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Alexandros Rouvas,1 Ioannis Datseris,2 Sofia Androudi,3 Miltiadis Tsilimbaris,4 Stamatina A Kabanarou,5 Nikolaos Pharmakakis,6 Chryssanthi Koutsandrea,7 Alexander Charonis,8 Olga Kousidou,9 Georgia Pantelopoulou9 1 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece; 2OMMA Ophthalmological Institute of Athens, Athens, Greece; 3Ophthalmology Clinic, University of Thessaly, Larissa, Greece; 4Ophthalmological Clinic, University of Crete Medical School, Heraklion, Greece; 5Department of Ophthalmology, General Hospital of Athens ‘korgialenio-Benakio’, Athens, Greece; 6Department of Ophthalmology, University of Patras, Patras, Greece; 7Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece; 8Retina Service, Athens Vision Eye Institute, Athens, Greece; 9Medical Department, Novartis (Hellas), Athens, GreeceCorrespondence: Olga Kousidou, Medical Department, Novartis (Hellas), National Road No. 1 12th Km, Metamorphosis, Athens, GR-144 51, Greece, Tel +30 210 289 7189, Fax +302102835053, Email olga.kousidou@novartis.comPurpose: Real-world evidence on short-term outcomes of ranibizumab in wet age-related macular degeneration (wAMD) following inadequate response to aflibercept is scarce. This study aimed to evaluate the functional and anatomic effects of switching to ranibizumab in cases of wAMD previously treated with aflibercept with inadequate response.Patients and Methods: Prospective, observational study performed in eight ophthalmology hospital/private clinics in Greece, enrolling consented patients with active wAMD, ≥ 50 years-old, who had initiated ranibizumab ≥ 28 days and < 2 months after their last aflibercept injection. Data were collected at enrollment, and at 1, 3 and 6 months post-treatment onset (post-baseline).Results: Between September-2015 and November-2017, 103 eligible patients (56.3% females; mean age: 74.8± 8.6 years) were consecutively enrolled. The age at AMD diagnosis in the study eye was 71.3± 8.8 years. Aflibercept (median of 5 injections received over 11.3 months) had been discontinued for anatomical (in 69.9%) and/or functional (38.8%) reasons. At baseline (median: 24.3 months after wAMD diagnosis), choroidal neovascularization was occult in 69.1% of evaluable study eyes; 60.2% of the study eyes had pigment epithelial detachment (PED); 42.7% cysts; 21.4% fibrosis; 66.0% subretinal, and 59.2% intraretinal fluid. At 6 months post-baseline: a median of 3 ranibizumab injections (range: 1– 6) had been received; the best-corrected visual acuity (BCVA)≥ 0 letter gain rate was 81.8%; the BCVA ≥ 15 letter gain rate was 17.0%; BCVA gain was 3.2 letters [mean increase: 3.2± 10.0 letters; median: 0.0; p = 0.002]; PED greatest basal diameter (GBD; median: 1470.5 μm) also decreased (median decrease: 114.0 μm; p = 0.019). Baseline central retinal thickness (CRT; median: 312.0 μm) remained unchanged. One patient permanently discontinued ranibizumab due to adverse event occurrence, assessed as not causally related to ranibizumab. There were no ranibizumab-related adverse reactions.Conclusion: Six-month treatment with ranibizumab in aflibercept inadequate responders led to visual acuity and PED GBD improvements, with no statistically significant CRT change.Keywords: best corrected visual acuity, central retinal thickness, pigment epithelial detachment

The purpose of this study was to compare the anatomical and functional outcomes of ranibizumab versus aflibercept for the treatment of diabetic macular edema (DME) in a long-term follow-up.Participants in this prospective study were 112 treatment naïve patients with DME, who received treatment with either intravitreal ranibizumab (n = 54) or aflibercept (n = 58). The demographic data, the best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) characteristics were evaluated at baseline and at month 1, 2, 3, 6, 12, and 18 post treatment, while factors affecting visual outcome were determined using multivariate analysis.At month 18, the mean BCVA of ranibizumab-treated eyes increased 7.9 letters compared to 6.9 letters for eyes receiving aflibercept, with greater number of injections in ranibizumab group (9.2 ± 2.3 vs. 7.6 ± 2.1 injections in the ranibizumab and aflibercept group respectively,Ranibizumab and aflibercept presented similar anatomical and functional outcomes in 18-month follow-up in patients with DME. It is important to determine factors, affecting VA, so as to provide individualized treatment.

To evaluate the efficacy and outcomes of tectonic epikeratoplasty with use of ethanol-preserved corneal grafts for the management of perforated corneal melts. The present retrospective case series includes 10 eyes which underwent tectonic epikeratoplasty for perforated corneal melts. The stromal remainders of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation were stored in 95% ethanol and used as emergency tectonic grafts for restoring globe integrity after sterile and infectious perforated corneal melts. In 6 cases with subtotal corneal melt, DMEK remainders (endothelium-denuded corneoscleral buttons) were used for 'limbus to limbus' tectonic epikeratoplasty and in 4 cases DSAEK remainders (anterior stroma) were used to seal focal perforated melts. Graft storage time was 5.1 ± 4.9 (ranging from 0.5 to 17) months. The surgeries were successful in all cases with restitution of the globe integrity. During the postoperative course 4 cases developed a graft melt (corneoscleral button for limbus to limbus tectonic epikeratoplasty, n = 3; lamellar patch, n = 1) within 2-6 months after the initial procedure. Three patients underwent successful repeat tectonic epikeratoplasty. In the fourth case of graft melt the globe was enucleated due to underlying expulsive haemorrhage and severe pain. The short-term results of the present case series suggest that the use of ethanol-stored stromal remainder of donor corneas after endothelial keratoplasty is an efficient temporary measure for tectonic restoration of perforated corneas.

