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Introduction:Central Serous Chorioretinopathy(CSCR) is an idiopathic disorder with neurosensory detachment primarily affecting the macula. Aim:The aim of this study was to evaluate the stressful events of life within 1 year preceding onset of CSCR and study the correlation with the type of leak. Materials and Methods:A prospective study was done on 30 patients of CSCR in a tertiary care centre. Demographic data and history were noted, a comprehensive ophthalmic examination was done.All cases underwent OCT & fundusfluorescein angiography (FFA). They were given a Social Readjustment Rating Score (SRRS) based on life change unitsin the past one year based on a questionnaire. 30 patients from normal population formed a control group. Results: 93.3% were males, mean age was 38 yrs. The mean SRRS was 136.73 in the CSCR group compared to 100.5 in the control group. 40 % patients in the CSCR group had scores above 150 compared to 30 % in the control group. 50% of the patients with multifocal leak had SRRS between 150- 299 compared to 36.36 % among patients with single leak. Conclusion:Psychological stress plays a significant role in triggering or exacerbating CSCR. Relaxation therapies & stress management programmes may help in preventing recurrences.

Uveitis is one of the vision threatening eye diseases. There are several conditions that can mimic uveitis. An approach to uveitis should include uveitis oriented history, ophthalmic examination, systemic evaluation, ancillary tests and laboratory investigations. Various signs and symptoms can occur in different types of uveitis. There is a new grading system of anterior chamber inflammation and vitreous inflammation by SUN working group. There is also an anatomic and an etiological classification of uveitis. New classification systems have been proposed recently for intraocular tuberculosis, ocular sarcoidosis, Vogt-Koyanagi-Harada disease, Behcet’s disease and acute retinal necrosis. This review article will update the clinical approach and various classification systems in uveitis.

To evaluate the changes in ocular surface and functions of tear-film in patients treated with systemic isotretinoin, to assess diagnostic performance of ocular surface disease index (OSDI) test in the dry eye conditions in association with the use of isotretinoin, and to determine the correlation between all tear-film function tests, OSDI and the dose and duration of isotretinoin administration. One hundred and twenty eyes of 60 subjects treated with oral isotretinoin were enrolled. All patients underwent ophthalmic examination at the baseline and another examination during the course of treatment. Biomicroscopic ophthalmic examination of the meibomian glands, non-anesthetized Schirmer test, and tear film break-up time (BUT) were performed. Subjective ocular complaints were scored with an OSDI questionnaire. Average Schirmer scores were not significantly changed by isotretinoin treatment. There were significant differences in the average OSDI score, the average meibomian gland disease (MGD) grade and average BUT value of both eyes during the treatment compared with baseline values (p

Purpose. To evaluate the efficacy and safety of a modified technique of corneal collagen cross-linking in comparison with the standard approach by the nature changes in clinical and morphological parameters of the cornea in the early and longterm postoperative period. Material and methods. The study included two groups of patients: the group 1 consisted of patients operated on for progressive keratoconus in the classical way of corneal collagen cross-linking – 25 individuals (25 eyes), the group 2 – patients treated by the modified cross-linking technique – 36 individuals (36 eyes). Before and after the procedure in the follow-up of 1, 3, 6 and 12 months, all patients underwent an extended ophthalmic examination, including the optical coherence tomography (OCT) of the cornea (Cirrus HD 3000, Carl Zeiss, Germany), the confocal microscopy (Confoscan4, Nidek, Japan). Results. Re-epithelialization of the cornea occurred faster in the group 2. In both investigated groups a significant UCVA increase (from 0.15±0.04 to 0.35±0.07 in the group 1 and 0.13±0.025 to 0.33±0.04 in the group 2) and the BCVA (from 0.3±0.08 to 0.5±0.05 in the group 1 and 0.4±0.04 to 0.87±0.18 in the group 2) was noted in the follow-up period of 6-12 months. After 1 month postoperatively the well-defined linear opacities in the middle and posterior layers of the stroma – the so-called «demarcation lines» or «posterior stromal hazes» appeared during the ophthalmic bio-microscopy as well as in the OCT of cornea in all observed patients. In this period the depth of the «demarcation line» position in the group 1 averaged 252±15.0μm, in the group 2 – 235±10.0μm. The confocal microscopy showed that histomorphological changes were more pronounced in the group 1 within all above-mentioned periods. In the 3-month follow-up in the group 2 a statistically significant reduction in our proposed scoring estimation of all the studied signs, and a maintenance of this trend were detected in the follow-up period after 6 and 12 months, that indicates a more mild and rapid regeneration of cornea after the corneal collagen cross-linking surgery performed according to the modified technique. The endothelial cells density (ECD) remained unchanged in all followup periods in both groups. Conclusions. Thus, a manifestation of positive dynamics in the postoperative UCVA, BCVA and the unchanged ECD in all cases allows to consider both options of corneal collagen crosslinking safe, with a comparable clinical efficacy. However, a more pronounced positive dynamics in the BCVA in the group 2, a milder course of the early postoperative period for patients, consisting in a more rapid completion of the re-epithelialization process, as well as and the availability of adequate and safe level histomorphological changes in the cornea after the cross-linking enable to recommend the modified technique for the treatment of progressive keratoconus.

Two case reports are used to illustrate the signs and symptoms, complications and treatments of chronic socket inflammation due to intraorbital implants. The ophthalmic examination, surgeries and treatments are documented. Two anophthalmic cases that underwent enucleation and multiple orbital surgeries to enhance the anophthalmic socket volume developed pain, intense discharge and contracted cavities with chronic inflammation in the socket which was nonresponsive to medical therapy. Computed tomography indicated a hypodense foreign body in both cases causing an intense inflammatory reaction. The implants were removed by excisional surgery and a room temperature vulcanized silicone implant was retrieved in both cases. Socket inflammation resolved in both cases after implant removal. An intraorbital inflammatory reaction against an intraorbital implant can cause chronic socket inflammation in patients with a history of multiple surgeries. Diagnosis requires imaging and the definitive treatment is implant removal.

