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Janssens R, van Rijn LJ, Eggink CA, Jansonius NM, Janssen SF. Ultrasound biomicroscopy of the anterior segment in patients with primary congenital glaucoma: a review of the literature. Acta Ophthalmol 2021; 100:605-613. [PMID: 34939345 DOI: 10.1111/aos.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/07/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE Primary congenital glaucoma (PCG) is a form of childhood glaucoma caused by maldevelopment of the anterior chamber. Disease severity differs greatly amongst patients. Ultrasound biomicroscopy (UBM) is a non-invasive technique that can visualize the anterior segment in infants in vivo. The purpose of this narrative review is to make an overview of the UBM data in PCG and study the applicability of UBM in characterizing the disease. METHODS An online search was performed on PubMed in December 2020. After a critical appraisal of the included articles, study and patient characteristics were summarized. The UBM measurements of the anterior segment in PCG of the different studies were analysed. RESULTS Six studies were included in this review. All were cross-sectional prospective studies. A total of 221 PCG eyes were examined. PCG eyes showed a larger trabecular iris angle, decreased iris thickness, narrower or absent Schlemm's canal and an increased zonular length compared to controls. Abnormal tissue membrane covering the trabecular meshwork and abnormal insertion of the iris and ciliary process were frequently found. The success rate of glaucoma surgery depended on the severity of anterior segment malformations found with UBM. CONCLUSION Malformations of the anterior segment in PCG can be demonstrated by UBM in vivo. This imaging can help to characterize disease severity and might support surgical treatment decisions.
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Affiliation(s)
- Robin Janssens
- Department of Ophthalmology Amsterdam University Medical Center location VUmc Amsterdam The Netherlands
| | - Laurentius J. van Rijn
- Department of Ophthalmology Amsterdam University Medical Center location VUmc Amsterdam The Netherlands
- Department of Ophthalmology OLVG Hospital Amsterdam The Netherlands
| | - Cathrien A. Eggink
- Department of Ophthalmology Radboud University Medical Center Nijmegen The Netherlands
| | - Nomdo M. Jansonius
- Department of Ophthalmology University Medical Center Groningen Groningen The Netherlands
| | - Sarah F. Janssen
- Department of Ophthalmology Amsterdam University Medical Center location VUmc Amsterdam The Netherlands
- Department of Ophthalmology Dijklander Hospital Hoorn The Netherlands
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Oliveira dos Santos C, Hanemaaijer NM, Ye J, van der Lee HAL, Verweij PE, Eggink CA. Chlorhexidine for the Treatment of Fusarium Keratitis: A Case Series and Mini Review. J Fungi (Basel) 2021; 7:255. [PMID: 33805369 PMCID: PMC8066532 DOI: 10.3390/jof7040255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Fungal keratitis is difficult to treat, especially Fusarium keratitis. In vitro studies show that chlorhexidine could be an interesting option as monotherapy. We describe a case series of four patients (four eyes) with Fusarium keratitis at Radboud University Medical Center (Nijmegen, the Netherlands). The patients were treated with chlorhexidine 0.02% eye drops. The in vitro activity of eight antifungals and chlorhexidine was determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth microdilution method. We also reviewed the literature on the use of chlorhexidine in the treatment of fungal keratitis. Topical chlorhexidine was well tolerated, and all patients showed complete resolution of the keratitis upon treatment with chlorhexidine. A PubMed search of the available literature was conducted (last search 8 March 2020) and yielded two randomized clinical trials (natamycin versus chlorhexidine) and one case report addressing the treatment of fungal keratitis with chlorhexidine. Chlorhexidine was found to be safe with regard to toxicity and to be superior to natamycin in the clinical trials. Chlorhexidine showed in vitro fungicidal activity against Fusarium and clinical effectiveness in our cases, supporting further clinical evaluation. Advantages of chlorhexidine are its topical application, its general availability, its low costs, its broad-spectrum activity, and its fungicidal mechanism of action at low concentrations.
