Open Access Case study

Asymptomatic Uveitis as Primary Manifestation of Sarcoidosis

F. Nilüfer Yalçındağ, Özge Yanık, Özlem Özdemir Kumbasar

Ophthalmology Research: An International Journal, Page 268-274
DOI: 10.9734/OR/2014/10636

Aim: To emphasize that ocular involvement in sarcoidosis may be the initial manifestation of the disease and can be completely asymptomatic.

Presentation of Case: A 36 year-old female was referred to uvea service with detection of keratic precipitates and anterior chamber cells during routine eye examination. She did not show any symptoms of uveitis. A slit lamp examination revealed bilateral medium-sized, round, centrally located granulomatous keratic precipitates on corneal endothelium and +1 cell reaction in anterior chamber. Dilated fundus examination showed bilateral vitreous cells and small vitreous opacities in the right eye. Serum levels of angiotensin-converting enzyme were increased. Her chest X-ray study was significant for bilateral hilar adenopathy, and transbronchial needle aspiration biopsy confirmed the diagnosis of sarcoidosis. Patient responded well to systemic steroid therapy with complete disappearance of the signs.

Discussion: Ocular involvement in sarcoidosis may occur as the disease process, it also can be the first clinical manifestation of the disease. Although the incidence of pulmonary involvement is nearly one and half times higher than ocular involvement, the most frequent initial symptom of sarcoidosis is eyesight disorder. The reason for that is late emergence of symptoms caused by lung involvement such so symptoms related to ocular involvement generates the major complaints at the first application.

Conclusion: Early diagnosis of sarcoidosis is important for avoiding ocular complications as well as prevention of other system involvements. Ophthalmologists have a critical role in the diagnosis and follow-up of the disorder because of increasing incidence of the ocular involvement.


Open Access Case study

Osteogenic Osteosarcoma of the Orbit: A Case Report

Rahmi Duman, Sibel Özdoğan, Mehmet Balcı, Ercan Kahraman, Olcay Kandemir

Ophthalmology Research: An International Journal, Page 275-280
DOI: 10.9734/OR/2014/10334

Osteogenic osteosarcoma of the orbit is a rare and aggressive type of osteosarcoma. Head and neck osteosarcomas occur most commonly in the third and fourth decades and have equal sex predisposition. A 56-year-old male patient was admitted to our clinic with proptosis on the left side and ptosis that had been present for five months. Ophthalmic examination revealed normal eye movements and vision. There was no pain and no paresthesia or any other significant complaint or clinical finding. Magnetic resonance imaging studies showed a hyperintense, destructive extraconal mass lesion adjacent to the lateral wall invading retrobulber fat tissue of the left orbit. The patient underwent a lateral orbitotomy. Histopathological examination revealed osteogenic osteosarcoma of the orbit. Herein, we report a case with osteogenic osteosarcoma arising from the orbit is presented. The differential diagnoses of this tumor and the surgical results of radical resection are also presented.


Open Access Case study

Presumed, Adult-onset Eosinophilic Granuloma of the Orbital Roof Showing Spontaneous Resolution

Francesco Blasetti, Antonio Pinna

Ophthalmology Research: An International Journal, Page 391-396
DOI: 10.9734/OR/2014/12162

Aims: To describe an unusual case of presumed, adult-onset eosinophilic granuloma of the orbital roof, which showed spontaneous resolution.

Presentation of Case: A 42-year-old man presented with a three-month history of relapsing oedema in his right upper eyelid. Slit-lamp examination of both eyes was unremarkable, ocular motility was normal, and there was no proptosis. CT and MRI head scans disclosed a 15mm solid mass in the right anterior cranial fossa, which had eroded the orbital roof and penetrated into the orbit. An initial diagnosis of orbital intradiploic meningioma was made. Total resection of the lesion was planned and the patient was put on the waiting list for neurosurgery. One year later, preoperative MRI disclosed a significant regression of the lesion. Six months later, CT and MRI showed complete disappearance of the lesion and full re-ossification of the orbital roof. A presumptive, final diagnosis of eosinophilic granuloma was made and the patient was cancelled from the waiting list for neurosurgery. There have been no MRI changes in the last 24 months.

Discussion: In this report, initial radiological images were apparently consistent with an orbital intradiploic meningioma. However, this diagnosis turned out to be wrong, because spontaneous resolution of adult-onset orbital intradiploic meningioma has never been reported. Conversely, orbital eosinophilic granuloma may heal without treatment, even though its occurrence in adults is exceptional.