The exact contribution of the orbital lacrimal gland (OLG) is unknown and is still a subject of debate and inconsistency in literature. Currently, there are no detailed studies addressing the influence of the OLG removal on tear production in equines. This study aimed to address the influence of surgical excision of the OLG on aqueous tear production and ocular surface health in donkeys. The study was conducted on six clinically healthy donkeys with no ophthalmic abnormalities. In each donkey, the OLG of the left eye was surgically excised, whereas the right eye was served as a control. External ophthalmic examination, Schirmer tear test (STT) I and II, tear pH, fluorescein staining test were conducted on both eyes, preoperatively and at one-week intervals for 60 days, postoperatively. There were significant decreases in STT I and II values (P = .0001 and .0001, respectively), whereas tear pH values showed a significant increase (P = .0001) in the operated eyes compared with the control ones. There were no overt clinical signs characteristics of keratoconjunctivitis sicca (KCS) in the operated eyes. However, there was evidence of microinjury of the keratoconjunctival epithelium evidenced by positive fluorescein uptake, postoperatively. Surgical excision of the OLG significantly diminished the aqueous tear production and threatened the corneal epithelium as a result of corneal dehydration. On the contrary to the recommendations of other studies, eyes subjected to this procedure should receive treatment of dry eye to prevent development of KCS, postoperatively.

Purpose: The aim of this study was to compare the cost-effectiveness and perform cost-utility analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) vs. penetrating keratoplasty (PK) in Indian population. Methods: This was an institutional, ambispective, observational study. Patients who underwent PK or DSAEK for endothelial dysfunction were included and followed up for 2 years; those with other ocular comorbidities were excluded. The analysis was performed from the patient’s perspective receiving subsidized treatment at a tertiary care hospital. Detailed history, ophthalmic examination, total expenditure by patient, and clinical outcomes were recorded. The main outcome measures were best spectacle-corrected visual acuity (BSCVA), graft survival (Kaplan–Meier survival estimates), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Utility values were based on quality-adjusted life years (QALYs) associated with visual acuity outcomes. Statistical analysis was performed using SPSS software package, version 12.1; a value of P < 0.05 was considered statistically significant. Results: A total of 120 patients (PK: 60, DSAEK: 60) were included. At 2 years, for a similar logMAR BSCVA, [PK (0.32 ± 0.02), DSAEK (0.25 ± 0.02); P = 0.078], the overall cost for PK (13511.1 ± 803.3 INR) was significantly more than DSAEK (11092.9 ± 492.1 INR) (difference = 1952.6 INR; P = 0.01). ICER of DSAEK relative to PK was –39,052 INR for improvement in 1 logMAR unit BSCVA. ICUR of DSAEK relative to PK was –1,95,260 INR for improvement in 1 QALY. Conclusion: DSAEK was more cost-effective than PK in patients with endothelial dysfunction at 2 years.

Bilateral optic disc swelling is an important clinical sign for potentially life-threatening and sight-threatening conditions, with the most common being raised intracranial pressure and pseudopapillitis. Perhexiline-related and amiodarone-related optic disc swellings are diagnoses of exclusion. This report describes the diagnosis of a man with perhexiline-induced and amiodarone-induced optic neuropathy after extensive investigation consisting of full ophthalmic examination, biochemical screen, temporal artery biopsy, CT, MRI, positron emission tomography and lumbar puncture. There was partial to complete resolution of optic neuropathy following cessation of the causative medication. We postulate that the underlying mechanism of perhexiline toxicity could be mitochondrial dysfunction related. Our case demonstrates that patients treated with perhexiline and amiodarone should be monitored closely for ocular side effects.

This study presents the long-term results on canaloplasty in a group of patients affected by pigmentary glaucoma, and studies the progression of the disease after surgery. Material and methods: Twenty-nine eyes of 25 patients with pigmentary glaucoma in maximum tolerated medical therapy with significant visual field damage progression underwent canaloplasty and were followed up to 11 years (mean 59.8 &plusmn, 30.1 months). All patients underwent a complete ophthalmic examination every 6 months. Results: The pre-operative mean intraocular pressure (IOP) was 31.8 mmHg &plusmn, 10.9 (range 21&ndash, 70) with an average of 3.3 medications. After 1, 2, 3, and 4 years, the mean IOP was 15.9 &plusmn, 4.0, 14.4 &plusmn, 7.3, 14.1 &plusmn, 2.1, and 15.7 mmHg, respectively, with 0.4, 0.5, and 0.7 medications, respectively. Four patients underwent trabeculectomy after 3 to 30 months due to uncontrolled IOP. Gonioscopy showed a significant reduction of pigment in trabecular meshwork in all cases, starting from the sixth month. In some cases, the pigment was almost completely reabsorbed after two years, suggesting an accelerated transit and escape of the granules through the trabecular spaces. Conclusions: Canaloplasty seems to be a reasonable option in treating patients affected by progressive pigmentary glaucoma. The reabsorption of pigment granules from the trabecular meshwork could, at least in part, explain the relatively high success rate observed after this surgical procedure.

Aim: The aim of this article is to present the microstructural characteristics of outer retinal tubulations (ORTs) in patients with exudative age-related macular degeneration (AMD) and to assess their predictive value for poor visual acuity. Materials and Methods: Fifty-five eyes of 50 patients with wet AMD were examined. All subjects underwent a complete ophthalmic examination and optical coherence tomography (OCT). Statistical analyses were carried out using SPSS v. 19.0. Results: The median follow-up period was 8.31±8.86 months (3 to 36 months). ORTs were found in 8 (14.5%) of all examined with OCT patients. There was no statistically significant correlation between these changes and visual acuity. Conclusion: ORTs are rarely seen in patients with exudative AMD. Their predictive value of visual acuity based on such small amount of cases could be difficult to assess.

