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April 30, 2003
Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery
AJO April 2003
To investigate the effect of the vision of the fellow eye on the visual acuity of eyes after successful macular hole surgery.A consecutive series of eyes with successful macular hole closure were studied and assigned to one of two groups according to the visual acuity of the fellow eye; a group with visual acuity less than 20/200 and a group with visual acuity of 20/200 or better. Preoperative and postoperative visual acuity in the two groups was measured based on the logarithm of the minimal angle of resolution (LogMAR), and postoperative visual acuity was also determined by using the multiple-letter visual acuity chart, which permitted measurement of visual acuity at an extrafoveal point.Results : Group 1 (<20/200) consisted of 19 eyes and group 2 (>20/200) consisted of 51 eyes. LogMAR visual acuity at 6 months postoperatively was significantly better in group 1 than in group 2 (0.21 vs 0.41, P < .01). The logMAR change 6 months after surgery was significantly greater in group 1 than in group 2 (0.49 vs 0.23, P < .01). There was no significant difference between two groups in logMAR visual acuity at 6 months postoperatively determined with the multiple-letter visual acuity chart (0.20 vs 0.29, P > .05)
| ConclusionsVisual recovery after successful macular hole surgery is inversely correlated with vision in the fellow eye. Learning to use eccentric fixation may contribute to visual improvement after macular hole surgery. |
Posted by at 06:13 PM
Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery
AJO April 2003
To investigate the effect of the vision of the fellow eye on the visual acuity of eyes after successful macular hole surgery.A consecutive series of eyes with successful macular hole closure were studied and assigned to one of two groups according to the visual acuity of the fellow eye; a group with visual acuity less than 20/200 and a group with visual acuity of 20/200 or better. Preoperative and postoperative visual acuity in the two groups was measured based on the logarithm of the minimal angle of resolution (LogMAR), and postoperative visual acuity was also determined by using the multiple-letter visual acuity chart, which permitted measurement of visual acuity at an extrafoveal point.Results : Group 1 (<20/200) consisted of 19 eyes and group 2 (>20/200) consisted of 51 eyes. LogMAR visual acuity at 6 months postoperatively was significantly better in group 1 than in group 2 (0.21 vs 0.41, P < .01). The logMAR change 6 months after surgery was significantly greater in group 1 than in group 2 (0.49 vs 0.23, P < .01). There was no significant difference between two groups in logMAR visual acuity at 6 months postoperatively determined with the multiple-letter visual acuity chart (0.20 vs 0.29, P > .05)
| ConclusionsVisual recovery after successful macular hole surgery is inversely correlated with vision in the fellow eye. Learning to use eccentric fixation may contribute to visual improvement after macular hole surgery. |
Posted by at 06:08 PM
Clinical results of excimer laser photorefractive keratectomy for high myopic anisometropia in children: Four-year follow-up
JCRS, April, 2003
Twenty-one patients aged 7 to 15 years with high myopic anisometropia had multizonal PRK in the more myopic eye and were retrospectively analyzed. The scanning-slit Nidek EC-5000 excimer laser was used. All patients completed a 4-year follow-up.
The mean preoperative spherical equivalent (SE) refraction was 8.93 diopters (D) ± 1.39 (SD) (range −6.75 to −11.75 D) and the mean postoperative SE, −1.66 ± 0.68 D (range −0.50 to −2.75 D) (P <.05). The mean preoperative UCVA of 0.034 ± 0.016 increased to 0.35 ± 0.15 (P <.05) postoperatively. The mean preoperative BSCVA was 0.53 ± 0.19 and changed to 0.64 ± 0.16 postoperatively.
Conclusions: Photorefractive keratectomy was safe and effective in correcting high myopic anisometropia in children who were contact-lens intolerant. It provided good visual results and preserved or improved BV over the 4-year follow-up
Posted by afarahi at 01:28 AM
April 29, 2003
LASIK after retinal detachment surgery
BJO May 2003
To assess the efficacy and safety of laser in situ keratomileusis (LASIK) for correction of myopic refractive errors in eyes which have previously undergone retinal detachment surgery. In a prospective, non-comparative case series, 10 eyes of nine patients who had a myopic refractive error and had previously undergone retinal detachment surgery underwent LASIK surgery according to the standard surgical protocol. The surgery could be completed in eight eyes and in two eyes it was aborted intraoperatively.Eight eyes underwent successful LASIK surgery. There was no retinal complication after LASIK.
Conclusion: LASIK may be used to correct refractive errors in eyes that have undergone retinal detachment surgery. However, scarred conjunctiva in such cases may prevent generation of optimal suction for the microkeratome.
Posted by mehdi khanlari at 10:32 PM
Low content of the natural ocular anti-angiogenic agent pigment epithelium-derived factor (PEDF) in aqueous humor predicts progression of diabetic retinopathy
Diabetologica 2003
Pigment epithelium-derived factor is an important negative regulator of angiogenic activity of aqueous humor, and its content in the aqueous humor of diabetic patients strongly predicts who among them will develop progression of retinopathy
Posted by mmiraftab at 12:27 PM
Winter ESCRS meeting focuses on IOLs, wavefront technology
OCULAR SURGERY NEWS EUROPE/ASIA-PACIFIC EDITION April 2003
The future of refractive surgery lies in IOL technologies and in the application of wavefront technology to an increasingly wider range of indications. This was, in brief, the message that speakers at the winter meeting of the European Society of Cataract and Refractive Surgery brought to its 800 attendees. Most of the attention at the meeting here was devoted to these two topics
Posted by mmiraftab at 12:22 PM
April 28, 2003
ABC of diabetes : Clinical review (2)
BMJ 2003;326:924-926 ( 26 April )
Blindness in diabetic patients
vision threatening retinopathy is usually due mainly to neovascularisation in type 1 diabetes and maculopathy in type 2 diabetes. In North America, 3.6% of patients with type 1 diabetes and 1.6% of patients with type 2 diabetes are legally blind. In England and Wales, about 1000 diabetic patients are registered as blind or partially sighted each year, with diabetic retinopathy being the commonest cause of blindness in the working population.
Vitreous haemorrhage occurs suddenly and painlessly. The blood usually clears over the following weeks, but the underlying proliferative retinopathy causes repeated haemorrhages and progressive visual loss in most cases if it is not treated. Retinal detachment resulting from contracting fibrous bonds sometimes causes blindness.
MaculopathyMacular disease has three causes in diabetic patients: exudative maculopathy, retinal oedema, and ischaemia. Deterioration of vision in these situations is often insidious. Deterioration can be prevented to some extent by appropriate laser treatment, but once vision has been lost it cannot be restored. Ischaemic maculopathy due to loss of perifoveal capillaries may cause severe visual loss and is difficult to treat.
CataractLens opacities or cataract develop earlier in diabetic patients and often progress more rapidly.
Primary open angle glaucoma has an increased prevalence in diabetic patients compared with the general population.
Prevention of blindness
Physicians must actively seek retinopathy in diabetic patients as laser photocoagulation can often prevent blindness if the condition is detected early enough. The indications for laser treatment are:
1-New vessels on disc or elsewhere in retina; advanced pre-proliferative changes 2- Clinically significant macular oedema (see above) 3- Encroachment of hard exudates on the fovea.
Chronic vitreous haemorrhage that precludes a view of the retina can be treated by vitrectomy and endolaser. Tractional retinal detachment can be managed by vitrectomy. Restoration of visual acuity can be impressive, but it is dependent on the underlying condition of the retina.
Posted by mehdi khanlari at 05:47 AM
Subsurface Photodisruption in Human Sclera
OPHTHALMIC SURGERY, LASERS AND IMAGING Vol. 34 No. 2 March/April 2003
Approximately 105 million people worldwide have glaucoma, and approximately 5 million are blind from its complications. Current surgical techniques often fail because of scarring of the conjunctival tissue, Tenon’s tissue, or both. Femtosecond lasers can create highly precise incisions beneath the surface of a tissue, as previously demonstrated in the transparent cornea. Because the sclera is a highly scattering subsurface, photodisruption has not been previously possible.To overcome scattering, a laser operating at 1,700 nm was used to make subsurface cuts in human sclera in vitro via photodisruption.Sub–10-µm width incisions were created beneath the surface without collateral tissue effects, something not possible with shorter wavelengths used to date in corneal applications with the femtosecond laser.
CONCLUSION : Completely subsurface photodisruptions can be accomplished in human sclera in vitro. In vivo studies are required to evaluate the potential use of this technology for scleral applications.
Posted by mehdi khanlari at 05:01 AM
April 27, 2003
Improved functional visual acuity after punctal occlusion in dry eye patients
AJO May 2003
To report an increased functional visual acuity, which was recently reported as a simulation of visual function of daily acts of gazing, in dry eye patients after punctal occlusion,in a prospective comparative interventional study, researchers measured ordinary best-corrected visual acuity and functional visual acuity in eight eyes of eight dry eye patients after punctal occlusion, and compared the results with those of 22 eyes of 22 dry eye patients without punctal occlusion.Functional visual acuity in dry eye patients after punctal occlusion was 0.962 in decimal notation, which was significantly higher than that of patients without punctal occlusion, 0.283 (P < .0001).This study shows that punctal occlusion can improve the impaired functional visual acuity of dry eye patients.
Posted by kjalali at 07:02 PM
April 26, 2003
Retention of corneal epithelial cells following Goldmann tonometry: implications for Creutzfeldt-Jakob disease (CJD) risk
British Journal of Ophthalmology May 2003;87:583-586
Reusable Goldmann tonometer prisms were used to perform applanation tonometry on different groups of patients. Following tonometry, retained materials were collected from the tonometer prism head and examined using cytological methods. The used tonometers were subjected to a series of conditions to evaluate their effect on the residual cell numbers found on the tonometer heads. These included wiping alone and wiping or washing followed by disinfection of the tonometer prism. The effect on cell counts of drying the prism overnight was studied, as well as drying overnight and then wiping and disinfecting. All disinfections were performed with sodium hypochlorite (0.05% w/v). The cytology specimens of 69 patients were studied. Patients using eye drops regularly desquamated significantly more corneal epithelial cells with Goldmann tonometry than patients not using regular eye drops. The mean number of cells was 156 (range 0–470) for patients using eye drops and 14 (4–57) for patients not using eye drops (p = 0.004). Wiping or washing the tonometer head reduced the cell number significantly but neither method completely eliminated cells. The two methods were not significantly different (p=0.3). Drying left a large number of cells (23–320 cells). Retained corneal epithelial cells, following the standard decontamination routine of tonometer prisms, may represent potential prion infectivity. Manual cleaning was the most important step in reducing epithelial cell retention
Posted by mmiraftab at 01:57 PM
Riboflavin/ultraviolet-a–induced collagen crosslinking for the treatment of keratoconus
Theo Seiler
AJO MAY 2003
In animal eyes, a significant increase in corneal biomechanical stiffness has been found after collagen crosslinking by combined riboflavin/ultraviolet-A (UVA) treatment. The aim of the present study was to evaluate the clinical usefulness of riboflavin/UVA-induced collagen crosslinking for bringing the progression of keratoconus to a halt.
Twenty-three eyes of 22 patients with moderate or advanced progressive keratoconus (maximum K value, 48–72 diopters) were included. After central corneal abrasion, photosensitizing riboflavin drops were applied and the eyes exposed to UVA (370 nm, 3 mW/cm2) in a 1-cm distance for 30 minutes. Postoperative examinations were performed in 6-month intervals, including visual acuity testing, corneal topography, slit-lamp examination, measurement of endothelial cell density, and photographic documentation. The follow-up time was between 3 months and 4 years.In all treated eyes, the progression of keratoconus was at least stopped. In 16 eyes (70%) regression with a reduction of the maximal keratometry readings by 2.01 diopters and of the refractive error by 1.14 diopters was found. Corneal and lens transparency, endothelial cell density, and intraocular pressure remained unchanged. Visual acuity improved slightly in 15 eyes (65%).Collagen crosslinking may be a new way for stopping the progression of keratectasia in patients with keratoconus. The need for penetrating keratoplasty might then be significantly reduced in keratoconus. Given the simplicity and minimal costs of the treatment, it might also be well-suited for developing countries. Long-term results are necessary to evaluate the duration of the stiffening effect and to exclude long term side-effects.
