Advanced glaucoma following Nd:YAG capsulotomy: a case report

Background

We present a case of aphakic pupil block caused by vitreous prolapse into the anterior chamber following Nd:YAG capsulotomy.

Case presentation

This resulted in advanced glaucoma in a young patient, which presented a significant clinical management challenge.

Conclusions

Ultimately, at the time of writing, her intraocular pressure and uveitis were well controlled, however the long-term outcome remains uncertain, given the uncompromising natural history of her complicated ocular condition.

     

Safety and reliability of femtosecond laser-assisted cataract surgery for Japanese eyes

Purpose

To assess the safety and efficacy of femtosecond laser-assisted cataract surgery (FLACS) in Japanese eyes.

Study design

Retrospective case series.

Methods

The clinical records of 529 consecutive eyes of 312 Japanese patients who underwent FLACS from 2013 to 2016 were reviewed. The completion rates of anterior capsulotomy and corneal incisions using the femtosecond laser (LenSx, Alcon) and the number of attempts to achieve secure docking between the cornea and laser system were recorded. The uncorrected and corrected distance visual acuities (VAs) and uncorrected and distance-corrected near VAs 1 week postoperatively were evaluated.

Results

Anterior capsulotomies were completed in 98.7% of eyes. The corneal incisions were incomplete in 8.3%, which included eyes with arcus senilis and neovascularization. The mean corneal endothelial cell reduction rate was 5.5%. Multiple docking attempts were required in 22.9% of eyes, while canthotomy was performed in two eyes. The postoperative VAs were favorable.

Conclusion

FLACS was safe and reliable in Japanese eyes. Further improvements in docking are required to accommodate small corneas and narrow palpebral spaces.

     

Additive effects of orthokeratology and atropine 0.01% ophthalmic solution in slowing axial elongation in children with myopia: first year results

Purpose

To investigate the additive effects of orthokeratology (OK) and atropine 0.01% ophthalmic solution, both of which are effective procedures to slow axial elongation in children with myopia.

Study design

Prospective randomized clinical trial.

Methods

Japanese children aged 8–12 years with a spherical equivalent refractive error of ??1.00 to ??6.00 diopters were included. A total of 41 participants who had been wearing the OK lenses successfully for 3 months were randomly allocated into two groups to receive either the combination of OK and atropine 0.01% ophthalmic solution (combination group) or monotherapy with OK (monotherapy group). Subjects in the combination group started to use atropine 0.01% ophthalmic solution once nightly from 3 months after the start of OK. Axial length was measured every 3 months using non-contact laser interferometry (IOLMaster), and the axial length measurement at month 3 of OK therapy was used as the baseline value in both groups. The increase in axial length over 1 year was compared between the two groups.

Results

A total of 40 consecutive subjects (20 subjects in the combination group and 20 in the monotherapy group) were followed for 1 year. The increase in axial length over 1 year was 0.09?±?0.12 mm in the combination group and 0.19?±?0.15 mm in the monotherapy group (P?=?0.0356, unpaired t test).

Conclusion

During the 1-year follow-up, the combination of OK and atropine 0.01% ophthalmic solution was more effective in slowing axial elongation than OK monotherapy in children with myopia.

     

Acute visual loss and intraretinal hemorrhages associated to energy drink consumption

Purpose

To report the association of acute visual loss secondary to intraretinal hemorrhages and energy drink consumption.

Methods

Case report and literature review.

Results

A 48-year-old hypertensive man developed an elevation in systemic blood pressure, tachycardia, and acute visual loss secondary to intraretinal hemorrhages shortly after drinking several cans of energy drinks.

Conclusion

High consumption of energy drinks may lead to intraretinal hemorrhages and acute visual loss.

     

Corneal endothelial changes following a single session of selective laser trabeculoplasty for pseudoexfoliative glaucoma

Purpose

To evaluate corneal endothelial cell parameters after a single session of selective laser trabeculoplasty (SLT) in pseudoexfoliative glaucoma (PEG) patients.

Methods

Corneal endothelial cell parameters of 18 PEG patients were compared with 18 healthy subjects following SLT treatment. All patients underwent SLT treatment to 180 degrees of inferior trabecular meshwork. Corneal measurements were performed using specular microscopy (Noncon Robo SP8000, Konan Medical, Hyogo, Japan). Endothelial cell density (ECD), hexagonal cell ratio (HEX), coefficient of variation (CV) of the corneal endothelial cell layer and central corneal thickness of the patients were measured at each visit.

