Incidence Of Secondary Glaucoma Research Articles

Ten-year outcomes of congenital cataract surgery performed within the first six months of life.

To investigate the long-term outcomes of congenital cataract surgery performed within the first 6 months of life. 11 ophthalmic surgical sites in Japan. Retrospective chart review. Medical charts were retrospectively reviewed for 216 eyes of 121 patients. The age at surgery was 2.9 ± 1.7 months, with follow-up duration 13.0 ± 2.3 years. The cohort consisted of 83 cases with bilateral aphakia, 12 with bilateral pseudophakia, 20 with unilateral aphakia, and 6 with unilateral pseudophakia. Surgical intervention within the critical period of visual system development (10 weeks for bilateral and 6 weeks for unilateral cases) led to significantly better final visual acuity than surgery conducted after this time frame. The incidence of secondary glaucoma was similar between groups while the occurrence of visual axis opacification was more frequent with earlier surgery. A forward stepwise multiple regression analysis revealed that the final visual acuity was significantly associated with laterality of cataract (better outcomes in bilateral cases), phakic status (with pseudophakia outperforming aphakia), presence of systemic and ocular comorbidities, and development of secondary glaucoma. Secondary glaucoma was significantly more prevalent in aphakic eyes than pseudophakic eyes. In patients with genuine congenital cataract, surgery within the critical period of visual development results in better final visual acuity, albeit with an increased risk of visual axis opacification. The use of IOL with sophisticated surgical techniques shows promise even in congenital cataract surgery.

The Frequency of Intraocular Pressure Elevation, Incidence of Secondary Glaucoma, and Surgical Treatment With Postoperative Complications in Pediatric and Adult Patients With Uveitis.

Purpose To determine the etiology and anatomic localization of uveitis, the frequency of intraocular pressure (IOP) elevation, and the type of secondary glaucoma and to assess the medical, surgical, and postoperative complications in adult and pediatric patients with acute or chronic uveitis. Methods A total of 307 eyes of 186 patients who were followed up in the Uvea-Behçet Unit of the Ophthalmology Department,Erciyes University, Turkey, were included in the study. Demographic, ocular, and systemic data were recorded; ophthalmological examinations were performed; and recurrences and complications of uveitis were identified. The eyes with IOP over 22 mmHg, types of secondary glaucoma, their etiologies, efficiency of medical and surgical treatments, and complications were recorded. Results The mean age was 33 ± 12 years (range: 6-65). Of the 186 patients, diagnoses were as follows: idiopathic uveitis in 84 (45.2%), Behçet disease in 65 (34.9%), ankylosing spondylitis in eight (4.3%), juvenile idiopathic arthritis in five (2.7%), herpetic keratouveitis in three (1.6%), Fuchs iridocyclitis in three (1.6%), Vogt-Koyanagi-Harada syndrome in three (1.6%), tuberculosis uveitis in three (1.6%), Crohn disease in three (1.6%), ocular toxoplasmosis in two (1.1%), multiple sclerosis in two (1.1%), Lyme disease in two (1.1%), rheumatoid arthritis in two (1.1%) and tubulointerstitial nephritis in one patient (0.5%). Secondary glaucoma was detected in 67 (21.9%) of 307 eyes, which developed in 13.7% and 26.8% of the eyes with acute and chronic uveitis, respectively. Of 67 eyes, it was open-angle glaucoma in 58 (86.5%), angle-closure glaucoma in six (9.0%), and neovascular glaucoma in three (4.5%). Control of IOP was achieved by medical therapy in 53 eyes (79.1%) and by surgery in 12 eyes (17.9%), whereas evisceration was required in two eyes (3.0%). Laser iridotomy was performed in four eyes (33.4%), trabeculectomy with mitomycin-C (MMC) in six eyes (50.0%), laser iridotomy plus trabeculectomy with MMC in one eye (8.3%), and express mini shunt implantation in one eye (8.3%). After surgery, IOP was controlled without anti-glaucomatous agents in six eyes (50%) and with anti-glaucomatous agents in the remaining six eyes (50.0%). Conclusion Secondary glaucoma is one of the most important complications of uveitis and may result in severe visual impairment. Early diagnosis and appropriate treatment can prevent these potential complications.

