Search

Purpose: To describe the retinal vascular changes in birdshot chorioretinopathy (BSCR) using optical coherence tomography angiography (OCTA) and to compare them with changes in macular thickness., Methods: In this multicenter study, patients with a diagnosis of BSCR and a positive HLA-A29 underwent fluorescein angiography, spectral domain optical coherence tomography (SD-OCT), and OCTA. The foveal avascular zone (FAZ) and the area of capillary non-perfusion were manually measured by two examiners in fluorescein angiography (FA) and 3 × 3-mm OCTA images of the superficial retinal layer. These measurements were compared to central retinal thickness. To calculate normal capillary density, we collected data from 22 controls who had OCTA performed on one visit only., Results: A total of 44 eyes with BSCR were enrolled. The mean automated parafoveal superficial capillary density in BSCR eyes was 0.47 ± 0.03. The differences between the foveal capillary density of BSCR patients and healthy subjects were statistically significant ( P  < 0.001). The mean area of FAZ manually measured on the 3 × 3 mm unsegmented OCTA images was larger in eyes with BSCR (1.34 ± 0.41 mm 2 ; P  < 0.0001). Measurement of FAZ area showed good interobserver ( κ 0.88) and intraobserver repeatability ( κ 0.79) on OCTA images. The intraclass correlation coefficient for FAZ measurements on FA between the two observers was 0.48. The OCT retinal thickness maps of all BSCR eyes demonstrated statistically significant thinning compared to those of control subjects ( P  < 0.01)., Conclusion: Our study demonstrates the potential contribution of OCTA as a new non-invasive imaging technology that monitors disease activity in BSCR patients., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To report the clinical course and management of unusual anterior and posterior segment features of Coats disease and their relation to the age of the patients to increase the awareness towards these rare clinical features rarely described in the current literature., Methods: A retrospective descriptive review of 45 eyes of 45 patients affected by Coats disease was conducted at the Retinoblastoma Referral Center and Ophthalmology Unit of the University of Siena in Italy analyzing data from 2000 to 2022. Medical records and images were revised to find some cases presenting unusual anterior and posterior segment features in patients affected by Coats disease.We identified therefore 4 unusual clinical conditions: retinal macrocysts, anterior chamber cholesterolosis, fovea-sparing Coats disease and secondary vasoproliferative tumor., Results: Two patients presented with retinal macrocyst (2/45  =  4.4%), one with anterior chamber cholesterolosis (1/45  =  2.2%), two with fovea sparing Coats disease (2/45  =  4.4%) and one with vasoproliferative tumor associated (1/45  =  2.2%) for a total of six (6/45  =  13.3%) patients manifesting unusual anterior or posterior segment features in Coats disease., Conclusion: Unusual anterior and posterior segment features of Coats disease such as retinal macrocyst and anterior chamber cholesterolosis have been more frequently reported in younger children while fovea-sparing and vasoproliferative tumors have been more commonly described in older patients. Age is then a strong prognostic marker which allows to distinguish two different phenotypes of Coats disease: patients younger and older than 3 years old with more aggressive and milder phenotype respectively., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To present two consecutive cases of Central Retinal Artery Occlusion (CRAO) with unusual Optical Coherence Tomography (OCT) presentation of Hyperreflective Spots (HRS) in the posterior vitreous., Case Report: The first patient was a 59 years-old male who developed CRAO in the post-operative period after aortic valve replacement. OCT scans revealed the presence of many HRS in the posterior vitreous, remarkably decreased in number at two months follow-up. The second patient was a 74-year-old male who developed CRAO after arterial chemoembolization for recurrent hepatocellular carcinoma. OCT scans showed again the presence of hyperreflective spots in the posterior vitreous and their reduction at two months follow-up with inner retinal atrophy as the final outcome in both cases., Conclusions: HRS in the posterior vitreous have been described in inflammatory eye conditions such as uveitis, diabetic macular edema, post cataract surgery, and considered a clinical sign of inflammation. To our knowledge, the combination of CRAO and HRS has not been previously reported. The number of HRS seems to decrease over time, suggesting a role for inflammatory response in the acute stage of CRAO. A similar pathogenic process is known to occur during cerebral ischemia, where the inflammatory response may exacerbate brain injury and post-ischemic damage.