The purpose of this study was to report the external dacryocystorhinostomy (ext-DCR) using silicone intubation in a child with dyskeratosis congenita (DC) who had presented by bilaterally acquired nasolacrimal duct obstruction (NLDO), punctal stenosis, and mucocutaneous changes. We report the 13-month results of an 11-year-old boy with DC who underwent bilateral ext-DCR with silicone stenting under general anesthesia. Ophthalmic examination revealed bilateral punctal stenosis and NLDO with normal fundus examination. He was referred to pediatrics and was diagnosed as DC, based on classic reticular skin pigmentation, nail dystrophy, and oral leukoplakia, without any other systemic involvement. Treatment consisted of bilateral ext-DCR using silicone stenting by 6 months. Management of surgery and post-operative 13-month follow up results was observed. DC is a rare heterogeneous multisystem disorder of telomere maintenance, which may present with ophthalmologic features. Although the lacrimal system abnormalities have been reported most frequently ocular findings in DC, this is the first case to present the management and long-term results of DCR using silicone intubation. This case aims to raise awareness of the various systemic and ocular manifestations and possible complications of DC and to present long-term results of ext-DC in a patient with DC.

Importance The new coronavirus disease 2019 (COVID-19) pandemic poses a particular threat to health care professionals; however, there appear to be no objective data that demonstrate the risks of encountering individuals carrying the virus asymptomatically in the case of maintained elective examinations. Objective To investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the environmental surfaces of an ophthalmology examination room after visits by patients who were asymptomatic and had passed COVID-19 triage. Design, Setting, and Participants This is a quality improvement study conducted 1 week after the first officially confirmed COVID-19 case in Izmir Tepecik Training and Research Hospital, Izmir, Turkey, on March 20, 2020. A triage system was used to determine the risk of COVID-19 from patients who were asymptomatic and presented for examination in an ophthalmology clinic. Real-time polymerase chain reaction testing was used to detect the presence of viral RNA material in samples from the biomicroscope stage, slitlamp breath shield, phoropter, tonometer, and door handles. The first group of samples was taken before the beginning of the examinations, and the second group of the samples was taken after the last patient had left the room. Main Outcomes and Measures The main outcome was the presence of viral material on surfaces in 5 circular zones with a diameter of 1 m each around where the patients sat. Results Thirty-one persons visited the room, of whom 22 underwent ophthalmic examination and 9 were companions. The mean (SD) examination time was 9 (4) minutes (range, 5-13 minutes). Seven samples were taken before examinations and 7 after examinations. Two samples that were taken after examinations were found to be positive for COVID-19, 1 from the slitlamp breath shield and 1 from the phoropter. Conclusions and Relevance This study showed the presence of COVID-19 viral material in a circle 1 m in diameter around where the patients sat. However, real-time polymerase chain reaction could only detect viral material, not the infectivity of these virus samples.

Purpose To describe the mean and normal range of intraocular pressure (IOP) and its associations in healthy Iranian school children using the noncontact tonometer. Methods In this cross-sectional study as part of the Shiraz Pediatric Eye Study, a stratified random sampling was performed among elementary school children of Shiraz, Iran. Basic demographics and socioeconomic status of households, past medical history, drug history, and eye health history were collected for each eligible student. Children underwent complete ophthalmic examination. Axial length, corneal curvature, and anterior chamber depth were measured using the IOL-Master 500. Results Of 2,001 eligible children, 1,901 (95.0%; 3,802 eyes) with a mean age of 9.1 ± 1.6 years (standard deviation; range, 6-12 years) had reliable IOP. The mean spherical equivalent refraction was 0.5 ± 1.3 D for the right eye and 0.6 ± 1.2 D for the left eye. Mean IOP in the right eye was 15.1 ± 2.5 mm Hg (median, 15.0; range, 8.0–27.0 mm Hg); in the left eye, 15.2 ± 2.5 mm Hg (median, 15.0; range, 9.0–28.0 mm Hg). In multiple regression analyses, the mean IOP was significantly lower among asthmatic children compared to normal participants (P = 0.007). The measured IOP was significantly higher in myopic participants than hyperopic patients (P = 0.003). Conclusions This study provides a useful normative IOP database using the noncontact tonometer for healthy Iranian school children.

To evaluate the dry eye disase and meibomian gland dysfunction with meibography of Seborrheic Dermatit patients.A hundred-ten of 50 patients with Seborrheic Dermatitis (group 1) and 100 eyes of 50 healthy individuals (group 2) were enrolled in this prospective study. All subjects were performed a comprehensive ophthalmic examination including lid margin alterations and meibomian gland obstruction assessment, Ocular Surface Disease Index assessment, tear film break-up time test, corneal and conjunctival fluorescein staining assessment, Schirmer test. In addition, upper and lower lids were evaluated for meibomian gland loss with non-contact meibography. The Meibomian glands were graded from grade 0 (no loss of Meibomian glands) to grade 3 (gland loss2/3 of the total Meibomian glands).The mean ages of Group 1 and Group 2 were 29.1 ± 9.1(range, 18-48) and 30.6 ± 6.3(range, 20-49) years, respectively. MGD(n = 19, %34.5), Meibium gland loss(%36.4 ± 18.1), upper meiboscore (0.7 ± 0.8), lower meiboscore(0.6 ± 0.7) and DED (n = 10, %18.2) were significantly higher in the SD patients compared with the control participants (p = 0.002, p 0.001, p = 0.011, p = 0.005, p = 0.048, respectively). There was significant relationship between age with Meibomian gland loss, MGD and DED (p = 0.017, p = 0.004, p = 0.002, respectively).Seborrheic Dermatitis may influence meibomian gland morphology and as a result causing meibomian gland dysfunction and dry eye disase. For this reason, patients with Seborrheic Dermatitis should be evaluated for meibomian gland dysfunction and dry eye disase, and start treatment when needed.

