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March 31, 2004
CIBA Finalizes Sale of its Surgical Business
CRST March 2004
NCIBA Vision Corporation (Atlanta, GA) has completed the sale of a significant portion of its surgical business. IOLTECH, SA (La Rochelle, France), has purchased CIBA Vision’s Vivarte and Vivarte Presbyopic phakic refractive lens, CV232 SRE IOL; Tear Saver and Tear Saver PLUS punctum plugs; UniVisc viscoelastic; VisThesia viscoelastic that includes anesthesia; and Ophthalin and Ophthalin Plus viscoelastics. IOLTECH has also purchased certain marketing and distribution rights to the PRL phakic refractive lens.CIBA Vision will retain its equity share in Refocus Group, Inc. (Dallas, TX). However, Refocus will reassume the licensing and all marketing rights worldwide to its PresVIEW Scleral Implant and the Surgical Spacing Procedure for the treatment of presbyopia, glaucoma, and ocular hypertension
Posted by mehdi khanlari at 10:07 AM
Corneal Staining and Anesthetic in One Drop
CRST March 2004
Accutome Inc. (Malvern, PA) introduced Flura•Safe, an eye drop that reportedly stains and anesthetizes the eye in one drop. Flura•Safe combines a large-molecule fluorescein, Fluorexon, with the anesthetic Benoxinate. The combination drop allows for soft contacts to be reinserted without irrigating the eye and with no lens staining. Additionally, physicians can perform Goldmann tonometry without delay.Al Sawaya, PhD, of New York and Jerry Rosenstein, OD, of Southern California, created Flura•Safe; Accutome distributes the product; and Altaire Pharmaceuticals, Inc. (Aquebogue, NY), manufactures it. For product information, contact Accutome at (800) 979-2020.
Posted by mehdi khanlari at 10:03 AM
Reduction of Pupil Size and Halos With Minus Lenses After Laser in situ Keratomileusis
JOURNAL OF REFRACTIVE SURGERY ,March/April ,2004
CONCLUSIONS:Pupil diameters and halos decreased with a -1.00-D overcorrection in patients following LASIK. Patients with pupil-dependent night halos after LASIK may benefit from mildly over-minused lenses.
Posted by afarahi at 01:21 AM
March 27, 2004
Clinicopathologic Study of Conjunctivochalasis
Cornea,April,2004
A biopsy of redundant conjunctiva from the same anatomic location of 44 eyes with conjunctivochalasis was examined histologically. All patients, 9 men and 35 women, aged 66.6 ± 7.5 years underwent conjunctivoplasty (termed tear meniscus reconstruction).In all 44 cases, histologic examination disclosed normal conjunctival epithelium and negligible inflammation and lymphocyte infiltration; 39 patients manifested microscopic lymphangiectasia. Elastica van Gieson staining demonstrated elastic fiber fragmentation and sparsely assembled collagen fibers in all 44 cases.
Conclusion: Based on our histopathologic findings, we hypothesize that mechanical forces between the lower lid and conjunctiva gradually interfered with lymphatic flow. Chronic, prolonged mechanical obstruction of lymphatic flow may result in lymphatic dilation and eventually give rise to clinical conjunctivochalasis.
Posted by afarahi at 12:54 PM
March 25, 2004
Successful Occlusion Therapy for Amblyopia in 11- to 15-Year-Old Children
Journal of Pediatric Ophthalmology and Strabismus , March/April, 2004
Fifty-five compliant children 11 to 15 years old who had amblyopia were treated with full-time (during all waking hours) occlusion of their good eye until no further improvement in the visual acuity of their amblyopic eye was observed on 3 consecutive monthly follow-up examinations. After this, part-time (4 hours per day) occlusion therapy was used randomly in 24 of 55 patients for 3 to 6 months for maintenance of the final visual acuity. All 55 of the patients had improved visual acuity after treatment. The mean improvement was 0.46 logMAR unit (4.6 Snellen lines). Thirty-two of the patients had a mean follow-up of 17.6 months after the cessation of full-time and maintenance occlusion therapy. Twentynine (91%) of the 32 patients maintained improved visual acuity, whereas 3 (9%) exhibited a regression in visual acuity. Maintenance occlusion therapy did not have a significant stabilizing effect on the improved visual acuity.
CONCLUSION:Compliant, full-time occlusion effectively improves acuity in children 11 to 15 years old who have amblyopia due to strabismus, anisometropia, or both. Most older patients have lasting improvement with or without maintenance patching.
Posted by afarahi at 07:54 PM
March 22, 2004
Link between axial length, BRVO affirmed
OSN March 2004
The chief ocular risk for developing branch retinal vein occlusion is a shorter axial length, an Israeli study concluded. The study confirms results of previous studies in this regard, the authors saidAll patients had unilateral BRVO and a normal fellow eye with no previous ocular disease. No fellow eyes developed BRVO during the course of follow-up. In 18 patients, BRVO involved the superior-temporal branch; in four patients, the inferotemporal branch was involved, and in two patients a nasal vein. The mean patient age was 62.4 years. Both eyes of each patient underwent a complete ophthalmic exam, including slit-lamp biomicroscopy, gonioscopy, IOP measurement by applanation tonometry and fundus examination. The mean axial length was 22.82 mm in the affected eyes and 23.05 mm in the fellow eyes. The mean axial length in the affected eyes was significantly shorter than in the fellow eyes (P = .037). Previous studies have linked BRVO to axial length, but have not analyzed axial length, spherical equivalent and keratometry readings in the same group of patients, the study authors assert.