Purpose: To report the unique case of a pair of phenotypically discordant monozygotic twins, with one of them affected by unilateral Coats disease., Case Report: Both patients underwent a complete ophthalmologic evaluation and were genetically tested with whole-exome sequencing (WES). Any known or unknown potential genetic determinant of Coats disease wasn't found., Conclusion: It may suggest a non-genetic etiology for this disorder. This represents, to the best of our knowledge, the first case of genetic analysis of monozygotic twins, one of whom is affected by Coats disease. Further studies are warranted, including performing genetic analysis directly on retinal biopsy tissue.

Purpose: To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone., Methods: We performed AMT with "contact lens sandwich technique" (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures., Results: The procedures were performed successfully with no complications.CLS-AMT showed significantly shorter healing time than BCL (24.0  ±  19.1 vs 42.9  ±  14.6 days; P < 0.05, Mann-Whitney test). Recurrence rates were 12% and 27% for CLS-AMT and BCL, respectively., Conclusion: CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.

Purpose: To assess the blood flow and vascular visibility of irises in relation to pigmentation and pupil size, using an anterior segment optical coherence tomography angiography (OCTA)., Materials and Methods: This is a cross-sectional study. OCTA images were acquired in the nasal and temporal quadrants from a cohort of 30 healthy subjects in photopic (miosis) and scotopic (mydriasis) conditions. Patients were divided according to iris color (less pigmented: group L vs more pigmented: group D). Vascular parameters (vessel density (VD), vessel length density (VLD), fractal dimension (FD)) were applied and compared among groups L and D, location and different pupil status. A novel vascular index called Luminance Index (LI) was developed and applied in order to quantify vascular flow and evaluate its variation in photopic and scotopic conditions. Multivariable analyses were performed to evaluate possible predictors of VD and LI., Results: No differences were found for all vascular measurements (VD, VDL, FD, LI) between nasal and temporal quadrants. All vascular measurements were higher in group L than in group D ( p  < 0.05), except for LI and FD in photopic condition. In group L, all vascular parameters increased ( p  < 0.001) after dark adaptation. In group D, only LI increased after dark adaptation ( p  < 0.001). Pigmentation and iris thickness were significantly associated with VD in scotopic and photopic conditions, and with LI only in scotopic condition., Conclusions: Pigmentation still remains a major issue for vascular visibility. Quantitative and qualitative vascular changes follow pupil size variation. LI could be a new surrogate to quantify blood flow.

Purpose: We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma., Materials and Methods: We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21 mmHg, B: <18 mmHg, and C: <15 mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves., Results: Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70 ± 14.439 months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group ( p  = 0.033, p  = 0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46 ± 7.07 to 12.27 ± 4.06 at 12 months ( p  < 0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95 ± 3.08 vs 13.00 ± 4.56, p  = 0.0003)., Conclusion: In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.

Introduction: Anteriorepi-capsular plaque (ACP) is usually eccentric and is associated with persistent iris strands arising from the collarette. Outcomes of lens preserving ACP peeling along with removal of persistent pupillary membrane (PPM) strands have seldom been reported with only a few cases within some case series appearing in the literature. Herein we aim to report outcome after surgical removal of ACP associated with PPM in children., Methods: Research was done in three different Institutes. Charts were reviewed for all children who had undergone ACP removal surgery from 2010. Age at surgery, gender, preoperative best corrected visual acuity (BCVA), preoperative refraction, morphologic details of ACP, intraoperative complications, ophthalmic viscosurgical device use, age at last follow-up, postoperative complications, and postoperative BCVA were reviewed., Results: A total of 16 patients, 10 male and 6 female, were included in study. Age at surgery ranged from 2 to 86 months old. Age at last follow up visit ranged from 2 to 14 years old. Postoperative complications were not observed in any of the 16 patients. Specifically, in all patients the crystalline lens remained clear at the last follow up visit., Conclusions: Congenital ACP of the lens associated with PPM and clear lens can be safely surgically removed with a very low risk of iatrogenic cataract in the early period after surgery.

Pulled-in-two syndrome (PITS) is a serious intraoperative complication of strabismus surgery in which an extraocular muscle manipulated during the procedure is ruptured and potentially lost. Usually, there is a systemic or local condition that determines muscle weakness when put under tension. If the proximal portion of the broken muscle can be found, it can be reattached to the ocular globe or remaining muscle. If this is not possible, there are multiple varying approaches. We present three cases of PITS of the inferior rectus muscle, treated with good results with anterior and nasal transposition of the inferior oblique muscle. We propose this surgery as another potential technique if the muscle can not be retrieved.