To describe the outcomes of endothelial keratoplasty (EK) for bullous keratopathy in eyes with a retained angle-supported anterior chamber intraocular lens (acIOL). Among 263 consecutive EK procedures, 7 DMEK and 11 DSAEK procedures were identified in eyes with an acIOL and included in the present retrospective case series. Pre- and postoperative status including ocular history, anatomical outcome and complications as well as best-corrected visual acuity was evaluated. Ocular history included complicated cataract surgery (n = 11), ocular trauma (n = 4) and primary intracapsular cataract extraction (n = 3). Surgery-related complications included primary graft failure (n = 1), graft detachment (n = 1), endophthalmitis (n = 1) and allograft rejection (n = 1). A clear cornea at the final examination (14 ± 4 months) was observed in 14/18 (78%), while the visual outcome was limited due to significant ocular comorbidity in 9 out of 14 uncomplicated procedures. The presented short-term outcomes suggest that both DMEK and DSAEK are feasible in eyes with an angle-supported acIOL yielding an acceptable graft survival rate in the first postoperative year.

Purpose: To report a case of foveal neovascularization in a patient with proliferative diabetic retinopathy as seen on optical coherence tomography angiography (OCT-A). Methods: Multimodal imaging was used for diagnostic investigation. Patient: A 61-year-old male with a 16-year history of insulin-dependent diabetes mellitus was referred to our medical retina department for examination and management. Meticulous fundus examination and multimodal imaging revealed proliferative diabetic retinopathy lesions, including neovascularization located in the foveal area. Results: OCT-A allowed us to detect the neovascular lesion, confirm that it originated from perifoveal capillaries, estimate its retinal depth, and evaluate the vessel blood flow in multiple layers. Conclusion: To the best of our knowledge this is the first report of OCT-A imaging of foveal neovascularization in diabetic retinopathy. OCT-A is a very useful examination for the diagnostic investigation of patients with diabetic retinopathy.

BACKGROUND Age-related macular degeneration (AMD) is a multifactorial degenerative ocular disease that leads to loss of central vision. Functional gene polymorphisms have already been associated with the disease (for example, ARMS2 A69S, rs10490924). AIM The goal of our study was to verify the correlation of the aforementioned ARMS2 variation with the disease, to examine, for the first time, the role of the CD14 C260T variation (rs2569190), and to investigate the association of two TLR4 polymorphisms (Asp299Gly or rs4986790 and Thr399Ile or rs4986791) in a Greek population with the wet form of AMD. PATIENTS AND METHODS Genomic DNAs were isolated from blood samples of 103 healthy controls and 120 Greek patients with wet AMD who were age- and sex-matched, and all of whom were clinically evaluated. For the genotyping of all selected polymorphisms, polymerase chain reaction-restriction fragment length polymorphism analysis was performed. RESULTS AND CONCLUSIONS This study confirmed the association between the ARMS2 variation and AMD, detecting the T risk allele in a significantly higher frequency in the patient group, compared with the control subjects (45% vs 29.13%, P

Purpose To outline the short- and long-term motor outcomes of unilateral medial rectus muscle recession and lateral rectus muscle resection for the correction of moderate angle infantile esotropia. Methods A retrospective study of 109 consecutive patients with moderate angle infantile esotropia treated with graded unilateral recession-resection surgery. Criteria for successful motor outcome included alignment ±10Δ from orthophoria. Outcome evaluation was a comparison of successful alignment versus an overcorrection or undercorrection at eight weeks postoperatively as well as on the final follow-up examination. Results The mean preoperative deviation was 35.5 prism diopters (Δ) and mean follow-up time was 4.9 years. At the eight-week postoperative examination, 99 patients (89.9%) were successfully aligned, as opposed to 75 of 95 patients (78.9%) at the final postoperative visit (P=0.041). There was no statistically significant difference between the rate of early versus late undercorrections (7.3% versus 12.5%, P=0.267) or overcorrections (2.7% versus 8.3%, P=0.125). Ten patients had an esotropic drift over time and 10 patients had an exotropic drift. Recurrent esotropia was associated with high hyperopia and presumed infantile esotropia diagnostic entity. The Kaplan-Meier estimate of survivorship of a successful motor outcome was 75.5% at five years and 71% at 15 years postoperatively. The mean response to surgery was 2.9Δ per mm of muscle recessed and resected and was positively related to the preoperative angle of deviation (R=0.615). Conclusions The unilateral recession-resection procedure for the correction of infantile esotropia is shown to be associated with a favorable survival of motor outcomes and a relatively balanced rate of undercorrections versus overcorrections tending to be maintained through the follow-up period.

