Descemet Membrane Endothelial Keratoplasty After Failed Descemet Stripping Without Endothelial Keratoplasty

Cornea. 2017 Apr 21. doi: 10.1097/ICO.0000000000001214. [Epub ahead of print]

Descemet Membrane Endothelial Keratoplasty After Failed Descemet Stripping Without Endothelial Keratoplasty.

Abstract

PURPOSE:

To describe the clinical course, surgical experience, and postoperative outcomes of 3 patients with Fuchs endothelial dystrophy who underwent Descemet membrane endothelial keratoplasty (DMEK) after failed Descemet stripping without endothelial keratoplasty.

METHODS:

Three patients who underwent DMEK for management of persistent corneal edema after deliberate Descemet stripping in the setting of Fuchs endothelial dystrophy were identified. Patients were examined at day 1, week 1, and months 1, 3, and 6 after DMEK. Visual acuity, central corneal thickness (CCT), and evaluation of central corneal endothelial cell counts were recorded.

RESULTS:

Two women and one man, aged 56, 72, and 68 years, were included. The time interval between primary Descemet stripping and DMEK ranged from 3.5 to 8 months. Preoperative visual acuities were 20/200, 20/300, and 20/80. Immediately before DMEK, no patients had countable central endothelial cells, and CCTs were 825, 1034, and 878 μm. After DMEK, all patients had improvement in visual acuity to 20/70, 20/20, and 20/20 with CCTs of 529, 504, and 528. The postoperative period in the first case was notable for the immediate development of a pigmented pupillary membrane with posterior synechiae, as well as cystoid macular edema, of uncertain chronicity, noted 1 month postoperatively. The second case also developed posterior synechiae. Two cases completed 6-month endothelial cell counts totaling 2200 and 3114 cells per square millimeter (endothelial cell loss of 13% and 5.3%).

CONCLUSIONS:

DMEK is a reliable procedure to facilitate corneal rehabilitation and visual recovery in the event of poor corneal clearance after Descemet stripping without endothelial keratoplasty.

The postoperative period in the first case was notable for the immediate development of a pigmented pupillary membrane with posterior synechiae, as well as cystoid macular edema, of uncertain chronicity, noted 1 month postoperatively. The second case also developed posterior synechiae. Two cases completed 6-month endothelial cell counts totaling 2200 and 3114 cells per square millimeter (endothelial cell loss of 13% and 5.3%).

CONCLUSIONS:

DMEK is a reliable procedure to facilitate corneal rehabilitation and visual recovery in the event of poor corneal clearance after Descemet stripping without endothelial keratoplasty.

Automated Staging of Age-Related Macular Degeneration Using Optical Coherence Tomography

Invest Ophthalmol Vis Sci. 2017 Apr 1;58(4):2318-2328. doi: 10.1167/iovs.16-20541.

Automated Staging of Age-Related Macular Degeneration Using Optical Coherence Tomography.

Abstract

PURPOSE:

To evaluate a machine learning algorithm that automatically grades age-related macular degeneration (AMD) severity stages from optical coherence tomography (OCT) scans.

METHODS:

A total of 3265 OCT scans from 1016 patients with either no signs of AMD or with signs of early, intermediate, or advanced AMD were randomly selected from a large European multicenter database. A machine learning system was developed to automatically grade unseen OCT scans into different AMD severity stages without requiring retinal layer segmentation. The ability of the system to identify high-risk AMD stages and to assign the correct severity stage was determined by using receiver operator characteristic (ROC) analysis and Cohen’s κ statistics (κ), respectively. The results were compared to those of two human observers. Reproducibility was assessed in an independent, publicly available data set of 384 OCT scans.

RESULTS:

The system achieved an area under the ROC curve of 0.980 with a sensitivity of 98.2% at a specificity of 91.2%. This compares favorably with the performance of human observers who achieved sensitivities of 97.0% and 99.4% at specificities of 89.7% and 87.2%, respectively. A good level of agreement with the reference was obtained (κ = 0.713) and was in concordance with the human observers (κ = 0.775 and κ = 0.755, respectively).

CONCLUSIONS:

A machine learning system capable of automatically grading OCT scans into AMD severity stages was developed and showed similar performance as human observers. The proposed automatic system allows for a quick and reliable grading of large quantities of OCT scans, which could increase the efficiency of large-scale AMD studies and pave the way for AMD screening using OCT.

CONCLUSIONS:

A machine learning system capable of automatically grading OCT scans into AMD severity stages was developed and showed similar performance as human observers. The proposed automatic system allows for a quick and reliable grading of large quantities of OCT scans, which could increase the efficiency of large-scale AMD studies and pave the way for AMD screening using OCT.

Proliferative Diabetic Retinopathy with Marked Sheathing of the Retinal Arteries following Vitrectomy

Case Rep Ophthalmol. 2017 Jan 24;8(1):40-48. doi: 10.1159/000456027.

Two Cases of Proliferative Diabetic Retinopathy with Marked Sheathing of the Retinal Arteries following Vitrectomy.