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Affiliation(s)
- Claudy Oliveira dos Santos
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.M.H.); (H.A.L.v.d.L.); (P.E.V.)
- University Medical Center, Department of Medical Microbiology, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Nicolien M. Hanemaaijer
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.M.H.); (H.A.L.v.d.L.); (P.E.V.)
| | - Jelina Ye
- Department of Ophthalmology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.Y.); (C.A.E.)
| | - Henrich A. L. van der Lee
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.M.H.); (H.A.L.v.d.L.); (P.E.V.)
| | - Paul E. Verweij
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.M.H.); (H.A.L.v.d.L.); (P.E.V.)
| | - Cathrien A. Eggink
- Department of Ophthalmology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.Y.); (C.A.E.)
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Trzcionkowska K, Vehmeijer WB, Kerkhoff FT, Bauer NJ, Bennebroek CA, Dijk PH, Dijkman KP, Dungen FA, Eggink CA, Feenstra RP, Groenendaal F, Heijst AF, Hoeven MA, Kornelisse RF, Kraal‐Biezen E, Lopriore E, Onland W, Renardel de Lavalette VW, Rijn LJ, Schuerman FA, Simonsz HJ, Voskuil‐Kerkhof ES, Witlox RS, Termote JU, Schalij‐Delfos NE. Increase in treatment of retinopathy of prematurity in the Netherlands from 2010 to 2017. Acta Ophthalmol 2021; 99:97-103. [PMID: 32701185 PMCID: PMC7891652 DOI: 10.1111/aos.14501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
Purpose Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. Methods Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1‐1‐2010 to 31‐3‐2013 and P2: 1‐4‐2013 to 31‐12‐2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. Results Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1‐fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born <25 weeks increased by factor 1.23 and higher oxygen saturation levels were aimed at in most centres. At treatment decision, 59.6% (P1) versus 83.5% (P2) (p = 0.263) infants were classified as Type 1 ROP (ETROP classification). Infants were treated with laser photocoagulation (98 versus 96%) and intravitreal bevacizumab (2 versus 4%). Retreatment was necessary in 10 versus 21 (p = 0.160). Retinal detachment developed in 6 versus 13 infants (p = 0.791) of which 2 versus 6 bilateral (p = 0.599). Conclusion In period 2, the number of infants treated according to the ETROP criteria (Type 1) increased, the number of ROP treatments, retinal detachments and retreatments doubled and the absolute number of retinal detachments increased. Neonatal data did not provide a decisive explanation, although changes in neonatal policy were reported.
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Affiliation(s)
| | | | | | | | | | - Peter H. Dijk
- University Medical Center Groningen Groningen Netherlands
| | | | | | - Cathrien A. Eggink
- Radboud University Medical Center – Amalia Children’s Hospital Nijmegen Netherlands
| | | | | | - Arno F. Heijst
- Radboud University Medical Center – Amalia Children’s Hospital Nijmegen Netherlands
| | | | | | | | | | - Wes Onland
- Amsterdam University Medical Center Amsterdam Netherlands
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Oliveira Dos Santos C, Kolwijck E, van Rooij J, Stoutenbeek R, Visser N, Cheng YY, Santana NTY, Verweij PE, Eggink CA. Epidemiology and Clinical Management of Fusarium keratitis in the Netherlands, 2005-2016. Front Cell Infect Microbiol 2020; 10:133. [PMID: 32318355 PMCID: PMC7146074 DOI: 10.3389/fcimb.2020.00133] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Recognizing fungal keratitis based on the clinical presentation is challenging. Topical therapy may be initiated with antibacterial agents and corticosteroids, thus delaying the fungal diagnosis. As a consequence, the fungal infection may progress ultimately leading to more severe infection and blindness. We noticed an increase of fungal keratitis cases in the Netherlands, especially caused by Fusarium species, which prompted us to conduct a retrospective cohort study, aiming to describe the epidemiology, clinical management, and outcome. Materials and Methods: As fungi are commonly sent to the Dutch mycology reference laboratory for identification and in vitro susceptibility testing, the fungal culture collection was searched for Fusarium isolates from corneal scrapings, corneal swabs, and from contact lens (CL) fluid, between 2005 and 2016. All Fusarium isolates had been identified up to species level through sequencing of the ITS1-5.8S-ITS2 region of the rDNA and TEF1 gene. Antifungal susceptibility testing was performed according to the EUCAST microbroth dilution reference method. Antifungal agents tested included amphotericin B, voriconazole, and natamycin. In addition, susceptibility to the antisepticum chlorhexidine was tested. Ophthalmologists were approached to provide demographic and clinical data of