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Background: This study aims to evaluate and compare central foveal thickness (CFT) changes after cataract surgery between normal and diabetic patients without retinopathy, using optical coherence tomography (OCT)., Patients and Methods: Ninety-eight patients (49 patients with type 2 diabetes and 49 healthy controls, sex- and age-matched) undergoing phacoemulsification in one eye were included. The presence of retinopathy was an exclusion criterion. The OCT examination was performed preoperatively as well as one, three, six and twelve months postoperatively. CFT was evaluated and compared between groups., Results: Preoperative CFT showed no significant difference between the two groups (normals: 205 ± 18 μm vs. diabetics: 202 ± 23 μm, p > 0.1). Postoperative CFT in diabetics at all time-points of the follow-up period was significantly increased when compared to controls (first month, normals: 215 ± 28 μm vs. diabetics: 262 ± 33 μm, p < 0.05; third month, normals: 211 ± 19 μm vs. diabetics: 250 ± 27 μm, p < 0.05; sixth month, normals: 208 ± 12 μm vs. diabetics: 266 ± 13 μm, p < 0.05; and twelfth month, normals: 209 ± 13 μm vs. diabetics: 280 ± 11 μm, p < 0.05). The incidence of cystoid macular edema (CME) was 4.0 % and 28.6 % for the control group and the diabetic group, respectively, at the end of the follow-up period (p < 0.05)., Conclusion: Eyes of diabetic patients without retinopathy present higher CFT and a higher incidence of CME after cataract surgery on OCT examination compared to eyes of healthy controls. This may explain the unsatisfactory visual acuity following cataract surgery in these patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The purpose of this study is to describe the experience of Jules Gonin Eye Hospital on the long-term outcome of anti-TNF-alpha therapy in chronic non-infectious uveitis., Patients and Methods: We identified and followed those patients with chronic non-infectious uveitis who received systemic anti-TNF-alpha therapy. Anti-TNF-alpha therapy was administered when no response had been obtained with classical immunosuppressive therapies or in the presence of severe rheumatoid disease., Results: Fifteen patients (28 eyes), 7 male and 8 female (mean age, 43 years; range: 7 to 70 years) were identified. Diagnoses included HLA-B27-associated anterior uveitis (n = 4), sarcoidosis (n = 2), juvenile idiopathic arthritis (n = 2), idiopathic retinal vasculitis with uveitis (n = 2), pars planitis (n = 2), Adamantiades-Behçet disease (n = 1), birdshot retinochoroidopathy (n = 1), and Crohn's disease (n = 1). Mean duration of ocular disease was 8 years (range: 1 to 29 years). Treatment with infliximab (n = 11), etanercept (n = 2), or adalimumab (n = 2) was initiated. One patient with etanercept was switched to infliximab due to lack of clinical response. Clinical and angiographic regression of uveitis was observed within the first two months of therapy in all patients, and was maintained throughout the entire follow-up period (mean 18 months; range: 3 - 72 months). Recurrence was observed in 3 patients, and resolved after adjustment of therapy. Adverse events were recorded in only one patient (arterial hypotension)., Conclusions: In this series of patients with chronic non-infectious uveitis, anti-TNF-alpha therapy was effective and safe. Further clinical studies are needed to determine an adequate duration of therapy.

Background: This study aims to evaluate the outcome of primary vitrectomy/gas for pseudophakic retinal detachment (RD) located inferiorly or associated to inferior breaks., Patients and Methods: We performed a retrospective, non-randomised study comprising 18 pseudophakic RD eyes with inferior RD (group A) and 19 pseudophakic RD eyes with inferior breaks (group B) treated with primary vitrectomy and gas tamponade (SF (6) 20 %). Pre- and postoperative characteristics were analysed, focusing on RD recurrences., Results: In group A, RD recurred in 2/18 eyes (11 %) and was associated to proliferative vitreoretinopathy (PVR) both at first intervention and on recurrence. In group B, RD recurred in 4/19 eyes (21 %). One eye presented PVR at first intervention and all at re-intervention. Anatomic reapplication was achieved after second vitrectomy/gas in 2/4 eyes of group B, whereas long-term silicon oil tamponade was needed in 2 eyes of each group., Conclusions: This series shows a high success rate of primary vitrectomy/gas in pseudophakic RD patients with inferior RD or detachment associated to inferior breaks. Recurrences after vitrectomy are most often related to the presence of PVR.

