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  • ISSN: 2333-6447
    Volume 5, Issue 2
    Short Communication
    Don Minckler*
    Traditional surgical methods in adults with open-angle glaucomas in which medical and or laser therapy fail include trabeculectomy with adjunctive anti-fibrotics or aqueous shunts. In pediatric cases, goniotomy, trabeculotomy or shunts are employed. While often effective methods to transiently control intraocular pressures, all these surgeries are relatively destructive to ocular anatomy and fraught with complications including rapid failure, conjunctival scarring, and especially wound leaks in adults receiving adjunctive anti-fibrotics during or after trabeculectomy, of great concern due to risk of late infection. New and evolving methods of minimally invasive glaucoma surgery (MIGS) are likely to greatly simplify glaucoma surgery with equivalent or satisfactoryintraocular pressure (IOP) control and far fewer complications. The so-far FDA approved procedures include Trabectome (NeoMedix 2004), and iStent (Glaukos Corporation 2012). Other devices under development include the AquaSys Implant (Allergan) and the CyPass MicroStent (Transcend Medical).
    Sergei Alpatov*
    Background or Purpose: To evaluate the effect of pars plana vitrectomy (PPV) combined with joining of the hole edges on the closure of full-thickness macular holes.
    Methods: clinical interview of surgeon. Various types of macular holes treatment are discussed.
    Conclusions: Mechanical joining and compression of the retinal edges during surgery for Stage 3 or 4 idiopathic macular holes appears to yield a promising anatomical and functional result.
    Case Report
    Arwa Azmeh*
    Aim: To report a case of acute visual loss at the time of intravitreal bevacizumab injection, with exacerbation of chronic kidney disease
    Methods: A 79 –years- old male, had acute visual loss to hand motion HM immediately at the time of intravitreal bevacizumab injection for age related macular degeneration AMD, which progressed to no light perception NLP one hour later. Intraocular pressure measurements IOP and fundus examinations were done at the time of injection, 1 hour, 1 day, 1 week and 1 month post injection. Carotid Doppler imaging CDI was performed 1 day post injection. B scan ultrasonography and OCT were done at follow-ups.
    Results: Patient's IOP was normal at the time of injection, 1hour, 1day, 1 week and 1 month post injection, with continued perfusion of central retinal artery CRA and normal appearance of optic disc. At 1 day post injection retinal and subretinal hemorrhages around posterior pole were noticed, with exudative macular detachment.1 week later macular detachment resolved and at 1 month macula became extensively atrophic. Final visual acuity was NLP. CDI revealed atherosclerotic changes on both sides. 1 month post injection patient had an acute attack of chronic kidney failure.
    Discussion: Visual loss was thought to be caused by choriocapillaries occlusion secondary to intravitreal bevacizumab. Exacerbation of chronic kidney disease was caused by reduction in systemic VEGF levels post intravitreal bevacizumab.
    Conclusion: Possible effects of intravitreal bevacizumab on systemic, retrobulbar and ocular circulation should always be kept in mind when facing unexplained acute visual loss post injection.
    Shen J* and Spors F
    Myopia is an ophthalmic condition in which the refractive power of the eye is too strong relative to its length. In general, myopia is differentiated into refractive and axial myopia, with the latter being the more common condition. In this situation the eye is axially elongated, which is associated with increased risk of ocular diseases. Worldwide the prevalence rates of myopia are continuously rising. Currently, every 1 out of 3 adults in the United States is myopic [1].
    Case Report
    Adam B. Jacobson, Thaddeus L. Wandel, and Alan D. Springer*
    Purpose: Foveal hypoplasia is described as an absent or shallow pit, thickened inner retina, shortened outer segments, and an increased retinal thickness. Bilateral foveal hypoplasia is often associated with other ocular comorbidities, including albinism, aniridia, microphthalmia, and retinopathy of prematurity. We are reporting a case of unilateral isolated foveal hypoplasiain an adult, using high resolution Cirrus OCT raster scans.
    Observations: The scan showed a patient with an epiretinal membrane, no evidence of macular edema, and an absent foveal pit in one eye. The scan also revealed thick inner retinal laminae overlying a fovea externa with outer segments that had normal lengths, not normally seen in uncomplicated cases of epiretinal membranes.