patients identified through a positive culture. Results: Between 2005 and 2016, 89 cases of Fusarium keratitis from 16 different hospitals were identified. The number of cases of Fusarium keratitis showed a significant increase over time (R2 = 0.9199), with one case in the first 5 years (2005–2009) and multiple cases from 2010 and onwards. The male to female ratio was 1:3 (p = 0.014). Voriconazole was the most frequently used antifungal agent, but treatment strategies differed greatly between cases including five patients that were treated with chlorhexidine 0.02% monotherapy. Keratitis management was not successful in 27 (30%) patients, with 20 (22%) patients requiring corneal transplantation and seven (8%) requiring enucleation or evisceration. The mean visual acuity (VA) was moderately impaired with a logMAR of 0.8 (95% CI 0.6–1, Snellen equivalent 0.16) at the time of Fusarium culture. Final average VA was within the range of normal vision [logMAR 0.2 (95% CI 0.1–0.3), Snellen equivalent 0.63]. CL wear was reported in 92.9% of patients with Fusarium keratitis. The time between start of symptoms and diagnosis of fungal keratitis was significantly longer in patients with poor outcome as opposed to those with (partially) restored vision; 22 vs. 15 days, respectively (mean, p = 0.024). Enucleation/evisceration occurred in patients with delayed fungal diagnosis of more than 14 days after initial presentation of symptoms. The most frequently isolated species was F. oxysporum (24.7%) followed by F. solani sensu stricto (18%) and F. petroliphilum (9%). The lowest MICs were obtained with amphotericin B followed by natamycin, voriconazole, and chlorhexidine. Conclusion: Although Fusarium keratitis remains a rare complication of CL wear, we found a significant increase of cases in the Netherlands. The course of infection may be severe and fungal diagnosis was often delayed. Antifungal treatment strategies varied widely and the treatment failure rate was high, requiring transplantation or even enucleation. Our study underscores the need for systematic surveillance of fungal keratitis and a consensus management protocol.
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Affiliation(s)
- Claudy Oliveira Dos Santos
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands.,Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Eva Kolwijck
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
| | | | - Remco Stoutenbeek
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nienke Visser
- Maastricht University Medical Center+, University Eye Clinic, Maastricht, Netherlands
| | - Yanny Y Cheng
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Nathalie T Y Santana
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
| | - Cathrien A Eggink
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, Netherlands
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Randag AC, van Rooij J, van Goor AT, Verkerk S, Wisse RPL, Saelens IEY, Stoutenbeek R, van Dooren BTH, Cheng YYY, Eggink CA. The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes. PLoS One 2019; 14:e0222092. [PMID: 31491000 PMCID: PMC6731013 DOI: 10.1371/journal.pone.0222092] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the incidence of Acanthamoeba keratitis in the Netherlands between 2009 and 2015 and to analyse predicting factors for treatment outcome. Methods Patient characteristics, diagnostic methods, diagnostic delay, therapy prior to and after diagnosis, and visual outcome were obtained from medical files of all patients diagnosed with Acanthamoeba keratitis in the Netherlands between 2009 and 2015. A logistic regression analysis on treatment failure, defined as a best corrected visual acuity of less than 20/40 Snellen decimals (i.e. >0.3 logMAR or an approximate loss of three lines of visual acuity) and/or the need for keratoplasty, was performed to determine predicting factors. Results Two hundred and twenty-four eyes of 224 patients were included. Ninety-five percent of the patients were contact lens wearers, of whom 74% wore soft contact lenses. The number of cases increased from 16 in 2009 to 49 in 2015. This resulted in an estimated incidence of 1 in 21,000 for soft contact lens wearers in 2015. Eighty-seven eyes (39%) met the criteria for treatment failure. In a multivariable regression analysis, higher age at presentation, a higher severity stage and corticosteroid use before diagnosis were positively correlated with treatment failure. Early referral to a cornea specialist was associated with better clinical outcomes. Conclusions Although Acanthamoeba keratitis is still a relatively uncommon disease, the incidence in soft contact lens wearers has increased to reach 1 in 21,000 in 2015. Treatment failure occurred in 39% of cases, with age, higher severity stage, corticosteroid use before diagnosis and indirect referral to a cornea specialist as important risks factors.