Background: The purpose of this study was to present the outcomes of intraocular lens exchange in patients with opacified hydrophilic acrylic intraocular lenses., Patients and Methods: Fifteen patients, who underwent uncomplicated phacoemulsification and hydrophilic acrylic intraocular lens (model SC600-2) implantation with good visual recovery, were re-referred to our department 76 - 188 weeks post-surgery due to progressive visual loss resulting from opacification of the implant. Intraocular lens exchange followed. The method of lens exchange is described. The effect on the best corrected visual acuity and on their refraction, the operative and postoperative complications are reported., Results: All 15 patients underwent intraocular lens exchange. Twelve patients (80 %) had improvement of their best corrected visual acuity, in two cases (13 %) the best corrected visual acuity did not change, and in one case (7 %) the best corrected visual acuity deteriorated, this being attributed to progression of her age-related macular degeneration. None of the patients developed zonular dehiscence; in one patient the exchange was complicated with posterior capsule rupture, and an anterior chamber intraocular lens was implanted. One patient required cutting of the haptics before removal of the opacified intraocular lens. The mean Snellen (decimal) visual acuity was 0.35 (range 0.1 to 0.6) before lens exchange and 0.49 (range 0.1 to 0.6) six weeks after; the difference was significant (P < 0.05). Excluding the patient with the deterioration of her age-related macular degeneration, mean visual acuity of the remaining fourteen patients after the intraocular lens exchange was even better (0.56)., Conclusion: Exchange of opacified hydrophilic acrylic intraocular lenses seems to be the only currently available effective treatment, leading to improvement of visual acuity.

Background: This study aims to compare the frequency of intraoperative and postoperative complications between the modern phacoemulsification technique and the extracapsular cataract extraction technique in patients with pseudoexfoliation syndrome., Patients and Methods: A prospective randomized study comprised 94 eyes with cataract, pseudoexfoliation syndrome, small pupil and slight to moderate phacodonesis. These eyes were randomly assigned into two groups. In the first group all patients (47 eyes) were operated on using a standard phacoemulsification technique (iris hooks, anterior capsule staining and capsular tension ring after capsulorhexis), while in the second group all patients (47 eyes) underwent a classic extracapsular cataract extraction. The main outcome measures were the frequency of intraoperative zonular tears, capsular rupture, vitreous loss and corneal edema, as well as the best-corrected visual acuity., Results: Intraoperative zonular separation was recorded in one eye (2.1 %) and in 15 eyes (31.9 %) for the first and second groups, respectively (P < 0.001). Posterior capsule rupture with or without zonular separation occurred in two eyes (4.2 %) of the first group and in eight eyes (17.0 %) of the second group (P < 0.05). Vitreous loss also had a higher rate in the second group (17.0 % versus 4.2 %, P < 0.05). The postoperative difference in best-corrected visual acuity was also significant between the two groups, being higher in patients operated on using phacoemulsification technique (P < 0.001)., Conclusions: In the difficult cases of cataract associated with pseudoexfoliation syndrome, small pupil and phacodonesis, the modern small-incision cataract surgery provides better results with a low rate of intraoperative and postoperative complications when compared with the extracapsular cataract extraction technique.

Background: The purpose of our study was to evaluate the variations of the optic disc PO (2) during normoxia and hyperoxia (100 % O (2)), before and after intravenous administration of acetazolamide., Material and Methods: PO (2) measurements were obtained at intervascular areas of the optic disc in 11 anaesthetized miniature pigs using oxygen-sensitive microelectrodes introduced through the vitreous cavity by a micromanipulator. PO (2) was measured continuously during 10 minutes under systemic normoxia and systemic hyperoxia. Oxygen measurements were repeated under these conditions after intravenous injection of acetazolamide (bolus of 500 mg) in 8 animals., Results: In systemic hyperoxia, the optic disc PO (2) increased moderately (DeltaPO (2) = 4.7 +/- 2.5 mmHg; p < 0.001; n = 11) in parallel with systemic PaO (2). Acetazolamide led to a slow and progressive increase in the optic disc PO (2) (DeltaPO (2) = 2.1 +/- 1.7 mmHg; p > 0.1; n = 8 after 10 min, while DeltaPO (2) = 4.3 +/- 3.2 mmHg; p < 0.05; n = 8 after 30 min), in parallel with a slow and progressive increase in systemic PaCO (2). The optic disc PO (2) increased much more significantly after injection of acetazolamide under systemic hyperoxia (DeltaPO (2) = 13.3 +/- 3.1 mmHg; p < 0.001; n = 8)., Conclusions: Systemic hyperoxia alone is not sufficient to increase substantially the optic disc PO (2) in miniature pigs due to a vasoconstrictor effect. Intravenous injection of acetazolamide can increase the optic disc PO (2) progressively, due to a vasodilatory effect of elevated systemic PaCO (2). The association of acetazolamide injection with systemic hyperoxia can further improve the oxygenation of the optic disc.