision in treated eyes. In these two patients, the final best-spectacle-corrected visual acuity and visual evoked responses were comparable between the two eyes, while automated visual fields were less constricted in treated eyes. Complications included ocular hypertension, mild progression of cataract, and mild ptosis in one patient each. Conclusions. Periocular corticosteroids shortened the duration of diabetic papillopathy from a reported median of 5 months to 3 weeks in the present uncontrolled observational study, partly by their angiostatic and antioedema effects at the level of the anterior optic nerve. Intraocular pressure needs to be monitored in eyes receiving periocular corticosteroids.展开更多
PURPOSE: To investigate the effect of retrobulbar anaesthesia on retrobulbar haemodynamics, colour Doppler imaging was performed. Furthermore, the additive effect of epinephrine was examined. Method: Forty-one patient...PURPOSE: To investigate the effect of retrobulbar anaesthesia on retrobulbar haemodynamics, colour Doppler imaging was performed. Furthermore, the additive effect of epinephrine was examined. Method: Forty-one patients (age 72.7±8.9; 22 f, 19 m) undergoing planned cataract surgery were included in a prospective study. Colour Doppler imaging was performed before and directly after retrobulbar anaesthesia and after cataract surgery to measure the peak systolic velocity (PSV) and end diastolic velocity (EDV) in the ophthalmic artery, central retinal artery and central retinal vein. In 18 patients lidocaine 2%with-out additives (2 ml, retrobulbar transconjunctival injection) and in 23 patients lidocaine 2%with epinephrine 1:200,000 was used. Results: After retrobulbar anaesthesia both groups had a significant reduction of the PSV and of the EDV. After surgery flow velocities increased again. The addition of epinephrine resulted in a significantly greater reduction and slower recovery of flow velocities. Conclusion: Retrobulbar anaesthesia induces a marked reduction of velocity in the retrobulbar vessels. The supplement epinephrine increases this effect, and recovery is much slower. Thus, particularly in patients with already disturbed ocular haemodynamics epinephrine should not be used in order to avoid irreversible functional damage.展开更多
Purpose We aimed to describe the demographic and clinical features, ocular man ifestations, complications, visual prognosis, and treatment in a large populatio n of Turkish patients with Behcet uveitis. We also aimed ...Purpose We aimed to describe the demographic and clinical features, ocular man ifestations, complications, visual prognosis, and treatment in a large populatio n of Turkish patients with Behcet uveitis. We also aimed to compare visual progn osis between male and female sex and between patients who presented before and a fter 1990. Design Observational case series. Methods A retrospective study of 88 0 consecutive patients (1,567 eyes) with Behcet uveitis seen at the Uveitis Serv ice, Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul Univers ity, from 1980 to 1998. All patients met the classifi cation criteria of the Int ernational Study Group for Behcets Disease. Information on the patients sex, age at onset of uveitis, ocular features, ocular complications, visual acuity, and systemic treatment was collected. Results Five hundred ninetynine patients ( 68%)weremale and 281 (32%)were female. The mean age at onset of uveitiswas 28. 5 years inmale and 30 years in female patients. Ocular involvement was bilateral in 78.1%and unilateral in 21.9%of the patients. Panuveitiswas the most common form in both sexes. Fundus lesions as well as sightthreatening complications we re more common in males. At the beginning of the follow up, potential visual ac uity was 0.1 or less in 30.9%of eyes in males and 24.2%of eyes in females. Kap lan Meier survival analysis estimated the risks of losing useful vision (>0.1) at 5 and 10 years for males and females as 21%vs 10%and 30%vs 17%, respectiv ely. Male patients who presented in the 1990s had a significantly lower risk of losing vision compared with male patients who presented in the 1980s. Conclusion Behcet uveitis starts frequently around the end of the third decade and has a m ale predominance. The disease is more severe and the risk of losing useful visio n is higher in males than in females. However, this risk has been significantly reduced in the 1990s.展开更多
Purpose: The inflammatory response in acute anterior uveitis (AU) is believed to be primarily mediated by autoreactive Tcells. We wanted to evaluate whether t he T-cell activation marker CD40 ligand is involved in the...Purpose: The inflammatory response in acute anterior uveitis (AU) is believed to be primarily mediated by autoreactive Tcells. We wanted to evaluate whether t he T-cell activation marker CD40 ligand is involved in the AU immunopathogenesi s. Methods: We evaluated the expression of the CD40 ligand on CD4+T-cells, CD8 +T-cells and CD19+B-cells on peripheral blood mononuclear cells using flow c ytometry in six patients with unilateralAU, six patientswith monosymptomatic opt ic neuritis (ON) as inflammatory controls, and in six healthy controls. The ex v ivo induction of the CD40 