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Purpose. Postintravitreal injection (IVI) endophthalmitis is a rare but devastating complication. Herein, we report the incidence ,and clinical and microbiological characteristics, as well as the visual outcome, in IVIs endophthalmitis in two medical centers. Methods. All patients undergoing intravitreal injections between 1/2018 and 12/2019 in two large medical centers were analyzed for post-IVI endophthalmitis. Results. Of the total of 51,356 IVIs performed, 23 cases of post-IVI endophthalmitis were diagnosed, yielding an overall incidence of 0.045%. The median interval from IVI to symptoms onset was 2 days (IQR: 1–5). Cultures were positive in 56% of the cases (100% Gram-positive bacteria and 76% coagulase-negative staphylococcus). Parameters associated with higher culture-positive rates included samples taken during vitrectomy, WBC on vitreous smear, the number of IVIs in the 12 months prior to presentation, and the time interval from last IVI to diagnostic sampling. At 6- and 12-month follow-up, the median change in VA (logMAR) was −1.10 (IQR: (−1.32)–(−0.40)) and −1.02 (IQR: (−1.10)–(−0.30)), respectively. Younger age and better BCVA at presentation were associated with better VA outcome, while positive culture result and systemic steroids treatment were each associated with the worse visual outcome. We found no difference in visual outcomes between PPV and TAI as a primary procedure. Conclusion. Post-IVI endophthalmitis is a rare complication, and most patients do not regain their initial VA. Certain parameters (clinical, microbiological, and therapeutic) may help anticipate the outcome and guide decision making regarding diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). Methods. The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. Results. In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p = 0.009 for general vision, p < 0.001 ; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Conclusions. Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate clinical outcome during 24 months follow-up between small incision lenticule extraction combined with cross-linking (SMILE Xtra) and small incision lenticule extraction (SMILE) only. Setting. Ophthalmology Division of San Rossore Medical Center, Pisa, Italy. Design. Retrospective comparative case series. Methods. The study comprised 70 eyes (35 patients); 40 eyes were corrected using SMILE and 30 eyes were corrected using SMILE Xtra using a low energy protocol. The outcomes were compared at 1, 6, 12, and 24 months postoperatively. Results. The mean spherical equivalent (SEQ) reduced from −7.18 ± 1.21 D to −0.01 ± 0.09 D in the SMILE group and from −6.20 ± 2.99 D to −0.04 ± 0.1 D postoperatively in SMILE Xtra (p < 0.05). At 24 months the mean SEQs were −0.01 ± 0.24 D for SMILE and −0.15 ± 0.33 D for SMILE Xtra (p > 0.05). At 1, 6, 12, and 24 months, there were no statistically significant differences between the SMILE and SMILE Xtra groups in logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA), safety, and efficacy index (p > 0.05). The mean average keratometry (K-avg) at 1, 6, 12, and 24 months after surgery did not shown any statistically significant difference between SMILE and SMILE Xtra group (p > 0.05). The mean maximum keratometry (K-max) readings at 1, 6, 12, and 24 months were not statistically significant between SMILE and SMILE Xtra group (p > 0.05). The preoperative mean thinnest point pachymetry (TTP) was 543.90 ± 22.85 μm in the SMILE group and 523.40 ± 37.01 μm in the SMILE Xtra group (p < 0.05). At 1, 6, 12, and 24 months the mean TTP was not statistically significant between the SMILE and SMILE Xtra groups (p > 0.05). At 24 months, the TTP was 408.29 ± 38.75 μm for the SMILE group and 402.22 ± 37 μm for the SMILE Xtra group (p > 0.05). In the preoperative period, the mean maximum posterior elevation (MPE) was 8.63 ± 4.35 μm for SMILE and 8.13 ± 2.54 μm for SMILE Xtra (p > 0.05). After the surgical procedure, both groups showed a statistically significant increase of the MPE (p < 0.05). At 24 months, the MPE was 11.00 ± 4.72 μm for SMILE Xtra and 10.14 ± 3.85 μm for the SMILE group (p > 0.05). In the preoperative period, the means of the root mean square (RMS) of high-order aberration (HOA) were 0.08 ± 0.03 μm for the SMILE group and 0.08 ± 0.03 μm for the SMILE Xtra group (p > 0.05). At 24 months, the RMS of HOA was 0.13 ± 0.07 μm for the SMILE group and 0.14 ± 0.07 μm for the SMILE Xtra group (p > 0.05). In the preoperative period, the root mean square of coma aberration (RMS-Coma) aberration was 0.06 ± 0.09 μm for the SMILE group and 0.04 ± 0.03 μm for the SMILE Xtra group (p > 0.05). At 24 months, the coma aberration of SMILE group was 0.12 ± 0.21 μm and 0.16 ± 0.25 μm for SMILE Xtra group (p > 0.05). Conclusions. SMILE Xtra procedure is a safe and simple procedure that can be offered to patients with high corneal ectasia risk because there were no differences in the indices of ectasia compared to the group treated only with SMILE which has a low corneal ectatic risk. [ABSTRACT FROM AUTHOR]

