SciCombinator

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Journal: European journal of ophthalmology

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Purpose. To report a case of scleral dislocation mimicking glaucoma progression.
Methods. Interventional case report.
Results. A 71-year-old man was referred for glaucoma surgery in his right eye because of perimetry defect progression and uncontrolled intraocular pressure despite maximal medical therapy. A scleral buckling procedure in his right eye was previously performed for rhegmatogenous retinal detachment. At the time of presentation, a visible protruded sponge buckle element was noted at ocular inspection, without any sign of infection. The buckle element was posteriorly in contact with the optic nerve and anteriorly protruding under intact conjunctiva. We eventually managed for its removal via upper eyelid orbitotomy. Visual field lesions were unchanged on every follow-up visit.
Conclusions. This case report describes severe permanent optic nerve damage due to previous misdiagnosis of a rare complication of scleral buckling surgery. Our surgical solution appears to be a safe and successful approach for this ocular disorder, also able to stabilize visual function and interrupt disease progression.

Concepts: Medicine, Therapy, Retina, Visual system, Ophthalmology, Optic nerve, Visual field, Scleral buckle

28

Purpose. To describe the complete sequence of the progressive vasculopathy in macular telangiectasia type 2.
Methods. This is a report of a case demonstrating the complete vasogenic sequence in macular telangiectasia type 2 over the course of 15 years, and representative images from a collective of 150 patients with macular telangiectasia type 2 employing fundus photography, fluorescein angiography, and optical coherence tomography.
Results. Macular telangiectasia may progress along a predictable vasogenic sequence which consists of nonproliferative stages, characterized by temporal loss of macular luteopigment and inner retinal volume loss in the absence of vascular changes, followed by a progressive proliferative vasculopathy, first involving the deep capillary plexus with eventual extension of the vascular changes circumferentially in the inner retinal capillary plexus. Late proliferative stages may become indistinguishable from advanced neovascular age-related macular degeneration.
Conclusions. While it is rare to observe the complete vasogenic sequence of macular telangiectasia type 2, a classification into nonproliferative and proliferative stages can be established, and may prove helpful as the mechanisms driving the pathogenic process through those stages are identified.

Concepts: Optics, Medical imaging, Retina, Ophthalmology, Macular degeneration, Fluorescein angiography, Fundus camera, The Progressive

28

Purpose. To report the efficacy and ocular tolerance of a new tamponade made with ether and silicone oil (HeavySil [HSIL]) for the treatment of retinal detachment (RD) complicated by inferior proliferative vitreous retinopathy (PVR).
Methods. Prospective noncomparative interventional study on 31 consecutive eyes that underwent pars plana vitrectomy and were treated with HSIL as an intraocular tamponade. All patients presented with at least one retinal break and grade B-C PVR located between 4 and 8 o'clock. The main endpoint criteria were retinal reattachment after the removal of HSIL and complications arisen from the use of this tamponade.
Results. Primary anatomic success was achieved in 27 out of 31 cases. Mean visual acuity improved from logMAR 1.4 (SD 0.7) to logMAR 1.1 (SD 0.6) (p=0.02).
The main complications reported were cataract formation (5 out of 7 phakic eyes cases), clinically visible emulsification (6 cases), and difficulty of oil removal in 3 cases. Severe intraocular inflammation with HSIL in situ was found in only one case.
Conclusions. HeavySil, a saturated solution of ether with silicone oil, is a safe and effective tamponade agent for the treatment of complicated RD. The most common complications are cataract formation and oil emulsification.