Long-term surgical outcomes of pediatric cataract—multivariate analysis of prognostic factors

We assessed the 10-year postoperative outcomes of pediatric cataract patients who underwent surgery at the age of 6 years or younger. A retrospective review of medical charts was conducted for 457 eyes of 277 patients, with the age at surgery averaging 1.3 ± 1.5 years (mean ± SD) and the follow-up duration averaging 12.8 ± 2.4 years (ranging from 10 to 17 years). The cohort included 250 eyes of 125 cases with bilateral aphakia (age at surgery 0.5 ± 0.8 years), 110 eyes of 55 cases with bilateral pseudophakia (1.9 ± 1.6 years), 42 cases with unilateral aphakia (1.1 ± 1.3 years), and 55 cases with unilateral pseudophakia (2.6 ± 1.7). A forward stepwise multiple regression analysis revealed that the best-corrected visual acuity at the final visit was significantly associated with laterality of cataract (with bilateral cases showing better results compared to unilateral cases), presence of systemic comorbidities, presence of ocular comorbidities, development of glaucoma, and phakic status (with better results in the pseudophakia group than the aphakia group). The age at surgery did not significantly affect visual acuity outcomes. A multiple logistic regression analysis demonstrated that the incidence of secondary glaucoma was significantly linked to younger age at surgery, phakic status (higher in aphakic than pseudophakic eyes), and presence of systemic comorbidities. In conclusion, after pediatric cataract surgery, final visual acuity was better in patients with bilateral cataracts, those treated with an intraocular lens, and cases without systemic or ocular comorbidities and secondary glaucoma. The development of secondary glaucoma was linked to younger age at surgery, aphakic status, and presence of systemic comorbidities.

Outcomes of surgical treatment of congenital cataract with microphthalmia in infancy

Objective: To examine the outcomes of surgical treatment for infants with congenital cataract and microphthalmia (CATM). Methods: It was a retrospective case series study. Data of 28 (55 eyes) CATM children who underwent cataract surgery at the Qingdao Eye Hospital of Shandong First Medical University and were followed up for more than 5 years between January 2010 and December 2014 under the age of 6 months. There were 15 male and 13 female children. The age at the time of surgery was (3.2±1.3) months, and the follow-up time was (8.2±1.7) years. The data included the basic information of the children, the ocular biological parameters before and after surgery and intraocular lens (IOL) implantation, and the occurrence of complications. Paired t-tests or Wilcoxon signed rank tests were used to compare groups, and logistic regression analysis was used to identify factors related to IOL implantation, secondary glaucoma, and visual axis opacification (VAO). Results: The mean preoperative axial length was (16.6±1.0) mm, and the mean horizontal corneal diameter was (9.5±0.9) mm. The axial growth rate within 2 years after the first stage of surgery was (1.4±0.8) mm/year. None of the children had an IOL implanted before the age of 2. Sixty percent of the eyes (33/55) received IOL implantation within 2 to 4 years after the first stage of surgery, while the remaining 40% (22/55) did not receive IOL implantation at the last follow-up. The axial growth rate was (0.9±0.7) mm/year within two years after the second stage of surgery. Postoperative secondary glaucoma occurred in 7 eyes (12.7%), and VAO occurred in 15 eyes (27.3%). IOL implantation was associated with preoperative axial length (OR=0.072, P<0.001) and age at the first stage of surgery (OR=7.270, P<0.001), but not with preoperative corneal diameter (P=0.735). The incidence of VAO was associated with preoperative corneal diameter (OR=4.124, P=0.011), but not with age at the first stage of surgery (P=0.489) or preoperative axial length (P=0.489). No factors related to the occurrence of secondary glaucoma were found. The best corrected visual acuity at the last follow-up after IOL implantation was (0.37±0.28) logMAR, which was better than that of children without IOL implantation (0.67±0.19) logMAR (U=49.50, P=0.003). Conclusions: Children with CATM can obtain the opportunity for IOL implantation through early surgery and ultimately achieve good visual outcomes. Properly selecting the timing for implanting IOL can keep the incidence of secondary glaucoma at an acceptable level.