Backgrounds. Acute invasive fungal rhinosinusitis (AIFRS) is a hazardous infectious disease with rapid progression and high mortality and morbidities. Further orbital involvement is commonly seen. This study aims to analyze risk factors, clinical characteristics, and outcomes between patients with or without orbital involvement. Methods. A retrospective review was performed in a single tertiary medical center over a span of 13 years (2005–2018). A total of 21 patients with diagnosis of AIFRS were enrolled. We reviewed the patients' basic characteristics, comorbidities, clinical presentations, image study findings, culture pathogens, and treatment outcomes and analyzed the differences between orbital-involved and orbital sparing disease. Results. The most common comorbidities in AIFRS were diabetes mellitus (DM) and hematological malignancy. Nine the 21 AIFRS patients had orbital-involved disease. Patients with orbital involvement had a higher prevalence of DM (p < 0.05). Image studies revealed significant infection of the ethmoid sinus, sphenoid sinus, and frontal sinus in the group with orbital complication (p < 0.05). Mucor, Rhizopus, and Aspergillus were cultured in both groups. Five patients in the orbital involvement group expired, with all of them having an initial presentation of conscious disturbance (p < 0.01). Rhino-orbital-cerebral fungal infection was noticed in 3 of the 5 expired patients. Conclusion. In AIFRS patients, DM other than hematological malignancy was the main risk factor for orbital-involved disease. Patients with ethmoid, sphenoid, or frontal sinusitis had a higher possibility of orbital complication. Poor consciousness at initial presentation revealed highest possibility of rhino-orbital-cerebral fungal infection and led to death. [ABSTRACT FROM AUTHOR]

Introduction. Computer vision syndrome (CVS) is "a complex of eye and vision problems related to near work experienced during computer use." It is one of the rising health concerns related to technology (cell phones and tablets) due to continuous use of computers among students. The aim of this study was to determine the prevalence of CVS, associated risk factors, and commonly associated symptoms and to assess the awareness and proper practice of using computers for studying. Methods. A cross-sectional descriptive study was conducted among 651 undergraduate medical students in King Abdulaziz University, Jeddah, Saudi Arabia. An electronic survey was conducted to collect the data. Data were analyzed using SPSS v21. The chi-square test (Fisher's exact test when required) was used to study the significance of associations. P value <0.05 was considered statistically significant. Results. High prevalence of CVS was observed, in which 95% (558) reported at least one symptom during studying using computers. Most frequently reported symptoms were excessive tearing and neck, shoulder, or back pain. Female students had a higher risk of CVS (P = 0.003). Students who are myopic or hyperopic showed no association. Astigmatism was associated significantly with CVS (P = 0.03). Using spectacles or contact lens showed no association. Students with dry eye disease revealed a significant association with CVS (P = 0.01). The most significant risk factors related to the daily usage of computer were longer duration of studying (P < 0.001), short distance from the screen (P < 0.05), and high brightness of the screen (P < 0.05). The most significant preventive measure taken to relieve the symptoms was applying the 20-20-20 rule. Conclusion. CVS is common among medical students; significant risk factors need to be addressed to reduce the symptom and to ensure a better productivity of work. It is a necessity to raise awareness among medical students regarding computer-related health problems. [ABSTRACT FROM AUTHOR]