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Techniques for Stiffening the Cornea
Prevention of collagen crosslinking increases form-deprivation myopia in tree shrew
Posted by mmiraftab at 01:31 PM
ABC of diabetes : Clinical review (1)
BMJ 2003;326:924-926 ( 26 April )
Retinopathy
Blindness is one of the most feared complications of diabetes but also one of the most preventable. Diabetes is the commonest cause of blindness in people aged 30 to 69 years. Twenty years after the onset of diabetes, almost all patients with type 1 diabetes and over 60% of patients with type 2 diabetes will have some degree of retinopathy. Even at the time of diagnosis of type 2 diabetes, about a quarter of patients have established background retinopathy. Treatment can now prevent blindness in the majority of cases, so it is essential to identify patients with retinopathy before their vision is affected.
Classification of retinopathy
Diabetic retinopathy is due to microangiopathy affecting the retinal precapillary arterioles, capillaries, and venules. Damage is caused by both microvascular leakage from breakdown of the inner blood-retinal barrier and microvascular occlusion. These two pathological mechanisms can be distinguished from each other by fluorescein angiography.
Background retinopathy
Microaneurysms are small saccular pouches, possibly caused by local distension of capillary walls. They are often the first clinically detectable sign of retinopathy and appear as small red dots, commonly temporal to the macula.Haemorrhages may occur within the compact middle layers of the retina and appear as "dots" or "blots." Rarely, haemorrhages occur in the superficial nerve fibre layer, where they appear flame shaped; these are better recognised as related to severe hypertension. Hard exudates are yellow lipid deposits with relatively discrete margins. They commonly occur at the edges of microvascular leakage and may form a circinate pattern around a leaking microaneurysm. They may coalesce to form extensive sheets of exudate. Vision is affected when hard exudates encroach on the macula.Retinal oedema is due to microvascular leakage and indicates breakdown of the inner blood-retinal barrier. It appears as greyish areas of retinal thickening. The thickening may look like a petal shaped cyst on the macula, and this can cause severe visual deterioration.Clinically significant macular oedema requires treatment. It is defined as any one of the following:
Retinal oedema within 500 µm (one third of a disc diameter) of the fovea
Hard exudates within 500 µm of the fovea if associated with adjacent retinal thickening
Retinal oedema that is one disc diameter (1500 µm) or larger, any part of which is within one disc diameter of the fovea.
Twenty per cent of eyes with clinically significant macular oedema will have serious visual loss in two years without treatment compared with 8% of treated eyes.
Preproliferative retinopathy
Retinal ischaemia due to microvascular occlusion may lead to neovascular proliferation. Signs of ischaemia include cotton wool spots, large dark blot haemorrhages, venous beading and looping, and intraretinal microvascular abnormalities. Cotton wool spots appear as white patches with rather feathery margins and represent microinfarcts in the nerve fibre layer; they become clinically important when there are more than five.
Proliferative retinopathy
New vessel formation may occur at the optic disc (NVD) or elsewhere on the retina (NVE). New vessels on the disc are particularly threatening to vision, and if allowed to progress they often lead to vitreous haemorrhage. If untreated, 26% of eyes with "high risk" and neovascular proliferation on the disc will progress to severe visual loss within two years. With laser treatment, this figure is reduced to 11%.
Advanced eye disease
In advanced proliferative diabetic retinopathy, progressive fibrovascular proliferation leads to blindness due to vitreous haemorrhage and traction retinal detachment. Rubeosis iridis and neovascular glaucoma occur when new vessels form on the iris and in the anterior chamber drainage angle, leading to a painful blind eye that occasionally requires enucleation.
Posted by mehdi khanlari at 12:44 PM
Antioxidant Protection against Corneal Damage by Free Radicals during Phacoemulsification
Investigative Ophthalmology and Visual Science April 2003
To examine the role of ascorbic acid in reducing corneal endothelial cell loss secondary to high-energy ultrasound energy during phacoemulsification surgery. Seventeen rabbit eyes were subjected to prolonged phacoemulsification within the anterior chamber, without manipulation or damage to other ocular structures. In nine eyes, a balanced salt ophthalmic solution was used as the phacoemulsification irrigation solution, and in eight eyes the solution plus 0.001 M ascorbic acid was used, all other parameters being identical between the two groups. Specular microscopy was performed in all eyes before and 1 week after surgery. The animals were then killed, and the corneas were examined histologically. There was no significant difference in preoperative endothelial cell counts between the two groups.
CONCLUSIONS. The addition of ascorbic acid to the irrigation solution significantly reduced the amount of endothelial cell loss during phacoemulsification by approximately 70%. This is thought to be due to the free-radical–scavenging properties of ascorbic acid. Further studies are warranted to find the optimal concentrations and combinations of free radical scavengers to be used in phacoemulsification irrigation solutions.
Posted by mehdi khanlari at 12:12 PM
A Potential Mechanism for Intraocular Pressure Reduction after Phacoemulsification
Investigative Ophthalmology and Visual Science April 2003
Normal and glaucomatous trabecular meshwork (TM) cell culture lines were initiated from tissue isolated from human cadaveric eyes or trabeculectomy specimens. Cultured cells were treated for 60 seconds with a phacoemulsification ultrasound probe set to a power of 70%. Activation of the TM cell-specific stress response was assayed by enzyme-linked immunosorbent assay (ELISA) and immunolocalization. Normal TM cell cultures did not release detectable levels of the stress response protein, IL-1, into their culture medium. In contrast, IL-1 was easily detected after treatment with ultrasound energy. Consistent with earlier findings, glaucomatous TM cells produced IL-1 constitutively, and the level of expression was increased after treatment with phacoemulsification ultrasound. As was previously demonstrated, the stress-regulated transcription factor NF-B was present in the cytoplasm of normal cells, but in the nucleus of glaucomatous cells. After treatment with ultrasound energy, NF-B translocated to the nucleus in the normal cells. Endothelial leukocyte-adhesion molecule (ELAM)-1 was not detected in normal TM cells, but was constitutively present on glaucomatous TM cells, consistent with findings in previous work. ELAM-1 expression was induced in normal cells by ultrasound treatment.
CONCLUSIONS. A potentially IOP-lowering stress response is induced in TM cells by ultrasound. The findings suggest that this response may be induced clinically during cataract removal by phacoemulsification, and may be one mechanism responsible for the reduction in IOP that often follows this procedure.
Posted by mehdi khanlari at 12:09 PM
April 25, 2003
Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience
AJO April 2003
Phacoemulsification cataract surgery is one of the most important surgical procedures learned by ophthalmology residents during their residency training. We evaluated the visual outcomes and incidence of vitreous loss of phacoemulsification cataract surgeries performed by ophthalmology residents without prior planned extracapsular cataract extraction experience.A retrospective review was performed on 332 consecutive phacoemulsification cataract surgeries performed by third-year ophthalmology residents from July 1999 through June 2001. Data included are preoperative and postoperative best-corrected visual acuity, preexisting ocular comorbidities, and intraoperative and postoperative complications.Postoperative best-corrected visual acuity was 20/40 or better in 89% of eyes. After excluding the cases with preexisting ocular comorbidities, the percentage increased to 97.7%. Vitreous loss occurred in 4.8% of cases.
Conclusions
Ophthalmology residents can learn to perform phacoemulsification cataract surgery safely and effectively without prior planned extracapsular cataract extraction experience.
Posted by mehdi khanlari at 11:23 PM
Clinical features and treatment of late enophthalmos after orbital decompression
A condition suggesting cause for idiopathic "imploding antrum" (silent sinus) syndrome
Ophthalmology,April,2003
Six patients experienced relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity at between 3 and 6 months after bone-removing orbital decompression for thyroid orbitopathy. All patients underwent middle meatal antrostomy, together with mobilization and elevation of the collapsed orbital contents by firm packing of the affected maxillary antrum through a buccal antrostomy, the pack being removed about 3 weeks after placement.
After antral drainage and packing, there was an improvement in enophthalmos (mean, 2.7 mm; range, 0–4 mm) and all but one globe returned to within 2 mm of exophthalmometry of the contralateral eye. For recurrent enophthalmos in two patients (minor in one patient and marked in the other), later repair of the orbital floor was undertaken through a lower eyelid swinging flap, using porous polythene sheet, with good cosmetic outcome.
CONCLUSIONS: Late-onset enophthalmos after bone-removing orbital decompression seems to be the result of obstruction of maxillary antral aeration, with secondary fluid retention and a subatmospheric pressure in the sinus. This iatrogenic condition, associated in most cases with inward collapse of the maxillary walls, provides a guide to a hypothetical mechanism for the idiopathic imploding antrum (silent sinus) syndrome.
Posted by afarahi at 10:46 PM
Clinical and radiologic characteristics of the imploding antrum, or "silent sinus," syndrome
Ophthalmology,April,2003
Fourteen patients seven men and seven women, between the ages of 25 and 78 years (mean, 41.3 years), had unilateral enophthalmos, their having noted the anomaly for an average of 8 months (range, 1–36 months). On the affected side, there was 1 to 4 mm enophthalmos and up to 4 mm hypoglobus. The condition is characterized radiologically by a smooth inward bowing of the walls of the maxillary antrum on the affected side, with secondary enophthalmos and hypoglobus.
CONCLUSIONS: The silent sinus syndrome mainly presents as unilateral enophthalmos in younger people and has very characteristic clinical and radiologic signs with, in many cases, abnormal intranasal anatomic characteristics on the affected side. Although chronic and largely asymptomatic sinus disease may be the underlying cause, an acute event precipitates collapse of the orbital floor or (in fact) a widespread "implosion" of all antral walls resulting from maxillary atelectasis. Therefore, we prefer the term imploding antrum syndrome—describing the relatively acute, symptomatic, event—rather than the name silent sinus syndrome, which relates to a putative underlying mechanism.
Posted by afarahi at 10:04 PM
Inadvertent conjunctival trauma related to contact with drug container tips, A masquerade syndrome
ophthalmology/ 2003/ April
PURPOSE: To report the diagnosis, clinical course, and management of acute painful red eye syndrome associated with unintentional tube- or bottle-tip-induced conjunctival trauma. PARTICIPANTS: Twelve eyes of 12 patients (8 female and 4 male, aged 21–84 years) who were urgently reported or referred with a variety of diagnoses resulting from acute onset of red, painful eye. Four eyes had corneal transplants, two were recovering from herpetic keratitis, two had undergone cataract surgery or a laser in situ keratomileusis procedure, one had a corneal neurotrophic ulcer, and one used a contact lens. All the patients had received new medications (ophthalmic ointments in nine patients, topical drops in three patients) within 1 week before onset of symptoms.
RESULTS: All 12 patients presented red, painful eyes, congested lower palpebral conjunctiva, epithelial conjunctival erosions, and episcleritis.Instructions on proper method of drug administration and eye patching with lubrication were followed, within 2 weeks, by healing of conjunctival lesions.CONCLUSIONS: Drug containers may cause nonintentional conjunctival trauma and simulate severe ocular disorders. Physicians should be aware of this diagnosis in any case of prolonged and unexplained ocular irritation and should instruct patients as to the proper instillation of topical ophthalmic medications.
Posted by pakravanmd at 08:33 PM
Transconjunctival mitomycin-C in needle revisions of failing filtering blebs
ophthalmology/ 2003/ April
PURPOSE: To report the efficacy and safety of transconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs. METHODS: Needling of the bleb was performed with a 25-gauge needle. The site of the needle puncture was sutured and followed by application of transconjunctival mitomycin-C (0.5 mg/ml) by means of a sponge left in contact with the conjunctival epithelium for 6 minutes. RESULTS: Mean preoperative intraocular pressure was 22.1 ± 8.0 mmHg, which was reduced by 9.6 ± 7.9 mmHg to a mean postoperative intraocular pressure of 12.5 ± 6.1 mmHg. Kaplan-Meier survival analysis showed a probability of continued success at 12 months of 76.1%, and at 24 months of 71.6%. The most common complication was hyphema in 7.1% of patients. Twenty-six eyes also received postoperative injections of 5-fluorouracil. CONCLUSIONS: Transconjunctival mitomycin-C may enhance success of the needling procedure in failing filtering blebs.
Posted by pakravanmd at 08:19 PM
Endocrine abnormalities in patients with central serous chorioretinopathy
ophthalmology/ 2003/ April
PURPOSE: To investigate and to identify endocrine and metabolic abnormalities in patients with central serous chorioretinopathy (CSCR).METHODS: Serum and urinary catecholamines, glucocorticoids, mineralocorticoids, serum testosterone, and thyroid-stimulating hormone (TSH) function were evaluated prospectively. RESULTS: Fifty percent (12 of 24) of patients with active acute CSCR showed elevated 24-hour urine cortisol or tetrahydroaldosterone levels. Serum aldosterone levels were low in 7 of 24 (29.1%) patients. Single morning plasma catecholamine levels were elevated in 7 of 24 patients, although 24-hour urine metanephrines (catecholamine breakdown products) were normal. Serum testosterone and TSH levels were normal in nearly all (23 of 24) patients. CONCLUSION: Many patients with acute CSCR have elevated 24-hour urine corticosteroids, which may contribute to the pathogenesis of the disorder. Endogenous mineralocorticoid dysfunction is a newly described feature of CSCR.