Posted by mehdi khanlari at 05:03 PM
Mechanisms Of Electroacupuncture-Induced Ocular Hypotension
Medical Ocupuncture,2004
Endogenous enkephalin and BNP were involved in the bilateral aqueous humor dynamics and blood pressure responses induced by EA. The presumed mechanisms of action of EA involve increased endorphin levels and BNP in aqueous humor. Based on the current studies in rabbits and rats, acupuncture is suggested as an adjuvant treatment of glaucoma. Because acupuncture treatment is well accepted for therapy of a variety of diseases, this approach may offer additional tools for the treatment of glaucoma, especially for patients intolerant of certain glaucoma medications. However, further investigation is required to determine the value and efficacy of acupuncture treatments in humans.
Posted by afarahi at 01:02 PM
Hormone replacement may ease postmenopausal dry eye, study suggests
OSN,March,2004
Hormone replacement therapy may help reduce degradation of the tear film associated with menopause, according to a study. Changes in IOP and retrobulbar blood flow, which are also intensified by menopause, may also be affected.
Dr. Özgül Altintas and colleagues at the University of Kocaeli in Izmit, Turkey, conducted the study, which enrolled 20 menopausal women with no ocular or systemic diseases who were planning to receive hormone replacement therapy (HRT) and compared them to a control group of 24 healthy, age-matched but nonmenopausal women.
At baseline, the menopausal women had a decreased quality and amount of tear film compared to the control group. After 2 months of treatment, the HRT patients experienced a significant increase in the quality and amount of tears (P < .001) and a significant decrease in IOP (P < .001).
Posted by afarahi at 12:57 PM
March 20, 2004
Happy New Year 1383
1.bmp
Posted by mmiraftab at 12:00 PM
March 18, 2004
Typical optic neuritis may signal multiple sclerosis
Ophthalmology Times March 1, 2004
The risk of developing MS for all patients with optic neuritis is 38% at 10 years. And importantly, if a patient does not develop MS within the first 5 years after the development of optic neuritis, the chances of developing MS drop "precipitously between year 5 and 10." With a normal MRI study at the onset of optic neuritis, the chances of developing MS are 16% at 5 years. Interestingly, in such patients, after 5 years, the chances of developing MS over the next 5 years (year 10 after an attack of optic neuritis) decrease to 7%. This, Dr. Kaufman emphasized, is important information to impart to the patient with typical optic neuritis. "Another interesting point is that at 10 years the overall rate of development of MS is 56% regardless of the presence of one or multiple brain lesions. Those with no lesions have a 22% chance of developing MS. Good prognostic factors are lack of pain, which is associated with better prognosis; male gender in the presence of a normal MRI study is associated with a 10% risk of developing MS 10 years after onset of optic neuritis; and only 5% of men with papillitis and normal MRI studies develop MS at 10 years. In addition, patients with recurrent optic neuritis develop MS more often than those who have not had recurrent optic neuritis. A normal MRI study indicates that the chances of developing MS are only 22% after 10 years. There is a question about whether the use of interferon beta-1 alpha (Avonex, Biogen Corp., www.Avonex.com) at the beginning of the optic neuritis would reduce the incidence of MS. The Controlled High-Risk Subjects Avonex MS Prevention Study (CHAMPS) found that patients with typical optic neuritis along with other types of neurologic disease suggestive of demyelination (such as internuclear ophthalmoplegia) developed MS at a slower rate when Avonex treatment was started after the first attack of demyelination.
Posted by mehdi khanlari at 08:21 AM
March 13, 2004
Endothelial cell density after deep anterior lamellar keratoplasty (Melles technique)
American Journal of Ophthalmology Volume 137, Issue 3 , March 2004, Pages 397-400
In 21 eyes of 21 patients, a deep anterior lamellar keratoplasty procedure was performed. Before surgery and at 6, 12, and 24 months after surgery, specular microscopy was performed to evaluate the endothelial cell density. For each postoperative time interval, the mean endothelial cell loss relative to the preoperative value was calculated.Mean postoperative endothelial cell loss averaged 283 cells/mm2 (± 293) at 6 months, 335 cells/mm2 (± 309) at 12 months, and 421 cells/mm2 (± 316) at 24 months. Estimate relative endothelial cell density losses obtained by mixed model analysis of variance were 11.1%, 2.0%, and 1.2%, respectively, each time compared with its previous measurement point. Second order comparisons showed that the loss within the first 6 months was significantly higher than after 6 months.In deep anterior lamellar keratoplasty, the recipient corneal endothelium showed a small initial drop in endothelial cell density followed by a physiologic rate of cell loss. Cell survival after lamellar keratoplasty may be expected to be better when compared with that following penetrating keratoplasty.
Posted by mmiraftab at 06:25 PM
New onset of herpes simplex virus epithelial keratitis after penetrating keratoplasty
American Journal of Ophthalmology Volume 137, Issue 3 , March 2004, Pages 415-419
We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy.Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%).The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection
Posted by mmiraftab at 06:22 PM
March 12, 2004
A prospective, pilot study of treatment of amblyopia in children 10 to <18 years old
AJO,March,2004
Sixty-six amblyopic patients aged 10 to <18 years with amblyopic eye acuity of 20/40 to 20/160 were treated with daily patching (?2 hours a day) combined with at least 1 hour of near activities. Visual acuity was measured before and after 2 months of prescribed treatment.
Visual acuity improved 2 or more lines from baseline in 18 (27%) of the 66 patients ,and the improvement appeared similar in 10- to <14-year-olds and 14- to <18-year-olds.
Conclusions:Amblyopia treatment can improve visual acuity in older children and adolescents. A randomized controlled trial is needed to determine if there is an upper age limit for which amblyopia treatment is successful.
Posted by afarahi at 08:09 PM
Smoking and blindness
BMJ,March,2004
While most people and many patients attending eye clinics recognise many adverse health hazards of tobacco smoking, they remain largely unaware of its link with blindness. Although smoking is associated with several eye diseases, including nuclear cataract and thyroid eye disease,the most common cause of smoking related blindness is age related macular degeneration, which results in severe irreversible loss of central vision. Current treatment options are of only partial benefit to selected patients. Identifying modifiable risk factors to inform efforts for prevention is a priority.