Purpose. To assess functional and morphological alterations following video-documented surgery for epiretinal membranes. Methods. Forty-two patients underwent video-documented 23-gauge vitrectomy with peeling of epiretinal (ERM) and inner limiting membrane (ILM). Patient assessment was performed before and 3 and 6 months including best corrected visual acuity (BCVA), slit lamp biomicroscopy, SD-OCT, and central 2° and 18° microperimetry. In addition, all video-documented areas of peeling on the retinal surface were evaluated postoperatively using an additional focal 2° microperimetry. Retinal sensitivity and BCVA were correlated with morphological changes (EZ and ELM) in the foveal region and in regions of membrane peeling. Results. Overall, BCVA increased from 0.6 (±0.2) to 0.2 (±0.2) logMAR after 6 months with an increase in retinal sensitivity (17.9 ± 2.7 dB to 26.8 ± 3.1 dB, p<0.01). We observed a significant correlation between the integrity of the EZ but not of the ELM and the retinal sensitivity, overall and in peeling areas (p<0.05). However, no significant correlation between alterations in the area of peeling and overall retinal sensitivity regarding visual acuity gain could be observed after 6 months (p>0.05). In contrast, overall postoperative retinal sensitivity was significantly decreased in patients with a visual acuity gain lower than 2 lines (p<0.05) correlating with EZ defects seen in OCT. Conclusions. Mechanical trauma of epiretinal membrane and ILM peeling due to the use of intraocular forceps may affect the outer retinal structure. Nevertheless, these changes seem to have no significant impact on postoperative functional outcome. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the role of spectral-domain optical coherence tomography (SD-OCT) in early detection of Chloroquine maculopathy in rheumatoid arthritis (RA) patients. Methods. 40 left eyes of 40 female rheumatoid arthritis patients who received treatment chloroquine for more than one year were recruited in the study. All patients had no symptoms or signs of Chloroquine retinopathy. They were evaluated using SD-OCT, where the Central Foveal Thickness (CFT), parafoveal thickness and perifoveal thickness, average Retinal Nerve Fiber Layer (RNFL) thickness, and Ganglion Cell Complex (GCC) measurements were measured and compared to 40 left eyes of 40 normal females. Results. The mean CFT was found to be thinner in the Chloroquine group (238.15 µm ± 22.49) than the normal controls (248.2 µm ± 19.04), which was statistically significant (p value = 0.034). The mean parafoveal thickness was lesser in the Chloroquine group than the control group in all quadrants (p value <0.05). The perifoveal thickness in both groups showed no statistically significant difference (p value >0.05) in all quadrants. No significant difference was detected between the two groups regarding RNFL, GCC, or IS/OS junction. Conclusions. Preclinical Chloroquine toxicity can lead to early thinning in the central fovea as well as the parafoveal regions that is detected by SD-OCT. [ABSTRACT FROM AUTHOR]

Objective. To compare the effects of prednisolone and of loteprednol after combined phacoemulsification and trabecular micro-bypass stent implantation (phaco-iStent). Methods. Patients who underwent phaco-iStent between April 2013 and November 2014 were identified by retrospective chart review. Postoperatively, they received either prednisolone (n=38) or loteprednol (n=58). Baseline data was compared. Primary outcomes including intraocular pressure (IOP) and number of glaucoma medications (NGM) were analyzed at preoperative visit, postoperative day 1, weeks 1-2, weeks 3-4, and months 2-3. Results. Both groups had similar preoperative parameters (p>0.05). The mean IOP spike occurred at postoperative weeks 1-2 with an increase of 2.21 ± 7.30 mmHg in the loteprednol group and 2.54 ± 9.28 mmHg in the prednisolone group. It decreased by weeks 3-4 in both groups and continued to improve at months 2-3. NGM showed significant reduction (p<0.0001) after the surgery and remained stable in both groups. No significant group effect or time-group interaction in IOP and NGM evolution was detected (p>0.05). The proportions of patients needing paracentesis were similar between the two groups. Conclusion. Similar early IOP elevations after combined phaco-iStent occurred with both prednisolone and loteprednol. Facilitated glucocorticoid infusion, altered aqueous humor outflow, and local inflammation may be contributing factors. [ABSTRACT FROM AUTHOR]

Purpose. To determine the clinical features, microbial profiles, treatment outcomes, and prognostic factors for endogenous bacterial endophthalmitis (EBE). Methods. The medical records of 27 eyes of 21 patients diagnosed with EBE for 11 years were reviewed. Collected data included age, site of infection, visual acuities (VAs), microbial profiles, and treatment regimen. Results. The mean age was 68.5 years. Gram-positive organisms accounted for 76.2%, while gram-negative ones accounted for 19.0%. Staphylococcus aureus was the most common causative organism (52.3%) of which 72.7% was methicillin-resistant S. aureus. A final VA of ≥20/40 was achieved in 44% and 20/200 or better was in 64%. Eyes with initial VA of ≥20/200 (P = 0.003) and focal involvements (P = 0.011) had significantly better final VA. Initial VA (P = 0.001) and the interval between onset of ocular symptoms and intravitreal antibiotic injection (P = 0.097) were associated with final VA in eyes receiving intravitreal antibiotics. Conclusions. EBE is generally associated with poor visual outcome; however the prognosis may depend on initial VA, extent of ocular involvement, and an interval between onset of ocular symptoms and intravitreal antibiotic injection. Early diagnosis and early intravitreal injection supplement to systemic antibiotics might lead to a relatively good visual outcome. [ABSTRACT FROM AUTHOR]