Posted by pakravanmd at 08:02 PM
Myopia, genetics, and ambient lighting at night in a UK sample
British Journal of Ophthalmology 2003 MAY;87:580-582
Background: It has been reported that exposure to artificial lighting at night during the first 2 years of life was very strongly associated with subsequent myopia development.Results: Myopia occurred with approximately equal frequency in those who slept with and without light exposure at night. In contrast, two largely genetic factors, parental myopia and race, were both significantly associated with myopia development, as has been found previously. Conclusion: This study provides further support for the view that night-time light exposure during infancy is not a major risk factor for myopia development in most population groups. In a subset of this cohort for which spectacle prescriptions were available for both parents (49 trios), the heritability of ocular refraction was estimated to be 0.31.
Posted by mmiraftab at 07:13 PM
Five year results of viscocanalostomy
BJO APR 2003
Viscocanalostomy is a non-penetrating filtration procedure for the surgical treatment of medically uncontrolled open angle glaucoma. The more classic trabeculectomy, with or without antimetabolites, has a well documented complication rate. Viscocanalostomy was designed in an attempt to lower the risk of incidence of such complications, thus offering both surgeon and patient a safer, more convenient option.
To prospectively study the success rate and complications of viscocanalostomy, a prospective non-randomised consecutive case series of 57 eyes (57 patients) with medically uncontrolled primary and secondary open angle glaucoma was done. Viscocanalostomy was performed on all participants with injection of viscoelastic in the surgically created ostia of Schlemm’s canal as well as in the scleral bed, the superficial scleral flap was loosely sutured. Intraocular pressure, visual acuity, and number of goniopunctures were measured.
Results: The mean follow up period was 34.1 months. The mean preoperative IOP was 24.6 mm Hg; while the mean postoperative IOP was 5.6 mm Hg at day 1 and 13.9 mm Hg at 36 month. Patients who achieved IOP below 21 mm Hg with or without medication were 90% at 60 months, complete success rate (IOP<21 mm Hg without medication) was 60% at 60 months. 21 patients (37%) needed Nd:YAG goniopuncture postoperatively to control raised IOP, mean time for goniopuncture application was 9.4 months, mean pre-goniopuncture IOP was 20.4 mm Hg and mean postgoniopuncture IOP was 12.6 mm Hg (p <0.0001).
Conclusion: Viscocanalostomy appears to be a promising modification of filtering surgery.
ESMM
Posted by mtmdop at 12:11 PM
Autorefractometry after laser in situ keratomileusis
JCRS JUN 2003
To correlate cycloplegic subjective refraction with cycloplegic autorefractometry in eyes that have had LASIK.
Subjective refraction and autorefractometry under cycloplegia were performed in 73 eyes of 46 patients 1, 6, and 12 months after LASIK to correct myopia or myopic astigmatism. The preoperative subjective refraction and autorefractometry under cycloplegia in the same eyes served as controls.
Results
A statistically significant difference between subjective refraction and autorefraction was found in the sphere and cylinder at all postoperative times. No statistically significant difference was found in the axis. There was no statistically significant difference in the control eyes.
Conclusions
After LASIK, automated refractometry tends to overestimate spherical and cylinder power compared to subjective refraction even under cycloplegia.Automated refractometry in eyes that had had LASIK was reliable in the axis only .Retreatments after LASIK should be based on subjective refraction rather than automated refractometry.
Posted by mtmdop at 11:30 AM
Corneal Lymphangiogenesis: Evidence, Mechanisms, and Implications for Corneal Transplant Immunology
Cornea 2003; 22(3):273-281
The normal cornea is devoid of blood and lymphatic vessels but can become vascularized secondary to a variety of corneal diseases and surgical manipulations. Whereas corneal (hem)angiogenesis, i.e., the outgrowth of new blood vessels from preexisting limbal vessels, is obvious both clinically and histologically, proof of associated corneal lymphangiogenesis has long been hampered by invisibility and lack of specific markers. This has changed with the recent discovery of the lymphatic endothelial markers vascular endothelial growth factor receptor 3, LYVE-1 (a lymphatic endothelium-specific hyaluronan receptor), Prox 1, and Podoplanin.Whereas corneal angiogenesis in vascularized high-risk beds provides a route of entry for immune effector cells to the graft, lymphangiogenesis enables the exit of antigen-presenting cells and antigenic material from the graft to regional lymph nodes, thus inducing alloimmunization and subsequent graft rejection.Antilymphangiogenic strategies may improve transplant survival both in the high- and low-risk setting of corneal transplantation.
Posted by mmiraftab at 01:11 AM
Bilateral Spontaneous Corneal Perforation Associated With Complete External Ophthalmoplegia in Mitochondrial Myopathy (Kearns-Sayre Syndrome)
Cornea 2003; 22(3):267-270
We report on a 36-year-old female patient with Kearns-Sayre syndrome, confirmed by biochemistry, histology, and genetics. Over a period of 10 years, progressive ophthalmoplegia led to recurrent conjunctivitis, keratitis, and corneal ulceration. Almost total external ophthalmoplegia including involvement of the orbicularis oculi muscles was observed. Despite advanced ptosis, there was lagophthalmos of 2 mm with near complete extinction of globe motility in both eyes. The left eye showed a peripheral corneal perforation parallel to the lower limbus. After successful penetrating keratoplasty in the left eye, despite preventive measures, a peripheral corneal perforation also occurred in the right eye. Penetrating keratoplasty was therefore also performed on the right eye. To achieve a satisfactory functional result, large-diameter transplants were necessary in both eyes. To prevent immune reactions, cyclosporine therapy was initiated prophylactically. Sixteen and 9 months after penetrating keratoplasty, the corrected visual acuity was 20/60 in the right eye and 20/100 in the left eye, with clear transplants on both sides.Patients with progressive ophthalmoplegia require thorough neurologic investigation and evaluation. Lagophthalmos in the presence of almost absent globe motility requires extensive preventive measures to avoid exposure keratitis. In spite of this, in the presented case, corneal perforation of the second eye could not be prevented.
Posted by mmiraftab at 01:07 AM
April 24, 2003
Keratocytes: more than a framework for the window
Clinical & Experimental Ophthalmology 31 (2), 91-92
Using the cell tracker dye 5-chloromethylfluorescein diacetate (CMFDA) to show exquisite detail of the stromal network, following up earlier work they have completed on the porcine cornea and fibroblast networks in connective tissue explants. They show previously unseen process ramifications, orientated in both lateral and anteroposterior directions. Taken in conjunction with increasing evidence for extensive gap junction connections within the corneal stroma, the stromal keratocyte network is clearly both very extensive and highly coupled.Why is this important? In this avascular tissue the keratocyte network will provide a means by which nutrients and metabolites are passed into the central regions of the stroma, and waste products out. In this sense the corneal keratocyte has an analogous role to the astrocyte in the central nervous system. The astrocytes are also extensively coupled, vital for their role in maintaining the neuronal environment. 8 These cells remove waste products (including neurotoxins such as potassium and glutamate released during neuronal depolarization) and pass back metabolites. In cases of injury, however, not only do the astrocytes become activated, but they increase their level of cell coupling.
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Posted by mmiraftab at 10:12 PM
April 23, 2003
Endolacrimal KTP Laser–Assisted Dacryocystorhinostomy
Arch Otolaryngol Head Neck Surg, March, 2003
This study is a case series of 78 adult patients who required surgery for dacryostenosis. Endolacrimal potassium-titanyl-phosphate(KTP) laser was used to perform a bony osteotomy of the lacrimal sac into the nasal cavity. The position for the perforation was controlled by endonasal endoscopy. The procedure was performed under either general or local anesthesia.
One year after surgery, 65 (83%) of the 78 patients were free of symptoms. Seven patients experienced intermittent tearing, and 6 had revision surgery because of restenosis.
Conclusions . The success rate of 83% achieved with KTP laser–assisted dacryocystorhinostomy, using miniendoscopes for lacrimal endoscopy to visualize the exact site of obstruction, is better compared with that of prior studies without the use of miniendoscopes (with success rates of 47%-85%). The advantages of this technique are that it is a minimally invasive procedure, requires a short operating time, and avoids use of an external incision.
Posted by afarahi at 07:50 PM
Case report: Unique case including disc edema and large sub-ILM hemorrhage
OCULAR SURGERY NEWS 4/15/03
A 30-year-old man presented with a history of sudden, painless diminution of vision in the right eye of 1-day duration. No history of floaters, flashes, trauma or similar self-limiting episodes,recent febrile illness, constipation, lifting heavy weights or bouts of severe cough, promiscuity, bleeding diathesis, alcoholism or hepatic disease. His history was significant for a febrile illness in childhood with ocular involvement of the left eye for which some operative procedure was done, the details of which were not available, and he has had poor vision since then. The patient was a high myope wearing spectacles since the age of 15. He was not on any medication, nor did he have any drug allergies. He had a family history of tuberculosis, but the patient himself did not have any manifestations suggestive of Koch’s.
ExaminationOn ophthalmic examination, his BCVA was 20/400 and FC 1 m in the OD and 2 m in the OS. He had a left divergent squint. Slit-lamp examination of the OD was within normal limits and there was no RAPD. OS an updrawn pupil with an adherent leukoma. IOP were 16 mm Hg and 18 mm Hg in the OD & OS respectively. Gonioscopy by Goldmann 2 mirror revealed angles open up to the scleral spur, with heavy pigmentation in OD. The left eye revealed broad peripheral anterior synechiae superiorly. Remaining angle was open up to the scleral spur, with heavy trabecular meshwork pigmentation.Dilated fundus examination revealed tortuous retinal vasculature with multiple aneurysmal dilatations. There were dot-and-blot hemorrhages scattered throughout the fundus. The disc was edematous and there was edema at the posterior pole. 
There was a large area (measuring 5 to 6 disc diameters) of sub-ILM bleed just above the macula The left fundus showed a pale disc, no foveal reflex, attenuated vessels and attached retina.Fundus fluorescein photograph (right eye) showing aneurysms at the posterior pole, disc and macular edema, vasculitis of the superotemporal vessel and a large area of blocked fluorescence just above the macula, suggestive of a large retinal hemorrhage (left). Fundus fluorescein photograph (right eye) showing marked variation in caliber of retinal vasculature in between aneurysms (right). A large area sub-ILM bleed is also seen.
What is Your Diagnosis?
Posted by mehdi khanlari at 06:55 PM
Pearls on Ocular trauma
OSN April 2003
Ocular trauma is a major cause of visual morbidity and the most common cause of unilateral blindness.In the United States annually, more than 2.5 million people suffer an eye injury, and globally more than half a million blinding injuries occur every year.Worldwide every year there are approximately 1.6 million people blind from eye injuries, 2.3 million bilaterally visually impaired and 19 million with unilateral visual loss.The maximum incidence of ocular trauma is reported in young adults and in the elderly, with a large preponderance of these injuries affecting men.Approximately half of all patients who present to an eye casualty department do so because of ocular trauma, although only 2% to 3% of all eye injuries require hospital admission.
Posted by mehdi khanlari at 06:23 PM
Partial Flap During Laser in situ Keratomileusis: Role of Smaller Diameter Corneal Flap of Original Thickness
JOURNAL OF REFRACTIVE SURGERY Vol. 19 No. 2 March/April 2003
To report results of smaller diameter corneal flap of original thickness in the management of partial flap during laser in situ keratomileusis (LASIK).Retrospective review of the case records of three patients (3 eyes) who had a partial corneal flap during LASIK.Retreatment was performed using an 8.5-mm-diameter corneal flap, which was smaller than the original partial flap of 9.5-mm diameter. The recut depth was maintained as the original cut depth of 160 µm. No intraoperative or postoperative complications were noted. At follow-up 4 weeks later, two patients had an uncorrected visual acuity of 20/20. One patient had uncorrected visual acuity of 20/40 that improved to preoperative best spectacle- corrected visual acuity of 20/30 with a correction of +0.50 -1.25 x 170°.