Results

There was a statistically significant decrease in ECD (p = 0.004) and a statistically significant increase in CV (p = 0.041) at superior cornea 1 week after SLT. They returned to pre-SLT values at 1 month. One hour post-SLT HEX of inferior cornea was statistically significantly reduced (p = 0.01). At central cornea, there was a significant increase in HEX after 1 week (p = 0.001). Post-SLT IOP showed a significant positive correlation with CV and significant negative correlation with HEX at superior and inferior cornea. There was no correlation between total laser energy used and endothelial cell parameters.

Conclusion

Effect of a single session of SLT on corneal endothelium of PEG patients appears to be transient, and superior cornea was more affected than central and inferior cornea. All parameters returned to pre-SLT values at 1 month after treatment.

     

The influence of mitomycin C concentration on the outcome of trabeculectomy in uveitic glaucoma

Purpose

To evaluate the influence of mitomycin C (MMC) concentration on the outcome of trabeculectomy in uveitic glaucoma.

Methods

Retrospective comparative study included 50 patients who underwent MMC-enhanced trabeculectomy for uncontrolled uveitic glaucoma. Patients were divided into two groups based on the concentration of MMC used during trabeculectomy (high [0.04%] or low [0.02%]). The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the need for further glaucoma surgeries, and trabeculectomy success.

Results

There were no differences in the IOP nor antiglaucoma medications. The success rates were 76.0 and 68.0%, while the failure rates were 24.0 and 32.0% in the 0.02 and 0.04% MMC groups, respectively.

Conclusion

Trabeculectomy augmented with low (0.02%) MMC concentration seems to have comparable outcomes in uveitic glaucoma compared with high (0.04%) concentration.

     

Corneal crosslinking for keratoconus in Japanese populations: one year outcomes and a comparison between conventional and accelerated procedures

Purpose

We retrospectively investigated the efficacy of corneal crosslinking (CXL) on progressive keratoconus in a Japanese population and compared the outcomes of conventional and accelerated CXL.

Study design

A retrospective cohort study

Methods

A total of 108 consecutive eyes in 95 patients (75 men; 21.9 ± 6.2 years) with progressive keratoconus were enrolled. The epithelium was ablated in all eyes. After presoaking the corneal stroma in riboflavin, UV-A was irradiated at 3.0 mW/cm² (conventional CXL) for 30 min on 23 eyes and 18.0 mW/cm² for 5 min (accelerated CXL) on 85 eyes. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometric value, corneal thickness, corneal endothelial cell density (ECD), intraocular pressure, and complications were evaluated at 1, 3, 6, and 12 months after the procedure.

Results

BSCVA, manifest refraction, ECD, and corneal thickness did not change significantly after both procedures. The keratometric value was significantly decreased from the preoperative value at 12 months (p < 0.001). Progression to more than 1.0 D after CXL was observed in 10 eyes (9.3%). The ΔKmax was negatively associated with preoperative Kmax (p < 0.001) and positively associated with preoperative thinnest corneal thickness (p < 0.001). Both treatment modules showed no significant difference in all parameters.

Conclusion

CXL was as effective in treating keratoconus in Japanese patients as in individuals of other ethnicities. Overall, CXL could be performed using either the conventional or accelerated approach to halt the progression of keratoconus in Japanese populations.

     

Two cases of repeating recurrences and spontaneous closures of macular holes in vitrectomized eyes

Background

Three eyes of 2 cases had repeating recurrences and spontaneous closures of macular holes (MHs) after vitrectomy.

Cases

A 66-year-old man had rhegmatogenous retinal detachment (RRD) in his left eye and underwent vitrectomy with successful retinal reattachment. A full-thickness MH developed 1 year after the vitrectomy and spontaneously closed 1 month later. Opening and spontaneous closure of the MH recurred an additional 4 times over 7 years. An 80-year-old man had suffered intraocular lens (IOL) dislocation and underwent vitrectomy in his left eye. An MH developed in the eye 6 years and 3 months after the vitrectomy. Repeated opening and spontaneous closure of the MH occurred twice in the left eye. The same patient also suffered IOL dislocation and underwent vitrectomy in his right eye. An MH also developed in the right eye 2 years and 9 months after the vitrectomy. Repeated opening and spontaneous closure of the MH occurred 3 times in the right eye.

Observations

The visual acuity was maintained at the last visit in both cases.

Conclusions

MHs in vitrectomized eyes can show repeated recurrence and spontaneous closure.

     

Evaluating the growth of eyelid lesions: comparison of clinical evaluation and a software-based model

Purpose

To evaluate the accuracy of clinicians in evaluating the growth of eyelid lesions and to compare the measurements of experienced ophthalmologists to a novel computerized measurement method.