Introduction: To investigate how a subset of patients with partially accommodative esotropia, with a manifest deviation <10 Prism Diopters (PD) at distance and an angle of strabismus at near wider than 10 PD, could respond to a surgical approach based on the misalignment at near., Methods: Six patients examined from 2015 to 2019 met criteria for inclusion: partially accommodative esotropia, patients compliant to full correction for at least 6 months, angle of esotropia for near larger at least 10 PD, angle of misalignment obtained with the alternate prism cover test and simultaneous prism cover test at distance <10 PD. All patients underwent bilateral medial recti recession. They were examined at 3 weeks and at 6 months., Results: No significant difference in the angle of esotropia at distance was found at any follow-up (Baseline: 7.17 ± 1.33 PD vs 3 weeks: 7.0 ± 1.01 PD vs 6 months: 7.33 ± 1.03 PD, p  = 0.65, and p  = 0.36, respectively). No case of consecutive exotropia was described. Considering the angle at near, there was a significant reduction at 3 weeks (Baseline: 41.7 ± 6.83 PD vs 3 weeks: 9.33 ± 1.63 PD, p  = 0.027), that remained stable at the final follow-up (9.0 ± 1.1 PD, p  = 0.32). All patients were suppressors and had nil stereopsis pre-operatively, all of them developed fusion and a different degree of stereopsis [276 ± 284 arcseconds (Range 80-800)]., Conclusions: A surgical approach based on the angle of strabismus for near could obtain satisfactory ocular alignment without consecutive exotropia in children with partially accommodative esotropia wearing full refractive correction, with a manifest deviation for distance <10 PD and a higher misalignment for near, at least for 6 months after surgery.

Purpose: To describe a case of unilateral multiple bullous neurosensory retina detachments (NRDs) secondary to non-Hodgkin's aggressive large B-cell lymphoma treated with chemotherapy and high doses of systemic steroids., Methods: A case report based on patient observation, clinical records, and retinal imaging during 2 years of follow-up., Results: A 26-year-old Hispanic man presented at our clinic with sudden unilateral visual loss and multiple NRDs in the left eye with increased choroidal thickness, 1 week after oral steroid treatment due to low back pain and fever. In the following days, a non-Hodgkin's aggressive large B-cell lymphoma was diagnosed. The patient underwent three cycles of chemotherapy (CHT) with protocol R-CHOP21 (including oral prednisone) with complete resolution of NRD. During 2 years of follow-up, no recurrence of NRD occurred, despite the need to continue CHT with oral steroids for a year due to lymphoma relapse., Conclusion: Neurosensory retina detachments may be an initial manifestation of large B-cell lymphoma as a consequence of a pro-inflammatory state involving the chorioretinal structures, thus adding steroid treatment could be useful for its resolution.

Introduction: After vertical recti transposition surgery, a torsional change may occur. We hypothesized that step-by-step monitoring of the intraoperative torsional position of the eye can avoid any unexpected complications and identify critical moments of surgery that may have adverse effects., Methods: Nine patients with sixth nerve palsy that underwent complete transposition of the superior (SR) and inferior rectus (IR) muscles to the lateral rectus muscle by means of the technique of augmented vertical recti transposition were prospectively included. The torsional position of the eye was recorded at eight stages of the procedure., Results: We observed two distinct patterns of induced torsional deviation during partial disinsertion of a vertical rectus muscle depending on whether disinsertion began medially or laterally, after cutting about 3/4 of the muscle fibers: ¾ nasal disinsertion of the SR and ¾ temporal disinserton of the IR caused intorsion, ¾ temporal disinsertion of the SR and ¾ nasal disinsertion of the IR caused extorsion. Torsion improved after the vertical rectus was attached temporally to the sclera along the spiral of Tillaux with tying of the augmentation suture to the LR. The greatest change in torsion was from ¾ temporal disinsertion of the SR (5°extorsion), to reattachment along the spiral of Tillaux temporally (5°intorsion)., Conclusion: The SR and IR have different torsional effects, which only appears when more than half of the fibers are detached. Augmented transposition does not cause any additional torsional effects. This intraoperative monitoring system can be used to detect unintended torsional complications, especially during transposition surgery.

