Quantification of blood-aqueous barrier breakdown after phacoemulsification in Fuchs' heterochromic uveitis

PURPOSE: To quantify the breakdown of the blood-aqueous barrier (BAB) following phacoemulsification with posterior chamber lens implantation in eyes with Fuchs' heterochromic uveitis (FHU). PATIENTS AND METHODS: In this retrospective study, 19 eyes of 19 patients with FHU (mean age 38 +/- 14 years) and 35 eyes of 35 patients with senile cataracts (mean age 63 +/- 9 years) underwent phacoemulsification with one-piece PMMA posterior chamber lens implantation. Aqueous flare was quantified using the laser flare-cell meter (LFCM, Kowa FC-1000) following medical pupillary dilation preoperatively and 1, 3, and 5 days, then 1 and 6 weeks and 6 months postoperatively. RESULTS: Mean preoperative aqueous flare (in photon counts per millisecond) in FHU vs. controls was 11.7 +/- 3.5 vs. 5.8 +/- 1.7. Following cataract surgery, mean aqueous flare increased to 27.8 +/- 4.4 vs. 16.0 +/- 4.5 on day 1, decreased to 23.6 +/- 4.0 vs. 11.8 +/- 3.5 on day 3, and to 18.0 +/- 3.0 vs. 9.5 +/- 1.7 on day 5. In FHU eyes, it was 13.9 +/- 2.7 after 1 week, and had returned to preoperative levels after 6 weeks (10.9 +/- 2.5) and remained stable for up to 6 months (mean 10.3 +/- 2.2). Pre- and postoperatively, aqueous flare values were 2-3 times higher in FHU eyes than in control eyes with senile cataract (p = 0.01). No postoperative complications such as fibrin formation, synechiae, macrophages on the intraocular lens optic or endophthalmitis were observed in any of the patients. CONCLUSIONS: BAB breakdown following phacoemulsification with posterior chamber lens implantation is relatively mild in eyes with FHU and the BAB appears to be fully reestablished to preoperative levels 6 weeks postoperatively, explaining the usually good outcome of cataract surgery in this condition.     

Increased aqueous flare intensity in eyes with liquefied after-cataract

PURPOSE: To describe aqueous flare intensity in eyes with white liquefied after-cataract. SETTING: Department of Ophthalmology, Toyama Medical and Pharmaceutical University, Toyama, Japan. METHODS: Seven patients with unilateral liquefied after-cataract and another 10 unaffected patients with an intraocular lens (IOL) were examined. The eyes were divided into 3 groups. The first group was composed of 7 eyes with liquefied after-cataract. The second group included the fellow eyes of the patients with unilateral liquefied after-cataract; 4 had an IOL, and 3 had cataract. The third group included 10 additional eyes without liquefied after-cataract. All patients underwent cataract operations consisting of phacoemulsification/aspiration with continuous curvilinear capsulorhexis and acrylic IOL implantation in the capsular bag. Aqueous flare was measured using a laser flare-cell meter. RESULTS: The mean +/- SD of aqueous flare intensity was significantly higher in the first group (11.8 +/- 1.8 photon counts/msec) than in the second group (6.4 +/- 0.8 photon counts/msec) and in the third group (6.3 +/- 0.7 photon counts/msec). CONCLUSION: It is possible that liquefaction of after-cataract and disruption of the blood-aqueous barrier may be related.     

Anterior chamber inflammation following cataract surgery in patients with non-insulin-dependent diabetes mellitus