Konstantinos Andreanos, Chryssanthi Koutsandrea, Dimitris Papaconstantinou, Andreas Diagourtas, Andreas Kotoulas, Panagiotis Dimitrakas, Marilita M Moschos First Department of Ophthalmology, University of Athens, “G. Gennimatas” General Hospital of Athens, Athens, Greece Purpose: The aim of the study was to assess the influence of central corneal thickness (CCT) and corneal curvature in tonometry measurements taken by Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT).Methods: This was a prospective study of 185 eyes from 97 subjects, attending outpatient ophthalmology appointments, who underwent intraocular pressure measurements by GAT and Pascal DCT. CCT and corneal curvature were obtained using ultrasound pachymetry and Orbscan topography, respectively. All measurements were carried out among males and females during the period 2009–2012. Apart from the usual descriptive and exploratory data analysis, one-way analysis of variance and agreement analysis were performed, linear as well as intraclass correlation coefficients were estimated, and multiple scatter and Bland–Altman plots were produced.Results: Mean IOP measurements obtained were 17.21±4.10 mmHg by DCT and 13.23±4.07mmHg by GAT. Mean difference between the GAT and DCT measurements was 3.88±2.8 mmHg. MeanCCT and corneal curvature were 522.78±52 µm and 43.83±2.9823 D, respectively.Conclusion: Intraocular pressure measured by GAT was consistently lower when compared with DCT, and this difference was greatest with thinner CCT. Flat corneas seem to influence GAT measurements compared to DCT. Keywords: glaucoma, Goldmann, Pascal, tonometry

To evaluate the efficacy of the treatment with intravitreal triamcinolone acetonide or dexamethasone intravitreal implant in patients with postoperative cystoid macular edema (PCME).Thirty eyes of 29 patients with PCME were randomized into two groups: one group initially received an injection of 4 mg triamcinolone; retreatment after 3 months was dependent on functional and anatomic outcome in a PRN regimen. The second group received a single injection of the dexamethasone intravitreal implant (Ozurdex). Patients were followed for 6 months. The main outcomes were best-corrected visual acuity (BCVA) and central millimeter retinal thickness (CMMT).Mean BCVA improved significantly in both groups at 3 months (p ≤ 0.05) and 6 months (p ≤ 0.05) after treatment. There was no statistically significant difference between the two groups in visual acuity improvement at 3 months (p0.05) or 6 months (p0.05). Mean CMMT of both groups also decreased significantly after treatment at 3 and 6 months (both p ≤ 0.05) and the reduction was significantly superior in the triamcinolone group compared to ozurdex group at 1 week and 6 months (p ≤ 0.05). All cases with intraocular hypertension were managed with IOP-lowering medication and no surgery was required during the study. One patient was excluded because of endophthalmitis in the triamcinolone group.Intravitreal triamcinolone and dexamethasone implant are both equally effective in increasing visual acuity in patients with PCME at a 6-month follow-up. However, macular edema seems to respond more rapidly with intravitreal triamcinolone, and 3-monthly repetitive injections maintain the reduction in retinal thickness better than a single dexamethasone implant at the first 6 months of follow-up period.

Introduction. During the past decade, novel techniques of corneal transplantation allowing faster and better restoration of vision have emerged. The present cohort study describes a shift of indications and techniques that has occurred in the field of corneal transplantation over a 17-year period in Greece.Methods. All patients undergoing keratoplasty between January 1999 and December 2015 at an academic tertiary referral center in Athens, Greece, were retrospectively reviewed. The annual incidence of keratoplasty indications and techniques was recorded and analyzed.Results. A total of 1382 keratoplasty procedures were included. Leading indications were bullous keratopathy (BK) (37.5%), followed by allograft rejection (17.7%), corneal scar (12%), keratoconus (KC) (10.3%), and Fuchs endothelial dystrophy (FED) (8.8%). A decreasing trend was observed for KC (P=0.009) and an increasing trend for BK (P=0.003) and FED (P=0.001). In 2015, the incidence of penetrating keratoplasty (PK) had decreased from 100% (1999 to 2009) to 21.4%; for cases with isolated pathology of the corneal endothelium, DSAEK was the preferred technique (59.8%), while the respective rate of DMEK was 18.8%.Conclusion. Herein, we observed an increasing trend of endothelial pathology among keratoplasty indications as well as a major shift in preferred techniques due to a wide adoption of the new EK procedures.

Background.To evaluate the correlation of fundus autofluorescence (FAF) with indocyanine green angiography (ICGA) in patients with various posterior uveitis disorders.Methods. Interventional case series including 23 eyes of 15 patients with diagnosis of a specific type of retinochoroiditis, such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous-like choroiditis, multifocal choroiditis (MFC), Harada disease, and syphilitic retinochoroiditis. Also, some cases with undefined retinochoroiditis were included. FAF and ICGA were performed and correlated at baseline and during follow-up after treatment.Results. In ICGA, early hypofluorescence was found to be the hallmark of acute choroidal inflammation, resolving in later stages and remaining in the late phase in areas with retinal pigment epithelium (RPE) damage. Poorly defined hyperautofluorescent areas correlated with acute choroidal lesions. Hypoautofluorescent delineation suggested the initiation of RPE healing processes, correlating well with the late phase of ICGA and delineating the RPE damage. Early hyperautofluorescence with late hypofluorescence in ICGA indicated the presence of primary RPE involvement.Conclusion. FAF contributes to the interpretation of RPE disease and may be a useful tool for the follow-up of progressive inflammatory disorders. Comparative evaluation of FAF and ICGA allows a characterization of the sequence of inflammatory events and the level of tissue affected.