CONCLUSION
A smaller diameter corneal flap of original thickness can be used for retreatment of partial flap during LASIK. A thicker posterior stromal bed after laser ablation may be retained with this technique, compared to retreatment using a corneal flap of greater thickness. [J Refract Surg 2003;19:165-168]
Posted by mehdi khanlari at 06:10 PM
Outcomes After Laser in situ Keratomileusis Retreatment in High Myopes
JOURNAL OF REFRACTIVE SURGERY Vol. 19 No. 2 March/April 2003
| CONCLUSION : The ablation zones following primary LASIK and retreatment should be >5.00 mm and remain unchanged to improve visual performance. |
Posted by mehdi khanlari at 05:53 PM
Intraocular Pressure in Myopic Patients After Worst-Fechner Anterior Chamber Phakic Intraocular Lens Implantation
JOURNAL OF REFRACTIVE SURGERY Vol. 19 No. 2 March/April 2003
To assess intraocular pressure measured with a Goldmann tonometer over a period of 1 year after implantation of a Worst-Fechner anterior chamber phakic intraocular lens to correct myopia of -7.00 D or more.We performed a prospective, nonmasked study of 100 patients (100 myopic eyes) who had a Worst-Fechner phakic intraocular lens implanted to correct myopia of -7.00 D or greater. Central corneal Goldmann tonometry was performed before surgery and 1, 3, 6, and 12 months after surgery. The influence of different variables was assessed.IOP showed a significant increase of of a mean 2.1 mmHg at 3 months after surgery (P=.001). There was not a statistically significant difference between IOP before surgery and 6 months after PIOL implantation (P=.244) or 1 year after surgery (P=.845). In one eye, the lens was explanted 11 months after surgery because of the presence of ocular hypertension. No variables studied showed a statistically significant difference from before to after surgery.
CONCLUSIONS
Worst-Fechner anterior chamber phakic intraocular lens implantation led to a slight transitory increase of intraocular pressure during the first 3 months after surgery, but returned to preoperative levels by 6 months after implantation. [J Refract Surg 2003; 19:131-136]
Posted by mehdi khanlari at 05:47 PM
April 22, 2003
Efficacy and Safety of Topical Azelastine Compared With Topical Mitomycin C in Patients With Allergic Conjunctivitis
Cornea 2003; 22(3):210-213
Sixty-three patients (29 male, 29 female; 34 in the age range of 6 to 65 years) with allergic conjunctivitis were enrolled in this study. The patients were randomly assigned to receive topical azelastine 0.02% (n = 31) or topical MMC (0.2 mg/10 mL) (n = 31) four times daily for 3 months.More patients in the MMC group had relief of symptoms like redness in the MMC group versus in the azelastine group; photophobia in the MMC group versus six in the azelastine group, discharge in the MMC group versus in the azelastine group, and foreign body sensation in the MMC group versus in the azelastine group, while more patients in the azelastine group had relief of lacrimation in the azelastine group versus in the MMC group; and pain in the azelastine group versus eight in the MMC group. The MMC group also showed a greater decrease in follicles in the MMC group versus six in the azelastine group and papillae in the MMC group versus four in the azelastine group. Both drugs were found to be equally effective in relieving itching in the MMC group versus in the azelastine group. In the MMC group, 27 (87.1%) patients had conjunctival hyperemia, 28 (90.3%) patients had episcleritis, and 29 (93.6%) patients had irritation. The use of topical azelastine did not cause any adverse event.Though this was a short-term study, we found topical MMC to be more effective than topical azelastine in the treatment of allergic conjunctivitis both in terms of relief of symptoms and resolution of signs. The use of topical MMC in low doses does not cause any significant adverse effect.
Posted by mmiraftab at 12:12 PM
May nitric oxide molecule have a role in the pathogenesis of human cataract?
Experimental Eye Research Volume 76, Issue 1, Pages 1-135 (January 2003)
Recent studies have shown that nitric oxide molecule may have a role in the development of cataract. In this study, we measured the levels of a nitric oxide metabolite (nitrite) in the cataractous and normal human lenses. A modified Griess assay was used to determine the nitrite levels in the lenses as a measure of nitric oxide, based on the spectrophotometric method. Nitrite was detected in 26 (44·1%) cataractous lenses and was found below the detection limit in 33 (55·9%) cataractous lenses. Mean nitrite levels in cataractous lenses(2·77 ^ 5·26 nmol/100 mg) was found higher than the normal lenses (0·77 ^ 0·79 nmol/100 mg) but this increase was not statistically
significant. Comparison of nitrite levels among lenses with various types of cataracts revealed higher levels in lenses with posterior subcapsular cataracts. Hypertensive patients had also significantly higher nitrite levels in their cataractous lenses. The increased levels in the cataractous lenses display a possible role of nitric oxide in the pathogenesis of cataract in human eyes.
Posted by mmiraftab at 11:44 AM
Bilateral Marginal Sterile Infiltrates and Diffuse Lamellar Keratitis After Laser in situ Keratomileusis
Journal Of Refractive Surgery Vol. 19 No. 2 March/April 2003
Two patients developed acute bilateral, marginal, catarrhal infiltrates in the early postoperative period after LASIK. Both patients had moderate to severe chronic meibomian gland dysfunction preoperatively. One patient (both eyes) developed grade 3 diffuse lamellar keratitis (DLK) that required both flaps to be lifted for irrigation and cleaning on postoperative day 5. Fungal and bacterial cultures were negative in both eyes of both patients. The condition resolved with intensive topical corticosteroids and fortified antibiotics. Regression of refractive error and the need for enhancement was encountered in all eyes. There was mild recurrence in one eye of each patient with pretreatment with topical corticosteroids prior to enhancement.Endogenous factors such as chronic blepharitis and meibomian gland dysfunction may trigger inflammation resulting in sporadic cases of catarrhal infiltrates after LASIK. These patients may have chronic inflammatory milieus that can trigger sporadic cases of catarrhal infiltrates after LASIK, with accompanying diffuse lamellar keratitis.
Posted by mmiraftab at 11:35 AM
April 21, 2003
PRK for Epithelial Ingrowth in Buttonhole After LASIK
Cornea April 2003
To evaluate the efficacy of photorefractive keratectomy (PRK) in progressive central epithelial ingrowth after buttonholes after laser in situ keratomileusis (LASIK).Two eyes of two patients with progressive central epithelial ingrowth and fibrosis in flap buttonholes after LASIK underwent PRK 6 months following primary surgery.Epithelial ingrowth was treated successfully in both eyes. The uncorrected visual acuities were 20/20, and there was no evidence of recurrent epithelial ingrowth after 6 months.Conclusions.
Photorefractive keratectomy is a useful modality in the treatment of central epithelial ingrowth in buttonholes following LASIK. As a single-step surgery, it offers both therapeutic and optical advantages by simultaneously clearing the corneal opacity and correcting the refractive error in selected cases.
Posted by mehdi khanlari at 01:18 PM
Keratoconus, Myopia, and Personality
Cornea April 2003
To determine whether there is an association between keratoconus and personality attributes including obsessionality traits.We reviewed all charts in the regional contact lens clinic, identifying patients who had attended from January 1997 to January 2000 and had a diagnosis of either keratoconus or myopia of at least 6 diopters. This yielded 289 keratoconics and 149 myopes who were contacted by mail and invited to complete two standardized personality questionnaires (Maudsley Obsessive-Compulsive Inventory and the revised Eysenck Personality Questionnaire). On receipt of consent, questionnaires and an explanatory letter were sent to potential participants.Conclusion : This study indicated that there is little evidence to suggest that keratoconics differ significantly in personality from a group of moderate to high myopes who also depend on contact lens correction for distance vision. Although myopes showed marginally higher levels of psychoticism than did keratoconics, analysis of the range of personality traits assessed indicates that the differences between the two groups is not significant. The authors could not substantiate the clinical notion of the keratoconic personality.
Posted by mehdi khanlari at 01:15 PM
Corneal Opacity and Cataract: Triple Procedure Versus Secondary Approach
Cornea April 2003
To determine the efficacy of planned secondary cataract surgery after keratoplasty.Twenty patients (22 eyes) with simultaneous corneal pathology and cataract were enrolled in a prospective, interventional, case-matched, nonrandomized comparative trial. Penetrating keratoplasty (PKP) and extracapsular cataract extraction (ECCE) with IOL insertion (triple procedure) were performed in 11 eyes, and planned phacoemulsification (PEA) with IOL insertion after PKP was performed in 11 case-matched eyes.There were 10 eyes (91%) within ±2.0 D of expected values in the secondary PEA group versus 5 patients (45%) in the triple procedure group. No difference was observed in endothelial cell density after 1-year follow-up.
Conclusions.
Planning for secondary PEA in PKP patients with cataracts is a safe and reliable procedure to obtain less post surgical refractive error. Performing a two-stage intervention has no effect on corneal endothelial viability after 1 year.
Posted by mehdi khanlari at 01:10 PM
Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery
AJO April 2003
To investigate the effect of the vision of the fellow eye on the visual acuity of eyes after successful macular hole surgery.A consecutive series of eyes with successful macular hole closure were studied and assigned to one of two groups according to the visual acuity of the fellow eye; a group with visual acuity less than 20/200 and a group with visual acuity of 20/200 or better. Preoperative and postoperative visual acuity in the two groups was measured based on the logarithm of the minimal angle of resolution (LogMAR), and postoperative visual acuity was also determined by using the multiple-letter visual acuity chart, which permitted measurement of visual acuity at an extrafoveal point.Results : Group 1 (<20/200) consisted of 19 eyes and group 2 (>20/200) consisted of 51 eyes. LogMAR visual acuity at 6 months postoperatively was significantly better in group 1 than in group 2 (0.21 vs 0.41, P < .01). The logMAR change 6 months after surgery was significantly greater in group 1 than in group 2 (0.49 vs 0.23, P < .01). There was no significant difference between two groups in logMAR visual acuity at 6 months postoperatively determined with the multiple-letter visual acuity chart (0.20 vs 0.29, P > .05)
| ConclusionsVisual recovery after successful macular hole surgery is inversely correlated with vision in the fellow eye. Learning to use eccentric fixation may contribute to visual improvement after macular hole surgery. |
Posted by mehdi khanlari at 12:59 PM
Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery
AJO April 2003
To investigate the effect of the vision of the fellow eye on the visual acuity of eyes after successful macular hole surgery.A consecutive series of eyes with successful macular hole closure were studied and assigned to one of two groups according to the visual acuity of the fellow eye; a group with visual acuity less than 20/200 and a group with visual acuity of 20/200 or better. Preoperative and postoperative visual acuity in the two groups was measured based on the logarithm of the minimal angle of resolution (LogMAR), and postoperative visual acuity was also determined by using the multiple-letter visual acuity chart, which permitted measurement of visual acuity at an extrafoveal point.Results : Group 1 (<20/200) consisted of 19 eyes and group 2 (>20/200) consisted of 51 eyes. LogMAR visual acuity at 6 months postoperatively was significantly better in group 1 than in group 2 (0.21 vs 0.41, P < .01). The logMAR change 6 months after surgery was significantly greater in group 1 than in group 2 (0.49 vs 0.23, P < .01). There was no significant difference between two groups in logMAR visual acuity at 6 months postoperatively determined with the multiple-letter visual acuity chart (0.20 vs 0.29, P > .05)
| ConclusionsVisual recovery after successful macular hole surgery is inversely correlated with vision in the fellow eye. Learning to use eccentric fixation may contribute to visual improvement after macular hole surgery. |
Posted by mehdi khanlari at 12:32 PM
April 20, 2003
Cataract and the use of statins: a case-control study
Q J Med 2003; 96: 337-343
In animal studies, statins have induced cataract formation. Because incident cataract is relatively uncommon, studies in humans have been unable to exclude a clinically important effect.To assess the risk of cataract associated with the use of statins, and whether it is increased by concurrent use of drugs that inhibit the cytochrome P450 system,patients were randomly sampled from the UK General Practice Research Database. The study included 15 479 people with cataract and 15 479 controls matched for age, sex, practice and observation period.Results: The crude odds ratio (OR) for the association between any recorded exposure to statins and cataract was 1.41 (95%CI 1.21–1.65), but this reduced to 1.04 (95%CI 0.89–1.23, p=0.6) after adjustment for consultation rate. There was no evidence that the risk increased with higher doses or longer duration of statin use, or that the risk varied by individual statin. There was no evidence that the risk of cataract was increased by concurrent use of statins and drugs that inhibit the cytochrome P450 system.In the short- and medium-term, statins do not seem to be associated with an increased risk of cataract. The need to assess the effects of long-term statin exposure on the eye remains.