Teaching and learning how to perform examination of the ocular fundus is challenging. Smartphones can support to enhance students' confidence and experience.Following an optional year-4 ophthalmoscopy practical using hand-held ophthalmoscopes, students completed a questionnaire using a visual analogue scale (VAS) investigating if students felt smartphone use aided learning and if student's self-assessed confidence in visualising the ocular fundus had improved. VAS scores were compared using the Wilcoxon signed rank test (significance: P0.05).All 30 year-4 students attending the practical participated to the study. Confidence in performing direct ophthalmoscopy significantly increased after the practical. Confidence after the practical was 65.3 (±19.8) per cent compared with before the practical when confidence was 20.1 (±15.6) per cent (P0.001). The perceived usefulness of traditional teaching was 62.3 (±23.8) per cent. The perceived usefulness of the teaching with the smartphone was 91.1 (±8.6) per cent. While students found both methods useful, they perceived the use of the smartphone to be significantly more useful (P0.001). Free-text comments on the use of the smartphone were all positive and included 'useful', 'fun' and 'good teaching tool'.This study shows that students positively received the use of the smartphone, which can be a useful tool to teach the equine ocular examination to undergraduate veterinary students.

Objective: The purpose of this study was to evaluate whether the complexity of the corneal pulse (CP) signal can be used to differentiate patients with primary open-angle glaucoma (POAG) from healthy subjects. Approach: The study sample consisted of 28 patients with POAG and a control, age-matched group of 30 subjects. After standard ophthalmic examination, the CP signal from a randomly selected eye of each participant was measured using non-contact ultrasonic micro-displacement measurement technology. After pre-processing, the complexity of the CP signal was estimated using refined composite multiscale fuzzy entropy (RCMFE) up to scale factor 50. The average RCMFE values were computed from three repeated measurements of the CP signals for each participant and each scale factor. Main results: The complexity of the CP signal in glaucomatous eyes was higher than that observed in healthy ones. Also, RCMFE of the CP signal was found to differentiate (statistically significantly) between the two groups for scales in the range from 26 to 43. For these scales, the one for which the lowest p-value (t-test, p = 0.017) was obtained when comparing RCMFE between the two groups was selected as the optimal scale. Next, a receiver operating characteristic analysis for the optimal scale showed that the proposed approach of calculating the multiscale entropy of the CP signal has some potential to discriminate between patients with POAG and healthy controls (sensitivity, specificity and accuracy of 0.643, 0.700 and 0.672, respectively). Significance: In conclusion, RCMFE, as a complexity measure, may be considered an auxiliary indicator to support glaucoma diagnostics.

Background Keratometry is clinically important and is routinely performed as part of human ophthalmic examination. In veterinary ophthalmology, little is known about keratometry in dogs, and its practical application has been limited. The present study aimed to describe keratometry in some dog breeds popular in Japan using a handheld keratometer. Methods Client-owned dogs of various signalment were enrolled prospectively in the keratometry examination. Interbreed variations in mean corneal curvatures (R1R2avg) and corneal astigmatism (Δ(R1−R2)) were evaluated statistically with respect to their bodyweight based on the data which fulfilled the predetermined inclusion criteria. P

In most cases, an ophthalmic examination can be performed at the ocular surface, including cornea and conjunctiva. The cornea is arranged into well-organized layers, and each layer plays a significant role in maintaining the transparency and viability of the tissue. The conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside of the eyelids. The inflammation of ocular surface can be divided into infectious and noninfectious causes, including allergic, and toxic, as well as immune-mediated diseases. Various ophthalmic examinations of this chapter provide assistance to the diagnosis of the ocular surface disease. In additional, culture or cytology from the ocular surface may provide further information to diagnose of disease or to guide therapy.

textabstractPurpose: In eye movement perimetry (EMP), the extent of the visual field is tested by assessing the saccades using an eye tracker. The aim of the present study was to determine the effects of age and sex of the subjects, the eccentricity and intensity of the peripheral stimuli on saccadic reaction time (SRT), and the interaction between these parameters in healthy participants. Methods: Healthy participants aged between 20 to 70 years underwent a complete ophthalmic examination and an EMP test. SRT was determined from detected peripheral stimuli of four intensity levels. A multilevel mixed-model analysis was used to verify the influence of subject and stimulus characteristics on SRT within the tested visual field. Results: Ninety-five subjects (mean age 43.0 [15.0] years) were included. Age, stimulus intensity, and eccentricity had a statistically significant effect on SRT, not sex. SRTs were significantly faster with increasing stimulus intensity and decreasing eccentricity (P < 0.001). At the lowest stimulus intensity of 192 cd/m2, a significant interaction was found between age and eccentricity. Conclusions: The current study demonstrated significant SRT dependence across the visual field measured up to 278, irrespective of sex. The presented SRT values may serve as a first normative guide for EMP. Translational Relevance: This report of SRT interaction can aid in refining its use as a measure of visual field responsiveness.

Morphology and physiology of bird eyes are similar to mammals; although, there are peculiarities that should be considered for a correct interpretation of an ophthalmic examination. While the ophthalmology of domestic species is already well established, there are gaps to be filled regarding birds, particularly due to the large number of existing species. This literature review consists of a brief contribution regarding peculiarities of anatomy, physiology, and ophthalmic semiotechnique of the avian eye. RESUMO: A morfologia e a fisiologia dos olhos das aves são similares àquelas de mamíferos, mas existem particularidades que devem ser consideradas para a correta interpretação do exame oftálmico. Enquanto a oftalmologia de espécies domésticas já é bem estabelecida, ainda há diversas lacunas no que tange às aves, particularmente devido ao grande número de espécies existentes. Este trabalho objetiva realizar uma revisão bibliográfica abrangendo anatomia, fisiologia e semiologia oftálmica de aves.