Abstract

PURPOSE:

The aim of this paper was to report 2 patients (3 eyes) with proliferative diabetic retinopathy (PDR) who showed marked sheathing of the retinal arterioles that was ultimately attributed to calcification following vitrectomy.

CASES:

Case 1 involved a 65-year-old female with PDR who underwent bilateral vitrectomy for traction retinal detachment. Postoperatively, bilateral retinal redetachment (reRD) was observed. Sheathing of the retinal arterioles was observed at the same time, yet was not apparent preoperatively. Case 2 involved a 71-year-old female with PDR who underwent vitrectomy for vitreous hemorrhage. Postoperatively, reRD was observed, and fundus findings showed sheathing of the retinal arterioles. In both patients, silicone oil tamponade and retinopexy were performed at reoperation, but sheathing of the retinal arterioles persisted postoperatively. Fluorescein fundus angiography showed that retinal blood flow was maintained, and no vessel leakage occurred. In addition, no sheathing of the retinal veins was observed. Optical coherence tomography (OCT) showed a higher intensity for retinal arterioles with sheathing than for normal retinal arterioles.

CONCLUSION:

Vessel sheathing in our 2 patients (3 eyes) differed from the sheathing seen in vasculitis. Based on the hyperintensity on OCT, this sheathing may have been due to retinal artery calcification induced by hypoxia and inflammation associated with reRD.

KEYWORDS:

Calcification; Diabetic retinopathy; Retinal arterioles; Retinal detachment; Sheathing; Vitrectomy

CONCLUSION:

Vessel sheathing in our 2 patients (3 eyes) differed from the sheathing seen in vasculitis. Based on the hyperintensity on OCT, this sheathing may have been due to retinal artery calcification induced by hypoxia and inflammation associated with reRD.

KEYWORDS:

Calcification; Diabetic retinopathy; Retinal arterioles; Retinal detachment; Sheathing; Vitrectomy

Ophthalmia Secondary to Cobra Venom Spitting

Case Rep Ophthalmol. 2017 Feb 10;8(1):99-103. doi: 10.1159/000458519.

Ophthalmia Secondary to Cobra Venom Spitting in the Volta Region, Ghana: A Case Report.

Abstract

PURPOSE:

To report the first case of ophthalmia due to contact with cobra venom in the Volta Region, Ghana.

METHODS:

An ointment containing vitamin A was applied to treat the patient’s unilateral defects in the corneal epithelium and the consequent diminished visual acuity.

RESULTS:

Healing of the corneal epithelium and improvement of visual acuity were observed after only 1 day.

CONCLUSIONS:

This case suggests that consequences of cases of cobra venom spitting in the eyes can be minimal if immediate treatment is provided.

KEYWORDS:

Cobra venom; Ghana; Ophthalmia

Case Rep Ophthalmol. 2017 Feb 10;8(1):99-103. doi: 10.1159/000458519.

Ophthalmia Secondary to Cobra Venom Spitting in the Volta Region, Ghana: A Case Report.

Abstract

PURPOSE:

To report the first case of ophthalmia due to contact with cobra venom in the Volta Region, Ghana.

METHODS:

An ointment containing vitamin A was applied to treat the patient’s unilateral defects in the corneal epithelium and the consequent diminished visual acuity.

RESULTS:

Healing of the corneal epithelium and improvement of visual acuity were observed after only 1 day.

CONCLUSIONS:

This case suggests that consequences of cases of cobra venom spitting in the eyes can be minimal if immediate treatment is provided.

KEYWORDS:

Cobra venom; Ghana; Ophthalmia

Case Rep Ophthalmol. 2017 Feb 10;8(1):99-103. doi: 10.1159/000458519.

Ophthalmia Secondary to Cobra Venom Spitting in the Volta Region, Ghana: A Case Report.

Abstract

PURPOSE:

To report the first case of ophthalmia due to contact with cobra venom in the Volta Region, Ghana.

METHODS:

An ointment containing vitamin A was applied to treat the patient’s unilateral defects in the corneal epithelium and the consequent diminished visual acuity.

RESULTS:

Healing of the corneal epithelium and improvement of visual acuity were observed after only 1 day.

CONCLUSIONS:

This case suggests that consequences of cases of cobra venom spitting in the eyes can be minimal if immediate treatment is provided.

KEYWORDS:

Cobra venom; Ghana; Ophthalmia

Comparison of laser in situ ketatomileusis and photorefractive keratectomy for myopia using a mixed-effects model.

Lasik,photorefractive keratectomy,myopia,photorefractive-keratectomy,myopia. PLoS One. 2017 Mar 31;12(3):e0174810. doi: 10.1371/journal.pone.0174810. eCollection 2017.laser in situ ketatomileusis,photorefractive keratectomy,myopia,
Comparison of laser in situ ketatomileusis and photorefractive keratectomy for myopia using a mixed-effects model.