Posted by afarahi at 07:49 PM
Intraocular lens implantation during infancy: Perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members
Journal of AAPOS,Dec,2003
In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a unilateral congenital cataract(UCC), but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant.
Conclusions :Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.
Posted by afarahi at 07:40 PM
March 11, 2004
Phacoemulsification with topical anesthesia performed by resident surgeons
J Cataract Refract Surg 2004; 30:149–154
USA. Of the 291 cases, 119 were retrobulbar and 172 were topical. Residents began using topical anesthesia after a brief introductory period with retrobulbar anesthesia. Vitreous loss occurred in 15 cases (5.1%), 8 retrobulbar (6.7%) and 7 topical (4.1%).Postoperative complications occurred in 30 cases (10.3%), 17 topical (9.9%) and 13 retrobulbar (10.9%) (P =.85). Overall, 245 cases (84.2%) achieved a final best corrected visual acuity (BCVA) of 20/40 or better. When cases with preexisting conditions limiting final acuity were eliminated, 92.1% achieved a final BCVA of 20/40 or better. More topical cases (112, 65.1%) than retrobulbar cases (64, 53.8%) achieved a final BCVA of 20/25 or better , and more topical cases (149, 86.6%) than retrobulbar cases (96, 80.7%) achieved a final BCVA of 20/40 or better Conclusion: Topical anesthesia is safe and efficacious for phacoemulsification performed by resident surgeons early in training after a brief introduction to phacoemulsification using retrobulbar anesthesia.
Posted by alireza habibollahi at 11:58 PM
Phacoemulsification parametersSeries 20000 Legacy Versus Legacy with AdvanTec software and NeoSoniX handpiece
J Cataract Refract Surg 2004; 30:144–148
To examine the differences in average phaco power and effective phaco time (EPT) and evaluate the clinical results with the standard Series 20000® Legacy® system (Alcon) and the Legacy with AdvanTec® software and the NeoSoniX® handpiece (Alcon). The mean phaco power and EPT in 240 eyes having PE using Legacy 20000 system were compared with results in 240 eyes of 240 patients operated on by the same surgeon using the Legacy with AdvanTec software and the NeoSoniX handpiece.Results:The EPT and mean phaco power were less in the AdvanTec–NeoSoniX group than in the standard Legacy 20000 group in all cases. The mean EPT was 56.9 seconds in the standard Legacy 20000 group and 4.2 seconds in the AdvanTec–NeoSoniX group. The mean phaco power was 19.2% and 5.1% respectively. The difference between groups was statistically significant in EPT (No trace of corneal striae or edema was observed in 92% eyes on the first postoperative day. The best corrected visual acuity was 20/25 or better in 60% of cases.
Conclusions:
The Legacy system with AdvanTec software and the NeoSoniX handpiece significantly reduced the mean EPT and phaco power. This low-power technology minimizes intraoperative damage to ocular structures and maximizes the level and rapidity of visual rehabilitation.
Posted by alireza habibollahi at 11:34 PM
RAPD in patients with asymmetric cataracts
J Cataract Refract Surg 2004; 30:132–136
40 patients with asymmetric cataract and a differences of 3 or more lines of Snellen visual acuity between eyes had detailed ophthalmic examinations.23 had an RAPD in the eye with less severe cataract. The RAPD resolved or switched to the other eye after cataract extraction. All 5 patients with a unilateral totally opaque lens had a contralateral RAPD, confirming the relationship between totally opaque cataracts and RAPDs. The difference in visual acuity between the 2 eyes did not differ between patients with RAPD and those without RAPD. There was no association between the presence of RAPD and postoperative visual acuity. Conclusions:More than half the patients with asymmetric cataract had an RAPD that resolved in the eye with less severe cataract after cataract extraction. All patients with a unilateral totally opaque lens had an RAPD. The presence of a preoperative RAPD was not related to postoperative visual acuity.
Posted by alireza habibollahi at 11:24 PM
March 10, 2004
Decreased incidence of capsule complications and vit.loss during phaco in eyes with PEX syndrome
J Cataract Refract Surg 2004; 30:127–131
USA, 67 eyes with PEX syndrome and 1670 eyes without pseudoexfoliation. The incidence of vitreous loss, capsule tears, and zonular dialysis was compared between the 2 groups. The incidence of vit-loss was 1.5% in eyes with pseudoexfoliation syndrome and 2.3% in eyes without pseudoexfoliation. The difference between the 2 groups was not statistically significant ,no cases of posterior capsule tears or zonular dialysis in pseudoexfoliation eyes without vitreous loss. No IOL dislocated over a mean follow-up of 54.1 months. Conclusion: Although caution is still advised, patients with pseudoexfoliation syndrome who have phacoemulsification can achieve results similar to patients without pseudoexfoliation.
Posted by alireza habibollahi at 10:51 PM
March 09, 2004
Variable optical zones possible with wavefront ablation
Ophthalmology Times February 15, 2004
The recently approved Zyoptix system (Bausch & Lomb) for wavefront-guided ablation is the only customized laser approved for use with variable optical zones, and that is an important feature because larger op-tical zones give better out-comes, said Scott M. Mac- Rae, MD, during the International Society of Refractive Surgery/ American Academy of Ophthalmology sub- specialty day meeting.Larger optical zones provide better outcomes with reduction in higher-order aberrations.