Purpose: To evaluate the quality of life related to vision (QoL) in patients with ocular hypertension under treatment. Methods: The study included two groups. The first one consisted of 60 ocular hypertension patients under topical hypotensive medications and the second one of 60 healthy persons. The Greek language version of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was completed by all patients. Results: The median scores of the total score and also for almost all the NEI VFQ-25 subscales were significantly decreased for the first group of ocular hypertension patients (OHT) under topical therapy. Females presented higher QoL than that of males. The patients who used one medication presented higher QoL than that of the patients who used more than one. The best corrected visual acuity (BCVA) and the intraocular pressure (IOP) were significantly correlated with QoL. The index of the visual fields, pattern standard deviation (PSD), was significantly related to the quality of life of OHT. The age, the cup to disk ratio and the central corneal thickness had also significant correlations with subscales of the QoL. Conclusions: The quality of life OHT patients under topical treatment is significantly decreased than healthy persons. Male sex and the number of medications affect QoL more. BCVA and IOP represent the clinical findings that best correlate with several subscales of QoL. PSD is a significant index that correlates well with the quality of life of OHT patients.

To compare endothelial cell loss and complications following Descemet membrane endothelial keratoplasty (DMEK) with use of three commercially available injectors. From 179 consecutive DMEK procedures, 66 cases with uncomplicated graft preparation and completed 12-month follow-up were included in this retrospective study. According to the injector used, 3 groups were formed: group 1 (D.O.R.C. injector, n=16), group 2 (Geuder injector, n=24), and group 3 (Pasteur laboratory pipette, n= 26). Endothelial cell density (ECD) and endothelial cell loss were evaluated preoperatively and at 3, 6 and 12 months postoperatively; surgery-related complications were recorded. Donor ECD was 2416±179 cells/mm2 (group 1), 2417±164 cells/mm2 (group 2), and 2478±234 cells/mm2 (group 3). At 12 months postoperatively ECD was 1473±403 cells/mm2 (group 1), 1379±317 cells/mm2 (group 2), and 1316±456 cells/mm2 (group 3) (P=0.533, ANOVA). Endothelial cell loss 12 months postoperatively was 39±15% (group 1), 43±13% (group 2), and 47±17% (group 3) (P=0.386, ANOVA). A single case of iris bleeding and reflux of the graft out of the anterior chamber (both in group 3) was noted. Partial graft detachment occurred in group 1 (n=1), group 2 (n=5), and group 3 (n=7) and rebubbling was performed in 6% (group 1), 17% (group 2), and 27% (group 3). To our knowledge, this is the first clinical study assessing the safety of three different DMEK injectors. Group 1 (D.O.R.C injector) showed the least and group 3 (Pasteur laboratory pipette) the highest endothelial cell loss without reaching statistical significance at 12 months after surgery. Therefore, the graft injector may be chosen according to surgeon’s preference.

To describe a new technique of Ahmed glaucoma valve implantation in patients with refractory glaucoma and present the long-term results. Twenty-eight eyes of 28 patients with refractory glaucoma participated in the study. “Double scleral tunnel in tandem” technique was used for glaucoma valve implantation in all patients. The technique consists of the formation of two scleral tunnels in tandem so as to completely cover the extraocular part of valve’s tube and facilitate a parallel to the iris placement of the intraocular part of the tube. Postoperative hypotony developed in two (7.1%) cases which resolved within 3 days in all cases. One (3.6%) eye manifested postoperative hyphema that resolved without complications within a week, and two (7.1%) cases presented with exposure of the tube. The average highest postoperative intraocular pressure (IOP) during the follow-up period was 19 mmHg (range 8–38 mmHg) without medications, and the average IOP at the last follow-up visit was 14.5 mmHg (range 8–22 mmHg). Additional treatment for IOP control was necessary in 11 (39.3%) cases. The average follow-up period was 60 months. This novel technique was found to be easy to master, effective and with low cost and rate of complications.

To report midterm outcomes of strabismus strategy for management of diplopia in chronic progressive external ophthalmoplegia and specific surgical planning rationale. Retrospective interventional case series. Two patients, a 26-year-old male and a 36-year-old female, diagnosed with chronic progressive external ophthalmoplegia presented with blepharoptosis and intermittent diplopia. Ocular motility examination was significant for bilateral profound impairment of adduction with relative preservation of abduction, infraduction and elevation. Control of intermittent exotropia gradually worsened over 3 and 1.5 years of follow-up, respectively, in the presence of documented stability of the angle of exodeviation. Strabismus surgery involving modest amounts of bilateral medial rectus resection and lateral rectus recessions was undertaken. Surgical intervention was successful in controlling alignment in primary position and alleviating diplopia and asthenopia after 9 and 8 years of follow-up time, respectively, despite slow progression of ophthalmoplegia. Bilateral selective impairment of adduction and intermittent exotropia may be the presenting ocular motility disturbance in chronic progressive external ophthalmoplegia. Properly designed strabismus surgery may provide sustainable, in the midterm, control of alignment and symptomatic relief in selected patients with CPEO.

Purpose To describe a simple ex vivo porcine model for teaching Descemet Membrane Endothelial Keratoplasty (DMEK). Methods Twenty freshly enucleated porcine eyes were used to create a pseudo-graft from the porcine lens capsule and implant it into an intact porcine globe using the standardized ‘no-touch’ technique of the Netherlands Institute for Innovative Ocular Surgery (NIIOS). Results The DMEK pseudo-graft could be inserted, centred, unfolded and appositioned in all cases. Conclusions Practicing DMEK surgery under wetlab conditions was feasible by the described simple and low-cost model. This new tool may facilitate the adaptation of DMEK by cornea surgeons.