Posted by agholami at 10:59 PM
Comparison of biometric measurements using partial coherence interferometry and applanation ultrasound1
JCRS April 2003
To compare and contrast axial length (AL) measurements assessed by ultrasound biometry and optical biometry.Optical biometry and ultrasound biometry were performed in 360 eyes to measure AL . In eyes with a clear-appearing crystalline lens, there was a statistically significant median difference in AL measurements between the 2 methods in eyes with a normal or long length. In eyes with cataract, there was a statistically significant median difference in AL measurements in eyes with a normal or short length. In these cases, optical biometry produced larger readings than ultrasound biometry. In eyes with a posterior chamber intraocular lens, there was no statistically significant difference between the 2 methods in eyes of all lengths. In all eyes, the 2 methods produced reliable measurements.
Conclusions
These results show that optical biometry and ultrasound applanation biometry give statistically significant differences in AL measurement in patients with cataract and normal lenses. In these cases, optical biometry provided clinically relevant larger values than ultrasound applanation. Optical biometry provides an alternative to ultrasound biometry. However, ultrasound biometry may be indicated in certain complex cases.
Posted by mehdi khanlari at 10:42 PM
The effects of aspirin and warfarin therapy on haemorrhage in vitreoretinal surgery
Acta Ophthalmologica Scandinavica
No substantial recommendations exist regarding the management of anticoagulant drugs prior to ocular surgery. Stopping anticoagulation can cause fatal emboli, but sight-threatening bleeds may occur if anticoagulation is continued. We examined the effects of anticoagulation on vitreoretinal surgery.Sixty patients in the study were taking aspirin and seven were taking warfarin. There were 11 cases of choroidal haemorrhage, one of which involved a warfarin user. Of 325 retinal detachment repairs, 21 (6.5%) had preoperative vitreous haemorrhages. Two of these patients were on aspirin and two were on warfarin. Sixty-six vitrectomies were performed for diabetic vitreous haemorrhages, of which nine re-bled postoperatively. One of these patients was taking warfarin. The association of warfarin with bleeding was statistically significant (relative risk 6.185).
Conclusion:
Anticoagulation had no effect on the number of significant perioperative (choroidal) haemorrhages. Aspirin had little effect on bleeding during vitreoretinal surgery. Warfarin, however, was associated with bleeding complications. We suggest that aspirin should not be stopped prior to surgery. Warfarin may be stopped if the patient's thromboembolic risk is low.
Posted by mehdi khanlari at 10:11 PM
April 19, 2003
Indications for therapeutic contact lens
Review of Ophthamology April 2003
• Chronic corneal edema due to endothelial failure results ultimately in bullous epithelial lesions that break down and cause pain and irritation. Bandage contact lens therapy relieves pain but doesn’t usually improve vision. A goal in therapy is to control pain while preventing corneal vascularization, particularly if the patient is a candidate for keratoplasty.
• Recurrent corneal erosions. There are several different conditions that may cause recurrent corneal erosions. Anterior causes include abrasive trauma, epithelial basement membrane dystrophy, and Reis-Bückler’s dystrophy. Stromal dystrophies such as granular and lattice dystrophy may also produce secondary corneal epitheliopathy.
• Persistent epithelial defects and ulcers. Bandage contact lenses are occasionally used in the management of persistent corneal epithelial defects and corneal ulcers, including post-infectious, trophic and autoimmune-related ulcers.
• infectious corneal ulcers to provide protection of the fragile, healing corneal epithelium while maintaining effective delivery of antibiotics via a depot mechanism.
A trophic corneal ulcer usually presents as a persistent epithelial defect with possible stromal ulceration and is often associated with decreased corneal sensation. The goal in treating this lesion is to promote epithelial healing and prevent the secondary stromal ulceration. A soft contact lens with good oxygen permeability may provide protection of the healing epithelium.
• filamentary keratopathy.
• Peripheral ulcerative keratitis is a thinning disorder of the corneal stroma often associated with an autoimmune etiology and inflammatory mediators causing collagen destruction of the stroma. A bandage lens can provide protection of the healing cornea and promote stromal vascularization to prevent further melting.
• Corneal irregularity. Bandage contact lenses can provide significant pain relief in conditions where the anterior surface of the cornea is elevated and irregular, sometimes even improving visual acuity. One such condition is filamentary keratitis, a disorder of irregular epithelial healing leading to mucous filament adhesion to focal epithelial micro-erosions of the cornea. Contacts lenses in this condition provide comfort and sometimes improve vision.
• Thygeson’s superficial punctate keratitis and
• superior limbic keratitis (SLK).
Posted by mehdi khanlari at 11:04 PM
Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection
Ophthalmology (2003) 110: 681-686
To describe the pharmacokinetics occurring after the direct injection of triamcinolone acetonide into the vitreous humor of humans, an aqueous humor sample was obtained from 5 eyes via an anterior chamber paracentesis at days 1, 3, 10, 17, and 31 after a single 4-mg intravitreal injection of triamcinolone acetonide. At each visit, visual acuity and intraocular pressure were measured and indirect ophthalmoscopy was performed. A fluorescein angiogram was carried out at day 10. Concentrations were determined using high performance liquid chromatography. Peak aqueous humor concentrations ranged from 2151 to 7202 ng/ml, half-lives from 76 to 635 hours, and the integral of the area under the concentration-time curve (AUC0-t) from 231 to 1911 ng/h per milliliter. After a single intravitreal injection of triamcinolone, the mean elimination half-life was 18.6 days in nonvitrectomized patients. The half-life in a patient who had undergone a vitrectomy was shorter at 3.2 days.
CONCLUSIONS: There was considerable intrasubject variation among peak concentration, AUC0-t values, and elimination half-lives. After intravitreal injection, measurable concentrations of triamcinolone would be expected to last for approximately 3 months (93 ± 28 days) in the absence of a vitrectomy.
Posted by agholami at 10:43 PM
A Brief History of Fluoroquinolones
Review of Ophthamology April 2003
Fluoroquinolones were the first class of man-made antibiotics. All fluoroquinolones share a common molecular core with attached chemical domains designed to bind to bacterial DNA and the bacterial enzymes DNA gyrase and topoisomerase IV. DNA gyrase uncoils the supercoiled bacterial genome, allowing other replication enzymes, such as DNA polymerase, to function. DNA gyrase consists of four subunits, encoded by the gyrA and gyrB genes. DNA topoisomerase IV detaches daughter chromosomes after the completion of DNA replication. Both enzymes are necessary parts of the DNA replication and cell division process. The fluoroquinolone molecule forms a complex with the DNA and enzymes, locking the DNA in a lethal broken state. Since these enzymes are conserved in the bacterial genome, fluoroquinolones are bactericidal to many different bacteria.1,2 In 1958, the molecule 7-chloroquinolone was found to have antibiotic properties and, in 1962, nalidixic acid, the precursor to fluoroquinolones, was developed. Its narrow antibacterial spectrum, short half-life and high protein binding limited its effectiveness, though. In 1978, however, norfloxacin, a new molecule that improved on these three factors, was developed, making it the first fluoroquinolone. Modifying certain chemical domains on the central structural core of the molecules allows researchers to create additional antibiotics with improved effectiveness. In this manner, ofloxacin and ciprofloxacin were developed and are considered to be the second generation of fluoroquinolones. They improved on the gram-negative activity of norfloxacin and its duration of action, and, as such, are still important systemic and topical antibiotics.
Posted by mehdi khanlari at 10:39 PM
Vitamin D analogs, a new treatment for retinoblastoma
Ophthalmic Genetics 2002, Vol.23, No.3, pp. 137-156
We identified vitamin D receptors in retinoblastoma and examined the effectiveness and mechanism of action of these analogs. Methods: Reverse-transcriptase polymerase chain reaction (RT-PCR) amplification was used to detect vitamin D receptor mRNAs in human and mouse retinoblastomas. The effectiveness and toxicity of vitamin D2, calcitriol, and synthetic analogs were studied in the athymic/Y-79 xenograft and transgenic mouse models of RB. Dosing was 5X/week for five weeks. Dose-response studies focused on tumor inhibition; toxicity studies investigated survival and serum calcium. The mechanism of action of vitamin D was investigated using terminal transferase dUTP labeling 3'-overhang ligation to measure apoptosis; immunohistochemistry measured p53-dependent gene expression and cell proliferation. Result: Vitamin D receptor mRNAs were detectable in Y-79 RB cells, LHß-Tag tumors, and human RB specimens using RT-PCR. Calcitriol inhibited cell growth in vitro. Calcitriol and vitamin D2 inhibited in vivo growth in xenograft and transgenic models, but therapeutic levels were toxic due to hypercalcemia. Two analogs, 16,23-D3 and 1a-OH-D2, inhibited tumors in animal models of RB with reduced toxicity. The mechanism of action appears related to increased p53-related gene expression resulting in increased apoptosis. Conclusion: 16,23-D3 and 1a-OH-D2 are effective in tumor reduction in two mouse models of RB with low toxicity. These results warrant initiating phase 1 and phase 2 clinical studies in children.
Posted by mmiraftab at 06:16 PM
Wavefront-guided, -assisted, -adjusted: Choosing the right approach
OCULAR SURGERY NEWS EUROPE/ASIA-PACIFIC EDITION April 2003
Refractive surgeons must learn the distinctions among a host of options to know what type of correction to offer their patients.In the coming year, the availability of new modes of wavefront-guided ablation will enable surgeons to expand their laser vision correction options. These modes will soon include wavefront-adjusted, wavefront-assisted and wavefront-guided ablation, in addition to the conventional ablation protocols already available.
The question becomes, who should be treated with which type of platform?
Posted by mmiraftab at 05:52 PM
A Randomized Trial of Beta Carotene and Age-Related Cataract in US Physicians
Arch Ophthalmol. 2003;121:372-378.
| Conclusions : Randomized trial data from a large population of healthy men indicate no overall benefit or harm of 12 years of beta carotene supplementation on cataract or cataract extraction. However, among current smokers at baseline, beta carotene appeared to attenuate their excess risk of cataract by about one fourth. |
Posted by mehdi khanlari at 01:02 PM
Lindstrom: The future of presbyopic correction lies in IOLs, intracorneal lenses
OSN 4/13/03
Presbyopia will be the primary challenge for refractive surgeons as the baby boomer generation ages, said Richard L. Lindstrom, MD, delivering the Binkhorst Lecture here at the opening session of the American Society of Cataract and Refractive Surgery meeting. “If you are looking for a handicap to overcome, this is certainly one that presents a tremendous opportunity, noting that currently 51% of the U.S. population is presbyopic. “Perhaps as many as 68 million potential surgical eyes could be treated if we had an effective, safe therapy.But surgical correction of presbyopia is clearly in its early years,”Noting that no surgical procedure or device is approved by the Food and Drug Administration for the treatment of presbyopia,Correction with multifocal IOLs is now giving good results in properly selected patients. In the U.S., the most rapidly growing refractive procedure today is refractive lensectomy and I see significant growth there,We are going to see explosive development of accommodating IOLs, new technology IOLs like adjustable IOLs, as well as corneal inlays that are going to expand our options significantly in this area of treatment for presbyopia.”
Posted by mmiraftab at 11:15 AM
Technolas approval
Ophthalmology Management April 2003
The FDA has approved the Bausch & Lomb Technolas 217A excimer laser system for correcting hyperopia. The new approval expands the treatment range of the Technolas from myopia up to -12D with or without astigmatism, to hyperopia up to +4D, with or without astigmatism
Posted by mmiraftab at 10:38 AM
April 18, 2003
Pelion Capsulorhexis Forceps
Cataract & Refractive Syrgery Today April 2003 
Pelion Surgical LLC (Aiken, SC), a new instrument company, has designed a capsulorhexis forceps for microincisional cataract surgery.
| The forceps features “micro-fine” tips on a 23-gauge shaft that allow the forceps to be used through a sideport incision. |
Posted by mehdi khanlari at 10:49 PM
Refractive Challenge : Enlarging the Optical Zone
Cataract & Refractive Syrgery Today April 2003
CASE HISTORY
In 1995, a 50-year-old white female underwent bilateral radial keratotomy that targeted plano for -4.50 D of myopia. She was undercorrected, so the surgeon performed myopic automated lamellar keratomileusis (ALK) on her right and left eyes in 1995 and 1996, respectively. The right eye experienced secondary hyperopia, while the left eye remained myopic. Next, the surgeon performed LASIK on the patient’s left eye using the Chiron ACS (Bausch & Lomb Surgical, San Dimas, CA) in 1998 and on her right eye in 1999 with the Hansatome microkeratome (Bausch & Lomb Surgical).