PURPOSE: The aim of the study was to estimate the early breakdown of the blood-aqueous barrier (BAB) following uneventful cataract surgery in patients with non-insulin dependent diabetes mellitus. MATERIAL AND METHODS: Aqueous flare was estimated in 54 diabetic eyes before and after cataract surgery. Fifteen eyes underwent uneventful ECCE (extracapsular cataract extraction with "can opener" capsulotomy) and 39 phacoemulsification with continuous curvilinear capsulorhexis. All procedures were performed by experienced surgeons. Fifty six eyes of age-matched healthy patients undergoing uncomplicated cataract surgery served, as control. Anterior chamber flare was quantified preoperatively, 1 and 3 days postoperatively, using laser-flare meter (Kowa FM-500). Laser flare values were expressed in photon counts/millisecond. RESULTS: Mean preoperative anterior chamber flare in diabetes type 2 was as follows: normal fundus--6.7, background retinopathy--8.6 and proliferative retinopathy--14.1 (p < 0.01 vs NF group). Significantly lower anterior chamber flare measurements following phacoemulsification (25.0-1 day, 17.8-3 days post surgery), than after ECCE (63.7 and 45.6, respectively) (p < 0.01) were observed in diabetic eyes. In phaco group, we noted lower flare values in eyes without retinopathy; 25.2-1 day, 14.0-3 days post surgery, than in proliferative retinopathy (31.5 and 28.4, respectively) (p < 0.05 vs no retinopathy group). CONCLUSIONS: Phacoemulsification, as a less traumatising technique produces less BAB breakdown and seems to be more suitable than ECCE in diabetic eyes. Following phacoemulsification, eyes with proliferative retinopathy had significantly higher flare values than eyes without retinopathy.     

Vascular endothelial growth factor in fellow eyes of eyes injected with intravitreal bevacizumab

BACKGROUND: To study the effect on untreated fellow eyes of eyes treated with an intravitreal injection of bevacizumab. METHODS: Bevacizumab (1.25 mg/0.05 ml) was injected into the vitreous cavity of one eye (the first eye) as a preoperative adjunctive therapy for proliferative diabetic retinopathy; vitrectomy was performed 1 week later. Immediately after vitrectomy, bevacizumab (1.25 mg/0.05 ml) was injected into the fellow eye (the second eye) followed by vitrectomy 1 week later. Aqueous humor samples were obtained from both eyes in five cases just before intravitreal injection of bevacizumab and just before vitrectomy 1 week later. Vascular endothelial growth factor (VEGF) concentrations in the aqueous humor were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: VEGF concentrations in the aqueous humor of the first eyes ranged from 146 to 398 pg/ml (mean, 302+/-100 pg/ml) before intravitreal injection of bevacizumab; 1 week later, the VEGF concentrations in the injected eyes were less than 31 pg/ml, the lower limit of the ELISA, in all cases (p<0.001). The concentrations in the uninjected fellow eyes ranged from 181 to 551 pg/ml (mean, 382+/-119 pg/ml). CONCLUSIONS: There seemed to be no or a minimal effect of the intravitreal injections of bevacizumab on the uninjected fellow eyes.     

Analysis of the blood aqueous barrier by measurement of aqueous flare in 31 eyes with Fuchs' heterochromic uveitis with and without secondary open-angle glaucoma

BACKGROUND: Fuchs' heterochromic uveitis is characterized by low-grade intraocular inflammation and a relatively benign clinical course. It was the aim of this study to quantitatively determine alterations of the blood-aqueous barrier in this disease by measuring the aqueous flare. METHODS: 31 affected eyes of 31 patients with the characteristic clinical picture of Fuchs' heterochromic uveitis, 31 apparently unaffected contralateral eyes, and 120 age and sex-matched normal control eyes were included in this retrospective study. Five of the eyes with Fuchs' heterochromic uveitis showed signs of secondary open-angle glaucoma. Determination of aqueous flare was performed in all eyes using the laser flare-cell meter FC-1000 (Kowa, Japan) after pupillary dilation. RESULTS: Aqueous flare values were moderately but significantly increased in eyes with Fuchs' heterochromic uveitis (mean 12.1 +/- 3.6 photon counts/ms) in comparison to normal control eyes (4.1 +/- 1.3 photon counts/ms, p < 0.001). Flare values of apparently unaffected contralateral eyes (mean 3.9 +/- 1.1 photon counts/ms) did not differ from normal control eyes (p = 0.5). In the group of eyes with Fuchs' heterochromic uveitis, aqueous flare was comparable in eyes with and without secondary open angle glaucoma (11.9 +/- 2.5 versus 12.1 +/- 3.8 photon counts/ms, p = 0.9). CONCLUSION: The alteration of the blood-aqueous barrier in patients with Fuchs' heterochromic uveitis is unilateral and relatively mild, corresponding to the well-known clinical picture of the disease. Secondary open-angle glaucoma appears not to be associated with additional increase of aqueous flare. The unilaterality and the relatively homogeneous distribution of the degree of increased aqueous flare values support the clinical impression that Fuchs' heterochromic uveitis is a distinct clinical entity that should be differentiated from other variants of chronic anterior uveitis.     