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Affiliation(s)
- Anna C. Randag
- Rotterdam Eye Hospital, Rotterdam, the Netherlands
- * E-mail:
| | | | | | - Samuël Verkerk
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Isabelle E. Y. Saelens
- University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Bart T. H. van Dooren
- Amphia Hospital, Breda, the Netherlands
- Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
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Eggink CA, Oliveira Dos Santos C, Randag AC, Wijdh RJ. [Infectious keratitis in contact lens wearers]. Ned Tijdschr Geneeskd 2019; 163:D3190. [PMID: 31120209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Infectious keratitis in contact lens wearers Infectious keratitis is a sight-threatening complication in contact lens wearers. The infection is most frequently caused by bacteria (Pseudomonas aeruginosa). However, fungi or Acanthamoeba are found in increasing frequency. Three cases illustrate a characteristic course: patient A (11-year-old male) was treated for three weeks before the characteristic aspect of Acanthamoeba keratitis was recognized and confirmed. Patient B (45-year-old female) developed a severe corneal ulcer within 4 days; microbiological diagnostics confirmed Pseudomonas aeruginosa keratitis. Examination of patient C (27-year-old female) showed an infiltrate with satellites, typical of fungal keratitis. It is important to check the use of contact lenses in patients with keratitis. Referral to the ophthalmologist is mandatory: immediate in cases with an infiltrate. A dentritiform epithelial lesion in a contact lens wearer is indicative of Acanthamoeba keratitis, whereas fungal keratitis shows satellites or feathering edges. Steroids may only be prescribed by an ophthalmologist after confirmation of the causative agent.
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Klont RR, Eggink CA, Rijs AJMM, Wesseling P, Verweij PE. Successful Treatment ofFusarium Keratitis with Cornea Transplantation and Topical and Systemic Voriconazole. Clin Infect Dis 2005; 40:e110-2. [PMID: 15909252 DOI: 10.1086/430062] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Accepted: 01/27/2005] [Indexed: 11/03/2022] Open
Abstract
A case of invasive Fusarium keratitis in a previously healthy male patient was treated successfully with cornea transplantation and systemic and topical voriconazole after treatment failure with topical amphotericin B and systemic itraconazole. Topical voriconazole was well tolerated, and, in conjunction with the oral administration, it resulted in a high level of the drug in the anterior chamber of the eye (which was 160% of the plasma drug level).