Design

Prospective, single center, observational study.

Methods

Six experienced ophthalmologists were asked to measure 3 simulated eyelid lesions using a slit lamp. These lesions were then enlarged, and the same examiners were asked to measure the enlarged lesions without prompting that the lesions had changed. Slit lamp photography of the original lesions and enlarged lesions were analyzed using freely available software from the National Institutes of Health. The results of clinician measurements were compared to the software-generated data.

Results

Clinician data regarding the growth of the lesions were as follows: ?40.9 to +76.8% for lesion 1, +29.3 to +134.4% for lesion 2, and +148.5 to +1169.2% for lesion 3. Software-based measurements were as follows: +53.6, +100.7, and +182.2% for lesions 1, 2, and 3, respectively.

Conclusions

Monitoring growth of eyelid lesions in clinical practice can be challenging. We propose that using computerized software to analyze surface area of concerning eyelid lesions may provide a significant advantage over current clinical practices.

     

Non-arteritic anterior ischemic optic neuropathy (NA-AION) after intravitreal injection of bevacizumab (Avastin®) for treatment of angoid streaks in pseudoxanthoma elasticum

Background

To report a case of nonarteritic anterior ischemic optic neuropathy (NA-AION) following intravitreal injection of bevacizumab (Avastin®).

Methods

Interventional case report with an 18-month follow-up.

Results

A 51-year-old male with pseudoxanthoma elasticum presented with NA-AION 2 weeks after treatment with intravitreal of bevazicumab (Avastin®) for choroidal neovascularisation secondary to angioid streaks. Except from a small optic disc without cupping he did not show further risk factors.

Discussion

Risk of NA-AION should be taken into consideration when deciding for intravitreal application of drugs including anti-vascular endothelial growth factors (VEGF) agents like bevacizumab (Avastin®) in the treatment of retinal vascular diseases.

     

Short-term effect of additional apheresis on visual acuity changes in patients with steroid-resistant optic neuritis in neuromyelitis optica spectrum disorders

Purpose

To evaluate temporal changes in visual acuity in patients with steroid-resistant optic neuritis (ON) in neuromyelitis optica spectrum disorders (NMOSD) after apheresis.

Design

Retrospective observational study, clinical case series

Subjects and methods

We reviewed the medical charts of 15 eyes of 9 consecutive patients with ON in NMOSD who underwent apheresis between March 2010 and September 2017. All patients were seropositive for anti-aquaporin 4 (AQP4) antibody and resistant to steroid pulse therapy. Apheresis was performed by either simple plasma exchange or/and immune adsorption therapy.

Results

Twelve eyes (80%) showed improvement with logMAR?>?0.3 at 1 month after apheresis. Within 1 month after apheresis therapy, logMAR on average significantly decreased, the magnitude of change being greatest within the first week. Thereafter visual acuity became stable in 10 of the 11 eyes, until 12 months. However, two eyes (12%) showed recurrence of visual acuity reduction 3 months after the cessation of apheresis. There were a few serious complications during and after apheresis, but these were completely treatable.

Conclusions

Additional apheresis therapy rapidly improves the visual acuity of steroid-resistant seropositive AQP4 ON.

     

The PALM Technique: histological findings of masked phototherapeutic keratectomy on rabbit corneas

Background

To compare the corneal healing response between conventional and phototherapeutic keratectomy through a masking agent, in rabbit corneas.

Methods

24 adult rabbits underwent phototherapeutic keratectomy. Animals were divided in two groups: 12 received photoablation through a masking agent (PALM gel) and the remaining 12 received conventional phototherapeutic keratectomy of equal depth and served as control. Light and transmission electron microscopy was performed in specimens of both groups obtained: immediately after, four hours, one week, one, three and six months after treatment.

Results

Reepitheliazation was complete within five days in all eyes. Light and transmission electron microscopy did not reveal any differences of the healing process in the experimental eyes compared to the controls.

Conclusion

Photoablation through the PALM technique did not result any evident alterations of the reepithelisation and stromal healing process.

     

Twenty five-gauge endoscopic vitrectomy for proliferative vitreoretinopathy with severe corneal opacity

Purpose

To report 4 cases undergoing 25-gauge endoscopic vitrectomy for the treatment of proliferative vitreoretinopathy with severe corneal opacity in which a transpupillary view of the fundus was not possible.

Study Design

A retrospective interventional case series.

Methods

The main outcomes measured were postoperative anatomic status of the retina and subjective improvement of vision. Results: Postoperative reattachment of the retina and subjective improvement of vision were achieved in all 4 eyes.