    Conclusions: A macular epiretinal membrane (ERM), rippling of the retina under the ERM, and an absent foveal pit are usually interpreted as being caused by traction and edema. Quantitative analysis of the OCT suggests that this patient should be diagnosed as having unilateral foveal hypoplasia that is independent of the ERM. High resolution scans (4,096 A-scans/B- scan) can help distinguish macular edema from foveal hypoplasia.
    Guadilla AM*, Rodriguez M, Modamio-Gardeta L, Martín, Ancochea G, Del Barrio I, Orduña-Azcona J, Rodriguez C, Gonzalez M, Iniesta J, and Mínguez N
    Introduction: Best's vitelliform maculopathy is an autosomal dominant macular dystrophy associated to a mutation in the bestrophin-1 (BEST1) gene. There are some recessive inherited cases called autosomal recessive bestrophinopathy (ARB).
    Case presentation: We present a case of a 5 year old boy with hyperopia and accommodative esotropia. Best corrected visual acuity was 100/200 in the right eye (RE) and 80/200 in the left eye (LE). He only had one great-grandfather who became blind in late childhood as relevant family history. Biomicroscopic fundus examination revealed yellowish deposits in the macular region and mid periphery, subfoveal serous detachment and retinal pigment epithelium (RPE) irregularities in both eyes.
    Discussion: ARB is an unusual, early-onset maculopathy, with autosomal recessive inheritance pattern, in contrast to Best's classical dominant disease. ARB patients present retinal deposits and RPE irregularities, hyperopia and swallow chamber. Strabismus may be associated and surgery might be required in some cases. The diagnosis of suspicion is based on clinical ophthalmological examination, family history and electro-oculogram (EOG) test, but should be confirmed by genetic studies.
    Short Communication
    Peter R. Greene* and Vladimir Medved
    Purpose: An AC – DC series electrical circuit is developed to simulate myopia progression R = R(t) [diopters], as the accumulated negative voltage at the series capacitor, with voltage Vc = V(t) [volts] representing the refractive error R(t) [diopters].
    Methods: This circuit is an analogue computer which automatically solves 1st order system response equations for refractive status progression as a function of time, R(t). The new system voltage level is approached exponentially, typically with a time constant τ = RC = 60 to 100 days.
    Results: This analogue computer technique is a general result, and can incorporate any combination of initial refraction R(0), refractive correction R1, and daily near-point demand - dR(t) to the visual system. As an example, the initial conditions for the subject's myopia are specified at Vc = - 5.0 volts DC [R(0) = - 5.00D], with an applied negative square-wave varying from 0 to -3.0 volts AC, representing a typical daily accommodative near work demand.
    Conclusions: In terms of practical applications, positive +Add reading glasses, bifocals, and progressive addition lenses (PALs) have the effect of optically neutralizing the near-point environmental demands, stabilizing the negative system drift towards progressive myopia.
    Research Article
    Mamatha Manne, Padma Gunda, and Padma Tirunilai*
    Exposure to UV is one of the major risk factor for the development of age related cataracts (ARCs). UV filters present in lens protect the lens and retina from UV induced photo-damage and obstruction of normal vision. UV filters are produced by Kynurenine pathway, wherein Indoleamine 2,3-dioxygenase (IDO) is the first rate limiting enzyme. So, the present study was conducted for the first time to screen for the genetic variants of IDO gene causing different types of ARCs.
    331 cases [110- Nuclear (NC); 110- Cortical (CC) and 111- Posterior subcapsular cataracts (PSC)] and 210 normal individuals were screened by SSCP, Sequencing and RFLP techniques. In silico analysis was carried out using different bioinformatic tools.
    The study revealed 2 novel (c.596_597delinsTT in exon 7; c.822C>T in exon 9) and 2 known (c.422+90G>A in intron 4; -/CAA del in intron 8) variants in exon and exon-intron boundaries of IDO gene. Further, 2 novel (c.-979 G>A& c.-471 T>G) and 1 Known (c.-738 A>G) variants were detected in promoter region, affecting the transcription factor binding sites in-silico. The known c.422+90G>A variant having destructive effect on enhancer sites was found in 6 patients (3 NC and 3 PSC) and novel variant (c.596_597delinsTT) in exon 7 of IDO was found in 2 cases (1NC and 1CC), with a probable damaging effect on protein in-silico. CAA deletion in intron 8 was found to be polymorphic, showing 2 fold risk for developing PSC. Exon 9 c.822C>T variant detected only in controls was a silent mutation.