The patient presented in my office with complaints of poor nighttime vision and halos around lights at night. Glasses had not improved her symptoms. She had a bilateral UCVA of 20/60. The patient had a manifest refraction of +0.75 +0.25 X 35 and a BCVA of 20/25-2 OD. The manifest refraction and BCVA of her left eye were +0.50 +0.75 X 165 and 20/25. The slit lamp examination showed well-healed RK scars, as well as a relatively small but thick ALK flap in both eyes . Each eye’s LASIK flap was larger and thinner than its ALK flap. The steep transition zone was evident on the peripheral topography (blue edge to red edge) corresponding with 38.00 D centrally to 45.00 D peripherally. The patient’s pupils were 7.5 mm, extending beyond the edge of the color topography map and signifying that spherical aberrations factored into the patient’s complaints. Her central pachymetry measurements were 492 µm OD and 539 µm OS. The remainder of the examination was unremarkable.
HOW WOULD YOU PROCEED?
1. Would you perform an enhancement on a patient with two flaps per eye?
2. How would you relift the flap?
3. By what method would you enlarge the optical zone?
Posted by mehdi khanlari at 10:20 PM
Idiopathic Orbital Inflammation
Distribution, Clinical Features, and Treatment Outcome
Archives of Ophthalmology, April, 2003
Ninety eyes in 65 patients (22 men and 43 women) were studied. Diagnoses were isolated dacryoadenitis (n = 21), isolated myositis (n = 19), concurrent dacryoadenitis and myositis (n = 5), orbital apex syndrome (n = 6), and idiopathic inflammation involving the preseptal region, supraorbital region, sclera, Tenon capsule, orbital fat, or optic nerve (n = 14). Pain and periorbital swelling were the most common clinical features and were observed in 45 (69%) and 49 (75%) patients, respectively. Seventeen patients (26%) had bilateral involvement. Patients were treated with steroids alone (n = 45), steroids and subsequent radiation therapy (n = 8), steroids and nonsteroidal anti-inflammatory agents (n = 6), nonsteroidal anti-inflammatory agents alone in mild cases (n = 2), and, rarely, radiation therapy without steroids (n = 1) or surgical debulking alone (n = 1). Of 65 patients, 41 (63%) represented treatment successes, with complete symptom relief at the time of the last follow-up, and 24 (37%) represented treatment failures, with partial or no relief of symptoms.
Conclusion Systemic steroid with a slow taper has been the established first-line treatment for idiopathic orbital inflammation, but refractory cases accounted for a significant portion of treatment failures in our study, reflecting the need for a more systematic approach to the study of this multifaceted disease and for therapeutic alternatives to systemic steroids.
Posted by afarahi at 12:12 AM
April 17, 2003
Refractec Completes Phase III Presbyopia Clinical Trial Enrollment
Cataract & Refractive Syrgery Today April 2003
Refractec, Inc. (Irvine, CA), has completed patient enrollment for its FDA Phase III clinical trial evaluating Conductive Keratoplasty (CK) for the treatment of presbyopia. Recent data from the 160-eye CK presbyopia trial show that, at 12 months, 97% of the patients could see 20/20 at distance and read magazine- and newspaper-sized print; 75% could see 20/20 and read J2 at near; and 96% reported being “satisfied” to “very satisfied” with their outcome. The company plans to file for premarket approval later this year.
Posted by mehdi khanlari at 04:59 PM
April 15, 2003
Relationship between the axis and degree of high astigmatism and obliquity of palpebral fissure
J AAPOS, Feb, 2003
A cross-sectional study at a referral center of 53 children with astigmatism of more than +1.50 D in at least 1 eye was performed . A statistically significant correlation between the degree of total astigmatism and a larger abnormal slant (P = .0192) and between the axis and magnitude of corneal astigmatism and abnormal slant (P = .0092)was found. Higher degrees of eyelid slant (> 8° or < –4°) increased the risk of high cylinder magnitude (> 3.00 D) by an odds ratio of 4.17 (95% CI: 1.03, 19.95). Conclusions: Children with astigmatism with large degrees of slanting of their palpebral fissures are at higher risk for high astigmatism (> 3.00 D). The axis of the astigmatism is highly correlated with the slanting of the palpebral fissure.
Posted by afarahi at 12:33 AM
Clinical features predictive of successfully weaning from spectacles those children with accommodative esotropia
J AAPOS, Feb, 2003
It has been reported that most children with accommodative esotropia are not able to discontinue spectacle wear as they become older. We conducted a prospective study to determine which factors are predictive of successfully weaning children from spectacles.Twelve of 20 children (60%) were successfully weaned from spectacles. . The clinical characteristic most clearly associated with successful weaning was the refractive error at the time glasses were prescribed. Whereas 10 of 11 (91%) patients with < 3 D of hyperopia were weaned from spectacles, only 2 of 9 (22%) patients with 3 to 5 D of hyperopia were successfully weaned from their spectacles (P = .005). Conclusions: Many children with fully accommodative esotropia can be weaned out of spectacles during the grade school years. The degree of baseline hyperopia appears to be one of the best predictors of success.
Posted by afarahi at 12:14 AM
April 14, 2003
Astigmatism induced by simultaneous recession of both horizontal rectus muscles
J AAPOS, Feb, 2003
Changes have been reported in the refractive state of the eye after various types of strabismus surgery. This study investigates the effect of large simultaneous recession of both horizontal rectus muscles on the refractive state of the eye. Twenty-six eyes (13 patients) were refracted 1 to 2 weeks before and 6 to 8 weeks after large horizontal rectus muscle recessions for the purpose of damping nystagmus. A statistically significant change in astigmatism in the with-the-rule direction was induced with this procedure (+ 0.70 diopter cylinder, axis 90.0°, P < .0002). With the narrow range of amounts of recession performed, there was no demonstrable relation between the amount of recession and the amount of induced astigmatism. Conclusions: Recession of both horizontal rectus muscles, the same as has been reported for recession of one horizontal rectus muscle and recession-resection surgery on both horizontal rectus muscles, tends to induce a change in astigmatism in the with-the-rule direction.
Posted by afarahi at 11:54 PM
Historical aspect of Diabetes mellitus
Ophthalmology Times March 15, 2003
Polyuria was mentioned in the Ebers Papyrus, which dates from about 1500 bc. Aretaeus, a physician who lived in Asia Minor, wrote an accurate clinical description of diabetes mellitus including the classical triad of polyuria, polydipsia, and polyphagia. He concluded that the name diabetes comes from the Greek word for siphon, meaning to go through or to pass through, and the word mellitus, coming from the Greek word for sweet. Thomas Willis (1621-1675) wrote of the sweetness of the affected patient's urine and likened it to honey. Further analysis of the urine of diabetics was performed by Matthew Dobson (1735-1784), who, in 1776, was the first to demonstrate the presence of sugar in the urine. Adolf Kussmaul (1822-1902), author, researcher, and scientist, in 1873 described the respiration that is associated with diabetic coma and has been termed Kussmaul's breathing or Kussmaul's air hunger. In 1890 Oskar Minkowski (1858-1931), a Russian by birth who studied medicine in Germany, carried out critical investigations of the role of the pancreas in diabetes mellitus. The final chapter in this story is set in Canada where Frederick Grant Banting (1891-1941) began his orthopedic surgical practice in 1920. He became interested at that time in the idea of extracting the acting principle responsible for causing diabetes from the pancreas. He left his practice to go to the University of Toronto and work at the laboratory of John James Rickard Macleod (1876-1935). Macleod gave Banting a small laboratory, 10 dogs, and the aid of an undergraduate student, Charles Herbert Best (1899-1978), who was well versed in the analysis of carbohydrates. In May 1921 they began their studies. On July 30, 1921 after tireless experimentation, they showed that there was an internal secretion of the pancreas that, when given to dogs that had previously had their pancreas removed, would control the diabetes that occurred. Banting called this substance isletin and later changed it to insulin. By January 1922 insulin was purified, and human clinical trials began. Within 6 months, 1 year after the beginning of their research, insulin would become available to the world. In 1923 the Nobel Prize in physiology or medicine was awarded to Banting and Macleod. Banting was 32 years old at the time and thus is the youngest recipient of the Nobel Prize in physiology or medicine. No mention of Best was noted. Banting was angered and wrote profusely about Best's participation in the studies. He showed his disappointment with the Nobel committee by sharing the monetary prize with Best. In 1934 Banting was knighted. On February 2, 1941, he was killed in an airplane crash while he was heading for England to help England in its World War II conflicts. The young Nobel Prize laureate died all too soon but left a legacy for which generations of diabetics are thankful.
Posted by mehdi khanlari at 10:53 AM
Sub-Tenon’s anesthesia
Eyeworld April 2003 
Sub-Tenon’s anesthesia provides many of the advantages of retrobulbar anesthesia, without the risks. Unlike retrobulbar anesthesia, which must be administered before surgery, sub-Tenon’s anesthesia can be administered at any time during surgery. Additionally, it achieves akinesia. This is especially helpful when surgeons use topical anesthesia and a patient has excessive ocular movement, discomfort, or surgery becomes prolonged or complicated.The only patients who are not good candidates are those who have had extensive prior conjunctival surgery such as retinal reattachment surgery or extensive eye muscle surgery where one could encounter significant scarring of the conjunctiva or those who have retinal encircling bands.
The technique
Sub-Tenon’s anesthesia can be done using several different techniques. Rous uses a technique called simplified sub-Tenon’s/parabulbar anesthesia. He uses a needle that is 9/16 inches in length with a gentle curve. The bevel of the needle is on the inside of the curve.The anesthesia is given in the inferotemporal quadrant of the eye between the equator and the fornix. “The needle is placed tangentially, and then the curve of the needle just follows the curvature of the globe. I mix 4.5 cc of 2% Carbocaine (mepivacaine HCl, Abbott) with 0.5 cc of hyaluronidase. I usually give between 3.5 and 4 cc,” Rous said.The anesthesia is given in the preop area under direct visualization and does not require any conjunctival cut down. He uses sodium Pentothal (thiopental, Abbott) to put the patient to sleep for a few minutes. He separates the lids with a wire speculum, but finger spread can also be used. After the injection is given, a Honan’s balloon is placed over the eye.
Masket’s technique is a bit different. He makes a small buttonhole through the conjunctiva and through Tenon’s capsule. “Typically, the best place is in either the supranasal or the infranasal quadrant, working back maybe 8 to 10 mm from the limbus. That gets you into the posterior sub-Tenon’s space. One just undermines a little bit with the blunt end of the scissors. Then, using a specially designed cannula, hug the contour of the globe and pass the cannula posteriorly. Once the end of the cannula is behind the equator of the eye, it’s just a matter of instilling about 2 cc or 3 cc of local anesthetic,” he said He noted that the concentration of the anesthetic and the mixture of the anesthetic can vary from patient to patient depending on need. “If one wants to make the eye totally immobile, then you want to use a long-acting anesthetic, like half 0.75% Marcaine (bupivacaine, Abbott) and half 2% lidocaine,” he said.
Posted by mehdi khanlari at 09:42 AM
Complicated case: Grey epithelium in diabetic cataract patient
Eyeworld April 2003
Presenting the challenge (CloMitchell Gossman)
Recently, I performed uncomplicated phaco on a 75-year-old diabetic patient who had a very dense cataract. (His other eye is phthisical and is patched except at nighttime.)One day postop, he had substantial stromal edema when he returned to the referring optometrist. The patient was on tapering Pred Forte (prednisolone acetate, Allergan) and a short course (one week) of Ocuflox (0.3% ofloxacin, Allergan).The patient called my office two weeks later and expressed concern about the appearance of his cornea. I assumed it was persistent corneal edema and had him come in. Upon examination, I observed that his epithelium had a ratty, gray, rough appearance and there was superficial punctate keratitis (SPK). He had no stromal edema at all, and the endothelial matrix was fine.The patient did not respond to steroid treatment or intensive lubrication including preservative-free tears. I found his condition hard to blame on drop toxicity because the findings occurred well after the drops were finished.