Purpose: To compare the four-petal evisceration technique and the standard evisceration technique., Methods: In this retrospective, comparative case series study, sixteen charts of patients fulfilled the inclusion criteria and were were reviewed. Orbital implant exposition and complication rates between the two surgical techniques were evaluated., Results: A total of 16 eye of 16 patients fulfilled the inclusion criteria and were included in the analysis (eight in the four petal group and eight in the standard evisceration group).During postoperative follow-up there were no cases of implant exposure or migration in the four-petal group and two cases (25%) of implant exposure in the standard evisceration group.Exposed orbital implants dimension were both 16 mm and patients eviscerated for phtisis bulbiAll surgeries were uneventful, and there were no serious complications during the study., Conclusion: Four petal evisceration technique seems particularly useful in patients with phtisis bulbi because it allowed the placement of an implant significantly larger than the standard technique with low rate of esposition.

Purpose: To describe the unusual presentation, diagnosis, and clinical course of an early-onset X-linked infantile retinoschisis., Case Report: A 6-month-old infant presented with strabismus and poor fixation. After the detection of bilateral intraretinal hemorrhage and diffuse dystrophic retinal pattern at indirect ophthalmoscopy, the patient received a complete evaluation under anesthesia. Retinal wide-field imaging, spectral domain optical coherence tomography, and electroretinogram were performed and revealed a retinoschisis involving the posterior pole and the inferior periphery in the right eye. In the left eye, an inferior retinal detachment extending to the macula was detected. Blood sample and genetic counseling were required in the strong suspicion of an inherited retinal dystrophy. Genetic tests confirmed the diagnosis of X-linked retinoschisis (RS1 gene mutation). After consultation with a pediatric vitreoretinal surgeon, a wait and see strategy was chosen. The follow up visits showed a surprisingly good natural course of the disease., Conclusion: X-linked retinoschisis is a well-known inherited retinal disease potentially affecting young children as early as 3 months old. In this case, the stunning presentation (diffuse retinal pigment epithelium dystrophic changes resembling a macular dystrophy) and the positive course of the disease (resolution of macular retinal detachment in the left eye and stability of schisis in the right eye) arise some interesting considerations about the necessity of an early surgical treatment.

Introduction: The aim was to evaluate the effectiveness of the procedure of the superior oblique split Z-tendon lengthening to collapse A pattern and treat face turn in a cohort of patients with both incomitant intermittent exotropia and a vertical deviation associated with a bilateral asymmetric superior oblique overaction., Methods: We retrospectively reviewed the clinical records of patients with facial turn associated with intermittent exotropia and bilateral asymmetric superior oblique overaction, who underwent superior oblique muscle split tendon lengthening and concurrent horizontal surgery between 2009 and 2017., Results: A total of eight patients met the inclusion criteria. The preoperative average face turn was 26.8° (range, 20°-5°), and it significantly improved to 5.4° (range, 2°-8°) ( p  < 0.05). All the patients showed an improvement in the face turn with neutralization of the vertical deviation. The vertical deviation in the right gaze for the patient with a right turn and the left gaze in patients with left turn improved significantly (values of p  < 0.05)., Conclusion: The superior oblique split Z-tendon lengthening was an effective procedure to collapse the A pattern and the treatment of the face turn in a cohort of patients with both incomitant intermittent exotropia and a vertical deviation associated with a bilateral asymmetric superior oblique muscle overaction with less complications, and less varying results.

Introduction: Fundus photography is the gold standard for assessing ocular torsion over the last 30 years. However, it is not a precise and reproducible tool during clinical practice. Optical coherence tomography angiography is characterized by precise identification of the macula and the optic disc, and it could be an effective method to easily calculate the angle of ocular torsion, compared to fundus photography. The aim of this study was to show whether any difference in the measurement and the accuracy of the angle of torsion between the head of the optic nerve and the fovea was present., Methods: This is a prospective single-, referral-center study conducted at the San Giuseppe Hospital in Milan on 80 eyes of 40 adult patients, included in a random-sample way. Exclusion criteria were non-cooperation, higher refractive errors of ±3 diopters, retinal and optic disc pathologies, and ocular movement disorders., Results: Patients' mean age was 54.3 ± 16.3 (range: 22-83) years. The angle measured by the fundus camera was 7.78° ± 3.04°, while the angle measured by the angiography was 7.09° ± 3.08° (p = .035). The mean interocular difference was 1.54° ± 3.42° for fundus photography and 0.5° ± 4.71° for angiography (p = .013)., Conclusion: Optical coherence tomography angiography is a very useful, fast, precise, reproducible, and reliable technique in cooperative subjects, not inferior to the fundus camera and less prone to human error.