Mori Y1, Miyata K1, Ono T1, Yagi Y1, Kamiya K2, Amano S3.
Author information
Abstract
PURPOSE:
To compare the results of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for myopia using a mixed-effects model.
METHODS:
This comparative retrospective study was conducted in 1,127 eyes of 579 patients after LASIK and 270 eyes of 144 patients after PRK who had two or more postoperative follow-ups after 3 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refractive spherical equivalent (MRSE), percentage of eyes within ± 0.5 diopters (D) and ± 1.0 D of targeted refraction, and central corneal thickness were compared between PRK and LASIK groups using a mixed-effects model.
RESULTS:
Compared with the LASIK group, UCVA in the PRK group was significantly worse in the initial year but was significantly better after 4 years. The average BSCVA was not significantly different between the LASIK and PRK groups after 4 years. The average gain of BSCVA in the PRK group was significantly larger than that of the LASIK group after 2 years. MRSE in the LASIK and PRK groups showed a gradual myopic shift until 6 years after surgery. After 6 years, MRSE in the PRK group remained stable whereas MRSE in the LASIK group continued a myopic shift. The percentages of eyes within ± 0.5 D or ± 1.0 D in the LASIK group were significantly higher than those in the PRK group at 3 months but were significantly lower than those in the PRK group at 10 years.
CONCLUSIONS:
PRK for myopia shows better efficacy than LASIK for myopia after 4 years.

Lasik,photorefractive keratectomy,myopia,

Surgeon performing laser treatment. Not from article

What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the theoretical domains framework.

Diabetic retinopathy, Qualitative research,Theoretical domains framework, Type 2 diabetes, Young adults.  J Diabetes Complications. 2017 Mar 14. pii: S1056-8727(16)30935-7. doi: 10.1016/j.jdiacomp.2017.02.020. [Epub ahead of print].

What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the theoretical domains framework.

Lake AJ1, Browne JL2, Rees G3, Speight J4.
Author information
Abstract
AIMS:
Young adults with type 2 diabetes (T2D, 18-39years) face increased risk of vision loss from diabetic retinopathy (DR). Retinal screening is essential to detect DR, yet screening rates for this group are low and little is known about the underlying factors influencing this important behavior. Using the theoretical domains framework (TDF) to guide data collection and analysis, we explored screening barriers and facilitator, contrasting them with a comparator group of older adults with T2D (40+ years).
METHODS:
Thirty semi-structured telephone interviews (10 younger, 20 older adults) were conducted. Data were coded into TDF domains with salience identified by “frequency” of reference. Screening facilitators and barriers were systematically compared between groups.
RESULTS:
Although many screening facilitators and barriers were shared by younger and older adults, additional factors highly relevant to the former included: social comparison with others (‘social influences’); concern for the impact on the family unit, unrealistic optimism and perceived invulnerability (‘beliefs about consequences’); lack of time and financial resources (‘environmental context and resources’), and DR misconceptions (‘knowledge’).
CONCLUSIONS:
This study demonstrated that young adult retinal screening behavior was influenced by additional social cognitive factors compared to older adults, providing a first-step evidence base for clinicians and other health professionals, and potential targets for future eye health and retinal screening interventions.

Diabetic retinopathy, Qualitative research,Theoretical domains framework, Type 2 diabetes, Young adults

Bad diabetic retinopathy as might be seen in the people of this study

 

An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy.

Am J Case Rep. 2017 Apr 1;18:329-333.
An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy. Orbital Necrotizing Fasciitis,Antibiotics, Surgery,Hyperbaric Oxygen Therapy

Singam NV1, Rusia D2, Prakash R1.
Author information
Abstract
BACKGROUND Necrotizing fasciitis (NF) of the orbit is a rare and deadly condition that requires prompt surgical and medical management to decrease morbidity and mortality. CASE REPORT Here we present an interesting case of an individual who developed fulminant NF of the left orbit requiring emergent surgical intervention, antibiotics, and subsequent hyperbaric oxygen therapy in an attempt to save the eye. CONCLUSIONS With an early and aggressive multifaceted approach using antibiotics, surgery, and hyperbaric oxygen it may be possible to preserve eye structure and function. Without treatment NF is a rapidly progressive condition and can result in significant morbidity.

 

Am J Case Rep. 2017 Apr 1;18:329-333.
An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy. Orbital Necrotizing Fasciitis,Antibiotics, Surgery,Hyperbaric Oxygen Therapy

Singam NV1, Rusia D2, Prakash R1.
Author information
Abstract
BACKGROUND Necrotizing fasciitis (NF) of the orbit is a rare and deadly condition that requires prompt surgical and medical management to decrease morbidity and mortality. CASE REPORT Here we present an interesting case of an individual who developed fulminant NF of the left orbit requiring emergent surgical intervention, antibiotics, and subsequent hyperbaric oxygen therapy in an attempt to save the eye. CONCLUSIONS With an early and aggressive multifaceted approach using antibiotics, surgery, and hyperbaric oxygen it may be possible to preserve eye structure and function. Without treatment NF is a rapidly progressive condition and can result in significant morbidity.