I wondered if he had persistent epithelial toxicity due to preservatives in the postop drops. However, he had a lack of response to continued preservative-free tears. The patient denied eye rubbing and did not have nocturnal lagophthalmos.At this point, I am considering a prednisolone/Healon combination (prednisolone, Schein)/ (sodium hyaluronate, Pharmacia).For detailed response for this presentation Read More
Posted by mehdi khanlari at 09:28 AM
Doing away with dysphotopsia
Eyeworld April 2003
One all too common complaint of cataract patients following IOL implantation is the problem of dysphotopsia. As many as 10% of patients can have dysphotopic complaints,Negative dysphotopsia is typically referred to as a dark, temporal crescent, where patients feel as though they have a shade over the temporal region of their vision . It’s unclear whether that is only due to the incision, edema at the incision, or because we’ve now shifted our surgery temporally, or, whether it’s a true optical phenomenon associated with different type of lens implants.” Negative dysphotopsia typically does go away but remains a puzzle.
With positive dysphotopsia, there are a variety of unwanted images such as rings, arcs, and central flashes. “Measuring its frequency is extraordinarily difficult because there is no objective way to test for it . Over 50% of the patients in every study we have done will have some element of dysphotopsia
Dysphotopsia today is a product of the square-edge design, “My sense is that we are asking the lens implant to achieve more than just high-quality vision,” he said. “We’re asking the lens to also be a retardant against PCO and I would hope that we’ll find other ways in the foreseeable future to eliminate PCO, by means other than edge design.”Manufacturers have taken steps to try to reduce dysphotopsia associated with the square-edged lens. AMO has tried to curtail dysphotopsia with their OptiEdge design. With this three-part edge, the front edge is modified to get rid of unwanted images, since this is not important in PCO prevention, Clinically, Masket finds that patients still experience dysphotopsia with the OptiEdge, but this to a less extent than with other square-edged designs. “The original Sensar (AMO) lens had a round-edge design and that had a higher incidence of PCO but a lower incidence of dysphotopsia.The OptiEdge reduces PCO but still does induce dysphotopsia, but not as much as the original Alcon lens (AcrySof).”
Overall, dysphotopsia is very common,. “If you haven’t heard much about it, it’s because you’re not asking, because clearly, the patients are troubled by these issues,” he said.
Posted by mehdi khanlari at 09:16 AM
April 12, 2003
The Effect of Trabeculectomy on the Intraocular Pressure of the Unoperated Fellow Eye
Journal of Glaucoma 2003; 12(2):108-113
To investigate the intraocular pressure (IOP) changes in the unoperated fellow eye in patients who underwent trabeculectomy
Mean preoperative IOP levels were 37.0 ± 10.0 mm Hg in the operated eyes and 15.1 ± 3.1 mm Hg in the fellow eyes. Mean IOPs in the unoperated eyes on the postoperative first-day, first- and second-week, and first- and third-month visits (17.1 ± 5.7, 17.5 ± 5.1, 18.5 ± 5.4, 18.6 ± 5.1, and 19.0 ± 5.9 mm Hg, respectively) were significantly different compared with the preoperative levels for each period of time (P < 0.01). Eight fellow eyes underwent operations for uncontrolled glaucoma before month 3. Among the remaining 99 eyes, higher postoperative IOP values were measured in 33 (33%) eyes at all postoperative visits compared with the preoperative IOP levels. A consistent IOP rise equal to or higher than 5 mm Hg was detected in 12 eyes (12%) and a consistent IOP elevation of 30% or more was found in 14 eyes (14%) during the postoperative first 3 months. Contralateral IOP elevation was not correlated with patient age, type of glaucoma, or preoperative antiglaucomatous medications prescribed to the operated or fellow eyes.After filtration surgery, IOP of the unoperated fellow eye should also be monitored closely in order not to overlook a possible insidious rise, especially in glaucomatous eyes that were previously under good medical control.
Posted by mmiraftab at 10:56 AM
Introducing the UNFOLDER Emerald for SENSAR with OptiEdge
Posted by mmiraftab at 10:38 AM
Treatment of ocular inflammatory disorders with daclizumab
Ophthalmology (2003) 110: 786-789
To evaluate the efficacy and safety of daclizumab therapy for patients with various ophthalmologic inflammatory disorders (all having previously failed standard treatment methods). Daclizumab is safe and, at least in some patients, appears to be an effective medication in the treatment of ocular inflammatory disorders.
Daclizumab (Zenapax; Hoffman-LaRoche, Inc., Nutley, NJ) is a humanized immunoglobulin G monoclonal antibody produced by recombinant DNA technology that specifically binds CD25 of the human interleukin (IL)-2 receptor that is expressed on activated T lymphocytes. The medication is composed of 90% human and 10% murine antibody sequences that function as an IL-2 receptor antagonist for inhibiting IL-2 binding, thus selectively inhibiting activated but not resting T cells. Daclizumab is approved by the Food and Drug Administration in the United States for prophylaxis of acute organ rejection in patients receiving renal transplants. Reported off-label uses for the medication include treatment for liver transplant rejection,3 cardiac transplant rejection,4 graft-versus-host disease,5 and psoriasis.6 Nussenblatt et al7 reported that daclizumab was safe and effective in the treatment of 8 of 10 patients with otherwise treatment-resistant noninfectious intermediate and posterior uveitis. In experimental models, Guex-Crosier et al8 demonstrated that infusion of anti–IL-2 receptor antibody had a positive therapeutic effect on S antigen-induced experimental autoimmune uveitis in nonhuman primates
Posted by mmiraftab at 10:06 AM
Replacing the endothelium without corneal surface incisions or sutures
the first United States clinical series using the deep lamellar endothelial keratoplasty procedure
Ophthalmology (2003) 110: 755-764
A 9.0-mm limbal, scleral, partial-depth incision provided access for a deep lamellar corneal pocket dissection. A 7.5- to 8.0-mm posterior lamellar disc of recipient tissue was then excised and replaced through the pocket with a same size donor disc containing healthy endothelium. A temporary air bubble in the anterior chamber was used for donor tissue adherence, and no surface corneal incisions or sutures were necessary. At 6 and 12 months after surgery, all eight corneas were clear and the grafts were healed in good position. At 6 months, the BSCVA varied between 20/30 and 20/70, the average change in astigmatism from before surgery was +1.13 diopters (D; ±1.50 D), the average change in corneal power was -0.4 D (±1.7 D), the average pachymetry was 648 µm (±134 µm), and the average endothelial cell count was 2290 cells/mm2 (±372 cells/mm2). At 12 months, three of the four eyes reaching this time gate were 20/40 or better, with a change in astigmatism from before surgery of only +0.81 D (± 0.55 D), a corneal power change of -1.3 D (± 0.4 D), and an endothelial density of 2409 cells/mm2 (± 154 cells/mm2). One of the original nine eyes entered into this study required conversion to standard penetrating keratoplasty as a result of a microperforation during recipient pocket dissection and has experienced no ill effects.The DLEK procedure, with its absence of corneal surface incisions and sutures, is a safe procedure that preserves the normal corneal topography, minimizes astigmatism and corneal power changes, and provides a healthy donor endothelial cell count and function. If interface optical clarity can be maintained, then this technique offers considerable advantages over penetrating keratoplasty in the treatment of endothelial dysfunction.
Posted by mmiraftab at 10:00 AM
Retinal toxicity of intravitreal tissue plasminogen activator
Ophthalmology (2003) 110: 704-708
Two successive intravitreal injections of tPA (50 µg) 3 days apart with gas tamponade were given to treat a 49-year-old man with submacular hemorrhage. The adverse consequences of this treatment were monitored. A literature review of retinal toxicity of commercial tPA in animals was also done. Diffuse pigmentary alterations sparing the posterior pole, poor visual acuity after the absorption of submacular hemorrhage, reduced scotopic and photopic ERG A- and B-waves were noted.This is the first reported case of retinal toxicity of commercial tPA in humans that resembles the descriptions of tPA-mediated retinal toxicity in animal models. The dosage of intravitreal tPA (between 50 and 100 µg) may be toxic to the human retina.
Posted by mmiraftab at 09:35 AM
April 11, 2003
IMMERSION BIOMETRY TRAINING
Ophthalmology Management Jan 2004
Accutome Inc. now offers an immersion biometry training program. The company will send a service technician to your office to train your staff on the use of the AccuSonic A-Scan, including hands-on immersion training. Alternatively, Accutome will pay the tuition for one person to attend a hands-on CME-certified course on biometry with the purchase of the AccuSonic A-Scan.The company offers 30-day trials for its ultrasound equipment.
Accutome
Phone: (800) 979-2020
E-mail: eyeopenr@accutome.com
Web: www.accutome.com
Posted by mehdi khanlari at 07:41 PM
New developments in managing patients with eye injuries
Eyeworld April 2003
New recent developments reasonably promise further improvement.
1-Terminology. The BETT (Birmingham Eye Trauma Terminology, Table) achieved this goal, and has had a major impact on research and daily clinical practice.
2-EpidemiologyThe American Society of Ocular Trauma (ASOT) has free online software, with security and built-in research capabilities, for ophthalmologists who are interested in collecting and analyzing their trauma data (U.S.: www.useironline.org; worldwide: www.weironline.org).
3-Prognosis The Ocular Trauma Score (OTS; Ophthalmology Clinics of North America 2002; 15:163-166) uses six variables (initial visual acuity, injury type, and presence of: endophthalmitis, retinal detachment, and afferent pupillary defect), to estimate the final visual acuity category. Developed using more than 2,500 serious eye injuries, the OTS predicts the category of final vision (SD: 1 category) in 77% of the cases.The study confirmed earlier findings that the loss of light perception is not an irreversible "death sentence” to the eye. With proper intervention performed within the first two weeks post injury, one-quarter of eyes have improved, and several regained reading vision. It was also found that sympathetic ophthalmia, although it should be discussed with the patient and taken into consideration during decision-making, must not be the ultimate deciding factor.
4-Traumatic cataractThe ophthalmologist must understand that a traumatic cataract is a very different clinical entity.First, there are diagnostic difficulties: Corneal wound edema, blood or fibrin in the anterior chamber, and a narrow pupil may make it impossible to determine the presence of lens injury. Another key issue — ultimately deciding the injury's outcome — is the condition of the posterior segment. Vitreous hemorrhage and retinal detachment occur significantly more commonly in severely injured eyes in the presence of a traumatic cataract, which also may prevent preoperative diagnosis of the posterior segment pathology.
It is the condition of the eye, not the expertise of the surgeon that should determine the method of lens removal. In other words, phacoemulsification may do more harm than good in the presence of a sometimes difficult-to-visualize vitreous prolapse. Vitreous is present in the anterior chamber in one-third of eyes with lens injury, and many additional eyes have prolapse into the lens only. Suction without cutting may cause peripheral retinal tears and ultimately detachment. The use of vitrectomy instrumentation therefore must always be consideredFinally, it should be carefully evaluated whether an IOL should be implanted concurrently or subsequently.
5-Traumatic macular hole Before the advent of vitreous surgery, the patient's only hope was spontaneous resolution, a rare event. Vitrectomy, especially if combined with removal of the 2-:m-thick internal limiting membrane, now offers an over 95% chance of anatomical hole closure, and the vast majority of patients experience visual improvement as well. Even eyes with serious additional macular damage (choroidal rupture, contusion maculopathy) may improve,; surgery therefore should be offered to most patients. A new, 25-gauge vitrectomy system, the TSV25 (Bausch and Lomb), offers shorter operation time with more rapid postoperative recovery.
Posted by mehdi khanlari at 07:26 PM
First drug designed for myopia
Eyeworld April 2003
Pirenzepine, a selective M1 muscarinic antagonist that is the first drug developed specifically to slow the progression of myopia. Novartis Ophthalmics has received exclusive rights for development and commercialization of the drug .Pirenzepine is administered as a gel twice a day. Its exact mechanism of action has not been determined not based on the cycloplegic effects of pirenzepine, but, instead, is due to some type of neural effect. Researchers became interested in the drug because published data showed that atropine significantly slows progression of myopia. However, it produces significant side effects resulting largely from M3 muscarinic effects.“Pirenzepine seems to be very, very selective, much more so than atropine for the M1 receptor.
A 12-month Phase II trial was conducted in the United States in 174 children, ages 8 to 12, years of age with juvenile-onset myopia from -0.75 D to -4 D that there was reduction in the progression of myopia of up to 50%, with an excellent safety and tolerability profile.There have been no reported systemic side effects, and the mild, local side effects that have been reported are temporary mild blurring of near vision, temporary light sensitivity, and minor local allergic reactions, which are not uncommon in chronic medications. In most of the children enrolled in the Phase II trial, these were temporary because the children have such a large accommodative reserve that they’re able to adapt to the very mild cycloplegia that some patients experienced.”
Drug treatment may make refractive surgery unnecessary in some patients, while patients who would have been highly myopic could still be suitable candidates for surgery even after drug therapy.