Purpose: The purpose of our study was to assess the macular thickness and the electrophysiological changes in keratoconic patients without any systemic or ocular disorders. Methods: 64 eyes of 32 keratoconus patients as well as 60 eyes of 30 controls participated in the study. All participants underwent a complete ophthalmological examination, including best-corrected visual acuity (BCVA) assessment, color vision testing, fundus examination, intraocular pressure measurement, central foveal thickness (CFT) measurement by optical coherence tomography (OCT) scan, and multifocal-electroretinogram (mf-ERG) recording. CFT, retinal response density (RRD) and P1 latency were measured. Results: There was no statistically significant difference between the two groups concerning CFT and P1 latency in mf-ERG. The RRD in mf-ERG differed significantly between keratoconus patients and controls. Of note, BCVA was positively associated with RRD in keratoconus patients. Conclusion: In some cases of keratoconus, a macular dysfunction not visible ophthalmoscopically may coexist and the low visual acuity could be due not only to the corneal abnormality, but also to the photoreceptor dysfunction. As a result, the preoperative electrophysiological study of patients with keratoconus is crucial to avoid a needless corneal transplantation.

The purpose of this study was to assess the role of various diagnostic tests in early detection of retinal changes in β-thalassemia major patients. Thirty-eight visually asymptomatic β-thalassemia major patients receiving regular blood transfusions and iron-chelation therapy with deferoxamine (group A, n = 13), deferasirox (group B, n = 11) or deferoxamine with deferiprone (group C, n = 14) and fourteen age- and sex- matched healthy individuals were included in the study. All participants underwent ophthalmoscopy, full-field electroretinography (ERG), visual evoked potentials (VEP), multifocal electroretinography (mfERG), fundus autofluorescence (FAF) imaging and optical coherence tomography (OCT) scans. Retinal pigment epithelium changes were present in two cases. Scotopic ERG demonstrated decreased a-wave amplitude in groups A, B and C (p = 0.03, p = 0.002 and p = 0.002, respectively) and decreased b-wave amplitude in groups B and C (p = 0.002 and p = 0.01, respectively) compared to controls. Photopic ERG showed delayed b-wave latency in groups A and C (p = 0.03 and p = 0.03, respectively) ERG maximal combined response and VEP response did not differ between groups. MfERG showed reduced retinal response density in ring 1 in groups A, B, C (p

Objective To determine subtle changes of Heidelberg retina tomography (HRT) stereometric parameters and blue-on-yellow (B/Y) perimetry global indices for the early diagnosis of glaucoma in suspected subjects. Patients and methods Cross-sectional data on 174 eyes of 87 subjects from a larger cohort, attending the Glaucoma Department of the "G. Gennimatas" General Hospital of Athens from January 2004 to February 2014, were used in the study. Subjects were assigned to 3 groups: (a) "normals" not requiring treatment throughout the study (group 1), (b) suspects who developed glaucoma and required treatment during the study (group 2), and (c) patients with incipient glaucoma (group 3). Specific HRT and B/Y perimetry variables were compared among the 3 groups. Results Significant differences were established for the following HRT parameters: "reference height" differed significantly between groups 1 and 2 and groups 1 and 3; "cup shape measure" differed significantly between groups 1 and 2 and groups 2 and 3. B/Y perimetry global index "mean deviation" significantly distinguished group 2 from groups 1 and 3. Conclusions The results of the present study suggest the predictive value of the HRT stereometric parameters "reference height" and "cup shape measure" and of the B/Y perimetry global index "mean deviation" in glaucoma-suspected subjects; further corroboration through longitudinal studies is warranted.

Since their introduction by Chang et al. in 1987, perfluorocarbon liquids (PFCLs) have become a useful tool in vitreoretinal surgery. They are synthetic compounds with carbon-fluorine chemical chains that have specific physico-chemical properties, which make them valuable for the intraoperative management of the retina by simplifying vitreoretinal surgical maneuvers in a variety of settings. These maneuvers include retinal detachments associated with proliferative vitreous retinopathy, following penetrating trauma, giant retinal tears, dislocated lenses or lens implants and complications from proliferative diabetic vitreoretinopathy. Purified PFCLs are generally considered to be biologically inert. Despite the stability of PFCLs during vitreoretinal surgery, several studies have indicated that these compounds may be associated with toxicity in ocular tissues. The purpose of this review is to report the use and toxicity of PFCLs in vitreoretinal surgery and to present the latest perspectives on modified PFCLs (hydrofluorocarbon liquids (HFCLs) and HFCL-oligomers).

Pseudoxanthoma elasticum (PXE), also known as Groenblad syndrome, is an inherited disorder characterised by mineralisation and fragmentation of elastic fibres in a number of organs including the skin, eyes and arterial blood vessels. The clinical manifestations of PXE centre on three major organ systems: skin, cardiovascular system and the eyes. This review focuses on the ocular manifestations of pseudoxanthoma elasticum, namely, peau d'orange, angioid streaks and choroidal neovascularisation, the clinical course of patients, the diagnostic approaches and current therapeutic strategies, such as laser photocoagulation whether transpupillary thermotherapy or photodynamic therapy, macular translocation surgery and anti-vascular endothelial growth factor treatment.