Objectives To evaluate the combined effect of intramuscular acepromazine and methadone on tear production in dogs undergoing general anaesthesia for elective, non-ocular procedures. Design Prospective, non-randomised, pre-post treatment study. Setting Patients were recruited from a referral practice in the United Kingdom. Methods Thirty client-owned dogs were enrolled in this study and received a combined intramuscular premedication of methadone (0.3 mg/kg) and acepromazine (0.02 mg/kg) prior to general anaesthesia for elective, non-ocular procedures. Full ophthalmic examination was performed and tear production was quantified using the Schirmer tear test-1 (STT-1). On the day of general anaesthesia, an STT-1 was performed before (STT-1a) and after (STT-1b) intramuscular premedication with methadone/acepromazine. Results Using a general linear model, a significant effect on STT-1 results was found for premedication with methadone/acepromazine (P = 0.013), but not eye laterality (P = 0.527). Following premedication, there was a significant reduction observed in the mean STT-1 readings of left and right eyes between STT-1a (20.4 ± 2.8 mm/min) and STT-1b (16.9 ± 4.1 mm/min; P < 0.001). Significantly more dogs had an STT-1 reading less than 15 mm/min in one or both eyes after premedication (30%; 9/30 dogs) compared with before premedication (6.7%; 2/30 dogs; P = 0.042). Conclusions An intramuscular premedication of methadone and acepromazine results in a decrease in tear production in dogs prior to elective general anaesthesia. This may contribute to the risk of ocular morbidities, such as corneal ulceration, particularly in patients with lower baseline tear production.

Purpose. We aimed to investigate whether anterior chamber angle, depth, and volume change after myopic laser-assisted in situ keratomileusis (LASIK) in young patients. Methods. This retrospective study included 29 eyes of 29 patients (15 females and 14 males) between the ages of 18 and 39 years who underwent LASIK for the treatment of myopia. In addition to complete ophthalmic examination, anterior chamber angle (ACA), central anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured by using a Sirius rotating Scheimpflug camera combined with Placido disc corneal topography (CSO, Florence, Italy). Preoperative and postoperative values were compared using paired t-tests. Linear regression was used to evaluate the relationship between changes in refraction and changes in ACA, ACD, and ACV as well as between attempted maximum ablation depth and changes in ACA, ACD, and ACV. Results. The mean age of the study population was 25.5 ± 6.2 years. The mean preoperative and postoperative spherical equivalent values were −3.30 ± 1.92 D and −0.18 ± 0.29 D, respectively. ACV and ACA were not significantly changed after surgery; however, central ACD was significantly decreased (preoperatively = 3.366 ± 0.316 mm vs postoperatively = 3.3 ± 0.298 mm) with a mean difference of 0.066 ± 1.121 mm. There were no significant relationships between changes in refraction and anterior segment dimensions or between attempted maximum ablation depth and anterior segment dimensions. Conclusion. Measurements with Sirius showed that ACA and ACV did not change; however, central ACD significantly decreased after myopic LASIK in young patients, indicating that the preoperative central ACD value should not be used interchangeably with the postoperative central ACD value.

This article provides a brief, clinically relevant review of corneal surface disease in the ferret. A description of the ophthalmic examination of the ferret is provided. Stepwise descriptions of the most common ophthalmic abnormalities are provided, along with common rule-outs.

To evaluate circular neodymium: YAG laser incision in cases of anterior capsular contraction syndrome (ACCS) by comparing it to radial Neodymium: YAG laser incision as for efficacy and safety. Ophthalmology Department, Benha University Hospitals. The study was done on 74 eyes of 66 patients with symptomatic ACCS. Eyes were randomly allocated to one of the two groups. Group I were treated by circular YAG laser anterior capsulotomy. Group II were treated by radial YAG laser anterior capsulotomy. All cases passed a full ophthalmic examination before laser capsulotomy, 1 week, 1 month, 6 months and 12 months after laser. BCVA at the 1st week and the 1st month after the capsulotomy did not show any significant difference between the two groups; however at the 3rd and 6th months, the circular group showed better visual acuity than the radial group (p 0.001 and

Purpose. To compare outer retinal layer (ORL) thickness and photoreceptor outer segment (PROS) length between normal eyes and eyes with diabetic macular edema (DME), and also, to study the correlation between central macular thicknesses (CMT), ORL, and PROS length with best corrected visual acuity (BCVA) in DME. Methods. 80 eyes were included in the study; they were divided into two groups, group Ι (40 normal eyes) and group ΙΙ (40 eyes) with DME. Complete ophthalmic examination and OCT were done for all eyes. Comparison between ORL and PROS was done between both groups; also, correlation between ORL thickness, PROS length, and CMT with BCVA in group ΙΙ was studied. Results. CMT was greater in group ΙΙ than group Ι (392.70 ± 62.91 and 265.73 ± 17.17, respectively) (SS, p<0.001). ORL thickness was statistically significantly greater in group Ι than group ΙΙ (104.80 ± 4.94, 93.68 ± 6.34, p<0.001). Regarding PROS length, it was statistically significantly greater in group Ι than group ΙΙ (31.38 ± 3.4 and 26.65 ± 3.39, respectively, p<0.001). There was moderate correlation between BCVA and ORL thickness (r = −0.440, p=0.004) and strong correlation between BCVA and PROS length in group ΙΙ (r = − 0.690, p<0.001), while there was weak correlation between BCVA and CMT (r = 0.198, p=0.220). Conclusion. Both ORL thickness and PROS length were greater in healthy normal eyes than eyes with DME. BCVA was correlated better with PROS length and ORL thickness than CMT.

