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Purpose: To review the current literature on in vivo confocal microscopy anterior segment applications (cornea, conjunctiva, and glaucoma) and discuss its advantages in different pathological conditions., Methods: Review of selected relevant literature on in vivo confocal microscopy and its different applications., Results: In vivo confocal microscopy can be used to visualize most layers of the cornea and conjunctiva, providing excellent resolution. In the past, it was mainly utilized as a research tool; lately there seems to be an increasing interest for clinical applications; confocal microscopy aids the diagnosis and follow-up of many anterior segment disorders, such as corneal dystrophies, corneal and conjunctival inflammatory and neoplastic diseases, glaucoma patients, and assessment of surgical procedures., Conclusion: In vivo confocal microscopy is an important addition to the ophthalmic diagnostic tools with several anterior segment applications. Its clinical applications are being continuously explored and are quickly expanding to cover many new pathological aspects.

Introduction: Estimation of the prevalence of vision impairment in a population can be performed using epidemiological research. The purpose of this study was to measure, using spatial statistics, the prevalence of ophthalmologic disease identified at visits of the Mobile Ophthalmologic Unit (MOU) of the Vardinogiannion Eye Institute of Crete (VEIC) to villages in Crete. The study also aimed to estimate increased 'risk' of ophthalmological disease according to demographic and location factors and, thus, use the present findings as a basis for planning future services., Methods: Estimation of risks for cataract, glaucoma, and refractive errors were assessed by multiple logistic regression models in order to measure the effect of demographic (age, sex) and location (province, distance from nearest ophthalmologist) parameters. Spatial analysis was applied in order to produce a density and probability density map of ophthalmologic disorders using kriging interpolation methods., Results: Newly diagnosed cataracts and refractive errors were found more frequently in locations greater than 70 km from the nearest ophthalmologist (respectively, OR = 6.0 [95% CI = 1.637-9.482]; OR = 27.4 [20.038-39.028] p-value = 0.004). Those aged >60 years had higher risk for all eye abnormalities: cataracts (OR = 0.7; 95% CI = 0.238-0.938), glaucoma (OR = 1.6; 95% CI = 1.227-2.037), and refractive errors (OR = 0.5; 95% CI = 0.183-0.829)., Conclusion: The present study supports the use of local policies and preventive measures in rural areas of Crete in order to improve rural health standards. Some insights concerning the effectiveness of future visits of MOUs are provided, guided by spatial analysis.

Background and Objective: This study examines the value of ultrasound elastography for the examination of ocular and periocular structures., Subjects and Methods: Five patients, aged 22 to 75 years, who each had one blind eye were included. Patients underwent ultrasound elastography of their blind eye and periocular tissues using a 7-13 MHz probe. Strain grayscale and color-coded elastographic maps were recorded. In the former, a quantitative assessment of signal intensity (corresponding to elastic properties) for specific anatomical structures was performed., Results: Anterior vitreous displayed intermediate elasticity, whereas posterior vitreous displayed low elasticity. Medial and lateral rectus muscle elasticity was higher in primary position than in adduction or abduction., Conclusion: The pattern of elastic imaging in the vitreous cavity could be attributed to posterior vitreous detachment, whereas that of medial and lateral rectus muscles may be related to the level of muscle fiber strain., (Copyright 2010, SLACK Incorporated.)

Copyright of Journal of Optometry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the long-term results of phakic refractive lens (PRL; Carl Zeiss Meditec) implantation in eyes with high myopia. Methods: In this retrospective, noncomparative, interventional case series, 143 myopic eyes of 82 patients were treated for high myopia with the implantation of the silicone PRL in the posterior chamber. Results: Mean follow-up was 3.8±1.7 years (range: 1 to 6 years). Six years postoperatively (n=34), a statistically significant reduction was noted in the cycloplegic spherical equivalent from −14.08±4.00 diopters (D) (range: −24.88 to −4.75 D) before PRL implantation to −0.45±0.62 D (range: −1.00 to 1.00 D) (P<.001). At 6 years, 67.6% (23 eyes) and 91.2% (31 eyes) were within ±0.50 and ±1.00 D of target refraction, respectively. Mean logMAR uncorrected and corrected distance visual acuity improved significantly (P<.001) (counting fingers preoperatively in all eyes to 0.17±0.15 [range: 0.54 to −0.06] and 0.19±0.19 [1.00 to −0.08] to 0.07±0.10 [range: 0.30 to −0.10], respectively). Complications included anterior capsule damage (3 eyes), temporary intraocular pressure increase (14 eyes), pigment dispersion (1 eye), and PRL decentration (1 eye). No eyes presented any signs of cataract up to 6 years postoperatively. Conclusions: Long-term results show that PRL implantation is an effective and safe method for treating high myopia. [ABSTRACT FROM AUTHOR]