Introduction: We present an unusual case of anterior migration of a solid silicone encircling band 9 years after scleral buckling surgery.Materials and Methods: An 83-year old woman presented with acute onset of pain and discharge in her left eye. She had undergone cataract surgery complicated by endophthalmitis and managed with pars plana vitrectomy nine years earlier.Results: The patient was treated with transection and removal of the extruding encircling band. Pain ceased within two days. Two weeks postoperatively, the conjunctiva was well adapted without any discharge, ocular motility was as preoperatively.Discussion: Anterior migration of an encircling band through all four rectus muscle insertions is a very uncommon late complication following scleral buckling surgery. The remarkably good preservation of ocular motility in our case can be attributed to the slow advancement of the encircling band over nine years, which allowed a gradual reattachment of the rectus muscle insertions to the sclera.

The purpose of this study was to objectively evaluate the anterior chamber depth (ACD) after trabeculectomy and to correlate its variations with the intraocular pressure (IOP) and bleb functionality. Fifty eyes (46 patients) were included in this prospective study. ACD was documented with the use of a non-contact optical device (IOL Master-Carl Zeiss Meditec) and IOP was measured with the Goldmann applanation tonometer. Ophthalmological examination, IOP, and ACD measurements were performed before surgery, the day after and weekly thereafter. Linear regression Analysis between the 2 variables was performed and correlation coefficients were estimated. A 2-tailed t test was used and a P value

Marilita M Moschos,1 Eirini Nitoda,1 Irini P Chatziralli,1 Zisis Gatzioufas,2 Chryssanthi Koutsandrea,1 George Kitsos3 1First Department of Ophthalmology, Medical School, National and Kapodistrian University of Athens, Athens, Greece; 2Swiss Eye Research Foundation, Orasis Eye Clinic, Reinach, Switzerland; 3Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece Objective: This study was conducted to evaluate the macular status of patients treated with hydroxychloroquine before and after cessation of treatment.Methods: Forty-two patients with systemic lupus erythematosus underwent ocular examination based on visual acuity evaluation, optical coherence tomography retinal thickness measurements, and multifocal electroretinography (mfERG) records at first visit. The tests were repeated 6 months after treatment withdrawal and compared to the findings at their first visit.Results: Mean visual acuity (measured in log minimum angle of resolution) of both eyes was statistically increased after hydroxychloroquine discontinuation (difference in means: 0.06 [P

Purpose: To compare visual field loss and retinal nerve fiber layer (RNFL) defects in cases of rhegmatogenous retinal detachment (RRD) treated with scleral buckle (SB) versus pars plana vitrectomy (PPV) and C3F8 injection. Methods: This was a prospective, comparative interventional study of 50 eyes with primary RRD, treated with PPV (25 eyes) or SB (25 eyes). All measurements took place at least 9 months following successful and uncomplicated surgical treatment. The visual field total deviation (TD) values for preoperative attached and detached areas were calculated and compared separately. The optic nerve head morphology was studied with Heidelberg retinal tomography (HRT), and the RNFL using spectral-domain optical coherence tomography. Results: The preoperative detached areas demonstrated more affected TD values (in dB) compared to the preoperative attached areas (-6.9 ± 5.2 vs. -4.3 ± 3.3 for the SB group and -9.6 ± 5.2 vs. -7.8 ± 5.1 for the PPV group; p = 0.001) in both groups. The preoperative attached areas of the SB group showed better TD values (calculated mean values) compared to the preoperative attached areas of the PPV group (-4.3 ± 3.3 vs. -7.8 ± 5.1, p = 0.007). The RNFL and HRT values showed no statistically significant difference between the two groups. Conclusions: It seems that the preoperative detached retina, despite successful reattachment, suffers permanent damage as a result of the detachment, irrespective of the method of treatment. In the PPV group, the postoperative functionality of the preoperative attached areas was detected to be worse compared to the postoperative functionality of the preoperative attached areas of the SB group. We postulate that this fact could be attributed to an additional traumatizing factor (possibly fluid-air exchange or gas injection) in patients with RRD treated with PPV.

Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease.

A 53-year-old woman presented with a right eye injury due to domestic violence. The crystalline lens in that eye was completely dislocated into the anterior chamber, fixated by the cornea and the iris. Fundoscopy showed a mild vitreous haemorrhage and a giant retinal tear. A modified lensectomy with a fragmatome was performed. During this procedure the capsule was preserved first to minimise the risk of corneal damage and second to reduce vitreous traction, which would repair the giant retinal tear.

