【In Press】Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

AIM: To check ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment (ASPVD) with vitreous hemorrhage. METHODS: Cross-sectional study of seventy five consecutive patients presenting with ASPVD symptoms was conducted at University Eye Clinic, University Hospital “Sveti Duh“, Zagreb. In each patient, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6 weeks period. RESULTS: In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Clinical examination of the fundus confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100% (95% CI 60-100), specificity 92%, positive predictive value 62% (95% CI 32-85) and negative predictive value 100% (95% CI 93-100). CONCLUSION: Ultrasound is a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.  

The influence of pterygium morphology on fibrin glue conjunctival autografting pterygium surgery

To evaluate the influence of pterygium morphology on the efficacy and safety of fibrin glue in pterygium surgery with conjunctival autografting. A prospective case series. During a period of 15 months, 45 patients (51 eyes) were recruited from the General Hospital for pterygium surgery. Seven eyes (13.73 %) were operated on for a recurrent pterygium. Autologous conjunctiva was harvested from the superior bulbar conjunctiva and fixed with fibrin glue. The pterygia were preoperatively divided into atrophic/grade 1 (n = 18; 35.29 %), intermediate/grade 2 (n = 22; 43.14 %) or fleshy/grade 3 (n = 11; 21.57 %) according to clinical morphology. Patients were evaluated for intraoperative and postoperative complications and recurrence rates. The success rate was defined by no pterygium recurrences. Patients with 2-year follow-ups were included in this study. Fifty-one patients (21 females/30 males) with a mean age of 60–65 years (range 24–87 years) took part in the study. All patients completed the study. No intraoperative complications were noted. Postsurgical complications included graft edema (n = 4; 7.8 %), graft hyperemia (n = 2; 3.8 %), and graft dislocation (n = 3; 5.9 %); these complications were transient. One graft unfastened completely (2 %) and five pterygium recurrences occurred (n = 5; 9.8 %). The overall success rate was 90 % after 2 years. In grade I group there were no recurrences, in grade 2 group there were two recurrences, and in grade 3 group there were three recurrences. There were significantly more recurrences in grade 3 group than in grade 2 group. There were more recurrences in both groups than in group 1 (60 vs 40 vs 0 % of all recurrences, p ≤ 0.05). The use of fibrin glue is a safe, easy and effective technique for attaching the conjunctival autograft in pterygium surgery. The morphology of pterygium influences recurrence rates, without significance for intraoperative and postoperative complications.  

Comparison of Wavelight Allegretto Eye-Q and Schwind Amaris 750S excimer laser in treatment of high astigmatism

Purpose

To compare functional outcomes of Wavelight Allegretto Eye-Q 400Hz and Schwind Amaris 750S excimer laser for astigmatism between 2 and 7 diopters(D).

Methods

Prospective comparative non-randomized case series of 480 eyes assigned in two laser groups and further divided into myopic and mixed astigmatism subgroups. All treatments were centered on corneal vertex. One-year results were compared between the groups. Statistical analysis was performed using z-test.

Results

Both Allegretto and Amaris postoperative uncorrected distance visual acuity (UDVA) improved in comparison to preoperative corrected distance visual acuity (CDVA). The difference was significant in the Allegretto group for myopic astigmatism (p?=?0.017). There was no difference in postoperative UDVA between lasers. Average sphere decreased in all groups for both lasers (p?p?p?p?p?p?= 0.023, mixed astigmatism p?Conclusion Both lasers are effective in terms of UDVA, CDVA, spherical correction, and preservation of high-order aberrations. However, Amaris was more effective in cylinder correction.  