Objective: To assess the efficacy of "Yokoyama Procedure," on non-highly myopic patients with acquired esotropia and hypotropia., Methods: The study involved 10 eyes of 5 patients with eso-hypotropia. Inclusion criteria were acquired esotropic-hypotropic strabismus with lateral rectus inferior displacement and superior rectus nasal displacement confirmed by magnetic resonance imaging, refractive errors between ±6 D, and axial length < 27 mm. Range of full duction movements and maximum angles of abduction-sursumduction was measured in each eye before and after surgery. All patients underwent T1- and T2-weighted magnetic resonance imaging. The surgery was aimed at creating a junction between the muscle bellies of the superior and lateral rectus muscles. This junction was made approximately 14 mm behind the insertions using a non-absorbable mersilene 5/0 suture (Yokoyama procedure)., Results: Mean patient age was 64.8 ± 4.8 years. The mean globe axial length was 25.4 ± 0.76 mm and a mean corresponding spherical equivalent refraction of -3.7 ± 1.7 D was observed. Eight eyes on 10 had mild limitation in abduction, while the remaining 2 had no limitation. Three out of 10 eyes showed a moderate limited sursumduction, 5 eyes were categorized as mild, and the remaining 2 had no limitation. No evident post-operative limitation was present in any eye, in both abduction and sursumduction (p < 0.01). Pre-operative esotropia and hypotropia were, respectively, 32 ± 11 prismatic diopters and 25 ± 5 prismatic diopters, and they were significantly reduced after surgery as 9 ± 1.7 prismatic diopters and 6 ±1 prismatic diopters (p = 0.043), respectively., Conclusion: Yokoyama procedure is an effective, fast, reversible procedure to face eso-hypotropic acquired strabismus, even in patients with a clear magnetic resonance imaging displacement of superior and lateral rectus muscles, and absence of globe dislocation and of elevated myopia.

Purpose: To describe the clinical features of a rare case of NBAS-SOPH-like mutations; to emphasize special aspects of the ocular and oro-facial regions., Methods: Case report., Case Description: We present a 5-year-old girl initially examined for her dysmorphic features, mental delay, strabismus, and high myopia. During the funduscopic examination, we observed optic atrophy with narrow thinned arterioles with the light brown reflex of the central retina. A genetic assessment revealed NBAS-SOPH like mutation. An assessment by a team of orthodontists defined typical characteristics., Conclusions: NBAS mutations can also cause complex disease with a broad clinical spectrum ranging from isolated recurrent acute liver failure (RALF) to a multisystemic phenotype. Due to the heterogeneity of the expressions, a multispeciality approach to this situation is recommended.

Purpose: To investigate the 2- and 5-year publication rates of abstracts presented at major international ophthalmology meetings., Methods: We analyzed a random selection of 20% of free papers and posters presented at the 2010 meeting of the Association for Research in Vision and Ophthalmology, the American Academy of Ophthalmology, the European Association for Vision and Eye Research, the Asia-Pacific Academy of Ophthalmology, and the 2009 European Society of Ophthalmology meeting. The PubMed (MEDLINE) database was searched to identify matching journal articles. Data collection included: topic, geographic origin, presentation type, publication status, and impact factor. A multivariate logistic regression model was used to assess odds of publication and impact factor., Results: Our analysis included 1742 research abstracts. The overall 2- and 5-year publication rates were 33.3% (n = 579) and 47.2% (n = 823), respectively. The highest publication rates were found for Association for Research in Vision and Ophthalmology (36.1% and 51.9%, p < 0.0001), paper presentations (44.5% and 60.5%, p < 0.0001), researches from Oceania (35.8% and 57.1%, p < 0.05) and North America (36.2% and 50.5%, p < 0.05), and Basic science studies (44% and 60.3%, p < 0.01). After adjustments, higher odds of publication were shown by the Association for Research in Vision and Ophthalmology and the American Academy of Ophthalmology meetings (p < 0.0001), papers (p < 0.0001), and Basic science (p < 0.05). The median impact factor was 3.20 (interquartile range = 1.90-3.40)., Conclusion: Less than half of abstracts presented at the major ophthalmology meetings reach publication within 5 years of their initial presentation. Professionals attending meetings may consider adopting a more critical approach to the preliminary results reported in presented abstracts. Increasing publication rates and reducing potential publication bias is of interest.