ligand on T-cells in patients and controls was also s tudied. Results: A significantly higher expression of the CD40 ligand on both CD 4+(p< 0.05)-and CD8+(p< 0.05) T-cells in patients with AU compared to ON pat ients and healthy controls was found. There was a significantly higher induction of the CD40 ligand on CD8+T-cells in AU patients compared to ON patients and healthy controls (p < 0.01). No differences in the B-cell population were obser ved between the three groups. Conclusion: Patients with AU had increased express ion of the CD40 ligand on T-cells in the blood and expressed higher levels of t he CD40 ligand when stimulated, compared to ophthalmological inflammatory contro ls and healthy controls. The data suggest that the CD40 ligand is involved in th e development of AU.展开更多
Purpose: To evaluate the efficacy of a new continuous functional visual acuity measurement (FVAM) system for the assessment of dry eye patients. Design: Prospective comparative study. Methods: Monocular recognition ac...Purpose: To evaluate the efficacy of a new continuous functional visual acuity measurement (FVAM) system for the assessment of dry eye patients. Design: Prospective comparative study. Methods: Monocular recognition acuity measured continuously by the FVAM system during a 30- second blinkfree period was defined as functional visual acuity (FVA). Examinations using the FVAM system were conducted in 35 eyes of 20 healthy controls and 19 eyes of 13 dry eye patients. Tear function examinations including the Schirmer test, tear film break- up time, and fluorescein and Rose Bengal staining were performed in all subjects. Functional visual acuity and tear functions were also examined before and after insertion of punctumplugs in dry eye patients. Functional visual acuity results at 10, 20, and 30 seconds were compared. Results: Functional visual acuity in dry eyes were significantly lower than control subjects at all time points (P < .05). Functional visual acuity after punctum plugs insertion improved significantly at all time points (P < .05).Conclusions: FVAM system seemed not only to be an effective tool in the assessment of dynamic visual acuity changes in dry eye and normal subjects but in evaluating the outcome of management of dry eye disease by punctum plugs.展开更多
We have developed a new technique to facilitate internal limiting membrane (ILM) peeling with triamcinolone acetonide during idiopathic macular hole surgery. Twelve eyes of 12 patients with a macular hole, stage 2 to ...We have developed a new technique to facilitate internal limiting membrane (ILM) peeling with triamcinolone acetonide during idiopathic macular hole surgery. Twelve eyes of 12 patients with a macular hole, stage 2 to 4 and size 0.12 disc diameters (DD) to 0.39 DD (mean, 0.20 DD), underwent vitrectomy with ILM peeling using triamcinolone. Before ILM peeling, a triamcinolone suspension (8 mg/mL in balanced salt solution) was sprayed around the macular hole, and the triamcinolone in the vitreous cavity was aspirated slowly, making the ILM more visible. Postoperatively, the macular hole was closed in all eyes, and the visual acuity was improved from 20/200 to 20/40 (median, 20/130) to 20/60 to 20/20 (median, 20/40). This technique can facilitate the ILM peeling without any adverse effects in this short-term observation.展开更多
Background:To report the occurrence of a full thickness macular hole in association with idiopathic parafoveal telangiectasia.Methods:Observational case report.Results:A 60-year-old female with a history of bilateral ...Background:To report the occurrence of a full thickness macular hole in association with idiopathic parafoveal telangiectasia.Methods:Observational case report.Results:A 60-year-old female with a history of bilateral idiopathic parafoveal telangiectasia presented with acute complaints of decreased vision and metamorphopsia in her right eye.The patient’s retinal examination was significant for idiopathic parafoveal telangiectasia bilaterally,and a new,full-thickness macular hole in the right eye which was confirmed by optical coherence tomography.Conclusions:Full-thickness macular hole formation may occur in conjunction with idiopathic parafoveal telangiectasia,which has not been reported to date.Idiopathic parafoveal telangiectasia,IPT,is a clinical entity with distinct biomicroscopic and fluorescein angiographic findings which may be divided into developmental and acquired forms.Idiopathic macular hole formation is a relatively common condition,which tends to occur more frequently in females in their 7th and 8th decades of life.Idiopathic parafoveal telangiectasia has been reported in association with lamellar macular holes,but,to our knowledge,not with a full thickness macular hole.Here in we report the case of a patient with bilateral idiopathic parafoveal telangiectasia who developed a full-thickness macular hole.展开更多