Conclusion: Upper eyelid oedema may be the presenting sign of an osteolytic intracranial mass eroding the orbital roof and extending into the orbit. Radiological differential diagnosis may be difficult. In adults, the detection of an osteolytic lesion and its subsequent spontaneous resolution may be suggestive of an eosinophilic granuloma.


Open Access Case study

Squamous Cell Carcinoma of the Lacrimal Sac: A Case and Literature Review

Duman Rahmi, Başkan Ceyda, Balci Mehmet, Özdoğan Sibel, Akdulum Ismail

Ophthalmology Research: An International Journal, Page 431-439
DOI: 10.9734/OR/2014/9904

Lacrimal sac squamous cell carcinoma is rare and often presents with unspecific symptoms of associated chronic dacryostenosis or dacryocystitis and may be falsely diagnosed as dacryocystitis. A chronically ill looking 73-year-oldcaucasian, who is a house wife, presented with excessive lacrimation in the right eye of 15 months duration and a right inner canthal mass of 6 months duration. The finding of a painless 2cm firm rubbery and smooth mass in the right medial canthus in addition to the symptoms prompted a diagnosis of chronic dacryocystitis and antibiotic therapy was initiated. However, there was no improvement with therapy. Further investigations, including magnetic resonance imaging (MR) were performed. Although the imaging suggested an inflammatory or infectious etiology, because of the suspicion of the malignancy, complete excision of the tumour, periosteum of the lacrimal fossa and nasolacrimal duct was performed via a medial orbitotomy. Histopathological examination revealed infiltrative well-differentiated highly keratinized squamous cell carcinoma arising from lacrimal sac. Herein, we report a case of squamous cell carcinoma of the lacrimal sac mimicking chronic dacryocystitis. 


Open Access Short Research Article

The Etiology and Antibiogram of Bacterial Causes of Conjunctivitis among Patients Attending the Eye Clinic at Rugarama Hospital in South Western Uganda

Agaba Michael, Joel Bazira

Ophthalmology Research: An International Journal, Page 378-383
DOI: 10.9734/OR/2014/10268

Background: Bacterial Conjunctivitis is a common eye condition that causes discomfort and is very irritating. It is a common condition in children and adults and can be caused by various bacterial agents.

Objective: To determine the prevalence, the common bacterial causes of conjunctivitis and their sensitivity to antimicrobial agents at the eye clinic of Rugarama Hospital, Kabale.

Materials and Methods: All specimens were obtained during routine checkups and outreach programmes in April, 2013. The isolates were obtained after inoculation of the specimens onto blood, chocolate and MacConkey agar plates, incubated at 370C for 18-24 hours under aerobic conditions except for chocolate agar plates which were kept in candle extinction jar. The isolates were identified using a combination of colony morphology, biochemical and / or serological tests. Antibiotic sensitivity testing was performed using the Kirby-Bauer disc diffusion method.

Results: One hundred ninety six conjunctival swabs were cultured of which 87 grew bacteria, giving a prevalence rate of 44.4%. Fifty eight of the positive samples were from males and 29 were from females. The age range was from 1 year to 85 years with majority above 40 years. Women were two times more affected than men. The isolated organisms included Staphylococcus aureus 85.1% and Neisseria gonorrhoea 14.9%. Most of the isolates were sensitive to gentamicin, tetracycline and ciprofloxacin while penicillin/oxacillin and chloramphenicol had the least bacterial coverage.

Conclusion: There is a high prevalence of bacterial conjunctivitis at the eye clinic of Rugarama Hospital with the commonest causes being S. aureus and N. gonorrhoeae. Ciprofloxacin, gentamicin, tetracycline can be used for empirical therapy of bacterial of conjunctivitis but not chloramphenicol and penicillin/oxacillin.


Open Access Minireview Article

Rock Inhibitors: Future of Anti-glaucoma Medication

Vishal Vohra, Harshika Chawla, Malvika Gupta

Ophthalmology Research: An International Journal, Page 361-367
DOI: 10.9734/OR/2014/10573

Glaucoma constitutes the major burden of irreversible blindness worldwide as of today. All the modalities of treatment are focussed on lowering intraocular pressure (IOP), from medical to surgical. With the advent of new drugs, drug compliance has increased among the patients but still is the most worrisome problem for doctors. Current research is focussed to treat glaucoma by means other than just lowering IOP. Among the various molecules under trial, one group is Rho kinaseinhibitors (ROCK INHIBITORS). They modulate cellular motility of the trabecular meshwork, schlemm’s canal, and ciliary muscle, thereby enhancing aqueous drainage. Being still under trials, hopes are on that these could revolutionise glaucoma therapy.