Purpose. To compare the clinical features of community-associated (CA) and healthcare-associated (HA) methicillin-resistant Staphylococcus aureus (MRSA) keratitis. Methods. Patients presenting with culture-proven MRSA keratitis between January 1, 2006, and December 31, 2010, at Chang Gung Memorial Hospital, Taiwan, were included in this study. The patients’ demographic and clinical information were reviewed retrospectively. Antibiotic susceptibility was verified using the disk diffusion method. Results. Information on 26 patients with MRSA keratitis was collected, including 12 cases of CA-MRSA and 14 cases of HA-MRSA. All MRSA isolates were susceptible to vancomycin; the only difference in drug susceptibility was that CA-MRSA isolates were more susceptible to trimethoprim/sulfamethoxazole than HA-MRSA P=.034. The most common risk factor for MRSA keratitis was ocular surface disease. No significant differences were observed between the 2 groups in terms of clinical features, treatments, and visual outcomes. Conclusion. In Taiwan, CA-MRSA rivals HA-MRSA as a critical cause of MRSA keratitis. Furthermore, CA-MRSA isolates are multidrug resistant. CA-MRSA and HA-MRSA keratitis are clinically indistinguishable, although larger studies are warranted to further evaluate this association. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the outcome and identify the prognostic factors of traumatic endophthalmitis over a 5-year period. Methods. We reviewed the medical records of all the traumatic endophthalmities that we treated in our department over the last 5 years (20092013). We extracted the following parameters: age, gender, wound anatomy, associated ocular lesions, treatment, and initial and final visual acuities. We used the program SPSS version 20.0.0. for the statistical analysis of our data. Results. During the last 5 years, we treated 14 traumatic endophthalmities, representing 46.66% of all types of endophthalmities. The infection rate in open globe injuries was 8.13% and 34.78%, if an intraocular foreign body (IOFB) was associated. All the patients were males with the median age of 37 years. Initial visual acuities varied between light perception and 0.4 and the timing of treatment from a few hours to 10 days. We administered antibiotic and anti-inflammatory drugs, systemically and intravitreally, in all cases. We performed pars plana vitrectomy in 64.28% of cases. In 57.14% of cases, the final visual acuity was 0.1 or more. Conclusions. IOFBs increased significantly the risk for endophthalmitis. The worse prognostic factors were retinal detachment at presentation and delayed treatment. This trial is registered with IRCT2014082918966N1. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the anatomical and functional outcome of repeated surgeries for recurrent retinal detachment. Methods. We retrospectively reviewed 70 cases with refractory retinal detachment of various etiologies that required multiple operations. Anatomical success (attached retina) or failure (totally/partially-detached retina) was assessed biomicroscopically. The BCVA was used for the evaluation of the functional outcome, at presentation and at the end of follow-up. Various pre-, intra-, and postoperative factors were associated with anatomical success or failure as well as with final functionality. Results. The mean number of surgeries was 4 (range: 2 to 10). The anatomical success rate was 80% (56 attached cases, 14 detached cases). 29% of the attached cases had a BCVA better than 20/40 (Snellen chart). The number of operations doesn't seem to affect significantly the final visual acuity. The PVR was found to affect both the anatomical and functional outcome (P = 0.014 & P = 0.002, respectively). Conclusions. In the present study, it is suggested that multiple operations for refractory retinal detachment may result in successful anatomic results, with a fare functional outcome at the same time. Eventually, we verified that the existence of PVR worsens the prognosis. [ABSTRACT FROM AUTHOR]

