Showing papers in "The Open Ophthalmology Journal in 2019"

The Spectrum of Microbial Keratitis: An Updated Review

Abstract: In microbial keratitis, infection of the cornea can threaten vision through permanent corneal scarring and even perforation resulting in the loss of the eye. A literature review was conducted by Karsten, Watson and Foster (2012) to determine the spectrum of microbial keratitis. Since this publication, there have been over 2600 articles published investigating the causative pathogens of microbial keratitis.

Fast Measure of Visual Acuity and Contrast Sensitivity Defocus Curves with an iPad Application

Abstract: To evaluate the repeatability of the fast measurement of the visual acuity (VADC) and contrast sensitivity (CSDC) defocus curves with a new test as well as the agreement of measurements at far distance obtained with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the ClinicCSF test for measuring Contrast Sensitivity Function (CSF).Records from fifty-nine subjects implanted with Multifocal Intraocular Lenses (MIOLs) were retrieved from our database. VADC and CSDC were measured from +1.00 D to -4.00 D in 0.50 D steps. The agreement with the ETDRS and the CSF at far distance was assessed in comparison to the 0 D location of the VADC and the CSDC, respectively. The repeatability was evaluated in 34 subjects who consecutively repeated two measures.Median Visual Acuity (VA) was -0.1 logMAR with the VADC at 0 D of defocus and 0 logMAR with the ETDRS (p>0.05). A total of 45.8% of eyes showed no differences between both tests and the difference was less than one line of VA in 96.6% of the eyes. The intrasubject repeatability was under one line of VA along all the defocus curve except for positive defocus levels. The CSDC showed the best agreement with the CSF for 18 cycles per degree. The CSDC was less repeatable than VADC. Mean time spent on completing the VADC and CSDC was 7.81 and 7.98 minutes, respectively.The VADC showed good agreement with the ETDRS and good repeatability despite the short testing time. In contrast, poorer repeatability was found for CSDC. Our method would facilitate the inclusion of VADC in clinical practice as it is a fast test, being also the first one including the measure of CSDC.

Age-related Macular Degeneration (AMD): A Review on its Epidemiology and Risk Factors

Abstract: Age-related Macular Degeneration (AMD) is a type of maculopathy that results in irreversible visual impairment among the aged population in developed countries. The early stages of AMD can be diagnosed by the presence of drusen beneath the retinal pigment epithelial (RPE) cells. The advanced stages of AMD are geographical atrophy (dry type) and neovascular AMD (wet type), which lead to progressive and severe vision loss. The advanced stage of dry AMD can be identified by extensive large drusen, detachment of the RPE layer and finally degeneration of photoreceptors leading to central vision loss. The late stage of wet AMD is diagnosed by the presence of Choroidal Neovascularization (CNV) identified by Optical Coherence Tomography (OCT) or retinal angiography. The principal of AMD management is to impede the progression of early AMD to advanced levels. Patients with CNV are treated with anti-VEGF (Vascular Endothelial Growth Factor) compounds to inhibit blood vessel growth and thereby reducing vision loss. Although preventive methods for dry AMD are under investigation, there are no proven effective treatments. A variety of environmental and genetic related risk factors are associated with increased incidence and progression of AMD. The genetic factors are found in the complement, angiogenic and lipid pathways. However, environmental factors, such as smoking and nutrition, are also major risk factors. Smoking is a modifiable environmental risk factor, which greatly increases the incidence and progress of AMD compared to non-smokers. There is growing evidence for the positive influence of a healthy diet containing high levels of anti-oxidant supplements. The reduction of serum lipids is another effective strategy for prevention AMD. Although no single preventive approach has been identified, knowing the high risk factors of AMD, along with modification of lifestyle is important for this multifactorial disease, especially in populations with higher genetic susceptibility. Though recent progress in early diagnosis of the disease has facilitated early and efficient intervention, further studies are required to gain more clarification of specific pathophysiology. In spite of decades of focused research on AMD, the pathogenesis of AMD is still not completely understood. Recently, numerous novel methods, including imaging techniques, new drug delivery routes, and therapeutic strategies, are improving the management of AMD. In this review, we discuss the current knowledge related to epidemiology and classifications of AMD.