Background: Interferon (IFN)-associated retinopathy is typically characterize d by retinal hemorrhages and cotton wool spots at the posterior fundus, but visu al function is usually maintained. With the use of optical...Background: Interferon (IFN)-associated retinopathy is typically characterize d by retinal hemorrhages and cotton wool spots at the posterior fundus, but visu al function is usually maintained. With the use of optical coherence tomography (OCT), two patients with IFN-associated retinopathy who had developed macular e dema and reduced visual acuity during the clinical course of IFN therapy were ob served. Cases: A 37-year-old man with chronic hepatitis C and a 59-year-old man with chronic myeloid leukemia, both of whom had received IFN therapy, were r eferred to our outpatient clinic. The former patient had complained once that hi s visual acuity had decreased after the termination of IFN therapy, and the latt er patient complained twice during IFN therapy that his visual acuity had decrea sed. Observations: In both patients, at the time of the visual disturbances, mac ular edema was clearly observed by OCT. Hypoalbuminemia and thrombocytopenia wer e observed at this time also. After the remission of the hypoalbuminemia and thr ombocytopenia, the macular edema observed by OCT disappeared and visual acuity r eturned to normal. Conclusion: During and after IFN therapy, OCT is a useful exa mination technique for revealing macular edema in patients who have decreased vi sion. Ophthalmologists should be aware of the ocular side effects of IFN therapy and carefully monitor patients for the possible occurrence of hypoalbuminemia a nd thrombocytopenia.展开更多
Purpose: To identify the characteristic ocular findings in patients with craniofacial cleft (CFC). Methods: Ophthalmologic examination wa s performed for a 16-year-old girl with no. 3 CFC and a 3-year-old boy with no....Purpose: To identify the characteristic ocular findings in patients with craniofacial cleft (CFC). Methods: Ophthalmologic examination wa s performed for a 16-year-old girl with no. 3 CFC and a 3-year-old boy with no. 5 CFC. Results: Exotropia was found in the 3-year-old boy with no. 5 CFC i nvolving the lateral orbit, and esotropia in the 16-year-old girl with craniof acial cleft no. 3 involving the medial orbit. Hypotropia, lower eyelid coloboma, amblyopia and an absence of stereopsis were common to both patients. Visual acu ity was improved from hand motion to 20/30 by means of occlusion therapy for amb lyopia in the 3-year-old boy. Strabismus surgery resulted in exophoria of 8 pr ism diopters (PD) in the 3-year-old boy and left esotropia of 8 PD in the 16- year-old girl. Conclusions: Amblyopia, hypotropia, esotropia (no. 3) and exotro pia (no. 5) should be verified in cases of CFC nos. 3 and 5. Ophthalmologic exam ination and early intervention for amblyopia may be mandatory for patients with CFC involving the orbit.展开更多
PURPOSE. To study deactivation of the rod photoresponse in infants using a paired-flash procedure. Rhodopsin content increases and scales the parameters of the activation of rod phototrans duction as rods develop. How...PURPOSE. To study deactivation of the rod photoresponse in infants using a paired-flash procedure. Rhodopsin content increases and scales the parameters of the activation of rod phototrans duction as rods develop. However, little is known about the kinetics of deactivation in the rods of young infants. METHODS. ERG responses to pairs of flashes were used to study the recovery of the rod response in 4- and 10- week-old infants and mature control subjects. The amplitudes of rod isolated a-wave responses to a probe flash (+ 3.3 log scot tds) presented 2 to 120 seconds after an equal-intensity test flash were measured. The interstimulus interval (ISI) at which the amplitude was half that of the response to the probe flash alone (t50) was determined by linear interpolation. RESULTS. Recovery time (t50) was significantly longer in infants than in adults (F=18.9, df 2, 32; P<0.01). The shape of the recovery function did not vary with age. The t50 values were inversely proportional to the parameters of activation of rod phototransduction. CONCLUSIONS. These results are evidence that the kinetics of deactivation in infants are slower and may be set by the proportion of rhodopsin isomerized.展开更多
The use of artificial intelligence(AI)in ophthalmology is not very new and its use is expanding into various subspecialties of the eye like retina and glaucoma,thereby helping ophthalmologists to diagnose and treat di...The use of artificial intelligence(AI)in ophthalmology is not very new and its use is expanding into various subspecialties of the eye like retina and glaucoma,thereby helping ophthalmologists to diagnose and treat diseases better than before.Incorporating“deep learning”(a subfield of AI)into image-based systems such as optical coherence tomography has dramatically improved the machine's ability to screen and identify stages of diabetic retinopathy accurately.Similar applications have been tried in the field of retinopathy of prematurity and agerelated macular degeneration,a silent retinal condition that needs to be diagnosed early to prevent progression.The advent of AI into glaucoma diagnostics in analyzing visual fields and assessing disease progression also holds a promising role.The ability of the software to detect even a subtle defect that the human eye can miss has led to a revolution in the management of certain ocular conditions.However,there are few significant challenges in the AI systems,such as the incorporation of quality images,training sets and the black box dilemma.Nevertheless,despite the existing differences,there is always a chance of improving the machines/software to potentiate their efficacy and standards.This review article shall discuss the current applications of AI in ophthalmology,significant challenges and the prospects as to how both science and medicine can work together.展开更多