To identify discriminating factors, using clinical ophthalmic examination findings and routine laboratory testing, that differentiate dogs with early sudden acquired retinal degeneration (SARDS; vision loss6 weeks' duration), age- and breed-matched control dogs, and dogs with pituitary-dependent hyperadrenocorticism (PDH).Client-owned dogs: 15 with SARDS with6 weeks duration of vision loss, 14 age- and breed-matched control dogs, and 13 dogs with confirmed PDH.Dogs underwent ophthalmic examination, electroretinography (ERG) fundus photography, and spectral-domain optical coherence tomography (SD-OCT) in addition to physical examination, urinalysis, serum biochemistry, complete blood count, and adrenocorticotrophic hormone (ACTH) stimulation testing. Statistical analysis was performed using receiver operating curve area under the curve analysis, principal component analysis with sparse partial least squares analysis, and one-way ANOVA.Dogs with SARDS all had absent vision and ERG a- and b-waves. SD-OCT demonstrated that dogs with SARDS had significantly thicker inner retina, thinner outer nuclear layer, and thicker photoreceptor inner/outer segment measurements than either controls or dogs with PDH. Discriminating laboratory parameters between dogs with SARDS and PDH with high specificity included post-ACTH serum cortisol (19.3 μg/dL), AST:ALT ratio (0.343), and urine specific gravity (1.030).We have identified significant discriminators between SARDS and PDH. This work provides the basis for future studies that could identify and examine dogs with SARDS prior to vision loss, which may extend the potential therapeutic window for SARDS.

Purpose: To determine the postoperative horizontal alignment changes following different inferior oblique (IO) weakening procedures on cases with IO overaction (IOOA). Methods: A total of 40 patients undergoing IO weakening surgery participated in this prospective interventional case series. A comprehensive ophthalmic examination was performed on all patients. The grade of IOOA was assessed based on the muscle function in the gaze of elevation in adduction. All study subjects were operated on by one of the IO weakening procedures including recession, myectomy, or anteriorization, and all were followed up for at least three months after the surgery. Postoperative change of the horizontal alignment in primary position was the main outcome measure. Results: Our findings showed that all types of IO weakening surgeries improved the postoperative muscle function, hypertopia, and V-pattern significantly (P = 0.001). Generally, IO weakening surgeries had no effect on the postoperative horizontal alignment, and mean exoshift of 0.44 ± 6.2 prism diopters (PD) was observed in all study subjects, specifically. It was found that 70% of cases had no postoperative horizontal changes, 15% showed improvement toward orthophoria, and 15% shifted away from orthophoria. Conclusions: Based on our findings, no horizontal alignment change would be expected in the majority of cases undergoing weakening procedures of overacted IO. Most of our cases did not show any change while a few of them presented eso- or exoshift less than 5 pd which can be clinically ignored. Keywords: Inferior oblique, Myectomy, Recession, Anteriorization, Horizontal alignment

A 16-year-old boy with early-childhood-onset retinal dystrophy and developmental delay was diagnosed with abetalipoproteinemia based on ophthalmic examination, history, and results of a peripheral blood smear. The diagnosis was confirmed by lipid profile and genetic testing, and an older sister was confirmed to be affected as well. Although abetalipoproteinemia is treatable in early childhood, most cases are diagnosed late if at all. We highlight clinical features that should raise suspicion for this treatable but likely under-diagnosed form of early-onset retinal dystrophy and document retinal optical coherence tomography findings for a genetically proven case.

To study types and thickness of interdigitation zone band in adult Chinese subjects, we conducted a cross-sectional study. The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 ± 9.8 years. 263 people (263eyes) with a mean age of 64.8 years were randomly selected cases without macular diseases included in the study. A detailed ophthalmic examination was performed including SD-OCT for measurement of the thickness of interdigitation zone band. There are two types of interdigitation zone band; the type1 which can distinguish RPE–BM complex in 170 eyes; and the Type 2 which the two layers merged involved 93 eyes. In type1, the mean thickness of the interdigitation zone band was significantly thicker in the foveal center (16.46 ± 2.92 μm), then nasal macular region (16.19 ± 2.69 μm), temporal macular region (15.73 ± 2.68 . μm), superior region (15.72 ± 2.70 μm), and inferior macular region (14.84 ± 2.63 μm) (P all P = 0.025) and level of education (P = 0.033). The increase in the thickness of the interdigitation zone band may play a role in the pathophysiologic features of various age-related ocular conditions.

Aims The current study was carried out to examine prevalence of complications related to diabetes mellitus (DM) and to investigate association between clinical variables and biochemical factors with complications of DM in patients treated in primary healthcare settings in the West Bank of Palestine. Materials and methods Sociodemographic, clinical, and biochemical variables were collected from 385 patients visiting 17 primary healthcare settings in the West Bank. Patients provided blood and urine samples, responded to a questionnaire interview, and were subjected to ophthalmic examination. Results HbA1c levels were predicted by duration of DM (p Conclusions Prevalence of complications related to DM was high among patients with DM treated in primary healthcare practice. These complications and risk factors were predicted by certain clinical characteristics and biochemical factors. Policies and programs are needed to manage these modifiable risk factors.

Purpose To describe the visual, tomographic, and electroretinographic findings in a patient with macular edema secondary to branch retinal vein occlusion who was submitted to three consecutive intravitreal injections of ziv-aflibercept. Methods The patient underwent a complete ophthalmic examination, as well as optical coherence tomography and full-field electroretinography at baseline and 90 days after the first injection. Results The best-corrected visual acuity improved from 20/400 to 20/40, and the central retinal thickness decreased from 791 μm to 198 μm after three consecutive intravitreal injections of ziv-aflibercept. Full-field electroretinography showed an increase in cone amplitude and decrease in rod amplitude. No adverse side effects were observed after injections. Conclusion Intravitreal injections of ziv-aflibercept showed both effectiveness and safety in the treatment of a patient with macular edema secondary to branch retinal vein occlusion. The observed anatomic (by ophthalmic examination, optical coherence tomography) and functional (best-corrected visual acuity, full-field electroretinography) improvements and lack of serious adverse side effects demonstrates the potential of intravitreal injections of ziv-aflibercept for the treatment of macular edema secondary to branch retinal vein occlusion.