Low Efficacy of Hypochlorous Acid Solution Compared to Povidone-iodine in Cataract Surgery Antisepsis

Abstract: Hypochlorous Acid Solution (HAS) is a non-irritating, odorless and transparent, pH-neutral substance having antimicrobial activity. The study aimed to compare the efficacy of HAS with a 10% povidone-iodine (PVI) solution for antisepsis in Phacoemulsification Cataract Surgery (PCS). Consecutive patients undergoing PCS in the Elbląg City Hospital, Poland, were enrolled in this prospective trial. In the morning just before surgery a swab was taken from the inferior conjunctival fornix of the eye that was to be operated. Patients were assigned to receive conjunctival irrigation with PVI or HAS in the operating room. Three minutes after lavage with PVI or HAS, conjunctival swabs were taken. During surgery the cornea and conjunctival sac were irrigated with Ringer’s lactate. The last swab was taken before removing the eye speculum. Overall, 110 patients completed the study; there were 59 patients in the PVI group and 51 patients in the HAS group. Conjunctival lavage with 10% PVI resulted in a decrease in bacterial load, while HAS application did not. In the HAS group a reduction in bacterial load was found after surgery. Patients after HAS irrigation reported significantly less discomfort associated with conjunctival lavage than with PVI. None of the patients developed postoperative endophthalmitis or any type of eye inflammation within the follow-up period. This study confirms the excellent antibacterial activity of a 10% povidone-iodine solution used for three minutes before cataract surgery. Conjunctival irrigation with Ringer lactate during PCS decreased the bacterial load of the conjunctival sac.

Transepithelial versus Epithelium off Crosslinking for Treating Keratoconus among Jordanians

Abstract: The progression of keratoconus is stabilized with the help of corneal collagen cross-linking (CXL) supported through photosynthesized riboflavin. This study aims to compare the effectiveness of the transepithelial procedure and epithelium off procedure of corneal collagen crosslinking among keratoconus patients in Jordan. The study recruited 80 patients suffering from progressive keratoconus, from a tertiary care setting in Jordan. These participants were randomly divided into two groups; group 1 with 40 participants subjected to transepithelial (Corneal collagen cross-linking) CXL; and 40 participants in group 2 received conventional epithelium off CXL. Improvement was observed in the mean contact lens, which corrected distance visual acuity (CDVA) from logMAR 0.332 ± 0.09 (group 1), 0.35 ± 0.09 (group 2) to 0.241 ± 0.07 (group 1), 0.21 ± 0.07 (group 2), respectively at the end of follow-up (12 months). The mean pachymetry improved from 429.81 ± 18.96 μm (group 1), 430.08 ± 17.05 μm (group 2) to 436.5 ± 15.49 μm (group 1), 436.44 ± 12.53 μm (group 2), respectively, after twelve months. Additionally, the mean Sim K astigmatism declined from 7.0 ± 2.0 (group 1), 6.73 ± 1.98 (group 2) to 5.97 ± 1.88 (group 1), 5.53 ± 0.08 (group 2) respectively at twelve months post-treatment. Majority of the patients in group 2 experienced more pain as compared to group 1 participants. The effectiveness of a cross-linking procedure related to keratometry readings and corneal thickness showed that conventional (epithelium off) CXL method is more effective than transepithelial CXL.

The Thiol-Disulfide Homeostasis and Coenzyme Q10 in Conjunction with Vitamin E Effect on Retinopathy Prematurity

Abstract: This study was performed to determine whether one drop of topical administration of Coqun® (Coenzyme Q10 and Vitamin E)-a potent antioxidant-twice a day has any effect on the thiol-disulphide homeostasis-a novel oxidative stress marker in the Retinopathy Of Prematurity (ROP) disease course. This was a prospective observational study comprising 28 infants with ROP at stage 2 and higher who followed up at the paediatric intensive care unit. Ferric reducing power of plasma (FRAP), albumin, ischemia-modified albumin (IMA) and thiol disulphide homeostasis levels were studied in the infants before and two weeks after Coqun® treatment. The mean gestational age was 27 (24–32) weeks, the mean birth weight was 1,012±326 g and the mean duration of care in an incubator was 64±23 days. FRAP levels were 0.91±0.17 μmol/L, IMAs were 0.85±0.29, native thiols were 248±38.9 μmol/L and total thiols were 284±39.2 μmol/L, respectively, at the beginning of therapy. FRAP levels 0.79±0.21(p= 0.006) μmol/L, IMAs 0.73±0.36(p = 0.096), native thiols 262±42.6(p = 0.164) μmol/L and total thiols 291±43.6(p = 0.344) μmol/L showed no difference after two weeks of therapy. Thiol disulphide homeostasis levels do not change with Coqun® therapy during ROP course.