BACKGROUNDANDOBJECTIVE: To determine the efficacy of intravitreal triamcinolone acetonide (IVTA) in the early treatment of severe cystoid macular edema (CME) related to acute branch retinal vein occlusion. PATIENTS AN...BACKGROUNDANDOBJECTIVE: To determine the efficacy of intravitreal triamcinolone acetonide (IVTA) in the early treatment of severe cystoid macular edema (CME) related to acute branch retinal vein occlusion. PATIENTS AND METHODS: Retrospective, non-comparative case series. Twelve eyes with severe CME (foveal thickness >450 μ m) secondary to acute branch retinal vein occlusion received IVTA. RESULTS: Average follow-up was 15.3 months. Mean visual acuity was 0.88 LogMar units (20/160) initially, 0.55 LogMar units (20/70) at 1 week, 0.46 LogMar units (20/60) at 1 month, and 0.49 LogMar units (20/60) at last follow-up. Visual acuity improved by 3 lines or greater in 42% of patients at 1 week, 50% at 1 month, and 42% at last follow-up. Average foveal thickness was 589 μ m (range,460 to 840 μ m) at baseline, 237 μ m at 1 week, 196 μ m at 1 month, and 235 μ m at last follow-up. All eyes showed reduction of foveal thickness as measured by optical coherence tomography. Eight eyes developed recurrentCME at an average of 5.5 months after initial IVTA injection. Ten eyes required additional intervention during the follow-up period. CONCLUSIONS: Early treatment of severe CME secondary to branch retinal vein occlusion with IVTA is effective in reducing foveal thickness as measured by optical coherence tomography and improving visual acuity. However,monotherapy with IVTA can be associated with a significant rate of recurrent CME.展开更多
文摘AIM： To analyze the effect of steep meridian small incision phacoemulsification cataract surgery on anterior,posterior and total corneal wavefront aberration.· METHODS： Steep meridian small incision phacoemulsification cataract surgery was performed in age-related cataract patients which were divided into three groups according to the incision site： 12 o＇clock, 9o＇clock and between 9 and 12 o＇clock（BENT） incision groups. The preoperative and 3-month postoperative root mean square（RMS） values of anterior, posterior and total corneal wavefront aberration including coma,spherical aberration, and total higher-order aberrations（HOAs）, were measured by Pentacam scheimpflug imaging. The mean preoperative and postoperative corneal wavefront aberrations were documented.·RESULTS： Total corneal aberration and total lower-order aberrations decreased significantly in three groups after operation. RMS value of total HOAs decreased significantly postoperatively in the 12 o＇clock incision group（P 〈0.001）. Corneal spherical aberration was statistically significantly lower after steep meridian small incision phacoemulsification cataract surgery in BENT incision group（P 〈0.05） and Pearson correlation analysisindicated that spherical aberration changes had no significant relationship with total astigmatism changes in all three corneal incision location.·CONCLUSION： Corneal incision of phacoemulsification cataract surgery can affect corneal wavefront aberration.The 12 o＇clock corneal incision eliminated more HOAs and the spherical aberrations decreased in BENT incision group obviously when we selected steep meridian small incision. Cataract lens replacement using wavefront-corrected intraocular lens combined with optimized corneal incision site would improve ocular aberration results.
文摘Objective:To assess the 10-year incidence of retinal vein occlusion(RVO)and its predictors in an older population.Methods:The Blue Mountains Eye Study examined 3654 residents aged 49 years and older(82.4% response)from 1992 to 1994,reexamined 2335 residents(75.1% of survivors)from 1997 to 1999,and reexamined 1952 residents(75.6% of survivors)from 2002 to 2004.Incident RVO was assessed from stereoscopic retinal photographs.Kaplan-Meier cumulative 10-year incidence was calculated.Results:After excluding 47 residents with RVO at baseline and 171 residents with no photographs at either followup examination,2346 residents were considered at risk of developing RVO.The cumulative 10-year incidence of RVO was 1.6%.Age was significantly associated with the incidence of RVO(P=.03,Mantel-Haenszel χ 2 test for trend).Factors predicting the incidence of RVO included mean arterial blood pressure(age-adjusted odds ratio OR,1.41 per 10-mm Hg increase),ocular perfusion pressure(OR,1.71 per 10-mm Hg increase),obesity(OR,2.16),and presence of retinal arteriolar wall signs(focal narrowing:OR,3.37;arteriovenous nicking:OR,4.09;and opacification:OR,4.89).Conclusions:Older age(≥ 70 years),increasing mean arterial blood pressure,and atherosclerotic retinal vessel signs were significant predictors of incident RVO.