Changes in anterior chamber flare and cells following cataract surgery.

The laser flare cell meter allows rapid non-invasive quantification of aqueous flare and cells. In this prospective study laser photometry was used to document the recovery of the blood-aqueous barrier in 27 normal eyes following cataract surgery. Aqueous flare and cells were highest on the first postoperative day, declining rapidly in the first week and returning to preoperative levels by 3 months. In six eyes (22.2%) there was an increase in either flare and cells or flare alone during the first postoperative week which was associated with a delayed recovery of the blood-aqueous barrier for up to 1 month following surgery. A consensual flare response was found to occur in the fellow eye in five patients (18.5%).     

Evaluation and monitoring of selected inflammation patterns in uveitis using laser tyndallometry

AIM: The purpose of the present study was to evaluate the degree of inflammation and to monitor the dynamics of the blood-aqueous barrier disruption in selected cases of uveitis using laser tyndalometry. MATERIAL AND METHOD: Measurements with the use of laser tyndalometer (Kowa FM-500) were performed in 72 patients (90 eyes) with various types of uveitis. They were divided into four groups: anterior uveitis (28 eyes), intermediate uveitis (pars planitis) (28 eyes), posterior uveitis (26 eyes) and panuveitis (8 eyes). Aqueous flare values were expressed as photon counts per millisecond. RESULTS: Tyndalometric mean values in control eyes were 4.8 +/- 1.0 ph/msec. Mean initial flare was pronounced in multifocal choroiditis and panuveitis--196.0 ph/msec, HLA-B27 positive acute anterior uveitis--145.4 ph/msec, and in acute herpes zoster anterior uveitis--52.4 ph/msec. It was mild to moderate in Fuchs uveitis syndrome--7.8 ph/msec, pars planitis--15.7 ph/msec, posterior uveitis in toxoplasmosis--6.8 ph/msec and toxocariasis--17.5 ph/msec. The potential of laser flare-meter for precise follow-up and adjustment of therapy was demonstrated in selected cases. CONCLUSIONS: Laser tyndalometry has been proved to be a useful tool for the objective and quantitative evaluation of anterior chamber flare in uveitis and for monitoring the effectiveness of the treatment, thus improving therapeutic efficacy of uveitis.     

Anterior capsular contraction after cataract surgery in vitrectomized eyes.

PURPOSE: To assess the contraction of continuous curvilinear capsulorhexis after cataract surgery in eyes with past pars plana vitrectomy. METHODS: In a prospective study, 16 eyes of 16 patients underwent phacoemulsification and implantation of a foldable acrylic intraocular lens after pars plana vitrectomy. Eyes after intensive or repeated vitrectomy were not included. Twenty eyes of 19 patients served as age-matched controls. Aqueous flare intensity was measured using the laser flare-cell meter 1 year after surgery. The area of anterior capsular opening (ACO) was determined by diaphanoscopy using the anterior eye segment analysis system EAS-1000 at 1 day and 1 year postoperatively. RESULTS: There was no significant difference in the mean ACO area between the vitrectomy and control groups both at 1 day and 1 year postoperatively. Aqueous flare intensity 1 year after surgery was slightly higher in the vitrectomy group, but the difference was not statistically significant. CONCLUSION: Eyes after simple vitrectomy are not at a higher risk of ACO contraction following cataract surgery.     

超声乳化白内障吸除术对血-房水屏障功能的影响

目的　观察小切口超声乳化白内障吸除人工晶状体植入术及相关因素对血 房水屏障功能的影响。方法　使用激光蛋白细胞检测仪对 60例 (64只眼 )白内障患者超声乳化白内障吸除人工晶状体植入术前、后的房水蛋白浓度进行定量检测 ,记录并比较闪光值。术后随访时间为 3个月。结果　超声乳化白内障吸除人工晶状体植入术前 ,术后 1d、1周、1个月及 3个月术眼房水的平均闪光值分别为 (6 94± 0 3 4 )、(2 6 2 7± 1 3 7)、(13 96± 1 0 5)、(9 0 7± 0 43 )及 (7 16± 0 2 7)光粒子数 /ms ,其中术后 1d、1周及 1个月高于术前 ,且差异均有显著意义 (P <0 0 5) ;术后 3个月与术前比较 ,差异无显著意义 (P >0 0 5)。术后早期术眼房水蛋白浓度与患者年龄呈正相关 (r =0 40 0 ,P =0 0 0 1) ,与患者的性别和眼别均无相关。术中虹膜脱出者术后 1d和 1周血 房水屏障功能破坏严重。结论　超声乳化白内障吸除人工晶状体植入术在术后短期内影响术眼的血 房水屏障功能 ;激光蛋白细胞检测仪可动态评价超声乳化白内障吸除术对血 房水屏障功能的影响。 (中华眼科杂志 ,2 0 0 4,40 :2 6 2 9)     