Posted by mmiraftab at 06:12 PM
Intracorneal implants may see a limited renaissance
Eurotimes February 2004
INTRACORNEAL implants may be a useful option in select patients with high hyperopia, although concerns remain about the mysterious deposits that appear on the lenses in virtually all patients who receive them, according to German ophthalmologist Michael C. Knorz MD."Even with confocal microscopy studies, we weren't able to determine what the deposits were. Maybe it's similar to what we saw with INTACS because there is a little space at the very edge of the implant and that provides room for debris or cells to accumulate. The implant itself remains crystal clear: there are no deposits within the implant. Instead it's a like an interface response although it is not inflammatory and does not respond to steroids and it is not something you can really remove." What really makes the deposits a cause for concern is that they cause forward light scattering, which in turn causes glare and other photic phenomena. Furthermore, a fairly high proportion of patients have been troubled enough by their visual symptoms to request explantation of the intracorneal implants."To say that the procedure is reversible is not entirely accurate. The symptoms get much better and most of the glare disappears. However, if you look at the cornea, and the longest post-explantation follow-up is about a year, you still see some faint haziness adjacent to the former position of the implant
Posted by mmiraftab at 06:05 PM
The Use of Apraclonidine in the Diagnosis of Horner Syndrome
Archives of Ophthalmology: Feb 2004. Vol. 122, Iss. 2; pg. 276
Horner syndrome refers to a condition where oculosympathetic pathway damage or dysfunction can cause ptosis, tniosis of the pupil, and anhydrosis. Congenital Horner syndrome is most commonly idiopathic or due to a traumatic birth. Acquired Horner syndrome in children is often postsurgical. Other causes include neuroblastoma, trauma, and brainstem processes.The diagnosis of this condition may be confirmed by instilling topical cocaine in each eye. The Horner pupil dilates poorly in comparison with the healthy pupil.Apraclonidine hydrochloride is an [alpha]-adrenergic receptor agonist that is approved for the treatment of elevated intraocular pressure following argon laser trabeculoplasty. A prior study4 of 6 adult patients with Horner syndrome showed that instillation of 1% apraclonidine into both eyes produced mydriasis in the affected eye only. In fact, all patients experienced a reversal of their baseline anisocoria. In every case, the miotic pupil on the Horner side dilated to become larger than the healthy side, whereas the size of the pupil on the unaffected side remained unchanged. Four patients had postganglionic Horner syndrome (third-order neuron) and 2 had preganglionic Horner syndrome (first-order and second-order neurons).
Posted by mmiraftab at 05:47 PM
A Direct Method to Measure the Power of the Central Cornea After Myopic Laser In Situ Keratomileusis
Arch Ophthalmol. 2004;122:159-166
Objective: To measure the corneal power after myopic laser in situ keratomileusis (LASIK).
Methods: Six central areas in 6 corneal power maps were studied using the Orbscan II statistical analysis device in 26 eyes that underwent myopic LASIK. Refractive and corneal power changes were compared. Factors related to wrong corneal power measurement were evaluated.
Main Outcome Measures: Cycloplegic refraction, refractive change at the corneal plane, and Orbscan II corneal power maps.
Results: Preoperatively, only posterior-mean power (P<<.001) and anterior-posterior power ratio (P<<.001) varied according to the size of the analyzed area. Postoperatively, total-optical (P=.03), keratometric-mean (P=.04), total-mean (P<.001), anterior-mean (P=.03), and posterior-mean (P<<.001) powers; and anterior-posterior power ratio (P<<.001) varied according to the area. Postoperatively, the difference between keratometric-mean and total-mean powers became larger (P<.001), and the anterior-posterior power ratio was reduced (P<<.001). A posterior-mean power change occurred (P=.04). Refractive change after myopic LASIK was best estimated by 2-mm total-mean power (mean±SD difference, 0.07±0.62 diopters [D]; P=.55) and 4-mm total-optical power (mean±SD difference, -0.08±0.53 D; P=.37).
Conclusions: Total corneal power is more positive and refractive change is underestimated when deduced from the anterior surface radius and keratometric refractive index. The anterior-posterior power ratio is not a fixed value. The best area to estimate the refractive change depends on the method used to obtain the power in diopters. Refractive change tended to be underestimated in larger areas and higher preoperative myopia. Orbscan II total-mean and total-optical power maps accurately assess the corneal power after myopic LASIK independent of preoperative data or correcting factors, and should improve intraocular lens calculation.
Posted by mmiraftab at 05:32 PM
Experimental evaluation of online optical coherence pachymetry for corneal refractive surgery
Graefe’s Arch Clin Exp Ophthalmol(2004) 242:24–30
Online optical coherence pachymetry (OCP) allows to monitor central changes of the corneal cross section intraoperatively.In this experimental evaluation the validity of the optical measurements for corneal refractive surgery was assessed. In this experimental evaluation, online OCP revealed to be a precise and reproducible method to assess the central corneal thickness and its changes intraoperatively.This could be important to monitor incisional and excimer laser-based corneal refractive procedures,such as PRK or LASIK.
Posted by mmiraftab at 05:23 PM
March 08, 2004
EX-PRESS Glaucoma shunt (EGS)
American glaucoma society meeting, March, 2004
EGS is a new glaucoma-filtering device. It is made of biocompatible stainless steel, 2.96 mm long with an outer diameter of 400 microns, with no valve.
Posted by pakravanmd at 05:56 AM
Eyepass Bi-Directional Glaucoma Implant
American glaucoma society meeting, March, 2004
The Eyepass is a Y-shaped bi-directional tubular implant that bridges the trabecular meshwork and shunts aqueous from the anterior chamber into schlemms canal.
Posted by pakravanmd at 05:48 AM
Trabectome, a novel surgical device, in glaucoma surgery
American glaucoma society meeting, March, 2004
The trabectome is a 19.5 gauge surgical device (like vitrectome probe) that consists of an insulated footplate capable of penetrating the trabecular meshwork into schlemms canal. An infusion and aspiration system combined with electro-surgery device removes a strip of trabecular meshwork overlying schlemms canal. The footplate protects underlying tissues from thermal trauma. The procedure needs a 1.5 mm clear corneal incision, goniotomy lens, and 10 minutes time.
