BackgroundThe ideal intraocular lens in cases of aphakia without capsular support is debated. Choices include anterior chamber lenses, iris- or scleral-sutured lenses, and iris-claw lenses. Our aim was to report our long-term evaluation of the use of retropupillary implantation of the Artisan iris-claw intraocular lens (RPICIOL) in several aphakic conditions without capsular support.MethodsA retrospective analysis of consecutive 320 eyes of 320 patients (222 males and 98 females) without capsular support in which we performed RPICIOL implantation in post-traumatic aphakia (141 eyes, group 1), post-cataract surgery aphakia (122 eyes, group 2), and in cases in which penetrating keratoplasty was associated with vitrectomy (57 eyes, group 3). Either anterior or posterior vitrectomy procedures were performed with 20–, 23-, or 25-gauge techniques for different associated anterior or posterior segment indications. We reviewed the refractive outcome, anatomical outcome, long-term stability of the implants, and possible long-term complications.ResultsThe mean patient age was 59.7 years (range, 16–84 years) in group 1; 60.1 years (range, 14–76 years) in group 2; and 65.8 years (range, 25–71.5 years) in group 3. The mean follow-up time was 5.3 years (range, 1 month to 8 years). At the end of the follow-up period, the mean post-operative best-corrected LogMAR visual acuity was 0.6 (range, perception of light to 0.3) in group 1; 0.3 (range, 0.5–0.1) in group 2; and 0.6 (range, hand movement to 0.2) in group 3. Disenclavation of RPICIOLs occurred in three cases because of slippage of one of the iris-claw haptics and spontaneous complete posterior dislocation occurred in one case. One case presented with retinal detachment, and no cases of uveitis were observed. Eight cases complained of chronic dull pain, and severe iridodonesis was seen in five cases. One case of post-operative macular edema was observed without post-operative increase in the mean intraocular pressure. There was no statistically different change in the endothelial cell density (cells/mm2) at the end of the follow-up period.ConclusionsRPICIOL for secondary implantations is a valid alternative strategy to scleral-fixated or angle-supported IOL implantation.

Optical coherence tomography (OCT) has already proven an important clinical tool for imaging and diagnosing retinal diseases. Concerning the standard commercial ophthalmic OCT systems, speckle noise is a limiting factor with respect to resolving relevant retinal features. We demonstrate successful suppression of speckle noise from mutually aligning a series of in vivo OCT recordings obtained from the same retinal target using the Stratus system from Humphrey-Zeiss. Our registration technique is able to account for the axial movements experienced during recording as well as small transverse movements of the scan line from one scan to the next. The algorithm is based on a regularized shortest path formulation for a directed graph on a map formed by interimage (B-scan) correlations. The resulting image enhancement typically increases the contrast-to-noise ratio (CNR) with a factor of three or more and facilitates segmentation and quantitative characterization of pathologies. The method is currently successfully being applied by medical doctors in a number of specific retinal case studies.

Intravitreal bevacizumab 1 mg every 6 weeks was followed by a moderate reduction in DMO without normalization of foveal and macular thickness. Our observations suggest that a larger study where patients are examined sooner after injection is needed to elucidate the potential relationship between changes in retinal vessel diameters and thickness changes in DMO.

ABSTRACT.Purpose: To describe different patterns of diabetic macular oedema (DMO) using a computerized alignment and averaging of sequences in optical coherence tomography (OCT) B-scans and to show the correlation of these patterns with the pathophysiology of the condition. Methods: We carried out a prospective, uncontrolled study, including 46 human subjects with untreated DMO. Enhanced OCT images were produced. We correlated different OCT patterns of DMO with ETDRS visual acuity and with the thickness of the central 1-mm of the macula. We also correlated these patterns with theories of the pathophysiology of DMO. Results: Enhanced OCT images enabled us to examine how different layers of the macula were affected. The external limiting membrane (ELM) was clearly seen in all stages, including advanced stages. The sequence of DMO events in different macular layers can be divided into five patterns. Morphologically, DMO starts at the outer nuclear layer ⁄ Henle's layer. As the oedema progresses, cysts are seen in the fovea and the DMO spreads further into the inner nuclear layer. The ELM seems to act as a barrier for proteins and plays an important role in the development of DMO. Conclusions: Enhanced OCT revealed new details of DMO pathophysiology. The different morphological patterns of DMO seen in enhanced OCT may represent different levels of severity of the disease.