Effect of mitomycin C on aqueous humor flow, flare and intraocular pressure in eyes with glaucoma 2 years after trabeculectomy

· Background: The purpose of this study was to determine the intraocular pressure (IOP), aqueous humor flow, flare and ocular side effects in eyes with a history of hypotony after trabeculectomy with adjunctive mitomycin C (MMC). · Methods: Thirty-six eyes with primary or secondary open-angle glaucoma and IOP ≤8 mmHg during the postoperative period were studied 745±315 days after surgery. MMC (0.2 or 0.5 mg/ml) was applied to the episclera with a cellular sponge. Flare was studied with the Kowa Laser Flare Meter 500. Aqueous humor flow was measured in the afternoon (Fluorotron Master II). IOP, visual fields and best corrected visual acuity were also examined. Twenty-two contralateral eyes without surgical intervention served as controls. · Results: The mean age of patients was 44.5±16.8 years. The mean IOP was significantly lower in the MMC group than in the control group: 9.6±6.4 mmHg vs 18.0±13.6 mmHg at 2 years (P<0.001). Aqueous flow was significantly lower in subjects treated with MMC than in controls (P<0.001). The flare values were significantly higher in the MMC-treated group, with a mean of 12.0±7.7 photon counts/ms, than in the control group, mean 7.9±4.6 photon counts/ms (P<0.019). · Conclusion: Our data suggest that MMC is a useful ocular hypotensive agent which seems to participate in a change in aqueous humor dynamics when applied topically as an aqueous solution. Received: 14 October 1997 Revised version received: 20 February 1998 Accepted: 4 March 1998     

Quantification of blood-aqueous barrier breakdown after photorefractive keratectomy for myopia

· Background: Photorefractive keratectomy (PRK) using the excimer laser is a well-established surgical technique for correction of mild to moderate myopic refraction errors in case of spectacle or contact lens incompatibility. As it is still uncertain whether this procedure causes intraocular inflammatory changes, it was the purpose of this study to quantify breakdown of the blood-aqueous barrier following PRK and to look for possible correlations with clinical parameters. · Patients and methods: Aqueous flare was quantified using the laser flare-cell meter after medical pupil dilation preoperatively and on days 1, 3 and 7 as well as 1 month and 3 months following PRK with a 193-nm excimer laser (MEL 60, Aesculap-Meditec) in 37 eyes of 22 patients. The preoperative spherical equivalents were −4.4±3.1 D (range −1.5 to −8.0 D). Pre-, intra- and postoperative treatment was standardized. · Results: Preoperatively, aqueous flare values were 3.9±0.8 photon counts/ms and showed no significant correlation with the spherical equivalent (p>0.1). Postoperatively, aqueous flare rise was very small with flare values not significantly higher than preoperative values. All postoperative flare values were below the normal limit ( <8.0 photon counts/ms). Flare was highest on day 3 after PRK surgery. There was no statistically significant correlation between aqueous flare and depth of stromal ablation. The number of aqueous “cells” did not increase following PRK at any postoperative follow-up examination. · Conclusion: Our results indicate that PRK in mild to moderate myopia does not cause a significant breakdown of the blood-aqueous barrier. Received: 28 January 1998 Revised version received: 6 April 1998 Accepted: 4 May 1998     