Posted by pakravanmd at 05:40 AM
Ultra high speed Optical Coherence Tomography
American glaucoma society meeting, March, 2004
Ultra high speed OCT is 72 times faster and has 1.5 fold better axial resolution than current clinica instruments.
Posted by pakravanmd at 05:22 AM
March 07, 2004
Xolair: A New antiallergic Drug
Eyeworld March 2004
we’re going to be looking for medicines that have anti-inflammatory activity approaching those of steroids, but without the side effects,” In addition, there will be longer-acting medicines that can be taken daily, or once or twice a week“This is sort of the Holy Grail — that’s what we would like to be able to do, to down-regulate IGE mechanisms so that the allergy doesn’t get triggered in the first place,” . There have already been developments like this in the general field of allergy, with drugs such as the anti-IGE molecule Xolair (Novartis, Basel, Switzerland).This drug, however, is only indicated for people with severe allergic asthma or severe allergic rhinitis and asthma. “If those people had conjunctivitis as well, we would see a down regulation in those symptoms,” . “The trouble with this agent is that it’s extremely expensive.”
Posted by mehdi khanlari at 11:48 PM
Multichannel Touch Tear MicroAssay System
Eyeworld March 2004
There is one similar method that exists called the (Touch Scientific Inc., Raleigh, N.C.),It allows surgeons to sample tear film and put it in a small machine that measures the amount of IgE, which is released during an allergic response.“You could use this not only as a way to diagnose an allergic condition but also to monitor the effectiveness of treatment by repeating the test and seeing if the levels of IgE are coming back into a normal range,” O’Brien said.
Posted by mehdi khanlari at 11:34 PM
PRK for hypermetropic anisometropic amblyopia in children approved by FDA as protocol study
Eyeworld March 2004
A protocol study on PRK in children to correct hypermetropic anisometropic amblyopia has been approved by the Food and Drug Administration.While laser eye surgery for children has been a controversial topic among ophthalmologists, lead study investigator Kenneth W. Wright, M.D, said he is confident that the procedure is an excellent alternative to glasses or contact lenses in patients with hypermetropic anisometropiaThe study is approved for using the VISX Star S4 excimer laser system (Santa Clara, Calif.) to correct the condition in cooperative children 7-18 years of age. The laser is used only upon one eye, the hypermetropic eye to match its visual capability to that of the good eyeChildren that are prescribed spectacles or contact lenses to correct this problem tend not to wear them, Wright said. In addition, because a plus lens in glasses causes image magnification compared to what is seen by the good eye in such patients, it’s hard for the children to fuse the images, he said. Laser surgery almost eliminates the difference in image size created by glasses,Wright said he has performed surgery on five patients — two off-label and three eyes in three patients for the FDA study. All went well and there have been no complications. Early data shows visual acuity improvement, he said. The FDA has approved 10 study patients for the initial trial.
Posted by mehdi khanlari at 11:24 PM
CIBA Vision divorces surgical division
Eyeworld March 2004
After five years of commitment to the surgical business, CIBA Vision has sold its surgical division including what some call “cutting edge” technology.The eyecare unit of Novartis AG (Basel, Switzerland) has sold its Vivarte and Vivarte Presbyopic phakic refractive lenses, along with a host of other products to IOLTECH SA (La Rochelle, France). Officials are still in the process of selling the Centurion SES EpiEdge epikeratome, which could take refractive surgery in a different direction if widely embraced.
Posted by mehdi khanlari at 11:15 PM
Four key points on antibiotic resistance
Eyeworld March 2004
• Investigators found that increasing numbers of conjunctival organisms were multi-resistant bacteria, with 26% of coagulase negative staph resistant to five or more antibiotics tested;
• When it came to eliminating multi-resistant coagulase negative staph, the antibiotics that were most effective in the study included vancomycin (Vancocin, Eli Lilly, Indianapolis), aminoglycosides (except neomycin), imipenem (Primaxin, Merck, Whitehouse Station, N.J.), meropenem (Merrem I.V., AstraZeneca, London), cefotaxime (Claforan, Aventis, Schiltigheim, France), and levofloxacin (Quixin, Santen, Napa, Calif.);
• Of the fluoroquinolones tested, ciprofloxacin Ciloxan, Alcon, Fort Worth, Texas), norfloxacin (Noroxin, Merck, Whitehouse Station, N.J.), ofloxacin (Ocuflox, Allergan, Irvine, Calif.), and levofloxacin, the bacteria were most susceptible to levofloxacin; and
• When faced with resistant strains, it makes sense for ophthalmologists to use the more recent fluoroquinolones rather than the older generation of fluoroquinolones, which have a fairly high resistance rate.
Posted by mehdi khanlari at 11:05 PM
Dissatisfied LASIK patients had 20/40 vision
Eyeworld March 2004
Researchers found that 50% of patients in a survey group that sought consultation because of dissatisfaction with LASIK had 20/40 vision or better, . In LASIK, it’s important for practitioners to remember that less is more: Less pain, less drops, less infection, less regression, less follow-up, and less reimbursement,If patients have high “quantity” of vision but perceive that they have low “quality,” they will consider LASIK unsatisfactory,For that reason, it’s important for practitioners to remain aware of LASIK complications before they occur and work to avoid them, he said. That can be difficult when the variables associated with LASIK are considered. Those variable may include:
The patient’s particular histories; patient’s refractive data; staff/technical support; the surgeon; the devices including the microkeratome and the excimer laser; and biological wound healing.O’Brien cited a study of 101 patients (161 eyes) that were identified as dissatisfied patients that sought a consultation at Wilmer after refractive surgery. The patient particulars included: Mean age 44.13 years; 46 females and 55 males; 24.16 months between their first surgery and consultation at Wilmer. Complaints included: Blurred distance vision (59%); glare (26.7%); dry eyes (21.1%); blurred near vision (19.3%); and other problems including night driving problems, halos, and eye pain.Despite the complaints, more than 50% of the patients had 20/40 vision or better. The patients had a total of 232 surgeries among them (1.44/eye). After consultation at Wilmer, the recommendation/plan included: Surgery for 52.8%; medication; glasses; SCL; RGPCL; punctal plugs; and observation for the other 47.2%.O’Brien noted that irregular astigmatism was most commonly associated with the loss of BSCVA; the number of previous surgeries did not correlate with worse outcome; and lubrication, glasses, contact lenses and future technologies were the most common interventional recommendations.