Purpose: To report complications after the implantation of intrastromal corneal ring segments (Keraring; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a femtosecond laser (IntraLase; Advanced Medical Optics, Santa Ana, California, USA) for channel creation. Methods: Retrospective chart review of 531 patients (850 eyes) who underwent Keraring insertion using a femtosecond laser for channel creation. Intraoperative and postoperative complications were recorded. Results: Intraoperatively, there were 22 (2.7%) cases of incomplete channel formation. The rest of the intraoperative complications were galvo lag error (system malfunction) [five eyes (0.6%)], endothelial perforation [five eyes (0.6%)] and incorrect entry of the channel [two eyes (0.2%)]. Postoperatively, there were 11 (1.3%) cases of segment migration, two (0.2%) cases of corneal melting and one (0.1%) case of mild infection. The overall complication rate was 5.7% (49 cases out of 850 eyes). Conclusion: In this study, intracorneal ring segment implantation using a femtosecond laser for channel creation was related to a number of complications. The most common complications were incomplete channel creation (intraoperatively) and segment migration (postoperatively). [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have examined factors affecting the position of the eyeball to the orbit. This study examined the role of effective orbital volume (EOV), defined as the difference between orbital and eyeball volume, as a determinant of eyeball position, using MRI scans. Methods: Forty-six patients were recruited from the Department of Ophthalmology of the University Hospital of Heraklion, Crete Greece. Patients with a history of orbital disease were excluded. Distances between eyeball poles and orbital landmarks were measured in T1 weighted transverse, sagittal and coronal orbital images. The protrusion of the eyeball in the sagittal and transverse planes was recorded. The volume of the eyeball and bony orbit, the EOV, the volume of the extraocular muscles as well as clinical information (age, gender, Hertel exophthalmometry) were also recorded. Results: EOV was significantly associated with orbital volume but not with eyeball volume. EOV was also significantly associated with transverse and sagittal globe ptotrusions. Females displayed significantly lower orbital and eyeball volumes as well as EOV than males but higher transverse globe protrusion than males. Conclusions: Variations in EOV are associated with orbital volume rather than with eyeball volume. EOV is associated with globe protrusion and may be taken into account in the planning of various procedures, including orbital decompression, treatment of enophthalmos or the size of orbital implants following enucleation. [ABSTRACT FROM AUTHOR]

Ocular rigidity is a macroscopic parameter characterizing the relationship between pressure and volume changes in the human eye. Ocular rigidity depends on the architecture and material properties of the globe. Measurements of ocular rigidity have mainly been performed by means of invasive manometric devices or paired Schiotz tonometry. These measurements pertain to the injection (or displacement) of a given volume in the eye and measurement of the associated intraocular pressure change. Ocular volume, age, intraocular pressure, arterial pressure and ocular blood volume have all been suggested to influence ocular rigidity. Moreover, rigidity has been shown to be altered in patients with glaucoma and age-related macular degeneration. The significance of an accurate assessment of this parameter is apparent in tonometry, tonography and pulsatile ocular blood flow measurements, while its possible role in the pathogenesis of ocular disease remains to be elucidated. [ABSTRACT FROM AUTHOR]

Background. To evaluate differences between Goldmann Applanation Tonometry (GAT) and Dynamic Controur Tonometry (DCT) following trabeculectomy. Methods. Thirty eight glaucomatous eyes with a history of trabeculectomy (Trabeculectomy group, TG), 20 eyes without a history of trabeculectomy but with a history of latanoprost use (Latanoprost group, LG), and 19 nonglaucomatous eyes (Control group, CG) were included. GAT-IOP, DCT-IOP, the difference between them (dIOP), the central corneal thickness (CCT), the axial length (AL), and the depth of the anterior chamber (ACD) were measured. Results. dIOP was significantly higher in TG (5.19 mmHg) than in LG (4.01 mmHg) and CG (1.98 mmHg). Correlations between AL and dIOP were statistically significant in both TG and LG but not in CG whereas correlations between dIOP and other clinical parameters examined were statistically not significant in all groups. Conclusions. The significantly higher dIOP in TG implies that the biomechanical properties of the ocular walls are altered following trabeculectomy. [ABSTRACT FROM AUTHOR]