Background To report the rare occurrence of peripheral retinal sea-fan neovascularization in a patient with chronic rhegmatogenous retinal detachment and describe the surgical management. Case presentation A 29-year-old female patient was referred to our department by her ophthalmologist for investigation and treatment of peripheral retinal neovascularization in her right eye(RE). Visual acuity(VA) at presentation was 20/200 RE and 20/20 LE. Fundoscopy of the RE revealed a chronic inferotemporal retinal detachment and peripheral neovascularization with a sea fan configuration. Fundoscopy of the LE was without any findings. Fluorescein angiography confirmed the sea fan neovascularization in the RE with leakage of the newly formed vessels and peripheral ischemia while the LE did not demonstrate any neovascularization angiographically. Family history was negative for retinitis pigmentosa and haemoglobinopathies. Patient underwent full blood count and haemoglobin electrophoresis to exclude thrombocytosis and sickle cell anaemia, and serum angiotensin-converting enzyme (SACE) measurement to exclude sarcoidosis. Examination with scleral indentation of the RE revealed 2 peripheral small retinal holes close to the ora serrata . The patient underwent a scleral buckling procedure with a small segmental buckle limited to the area of the holes and cryotherapy. Ccryotherapy was not applied to the area with neovascularization and no subretinal fluid drainage was performed. The detached retina was successfully re-attached surgically and the subretinal fluid was gradually absorbed within three months from the time of surgery. Complete regression of neovascularization was evident 2 months postoperatively and VA improved to 20/30. Three years later the clinical and functional findings remain unchanged. Conclusion Our case illustrates the rare but possible association of chronic retinal detachment with peripheral retinal sea-fan neovascularization; although the incidence is rare it may pose diagnostic and treatment dilemmas. In such cases and in the presence of retinal breaks, cryotherapy and a segmental buckle limited to the retinal holes and not on the neovascularization seems to suffice for the regression of the new vessels.

In this study, we conducted the genotyping of D326Y in COL4A3 and M1327V, as well as F1644F in COL4A4 polymorphisms, in a case-control sample panel of Greek origin population.A case-control panel, with 45 keratoconus (KC) patients and 78 healthy controls, were surveyed. DNA from each individual was tested for the D326Y in COL4A3 and M1327V, as well as F1644F in COL4A4 polymorphisms by direct sequencing.When analyzing the Hardy-Weinberg equilibrium, we observed no significant deviation from expected numbers in both KC patients and controls. The genotype frequencies in the polymorphisms tested were not found to be significantly associated with KC development risk. The M1327V AA and F1644F TT genotypes were significantly over-represented in healthy individuals.We could hypothesize that mutations in COL4A3 and COL4A4 genes are not involved in KC risk in Greek population. Nevertheless, the M1327V AA and F1644F TT genotypes were significantly over-represented in healthy individuals, suggesting a protective role of these genotypes in KC development risk in our population.

To examine the efficacy and safety of combined phaco-trabeculectomy in patients with cataract and controlled, open-angle advanced glaucoma and to identify preoperative predictive factors of postoperative glaucoma course.Departments of Ophthalmology, University of Athens, and General Hospital of Lamia, Greece.Prospective, interventional, parallel, cluster (units=examinations), randomized clinical study. 60 patients with visually significant cataract, visual field Mean Deviation (MD) worse than -15.0 dB, and preoperative intraocular pressure (IOP), controlled (consistently below 22 mmHg) on topical medications and with no previous ocular surgery, were randomly allocated (1:1) to phacoemulsification alone or phaco-trabeculectomy group. Intention-to-treat analysis was performed to compare the postoperative outcome and adjusted multivariate longitudinal linear regression analysis was performed to identify predictive factors of the main outcome measures, with postoperative visual field MD change up to two years postoperatively. Participant recruiters and data collectors were masked to group assignment.31 and 29 patients were randomized to phacoemulsification alone and phaco-trabeculectomy groups, respectively. Patients assigned to the phaco-trabeculectomy group experienced a 1.7 mmHg [95% CI:-3.1 to -0.23] reduction in IOP, a 1.4 dB [95% CI: -0.17 to 2.96] improvement in visual fields MD, a 0.6 [95% CI: -1.2 to -0.05] reduction in the number of glaucoma medications needed postoperatively, while the visual acuity improvement was similar between the two groups. Best predictors for visual field MD: degree of nuclear sclerosis, relative afferent pupilary defect (RAPD), preoperative MD deviation from -19.0 dB and preoperative cup-disc ratio deviation from 0.9. The phacoemulsification group experienced more IOP spikes (25 mmHg) with Odds Ratio (OR) of 0.34 [95% CI: 0.11-1.02]. No patient lost light perception.Phaco-trabeculectomy in advanced, controlled, open-angle glaucoma patients with cataract results in better postoperative visual field MD with no major adverse events.

Purpose: To report our results concerning the safety and efficacy of repeated sustainedrelease dexamethasone 0.7 mg implants (Ozurdex, Allergan, Inc., Irvine, CA) in patients with persistent Macular Edema (ME) due to Retinal Vein Occlusion (RVO) previously treated with anti- VEGF injections. Patients and Methods: Ten patients (5 males and 5 females/ 5 with CRVO and 5 with BRVO), all previously treated with at least 3 consecutive anti- VEGF injections and presented lack of anatomic improvement (CRT >250μm in OCT) accompanied by lack of visual improvement (no change or deterioration of VA), received one or more Ozurdex injections (up to five). Ozurdex was administrated on an ‘as needed’ regimen and patients underwent a complete ophthalmological examination, including Best Corrected Visual Acuity (BCVA) measurements, biomicroscopy, tonometry, and Fourier Domain Optical Coherence Tomography (FD-OCT) on a monthly basis. Furthermore, mean time intervals for OZURDEX re-injection were estimated. Results: In 9 out of 10 cases, the patients experienced improvement in BCVA after the Ozurdex implantation with reduction in CRT. The most frequently observed adverse events included IOP elevation (20% of cases), cataract progression (10%) and cataract formation (10%). No serious systemic or topical adverse events were observed in eyes undergoing repeated Ozurdex implantations. In one of the patients, it was observed that the implant was fractured into two pieces without affecting the efficacy of the implant or causing any side effects. Conclusion: Provided the complexity of molecular mechanisms involved in ΜE development and the effect of corticosteroids on many of these mechanisms, in our case series, Ozurdex appeared to be a safe and beneficial treatment option for persistent ME due to RVO, in patients with poor or complete lack of response after at least 3 consecutive monthly intravitreal anti-VEGF injections. The complication rate of cataract reported in our study is relatively high compared to previous reports. This might be attributed to the multiple injections, as the incidence of cataract increases with time. Regarding IOP elevation, there is no consensus among published clinical trials on the percentage of patients requiring IOP-lowering medications. Further studies with a greater patient population as well as a control group are required in order to confirm our findings.