Posted by mehdi khanlari at 10:47 PM
Chronic glaucoma common for infant cataract surgery patients
Eyeworld March 2004
A review of young cataract patients found those 9 months and younger at the time of surgery were nearly four times as likely to ultimately develop glaucoma.The study, published in a recent issue of the American Journal of Ophthalmology, attempted to isolate age as a factor in the development of chronic glaucoma as a post-operative complication of pediatric cataract surgery. Previous studies have found chronic glaucoma appears in between 1% and 32% of children undergoing such surgery.Rabiah attempted to limit additional factors by restricting patients in the analysis to those whose cataracts were unassociated with other ocular anomalies aside from microcornea.Glaucoma was considered present when a patient displayed intraocular pressure of at least 26 mm Hg on two measurements. Rabiah said that 26 mm Hg was chosen as a glaucoma indicator because it increased the likelihood that the elevated IOP-based glaucoma diagnosis was accurate in the absence of other measures, such as visual field or optic nerve analysis. Patient eyes with a pre-operative IOP of 22 mm Hg or higher or any other pre-operative signs of glaucoma were excluded from the study.
However, only three out of 19 eyes in patients 10 months to one year old at surgery eventually were diagnosed with glaucoma.Because the study identified microcornea as a predicator of glaucoma, Rabiah recommended the use of a caliper for precise measurement of corneal diameter in children operated on for cataracts.The high rate of glaucoma after early pediatric cataract surgery led Rabiah to recommend routine glaucoma screening on a regular basis for at-risk patients.
Posted by mehdi khanlari at 10:35 PM
March 06, 2004
ASCRS joins AAO, other physician organizations to stop laser eye surgery by optometrists in VA system
Eyeworld March 2004
ASCRS has joined with the American Academy of Ophthalmology (AAO), the American Medical Association (AMA), the American College of Surgeons (ACS), the American Osteopathic Association (AOA) and the American Academy of Family Physicians — the Veterans Eye Treatment Safety Coalition — in a unified effort to stop the current policy of the Department of Veterans Affairs (VA) that allows optometrists to perform laser eye surgery based on their state licensure and at the discretion of local VA facilities. As a result, an Oklahoma optometrist was credentialed to perform laser eye surgery at a VA hospital in Kansas. Oklahoma is the only state that allows certified optometrists to perform some ocular laser surgery procedures. In fact, 35 states specifically prohibit optometrists from performing laser eye surgery — including Kansas.
Posted by mehdi khanlari at 11:05 PM
Top ways to treat recurrent erosions…
Eyeworld March 2004
Non-surgical options
Patients that don’t have active erosions can be treated medically with a hypertonic ointment and tetracyclines to reduce risk of recurrence. A hypertonic ointment used at bedtime is particularly effective because it is long lasting — an important feature considering most erosions occur overnight.If a patient has an actual erosion with an epithelial defect, I typically treat them with lubricants and topical antibiotics to prevent bacterial keratitis.Some patients respond well to topical corticosteroids three times a day for a few weeks. These reduce inflammation and also inhibit the matrix metalloproteinases, which tend to be activated in recurrent erosion patients and tend to contribute to loose epithelium. Systemic tetracyclines also can be used for the same purpose.Topical cycloplegics can alleviate pain due to associated ciliary spasm. Therapeutic bandage contact lenses also can provide comfort while reducing further trauma from the lid. Patching is yet another option
Surgical options
I offer surgical therapy to patients that present with a second or third severe erosion despite more conservative treatment. I prefer to intervene surgically during an acute episode. This avoids the discomfort and inconvenience of creating new epithelial defects after the erosion has healed.The least aggressive of these is to debride the loose and necrotic-appearing epithelium. For patients with epithelial basement membrane dystrophy, it is often useful to scrape gently with a blade to remove reduplicated basement membrane from the surface and polish with a diamond burr. Recurrence rates afterward range from 6% to 11%.A similar effect can be obtained with a needle by performing anterior stromal puncture (ASP), which allows epithelial cells to adhere more firmly. . There is some disagreement over whether it is safe to treat the visual axis with ASP, due to concerns about potential scarring. I believe a surgeon comfortable with the procedure, and who treats superficially, can perform ASP over the visual axis without any visually significant scarring. The best way to avoid deep punctures is to bend the tip of a 25- or 27-gauge needle or to use a pre-bent needle, available from Storz (Bausch & Lomb, Rochester, N.Y.). Scientific literature suggests a 4% recurrence rate after ASP.YAG laser photoadhesion is similar to ASP in mechanism. . To perform photoadhesion, use the lowest power setting (1 mJ or less) on the laser and place a drop of fairly viscous artificial tears on the eye immediately prior to treatment. Aim at or just anterior to the surface of the cornea and look for a small bubble in the epithelium with each shot. A cracked or shattered starburst appearance in the anterior stroma means you are probably a little deeper than you need to be, although most of those go away in a few hours if low power is used. PTK is another option. Remove all the loose epithelium for 9 mm or 10 mm and paint Bowman’s with about two to three pulses in each area. Adequate treatment is signified by a shiny reflection from the surface of the cornea. The advantage of this procedure is that it treats a much larger area than ASP or YAG laser photoadhesion. The recurrence rate ranges from 10% to 40% in published studies.Finally, They may be good candidates for LASEK or PRK, because these procedures remove the basement membrane and Bowman’s layer. Thus, the epithelial adhesion problem can be treated at the same time that the refractive error is corrected.