Introduction: A variety vascular disorders can affect the orbit, often manifesting as solitary space-occupying lesions. This study presents a case series of 3 patients with multi-focal orbital vascular conditions emphasizing on the clinical and imaging findings which could assist in the diagnosis and treatment planning. Methods: Retrospective consecutive case series of 3 patients with multifocal orbital vascular conditions treated at the Department of Ophthalmology of the University Hospital of Heraklion, in Crete, Greece. Results: Presenting symptoms included diplopia with compensatory head tilt (1 case) and eyelid protrusion enhanced by Valsalva maneuver (2 cases). MRI and CT studies showed multiple contrast-enhancing vascular lesions, associated with calcifications (1 case). Two lesions were surgically removed, proving to be orbital varices. Conclusions: Orbital vascular lesions may present multi-focally and displace adjacent structures. MRI and CT imaging may reveal their multi-focal presence as well as associated features, such as phleboliths. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of implantation of a new posterior chamber phakic refractive lens (PRL, Ciba Vision Surgical) in highly myopic eyes.Setting: Department of Ophthalmology, Medical School, University of Crete, Vardinoyannion Eye Institute of Crete, Crete, Greece.Methods: Thirty-four myopic eyes of 19 patients were treated for high myopia with implantation of a silicone PRL in the posterior chamber. Mean patient age was 29.0 years ± 7.9 (SD) (range 18 to 44 years). Manifest refraction in spherical equivalent (MR), uncorrected (UCVA) and best corrected (BCVA) visual acuity (decimal scale), intraocular pressure, higher-order aberrations (root-mean-square [RMS] wavefront error measured with a Shack-Hartmann wavefront sensor WASCA analyzer [Carl Zeiss, Meditec]), possible complications, and subjective symptoms were evaluated.Results: Phakic refractive lenses were successfully implanted in all eyes. Mean follow-up was 17.17 ± 3.76 months (range 12 to 24 months). There was a statistically significant reduction in the MR (from -14.70 D ± 2.65 D [range -20.75 D to -10.50 D] to -0.61 D ± 0.89 D [range -2.25 D to 1.00 D]) (P<.001). Twenty-seven (79%) and 15 eyes (44%) were within ±1.00 D and ±0.50 D of target refraction, respectively. Mean UCVA significantly improved (from counting fingers to 0.62 ± 0.28 (range 0.08 to 1.20) (P<.001). Mean BCVA also improved from 0.70 ± 0.24 (range 0.10 to 1.00) to 0.85 ± 0.24 (range 0.10 to 1.20) (P<0.001). Overall, there was a mean increase in BCVA of 1.5 ± 1.5 lines (range loss of 2 lines to gain of 5 lines). There was no statistically significant difference in higher-order aberrations after PRL implantation (pre-PRL RMS: 0.18 μm ± 0.08 μm [range 0.09 μm to 0.38 μm]; post-PRL RMS: 0.21 μm ± 0.08 μm; [range 0.05 μm to 0.38 μm]) (P = .12).Conclusion: The PRL showed encouraging results in treating high myopia. Additional patients and longer follow-up period are needed to detect the long-term efficacy and safety of this refractive lens. [Copyright &y& Elsevier]

Objective: To evaluate the epidemiological correlation between age-related macular degeneration and pseudoexfoliation syndrome in the inhabitants of the island of Crete (Greece). Subjects and Methods: A total of 777 persons (315 men and 462 women, aged 40-99 years), representing a randomized sample (1.43%) of the Cretan population, underwent slitlamp and fundus examinations according to protocol. The results were statistically analyzed. Results: The prevalence of pseudoexfoliation was 16.1% (21.3% in men and 12.6% in women) and that of maculopathy, 7.9% (11.7% in men and 5.2% in women). The conditions were significantly correlated with each other (P = .002). Also, both displayed a significant direct correlation with age and altitude (for pseudoexfoliation, P < .001 and P = .002 for age and altitude, respectively; for age-related macular degeneration, P<.001 for age and for altitude) and an increase in bilateral incidence with progressing age. Conclusions: The observed prevalences of pseudoexfoliation and maculopathy were lower than those reported in the mainland of Greece and other Mediterranean regions. The correlation between age-related macular degeneration and pseudoexfoliation syndrome may be explained by the relationship of each disease with age and altitude. [ABSTRACT FROM AUTHOR]