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Affiliation(s)
- Rocus R Klont
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Odenthal MTP, Eggink CA, Melles G, Pameyer JH, Geerards AJM, Beekhuis WH. Intraocular lens power calculation for cataract surgery after photorefractive keratectomy. Arch Ophthalmol 2003; 121:1071. [PMID: 12860831 DOI: 10.1001/archopht.121.7.1071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Odenthal MTP, Eggink CA, Melles G, Pameyer JH, Geerards AJM, Beekhuis WH. Clinical and theoretical results of intraocular lens power calculation for cataract surgery after photorefractive keratectomy for myopia. Arch Ophthalmol 2002; 120:431-8. [PMID: 11934316 DOI: 10.1001/archopht.120.4.431] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To describe the refractive results of cataract surgery after photorefractive keratectomy (PRK) for patients with myopia, and to find a more accurate method to predict intraocular lens (IOL) power in these cases. DESIGN Nonrandomized, retrospective clinical study. PATIENTS AND METHODS Nine patients (15 eyes) who underwent cataract surgery after prior PRK to correct myopia were identified. The medical records of both the laser and cataract surgery centers were reviewed. MAIN OUTCOME MEASURES Eight different keratometric values (K values; measured or calculated) were entered into 3 different IOL calculation formulas: SRK/T, Holladay 1, and Hoffer Q. The actual biometry and IOL parameters were used to predict postoperative refraction, which was compared with the actual refractive outcome. Also, the relative underestimation of the refractive change in corneal dioptric power by keratometry after PRK was calculated. RESULTS In 7 of 15 eyes, IOL exchange or piggybacking was performed because of hyperopia. Retrospectively, the most accurate K value for IOL calculation was found to be the pre-PRK K value corrected by the spectacle plane change in refraction. Use of the Hoffer Q formula would have avoided postoperative hyperopia in more cases than the other formulas. The mean underestimation of the change in corneal power after PRK varied from 42% to 74%, depending on the method of calculation. CONCLUSION The predictability of IOL calculation for cataract surgery after PRK can be improved by using a corrected, refraction-derived K value instead of the measured, preoperative K value.
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Affiliation(s)
- Monica T P Odenthal
- Department of Ophthalmology, G2-217, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, the Netherlands.
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Abstract
PURPOSE To report results of holmium laser thermal keratoplasty used to treat induced hyperopia and induced, as well as pre-existing astigmatism after photorefractive keratectomy. METHODS Sixteen eyes of 16 patients were included in this study. Contact holmium laser (Technomed Holmium 25) was used in 7 patients to correct hyperopia (8 spots at 8 or 9 mm) and in 9 patients to correct astigmatism (4 spots at 7, 8, or 9 mm). Follow-up evaluation was done after at least 6 months. The effectiveness, stability, and safety of the procedure were investigated. RESULTS Spherical correction was ineffective (1.00 D or less) when applied at the 9-mm diameter treatment zone. Spherical correction applied at the 8-mm diameter treatment zone was ineffective in 1 eye. Three eyes achieved 1.00 to 2.00 D change, but 2 of these eyes showed an induced astigmatic change as well. Correction of astigmatism at the 7-mm diameter treatment zone resulted in a 0 to 4.00 D cylinder component change. Treatment at the 8-mm diameter treatment zone showed a 0 to 1.50 D effect and at the 9-mm treatment zone, 0.25 to 1.50 D. All eyes that achieved significant improvement (1.00 D or more change in cylinder component) showed significant overcorrection in the first postoperative phase. There were no sight threatening complications. CONCLUSION Holmium laser thermal keratoplasty can be useful for the treatment of overcorrection and induced as well as pre-existing astigmatism after photorefractive keratectomy. However, predictability is low and astigmatism can be induced with the attempted spherical correction.
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Affiliation(s)
- C A Eggink
- Institute of Ophthalmology, University Hospital Nijmegen, The Netherlands
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Eggink CA, de Boo TM, Lemmens WA, Deutman AF. Photorefractive keratectomy with an ablatable mask for myopic astigmatism. J Refract Surg 1999; 15:550-5. [PMID: 10504079 DOI: 10.3928/1081-597x-19990901-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
PURPOSE To evaluate efficacy, safety, and stability of photoastigmatic keratectomy (PARK) carried out with a Summit Apex Plus laser using an ablatable mask. METHODS Forty-one eyes of 41 patients with myopic astigmatism with follow-up of 12 months were evaluated. Treatment efficacy was compared in groups with high (>6.00 D) versus low (< or =6.00 D) preoperative spherical equivalent subjective manifest refraction, in groups with high (>2.00 D) versus low (< or =2.00 D) preoperative cylindrical component and in groups divided according to preoperative axis of cylinder. RESULTS At 12 months after surgery, mean spherical equivalent manifest refraction in all 41 eyes was -0.30 +/- 0.90 D. Mean cylinder component was 0.60 +/- 0.70 D. Mean reduction in astigmatic component was 67 +/- 47%. Uncorrected visual acuity of 0.5 or more was achieved in 79% of eyes; 71% of eyes achieved 0.8 or more. At 1 month after surgery, 49% of eyes had a loss of 2 or more lines of spectacle-corrected visual acuity. This loss was restored at 12 months. No statistically significant differences were found between the different subgroups. CONCLUSION Photoastigmatic keratectomy with ablatable mask gives satisfactory results. No relation in efficacy was found when taking into account the amount of preoperative spherical component, the cylindrical component, or the cylinder axis direction.