Anterior and Posterior Segment Manifestations of Pathological Myopia: A Clinical Study from Turkish Aegean Region

Abstract: Myopia is one of the most prevalent vision conditions caused by a mismatch between the refractive power and axial length of the eyeball. High myopia may have a degenerative disorder, including cornea, sclera, choroid, optic disc, vitreous, macula, and peripheral retina. Although there are few studies regarding clinical features of pathological myopia, especially in the far-eastern countries where myopia is common, but are no comprehensive data in our region. This study was aimed to demonstrate both anterior and posterior ocular segment manifestations of pathological myopia. One hundred forty eyes of 82 patients who met the pathological myopia criteria were enrolled in this prospective study. Measurements of Central Corneal Thickness (CCT), endothelial cell parameters, Anterior Chamber Depth (ACD), Axial Length (AL) and Subfoveal Choroidal Thickness (SFCT) were performed in all patients. Presence of posterior segment pathologies such as peripapillary atrophy, tilted disc, Lacquer's crack, foveoschisis, myopic maculopathy, Choroidal Neovascularization (CNV), and peripheral retinal degeneration was recorded. The mean age was 54.1 ± 14.2 years. 43 (52.4%) of the patients were female. One hundred patients (71.4%) were phakic and 40 (28.6%) were pseudophakic. The mean CCT, corneal endothelial cell density, ACD, AL, and SFCT were 548.91 ± 43.44 µm, 2335.89 ± 374.38 cells/mm2, 3.93 ± 0.79 mm, 28.75 ± 2.20 mm, and 94.56 ± 73.11 µm, respectively. Tilted disc, peripapillary atrophy and posterior staphyloma were detected in 89 (63.6%), 119 (85%) and 78 (55.7%) eyes, respectively. Normal fundus, tessellated fundus, diffuse chorioretinal atrophy, focal chorioretinal atrophy and macular atrophy were seen in 13 (9.3%), 59 (42%), 26 (18.6%), 14 (10%), and 28 (20%) eyes, respectively. Lacquer crack, CNV, and Fuchs spot were observed in 11 (7.9%), 39 (27.9%), and 47 (33.6%) eyes, respectively. This study reported clinical characteristics of eyes with pathological myopia in a retina specialty clinic at a tertiary referral center from the Turkish Aegean Region. Pathological myopia may affect both anterior and posterior ocular segments. However, posterior segment manifestations may be associated with lesions that threaten vision. Therefore, periodic follow-up in patients with pathological myopia is critical.

Topical Cyclosporine (0.05%) for Management of Dry Eyes in Patients Undergoing Cataract Surgery-A Comparative Study

Abstract: To assess the efficacy of topical cyclosporine 0.05% in the management of cataract surgery induced dry eye. This prospective, comparative, randomized, interventional study included 67 patients undergoing cataract surgery. The patients were randomized into three categories Group A: patients on topical lubricants and cyclosporine 0.05%, Group B: patients on topical lubricants only and Group C: patients not on any dry eye medication. Patients were given the respective treatment 2 weeks prior and 3 months after cataract surgery, along with an identical perioperative regimen of topical steroids, antibiotics and NSAIDs. Dry eye evaluation done 2 weeks pre-op, 1 week post-op and 3 months post-op consisted of a subjective questionnaire, tear osmolarity, Tear Break Up Time (TBUT) and Schirmer’s 1 without and with anaesthesia. Pre-operatively, all the 3 groups were matched in terms of mean age, tear osmolarity, TBUT and Schirmer’s 1 without and with anaesthesia scores. At 3 months, patients treated with both topical lubricants and cyclosporine (0.05%)(Group A) showed improvement subjective questionnaire, tear osmolarity, TBUT and Schirmer’s 1 tests. Patients treated with lubricants only (Group B) showed a significant worsening in TBUT and tear osmolarity at 1 week, however, the values returned to baseline at 3 months.The control group (Group C) had the worst TBUT scores at the end of 3 months and showed the persistence of raised tear osmolarity, suggestive of a prolonged ocular inflammation resulting in patient dissatisfaction. Topical cyclosporine (0.05%) may be a useful adjuvant to prevent and treat cataract surgery associated with dry eye symptoms, especially in patients with pre-existing dry eye disease.