Purpose. Alternaria spp. are an uncommon cause of mycotic keratitis. Previous studies on Alternaria keratitis have generally been limited to case reports. We examined the clinical characteristics of Alternaria keratitis in this study. Methods. The characteristics and outcomes of 7 patients with culture-proven Alternaria keratitis treated in our hospital were compared with 25 previously reported cases. Results. The risk factors for Alternaria keratitis were trauma in 5 patients and soft contact lenses in 1 patient. Six patients with early diagnosis (<2 weeks) were cured with medical antimicrobial treatment; a patch graft was required in 1 patient with perforation. When incorporated with previous reports on Alternaria keratitis (n = 32), 14 (44%) infections followed trauma, 10 (31%) were associated with preexisting corneal disease or previous ocular surgery, and 5 (16%) occurred in soft contact lens wearers. Successful medical treatment was achieved in 23 (72%) patients, including 10 out of 21 eyes (48%) treated with natamycin and/or amphotericin B. Therapeutic penetrating keratoplasty was performed in 9 (28%) cases. Conclusions. Alternaria keratitis is generally associated with specific risk factors and responds to medical treatment when early diagnosis is performed and prompt antifungal treatment is initiated. [ABSTRACT FROM AUTHOR]

Purpose. To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes. Procedure. A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010. Results. A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases. Conclusion. Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases. [ABSTRACT FROM AUTHOR]

Purpose. To report visual outcomes and patient satisfaction after unilateral or bilateral refractive lens exchange (RLE) with a single-piece bifocal diffractive multifocal intraocular lens (MIOL). Methods. All patients underwent RLE with the ZMB00 MIOL (Abbott Medical Optics). Patient charts were reviewed to evaluate the distance, intermediate, and near visual acuity (VA), contrast sensitivity, extent of visual symptoms (0-5), satisfaction (1-5), and rate of spectacle independence between unilateral and bilateral RLE group. Results. Forty-seven eyes of 28 patients were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were 0.01±0.12 (standard deviation), 0.27±0.18, and 0.15±0.11, respectively. No eyes lost >1 line of corrected distance VA. Monocular contrast sensitivity remained at normal level. Median scores of halos, night glare, and starbursts for 27 patients were 2.0,3.0, and 0.0, respectively. Median score of satisfaction was 4.0. There were no differences in visual symptom scores or satisfaction between unilateral and bilateral group (P > 0.05). Eighty percent of 25 patients reported total spectacle freedom, with similar rate between bilateral (82%) and unilateral group (75%) (P = 1.000). Conclusions. RLE with the bifocal diffractive MIOL was safe in presbyopic patients and resulted in a high rate of spectacle independence. [ABSTRACT FROM AUTHOR]

Purpose. To determine factors associated with the presence of significant ocular injury in subjects with orbital fractures. Subjects. A consecutive prospective cohort of 161 patients presenting to a general tertiary referral hospital with orbital fractures and undergoing initial conservative treatment was identified. Subjects were assessed at time of injury for the need for emergency surgery, and those initially treated conservatively were subsequently followed up by the Ophthalmology Department to assess for ocular injury requiring ophthalmic management at 1-7 days after injury. Associations between ocular injury and age, sex, visual acuity, presence of blowout fracture, extent of orbital involvement, and presence of distant facial fractures were assessed. Results. 142 male (average age of 32 [95% CI 30-35]) and 19 female (average age of 49 [95% CI 39-59]) subjects were identified. 17 subjects were diagnosed with significant ocular injury. Ocular injury was significantly associated with LogMAR VA worse than 0.2 (OR 49 [95% CI 11-217, P < 0.0001]), but no relationship was noted for age, sex, presence of blowout fracture, extent of fractures, or presence of distal facial fractures. LogMAR visual acuity worse than or equal to 0.2 had a 98% negative predictive value for ocular injury in the setting of orbital fractures. Conclusions. Demographic and nonophthalmic fracture characteristics were not useful predictors of ocular injury in orbital fractures. LogMAR visual acuity worse than or equal to 0.2 is a highly sensitive and useful guide of the need for ophthalmic referral in subjects with orbital fractures. [ABSTRACT FROM AUTHOR]