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Affiliation(s)
- C A Eggink
- Institute of Ophthalmology, University Hospital Nijmegen, The Netherlands
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Eggink CA, Bardak Y, Cuypers MH, Deutman AF. Treatment of hyperopia with contact Ho:YAG laser thermal keratoplasty. J Refract Surg 1999; 15:16-22. [PMID: 9987719 DOI: 10.3928/1081-597x-19990101-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the effectiveness, safety, and stability of contact Ho:YAG laser thermal keratoplasty for low to moderate hyperopia. METHODS Fifty-five hyperopic eyes of 39 patients were treated with a Technomed contact Ho:YAG laser; 23 eyes were treated a second time. Treatment parameters were 1 octagonal ring of 8 spots with a treatment diameter of 6 mm, 7 mm, or 8 mm. Efficacy of the Ho:YAG laser treatment was evaluated after 6 months, comparing 3 treatment zone diameters. Stability and efficacy after 12 months was evaluated comparing 7-mm and 8-mm treatment zone diameters. RESULTS Mean reduction of spherical equivalent refraction after 6 months was not statistically significantly different between the 6-mm or 7-mm diameter zones: 1.42 (+/- 1.30) D versus 2.22 (+/- 0.44) D. An 8-mm diameter treatment zone was significantly less effective, 1.12 (+/- 0.47) D. Longer follow-up did not show stability: mean reduction of spherical equivalent manifest refraction was 1.58 (+/- 0.45) D for the 7-mm diameter treatment zone and 0.82 (+/- 0.61) D for the 8-mm diameter treatment zone after approximately 12 months. Retreatment had a limited additive effect. No clinically significant loss of spectacle-corrected visual acuity was reported. No eyes lost more than 1 line of visual acuity. CONCLUSION Contact Ho:YAG laser thermal keratoplasty corrected hyperopia up to 2.50 D, but predictability was poor and a regression of initial effect occurred. Instability of refraction persisted to 1 year after surgery.
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Affiliation(s)
- C A Eggink
- Institute of Ophthalmology, University Hospital Nijmegen, The Netherlands
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Abstract
BACKGROUND To report our experience with laser suture lysis (LSL) following trabeculectomy with mitomycin C, its timing, effectiveness and related complications. METHODS We retrospectively examined 38 consecutive eyes of 36 patients that underwent LSL following trabeculectomy with mitomycin C. RESULTS The mean preLSL intraocular pressure (IOP) was 27.0 mm Hg (SD 6.3, range 16-39 mm Hg) and the postLSL IOP (IOP 1 h after the last session of LSL) was 16.0 mm Hg (SD 7.2, range 3-31 mm Hg). Following the LSL in 7 eyes (7 of 38) hypotony (IOP<6 mm Hg, lasting more than 24 h) developed. Two groups were defined. In group I no hypotony was found after LSL and group II went through a period of hypotony. The time interval between surgery and LSL was significantly shorter in group II (mean 5.7, SD 7.5, range 1-19 days), compared to group I ( mean 14.7, SD 13.0, range 1-44 days) (p=0.041). The mean final IOP (IOP measured at the last visit) was 13.3 mm Hg (SD 3.4, range 6-20 mm Hg) and mean follow-up was 6.1 months (SD 3.9, range 2.0-15.2 months). No hypotony was found at final examination. PostLSL IOP and final IOP were significantly lower in group II (p=0.002 and p=0.024 respectively). IOP reduction by LSL was significantly greater in group II (p=0.046). CONCLUSION LSL is an effective and safe procedure to lower the IOP following trabeculectomy with mitomycin C. Early application of LSL results in lower final IOPs, but has a higher risk of hypotony.