Open Access Original Research Article

The Epidemiology and Type of Macular Disease Seen in a Teaching Hospital in South-West, Nigeria

C. O. Adeoti, O. H. Onakpoya, O. U. Kolawole, D. S. Agbeleye

Ophthalmology Research: An International Journal, Page 259-267
DOI: 10.9734/OR/2014/8622

Aim: To examine the epidemiology and types of macular disease in our environment in order to advocate possible preventive interventions or address current behaviours that fall within established risk factors.

Study Design: A retrospective study.

Place and Duration of Study: The department of Ophthalmology, Ladoke Akintola University of technology (lautech) teaching hospital, Osogbo, Nigeria. June 2011 to May 2012.

Methodology: The charts of patients seen during the study period were reviewed.

 Patients with age-related maculopathy were classified into wet and dry. Blindness and low vision were defined according to the world Health Organization definition.

Results: One thousand and eight patients were seen during the study period and out of these, forty two patients (4.17%) were found to have macular disease. Of the 42 patients with macular disease, 29 (69.05%) had age-related macular degeneration (ARMD).

There were 19 (45.2%) males and 23(54.8%) female patients with their ages ranging between 10 and 80 years and mean of 58.69 years (SD 15.25).

Two (4.76%) were bilaterally blind while 9(21.43%) were blind in only one eye. Ten (23.81%) had low vision.

Conclusion: Macular disease is prevalent in this environment and ARMD is the commonest cause of macular disease. It is therefore necessary to educate the people about the established known risk factors in ARMD causation.


Open Access Original Research Article

Association of the CASQ1 Gene SNP rs3838216 with Graves’ Ophthalmopathy and Hashimoto’s Thyroiditis in Patients with Thyroid Autoimmunity

Hooshang Lahooti, Daniele Cultrone, Senarath Edirimanne, John P. Walsh, Leigh Delbridge, Patrick Cregan, Bernard Champion, Jack R. Wall

Ophthalmology Research: An International Journal, Page 281-293
DOI: 10.9734/OR/2014/10623

The pathogenesis of Graves’ ophthalmopathy is poorly understood, but there is evidence for the involvement of calsequestrin (CASQ1) as an autoantigen.

Aim: To compare the frequency of the single nucleotide polymorphism (SNP) rs3838216 (located in intron 1 of CASQ1) in patients with autoimmune thyroid disease (ATD), Graves’ Ophthalmopathy and controls.

Methods: Germline DNA was assayed for rs3838216 by MassARRAY SNP analysis using iPLEX technology of SEQUENOM in 405 individuals (98 males, 307 females) with ATD (comprising Graves’ Opthalmopathy (GO, N=74), Graves’ Hyperthyroidism (GH, N=131), Hashimoto’s thyroiditis (HT, N=92), and controls with no personal or family history of autoimmune thyroid disorders (N=108).

Results: Genotypes for rs3838216 differed significantly across groups with minor allele frequencies as follows: GO 17%, GH 24%, HT 19% and controls 30% groups (P=0.0427). P of SNP rs3838216 was significant in GO vs. control (odds ratio 2.16, P=0.003), and HT vs control (odds ratio 1.87, P= 0.008). On pair wise analysis, homozygosity for the major allele was associated with GO vs. control (odds ratio = 2.42, P=0.0046), and HT vs control (odds ratio 2.07, P=0.0116); whereas heterozygosity was associated with GO vs. control (odds ratio = 0.52, P=0.039), and HT vs control (odds ratio 0.570, P=0.054).

Conclusion: The CASQ1 gene SNP rs3838216 is associated with autoimmune thyroid disease and with GO in particular.


Open Access Original Research Article

A Patient’s Viewpoint of Cataract and Retinal Detachment Surgeries

A. Terry Bahill, Patrick J. Barry

Ophthalmology Research: An International Journal, Page 294-324
DOI: 10.9734/OR/2014/7034

Aims: The purpose of this paper is to (1) describe the changing details of a complex medical case study from the patient’s view allowing the reader to continually evaluate complications resulting from cataract and retinal detachment surgeries, (2) explain good and bad aspects of communications between patients, optometrists, ophthalmologists and systems engineers and (3) show a patient’s view of a detaching retina.