Aqueous flare in retinitis pigmentosa

· Background: The purpose of this study was to quantify blood-ocular barrier impairment by measuring aqueous flare in retinitis pigmentosa (RP) and to search for clinical correlations. · Methods: Forty-nine patients (94 eyes) with RP and 85 normal controls were examined. Aqueous flare was quantified with the noninvasive laser flare-cell meter (FC-1000, Kowa, Japan). Degrees of cystoid macular edema (CME), vitreous pigment dusting (VPD), intraretinal migration of retinal pigment epithelium, and waxy pallor of the optic nerve head were determined semiquantitatively by biomicroscopy. Data were analyzed using the t-test the Mann-Whitney U-test, the chi-squared test and regression analysis by taking into account the dependency of data from two eyes of the same patients. · Results: Aqueous flare (photon counts/ms) was significantly higher in RP (mean 10.11±3.53) than in normals (3.89±0.94; P<0.001). Clinically significant CME was present in 26% of eyes with RP, being significantly more frequent in autosomal dominant RP (11 of 16 eyes, 69%) than in other variants (17%; P<0.005). Multivariate analysis revealed that CME was most strongly associated with flare values (r=0.84, P<0.01), whereas – after adjusting for CME – correlations between aqueous flare and other clinical findings did not reach significance. · Conclusion: RP eyes show increased aqueous flare values, indicating impairment of blood-ocur barriers. This appears to be associated with CME and with autosomal dominant RP. Received: 27 June 1997 Accepted: 1 October 1997     

Trans-Tenon's retrobulbar triamcinolone acetonide infusion for refractory diabetic macular edema after vitrectomy

Purpose To evaluate the efficacy and safety of trans-Tenon's retrobulbar triamcinolone acetonide (TA) infusion for the treatment of refractory diabetic macular edema (DME) after vitrectomy. Methods After topical anesthesia, 20 eyes from 20 patients with persistent DME after pars plana vitrectomy were treated with trans-Tenon's retrobulbar infusion of 40 mg TA through an inferotemporal approach. The mean duration (±SD) between vitrectomy and trans-Tenon's retrobulbar TA infusion was 11.4±7.9 months. The mean follow-up period (±SD) after trans-Tenon's retrobulbar TA infusion was 13.3±2.8 months. Results At 1 week after trans-Tenon's retrobulbar TA infusion, the mean central retinal thickness (±SD) measured by optical coherence tomography was 381±99 μm, which was a statistically significant decrease in comparison with the preoperative thickness (555±112 μm) (P<0.001). Additional trans-Tenon's retrobulbar TA infusions were performed in ten eyes (50%), due to the recurrence of DME at 6.6±3.0 months after the first TA infusion. At the final examination, macular edema resolved in 13 (65%), improved in four (20%), and remained unchanged in three (15%) of the 20 eyes. At 1 month after trans-Tenon's retrobulbar TA infusion, the mean laser flare value (±SD) was 9.6±3.0 photon/ms, which was a statistically significant decrease in comparison with the preoperative value (15.5±5.9 photon/ms) (P<0.01). Furthermore, in ten eyes (50%) with recurrent DME, re-elevated laser flare values were observed prior to the recurrence of DME. The final best-corrected Snellen visual acuity improved by two or more lines in nine eyes (45%), and remained unchanged in 11 eyes (55.0%). IOP elevation equal to or higher than 21 mmHg was observed in three (15%) of the 20 eyes with TA infusion, and was controlled by topical medications. No other injection-related complications were observed. Conclusion Trans-Tenon's retrobulbar TA infusion is an effective and safe method for the treatment of refractory DME, which is present even after vitrectomy.     

Increased permeability of the blood-aqueous barrier after panretinal photocoagulation for proliferative diabetic retinopathy.

PURPOSE: To measure the permeability of the blood-aqueous barrier before and after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy. METHODS: Twenty patients with diabetic proliferative retinopathy in one eye and background retinopathy in the other eye were included. PRP was performed in the proliferative eye, while the other eye served as control. Aqueous flare intensity was measured with a laser flare cell meter before, 10 and 90 days after treatment. RESULTS: The flare was stable in the control eye with a flare of 4.5+/-2.3, 4.4+/-2.4, and 4.5+/-1.7 photon counts/ms (mean+/-standard deviation) on Day 0, 10 and 90. In the laser treated eye corresponding figures were 5.2+/-2.4, 9.6+/-3.3, and 7.1+/-2.8 photon counts/ms, with a significant increase in aqueous flare at 10 days (p<0.001) and 90 days (p=0.002). CONCLUSION: A significant increase in aqueous flare was found 10 days after PRP, indicating a breakdown of the blood-aqueous barrier after retinal laser treatment. The breakdown was still present, however, less pronounced, after 3 months.     