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Affiliation(s)
- Y Bardak
- Institute of Ophthalmology, University Hospital Nijmegen, The Netherlands
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Wanten GJ, Eggink CA, Bakker LJ, Smulders CM, Hieselaar LC, Koolen MI. [Ocular infection by Pseudomonas aeruginosa in a mechanically ventilated patient]. Ned Tijdschr Geneeskd 1998; 142:1615-7. [PMID: 9763844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A 59-year-old man developed bilateral keratitis several weeks after the initiation of mechanical ventilation because of respiratory failure and sepsis following abdominal surgery. Colonisation of the upper airways by P. aeruginosa had been established before. Invasion through corneal epithelial defects based on dehydration keratitis was the presumed route of infection. Despite aggressive treatment, including antibiotics, the infection was rapidly progressive in both eyes. The patient died of deterioration of his general condition. In order to prevent such eye infections in a patient on mechanical ventilation, there is a need of good eye care, prevention of corneal lesions and alertness, especially when the patient is colonised by virulent micro-organisms like P. aeruginosa.
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Affiliation(s)
- G J Wanten
- Bosch Medicentrum, Afd. Interne Geneeskunde
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Abstract
AIMS/BACKGROUND To describe a bilateral, mid peripheral, ring-shaped corneal opacity, not resembling any known corneal degeneration, dystrophy, or other disorder, and occurring without ocular or systemic disease. METHODS Ophthalmic examination, haematological screening, and ultrasound biomicroscopy. RESULTS A 25 year old man showed grey-white, granular opacities in both corneas, with an 8 mm diameter ring configuration, and a V-shaped distribution in the anterior stroma. The surrounding corneal stroma was clear, and the tear film, the epithelium and its basement membrane, Descemet's membrane, and the endothelium were normal. Evidence of systemic disease was not found. Family members did not show corneal abnormalities. CONCLUSION A bilateral corneal ring opacity may occur in healthy, asymptomatic, young people. These corneal rings may result from depositions of unknown origin, or possibly a rare corneal dystrophy.
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Abstract
Keratitis due to Nocardia farcinica occurred in a 49-year-old female after inappropriate cleaning of her semipermeable rigid contact lenses with basin-stored water during a holiday in France. N. farcinica was differentiated from Nocardia asteroides by its growth at 45 degrees C, acid production from rhamnose, its opacification of Middlebrook 7H10 agar, and its marked degree of resistance to all cephalosporins, aminoglycosides, tetracyclins, macrolides, and trimethoprim-sulfamethoxazole. To the best of our knowledge, this is the first reported case of human N. farcinica keratitis, confirming that this microorganism can be responsible for serious human disease.
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Affiliation(s)
- C A Eggink
- Department of Ophthalmology, University Hospital Nijmegen, The Netherlands
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Eggink CA, Vaandrager W, Burger DM, Sauerwein RW. [Acanthamoeba keratitis]. Ned Tijdschr Geneeskd 1996; 140:1130-33. [PMID: 8692340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Three patients, women aged 69, 25 and 30 years, with refractory keratitis were found to have a rare infection with Acanthamoeba. All wore soft contact lenses. The frequency of Acanthamoeba keratitis increased in recent years. At present, an efficacious antiprotozoal therapy is available, for instance in the form of polyhexamethylene biguanide and propamidine. In cases of refractory keratitis, the possibility of an Acanthamoeba infection should be taken into account.