文摘PURPOSE: The effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema from central retinal vein occlusion (CRVO) was investigated. DESIGN: A noncomparative, prospective, interventional case series. METHODS: In a clinical practice, 18 patients were enrolled with nonischemic CRVO and cystoid macular edema. Two milligrams of triamcinolone acetonide were injected into the vitreous of only one eye from each patient. The outcome measures were 1-mm mean central retinal thickness on optical coherence tomography and visual acuity. RESULTS: Mean duration of symptoms before surgery was 2 months (SD, 1.3 months). Ten patients required repeated injections for recurrent cystoidmacular edema (mean,1.8 injections). Mean visual acuity significantly improved from 20/300 to 20/166 (P=.007) at 1 month, 20/100 (P=.0005) at 2 months, 20/130 (P=.007) at 3 months, and 20/150 (P=.02) at 6 months but deteriorated again to 20/270 (not significant) at 12 months. There was a significant improvement in retinal thickness from presentation 518 μm, to 363 μm (P=.03) at 1 month, 304 μm (P=.04) at 2 months, and 353 μm (P=.01) at 3 months but not from presentation at 6 months (mean, 383 μm) and 12 months (mean, 406 μm). Eleven patients suffered intraocular pressure rises requiring intervention. Intravitreal triamcinolone acetonide did not prevent collateral circulation formation, which was seen in 10 patients. CONCLUSION: Intravitreal corticosteroid injection is very effective in reversing cystoid macular edema and improving visual acuity in recent-onset nonischemic CRVO in the first 6 months, but this is unfortunately not sustained at 1 year.
文摘Purpose: To investigate the visual prognosis of amblyopia associated with anisomyopia and myelinated nerve fibers. Design: Retrospective noncomparative case series. Methods: Twelve children with amblyopia associated with anisomyopia and myelinated nerve fibers were treated with spectacle correction after cycloplegic refraction and occlusion therapy for amblyopia. Their visual acuity was measured at each visit to the clinic. The patients were divided into three groups according to their final visual acuity, and statistical analyses were performed to evaluate the differences among these groups in terms of the initial age, spherical equivalent, anisometropia, the area of myelination, final age, and follow- up period. Results: The mean refractive error of the 12 children in spherical equivalents was- 8.16 diopters (range- 1.50 to approximately- 13.00 diopters). The mean age at the initiation of therapy was4.2 years (range 2.1 to 8.6) and the mean follow- up period was 2.6 years (range 0.5 to5.1). After the occlusion treatment, visual acuity improved to 20/30 in four patients, and to 20/60 in one patient. In the remaining six patients, visual acuity remained at 20/200 or worse. The amount of anisometropia and the area of myelination were significantly different between the group with a final visual acuity of 20/40 or better and the group with a final visual acuity of worse than 20/200. Conclusion: The visual acuity of about one third of the amblyopes with myelinated nerve fibers improved to 20/30. The prognostic factors for the visual improvement were the amount of anisometropia and the area of myelination.
文摘Background: Corneal ectasia is a serious complication after laser in situ keratomileusis(LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation(PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN~ IIz(Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN~ IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.Results: There was no statistical difference between the mean best-fit sphere(BFS) pre-LASIK and 6 years postop(P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm(range, 12 to-31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent(ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK.
文摘Background:To report the clinical features of surgically induced scleral staphyloma and investigate the management.Methods:Retrospective uncontrolled study.Results:A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed.The first patient was a 3-year-old young girl underwent corneal dermoid resection.The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C(MMC).The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery.All patients performed allogeneic sclera patch graft.In the at least half a year follow-up,the best corrected visual acuity(BCVA)of all the four patients were no worse than that of preoperative.Ocular symptoms disappeared,including eye pain,foreign body sensation,and so on.Unfortunately,the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month.Conclusions:Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid,pterygium,and cataract surgery.Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma.However sclera rejection and dissolution should be considered postoperatively.