Posted by mehdi khanlari at 10:42 PM
CK reduces ectasia in post-PKP keratoconus eyes
Eyeworld March 2004
Conductive keratoplasty (CK) offers the first treatment directed at reducing ectasia in recipient cornea in post-penetrating keratoplasty (PKP) keratoconus eyes, said Francis W. Price Jr., M.D., of Indianapolis.Spots placed in area of ectatic recipient cornea and 180 degrees away PRN. Source: Francis Price, MD “Thirty-five years ago, almost all patients that had transplants expected to wear a hard contact lens. But gradually we’ve gotten better and better results with the surgery,” he said.Alternatives to wearing a contact lens include relaxing incisions, compression sutures, wedge resections, regraft, and CK. “However, relaxing incisions only work if they are either in the graft or in the wound,” Price said.CK offers promise in improving visionAlthough CK to treat astigmatism is an off-label use, it is a promising way to improve vision in these patients.Current indications for CK after PKP include: Inability to wear glasses or contacts; failure to be a LASIK candidate; and failure to be a candidate for or experiencing a failure with relaxing incisions; and if the only other option is regraft to attain functional vision, Price said.To treat keratoconus, spots are placed in the area of the recipient cornea and 180 degrees away as needed. CK spots constrict the area of ectasia.After CK, patients are given aqueous cyclosporine-A 0.5% (Restasis, Allergan, Irvine, Calif.) four times daily, Ocuflox (0.3% ofloxacin, Allergan) four times daily.
Posted by mehdi khanlari at 10:14 PM
Surface ablation over LASIK flap: Recent studies spark new debate
EyeWorld March 2004
For some ophthalmologists, performing surface ablation on top of LASIK approaches the realm of taboo because they believe that terrible corneal haze could likely follow.But authors of two new studies suggest that pejorative belief should fall by the wayside, concluding that the risk of haze is often minimal for PRK over LASIK (or an aborted LASIK operation), making the procedure a safe remedy for stubbornly poor vision.Even so, experts continue to question the safety of such a procedure in an ophthalmic world where little is known about why haze develops.
PRK over aborted LASIK
For patients with LASIK flap complications, PRK can be a relatively safe procedure with minimal risk of haze, said James J. Salz, M.D., The study’s co-authors are composed of Salz; Robert W. Weisenthal, M.D., in private practice in DeWitt, N.Y. (lead author); Alan Sugar, M.D., associate chair and professor of ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, and colleagues. After a mean seven months of follow-up, six patients achieved 20/20; four gained 20/25; two arrived at 20/30; one was 20/80, purposely left undercorrected for monovision. Best spectacle-corrected vision was 20/20 in 10 of the 13 patients, but three lost one line of best spectacle-corrected vision (they were 20/25).
However, one of the patients, a 28-year-old woman, did present with 3+ corneal haze at post-operative month five and 20/400 uncorrected vision. After re-treatment with an excimer laser, a PTK and a tapering course of FML (fluorometholone ophthalmic ointment, Allergan, Irvine, Calif.), she was able to obtain 20/25 uncorrected vision with trace haze.One trick to making sure the rate of haze is low is to use Mitomycin C if the patient is a –4 or higher, Salz said. For lower corrections, he does not.“The risk is pretty low if you’re doing a –2 [correction] or less,” Salz said. “The deeper you go, the greater the risk of haze.”
Posted by mehdi khanlari at 10:06 PM
Diving for food: A super-vision solution?
EyeWorld March 2004
A tribe of highly-skilled child divers off the coast of Thailand can see more than twice as well under water as European children, according to a study in Current Biology published recently by Anna Gislen and colleagues. Gislen is a biology Ph.D. candidate, Lund University, Sweden.?I think this has proven that the eye is extremely flexible,? Gislen said. ?Nobody thought you could see well underwater, and these kids do.?The Moken are a Southeast Asian population of sea gypsies whose children dive for food and other underwater trinkets, Gislen said. Because the children do this frequently, Gislen believes they learned to maximize their visual potential under water. Gislen and study co-author Marie Dacke, Ph.D., Lund University, traveled to a group of islands off the coast of Thailand to test their vision.Once there, she presented six Moken children with achromatic sinusoidal gratings of different spatial frequencies underwater. She used 28 European children in the same age range as a control group.The underwater acuity of Moken children was 6.06 cycles/degree, more than double the 2.95 cycles/degree of the European children.Gislen found that the Moken achieved this by maximal accommodation (15 D to 16 Ds), and through extreme pupil constriction (1.96 mm compared to 2.5 mm in European children). While pupil size normally has little affect on resolution on land, a smaller pupil can enhance resolution when an image is extremely blurred, Gislen wrote. Super-vision is no myth, at least when underwater.
Posted by mehdi khanlari at 09:45 PM
March 05, 2004
Can Nutritional Supplements Benefit Ocular Health?