Evaluation of anterior chamber inflammatory activity in eyes treated with intravitreal bevacizumab

PURPOSE: To evaluate the effect of intravitreal bevacizumab on anterior chamber inflammatory activity. METHODS: Sixty-one consecutive patients with neovascular age-related macular degeneration were examined before, 1 day, and 1 week after intravitreal administration of 1 mg of bevacizumab (0.04 mL) for neovascular age-related macular degeneration. The intravitreal injection was performed under sterile conditions. Twenty-one fellow eyes served as controls. The anterior chamber inflammatory activity was evaluated using biomicroscopy and the laser flare meter (Kowa FM-500, Kowa Company, Ltd., Tokyo, Japan). RESULTS: None of the 61 consecutive patients had a significant, clinically detectable inflammatory response within 1 week of follow-up. Anterior chamber inflammatory activity measured by the laser flare meter ranged from 1.9 counts/ms to 70.0 counts/ms (mean +/- SD, 13.2 +/- 16.9 counts/ms; 95% confidence interval [CI], 7.8-18.6) before treatment. One day and 1 week after injection, values were between 3.2 counts/ms and 30.0 counts/ms (mean +/- SD, 9.1 +/- 6.2 counts/ms; 95% CI, 7.2-11.1) and 2.0 counts/ms and 25.1 counts/ms (mean +/- SD, 7.3 +/- 4.6 counts/ms; 95% CI, 5.8-8.8), respectively. There was a significant reduction of anterior chamber flare at 1 week compared with baseline (P = 0.031). The control eyes had constantly low flare measures. CONCLUSION: No inflammatory response was detected clinically and by the laser flare meter after intravitreal bevacizumab administration. The slight reduction in anterior chamber flare could be due to the known antiinflammatory effect of anti-vascular endothelial growth factor therapy.     

Late-onset retinal detachment associated with regressed retinopathy of prematurity

PURPOSE: To study the characteristics of late-onset retinal detachments in patients with regressed retinopathy of prematurity (ROP) and the condition of their fellow eyes. METHODS: We carried out a retrospective review of 29 patients (38 eyes) who had been treated at two institutions, one in the US and the other in Japan, between 1986 and 1997. The age at the time of treatment ranged from 6 to 51 years (mean=23.1). Five of the 38 eyes with tractional detachment were treated with either open-sky vitrectomy, closed vitrectomy, or scleral buckling; 27 of the 38 eyes with rhegmatogenous retinal detachment underwent scleral buckling or closed vitrectomy or both. The remaining 6 of the 38 eyes had subclinical rhegmatogenous detachment and were treated with photocoagulation or cryopexy, or followed without treatment. The most characteristic retinal breaks were multiple holes with a prevalence of equator and posterior types. RESULTS: Overall, anatomical reattachment was accomplished in 27/32 eyes (84%) that underwent surgery. Two thirds of the patients who underwent vitrectomy either initially or at a later time had poor postoperative visual acuity. More than half of the fellow eyes had retinal detachment and others had various characteristic fundus changes of regressed ROP. CONCLUSIONS: Long-term, probably life-long follow-up of high-risk patients is necessary so that diagnosis and treatment can be instituted at an early stage of retinal detachment.     

Alterations of aqueous flare and cells detected by laser flare-cell photometry in patients with Behcet’s disease

Purpose To quantitatively evaluate aqueous flare and cells in patients with Behcet’s disease. Methods This study included 30 Behcet’s patients (52 eyes) with active uveitis. The patients were treated with immunosuppressive agents. Aqueous flare and cells were quantified using the laser flare-cell photometry before treatment and 1 and 2 months after treatment. Result Before treatment, mean aqueous flare (ph/ms) in Behcet’s eyes was 25.7 ± 20.5. After treatment, flare values were significantly reduced after 1 and 2 months compared with those before treatment. No significant difference was found between flare values after 1 and 2 months. Before treatment, mean cell counts (cells/0.5 mm³) in Behcet’s eyes were 23.2 ± 29.4. After treatment, cell counts were also significantly reduced after 1 and 2 months compared with those before treatment. Cell counts were further significantly reduced from 1 to 2 months. Conclusion Both aqueous flare and cells were significantly increased in Behcet’s patients with active uveitis and improved after a two-month treatment. Breakdown of the blood–aqueous barrier lasts longer than aqueous cells in these patients.     