Concepts: Retina, Visual acuity, Ophthalmology, Vitrectomy, Diabetic retinopathy, Retinal detachment, Intraocular lens, Vision loss

27

Purpose. To evaluate the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL).
Methods. A multicenter, consecutive case series of patients with biopsy-proven conjunctival, orbit, eyelid, or lacrimal gland/sac lymphoma was performed. The electronic pathology and clinical records were reviewed for new or recurrent cases of ocular adnexal lymphoma. The main outcome measures included pathology and clinical staging (AJCC and Ann Arbor systems), treatment, and recurrence (local and systemic). Statistical analysis included demographic evaluations and the Kaplan-Meier survival probability method.
Results. Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue were the most common (n=60/83, 72%). The most common Ann Arbor clinical stages were IE (76%) followed by IIE (17%) and IIIE (7%). Pathology identified 13 cases (15%) that were upstaged to group IV (p=0.017). Similarly, AJCC clinical stages were cT1NOMO (21.7%), cT2NOMO (44.6%), cT3N0M0 (5%), and cT4NOMO (2.4%). Local control was achieved in 75% of treated patients. There were 19 local recurrences from which 14 (74%) belonged to the non-radiation treatment groups. Lower-risk groups (T1 and T2 without lymph node involvement or metastatic disease of AJCC and IE of Ann Arbor) had longer disease-free survival than the higher-risk groups (AJCC T1, T2 with nodal involvement or metastatic disease, T3, and T4 as well as Ann Arbor II, III, and IV). The overall mean follow-up was 43.3 months (range 6-274).
Conclusions. Regardless of stage, recurrence and disease-free survival were more closely related to treatment and histopathology rather than tumor size or site-specific location.

Concepts: Medicine, Cancer, Lung cancer, Cancer staging, Lymph node, Chemotherapy, Lymphoma, Lymphatic system

27

Purpose: To study the demographic and clinical characteristics of children who present to our hospital with blepharoptosis. 
Methods: A retrospective review of the hospital records of children presenting with blepharoptosis between November 2002 and December 2010 was conducted. Demographic data (age at presentation, gender, and family history) and clinical data (severity, etiology, and associated conditions) were studied. The number and type of any surgical procedure was also recorded. 
Results: A total of 408 eyes of 336 children were reviewed. The mean age at presentation was 
3.2 years (range 0.25-10 years). Blepharoptosis was unilateral in 64.7% of cases, 74% of which affected the left eye. A positive family history was elicited in 19.4% of cases. Recurrent ptosis constituted 9.3% of presenting cases. The commonest type was congenital (68.9%) followed by blepharophimosis syndrome (16.7%). Associated considerable refractive errors occurred in 13.2% of cases, strabismus in 6.8% of cases, and amblyopia attributed solely to occlusion in 10% of cases. Frontalis suspension was the most common surgery (58%) followed by anterior approach levator muscle resection (29%) and Whitnall sling procedure (13%). Undercorrection, whether primary or late, occurred in 36.5% of cases. The mean number of operations performed was 1.5 (range 1-4).
Conclusions: Blepharoptosis in children is most commonly dystrophic with poor levator function showing a predilection to left side affection. Associated strabismus, refractive errors, and amblyopia should be considered for proper management of these patients. More than one surgery is required to correct the ptosis even in experienced hands.

Concepts: Medicine, Surgery, Arithmetic mean, Ophthalmology, Demographics, Amblyopia, Ptosis, Blepharophimosis

27

Introduction: Amblyopia is a common childhood condition, which affects 2%-3% of the population. The efficacy of conventional treatment in amblyopia seems not to be high and recently perceptual learning has been used for treating amblyopia. The aim of this study was to address the efficacy of Internet-based perceptual learning in treating amblyopia.
Methods: A total of 530 eyes of 341 patients with amblyopia presenting to the outpatient department of West China Hospital of Sichuan University between February 2011 and December 2011 were 
reviewed. A retrospective cohort study was conducted to compare the efficacy of Internet-based 
perceptual learning and conventional treatment in amblyopia. The efficacy was evaluated by the change in visual acuity between pretreatment and posttreatment.
Results: The change in visual acuity between pretreatment and posttreatment by Internet-based perceptual learning was larger than that by conventional treatment in ametropic and strabismic amblyopia (p and lt;0.05), but smaller than that in anisometropic and other types of amblyopia (p and lt;0.05). The improvement in visual acuity by Internet-based perceptual learning was larger for patients with amblyopia not younger than 7 years (p and lt;0.05). The mean cure time of patients with amblyopia by Internet-based perceptual learning was 3.06 ± 1.42 months, while conventional treatment required 3.52 ± 1.67 months to reach the same improvement (p and lt;0.05). 
Conclusions: Internet-based perceptual learning can be considered as an alternative to conventional treatment. It is especially suitable for ametropic and strabismic patients with amblyopia who are older than 7 years and can shorten the cure time of amblyopia.