Methodology: This paper was written from the patient’s point of view of the interactions between the patient, the optometrist and the ophthalmologists during a dozen eye surgeries for cataracts and retinal detachments. It was excerpted from the patient’s notes (including test results, charts and images), surgical reports, letters to the doctors and their referral reports. This paper was written in the first person singular and in chronological order. This should help the reader to see changes in the interactions of the symptoms and treatments from ocular surgeries in a multifaceted medical example.

Results: This paper has documented malplacement of an intraocular lens, ignoring patient’s complaints of pain, lack of explanation of what the subject should expect after retinal detachment surgery (such as strabismus, diplopia, pain, wrinkled retina, and dynamic visual changes due to gas bubble absorption), lack of explanation for the subject’s potential visual acuity defects and color deficiencies, poor communication between patient care specialists about these defects, lack of knowledge by technicians using ophthalmological instruments, lack of documented processes for using these instruments (which means different technicians used the instruments differently), lack of proper medical care due to physician overload (i.e. scheduling more than 60 patients per day per physician), and ignoring the patient’s complaints of pain. While reading this paper, the reader should accept or challenge each of these assertions.

Conclusions: Pain is hard to diagnose, measure, quantify and treat, making it frustrating for both the patient and the physician: in this case, there were many causes of the pain, which caused confusion. For the last six years, this patient complained about ten specific symptoms, which were treated individually: treating this case as a system of interacting problems led to a better understanding and resolution.


Open Access Original Research Article

Intravitreal Dexamethasone Implant Plus Prompt Grid Laser for Macular Edema Due to Retinal Vein Occlusion

Justin B. Hellman, Joshua K. Fernandes, Ravi D. Patel, Seenu M. Hariprasad

Ophthalmology Research: An International Journal, Page 325-335
DOI: 10.9734/OR/2014/10753

Purpose: To evaluate the use of intravitreal dexamethasone implant followed by prompt grid laser for macular edema secondary to retinal vein occlusion (RVO).

Methods: Prospective, non-controlled, 12-month interventional case series of fifteen patients with vision loss due to macular edema secondary to RVO. Patients received an intravitreal injection with a 0.7mg dexamethasone implant followed by prompt macular grid laser within 2-4 weeks. Retreatment was offered in 3-month intervals. Primary outcome measures were change in mean log MAR best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 12 months. Secondary outcome was safety at 12 months.

Results: Fifteen eyes of fifteen patients (7 BRVO and 8 CRVO) were evaluated in the case series. The baseline mean log MAR BCVA of all patients was 1.14±0.71 with a significant improvement to 0.70±0.65 (p<0.01) at month 12. Patients had a baseline mean CMT of 513.6±168.5 µm with a significant improvement to 300.2±104.1 µm (p<0.01) at month 12. Safety analysis demonstrated three patients with an increase in IOP>10 mmHg and four patients with cataract progression.

Conclusions: Intravitreal dexamethasone implant followed by prompt grid laser appears to be potentially safe and efficacious for treatment of select patients with macular edema secondary to RVO and should be considered as a treatment option, particularly in patients recalcitrant to monotherapy.


Open Access Original Research Article

Tachyphylaxis to ranibizumab in the Treatment of Age-related Macular Degeneration

Naoko Koike, Tsuyoshi Otsuji, Akiko Tsumura, Tetsuya Nishimura, Kanji Takahashi

Ophthalmology Research: An International Journal, Page 336-343
DOI: 10.9734/OR/2014/11330

Purpose: To assess the patients with exudative age-related macular degeneration (AMD) who develop tachyphylaxis to ranibizumab after intravitreal injections of ranibizumab (IVR).

Methods: We reviewed the records of 115 eyes of 110patients who received IVR from April 2009 to September 2011 at the Kansai Medical University, Takii Hospital. Among the patients who were not regarded as initial non-responders, patients whose response deteriorated after repeated intravitreal use of ranibizumab were defined as having tachyphylaxis.

Results: In this study, we found a 5.2% rate (6/115) of subjects with tachyphylaxis. Two eyes of those with tachyphylaxis had a classic choroidal neovascularization component. There was no significant difference in lesion types between patients with tachyphylaxis and responders (P=0.47; chi-square test).