Purpose: To describe the technique of femtosecond laser–assisted intracorneal pocket creation, using a mask for the implantation of a corneal inlay in the non-dominant eye of a 56-year-old, emmetropic, presbyopic woman for the correction of presbyopia. Methods: Using the iFlap treatment-type software of the femtosecond laser (IntraLase 150, Abbott Medical Optics), a full lamellar cut was created at 280-μm depth. A keyhole-shaped mask was placed at the internal part of the glass of the applanation cone. A separator was used to separate the stroma, and an inserter was used to implant the inlay at the center of the line of sight. To determine the line of sight, the microscope and centration system of the excimer laser (Allegretto Wave 400 Hz, WaveLight Laser Technologie AG) were used. The Flexivue Microlens inlay (Presbia) was implanted. Results: No intra- or postoperative complications occurred during follow-up. Uncorrected near visual acuity improved from 20/50 to 20/20 at the first postoperative week. Conclusions: Femtosecond-assisted intracorneal pocket creation using a mask is a simple, safe, and efficient approach for the implantation of corneal inlays. [ABSTRACT FROM AUTHOR]

Purpose. To report a case of Parinaud's oculoglandular syndrome (POS) in which, despite the initially negative, a late onset of serologic positive titers was observed. Methods. Case report. Results. A 65-year-old man was examined for a foreign body in the left eye associated with granulomatous nodule on the palpebral conjuctiva, chemosis and a swollen preauricular lymph node. Despite the initially negative serologic titers to Bartonella henselae , a clinical diagnosis of POS was made and treatment was instituted initially with oral ciprofloxacin (500 mg twice a day). Three weeks later, serologic positive titers were found which confirmed the diagnosis of POS. Conclusion. Even though the improvements in diagnostic testing such as indirect immunofluorescence antibody, negative titles could be initially observed, confusing the diagnostic process. Other techniques (such as polymerase chain reaction (PCR) testing) should be also taken into consideration in cases with increased clinical suspicious of B. henselae indections. [ABSTRACT FROM AUTHOR]

Purpose: To compare the ocular rigidity in vivo measurements of patients with age-related macular degeneration (AMD) and control subjects. Design: Prospective comparative clinical study. Methods: The pressure-volume relation and the ocular rigidity coefficient were compared among 32 patients with AMD (AMD group: 16 with neovascular and 16 with nonneovascular AMD) and 44 age-matched control patients (control group) who underwent operation for cataract. This was achieved by an injection of 200 μl of a balanced salt solution (in steps of 4.5 μl) through the limbus in the anterior chamber, while the intraocular pressure was monitored continually with a transducer, up to the limit of 30 mm Hg. Results: The mean age (AMD group: 69.89 ± 15.92 years vs control group: 65.28 ± 12.34 years; P = .195), gender (AMD group: 13 female vs control group: 17 female; P = .513), eye’s axial length (AMD group: 23.14 ± 0.75 mm vs control group: 23.04 ± 1.16 mm; P = .725) of patients with AMD and the healthy control subjects were comparable. No statistically significant difference in ocular rigidity measurements between patients with AMD and control subjects (AMD group: 0.0142 ± 0.0077 μl−1 vs control group: 0.0125 ± 0.0049 μl−1; P = .255) was found. When we examined separately the two subgroups of patients with AMD (neovascular and nonneovascular AMD), the average ocular rigidity measurements were higher in patients with neovascular AMD vs both control subjects and patients with nonneovascular AMD (neovascular AMD group: 0.0186 ± 0.0078 μl−1 vs control group: 0.0125 ± 0.0048 μl−1 [P = .014] vs nonneovascular AMD group: 0.0104 ± 0.0053 μl−1 [P = .004]). Conclusions: Despite the limitations placed by the small sample of the examined cases, patients with neovascular AMD who are treated (with photodynamic therapy) have increased ocular rigidity measurements compared with patients with nonneovascular AMD and control patients. [Copyright &y& Elsevier]

A 42-year-old man had Intacs (Addition Technology Inc.) implantation for early pellucid marginal degeneration (PMD). Two Intacs segments (0.45 mm thickness) were inserted uneventfully in the fashion typically used for low myopia correction (nasal–temporal). Eleven months after the procedure, the uncorrected visual acuity was 20/200, compared with counting fingers preoperatively, while the best spectacle-corrected visual acuity improved to 20/25 from 20/50. Corneal topographic pattern also improved. Although the results are encouraging, concern still exists regarding the long-term effect of this approach for the management of patients with PMD. [Copyright &y& Elsevier]