Background. To investigate the influence of previous exposure to elevated thyroid hormones in euthyroid Graves' ophthalmopathy. Design. Retrospective, observational case series in university setting Median follow-up of 1 year with ranges of 0,8-7,6 years. Study performance of 10 years. Participants. We reviewed the clinical records of 731 Graves' ophthalmopathy patients. There were 88 (12%) patients with onset of Graves' ophthalmopathy during euthyroidism: 37 (5%) patients had ophthalmopathy without known history of thyroid dysfunction (group A) and 51 patients (6%) had onset of ophthalmopathy 6 months or more euthyroid after completion of antithyroid therapy (group B). Main Outcome Measures. Graves' ophthalmopathy was graded using the EUGOGO severity criteria. Unilaterality was investigated. TSH receptor antibody and thyroid peroxidase antibody were measured as markers of Graves' disease. Results. Group A had more often a normal ocular motility (46%) and less proptosis (14 ± 4 mm) compared to groupB(22%, 16±4 mm) (P = 0.032 and 0.028, resp.). TSH receptor antibody was more frequently elevated in group B (94%) than in group A (17%) (P < 0.001). Conclusion. Patients with euthyroid Graves' ophthalmopathy present more often with ocular muscle restriction and proptosis when previously exposed to elevated thyroid hormones. [ABSTRACT FROM AUTHOR]

Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes. Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG. Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average. Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes. [ABSTRACT FROM AUTHOR]

Objective. To formulate and evaluate slow release ketoconazole and ketorolac to treat fungal keratitis and associated inflammation. Methods. Experimental study with the following outcome measures. Pharmaceutical Evaluation. Mucoadhesive gels containing ketoconazole and ketorolac were used. Microbiological in vitro evaluation was performed using cup method. In vivo evaluation was performed on 24 rabbits divided into 2 groups, 12 rabbits each, group A (fast release formula; 6 times daily) and group B (slow release formula; 3 times daily). Each group was divided into two subgroups (6 rabbits each). Both eyes of rabbits were inoculated with Candida albicans. The left eye of all rabbits received the combination formulae. The right eye for one subgroup received ketoconazole as control 1 while the other subgroup received placebo as control 2. Clinical follow-up was done and, finally, the corneas were used for microbiological and pathological evaluation. Results. Gels containing high polymer concentration showed both high viscosity and mucoadhesion properties with slower drug release. The infected eyes treated with slow release formula containing both drugs showed better curing of the cornea and pathologically less inflammation than eyes treated with fast release formula. Conclusion. Slow release formula containing ketoconazole and ketorolac showed higher activity than fast release formula against fungal keratitis and associated inflammation. [ABSTRACT FROM AUTHOR]

Aim. To determine the frequency of detection of conjunctival C. trachomatis (CT), M. hominis (MH), and U. urealyticum (UU) infections in young adults with dry eye disease (DED), since these infections may potentially produce the chronic subclinical inflammation characteristic of DED. Materials and Methods. The study included subjects of 25-45 years of age, divided into the DED (n = 114) and nondry eye control (n = 98) groups, with the diagnosis based on self-reported complaints, biomicroscopy, the Schirmer I test, and break-up time. All patients had conjunctival scrapings taken to detect CT, MH, and UU with direct fluorescent-antibody assay kits. Results. At least one of the three microorganisms was found in 87.7% of the DED patients versus 8.2% of the controls. Of all the DED patients, 63.2%, 50.8%, and 42.1% were found to be infected with CT, MH, and UU, respectively. Multiple pathogens were identified in 65% of the DED patients found to be infected. CT infection was detected in 6.1% of the controls. Conclusion. C. trachomatis, M. hominis, and U. urealyticum were detected with high frequency in the conjunctiva of young adults with DED and may be an important risk factor for DED in them. [ABSTRACT FROM AUTHOR]

Background. To assess the peeling forces exerted by different calibers of microsurgical forceps on an experimental model of epiretinal membrane. Methods. A model of epiretinal membrane was constructed using thin cellulose paper and heptanes-isopropyl alcohol 1% mixture.The model was mounted on a force censoring device. Subsequently, flaps were created with three different microsurgical forceps of different calibers.We recorded the number of attempts, the duration of the event, and the pushing and the pulling forces during the peeling.The results were compared by a one-way ANOVA and a Fisher unprotected least significant difference test with an alpha value of 0.05 for statistically significance. Results.There was a statistical significant difference on the pulling and pushing forces between the 25 gauge (13.79 mN; -13.27mN) and the 23 (6.63 mN; -5.76 mN) and 20 (5.02mN; -5.30 mN) gauge, being greater in the first (P< 0.001). There were no differences in the duration of all events, meaning that all the forces were measured within the same period of time. Conclusions. The 25 gauge microsurgical forceps exerted the greatest mechanical stress over our simulated epiretinal membrane model and required more attempts to create a surgical suitable flap.The clinical implication of this finding is still to be determined. [ABSTRACT FROM AUTHOR]