Conclusion: There are a few percentages of AMD patients who develop tachyphylaxis to ranibizumab. No significant difference is observed in the prevalence of tachyphylaxis among the lesion types.


Open Access Original Research Article

Risk Factors for the Development of Inpatient Exposure Keratitis

Brian Lehpamer, Teddy Lyu, Karen Fernandez, Henry A. Futterman, Penny Asbell

Ophthalmology Research: An International Journal, Page 344-351
DOI: 10.9734/OR/2014/10600

Purpose: To identify the risk factors for inpatient exposure keratitis and make possible the development of improved educational tools for providers.

Methods: Retrospective chart review of inpatient ophthalmology consults at a major New York City teaching hospital, identifying patients with exposure keratitis. Patients included were seen by the ophthalmology consult service over a 3 year period and had exposure keratitis severe enough to require active treatment.

Results: The four most common risk factors were sedation and mechanical ventilation (22/61, 36%), facial nerve palsy (10/61, 16%), nocturnal lagophthalmos (7/61,11%) and cicatricial or post-surgical lid changes (5/61,8%).Inpatient location was identifiable in 59 cases. 31% (18/59) of cases came from the physical therapy and rehabilitation floors and 24% (14/59) from the intensive care units. There were significantly more exposure keratitis cases identified during the 1st Half of the Academic Year, July through December, (45/61,74%) than the 2nd Half of the Academic year, January through June. (16/61, 26%) [P=0.03].

Conclusions: Sedation and mechanical ventilation, facial nerve palsy, nocturnal lagophthalmos, and cicatricial or post-surgical lid changes are the most common risk factors for inpatient exposure keratitis. Further study of the role of the primary team in preventing exposure keratitis is needed, and comprehensive efforts should be undertaken to reduce the incidence of this disease.

Open Access Original Research Article

Visual Outcome versus Vision Satisfaction after Intravitreal Bevasizumb Injection in Diabetic Retinopathy

Gholamhossein Yaghoobi, Mohammad Ali Yaghoobi, Shima Mirshahi

Ophthalmology Research: An International Journal, Page 352-360
DOI: 10.9734/OR/2014/10095

Introduction: Diabetic retinopathy as an important complication of diabetes mellitus is a common cause of blindness in diabetic people. A cure or treatment is not available yet. This study was designed to investigate the effectiveness of the intravitreal injection of Avastin on patient’s visual satisfaction with diabetic retinopathy.

Materials and Methods: This study included 30 eyes of thirty diabetic retinopathy patients (mean age: 60.47±8.94 years) showing no recovery with common treatments. After the intravitreal injection of 1.25mg/0.05ml of Avastin, the examination was performed after injection. In this examination, the resolution of neovascularization, clearance of vitreous and visual acuity were evaluated versus visual satisfaction.

Results: 60% of patients were women (n=18) and 40% were men (n=12). All patients had type 2 diabetes for a period of 8. 47±5.28 years (range 2-25 years). The observed change was 0.22±0.63 log MAR in the best corrected visual acuity (BCVA) in right eye which was statistically significant (p=0.010). The BCVA in left eye was 0.31±0.74 log mar, also showing significant relation (p=0.020). BCVA Changes did not have a meaningful relationship with age and sex of patients, but these changes were negatively related to duration of diabetes retinopathy in both right and left eyes (p=0/048, p=0/006 respectively).

Conclusion: Avastin showed short-term statistically significant visual benefits and also, improvements in ophthalmic pathology in clinical examination versus visual satisfaction, however it was not compatible to ask all of the patient's visual satisfaction. Therefore, further studies will be needed to determine the therapeutic effects of this treatment option.


Open Access Original Research Article

A New Method for Calculating Residual Astigmatism Produced by Toric Intraocular Lens Rotation

Yasuo Yae, Toshiaki Kubota

Ophthalmology Research: An International Journal, Page 368-377
DOI: 10.9734/OR/2014/12067

Aims: To report a new method for calculating residual astigmatism when exact and inexact cylinder power toric intraocular lenses (IOLs) are rotated.

Methodology: Using Excel spreadsheets and sin2θ values, we expressed the cylinder powers of toric IOLs in percentage terms compared to corneal astigmatic powers and calculated values for various corneal astigmatisms and toric IOLs. From these values, we created charts of residual astigmatic powers and axes demonstrating the results of IOLs ranging from 50% to 150% and rotated 0º to 30º.