Retropupillary iris-claw lens

Aim: To evaluate the preoperative and intraoperative indications, postoperative complications, incidence of secondary glaucoma, and visual outcome in patient who underwent iris-claw implantation during cataract surgery and effect of vitrectomy on postoperative intraocular pressure (IOP). Material and Methods: A retrospective study was conducted from January 2016 to February 2020. One hundred eighty-seven eyes of 187 patients who underwent iris-claw lens implantation, with minimum 1 month follow-up, were included in the study. Analysis of records was done for preoperative, intraoperative findings and was recorded and postoperative best corrected visual acuity (BCVA) and IOP were noted in each follow-up. Results: Mean preoperative BCVA of 187 eyes was 1.78 logMAR (SD 0.68), which increased to 0.61 ± 0.50, 0.36 ± 0.26, 0.21 ± 0.16 logMAR at postoperative day 1, day 7, and 1 month, respectively. Most common indications included phacodonesis (17.65%), small dilating and nondilating pupil (11.22%), zonular dialysis (6.41%), and pseudoexfoliation in (4.81%). Few patients (6.94%) had preexisting corneal pathologies which lend up in intraoperative complications that lead to iris-claw implantation. Mean IOP in vitrectomized eye after 1 month was 15.53 (SD 2.16) mm Hg and those of nonvitrectomized was 16 (SD 1.90) mm Hg. Posterior capsular rent and whole capsular bag loss were the most common intraoperative indications. Incidence of secondary glaucoma was 2.13%. Irregular pupil was the most common anterior segment finding at 1 month postoperatively. Conclusion: Retropupillary iris-claw implantation is one of the safe and least complicated methods of managing intraoperative complications which gives good visual acuity and prevent patient from the trauma of multiple surgeries.

ФАКТОРЫ ПРОГНОЗА РАЗВИТИЯ ВТОРИЧНОЙ ГЛАУКОМЫ ПОСЛЕ СТЕРЕОТАКСИЧЕСКОЙ РАДИОХИРУРГИИ ПО ПОВОДУ МЕЛАНОМЫ ХОРИОИДЕИ

Stereotactic radiosurgery (SRS) demonstrates satisfactory results in terms of local tumor control and survival of patients with choroidal melanoma. At the same time, there are practically no studies aimed at establishing the dependence of the frequency and severity of SRS complications on the initial characteristics of the tumor and dose parameters of radiosurgery. The aim of this study was to analyze the incidence of post-radiation complications, as well as the relationship between the clinical characteristics of the tumor and the dosimetric parameters of stereotactic radiosurgery and secondary glaucoma. Material and methods. The prospective study included 43 patients with cT1-3N0M0 choroidal melanoma. The median prescribed dose per tumor margin at 50% isodose was 30 Gy, (23-35 Gy). The immediate effect of the treatment was assessed as positive in all the cases, except for increased blood flow according to Doppler ultrasound data, an increase in tumor size by more than 20% of the previously determined lesion according to MRI. Univariate and multivariate regression analyzes were performed using the Cox proportional hazards model, ROC analysis for statistically significant variables. Results. During the follow-up period (median was 16 months), an objective tumor response to treatment was recorded in 100% of cases. Secondary cataract after SRS developed in 4 (9.3%) cases, post-radiation retinopathy - in 9 (20.9%) cases, secondary retinal detachment - in 7 (16.3%) cases, secondary glaucoma - in 6 (14%) cases. After SRS during the observation period, the eyeball was preserved in 90.7% of patients. For the tumor volume parameter, the area under the curve was 0.92 (95% CI 0.84-1.00) with a cut-off point of 800 mm3. With a tumor volume less than this indicator, no cases of secondary glaucoma were detected. In the case of tumors with a volume equal to or greater than the calculated value, secondary glaucoma developed in 71% of cases. For the tumor thickness parameter, the area under the curve was 0.78 (95% CI 0.63-0.93) with a cut-off point of 7.6 mm. With a tumor thickness of less than 7.6 mm, the incidence of secondary glaucoma was 5% during the observation period, with a tumor thickness greater than this indicator - 72%. Conclusion. In the treatment of tumors with a volume of more than or equal to 800 mm3 and/or a thickness of more than or equal to 7.6 mm, radiosurgery as a monomethod is not recommended; it is necessary to resort to a combined method, including, along with SRS, tumor endoresection.