Purpose: To present a case of an HIV-positive patient with acute exudative polymorphous vitelliform maculopathy (AEPVM) and evaluate the presence of specific spectral-domain optical coherence tomography (SD-OCT) findings., Methods: Case report., Results: We reviewed the AEPVM cases reported in the literature and compared those to our patient to determine if there is a correspondence between the etiology that leads to the onset of AEPVM and clinical and SD-OCT findings., Conclusions: Acute exudative polymorphous vitelliform maculopathy is a disease that involves the outer retinal layers with lipofuscin deposits and serous detachment of the neuroepithelium with or without intraretinal cysts. Not much is known about the etiology and pathogenesis, and not many cases have been described. A review of the few clinical cases reported in the literature does not show a specific correspondence between etiology and SD-OCT findings.

Purpose: To describe a case of full-thickness macular hole (FTMH) after vitrectomy for lamellar hole (LH)., Methods: Case report., Results: The authors report a patient with progressive visual loss secondary to LH who developed FTMH following a vitrectomy repair. The postoperative findings as well as the clinical course after the second surgical approach are described., Conclusions: Surgeons should be aware of this complication following LH surgical approach.

Purpose: To describe the management with intracameral recombinant tissue plasminogen activator (rtPA) of severe fibrin effusion after phacoemulsification, and its prevention with sustained-release dexamethasone intravitreal implant., Methods: A 59-year-old man with chronic HLA-B27-associated uveitis underwent phacoemulsification followed by a sustained-release dexamethasone intravitreal implant., Results: A postoperative severe fibrin reaction was completely resolved after intracameral injection of rtPA. At the time of the phacoemulsification of the fellow eye, a dexamethasone implant was injected 5 days prior to surgery, with no fibrin formation., Conclusions: Intracameral rtPA may be successfully used in the management of severe fibrin reaction. Dexamethasone intravitreal implant to control postoperative inflammation may take several days until it achieves high concentrations in the vitreous.

Purpose: Involutional entropion is a common lower lid malposition. Addressing both the horizontal and the vertical lower eyelid laxity in patients with involutional entropion seems to have a more long-lasting effect on maintaining lower eyelid stability; however, there is some disagreement as to which approach is the best surgical intervention. The aim of this study was to determine differences in the surgical outcome of Jones retractor plication (JRP) alone versus Jones retractor plication with a lateral tarsal strip (JRP + LTS) for the treatment of involutional entropion., Methods: A retrospective case series comparison of 118 patients with primary involutional lower eyelid entropion was performed. Jones retractor plication alone was performed in 61 patients, and JRP + LTS in 57 patients. The baseline characteristics of the 2 groups were similar. Patients were retrospectively evaluated from a retrospective case-note review 3 weeks and 6, 12, 18, and 24 months postoperatively. Successful surgery was defined as a normal eyelid position., Results: A total of 115 patients fulfilled the inclusion criteria, 60 in the JRP group and 55 in the JRP + LTS group. Ten patients (16.5%) in the JRP group and 2 patients (3.5%) in the JRP + LTS group had a recurrence of the entropion at or before their 24-month follow-up visit (p = 0.03)., Conclusions: These data provide strong evidence that the success rate at 24 months is higher in patients treated with the JRP + LTS procedure compared with JRP alone.

Purpose: To investigate diplopia after orbital decompression in patients with thyroid-related orbitopathy., Methods: We retrospectively analyzed medical records of 45 consecutive patients who had undergone orbital decompression surgery (DS) and a subgroup of 10/45 patients who underwent disinsertion of the inferior oblique (IO) muscle during DS. Diplopia was assessed before DS and 1 and 3 months after DS. Residual strabismus defects were treated surgically approximately 3 months after DS with follow-up visits 1 week, 3 months, and 6 months postoperatively. Patients with horizontal or vertical diplopia were evaluated using the alternate prism-and-cover test and torsional diplopia (TD) using a double Maddox rod test to quantitate their strabismus., Results: Strabismus surgery was effective in treating the horizontal and vertical diplopia (13/40 cases with residual deviations required prism glasses), but did not resolve the TD. None of the patients with IO disinsertion during DS complained of TD before strabismus surgery. However, after strabismus surgery, TD occurred in all 10 patients with IO disinsertion vs 8/30 patients without IO disinsertion (p<0.001, Fisher exact test). Overall, TD was induced in 18/45 (40%) of the DS cohort., Conclusions: Patients with IO disinsertion during DS may be at increased risk of developing TD postoperatively. We recommend sparing or reattaching the IO muscle during DS when possible to reduce the risk of developing untreatable TD.