Results: Comparing residual astigmatic powers, the rank orders for each IOL were as follows: 100%<90%<80% at 5º of rotation, 90%<100%<80% at 10º of rotation, and 90%<80%<75%<100% at 15º of rotation. Thus, lower cylinder power IOLs perform better than higher power IOLs when rotated over 5º. Furthermore, the residual astigmatic powers of 125% IOLs were always higher than those of 100% IOLs; however, the residual astigmatic powers of 75% IOLs became lower than those of 100% IOLs when rotation exceeded 15º.

Conclusion: Our method shows that lower cylinder power IOLs are advantageous in environments where IOL rotation is likely and when inexact IOLs are utilized.

Open Access Original Research Article

Macular Thickness Measurement via Heidelberg Spectralis SD-OCT in Pediatric Patients

Ihsan Yilmaz, Abdullah Ozkaya, Yalcin Karakucuk, Irfan Perente, Ahmet Taylan Yazici

Ophthalmology Research: An International Journal, Page 384-390
DOI: 10.9734/OR/2014/11758

Aims: To determine the normative values of the macular thickness measurements via spectral-domain optical coherence tomography (SD-OCT) in healthy pediatrics.

Study Design:  Prospective study.

Place and Duration of Study: Beyoglu Eye Training and Research Hospital. Department of Retina, between November 2013 and May 2014.

Methodology: Sixty eyes of 30 healthy pediatric patients (20 females, 10 males) were included in this prospective study. Macular thickness measurements were performed via Spectralis SD-OCT. The average retinal thicknesses of the nine macular sectors as defined by the Early Treatment Diabetic Retinopathy Study and central macular volume were recorded.

Results: The mean age was 10.8±3.1 years (range 6-15). The mean central macular thickness was 261±27μm (range 223-434). The mean central volume was 8.66±0.32mm3 (range 8.01-9.54). The mean thickness was 342±13μm for superior inner, 327±15μm for temporal inner, 341±22μm for inferior inner, 339±20μm for nasal inner, 300±11μm for superior outer, 286±15μm for temporal outer, 291±11μm inferior outer, 315±23μm for nasal outer segment.

Conclusion: The means and normative reference ranges are provided for Spectralis OCT in healthy pediatrics, between 6-15 years old, and this values can be used as a standard to compare those of children suspected of having retinal or optic nerve abnormalities.


Open Access Original Research Article

The Effect of Required Injection Numbers during the First Year on the Clinical Course of Neovascular Age-related Macular Degeneration

Abdullah Ozkaya, Ihsan Yilmaz, Zeynep Alkin, Yalcin Karakucuk, Ahmet Taylan Yazici

Ophthalmology Research: An International Journal, Page 397-405
DOI: 10.9734/OR/2014/11667

Aims: To evaluate the effect of injection number of ranibizumab on an as-needed treatment regimen during the first year of treatment on the clinical course of neovascular age-related macular degeneration (nAMD).

Study Design:  Retrospective study.

Place and Duration of Study: Beyoglu Eye Training and Research Hospital. Department of Retina, between December 2009 and December 2011.

Methodology: The newly diagnosed nAMD patients who were treated with intravitreal ranibizumab on an as-needed treatment regimen with a follow-up period of at least 24 months were included in the study. The patients were divided into three groups according to the required injection numbers during the first year; group 1, 3 injections; group 2, 4-5 injections; group 3≥5 injections. Main outcome measures were the change in best corrected visual acuity (BCVA), and central retinal thickness (CRT). Secondary outcome measure was the number of injections during the second year.

Results: The study included 92 eyes of 87 patients. Group 1 consisted of 14 eyes (15.2%), group 2 consisted of 30 eyes (32.6%), and group 3 consisted of 48 eyes (52.2%). The visual outcomes seemed better in group 1; however, there was not a statistically significant difference among the three groups in regards of change in BCVA at all of the time points (p=0.4 for month 6, p=0.5 for month 12, p=0.6 for month 18, p=0.6 for month 24). There was not a statistically significant difference among the three groups in regards of change in CRT at all of the time points (p=0.2 for month 6, p=0.2 for month 12, p=0.1 for month 18, p=0.6 for month 24). The mean number of injections at month 12 and 24 was statistically different among the three groups (p<0.0001 for both).

Conclusion: This study did not show a relationship between injection numbers and treatment outcomes in patients with nAMD on an as-needed treatment regimen. However there was a difference among the three groups in regard of visual acuity which was not statistically significant.