    The variants associated with ARCresultsin the alteration of the structure and function of IDO protein–a vital component required for normal synthesis and action of UV filters involved in maintaining lens transparency and clear vision. Further studies in this line would confirm the role of IDO gene in developing ARCs.
    Special Issue on Eye & Contact Lens
    Research Article
    Yasuyo Nishi, Kazuno Negishi*, Kazuhiro Watanabe and Kazuo Tsubota
    Purpose: To determine the optimal design for pinhole type contact lenses (PCLs) without refractive power for obtaining a full range of resolution (clear vision) from far to near using a visual simulation system.
    Methods: The PCLs had a 6.0-mm diameter black opaque central zone with varying clear central zones. The total diameter and the base curve of the PCL were 14.0 mm and 8.5 mm, respectively. The visual simulation system consisted of a model eye and a charge-coupled device camera. The different PCLs were placed in front of the model eye and evaluated. Visual simulations were performed using this system at 5, 1, and 0.3 meters through a 3-mm aperture using Landolt visual acuity (VA) charts with different PCLs (clear central zone sizes, 2.0, 1.8, 1.6, 1.4, and 1.2 mm). The contrast levels of the gaps of the Landolt VA charts in the simulated images were analyzed using Photoshop software to determine the optimal PCL design.
    Results: The PCL's with a1.2-mm and 1.4-mm clear central zone maintained the best resolution and contrast of the simulated images for all distances. Conclusions: Our results suggested that a PCL without refractive power might be useful to obtain a full range of vision from far to near if designed optimally.
    Review Article
    Madhu Dyavaiah*, Phaniendra. A and Sudarshan. SJ2
    Contact lens (CL) wear is a common predisposing factor of microbial keratitis (MK). MK in CL wearers is a potentially sight-threatening corneal infection. The causative organism in all MK varies by geographical location and predisposition factors. The most commonly recovered causative organism in CL related MK is bacteria followed by fungi and Acanthamoeba. This review focuses on the incidence and causative organisms of MK in CL wearers. Awareness of contributory risk factors of MK in CL wearers is important to follow safer lens wear modalities and hygiene regimes to avoid possible infection. In developed nations, most MK in contact lens wear is by bacterial origin, whereas fungus is the leading causative agent in developing countries. The most common pathogens implicated in bacterial keratitis are Staphylococci and Pseudomonas. Some of the fungi that commonly cause fungal keratitis include Fusarium, Aspergillus and Candida species. Acanthamoeba keratitis is also a growing clinical problem both in developed and developing countries.
    Special Issue on Amblyopia and Strabismus
    Research Article
    Jamie C. Ho*, Yi Pang, Mai Ngoc Luu
    The association between amblyopia depth and amount of anisometropia remains controversial. Deeper amblyopia is generally associated with a larger magnitude of anisometropia; however, there are also many observed cases of deep amblyopia despite small amounts of anisometropia. The current standard of care in amblyopia treatment is based primarily on past research conducted on hyperopic participants. Our retrospective study reviewed the visual outcomes for forty eligible patients, ages 3-18 years old, with anisometropic amblyopia that were categorized into hyperopic, myopic, and astigmatic refractive groups. Analysis of variance comparatively analyzed the baseline and final acuity achieved by the three refractive groups. All patients responded to treatment with a group mean ( SD) inter ocular acuity improvement of 0.28 0.20 log MAR. There was no statistical significance in amount of improvement achieved among the three groups. Final inter ocular acuity difference was strongly correlated to baseline inter ocular acuity difference (p<0.0001, r=0.79). Amblyopia depth was correlated with magnitude of anisometropia in the hyperopia group (P=0.02, r=0.51), but not the myopic group (P=0.27, r=0.32). The implication of differing refractive etiology in amblyogenesis is a topic that requires further study. Still our results provide evidence that therapeutic treatment should be provided for all anisometropic amblyopes since all groups, regardless of refractive nature, were able to achieve comparable visual outcomes.
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