Purpose: To evaluate the clinical results obtained with excimer laser treatment of fully refractive accommodative esotropia., Methods: Fully refractive accommodative esotropia was corrected in 17 patients with laser in situ keratomileusis (LASIK) and in 3 patients with photorefractive keratectomy (PRK). The mean age of the patients at time of refractive surgery was 18.8 years (range 14 to 24 years). All surgical procedures were performed under local anesthesia. The preoperative and postoperative data were retrospectively analyzed with regards to visual acuity, ocular alignment, and stereopsis., Results: The mean preoperative deviation without correction was 18.1Delta for near vision and 13.7Delta for distance vision. After refractive surgery the mean postoperative deviation was 4Delta esophoria at near, and 2.5Delta of esophoria at distance: 10 patients (50%) showed esophoria for both distance and near vision, 2 patients (10%) esophoria only for near vision, and 8 patients (40%) orthophoria for both distance and near vision. Emmetropia (-/+1.00 D) was obtained in 97.5% of eyes (39 of 40). The mean correction obtained with excimer laser was +4.62 D(range +2.25 to +7.75, SD 4.52). The preoperative BSCVA was in all eyes greater than or equal to 20/30. There were no significant differences observed between the preoperative and postoperative mean best-corrected visual acuity (p=0.32). There were no complications. The follow-up period lasted a mean of 30.2 months., Conclusions: The treatment of fully refractive accommodative esotropia with excimer laser was found effective and safe, even in young or adolescent patients. More studies are needed to increase the patient experience and extend the follow-up period in order to evaluate the stability of these results over time.

Purpose: To evaluate the safety and efficacy of photorefractive keratectomy (PRK) performed under topical anesthesia in children with myopic anisometropia., Methods: Medium to high unilateral myopia was corrected in 18 patients by PRK. At the time of surgery patients were between 7 and 17 years of age (mean 10 years). All the surgical procedures were performed under topical anesthesia. Pre- and postoperative data regarding visual acuity, eye alignment, and binocular vision were analyzed., Results: The mean correction (SE) obtained with excimer laser was -8.21 D (range: -2.25 to -14.50, SD 3.90). The mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/70, and the postoperative mean BSCVA was 20/50. A significant difference was observed between the arithmetic mean of the preoperative and postoperative BSCVA (p=0.001). Two of 18 patients improved stereopsis; furthermore, surgery variation strabismus was registered in 33.3% of the patients, following PRK. Patients were followed up for a mean of 39 months., Conclusions: The treatment of medium to high unilateral myopia with PRK under local anesthesia was found effective and safe in pediatric and adolescent patients. This procedure may improve ocular alignment and stereopsis. Further studies are needed to increase the patient experience and extend follow-up time in order to assess the long-term stability of the RESULTS.

Purpose: To address the efficacy, safety, and stability of frontalis suspension of the upper eyelid with a silicone band for the treatment of severe congenital ptosis in infants., Methods: Data from 22 pediatric patients undergoing unilateral frontalis suspension with silicone band were retrospectively reviewed with a follow-up ranging from 18 to 30 months. The margin-reflex distance (MRD) and the corneal staining had been evaluated at each pre- and postoperative visit. Data were analyzed by analysis of variance and t test for paired data., Results: MRD was absent before surgery in all cases: it ranged from -1 mm to -4 mm (-2.4+/-0.8 mm). Immediately after surgery, it increased to 2.9+/-0.3 mm, and then progressively reduced by 0.6 mm within the first 3 months (p=0.001); a further reduction of 0.2 mm, occurring between 3 and 12 months after surgery, was not statistically significant. After the 12-month visit, no changes in MRD were found at follow-up for any patient. Corneal staining, which was present in five patients over the first 2 postoperative weeks, recovered without sequelae. Complications occurred in three eyes: overcorrection and corneal ulcer in one case requiring removal of the silicone band, one granuloma, and one extrusion of the silicone band from the upper frontal incision., Conclusions: During the study period, the frontalis suspension with a silicone band was an effective and safe procedure. MRD values were stable between month 3 and the end of follow-up, although this series does not preclude the possible occurrence of blepharoptosis at longer time intervals.

none.