Open Access Original Research Article

The Effect of an Air Bubble in the Anterior Chamber on the Change in Intraocular Pressure (IOP)

Amir Samsudin, Ian Eames, Steve Brocchini, Peng Tee Khaw

Ophthalmology Research: An International Journal, Page 406-417
DOI: 10.9734/OR/2014/12198

Purpose: To compare rate of change in IOP with and without air bubbles in the anterior chamber (AC).

Methods: Enucleated porcine eyes were infused with Balanced Salt Solution (BSS) at 10μl/min. In one experiment, 5 eyes each were injected with 0.15 or 0.30ml bubbles without prior removal of aqueous humour while 5 controls were not injected. In another experiment, 9 eyes were injected with 0.30ml bubbles with prior removal of 0.30ml aqueous humour while 8 controls were not injected. The rate of change in IOP from 5mmHg to 20mmHg was compared. Statistical analysis involved the unpaired t-test and one–way ANOVA. P<.05 was considered statistically significant.

Results: In the first experiment, after initial spikes IOP settled to +3.5+/-3.4mmHg and +4.7+/-5.1mmHg from the original baseline with 0.15ml and 0.30ml respectively (P=.13). The rate of change was 0.25+/-0.09mmHg/min for controls, 0.31+/-0.12mmHg/min for 0.15ml and 0.46+/-0.10mmHg/min for 0.30ml. The difference between the control and 0.30ml groups was significant (P=.02). In the second experiment, IOP after injection was 5.3+/-1.6mmHg compared to 5.9+/-0.7mmHg in the control group (P=.30). The rate of change in IOP was 0.28+/-0.09mmHg/min with bubbles and 0.30+/-0.08mmHg/min without (P=.68).

Conclusion: An air bubble in the AC does not affect the rate of increase in IOP.


Open Access Original Research Article

A Comparison of Accommodation Amplitudes of Three Different Acrylic Intraocular Lenses

Ramazan Yağcı, Mesut Erdurmuş, Uğur Emrah Altıparmak, Bahri Aydın, Ibrahim Feyzi Hepşen, Sunay Duman

Ophthalmology Research: An International Journal, Page 418-423
DOI: 10.9734/OR/2014/12038

Aim: To assess the accommodative amplitudes of three different foldable acrylic intraocular lenses (IOLs) by measuring with photorefractor Plusoptix CR03 (Plusoptix GmbH, Nuernberg, Germany).

Methods: Fifty five pseudophakic eyes of 46 patients (mean age 65.25±10.63 years) were analyzed one month after uneventful phacoemulsification and IOL implantation surgery. Rayner Centerflex (C-Flex) (n=17), AcyrSof MA60BM (n=17), Sensar AR40e (n=21) IOLs were implanted. An objective, dynamic measurement technique with R mode of Plusoptix CR03 device was used to measure accommodation. Accommodation was measured at near distance (0.33m) and far distance (5m).

Results: Accommodation amplitudes (mean ± SD) measured with photorefractor at near distance in Rayner, AcyrSof and Sensar groups were 1.45±0.76 diopter (D), 2.82±1.88 D, 2.44±1.02 D, respectively. Accommodative response of AcyrSof and Sensar IOLs was greater than Rayner IOL significantly (p=0.027 and p=0.004, respectively). At far distance, measured accommodation amplitudes in Rayner, AcyrSof and Sensar groups were 1.34±0.54 D, 1.87±0.74 D and 1.74±1.70 D, respectively. There were no significant difference between the groups (p=0.109).

Conclusion: The 3-piece hydrophobic acrylic IOLs, AcrySof MA60BM and Sensar AR40e) had a significantly higher accommodative response than the 1-piece plate-haptic hydrophilic acrylic Rayner C-Flex IOL.


Open Access Original Research Article

Outcome of Visual Screening of Hospital Workers in University of Uyo Teaching Hospital, Uyo, South–South Nigeria

Emmanuel O. Megbelayin, Emem G. Abraham, Sylvia I. Akpan

Ophthalmology Research: An International Journal, Page 424-430
DOI: 10.9734/OR/2014/12300

Background: The World Glaucoma Week (WGW) is a joint global initiative of the World Glaucoma Association (WGA) and the World Glaucoma Patients Association (WGPA) to raise awareness of glaucoma. As part of the celebration in 2013, the department of Ophthalmology University of Uyo Teaching Hospital organized a two-day free eye screening exercise for the staff of the hospital to determine the visual health status.