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Affiliation(s)
- C A Eggink
- Instituut voor Oogheelkunde, Academisch Ziekenhuis, Nijmegen
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Eggink CA, Deutman AF, Meurs PJ, Schilt PD, de Boo TM, Lemmens WA. [Results of photorefractive keratectomy using the excimer laser in the treatment of myopia; 1-year follow-up]. Ned Tijdschr Geneeskd 1995; 139:2369-75. [PMID: 7501077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Evaluation of the first excimer laser treatments of myopia. DESIGN Descriptive. SETTING Excimer Laser Centrum, Department of Ophthalmology, University of Nijmegen, Nijmegen, the Netherlands. METHOD 312 patients underwent spherical excimer laser treatment to correct myopia of 1.2 up to 10 diopters between February 1992 and October 1993. 245 patients completed a follow-up of one year or more; 36 retreatments were carried out. Group I (treatment 1.2 to 6 D) numbered 174 patients, group II (6.1-10 D) 71 patients. RESULTS After a follow-up period of one year or just before retreatment 79% of group I and 48% of group II achieved a refractive correction within 1 D of the attempted correction. Visual acuity without correction was 0.5 or more in 94% of group I and in 76% of group II. Less than one percent (n = 1) of group I and 6% (n = 4) of group II lost more than one line of best corrected visual acuity. Retreatment could correct 50% of those eyes that did not achieve a refraction within 1 D of attempted correction. Loss of visual acuity was corrected by retreatment in 5 of 6 cases of group I and in 7 of 11 cases of group II. CONCLUSION Based on a one-year follow-up, refractive surgery with the excimer laser appears to correct myopia between 1 and 10 D effectively. Predictability is diminishing on correcting higher amounts of refractive error. Thorough information of the patients regarding the results to be expected will prevent disappointment.
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Affiliation(s)
- C A Eggink
- Institut voor Oogheelkunde, Academisch Ziekenhuis, Nijmegen
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van Rij G, Beekhuis WH, Eggink CA, Geerards AJ, Remeijer L, Pels EL. Toxic keratopathy due to the accidental use of chlorhexidine, cetrimide and cialit. Doc Ophthalmol 1995; 90:7-14. [PMID: 8549246 DOI: 10.1007/bf01203289] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Due to economical reasons some ophthalmologists are using an irrigating solution made by the hospital pharmacy instead of the commercially available solutions. These irrigating solutions come in bottles which are identical to the ones used for other solutions. During the last three years bottles were accidentally mixed up five times. Consequently, bottles containing solutions such as chlorhexidine, cetrimide, chlorhexidine/centrimide and cialit solutions were used during cataract surgery. This resulted in immediate corneal edema which, in its turn resulted in a bullous keratopathy. Four patients underwent a penetrating keratoplasty. In one patient the cornea was covered with a conjunctival flap. Light microscopy of the corneas included epithelial edema, loss of keratocytes, and a disrupted and sometimes absent endothelial cell layer.
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Affiliation(s)
- G van Rij
- Department of Ophthalmology, University of Groningen, The Netherlands
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Abstract
The authors report on a case of congenital bilateral protruding corneal opacities. Clinical and histological examination was consistent with a diagnosis of Peters' anomaly with a defect in the endothelium and Descemet's membrane but without abnormalities of iris and lens. Corneal grafting was performed on both eyes. During a follow-up period of one year the corneas have remained clear. However, surgical intervention for glaucoma has been necessary.
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Affiliation(s)
- C A Eggink
- Institute of Ophthalmology, University of Nijmegen, The Netherlands
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Abstract
Three patients with the tilted disc syndrome from one family were examined. The presence of the trait in three consecutive generations suggests an autosomal dominant mode of inheritance, although in these patients with variable expression. The propositus showed bilateral inferonasal retinal ectasia, with atrophic subretinal scars. Linear-like lacquer cracks, radiating from the central scars, were also present running parallel to the margin of the optic nerve head. The linear streaks were very similar to those usually seen in traumatic tears of Bruch's membrane. The mechanical stretching of the ectatic area, and its abnormal location inferonasal to the optic disc might have been responsible for the unusual pattern of the lacquer cracks in our patient.
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Affiliation(s)
- F G Bottoni
- Institute of Ophthalmology, University of Nijmegen, The Netherlands
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