文摘Purpose. To ascertain the therapeutic effect of periocular corticosteroids in diabetic papillopathy. Methods. Prospec-tively, five consecutive adult-onset diabetic patients with symptomatic diabetic papillopathy underwent visual fields and fluorescein angiography before and after superonasal subtenon injection of corticosteroids. Results. The median duration of papillopathy was 2.5 weeks by ophthalmoscopy and 3 weeks by fluorescein angiography. The median recovery time of best-spectacle-corrected visual acuity was 2 weeks. Two patients developed sequential diabetic papillopathy, and both reported faster visual recovery and better subjective vision in treated eyes. In these two patients, the final best-spectacle-corrected visual acuity and visual evoked responses were comparable between the two eyes, while automated visual fields were less constricted in treated eyes. Complications included ocular hypertension, mild progression of cataract, and mild ptosis in one patient each. Conclusions. Periocular corticosteroids shortened the duration of diabetic papillopathy from a reported median of 5 months to 3 weeks in the present uncontrolled observational study, partly by their angiostatic and antioedema effects at the level of the anterior optic nerve. Intraocular pressure needs to be monitored in eyes receiving periocular corticosteroids.
文摘PURPOSE: To investigate the effect of retrobulbar anaesthesia on retrobulbar haemodynamics, colour Doppler imaging was performed. Furthermore, the additive effect of epinephrine was examined. Method: Forty-one patients (age 72.7±8.9; 22 f, 19 m) undergoing planned cataract surgery were included in a prospective study. Colour Doppler imaging was performed before and directly after retrobulbar anaesthesia and after cataract surgery to measure the peak systolic velocity (PSV) and end diastolic velocity (EDV) in the ophthalmic artery, central retinal artery and central retinal vein. In 18 patients lidocaine 2%with-out additives (2 ml, retrobulbar transconjunctival injection) and in 23 patients lidocaine 2%with epinephrine 1:200,000 was used. Results: After retrobulbar anaesthesia both groups had a significant reduction of the PSV and of the EDV. After surgery flow velocities increased again. The addition of epinephrine resulted in a significantly greater reduction and slower recovery of flow velocities. Conclusion: Retrobulbar anaesthesia induces a marked reduction of velocity in the retrobulbar vessels. The supplement epinephrine increases this effect, and recovery is much slower. Thus, particularly in patients with already disturbed ocular haemodynamics epinephrine should not be used in order to avoid irreversible functional damage.
文摘Purpose We aimed to describe the demographic and clinical features, ocular man ifestations, complications, visual prognosis, and treatment in a large populatio n of Turkish patients with Behcet uveitis. We also aimed to compare visual progn osis between male and female sex and between patients who presented before and a fter 1990. Design Observational case series. Methods A retrospective study of 88 0 consecutive patients (1,567 eyes) with Behcet uveitis seen at the Uveitis Serv ice, Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul Univers ity, from 1980 to 1998. All patients met the classifi cation criteria of the Int ernational Study Group for Behcets Disease. Information on the patients sex, age at onset of uveitis, ocular features, ocular complications, visual acuity, and systemic treatment was collected. Results Five hundred ninetynine patients ( 68%)weremale and 281 (32%)were female. The mean age at onset of uveitiswas 28. 5 years inmale and 30 years in female patients. Ocular involvement was bilateral in 78.1%and unilateral in 21.9%of the patients. Panuveitiswas the most common form in both sexes. Fundus lesions as well as sightthreatening complications we re more common in males. At the beginning of the follow up, potential visual ac uity was 0.1 or less in 30.9%of eyes in males and 24.2%of eyes in females. Kap lan Meier survival analysis estimated the risks of losing useful vision (>0.1) at 5 and 10 years for males and females as 21%vs 10%and 30%vs 17%, respectiv ely. Male patients who presented in the 1990s had a significantly lower risk of losing vision compared with male patients who presented in the 1980s. Conclusion Behcet uveitis starts frequently around the end of the third decade and has a m ale predominance. The disease is more severe and the risk of losing useful visio n is higher in males than in females. However, this risk has been significantly reduced in the 1990s.
文摘Purpose: The inflammatory response in acute anterior uveitis (AU) is believed to be primarily mediated by autoreactive Tcells. We wanted to evaluate whether t he T-cell activation marker CD40 ligand is involved in the AU immunopathogenesi s. Methods: We evaluated the expression of the CD40 ligand on CD4+T-cells, CD8 +T-cells and CD19+B-cells on peripheral blood mononuclear cells using flow c ytometry in six patients with unilateralAU, six patientswith monosymptomatic opt ic neuritis (ON) as inflammatory controls, and in six healthy controls. The ex v ivo induction of the CD40 ligand on T-cells in patients and controls was also s tudied. Results: A significantly higher expression of the CD40 ligand on both CD 4+(p< 0.05)-and CD8+(p< 0.05) T-cells in patients with AU compared to ON pat ients and healthy controls was found. There was a significantly higher induction of the CD40 ligand on CD8+T-cells in AU patients compared to ON patients and healthy controls (p < 0.01). No differences in the B-cell population were obser ved between the three groups. Conclusion: Patients with AU had increased express ion of the CD40 ligand on T-cells in the blood and expressed higher levels of t he CD40 ligand when stimulated, compared to ophthalmological inflammatory contro ls and healthy controls. The data suggest that the CD40 ligand is involved in th e development of AU.