Purpose. The purpose of this study was to measure retinal vessel caliber and to examine early changes in macular thickness using optical coherence tomography (OCT). We evaluated to what extend vascular caliber and macular thickness differed between patients with type 2 diabetes mellitus without diabetic retinopathy compared with healthy individuals. Methods. 26 diabetic patients without diabetic retinopathy and 26 normal participants without any retinal and optic nerve diseases underwent ophthalmic examination, fundus photography, and OCT imaging. Temporal inferior retinal vessel diameters were measured using OCT. Also, we measured macular thickness in nine ETDRS subfields using Cirrus OCT. Results. The mean age in the diabetic group was 61.5 years and in the control group, 55.5 years. Wider retinal arterioles and venules were found in patients with diabetes compared with healthy subjects (120 µm versus 96 µm, p

The article presents a new method to diagnose the pathology of macular pigment in repeatedly pregnant women with myopia differently dependent on the age as well as on both refraction and peripheral alterations in cases without clear symptoms when traditional ophthalmic examination doesn’t reveal any existing pathology.

Purpose The aim of this study was to determine the normative data of macular thickness in the Egyptian population and to assess the effect of different demographic data and ocular parameters on it using spectral-domain optical coherence tomography (SD-OCT). Patients and methods This cross-sectional study included 105 healthy Egyptian patients who underwent a comprehensive ophthalmic examination, including Spectralis SD-OCT scanning, at Alexandria Main University Hospital. One eye from each patient was chosen randomly to be included in the study. Macular thickness was calculated based on center thickness and nine areas that corresponded to the Early Treatment Diabetes Retinopathy Study map using OCT mapping software. The relationships between macular thickness and sex, age, axial length (AL), spherical equivalent, keratometry readings, intraocular pressure, BMI, parity, and use of oral contraceptive pills were analyzed. Results The study included 49 male and 56 female patients. The mean age of the patients was 40.41±14.17 years. The mean central subfield thickness was 262.70±19.64 μm. The mean macular thickness values in all areas of the Early Treatment Diabetes Retinopathy Study map were significantly greater in men than in women. As age increased, outer macular thickness decreased significantly in the overall group and in female but not in male patients (partial correlation). The AL correlated negatively with inner and outer macular thickness (partial correlation). However, spherical equivalent had no significant influence on multiple linear regression analysis. Central subfield thickness did not correlate significantly with keratometry readings, intraocular pressure, BMI, parity, or use of oral contraceptive pill. Conclusion The mean macular thickness values in the Egyptian population were found to be less than those seen in the Spectralis SD-OCT studies published previously on Caucasians but more than those seen in Blacks. Sex had the most significant effect on macular thickness in all regions. Age and AL showed a significant negative correlation with outer macular thickness.

Ocular manifestations among HIV infected children are diverse and global incidence varies from 7% to 75%. At this age, eye lesions are often unnoticed because of the incapacity to express eye discomfort. The purpose of this study is to describe ocular manifestations among HIV-infected children and hence associated factors in the Department of Paediatrics at the Yalgado Ouedraogo Teaching Hospital. This was a cross-sectional descriptive and analytical study conducted between July 2014 and December 2014. A complete ophthalmic examination was systematically done to all HIV-positive children attending the clinic, as part of their routine medical visit. The most recent socio-demographic, clinical, biological and treatment data were registered. Seventy-nine children had an ocular examination and among them 92.4% were on ARV treatment. The incidence of ocular manifestations was 46.7%. Median age was 8 years old (interquartile 6 - 12 years old). Sex ratio was 1.3. The risk of ocular manifestations involvement among boys was twice than that of girls. More than half (59.5%) of children who had ocular problems had not expressed ocular discomfort. Ocular adnexal lesions were more common (35.4%) compared to eye segments (8.9%) lesions. Anterior segment and posterior segment lesions were statistically associated with immune system depression (p = 0.003 and 0.001). However, this relationship was not statistically significant (p = 0.15). Five out of seven children who had eye fundus lesions had CD4 count

Purpose. To evaluate the diagnostic performance of the McMonnies questionnaire as a screening survey for dry eye in Chinese outpatients.Methods. The questionnaire was self-administered by 27,999 patients with dry eye symptoms. A thorough ophthalmic examination including tear break-up time (TBUT), fluorescein staining, and Schirmer I test was completed to make a clinical diagnosis of dry eye. Reliability, validity, and accuracy of the McMonnies questionnaire were assessed.Results. The McMonnies questionnaire showed poor internal consistency (Cronbachα=0.37), but excellent validity as the scores correlated with TBUT (Spearman test,r=-0.322,P<0.001) and Schirmer I test (Spearman’s test,r=-0.370,P<0.001), and significantly differed between the dry eye and control groups (2-samplet-test,t=69.51,P<0.001). The area under the receiver-operating characteristics (ROC) curve (AUC) was 0.729, suggesting moderate accuracy in identifying dry eye and non-dry eye patients. However, the AUCs varied significantly in different gender and age subgroups (ztest,P<0.001), as the discriminating ability declined with age. Analysis of the ROC curves also revealed that different cut-off points should be employed for each subgroup to achieve the same level of accuracy.Conclusions. The McMonnies questionnaire demonstrates moderate diagnostic value, and different cut-off points should be selected for various study populations.

Proposed is a novel eye vision testing system based on micromachines that uses micro-optic, micromechanic, and microelectronic technologies. The micromachines include a programmable micro-optic lens and aperture control devices, pico-projectors, Radio Frequency (RF), optical wireless communication and control links, and energy harvesting and storage devices with remote wireless energy transfer capabilities. The portable lightweight system can measure eye refractive powers, optimize light conditions for the eye under testing, conduct color-blindness tests, and implement eye strain relief and eye muscle exercises via time sequenced imaging. A basic eye vision test system is built in the laboratory for near-sighted (myopic) vision spherical lens refractive error correction. Refractive error corrections from zero up to −5.0 Diopters and −2.0 Diopters are experimentally demonstrated using the Electronic-Lens (E-Lens) and aperture control methods, respectively. The proposed portable eye vision test system is suited for children’s eye tests and developing world eye centers where technical expertise may be limited. Design of a novel low-cost human vision corrective eyewear is also presented based on the proposed aperture control concept. Given its simplistic and economical design, significant impact can be created for humans with vision problems in the under-developed world.