Objectives. To determine if hyperopia is a risk factor for primary angle-closure glaucoma (PACG) in the Dutch population and to identify other biometrical parameters as risk factors for PACG including axial length (AL), anterior chamber depth (ACD), and κ values. Methods. The study population consisted of PACG patients that had undergone a laser peripheral iridotomy (LPI). The control group consisted of age- and gender-matched cataract patients.The main outcome was hyperopia (spherical equivalent ≥+0.5 dioptres) measured with IOL Master or autorefractor. Refractive error, ACD, AL, and κ values were tested with a Mann-Whitney .. test and by logistic regression. Results. 117 PACG patients and 234 controls were included (mean age = 80 years ± 3.6).The prevalence of hyperopia in patients and controls was 69.6% and 61.1%, respectively (Fisher's test P = 0.076). Mann-Whitney U test showed no statistically significant relation with refractive error (P = 0.068) or κ values (P = 0.607). In contrast, ACD and AL were statistically significant (P < 0.001). Tested with logistic regression, only ACD was a significant predictor of PACG (P < 0.001). Conclusion. There was no statistically significant correlation between refractive error and PACG. ACD was strongly correlated, though, with PACG, whereas AL turned out to be a less significant risk factor. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this study was to evaluate the efficacy of dried human amniotic membrane (AM) in reducing the postoperative inflammatory response and scarring after strabismus surgery. Methods.The inflammatory response at the extraocular muscle reattachment site was analyzed after superior rectus (SR) resection in 12 rabbits. Dried human AM (Ambiodry2) was applied between the resected SR muscle plane and Tenon's capsule of the left eyes of rabbits. As a control, the right eyes of rabbits underwent SR resection only.The surgeon randomly ordered which eye gets operated first during the experiment. Two weeks later, enucleation was performed. Six sagittal sections were made for each eye at the insertion of the SR muscle.The grade of postoperative inflammation and the presence of fibrosis were evaluated in histological examinations. Results.There was no statistically significant difference in the intensity of inflammation and fibrous proliferation between the eyes treated with dried human AM after SR resection and those treated with SR resection only. Conclusions. The use of dried human AM was not effective in controlling the postoperative inflammation and scarring in rabbit eyes after extraocular muscle surgery.However, this may be due to the devitalized dry preparation of human AM (Ambiodry2), which may have lost the expected anti-inflammatory and anti-scarring properties, and further studies on humans may be necessary. [ABSTRACT FROM AUTHOR]

Purpose. To investigate if there is a prognostic implication of the presence of cellular debris in the anterior vitreous in patients with Behçet's disease (BD) without any ocular symptoms. Methods. One hundred and twenty eyes of 60 patients with BD were included in the study. The eyes were divided into two groups according to the presence of cellular debris in the anterior vitreous. The first group included 54 eyes which were cellular debris (+) (group A), and the second group included 66 eyes which were cellular debris (-) (group B). Fluorescein angiography (FA) was performed to all patients following routine ocular examination. Patients were called for the six monthly control visits to investigate possible new ocular involvement during followup. The Kaplan-Meier method was used to estimate survival curves. Results. Seven eyes (13%) in group A and four eyes (6.1%) in group B showed optic disc hyperfluorescence on FA (P = 0.2). None of the eyes with disc hyperflourescence on initial examination developed uveitis attacks in their followup. In Kaplan-Meier survival analysis there was a significant difference between the groups (group A 20.6% and group B 4.2%) by means of ocular involvement during their followup (log-rank = 6.85, P = 0.009). Conclusions. Presence of cellular debris in the anterior vitreous may have prognostic implications in patients with BD screened for ocular involvement. [ABSTRACT FROM AUTHOR]

Purpose. To analyze microstructural changes in the external limiting membrane (ELM) and photoreceptor layer before and after early and late conventional laser treatment in central serous chorioretinopathy (CSC) in 12 months follow-up study. Methods. A retrospective observational study included Group A: 19 patients (19 eyes) with symptomatic acute CSC and Group B: 16 patients (16 eyes) with symptomatic chronic CSC. Retinal microstructural changes were analyzed with SD-OCT paying a particular role in examining the photoreceptor layer and ELM. Results.The length of the photoreceptors, prior to treatment, was approximately 84 μm in Group A and 82,5 μm in Group B. Twelve months after laser treatment, photoreceptor length was approximately 49 μm in Group A and 43μm (range 20.55μm) in Group B. No patients in Group A had noticeable photoreceptor defects nor ELM defects, but in 15 eyes in Group B photoreceptor and ELM defects were detected (P < 0.0001). Conclusions. When analyzing the photoreceptor layer and ELM during active CSC, it is not possible to evaluate any irreversible changes which have already occurred in this layer. Damage to the photoreceptor layer and ELM in patients with chronic CSC was only found after laser treatment and the absorption of subretinal fluid. [ABSTRACT FROM AUTHOR]