Positive pressure during penetrating keratoplasty can be solved with a modified graft‐over‐host technique

Purpose: To describe a modified graft‐over‐host (MGOH) surgical technique which was used to prevent serious complications in cases of positive vitreal pressure during penetrating keratoplasty (PKP) and to compare the endothelial cell density (ECD) loss and clinical outcome between eyes undergoing MGOH or standard PKP. Methods: In the proposed MGOH technique, the donor graft is sutured over the recipient cornea as soon as signs of positive pressure are noticed, even before cutting the recipient cornea, and the surgery is continued by consecutive cutting of the recipient and continuous suturing of the donor cornea, quadrant by quadrant. Donor grafts were prospectively followed up for the graft clarity, ECD loss and the amount of astigmatism. Results: Of 220 cases scheduled for standard PKP in years 2009–2011, eight were operated by MGOH technique. Despite the fact that the donor cornea is situated over the recipient almost throughout the whole MGOH procedure, the ECD loss is equal between eyes operated on by MGOH technique and standard PKP, and none of the grafts had primary graft failure. The only disadvantage was an increased amount of astigmatism that was not as significant once the sutures were taken out. Conclusion: Modified graft‐over‐host technique seems to be a safe and effective method to prevent complications during PKP complicated by positive vitreal pressure.  

Enhanced S-cone syndrome with preserved macular structure and severely depressed retinal function

We present ophthalmic features and genetic analysis findings of a 44-year-old croatian patient with enhanced S-cone syndrome (ESCS). Complete ophthalmic examination, Ishihara colour vision test, dark adaptometry, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence imaging, Goldmann visual field and automated perimetry, full-field electroretinography (ERG), multifocal ERG, S-cone ERG and ON–OFF ERG were performed. Mutation screening of the NR2E3 gene, which encodes a photoreceptor-specific orphan nuclear receptor, was performed with polymerase chain reaction amplification and direct sequencing. The patient has good visual acuity and normal colour vision. Fundus examination showed normal posterior pole and nummular pigment depositions at the level of the retinal pigment epithelium in the mid-periphery of the retina. The SD-OCT images showed normal macular structure and thickness. The ERG showed characteristic findings: photopic and scotopic responses to the same stimulus had a similar waveform and were dominated by short-wavelength-sensitive mechanisms. Mutation analysis revealed the known NR2E3 mutation c.481delA (p.Thr161HisFsX18) and the novel NR2E3 variant c.1120C > T (p.Leu374Phe). To the best of our knowledge, this is the only ESCS patient older than 40 years who phenotypically has preserved macular structure, good central visual acuity and severely depressed full-field ERG as well as the first reported patient with NR2E3 mutation from Croatia.  

Optical low-coherence reflectometry enables preoperative detection of zonular weakness in pseudoexfoliation syndrome

Purpose  

To evaluate optical ocular components in patients with pseudoexfoliation syndrome using optical low-coherence reflectometry.  

Comparison of optical low-coherence reflectometry and applanation ultrasound biometry on intraocular lens power calculation

Background

The aim of the study was to determine whether the innovative non-contact optical low-coherence reflectometry method utilized by the Lenstar LS 900® agrees sufficiently with applanation ultrasound A-scan technique in routine biometric measurement and intraocular lens power calculation to replace it.

Methods

Twenty-two patients hospitalized at our eye clinic undergoing cataract surgery were assigned to have five consecutive measurements of axial length by two examiners in a single session using applanation ultrasound and the Lenstar. The applanation ultrasound intraocular lens power calculation was based on automated keratometry and applanation ultrasound axial length measurements. The Lenstar intraocular lens power calculation was based on its measurement of keratometry and axial length. Bland–Altman analysis was used to assess interobserver repeatability of applanation ultrasound and the Lenstar as well as agreement between the Lenstar and applanation ultrasound for axial length measurement and intraocular lens power calculation.

Results

Thirty-two eyes of 22 patients were analyzed. In 95% of the observations, predicted refractive error corresponded to –0.26?±?0.62 D and 0.01?±?0.20 D obtained with applanation ultrasound and the Lenstar, respectively.

Conclusions

Based on excellent repeatability of the Lenstar and acceptable repeatability of applanation ultrasound, two techniques may be used interchangeably. The predicted refractive error of ±0.20 D in 95% of the observations has never been achieved. Optical low-coherence reflectometry might become a new standard method for biometric measurement needed for intraocular lens-power calculation in patients with cataract.