Primary intraocular lens implantation in infants with unilateral congenital cataract operated before 12 weeks of age

The aim of this study was to report visual outcome and safety after cataract surgery with primary intraocular lens implantation before 12 weeks of age. Infants with visually significant unilateral congenital cataract having primary IOL implantation in the capsular bag before 12 weeks of age in 2007-2016 were enrolled for a prospective study examination in 2017. The medical records were also reviewed. In total, 23 patients with a median age at cataract surgery of 32 days (range, 12-75 days) were included. Seventeen (74%) eyes had persistent foetal vasculature (PFV). After a median follow-up of 6.3 years (range, 1.4-10.9 years), the corrected distance visual acuity was 0.8 logMAR (range, 3.0-0.1 logMAR). All, except one eye, required surgery for visual axis opacification (VAO), with a median of two (range 0-5) additional surgical procedures. Four (17%) eyes developed secondary glaucoma. Cataract surgery with primary IOL implantation before 12 weeks of age resulted in a high number of VAO operations, and the visual outcome varied considerably, showing the range in outcome for this challenging patient group. Co-existent PFV in these young patients was common. The incidence of secondary glaucoma was similar to other studies, despite the young age at surgery, high percentage of PFV and number of surgical procedures for VAO.

Value of ocular trauma score in predicting the incidence of secondary glaucoma after closed globe injury.

To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment. We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed. The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced. The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.

Comparison of complications and visual outcomes between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for fungal keratitis.

To compare the postoperative complications and visual outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PK) for fungal keratitis (FK). This retrospective study included 94 cases of BB-DALK for FK and 161 cases of PK for FK from a tertiary ophthalmology care centre. The most common FK pathogens were Fusarium (n= 84, 32.9%) and Aspergillus (n= 67, 26.3%). The recurrence rates after BB-DALK and PK were 3.2 and 5%, respectively (p= 0.723). The follow-up duration was 31.9± 15.8months in the BB-DALK group and 33.9± 15.0months in the PK group. The immune rejection rate was significantly lower in the BB-DALK group than in the PK group (1.1 vs. 18.6%, p< 0.001), as was the incidence of secondary glaucoma (p= 0.018). Endothelial cell density in the BB-DALK group tended to be stable at postoperative month 6, whereas the PK group still attenuated at a hyper-physiological rate. Postoperative best-corrected visual acuity (BCVA) significantly improved in both groups (p< 0.001). No significant difference between-group was observed in BCVA, refractive cylinder, and spherical equivalent postoperatively. Big-bubble DALK is a useful and safe alternative to PK for medically uncontrolled FK.