Diplopia is an infrequent but distressing adverse outcome after uncomplicated cataract surgery. Many factors may contribute to the occurrence of this problem, including prolonged sensory deprivation resulting in disruption of sensory fusion, paresis of one or more extraocular muscles, myotoxic effects of local anaesthesia, optical aberrations (for example, aniseikonia) and pre-existing disorders (for example, thyroid orbitopathy). The purpose of this review is to present the aetiology and clinical features of diplopia after cataract surgery and to discuss the possible modalities for the prevention and treatment of this frustrating complication.

The use of intravitreal injections of anti-Vascular Endothelial Growth Factor (anti-VEGF) has been used for a broad spectrum of ocular pathologic entities. Although the dose of anti-VEGF agents used for treating eye disease is minute compared with that used intravenously, intraocular administration can lead to systemic absorption and reduce serum VEGF levels. Several systemic side effects, such as hypertension and cardiovascular complications have been rarely reported in the literature. Renal complications of intravenous administration of anti-VEGF, are well known and include a variety of renal pathological damage which can induce proteinuria and hypertension. We describe herein, 2 cases of diabetic patients with preexisting kidney disease who presented severe reduction of their renal function after intraocular administration of anti-VEGF. Although a cause –effect correlation cannot be established unless further studies are performed, we believe that pretreatment counseling should include a discussion outlining the possible risk of aggravating of the renal function in patients with kidney disease. Close cooperation with the patient’s nephrologist and close monitoring of the patient may be required, in such cases, in order to monitor the renal function before and after the intravitreal administration of anti-VEGF.

Purpose To evaluate the presence and the evolution of cyst formation in optic disc pit maculopathy. Methods In this prospective study, 18 cases with optic disc pit maculopathy were studied. Five of them showed cyst formation in the fovea at the initial examination. The fundus findings were documented with slit-lamp biomicroscopy, indirect ophthalmoscopy, and stereoscopic photography of the posterior pole. All 5 patients were treated with a macular scleral buckle procedure. Results The presence of cysts in the elevated macula depends on the grade of the disease. Cyst formation can develop not only in the later stage of the disease but also quite early. In all 5 patients cyst formation gradually decreased and finally disappeared after the surgical procedure. Conclusions Cyst formation is an entity which accompanies the macular detachment associated with optic disc pit. The development of the cysts has been noticed after the establishment of the schisis-like separation and before or in conjunction with the formation of a lamellar macular hole which usually accompanies the optic disc pit maculopathy.

Spontaneously resolved exudative retinal detachment caused by orbital cellulitis in an immunocompromised adult

Laser peripheral iridotomy is the procedure of choice for the treatment of angle-closure glaucoma caused by relative or absolute pupillary block. Nd: YAG laser iridotomy has been reported to have several complications such as Iris bleeding, hyphema, transient IOP elevation, intraocular inflammation, choroidal, retinal detachment and vitreous hemorrhage. We report a case of a 74 year old lady on anticoagulant treatment who developed pupillary block and angle closure glaucoma after cataract surgery and anterior chamber intraocular lens (ACIOL) insertion complicated with intraoperative bleeding. The patient was treated with Nd: YAG laser iridotomy , however, the ACIOL was inadvertently fractured after a single shot of laser and it had to be replaced. Although the incidence is rare. Ophthalmologists and Opticians should be aware that an ACIOL may be fractured even after a single Nd:YAG laser shot and avoid to perform it close to the ACIOL. Pretreatment counseling should include this rare complication.

Torjesen clearly sums up the results of a recent trial showing that off-label use of bevacizumab (Avastin) is as effective as the more expensive licensed treatment for wet age related macular degeneration—ranibizumab (Lucentis).1 2 This will provide an …

We report a case of a 52-year-old man who developed superficial and intraretinal hemorrhages, retinal edema and extensive cotton-wool patches, 2 weeks after the subconjuctival injection of gentamicin at the end of a 25 gauge sutureless vitrectomy (pars plana vitrectomy) for the repair of a, macula on, retinal detachment in his left eye. Fluorescein angiography revealed sharply defined zones of retinal vascular non-perfusion, mostly confined to the posterior pole and visual acuity deteriorated to 1/20 and remained unchanged during the follow up time. Our case illustrates the possibility of aminoglycoside toxicity after 25-gauge transconjunctaval sutureless PPV when the latter is administered subconjuctivally. It emphasizes that less toxic subconjuctival antibiotics may be considered for sutureless surgery, since if aminoglycoside toxicity occurs, the patient's vision may be permanently affected.