Concepts: Cohort study, Learning, Depth perception, Strabismus, Diplopia, Amblyopia, Exotropia, Eyepatch

26

To evaluate diabetic retinopathy (DR) prevalence and risk factors, and the effectiveness of nonmydriatic fundus camera as a screening tool for the detection of DR, in a safety net hospital.

Concepts: Ophthalmology, Diabetic retinopathy, Fluorescein angiography, Fundus camera

26

Purpose: To measure and compare the optical quality of spherical and aspheric toric intraocular lenses (IOLs).

Methods: Wavefront aberrations of AcrySof Toric and IQ Toric IOLs (Alcon Laboratories) for different powers were measured at 3- and 5-mm pupils by Nimo TR0805 instrument. The Zernike coefficients of trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. The point spread functions (PSFs) of each IOL evaluated were calculated from the wavefront aberrations. The PSF images also were calculated from the IOL wavefront aberrations, adding the cornea’s aberrations to simulate the optical quality after their implantation.

Results: Spherical toric IOLs showed positive and aspheric toric IOLs negative spherical aberrations. Statistically significant differences were found in spherical aberration root mean square (RMS) values between spherical and aspheric IOLs for both pupil sizes (p<0.05). Aspheric toric IOLs showed higher spherical aberration RMS values. We found differences in PSF images between both IOL designs at 5-mm pupil. The PSFs corresponding to the aspheric toric IOLs showed more spread out than the PSFs corresponding to the spherical toric IOLs. However, when corneal aberrations were added, aspheric toric IOLs showed better optical quality than spherical toric IOLs.

Conclusions: At 3-mm pupil, the optical quality between the IOL designs was similar, but at 5-mm pupil the optical quality was higher for spherical IOLs than aspheric IOLs. However, when theoretical corneal aberrations were added, aspheric toric IOLs showed better optical quality than spherical toric IOLs, due to the compensation between aspheric toric IOL negative spherical aberration and corneal positive spherical aberration.

Concepts: Optics, Cornea, Lens, Contact lens, Root mean square, Intraocular lens, Pupil, Spherical aberration

26

Purpose: To describe a patient with nasolacrimal duct obstruction (NLDO) caused by dental impaction.

Methods: This is an interventional case report of an 18-year-old man presenting epiphora of the right eye. Previous surgical management was unsuccessful. Computed tomography (CT) of the orbits and sinuses was performed. Dacryocystorhinostomy (DCR) on the right lacrimal sac resulted in complete remission of symptoms. The DCR surgical outcome at last follow-up was recorded.

Results: The CT imaging showed ankylosis of deciduous canines and impaction of persistent canines. The root of the right impacted dental element was involved with the nasolacrimal duct, leading to NLDO. Endoscopic DCR resulted in complete remission of symptoms. The patient was symptom-free at last follow-up.

Conclusions: Our case adds NLDO to the long list of complications arising from dental impactions, highlighting the importance of correct early management of the latter condition. This case also shows that dental impaction can be included among the secondary mechanical causes of NLDO.

Concepts: Medical terms, Tears, Lacrimal sac, Lacrimal apparatus, Nasolacrimal duct, Fecal impaction, Impaction, Nasolacrimal canal

25

To assess efficacy and patient satisfaction after cataract surgery and implantation of a new accommodative bioanalogic intraocular lens (IOL).

Concepts: Ophthalmology, Contact lens, Intraocular lens, Phacoemulsification