Analysis of traumatic glaucoma in children

Objective To analyze the clinical characteristics of traumatic glaucoma in children. Methods This is a retrospective study.The data of 67 eyes of 67 cases with secondary glaucoma in 425 children with ocular trauma, aged 1 to 14 years, from Jan. 2014 to Dec. 2018 in First Affiliated Hospital of Zhengzhou University were analysed retrospectively. There were 52 eyes of 52 cases with secondary glaucoma caused by closed ocular trauma in closed ocular trauma group, and 15 eyes of 15 cases with secondary glaucoma caused by open ocular trauma in open ocular trauma group. The clinical characteristics, treatment methods and efficacy of treatment of the two groups were analyzed. The follow-up time was 1 month- 2 years. Results There were 251 cases of closed ocular trauma and 174 cases of open ocular trauma in children. The incidence of secondary glaucoma caused by closed ocular trauma (20.72%, 52/251) was higher than that of open ocular trauma (8.62%, 15/174), and the difference was statistically significant (χ2=11.323, P=0.001). The onset time of secondary glaucoma caused by closed ocular trauma was earlier than that of open ocular trauma. Hyphema (40.38%, 21/52) was the main cause of secondary glaucoma due to closed ocular trauma, and the mixed mechanism was the main cause of secondary glaucoma due to open ocular trauma (73.33%, 11/15). The two groups received conventional medicine first, and 22 cases (42.31%, 22/52) of closed ocular trauma group and 3 cases (20.00%, 3/15) in open ocular trauma group were converted to surgery because of lose control of IOP. The difference in surgery rate was not statistically significant between the two groups(χ2=2.477, P=0.116). At the last follow-up, the mean IOP of closed ocular trauma group was higher than that of open ocular trauma group (t=2.828, P=0.006). There was no statistical significance in BCVA between the two groups at the last follow-up (t=-1.244, P=0.218). Conclusion Secondary glaucoma caused by closed ocular trauma is more common than open ocular trauma. Treatment with medicine is still the first choice, but filtering surgery is an effective way to control secondary glaucoma with closed ocular trauma. Key words: Glaucoma, traumatic, children; Trauma, ocular, closed; Trauma, ocular, open

Twenty-three-gauge pars plana approach versus limbal approach for removal of congenital cataracts

Purpose To compare the 23-G vitrectomy system via pars plana approach with the limbal approach for the management of congenital cataract in Egyptian infants attending Mansoura Ophthalmic Center, Delta, Egypt. Patients and methods A total of 30 eyes of 21 infants with congenital cataract who attended Mansoura Ophthalmic Center, Egypt, were included. They were sorted out into two groups; each included 15 eyes. Group I underwent pars plana approach and group II underwent anterior limbal approach for phacoaspiration, posterior capsulorhexis, and anterior vitrectomy. Postoperative examination and follow-up results were recorded. Results There was significant statistical increase in mean duration of surgery in group I (59.27±12.69) than group II (39.93±9.04), with P value less than or equal to 0.001. There was no significant statistical difference in intraocular pressure values at preoperative period, at 1 week, 2 weeks, 1 month, 3 months, and 6 months postoperatively in the studied groups .There was no significant statistical difference in the incidence of visual axis opacification, secondary glaucoma, anterior chamber reaction, capsular phimosis, and wound leak between the two groups. However, there was a significant statistical increase in the incidence of preretinal hemorrhage in group I (26.7%, n=4) when compared with group II (0%, n=0), with P value of 0.032. There was no significant statistical difference in the incidence of secondary glaucoma during a 6-month follow-up period. Conclusion Posterior approach and anterior approach can be used safely for infantile cataract, and the application of the technique depends on surgeon experience and skills.

The relationship between inflammatory mediator expression in the aqueous humor and secondary glaucoma incidence after silicone oil tamponade.

The expression of inflammatory mediators in the aqueous humor and the incidence of secondary glaucoma after vitreous body resection combined with silicone oil tamponade for patients with retinal detachment were inestigated, and the roles of IL-17, IL-6 and TNF-α in secondary glaucoma after silicone oil tamponade were analyzed. Fifty-eight cases of retinal detachment treated by vitrectomy combined with silicone oil tamponade were examined at the time of silicone oil removal surgery. All patients underwent unilateral surgery. Patients were divided into observation (19 cases with) and control (39 cases without) groups depending on development of secondary glaucoma. Prior to silicone oil removal, expression levels of IL-17, IL-6 and TNF-α in the aqueous humor were examined. IL-17, IL-6 and TNF-α levels in the aqueous humor in the observation group were 204.2±18.3, 351.1±28.4 and 850.0±51.7 pg/ml, respectively, vs. 152.3±22.2, 254.4±26.8 and 625.6±61.2 pg/ml, respectively in the control group (P<0.001). The expression of IL-17 was positively correlated with those of IL-6 and TNF-α (r=0.687, 0.745; P<0.001). IL-17, IL-6 and TNF-α presented good diagnostic values for glaucoma. The receiver operating characteristic (ROC) areas were 0.957, 0.980 and 0.975, respectively (P<0.001). The expression of inflammatory mediators such as IL-17, IL-6 and TNF-α in the aqueous humor of patients with secondary glaucoma after silicone oil tamponade significantly increased relative to patients without secondary glaucoma. The resultant inflammation may be involved in the development of secondary glaucoma.