Case report A 41-year-old woman with a bilateral loss of visual acuity and a history of IgA nephropathy. The ophthalmic examination revealed bilateral neurosensory detachments that resolved completely after 4 months of peritoneal dialysis. Discussion Bilateral serous retinal detachments are a rare manifestation of IgA nephropathy, in which the etiology is probably multifactorial and their resolution depends on the underlying disease.

Autism spectrum disorders (ASD) manifest as abnormal social and language development along with repetitive behaviors. Reported prevalence is 1 in 68 children. Ophthalmic disorders have been reported in as many as 50 % of children with ASD, making a comprehensive ophthalmic examination necessary for all such children upon diagnosis. Photoscreeners are a useful tool to initially assess children with ASD. Eye examination techniques include observation, social story, visual schedule, and behavioral strategies to maximize chances of identifying ocular problems. Examination under anesthesia should be reserved for cases where ocular pathology is suspected and attempts to examine the child in the office have been unsuccessful.

This article reviews the more common congenital ocular conditions affecting the globe and adnexa. The aetiology and clinical appearance of the diseases are described, and treatment options are briefly discussed where they exist. The article discusses the importance of both a thorough ophthalmic examination and familiarity with the mechanisms of ocular development, to enhance our understanding of the ocular pathology of these conditions and to achieve accurate diagnoses.

To describe the clinical and molecular characteristics of a Chinese Leber hereditary optic neuropathy (LHON) pedigree with compound mitochondrial DNA (mtDNA) mutations of m.3635G A and m.14502T C.A total of 22 individuals (2 affected, 20 unaffected) from a five-generation Chinese family with LHON underwent comprehensive ophthalmic examination, including visual acuity, slit lamp examination, fundoscopy, visual field examination and visual evoked potentials (VEP). The complete mtDNA genome of the two patients were amplified by polymerase chain reaction, sequenced using a Bigdye terminator v3.1 cycle sequencing kit and analyzed on an ABI 3700XL Genetic Analyzer.Two LHON patients in the family presented typical features of LHON: painless and progressive deterioration of bilateral vision, bilateral optic atrophy, centrocecal scotomata in both eyes and significant prolonged P100 latency and low amplitude potential in VEP. Compound primary mtDNA mutations of m.3635G A and m.14502T C were identified in these two patients and another 12 living matrilineal members of the pedigree. Haplogroup analysis showed the patients in this LHON family belonged to the N9b1 haplogroup. Modeled mutant structure showed the mutations altered the molecular local space conformation on the surface of ND1 and ND6.Compound mtDNA mutations of m.3635G A and m.14502T C presented with low penetration, and the patients with these compound mutations exhibited mild visual impairment. The biological information analysis suggested that m.14502T C might play a protective role in LHON associated with m.3635G A. The haplogroup analysis indicated that the mtDNA haplogroup might be an important factor affecting the expression of LHON associated with m.3635G A and/or m.14502T C.

To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema.Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40 mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically.Forty-one eyes of 41 patients with a mean age of 63.49 ± 10.99 (55-86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p 0.001, p 0.001 and p = 0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p 0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case.PSTA application is an effective and safe option in BRVO-related macular edema.

To evaluate the short-term and long-term effects of fesoterodine fumarate treatment which is used for overactive bladder (OAB) on pupil diameter (PD), intraocular pressure (IOP) and accommodation amplitude (AA).Ophthalmic examination was performed before and after receiving medication (on the 30th and 90th day) on 120 eyes of 120 women whom were planned to begin anticholinergic treatment (fesoterodine fumarate, 4 mg/day, peroral) for OAB, prospectively. The changes in PD, IOP and AA were analyzed statistically.The mean age of 120 women was 52.06 ± 9.39 years (30-70 years). The mean PD, IOP and AA values were 4.12 ± 0.61 mm (3.00-5.70 mm), 15.58 ± 1.74 mmHg (11-20 mmHg) 2.28 ± 1.26 Diopter (D) (0.50-5.50 D) at baseline; 4.68 ± 0.65 mm (3.20-5.80 mm), 16.11 ± 1.72 mmHg (11-20 mmHg), 1.68 ± 1.04 D (0.25-4.50 D) at 30th day; and 4.28 ± 0.58 mm (3.10-5.70 mm), 16.09 ± 1.96 mmHg (11-19 mmHg), 2.18 ± 1.19 D (0.50-5.00 D) at 90th day, respectively. Although increases in PD values and decreases in AA values were statistically significant (p 0.001 for each), the changes in IOP values were not as such (p = 0.642). Visual complaint was not observed in any patient.The newest anticholinergic medication in women with OAB increased the PD and decreased the AA statistically significantly. Clinically, it seems to be well-tolerated by the patient.

Aims: The present study was planned to evaluate the prevalence of anisometropia in patients with refractive error, to compare the prevalence of different types of anisometropia and to study the prevalence of amblyopia in anisometropic patients. Material and Method: It was a cross sectional study in which 400 randomly selected patients were evaluated for anisometropia and also for anisometropic amblyopia. All patients underwent thorough ophthalmic examination including visual acuity testing, slit lamp examination and fundus examination. Later on the data was analysed statistically with different formulas like Chi square test, Fisher exact test etc. Results: The prevalence of anisometropia was found to be 16.5% in total 400 patients with refractive errors, out of which 57.5% were females and 42.5% were male patients. Prevalence was found maximum in 20-30 years age group (36.4%). Highest prevalence among various types of anisometropia was found of compound myopic anisometropia (37.9%). Conclusion: No gender difference was seen in prevalence of anisometropia. Prevalence of anisometropia significantly varied with different age groups. The prevalence of amblyopia in patients of anisometropia was found to be statistically significant (p value=.0001).