Use of Radiofrequency Diathermy for the Treatment of Chronic Corneal Neovascularization with Lipid Keratopathy

Abstract: No intraor postoperative complications were encountered. After the procedure, significant regression of neovascularization with decrease in lipid deposition and improvement in corneal opacification was observed in both patients during the 12-month follow-up. Corrected distance visual acuity improved from 20/200 preoperatively to 20/80 postoperatively in the first case while remained stable at 20/20 in the second case. Significant symptomatic improvement regarding photophobia and discomfort was noted in both patients.

Virtual Eye Simulation: An Aid in Evaluation of Capsular Block Syndrome

Abstract: To demonstrate the findings of three consecutive cases of postoperative Capsular Block Syndrome (CBS) diagnosed with the aid of Pentacam virtual eye simulation images. Observational case series report. Three patients underwent uneventful cataract removal and presented with blurry vision ranging from 4 days to 5 years after the surgeries were performed. In a case of early-onset postoperative CBS, virtual eye simulation images clearly revealed a reduced posterior chamber depth caused by the accumulation of transparent fluid in the area between the intraocular lens and the posterior capsule. In two cases of late-onset postoperative CBS, virtual eye simulation images better visualized the alignment between intraocular lens (IOL) and iris than slit lamp examination and Schiemflug images. All three of the cases underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, and their capsular bag distensions were resolved immediately. The patients with misalignments between IOL and iris experienced more improvement in best-corrected visual acuity as opposed to the one who did not. Virtual eye simulation is found to be a useful way in visualizing misalignment between IOL and iris and assisting diagnoses of both early- and late-onset postoperative capsular block syndrome.

Same-Site Deep Sclerectomy Re-Operation with Subconjunctival and Subscleral Collagen Matrix (Ologen™) and Minimal use of Mitomycin C

Abstract: This study aimed to evaluate the safety and efficacy of same-site Deep Sclerectomy (DS) re-operation with subconjunctival and subscleral collagen matrix (Ologen™) and minimal use of mitomycin C in cases of late failure blebs.A prospective evaluation of consecutive patients on which same-site DS was performed with subconjunctival and subscleral collagen matrix (Ologen™) and minimal use of mitomycin C; all performed at a single university institution. Intraocular pressure (IOP), number of glaucoma medications, postoperative interventions, postoperative complications and surgical success were registered at 24 hours, 1, 6 and 12 months after the surgery.Twenty-five eyes of 25 patients were included in this study. Time from first DS was 55.08 ± 28.16 months. Mean preoperative IOP was 20.88 ± 6.06 mmHg and it was reduced to 16.64 ± 4.02 mmHg, at 12 months after re-operation (p 0,007). At this final visit, requirements for topical medications dropped from a mean of 2.2 ± 1.0 to 0.72 ± 1.0 per patient and no medications were required in 60% of patients. Success was 36 % in criteria A (IOP ≤15mmHg), 72% in criteria B (IOP ≤18 mmHg) and 80 % in criteria C (IOP ≤15 mmHg), 12 months after the second surgery.The same-site DS re-operation with subconjunctival and subscleral collagen matrix (Ologen®) and minimal use of mitomycin C is a safe and adequate technique for the reduction of IOP, especially when targeted IOP is not lower than 15mmHg.