Penetrating Limbokeratoplasty for Gelatinous Corneal Dystrophy

Gelatinous corneal dystrophy is a very rare disease in Europe and North America. Patients suffer from pain, photophobia and loss of vision, usually before the age of 20. Transplantation of limbal stem cells was proposed due to the high rate of recurrence after conventional penetrating keratoplasty. We present the results of penetrating limbokeratoplasty, a combined transplantation of cornea and limbal stem cells, in patients with gelatinous corneal dystrophy. We present a series of 7 consecutive eyes with gelatinous corneal dystrophy, which were treated with penetrating limbokeratoplasty-4 eyes of 3 patients had already undergone multiple conventional corneal transplantations. We evaluated the follow-up regarding recurrences of the disease, graft rejections, clear graft survival and incidence of secondary glaucoma with the Kaplan-Meier method. Median age at surgery was 35 years. Postoperative treatment included topical steroids and systemic mycophenolate mofetil in all patients. Median graft survival was 6 years. Median time to a recurrence was 3 years. Median time to the first endothelial graft rejection was 2.5 years. Penetrating limbokeratoplasty offers a possibility to restore visual acuity over a long period of time. However, gelatinous corneal dystrophy remains a therapeutic challenge. Even with simultaneous transplantation of cornea and limbal stem cells, recurrences of the disease cannot be prevented permanently. This is also connected with discontinuing a sufficient local and systemic immunosuppression.

Incidence of secondary glaucoma after treatment of uveal melanoma with robotic radiosurgery versus brachytherapy.

Different modalities of radiation therapy nowadays allow for effective treatment of uveal melanoma combined with the advantage of eye preservation. However, this advantage can secondarily be impaired by radiation-related side effects. After local recurrence, secondary glaucoma (SG) has been described as second most frequent complication leading to need of enucleation. This study compares the incidence of SG after conventional Ruthenium (Ru)-106 brachytherapy (BT) versus CyberKnife robotic radiosurgery (RRS) which has been gaining importance lately as an efficient treatment option offering improved patient comfort. Medical records of all patients diagnosed with uveal melanoma in the Eye Clinic of the Ludwig-Maximilians-University Munich between 2007 and 2013 were reviewed. A total of 268 eyes of 268 patients treated with Ru-106 BT or CyberKnife-RRS as monotherapy were entered in this retrospective cohort study. Incidence of SG was correlated with treatment modality and baseline tumour characteristics. Fifty-three patients (19.8%) developed SG. At 5years, SG was significantly more frequent after RRS (46.7%) than BT (11.1%); however, tumour thickness (maximum apical height) as a marker of tumour progress was more pronounced in the RRS group. Subgroup analysis of 178 patients for tumours amenable to both BT and RRS (thickness ≤6mm) revealed comparable results at 3years (RRS: 13.8 versus BT: 11.2%), but a trend towards increased incidence after RRS beyond year three. However, this difference was not significant at 5years (28.2% versus 11.2%, p=0.138). Tumour thickness was significantly associated with incidence of SG. In tumours ≤6mm thickness, RRS and BT seem to offer a comparable safety profile in terms of SG. Beyond year three, SG was tendentially, but not significantly more frequent after RRS. Increasing tumour thickness is associated with risk of SG.