Refractive change after vitrectomy for epiretinal membrane in pseudophakic eyes

Purpose: To report the change in refraction in pseudophakic eyes following 23‐gauge vitrectomy for epiretinal membrane (ERM), without use of silicone oil, intraocular gas or scleral buckling. Methods: Retrospective review of the records of 28 pseudophakic eyes in 28 patients undergoing 23‐gauge pars plana vitrectomy for ERM. All 28 eyes had a measured preoperative refraction in their records and were seen minimum 2 months after vitrectomy for measuring their refraction. Fellow eyes (28 eyes) were used as controls. Results: The mean preoperative refraction was ?0.15 ± 0.85 dioptre (D), and the mean postoperative refraction was ?0.41 ± 0.93 D. Thus, a myopic shift was observed following vitrectomy with a mean change in refraction of ?0.26 ± 0.60 D (range +0.75 to ?2.13 D, p = 0.032). The postoperative change in refraction was within ±0.25, ±0.50 and ±1.00 D in 39%, 68% and 96% of the eyes, respectively. The mean absolute refractive error was 0.47 ± 0.44 D. The change in refraction in fellow eyes was +0.01 D (p = 0.82). Conclusion: The change in refraction following 23‐gauge pars plana vitrectomy for ERM in pseudophakic eyes was ?0.26 D.     

Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation

BACKGROUND: The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare it with the alterations following PK only. METHODS: This study included 72 eyes after triple procedure and 227 eyes after PK only. The diagnosis for PK was Fuchs dystrophy in 39%, keratokonus in 44%, stromal corneal dystrophy in 3% and avascular corneal scars in 6% of cases. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) at defined postoperative intervals (10 days, 6 weeks, then every 3 months until 1 year postoperatively). Patients with conditions associated with impairment of the BAB were excluded from the study. RESULTS: In the early postoperative course, aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 +/- 11.0) than in patients with PK only (9.8 +/- 3.2; P = 0.001). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2 +/- 2.3), whereas patients with triple procedure still showed significantly increased flare values (10.8 +/- 5.6; P = 0.01). At 6 months postoperatively, aqueous flare values of patients with triple had returned to normal levels (6.8 +/- 3.8) and did not differ significantly from those after PK only (5.2 +/- 1.9; P = 0.09). CONCLUSION: Our results indicate that triple procedure causes a more extensive and longer-lasting breakdown of the blood-aqueous barrier than PK only. Quantification of aqueous flare with the laser flare-cell meter is useful in the postoperative follow-up after triple procedure. Further studies are required to investigate the clinical relevance of BAB breakdown on endothelial cell count and the incidence of subsequent immunological graft rejection.     

Long-term intraocular pressure changes after vitrectomy for epiretinal membrane and macular hole

Background

To investigate long-term intraocular pressure (IOP) changes after vitrectomy for epiretinal membrane (ERM) or macular hole (MH).

Methods

We retrospectively reviewed the medical records of 57 eyes with ERM and 61 eyes with MH that underwent vitrectomy. IOP levels and changes at 1, 3, 6, 12 months, and the final visit from baseline were evaluated in vitrectomized eyes and non-vitrectomized fellow eyes.

Results

In the ERM group, the mean follow-up period was 29.3 months; the mean preoperative IOP in the operated eyes was 12.9?±?2.5 mmHg and the final IOP was 13.2?±?2.9 mmHg. In the MH group, the mean follow-up period was 25.6 months; the mean preoperative IOP in the operated eyes was 13.3?±?2.5 mmHg and the final IOP was 14.0?±?3.2 mmHg. The mean final IOP of the fellow unoperated eyes was 13.0?±?2.5 mmHg in the ERM group and it was 12.9?±?3.2 mmHg in the MH group. A significant difference was found between the operated eyes and fellow eyes at the final visit in the MH group (P?<?0.01) but not in the ERM group (P?=?0.40). MH group was significantly at high risk of IOP increase after vitrectomy (P?<?0.01).

Conclusions

IOP increase after vitrectomy was found in some eyes with MH during long-term follow-up but it was unlikely in eyes with ERM.