Purpose: When, at birth, the eyelid margin is rolled inward against the globe, the condition is referred to as congenital entropion. Upper eyelid involvement is commonly associated with a tarsal abnormality, while lower eyelid entropion is often associated with epiblepharon. Entropion does not resolve spontaneously, and may cause corneal pathology if untreated. The purpose of this study is to compare the two common techniques for the correction of congenital entropion., Methods: The authors performed a pilot study of 24 consecutive patients with lower bilateral congenital entropion to compare the results of incisional versus rotational surgery., Results: The rotational procedure was carried out in 14 patients; incisional surgery was performed in 10 patients. Twenty-one patients had good functional and cosmetic results. There were only three case of relapse after 3, 4, and 3 months., Conclusions: The authors consider both techniques satisfactory, but the procedure of choice, considering the age of the patients and previous studies, remains rotational sutures because of its simplicity, quickness, and low risk of complication.

Purpose: The diagnostic hallmark of Coats disease is development of "light bulb" telangiectasis in the retinal periphery, leading to posterior pole intraretinal and subretinal exudation. Even after complete obliteration of all abnormal vessels and resorption of all exudates, follow-up examinations are mandatory for several years., Methods: We retrospectively analyzed the charts, pictures and/or fluorescein angiographies of a series of 32 consecutive patients, in which the diagnosis of Coats disease was made. All patients underwent selective photocoagulation of the telangiectasis using a yellow-dye laser. Efficacy of treatment was monitored with drawings and/or fluorescein angiographies., Results: All our patients had unilateral disease, with macular involvement and exudative retinal detachment. Visual acuity improved in one patient, decreased from light perception to blindness in another, and was unchanged in the remainder., Conclusions: This is the first report of anatomical benefits from treatment with a yellow-dye laser (i.e., selective photocoagulation without cryotherapy or drainage) despite the presence of a severe form of Coats disease. Our young Coats patients responded quickly to treatment. With successful obliteration of the abnormal vasculature, exudates began to absorb in about 4 to 8 weeks although, in some cases, 10 to 12 months were needed to obtain resolution of the exudative detachment. Poor visual outcome of 20/100 or worse was common. In Coats patients, the key issue is continuous control and long-term follow-up. (Eur J Ophthalmol 2002; 12: 501-5).

Purpose: The diagnostic hallmark of Coats' disease is development of "light bulb" telangiectasis in the retinal periphery, leading to posterior pole intraretinal and subretinal exudation. Even after complete obliteration of all abnormal vessels and resorption of all exudates, follow-up examinations are mandatory for several years., Methods: We retrospectively analyzed the charts, pictures and/or fluorescein angiographies of a series of 32 consecutive patients, in which the diagnosis of Coats' disease was made. All patients underwent selective photocoagulation of the telangiectasis using a yellow-dye laser. Efficacy of treatment was monitored with drawings and/or fluorescein angiographies., Results: All our patients had unilateral disease, with macular involvement and exudative retinal detachment. Visual acuity improved in one patient, decreased from light perception to blindness in another, and was unchanged in the remainder., Conclusions: This is the first report of anatomical benefits from treatment with a yellow-dye laser (i.e., selective photocoagulation without cryotherapy or drainage) despite the presence of a severe form of Coats' disease. Our young Coats' patients responded quickly to treatment. With successful obliteration of the abnormal vasculature, exudates began to absorb in about 4 to 8 weeks although, in some cases, 10 to 12 months were needed to obtain resolution of the exudative detachment. Poor visual outcome of 20/100 or worse was common. In Coats' patients, the key issue is continuous control and long-term follow-up.

We describe a case of a four year-old boy, with congenital ectopia lentis et pupillae, who developed patchy unilateral depigmentation of the skin, hair and lashes. The association between ectopia lentis et pupillae and transillumination of the iris is well documented in the literature, but it has never been reported with skin hypopigmentation.

Neuron-specific enolase (NSE) is a unique form of the glycolytic enzyme enolase found exclusively in neurons and neuroendocrine tissues. Immunohistochemical techniques in which antineuron-specific enolase antibodies are used have made it possible to map out derivatives of the neural crest in humans. By using affinity-purified antibodies against NSE, we investigated whether the contribution of the neural crest cells to the development of the anterior ocular structures in the rat is similar to that in man. We found that filtration structures in rats show morphologically striking similarities with the analogous region of the human eye. Hence, the rat eye, with certain reservations, is a suitable model for experimental studies on ocular diseases that are characterized by chamber angle anomalies or congenital glaucoma.