Cataract Management in Juvenile Idiopathic Arthritis: Simultaneous versus Secondary Intraocular Lens Implantation

Purpose: To compare primary versus secondary intraocular lens (IOL) implantation after cataract removal in patients with juvenile idiopathic arthritis (JIA).Methods: Retrospective interventional study. Data were obtained for 40 children (40 eyes) with JIA-associated uveitis operated on for cataract before the age of 16 years between January 1998 and January 2005.Results: Twenty-one patients underwent primary IOL implantation at a mean age of 13.1 ± 2.6 (9–16) years. Mean follow-up was 48.2 ± 5.4 (35–64) months. Nineteen patients underwent cataract removal at a mean age 12.3 ± 2.0 (9–16) years and secondary IOL implantation 13.6 ± 0.3 (11–16) months later. Mean follow-up was 47.2 ± 6.5 (32–64) months. BCVA difference between the two groups was significant at 24-month visit only (p = 0.001). Incidence of secondary glaucoma was significantly lower in the group that underwent secondary IOL implantation (p = 0.01).Conclusion: Secondary IOL implantation after cataract removal in children with JIA-related uveitis provided a significantly lower incidence of secondary glaucoma.

Hyphema due to blunt injury: a review of 118 patients.

To determine the causes, associated ocular findings and visual acuity on presentation, complications and visual outcome following treatment in patients of hyphema due to blunt injury A retrospective study was performed in 118 patients with hyphema due to blunt injury admitted in University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The gender, age, race, cause of blunt injury resulting in hyphema, eye involved, vision at admission, other associated ophthalmological findings, complications and visual outcome were noted from the case records of patients. The data were analyzed using SPSS programme. Males were more predominantly affected (93.2%). Two-thirds of patients (67.8%) were aged below 30 years. Sports related injury (38.1%) was the most common cause for hyphema. Hyphema disappeared within 5 days in 66.9% of patients. Iris injuries were very commonly associated in the form of mydriasis, sphincter tear and iridodialysis. Associated vitreous haemorrhage was noted in 11.9% of patients. During the hospital stay, secondary haemorrhage was observed in 3.4% of patients. The best corrected vision of 6/18 or better was noted in 85.4% of patients at the last follow-up. The follow-up of these subjects was very poor and thus the incidence of secondary glaucoma could not be established. Moderate blood staining of cornea occurred in 0.8% of patients. Sports related injury is the most common cause of hyphema in Malaysia. Good visual recovery, without serious complications, is possible with appropriate and in-time treatment in hyphema patients due to blunt injury.

Glaukom und Keratoplastik

Glaucoma and corneal disorders are often associated and are of diagnostic, therapeutic and prognostic relevance for each other. Glaucoma is already present in approximately 15% of eyes prior to keratoplasty, whereas in addition approximately 15% of cases are diagnosed following corneal transplantation. Corneal opacities, surface irregularities and pachymetric deviations from the norm can have a negative impact on tonometry, perimetry and morphological glaucoma diagnosis. Digital and intracameral tonometry as well as flash VEP to determine the visual potential can be helpful in this setting. Increased intraocular pressure (IOP), long-term application of antiglaucomatous medication or the use of antimetabolites in glaucoma surgery can all induce keratopathy. Therefore, intraocular pressure should be regulated prior to corneal transplantation. Risk factors for the evolution of glaucoma following corneal transplantation are the specific indication and surgical technique (e. g. combined corneal and cataract/vitreoretinal surgery), as well as postoperative steroid application and chamber angle synechiae. Unpreserved glaucoma medication without pro-inflammatory effects should be preferred following keratoplasty. In the long term surgery to control IOP is required in approximately 25% of eyes. The wider use of lamellar techniques for corneal transplantation is likely to reduce the incidence of secondary glaucoma.