Conclusion

Twenty five-gauge endoscopic vitrectomy provides a clear view making it possible conduct pars plana vitrectomy in order to reattach the retina in cases of proliferative vitreoretinopathy with severe corneal opacity.

     

Twelve-year follow-up of penetrating keratoplasty

Purpose

To evaluate the long-term outcomes of penetrating keratoplasty (PKP) according to the corneal disease diagnosis and the number of PKP procedures performed.

Methods

Five-hundred-and-nine eyes from 403 patients who underwent PKP at Miyata Eye Hospital in Japan from 1998 through 2014, were included in this study. Medical charts were retrospectively examined to ascertain the corneal disease diagnosis and the period of graft survival. Graft survival rates were compared among various corneal disease diagnoses and among the number of PKP procedures performed. Changes in corneal endothelial cell density (ECD) were analyzed using a mixed-effects model. The presence/absence of various risk factors was compared between transparent grafts and failed grafts.

Results

The overall rate of graft survival at 12 years was 60.4%. The rates of graft survival in keratoconus was 100%, in corneal dystrophy 100%, in leukoma 70.8%, and in bullous keratopathy 51.7%. The rates of graft survival at 12 years for the first PKP was 65.4% and for the second PKP, 43.4% (p < 0.001). All cases of third PKP and fourth PKP failed within 8 years. Preoperative mean ECD (95% confidence interval) was 2722 (2666–2778) cells/mm²; it decreased exponentially after PKP. Mean ECD was 659 (440–878) cells/mm² at 10 years. Rejection, trauma, and infection occurred significantly more frequently in failed grafts than in transparent grafts.

Conclusions

The long-term prognosis of PKP depends on the original diagnosis. The long-term prognosis of re-grafting is worse than that of primary grafts. Rejection, trauma, and infection are risk factors for graft failure.

     

Intracorneal ring segment depth in keratoconus patients: a long-term follow-up study

Purpose

To compare the actual depth of the tunnel created with femtosecond laser for intracorneal ring segment (ICRS) implantation with the target depth in keratoconus patients.

Methods

In this mix design study, eligible keratoconus patients were identified through chart review. The inclusion criterion was a history of ICRS implantation with femtosecond laser more than 6 months prior to enrollment. Participants underwent anterior segment optical coherence tomography using Spectralis (Heidelberg Engineering GmbH, Heidelberg, Germany) for depth measurement defined as the distance from the anterior corneal surface to anterior rim of the ring.

Results

The mean age of the 30 participants was 31.4 ± 7.9 years, and 58.6% were male. Mean follow-up time after ring implantation was 25.8 ± 10.0 (range 7–41) months. Mean actual depth was 59.9% (42.4–86.8%), and the target depth was 85.0% (74.8–90.0%) (P < 0.001). The ring was at a depth of less than 70% in 25 eyes of the 30 (83.3%) studied eyes.

Conclusion

The mean 26 months after implantation, ring segments are placed at a shallower depth than originally intended. Therefore, although femtosecond laser technology is an acceptable method for the surgeon, it is necessary to revisit the depth calculator of the device.

     

Causes,background, and characteristics of binocular diplopia in the elderly

Purpose

We evaluated the background and characteristics of elderly patients with binocular diplopia including diseases caused by abnormalities in orbital pulleys.

Study design

Retrospective.

Methods

The participants were 236 patients aged 60 years or older who visited Kitasato University Hospital complaining of binocular diplopia. We classified strabismus by types and investigated the causes for each group. We diagnosed orbital pulley disorders using magnetic resonance imaging (MRI). Patients with orbital pulley disorders exhibited esotropia and/or vertical strabismus and did not present with cranial nerve palsy, systemic illness, or ocular injury.

Results

Classification of strabismus types was: exotropia (24.2%); esotropia (25.0%); vertical strabismus (30.1%), combined strabismus (20.8%). There were 50.9% cases of strabismus associated with vertical deviation. The causes of disease in each group were as follows: in the exotropia group, 50.9% convergence insufficiency exotropia, 21.1% basic exotropia; in the esotropia group: 35.6% orbital pulley disorder 33.9% sixth cranial nerve palsy; in the vertical strabismus group: 32.4% forth cranial nerve palsy, 31.0% orbital pulley disorder; in the combined strabismus group: 28.6% orbital pulley disorder, 28.6% forth cranial nerve palsy.

Conclusions

About half of the elderly patients with binocular diplopia exhibited vertical deviation. In addition, binocular diplopia was often caused by orbital pulley disorders. It is the first epidemiological study focusing on orbital pulley disorders diagnosed on the basis of MRI.