文摘Purpose: To evaluate the efficacy of a new continuous functional visual acuity measurement (FVAM) system for the assessment of dry eye patients. Design: Prospective comparative study. Methods: Monocular recognition acuity measured continuously by the FVAM system during a 30- second blinkfree period was defined as functional visual acuity (FVA). Examinations using the FVAM system were conducted in 35 eyes of 20 healthy controls and 19 eyes of 13 dry eye patients. Tear function examinations including the Schirmer test, tear film break- up time, and fluorescein and Rose Bengal staining were performed in all subjects. Functional visual acuity and tear functions were also examined before and after insertion of punctumplugs in dry eye patients. Functional visual acuity results at 10, 20, and 30 seconds were compared. Results: Functional visual acuity in dry eyes were significantly lower than control subjects at all time points (P < .05). Functional visual acuity after punctum plugs insertion improved significantly at all time points (P < .05).Conclusions: FVAM system seemed not only to be an effective tool in the assessment of dynamic visual acuity changes in dry eye and normal subjects but in evaluating the outcome of management of dry eye disease by punctum plugs.
文摘We have developed a new technique to facilitate internal limiting membrane (ILM) peeling with triamcinolone acetonide during idiopathic macular hole surgery. Twelve eyes of 12 patients with a macular hole, stage 2 to 4 and size 0.12 disc diameters (DD) to 0.39 DD (mean, 0.20 DD), underwent vitrectomy with ILM peeling using triamcinolone. Before ILM peeling, a triamcinolone suspension (8 mg/mL in balanced salt solution) was sprayed around the macular hole, and the triamcinolone in the vitreous cavity was aspirated slowly, making the ILM more visible. Postoperatively, the macular hole was closed in all eyes, and the visual acuity was improved from 20/200 to 20/40 (median, 20/130) to 20/60 to 20/20 (median, 20/40). This technique can facilitate the ILM peeling without any adverse effects in this short-term observation.
文摘Background:To report the occurrence of a full thickness macular hole in association with idiopathic parafoveal telangiectasia.Methods:Observational case report.Results:A 60-year-old female with a history of bilateral idiopathic parafoveal telangiectasia presented with acute complaints of decreased vision and metamorphopsia in her right eye.The patient’s retinal examination was significant for idiopathic parafoveal telangiectasia bilaterally,and a new,full-thickness macular hole in the right eye which was confirmed by optical coherence tomography.Conclusions:Full-thickness macular hole formation may occur in conjunction with idiopathic parafoveal telangiectasia,which has not been reported to date.Idiopathic parafoveal telangiectasia,IPT,is a clinical entity with distinct biomicroscopic and fluorescein angiographic findings which may be divided into developmental and acquired forms.Idiopathic macular hole formation is a relatively common condition,which tends to occur more frequently in females in their 7th and 8th decades of life.Idiopathic parafoveal telangiectasia has been reported in association with lamellar macular holes,but,to our knowledge,not with a full thickness macular hole.Here in we report the case of a patient with bilateral idiopathic parafoveal telangiectasia who developed a full-thickness macular hole.
文摘Background: Interferon (IFN)-associated retinopathy is typically characterize d by retinal hemorrhages and cotton wool spots at the posterior fundus, but visu al function is usually maintained. With the use of optical coherence tomography (OCT), two patients with IFN-associated retinopathy who had developed macular e dema and reduced visual acuity during the clinical course of IFN therapy were ob served. Cases: A 37-year-old man with chronic hepatitis C and a 59-year-old man with chronic myeloid leukemia, both of whom had received IFN therapy, were r eferred to our outpatient clinic. The former patient had complained once that hi s visual acuity had decreased after the termination of IFN therapy, and the latt er patient complained twice during IFN therapy that his visual acuity had decrea sed. Observations: In both patients, at the time of the visual disturbances, mac ular edema was clearly observed by OCT. Hypoalbuminemia and thrombocytopenia wer e observed at this time also. After the remission of the hypoalbuminemia and thr ombocytopenia, the macular edema observed by OCT disappeared and visual acuity r eturned to normal. Conclusion: During and after IFN therapy, OCT is a useful exa mination technique for revealing macular edema in patients who have decreased vi sion. Ophthalmologists should be aware of the ocular side effects of IFN therapy and carefully monitor patients for the possible occurrence of hypoalbuminemia a nd thrombocytopenia.
