Digital journal of ophthalmology : DJO最新文献

Purpose: Scleral-fixation of intraocular lenses (IOLs) provides an option for eyes that lack sufficient capsular support for in-the-bag IOL placement. The latest techniques for lens fixation include use of a novel suture material, Gore-Tex, and a sutureless method, with flanged intrascleral fixation. The purpose of this pilot study was to compare these methods in terms of anatomic and clinical outcomes.

Methods: A total of 35 eyes of patients 18-60 years of age who presented with aphakia, subluxated lens, or ectopia lentis were randomized into two groups. Group A (15 eyes) underwent flanged intrascleral IOL fixation using the Yamane technique; group B (20 eyes) underwent 4-point transscleral fixation of IOL using Gore-Tex suture. The following parameters were compared between groups on day 1, week 3, and month 6 postoperatively: logMAR uncorrected and best-corrected visual acuity, retinoscopy, IOL centration on slit-lamp biomicroscopy, and IOL tilt on ultrasound biomicroscopy.

Results: Postoperative visual acuity was better in group B: uncorrected, logMAR 0.89 ± 0.22 versus 0.72 ± 0.24 (P = 0.046); best-corrected, logMAR 0.51 ± 0.18 versus 0.37 ± 0.26 (P = 0.016). No significant difference was found in postoperative retinoscopy and astigmatism between groups. IOL tilt (>100 µm) occurred in 8 cases in group A and in 9 cases in group B; 87% in group A and 100% in group B were well centered. Complications in both groups were minimal.

Conclusions: In our small study cohort, both sutureless flanged IOL fixation and Gore-Tex sutured scleral IOL fixation resulted in excellent visual rehabilitation of patients with aphakia and subluxated lenses. Patients who underwent Gore-Tex suture fixation experienced better postoperative visual acuity, IOL centration, and stability.

A 23-year-old man presented with a 1-month history of a red and painful right eye, with visual acuity reduced to hand motions. Examination showed uveitis with keratic precipitates, cells and flare in the anterior chamber, and vitritis that obscured visualization of the right fundus. The following week, he was noted to have the following left-sided findings: reduced visual acuity (6/18), painless upper eyelid edema, an elevated, pink bulbar conjunctival lesion, limitation of ocular abduction, paresthesia in the V1 and reduced sensation in the V2 distributions. Blood tests showed pancytopenia. Results from the aspirate and trephine biopsy of his bone marrow were consistent with aggressive natural killer (NK) cell leukemia, a rare cause of ocular and periocular inflammation that requires a multidisciplinary team approach to care.

Purpose: To determine whether intereye asymmetry of a three-dimensional neuroretinal rim parameter, the minimum distance band, is useful in differentiating normal eyes from those with open-angle glaucoma.

Materials and methods: This is a cross-sectional study of 28 normal subjects and 33 glaucoma subjects. Subjects underwent spectral domain optical coherence tomography imaging of both eyes. From high-density raster scans of the optic nerve head, a custom-designed segmentation algorithm calculated mean minimum distance band neuroretinal rim thickness globally, for four quadrants, and for four sectors. Intereye minimum distance band thickness asymmetry was calculated as the absolute difference in minimum distance band thickness values between the right and left eyes.

Results: Increasing global minimum distance band thickness asymmetry was not associated with increasing age or increasing refractive error asymmetry. Glaucoma patients had thinner mean neuroretinal rim thickness values compared to normal patients (209.0 μm vs 306.0 μm [P < 0.001]). Glaucoma subjects had greater intereye thickness asymmetry compared to normal subjects for the global region (51.9 μm vs 17.6 μm [P < 0.001]) as well as for all quadrants and all sectors. For detecting glaucoma, a thickness asymmetry value >28.3 μm in the inferior quadrant yielded the greatest sum of sensitivity (87.9%) and specificity (75.0%). Globally, thickness asymmetry >30.7 μm yielded the greatest sum of sensitivity (66.7%) and specificity (89.3%).

Conclusions: This study indicates that intereye neuroretinal rim minimum distance band asymmetry measurements, using high-density spectral domain optical coherence tomography volume scans, may be an objective and quantitative tool for assessing patients suspected of open-angle glaucoma.