Large-Diameter Penetrating Keratoplasty: Indications and Outcomes

To report the indications and outcomes of patients who underwent large-diameter penetrating keratoplasty (LDPK) for the management of peripheral corneal disease. A retrospective chart review and data analysis of patients who underwent LDPK was performed. A retrospective chart review of 35 eyes of 32 patients undergoing LDPK between May 2000 and December 2006 at the Cincinnati Eye Institute/University of Cincinnati was completed. Corneal grafts 8.75 mm or larger were designated as large grafts. Graft diameter ranged from 8.75 mm to 10.0 mm. Indications for cornea transplantation included keratoconus (19), pellucid marginal degeneration (two), keratoconus and pellucid marginal degeneration (five), Fuchs endothelial dystrophy (one), corneal stromal scar (one), postradial keratotomy irregular astigmatism (two), and repeat penetrating keratoplasty (five). No evidence of preoperative stromal neovascularization was seen in any eye. Five of 35 eyes had experienced one previous graft failure. Minimum follow up was 12 months (range, 12-91 months) with a mean follow up of 29.8 months. Preoperative best-corrected visual acuity was 20/100 (range, 20/25 to hand movements), and postoperative best-corrected visual acuity was 20/32 (range, 20/20-20/125). Postoperatively, 43% of patients had 20/40 or better uncorrected visual acuity. Average postoperative manifest cylinder was +2.19 D (range, none to +4.75 D) with 77% of patients having less than +3.00 D of cylinder. The postoperative immunosuppression regimen included topical corticosteroid and topical cyclosporine 0.05%. The incidence of cataract formation in our study was 14.2%. The incidence of secondary glaucoma was 8.8%. Cornea graft rejection was noted in six of 35 eyes with resolution in 4/6. Repeat cornea transplant was required in one of six eyes for severe infectious keratitis, and one of six eyes was lost to follow up. At last follow up, 33 of 35 original grafts were clear with one graft lost to follow up and one eye requiring repeat keratoplasty. No graft rejection was experienced by any patient with a history of prior graft failure. LDPK may result in less postoperative astigmatism without an increased risk of graft failure if managed correctly postoperatively. Topical cyclosporine 0.05% may be a useful adjunct to decrease the incidence of graft rejection and failure. Ophthalmologists performing penetrating keratoplasty should consider a LDPK to reduce postoperative astigmatism and improve visual acuity outcomes in their patients.

Comparison of patients with Behçet's disease in the 1980s and 1990s

Objective To compare clinical findings in patients with Behçet's disease (BD) seen in 2 different decades (1980s and 1990s) to determine if there has been a shift toward the appearance of less severe disease. Design Retrospective, comparative case series. Participants Two hundred forty patients with uveitis caused by BD who had their first visit and at least a 4-month follow-up at the uveitis clinic of University of Tokyo Hospital between January 1980 and December 1999 were enrolled. Methods Patients were divided into 2 groups according to the date of the first visit. The clinical profiles were then compared between the 1980s group (133 patients, observed for 33.5±26.4 months) and the 1990s group (107 patients, observed for 46.9±32.6 months). Main outcome measures Number of ocular attacks per year, visual outcomes, and the percentage of patients who had cyclosporine or cyclophosphamide therapy. Results Age of onset, type of inflammation, incidence of secondary glaucoma, and surgical history of glaucoma and cataract did not differ between the 1980s and the 1990s. Conversely, in patients in the 1990s, the number of ocular attacks per year and the percentage of patients with cyclosporine or cyclophosphamide therapy decreased significantly. Furthermore, the percentage of eyes with good visual acuity (VA) (≧20/30) increased, and the percentage of eyes with poor VA (<20/200) decreased significantly at both the first and the last examinations. There was a trend for less bilateral disease and fewer genital ulcers in the 1990s as well. Conclusions Through a study of Japanese patients, we confirmed that the clinical outcomes of BD, especially judging by the number of ocular attacks per year and VA, indeed improved during the 1990s.

Nordic research in ophthalmology.

To provide an overview of some of the current activities in eye research in the Nordic countries. The presentations at the biannual Nordic Congress of Ophthalmology, held in Tampere, Finland in 2002, were reviewed and the contributions found most noteworthy are included in this article along with a limited discussion of each research field. However, space requirements prevented the inclusion of many interesting scientific contributions. Important contributions in various subfields of eye research and ophthalmology are reviewed. These include cornea, cataract, paediatric ophthalmology, glaucoma, diabetic eye disease, age-related macular degeneration, physiology and pharmacology and oncology. Eye research is very active in the Nordic countries and significant contributions are being made to ophthalmology in several fields on a world scale. We hope to continue to review Nordic contributions to eye research after each Nordic Congress of Ophthalmology and plan to make the reviews more systematic and comprehensive in the future.