Posted by mehdi khanlari at 07:06 PM
April 09, 2003
First Clinical Results With the Femtosecond Neodynium-glass Laser in Refractive Surgery
J Refract Surg 2003;19:94-103
PURPOSE: We evaluated four femtosecond laser intrastromal cutting procedures: creation of a corneal flap for laser in situ keratomileusis (LASIK), tunnel and entry cut for intracorneal ring, corneal flap and removable lens for keratomileusis, and intrastromal ablation for myopia and hyperopi. METHODS : A clinical trial using a femtosecond surgical laser (IntraLase Corporation) was performed in partially sighted eyes. Femto-LASIK treatment was performed on 46 eyes up to -14.00 D
CONCLUSIONS: Femtosecond lasers can produce precise intrastromal cutting, offering significant safety and other advantages (no razor blades, corneal trauma, partial resections, or sterilization issues) over current techniques.
Posted by pakravanmd at 01:37 AM
A Randomized Trial of Beta Carotene and Age-Related Cataract in US Physicians
Arch Ophthalmol. 2003;121:372-378
To examine the development of age-related cataract in a trial of beta carotene supplementation in men a randomized, double-masked, placebo-controlled trial performed.Male US physicians aged 40 to 84 years (n = 22 071) were randomly assigned to receive either beta carotene (50 mg on alternate days) or placebo for 12 years.Randomized trial data from a large population of healthy men indicate no overall benefit or harm of 12 years of beta carotene supplementation on cataract or cataract extraction. However, among current smokers at baseline, beta carotene appeared to attenuate their excess risk of cataract by about one fourth.
Posted by kjalali at 12:05 AM
April 08, 2003
Lessons from ONTT help in management of optic neuritis
Ophthalmology Times March 2003
The trial also found that routine blood tests and chest radiographs do not aid in diagnosis. Brain MRI should be done on all people presenting with acute optic neuritis to determine if they are at increased risk for MS. Silent brain lesions on MRI elevate a patient's risk for MS.Patients with optic neuritis and no brain lesions have a low 5-year risk of MS if they have no pain behind the eye, optic disc edema, peripapillary hemorrhage, retinal exudates, and/or mild vision loss, according to the ONTT.
Posted by mmiraftab at 10:45 AM
Mitomycin improves success rate for less-invasive lacrimal surgery, surgeons say
OSN, April, 2003
Adjunctive use of mitomycin-C can improve the success rate of transcanalicular dacryocystorhinostomy, according to two reports.
Two studies achieved high success rates when using MMC in their procedures.According to Dr. Camara, previous published studies on the effectiveness of TLA-DCR have reported success rates between 46% and 85% without the use of MMC. In his study, using MMC to delay healing of the osteotomy, 98.1% of surgeries were successful.
Raoul D. Henson, MD, an oculoplastic surgeon from Quezon City, Philippines, also reported high success using MMC in a transcanalicular procedure. In his evaluation, he achieved a success rate of 87.5%. According to both surgeons, the procedure can be performed with any surgical laser that has a fiberoptic small enough to fit into the patient’s punctum and a transcanalicular DCR technique offers several advantages over external and endonasal DCR procedures
Read more about surgical procedure and advantages....
Posted by afarahi at 12:49 AM
April 06, 2003
VISX, NIDEK SETTLE ALL LAWSUITS.
VISX and Nidek have signed a term sheet outlining a global litigation settlement that resolves all litigation between the companies worldwide, including all of the patent and antitrust lawsuits pending in the United States. It also involves a worldwide cross-license of certain of the companies? respective patents.VISX has agreed to pay $9 million in settlement of Nidek's antitrust suit and related claims. The settlement and cross-license agreement becomes final when both parties sign a final written agreement, after which each company will request the dismissal of all pending lawsuits in the appropriate courts. All other terms are confidential.
Posted by mmiraftab at 12:14 PM
Topical anaesthesia: a risk factor for post-cataract-extraction endophthalmitis?
Clinical & Experimental Ophthalmology Volume 31 Issue 2 Page 125 - April 2003
Between October 1997 and May 2000, there were 633 cataract extractions performed with 219 patients operated under topical anaesthesia and 414 under retrobulbar injection. The selection criteria were that surgically easier cases underwent topical anaesthesia. There were five patients who suffered postoperative endophthalmitis in their first week, of which four cases were under topical anaesthesia. This was shown to be borderline significance of P = 0.05 using the Fischer exact 2-tailed test. There was a complicated case, operated under retrobulbar anaesthesia, who had a low-grade endophthalmitis in the second postoperative week. The four topical cases and the case from the second week all grew Staphylococcus epidermidis. The retrobulbar case developing endophthalmitis in the first week grew alpha haemolytic Streptococcus. After May 2000, there was a change to performing all cataract surgery under retrobulbar anaesthesia and the next 453 cases had no incidence of endophthalmitis. Topical anaesthesia techniques in temporal clear corneal cataract extraction may be a factor in endophthalmitis.
Posted by mmiraftab at 12:12 PM
April 05, 2003
High intensity headlights could cause road accidents by dazzling oncoming drivers
Eurotimes April 2003
NEW high intensity discharge (HID) xenon headlight systems, which are three times brighter than the halogen headlights used on most cars, could cause road accidents by dazzling oncoming drivers and pedestrians. HID bulbs may make good headlights but the glare they cause could visually disable oncoming drivers, particularly the elderly.
“Xenon headlight systems project more light than conventional halogen headlights. Therefore, drivers of cars equipped with HID headlights benefit from increased road visibility and greater driving safety because they can see hazards earlier and have more time to respond. “But for the elderly in particular, who are already handicapped by night-time driving difficulties, glare from HID headlight encounters on two-lane roads can be dangerous,”
Posted by mehdi khanlari at 11:37 PM
New classification system to assist in diagnosis and treatment of limbal stem cell disease
Eurotimes April 2003
Staging system: Extent of limbal stem cell deficiency and status of conjunctiva.
A NEW classification system for stem cell disease should pave the way for improved diagnosis and treatment of a wide spectrum of corneal diseases.At a meeting of cornea specialists, Gary S Schwartz MD presented the new staging system, beginning with a reminder that a healthy conjunctival layer, with enough secretion of mucin and aqueous humour, needs to be complemented by a structurally normal adnexa and a healthy cornea. “In a lot of cases, all the elements are there, and our task is limited to keep the cornea healthy. For that we need a healthy endothelium and a healthy epithelium, which is what concerned us and what led us to develop this staging of limbal cell deficiency. The goal is for the new system to help in clarifying the diagnosis and subsequent therapeutic decision,” The classification is based on two factors: the extent of the limbal stem cell deficiency and the status of the conjunctiva.
With regard to cell deficiency, Dr Schwartz described two groups of patients. Stage I includes those who have lost less than half of their stem cell population, generally due to iatrogenic intervention, contact lens keratopathy or mild alkali injury. Stage II includes those patients with a loss greater than half of their stem cell population, generally associated with aniridia, severe S-J syndrome or severe alkali injury.The status of the conjunctiva is graded in three levels. Grade A represents a normal conjunctiva, such as that of patients who have suffered iatrogenic injury or who have aniridia. Grade B represents a quiet though abnormal conjunctiva, without active inflammation, such as can be seen after an old chemical injury that leaves a mild chronic inflammation. Grade C represents an inflamed conjunctiva which can have an internal origin (autoimmune diseases such as S-J syndrome or ocular cicatricial pemphigoid) or an external source, such as a recent alkali injury.
“The advantage of this classification system is that it allows us to compare like with like when evaluating the relative efficacy of various therapeutic procedures.
Posted by mehdi khanlari at 11:28 PM
Handheld GPS device helps blind steer safely through the metropolitan jungle
Eurotimes April 2003 
A HIGH-tech handheld navigation tool is set to revolutionise travel for the blind and partially sighted by helping them find their way around the urban jungle. The device, which uses advanced European Space Agency (ESA) satellite technology to locate and guide pedestrians in real time over a wireless internet connection, is being put through its paces is on European streets by volunteers from ONCE, Spain's national organisation for the blind.The application enables access to precise locations, directions and routing, detailed descriptions of surroundings such as points of interest, and other co-ordinates. It promises, in time, to reinvent travel for visually impaired people, offering them unprecedented levels of independence and confidence in navigating the most complex urban environments.To surmount the problem of buildings obscuring the EGNOS signal, the European Space Agency created a complementary technology known as SISNeT (Signal-In-Space through the internet) to relay the signal in real time over the internet using wireless networks.
The new handheld system, developed by Spanish company GMV Sistemas, makes use of this technology to improve the accuracy of GPS positions to a few metres, making it sensitive enough to locate obstacles in the street. “We think the addition of Sisnet to Tormes is very interesting. It should allow the blind user to navigate using a map, just as a sighted person can,” said Alfredo Catalina, who is overseeing the project at GMV. The addition of an Internet connection also has the potential to enhance the function of personal navigators in other ways.“When you are connected to the Internet you can also send messages back. You can ask for directions to a particular place or say that you are lost or have had an accident. By connecting the Internet to the world of navigation with, we are opening up many new possibilities,”
Posted by mehdi khanlari at 11:13 PM
Zyoptix system produces encouraging results in US for the correction of myopia
Eurotimes April 2003
The latest results from US clinical trials indicate that the Zyoptix (Bausch & Lomb) system for wavefront-guided Lasik provides excellent visual results with few complications, according to Stephen Slade MD, FACS. More than 94% of subjects maintained or improved their BCVA six months after surgery and 70.3% had unaided 20/16 vision. The results were based on a cohort of 340 eyes of 170 patients, with a combination of myopia of up to -7.0 D and astigmatism of up to -3.5 D. Follow-up was 100% at six months. Dr Slade said that the results were encouraging for both spherical and cylindrical aberrations. The postoperative UCVA was equal to or better than preoperative BCVA in 78% of eyes with spherical aberrations. While two eyes lost two lines of BCVA, 61% gained one line or more.Six months after surgery, 99% of subjects reported that they were satisfied with the results; 99.7% indicated improvement in quality of vision, of which more than 40% reported improvement in night vision while driving. Contrast sensitivity at low illumination was improved or the same in 77% to 83% of eyes.Refractive predictability was also excellent,. Almost 75% of eyes were within 0.5 D and close to 90% within 1.0 D of the expected outcome. The refractive stability for all 340 eyes, sphere and cylinder, tracked “very nicely” from day one to the six month period
Posted by mehdi khanlari at 10:59 PM
Corneal perforation during laser in situ keratomileusis after hyperopic electrothermal keratoplasty
AJO April 2003
A 49-year-old man presented with primary hyperopia in the right eye and residual hyperopia after electrothermokeratoplasty in the left eye. His refraction was +4.00 in the right eye and +7.00 -3.00 × 135 degrees in the left eye, with a central pachymetry of 535 m and 549 m, respectively. Phacoemulsification with intraocular lens (IOL) insertion in the right eye and a two-step keratophacorefractive procedure with a piggyback IOL insertion and LASIK in the left eye were proposed.Postoperative refraction was -0.50 -0.50 × 150 degrees 20/20 in the right eye. Postphacoemulsifi-cation refraction was -4.75 -4.25 × 135 degrees in the left eye. Laser in situ keratomileusis was performed in the left eye, 4 months later, with uneventful astigmatic laser ablation. During the myopic ablation, a sudden outcome of aqueous humor in one of the temporal corneal scars was observed.Unpredictably thin areas after electrothermokeratoplasty may lead to unexpected corneal perforation during LASIK. The available pachymetry systems may be unreliable after electrothermal keratoplasty.
Posted by mmiraftab at 11:15 AM
April 03, 2003
Gatifloxacin receives FDA approval
OSN
The Food and Drug Administration has granted regulatory approval to Allergan for its anti-infective fluoroquinolone gatifloxacin, the company announced today. Zymar (gatifloxacin ophthalmic solution) 0.3% has been approved for the treatment of bacterial conjunctivitis caused by susceptible strains of bacteria. A company statement notes Zymar’s molecular structure contains an 8-methoxy group, to which has been attributed the drug’s dual mechanism of action. The most frequently reported adverse events in the overall Zymar study population were conjunctival irritation, increased secretion of tears, inflammation of the cornea and papillary conjunctivitis. These events occurred in about 5% to 10% of patients. Other reported reactions occurring in 1% to 4% of patients were swelling of the tissue surrounding the cornea, conjunctival hemorrhage, dry eye, eye discharge, eye irritation, eye pain, eyelid swelling, headache, red eye, reduced visual acuity and taste disturbance, Allergan noted.
Posted by Ali Reza Naderi at 11:31 PM