Materials and Methods: A prospective observational study of hospital workers in tertiary health institution in Nigeria. Participants who consented to vision screening had preliminary interview and ocular examination. Data obtained was analyzed using SPSS 20.0. Test of statistical significance was with the chi-square test. Observed difference whose probability of occurring by chance (p-value<0.05) was considered statistically significant.

Results: A total of 401 patients were analyzed comprising 121 males and 280 females with a ratio of 1:2.3. Age range was 18 years to 66 years with a mean 39.8±9.2 years. Absolute glaucoma was recorded in 5 patients (1.2%), 71 patients (17.7%) were glaucoma suspects and 19 patients (4.7%) had glaucoma. Refractive error diagnosed in 167 (41.6%) was the commonest finding. There was strong, positive correlation between cup/disc ratio and intraocular pressure in the right eye p=0.021, p=0.006, which were statistically significant.

Conclusion: The study underscores the need for hospital workers to have routine vision screening with such exercises serving as avenues for health education.


Open Access Original Research Article

Apoptosis of Corneal Stromal Cells Induced by Telopeptides: An In vitro Study

Vimalin Jeyalatha, Jambulingam Malathi, Prema Padmanabhan, Hajib N. Madhavan

Ophthalmology Research: An International Journal, Page 440-447
DOI: 10.9734/OR/2014/12138

Background: Uncontrolled collagen degradation is the characteristics of keratoconus. Degradation of type 1 collagen releases telopeptides. The role of telopeptides on the apoptosis of corneal stromal cells have not been studied so far.

Methods: Human primary corneal stromal cells was cultivated and treated with varying concentrations of synthetic telopeptides (3.012µg, 6.125µg, 12.25µg, 12.25µg, 23.5µg, 47µg and 94µg) and incubated for 24 hours, 48 hours and 72 hours. MTT and TUNEL assay was performed following incubation. The difference between the number of viable cells present in the treated and untreated cells were considered for the analysis. 

Results: Primary corneal stromal cells treated with varying concentrations of synthetic telopeptide at 24 hours and 48 hours had no morphological or apoptotic changes, the viability remained 100%. The percentage viability was altered after 72 hours of incubation with the synthetic telopeptide. 47µg/ml, 94µg/ml concentrations of telopeptide showed considerable decrease in the cell viability (p<0.05, t test). 

Conclusion: The current study aims to evaluate the effect of telopeptides on primary corneal stromal cells in vitro and results revealed that the synthetic telopeptide had apoptotic effect. Similar phenomenon can be exhibited in keratoconus stromal cells.


Open Access Original Research Article

Initial Treatment of Glaucoma in a Rural Eye Clinic in Cameroon: Surgery or Medications

Kagmeni Giles, Domngang Christelle, Nguefack- Tsague Georges, Peter Wiedemann

Ophthalmology Research: An International Journal, Page 448-455
DOI: 10.9734/OR/2014/12365

Objective: To report the outcome at one year after  primary trabeculectomy with application of mitomycin-C in patient with primary open angle glaucoma  in a rural Black West African population in Cameroon.

Patients and Methods: Sixty three consecutive patients were enrolled in this retrospective study. Outcomes measured were post operative visual acuity, intra ocular pressure and complications at one year follow up.  Absolute success was achieved when the IOP was ≤20 without adjuvant medication.

Results: Sixty three records (57.14 % (n=36) males and 42.86% (n=27) females) were included in this study. The mean age was 56±14 years. The preoperative NCVA was   ≥0.2 in 73.01% of eyes (n=46). At one year follow up visual acuity was stable in 79.36% (n=50) eyes. The mean preoperative IOP was 34±3.30mmHg, given a target IOP of 19.44mmHg. The mean postoperative IOP was 17.60±4.70mmHg. This was significantly lower than the target pressure (p=0.001). Trabeculectomy was indicated at the first consultation in 76.20% (n=48) patients. The absolute success rate was achieved in 73.01% of cases. Post operative complications included: 7 intraocular inflammations, 3 early IOP elevation, 11 late IOP elevation, 12 cataracts and 1 endophtalmitis.

Conclusion: Trabeculectomy with anti metabolites, can be an effective method of reducing the long-term risk of glaucomatous progression in Africa despite potential limitations in patient follow-up.