Objective. To compare pre- and postoperative characteristics and surgical success rates of patients with and without previous episodes of dacryocystitis, who underwent external dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO). Methods.The medical files of all patients who underwent external DCR between 2006 and 2011 in our institution were reviewed. The retrieved data of patients with and without previous episodes of dacryocystitis were compared. Surgical success was determined by postoperative followup of at least 6 months. Results. A total of 185 patients with NLDO underwent external DCR of whom 152 (100 females and 52 males, mean age 67 ± 15 years) met the inclusion criteria. Sixty had previous episodes of dacryocystitis and 92 did not. Left-side obstruction was more common than right-side obstruction among patients with previous episodes of dacryocystitis (48.3% versus 31.7%, resp., P = 0.031). Glaucoma patients were significantly more likely to develop dacryocystitis than patients without glaucoma (P = 0.002). The success rate of external DCR was 94.4% for patients with previous episodes of dacryocystitis and 86.7% for patients without (P = 0.337). Conclusions. The surgical outcomes of external DCR in patients with or without a previous episode of dacryocystitis were similar. Patients with glaucoma and NLDO had a significantly higher risk of developing dacryocystitis. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate potential risk factors for developing tube shunt exposure in glaucoma patients. Patients and Methods. Forty-one cases from41 patients that had tube shunt exposure from1996 to 2005 were identified from the Robert Cizik Eye Clinic and Bascom Palmer Eye Institute. Each case was matched with 2 controls of the same gender and with tube shunts implanted within 6 months of the index case. Conditional logistic regression was used to determine risk factors. Results.The study cohort includes a total of 121 eyes from121 patients.The mean age was 63.6 ± 19.7 years, ranging from1 to 96 years.The average time to exposure was 19.29 ± 23.75 months (range 0.36-85.74 months). Risk factors associated with tube exposure were Hispanic ethnicity (P = 0.0115; OR = 3.6; 95% CI, 1.3-9.7), neovascular glaucoma (P = 0.0064;OR = 28.5; 95% CI, 2.6-316.9), previous trabeculectomy (P = 0.0070;OR = 5.3; 95% CI, 1.6-17.7), and combined surgery (P = 0.0381;OR = 3.7; 95%CI, 1.1-12.7). Conclusions.Hispanic ethnicity, neovascular glaucoma, previous trabeculectomy, and combined surgery were identified as potential risk factors for tube shunt exposure. These potential risk factors should be considered when determining the indication for performing tube shunt implantation and the frequency of long-term followup. [ABSTRACT FROM AUTHOR]

Purpose. To examine temporal patterns of visual acuity (VA) response to pooled 0.3 mg/0.5 mg ranibizumab treatment in patients with age-related macular degeneration and identify potential baseline predictors of response. Design. Retrospective analysis. Methods. Results from 1824 ranibizumab-treated patients receiving fixed monthly, quarterly, or as-needed dosing after three monthly loading doses in four phase III/IIIb trials (ANCHOR, MARINA, PIER, and SAILOR) were analyzed. Results. At month 3, 14.9% to 29.4% of patients had gained .15 letters. Not all patients achieved peak gains at month 3; many continued to have VA increases throughout treatment. After three monthly loading doses, continued monthly dosing resulted in further gains, as there were more delayed 15-letter responders at month 12 (14.7.16.1%) than with less frequent dosing (5.0.6.0%).Monthly dosing also resulted in more patients maintaining VA gains at later time points. Early 15-letter responders had lower baseline mean VA than delayed 15-letter responders in ANCHOR and MARINA; no other differences in baseline characteristics were noted. Conclusions. Although some patients have rapid improvements in VA, others do not experience peak VA until later during treatment. Continued monthly dosing resulted in a greater percentage of patients gaining .15 letters than with switching to less frequent dosing regimens. [ABSTRACT FROM AUTHOR]

Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in- and ambulatory care surgeries, respectively, was close to statistical significance (P = 0.054). Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety. [ABSTRACT FROM AUTHOR]