     

Evaluation of factors affecting visual acuity after Descemet stripping automated endothelial keratoplasty

Purpose

To elucidate the factors affecting visual acuity after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods

We reviewed consecutive patients who underwent primary DSAEK for corneal endothelial dysfunction at Inouye Eye Hospital from January 2010 through January 2015 and who had a follow-up of at least 6 months. Fifty-four eyes of 49 patients (24 men and 25 women) were enrolled; the mean age was 72.5 ± 8.7 years. Medical charts were retrospectively examined for best spectacle-corrected visual acuity (BSCVA), intraocular pressure, keratometric value, keratometric cylinder, grade of preoperative corneal edema, preoperative graft thickness, and endothelial cell density (ECD) before and at 1, 3, 6, 12, and 24 months after surgery. A multiple regression analysis was used to evaluate the factors associated with BSCVA at 3, 6 months, and 1 year after surgery. Explanatory variables included age, sex, preoperative factors (BSCVA, degree of corneal edema, donor ECD, and graft thickness), and factors at each time point (keratometric value, keratometric cylinder, and intraocular pressure).

Results

The mean logarithms of the minimum angle of resolution (logMAR) BSCVA preoperatively and at 1, 3, 6, and 12 months after surgery were 1.03 ± 0.49, 0.42 ± 0.26, 0.29 ± 0.21, 0.24 ± 0.20, and 0.22 ± 0.20, respectively. Multiple regression analysis showed that preoperative BSCVA alone was significantly associated with BSCVA at 3, 6, and 12 months.

Conclusion

A better preoperative BSCVA was associated with a better BSCVA after DSAEK, which suggests that DSAEK should be considered earlier than stromal changes such as subepithelial fibrosis occurrence.

     

Topical non-steroidal anti-inflammatory drugs for the treatment of cystoid macular edema post Descemet’s stripping automated endothelial keratoplasty

Purpose

To investigate the effectiveness of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular edema (CME) post Descemet’s stripping automated endothelial keratoplasty (DSAEK).

Study design

Retrospective observational study

Methods

In this study of 334 patients who underwent DSAEK at the Baptist Eye Institute, Kyoto, Japan between July 2011 and December 2015, 18 patients with postoperative CME (determined by optical coherence tomography) treated with topical NSAIDs after the onset of CME were included.

Results

At CME onset, 17 of the 18 patients were treated with bromfenac eye drops and 1 was treated with nepafenac eye drops. Post initiation of treatment with topical NSAIDs, CME in 17 (94.4%) of the 18 patients improved at 1 month and all cases completely recovered within 3 months. At 12-months post initiation of treatment, 61.1% (n?=?11) of patients achieved a visual acuity (VA) of 20/40 or better, and there was no significant difference of VA between the patients with or without an episode of postoperative CME (P?=?0.55).

Conclusion

The administration of topical NSAID eye drops was found to be effective in treating patients with CME post DSAEK.

     

Blood coagulation parameters after intravitreal injection of aflibercept in patients with neovascular age-related macular degeneration

Purpose

The aim of this study was to evaluate the effect of intravitreal injection of aflibercept (IVA) on blood coagulation tests in neovascular age-related macular degeneration (AMD) patients.

Methods

Thirty-four patients with neovascular AMD (study group) and 32 healthy individuals (control group) were enrolled. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured at different times in patients with neovascular AMD.

Results

The levels of PT and aPTT after IVA were decreased at 1 month after the first injection and 1 month after the second injection compared to the baseline measurement in the study group.

Conclusions

IVA may cause a decrease in the levels of PT and aPTT at 1 month after the first injection and 1 month after the second injection although these results are not statistically significant in our study.

     

Eyelid cleansing with ointment for obstructive meibomian gland dysfunction

Purpose

To investigate the efficacy of eyelid margin cleansing with ofloxacin ophthalmic ointment in obstructive meibomian gland dysfunction (MGD) patients.

Methods

Thirty-one eyes of 31 patients diagnosed with obstructive MGD were enrolled. All subjects were instructed to rub the eyelid edge with ofloxacin eye ointment once daily prior to bathing. Lid margin abnormalities, meibum properties, and tear stability were observed before and 3 months after ointment treatment. A questionnaire relating to the severity of MGD symptoms was administered after the treatment.

Results

Vascular engorgement, meibum, dandruff-like debris, and fluorescein staining scores significantly decreased after the treatment, whereas tear break-up time significantly increased (p < 0.05). Symptoms related to MGD improved after the treatment in 86.2 % of cases.

Conclusions

Cleansing treatment ofloxacin ophthalmic ointment at the eyelid margin may be effective for patients with obstructive MGD.