文摘Purpose: To identify the characteristic ocular findings in patients with craniofacial cleft (CFC). Methods: Ophthalmologic examination wa s performed for a 16-year-old girl with no. 3 CFC and a 3-year-old boy with no. 5 CFC. Results: Exotropia was found in the 3-year-old boy with no. 5 CFC i nvolving the lateral orbit, and esotropia in the 16-year-old girl with craniof acial cleft no. 3 involving the medial orbit. Hypotropia, lower eyelid coloboma, amblyopia and an absence of stereopsis were common to both patients. Visual acu ity was improved from hand motion to 20/30 by means of occlusion therapy for amb lyopia in the 3-year-old boy. Strabismus surgery resulted in exophoria of 8 pr ism diopters (PD) in the 3-year-old boy and left esotropia of 8 PD in the 16- year-old girl. Conclusions: Amblyopia, hypotropia, esotropia (no. 3) and exotro pia (no. 5) should be verified in cases of CFC nos. 3 and 5. Ophthalmologic exam ination and early intervention for amblyopia may be mandatory for patients with CFC involving the orbit.
文摘PURPOSE. To study deactivation of the rod photoresponse in infants using a paired-flash procedure. Rhodopsin content increases and scales the parameters of the activation of rod phototrans duction as rods develop. However, little is known about the kinetics of deactivation in the rods of young infants. METHODS. ERG responses to pairs of flashes were used to study the recovery of the rod response in 4- and 10- week-old infants and mature control subjects. The amplitudes of rod isolated a-wave responses to a probe flash (+ 3.3 log scot tds) presented 2 to 120 seconds after an equal-intensity test flash were measured. The interstimulus interval (ISI) at which the amplitude was half that of the response to the probe flash alone (t50) was determined by linear interpolation. RESULTS. Recovery time (t50) was significantly longer in infants than in adults (F=18.9, df 2, 32; P<0.01). The shape of the recovery function did not vary with age. The t50 values were inversely proportional to the parameters of activation of rod phototransduction. CONCLUSIONS. These results are evidence that the kinetics of deactivation in infants are slower and may be set by the proportion of rhodopsin isomerized.
文摘The use of artificial intelligence(AI)in ophthalmology is not very new and its use is expanding into various subspecialties of the eye like retina and glaucoma,thereby helping ophthalmologists to diagnose and treat diseases better than before.Incorporating“deep learning”(a subfield of AI)into image-based systems such as optical coherence tomography has dramatically improved the machine's ability to screen and identify stages of diabetic retinopathy accurately.Similar applications have been tried in the field of retinopathy of prematurity and agerelated macular degeneration,a silent retinal condition that needs to be diagnosed early to prevent progression.The advent of AI into glaucoma diagnostics in analyzing visual fields and assessing disease progression also holds a promising role.The ability of the software to detect even a subtle defect that the human eye can miss has led to a revolution in the management of certain ocular conditions.However,there are few significant challenges in the AI systems,such as the incorporation of quality images,training sets and the black box dilemma.Nevertheless,despite the existing differences,there is always a chance of improving the machines/software to potentiate their efficacy and standards.This review article shall discuss the current applications of AI in ophthalmology,significant challenges and the prospects as to how both science and medicine can work together.
文摘BACKGROUNDANDOBJECTIVE: To determine the efficacy of intravitreal triamcinolone acetonide (IVTA) in the early treatment of severe cystoid macular edema (CME) related to acute branch retinal vein occlusion. PATIENTS AND METHODS: Retrospective, non-comparative case series. Twelve eyes with severe CME (foveal thickness >450 μ m) secondary to acute branch retinal vein occlusion received IVTA. RESULTS: Average follow-up was 15.3 months. Mean visual acuity was 0.88 LogMar units (20/160) initially, 0.55 LogMar units (20/70) at 1 week, 0.46 LogMar units (20/60) at 1 month, and 0.49 LogMar units (20/60) at last follow-up. Visual acuity improved by 3 lines or greater in 42% of patients at 1 week, 50% at 1 month, and 42% at last follow-up. Average foveal thickness was 589 μ m (range,460 to 840 μ m) at baseline, 237 μ m at 1 week, 196 μ m at 1 month, and 235 μ m at last follow-up. All eyes showed reduction of foveal thickness as measured by optical coherence tomography. Eight eyes developed recurrentCME at an average of 5.5 months after initial IVTA injection. Ten eyes required additional intervention during the follow-up period. CONCLUSIONS: Early treatment of severe CME secondary to branch retinal vein occlusion with IVTA is effective in reducing foveal thickness as measured by optical coherence tomography and improving visual acuity. However,monotherapy with IVTA can be associated with a significant rate of recurrent CME.