Recurrent Photoreceptor Loss with Spontaneous Recovery as a Presenting Sign of Syphilitic Outer Retinopathy

Abstract: A 64-year-old male presented with sudden onset of decreased vision with a central blind spot and shimmering visual symptoms without significant inflammatory findings, and was noted on optical coherence tomography to have localized loss of photoreceptors, which spontaneously resolved after two weeks. This recurred subsequently three times spaced by months of recovery with normal vision and normal photoreceptors. In the fourth episode, the patient developed an arcuate-shaped area of outer retinitis more typical for acute syphilitic posterior placoid chorioretinitis, and the diagnosis was made serologically. With subsequent treatment for syphilis, there was not any recurrence after the treatment and vision recovered to 20/20 with a normal photoreceptor layer.

Evaluation of a Tele-assistance Technological Tool in Activities of Daily Life of People with Visual Disabilities

Abstract: Blind people lose an important degree of independence, which makes it difficult to carry out different activities of daily life. To develop and evaluate a telecare model that consisted of guiding a person with visual disability through a video conference to carry out activities of daily life. The telecare model is based on the guidance through voice commands. Telecare begins when a blind person, through a mobile device, transmits images, video and voice (video conference) in real-time to a person with normal vision in a different place that works as a guide, so that the guide knows the details of the blind person. The environment of the person that can solve immediate information needs, location or selection of objects requires visual support. It was evaluated with 37 people with visual disabilities through the Lawton & Brody scale. It is an improved progressive evolution in the level of independence of the Lawton and Brody scale, which presents an advance of just over 2 points in the scale thanks to the tele-assistance application (p = 0.000). The participants were at a moderate level of dependence and, after the tele-assistance tests, their level was mild. The highest score was obtained in activities related to money management and purchases. In contrast, participants had less value activities within the home. The results allowed us to verify the effectiveness of telecare to improve the independence and well-being of people with visual disabilities.

Clinical Evaluation of Dry Eye Syndrome in Patients with Proliferative Diabetic Retinopathy and Laser Therapy Indication

Abstract: Studies have shown a higher incidence of dry eye among patients with diabetes compared to patients without diabetes. However, information regarding dry eye in patients with proliferative diabetic retinopathy and laser therapy indication is not sufficient. To estimate the clinical manifestation of dry eye syndrome in patients with proliferative diabetic retinopathy and laser therapy indication. A cross-sectional study was performed during a local evaluation campaign of diabetic patients with vision disabilities at the Instituto Cearense de Oftalmologia in Fortaleza, CE, Brazil. Patients with proliferative diabetic retinopathy and laser therapy indication were included in the study. An anamnesis directly to dry eye complaints was performed, and eligible participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The slit lamp examination was performed with fluorescein staining; the tear break-up time (TBUT) was measured, and conjunctiva and corneal was evaluated using Rose Bengal (RB) staining. Finally, the Schirmer I test was performed. Twenty-five patients were included in the study with a diagnostic time of Diabetes Mellitus ranged from 1 to 35 years, with an average of 17.2 ± 8.7 years. In our sample, 14 patients (56%) reported glycemic control with insulin, while 11 patients (44%) had oral hypoglycemic agents. The most prevalent complaint was blurred vision (96% of patients) followed by low visual acuity (92%). A less prevalent complaint was pain (44%). The mean OSDI score was 49.4 ± 24.2. TBUT was less than 10 seconds in 21 patients (84%), and RB staining grade was more than 3 in 13 patients (52%). The results of the Schirmer I test ranged from 2 to 35 mm, with a mean of 13.57 ± 9.78 mm. It was smaller than 10 mm in 15 patients (60%). The frequency of manifestation of dry eye syndrome was very common in patients with proliferative diabetic retinopathy and laser therapy indication. Ocular surface care should be provided for those patients with significant ocular morbidity.

Specific Dog Allergen Immunoglobulin G Antibodies in Patients with Allergic Conjunctivitis

Abstract: The levels of serum dog-specific IgE and IgG, and total tear IgE of the seasonal and perennial groups were higher as compared to those of the control group (all p<0.05). The levels of serum dog-specific IgG of the perennial group were higher than those of the seasonal group (0.4 ± 0.6 vs. 0.0 ± 0.0). Multivariate analysis confirmed that the skin prick test result for dog allergen was related to the serum dog-specific IgG levels, but not IgE levels (p<0.01). The severity of allergic conjunctivitis was related to the serum level of dog-specific IgG antibodies (p<0.01).