ABSTRACT.Purpose: To study the morphological patterns of pterygia and pingueculae using high-resolution anterior segment spectral domain optical coherence tomography (SD-OCT). Methods: Prospective cross-sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD-OCT. Results: We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge-shaped mass of tissue separating the corneal epithelium from the underlying Bowman's membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD-OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD-OCT revealed a wedge-shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea. Conclusions: SD-OCT provided us with high-resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD-OCT in the evaluation of these lesions.

ABSTRACT.Purpose: To study the relationship between intraretinal optical coherence tomography (OCT) and fluorescein angiography (FA) findings in eyes with diabetic macular oedema (DMO). Methods: We carried out a retrospective observational case series. Thirty eyes with previously untreated DMO underwent FA and OCT. The same ETDRS template was overlaid on the FA images in order to compare OCT and FA. Transfoveal linear high-resolution OCT scans (at the 0-and 90-degree meridians) and FA pictures were compared according to the ETDRS rings. Results: Six distinct patterns of intraretinal changes in OCT correlated with changes in FA: (a) focal angiographic leakage did not correspond to any obvious intraretinal abnormality in OCT in four eyes; (b) localized thickening of the outer nuclear layer in OCT corresponded to focal leaking microaneurysm (focal oedema) in FA in 11 eyes; (c) diffuse thickening of the outer nuclear layer in OCT corresponded to diffuse angiographic leakage in 21 eyes; (d) cystoid expansion of the outer nuclear layer was found in seven eyes with a petaloid angiographic pattern of leakage; (e) cystoid expansion of the inner nuclear layer was found in relation to honeycomb angiographic oedema in five eyes, and (f) serous detachment of the fovea in OCT did not correspond to any distinct finding in FA in four eyes. Conclusions: Intraretinal abnormalities found in OCT correlate systemically with changes in FA. Very early DMO morphological changes may be seen better with FA than with OCT. Serous detachment of the fovea is seen in OCT, but not in FA. The combination of OCT and FA is useful in facilitating understanding of the pathophysiological changes that occur in DMO.

PurposeTo analyze the patterns, causes, and outcome of pediatric ocular trauma at Assiut University Hospital in Upper Egypt (South of Egypt).MethodsAll ocular trauma patients aged 16 years or younger admitted to the emergency unit of Ophthalmology Department of Assiut University between July 2009 and July 2010 were included in the study. The demographic data of all patients and characteristics of the injury events were determined. The initial visual acuity and final visual acuity after 3 months follow-up were recorded.ResultsOne hundred and fifty patients were included. The majority of injuries occurred in children aged 2–7 years (50.7%). There were 106 (70.7%) boys and 44 (29.3%) girls. The highest proportion of injuries occurred in the street (54.7%) followed by the home (32.7%). Open globe injuries accounted for 67.3% of injuries, closed globe for 30.7%, and chemical injuries for 2%. The most common causes were wood, stones, missiles, and glass. LogMar best corrected visual acuity at 3 months follow-up was: 0–1 in 13.3%; <1–1.3 in 27.3%; <1.3–perception of light (PL) in 56%; and no perception of light (NPL) in 3.3%.ConclusionsPediatric ocular trauma among patients referred to our tertiary ophthalmology referral center in Upper Egypt over a period of 1 year was 3.7%. Of these, 67.3% of cases had open globe injury, 30.7% had closed injury, and only 2% had chemical injury. In Upper Egypt, socioeconomic and sociocultural status, family negligence, and lack of supervision are important factors in pediatric eye injuries, as 92% of children were without adult supervision when the ocular trauma occurred. Nearly 86.6% of children with ocular trauma end up legally blind. Modification of these environmental risk factors is needed to decrease pediatric ocular morbidity.

SDAS-OCT imaging provided a range of characteristic patterns that could be used as an additional tool in diagnosis and management of bacterial and fungal microbial keratitis.