Review of Ophthalmology Feb 2004
Antioxidants
Research shows that antioxidants such as vitamin E and vitamin C help protect the macula from harmful free radicals, unstable molecules that cause irreparable oxidative cell damage.patients over age 55 at high risk for developing advanced AMD lowered their odds by 25 percent after taking vitamin C (500 mg), vitamin E (400 IU), beta-carotene (15 mg), zinc (80 mg) and copper (2 mg) daily for six years.Beta-carotene is not recommended for smokers due to the higher risk of lung cancer. Benefits were seen in patients with intermediate AMD and with advanced disease in one eye. The nutrients had no benefit, however, to those who had either no AMD or early signs of AMD.Ironically, the AREDS formula had no affect on the seven-year risk of development or progression of cataract. Yet, according to the Roche European American Cataract Trial, a three-year, multicenter randomized clinical study of 445 early-cataract patients, the combination of beta-carotene (18 mg), vitamin C (750 mg) and vitamin E (600 mg) produced a small deceleration in cataract progression.Vitamin C taken alone has also been shown to slow the progression of cataract. An observational study from Tufts University and Harvard Medical School in Boston found that women who consumed the highest levels of vitamin C had a 60 percent lower risk of developing a nuclear cataract than those who consumed the lowest levels. Additionally, women who took vitamin C for 10 or more years had a 60 percent lower risk for developing a nuclear cataract.
Carotenoids
Observational research shows that the carotenoids lutein and zeaxanthin found in a variety of fruits and vegetables and ocular supplements may protect against AMD. The rationale behind the positive associations is that lutein and zeaxanthin are found in high concentrations in the macula, where they naturally filter out blue light and protect the photoreceptor outer segments throughout the retina from oxidative stress and damage
Herbs and Other Nutrients
To date, no studies have shown a positive association between antioxidant intake and reduced glaucoma risk. But the herb Ginkgo biloba has been shown to possess antioxidant properties that help increase blood circulation in the optic nerve,and reduce vasospasm and serum viscosity.A recent randomized, placebo-controlled trial of 27 patients with normal tension glaucoma reported an improvement in pre-existing visual field damage in some ginkgo-treated patients.9 ?Ginkgo is an excellent herbal medicine,? says Dr. Reader. ?Ginkgo increases circulation by inhibiting platelet activation factor. It works very rapidly and very well,? he says.Bilberry fruit extract is believed to have anti-angiogenic properties that may help decrease blood-vessel leakage in AMD and diabetic retinopathy.10 Bilberry contains high concentrations of the antioxidant resveratrol and chemical compounds known as anthocyanosides that are said to maintain rhodopsin levels, the purple pigment used by the rods in the eye for night vision. ?Bilberry is an antioxidant that prevents oxidative damage to RPE cells that can lead to macular degeneration, and resveratrol also reduces the oxygenation breakdown,? says Dr. Reader. Research shows that omega-3 essential fatty acids, in the form of docosahexaenoic acid (DHA), may help rebuild photoreceptor cells and retinal cell membranes. A recent study reported that a high intake of omega-3s is associated with a lower risk of AMD.They?re also good for ocular lubrication in dry-eye syndrome. ?The omega-3s may replace the oils on the surface of the eye or block the inflammatory cascade associated with dry eye,? says Dr. Reader. One study reported that the EFA gamma-linolenic acid (GLA) is useful in Sj?gren?s syndrome and may help in other dry-eye conditions.
Posted by mehdi khanlari at 08:34 PM
Treatment of Intracameral Fibrinous Membranes With Tissue Plasminogen Activator
OPHTHALMIC SURGERY, LASERS AND IMAGING Vol. 34 No. 6 November/December 2003
In this technique, 0.1 mL of aqueous was aspirated, followed by injection of 0.1 mL (25 µg) of tPA into the anterior chamber in 15 patients with severe fibrinous membranes that developed after pars plana vitrectomy (n = 6), cataract extraction (n = 4), combined cataract and glaucoma surgery (n = 2), trabeculectomy (n = 1), and endophthalmitis (n = 2). The clearance of fibrinous membranes and changes in visual acuity and in intraocular pressure were observed.
Patients were treated 2 to 10 days postoperatively (mean, 5.6 ± 0.57 days). Complete fibrinolysis was observed in all cases. The mean time for clearance of fibrin was 7.73 ± 2.73 hours. A temporary increase in intraocular pressure was noted in two cases.CONCLUSIONIn this technique, intracameral injection of 25 µg of tPA is both effective and safe in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment.
Posted by mehdi khanlari at 07:39 PM
Enophthalmos as Initial Manifestation of Occult, Mammogram-Negative Carcinoma of the Breast
OPHTHALMIC SURGERY, LASERS AND IMAGING Vol. 35 No. 1 January/February 2004
A patient with enophthalmos was found to have occult metastatic breast carcinoma to the orbit despite normal findings on breast examination and mammogram. Enophthalmos can be a sign of serious systemic disease and should be appropriately investigated. Despite radiologically interpreted normal orbital and breast imaging, the clinician should rule out underlying subclinical malignancy and consider orbital biopsy. [Ophthalmic Surg Lasers Imaging 2004; 35:56-57.]
Posted by mehdi khanlari at 07:37 PM
Free Iris Cyst in the Anterior ChamberOPHTHALMIC SURGERY, LASERS AND IMAGING Vol. 35 No. 1 January/February 2004
A 50-year-old man had a free iris cyst in the anterior chamber that was treated by puncturing using an Nd:YAG laser. Following laser treatment, the cyst wall settled in the anterior chamber angle and no complications were encountered during 4 months of follow- up. [Ophthalmic Surg Lasers Imaging 2004;35:74-75.]
Posted by mehdi khanlari at 07:36 PM
Intraindividual comparison of epithelial defects during LASIK using standard and zero-compression Hansatome microkeratome heads
J Cataract Refract Surg 2004; 30:123–126
Frankfurt am Main, Germany in 186 eyes having LASIK, In 1 eye, the flaps were created with the Hansatome microkeratome using the standard Hansatome head and in the other eye, the flaps were created with a microkeratome head with a modified design (zero-compression head). Intraoperative evaluation of epithelial defects was done using a standardized protocol. . Conclusions:The Hansatome microkeratome with a zero-compression head significantly reduced the occurrence of intraoperative epithelial defects. The change in the construction of the Hansatome head is a useful improvement in LASIK technology.
Posted by alireza habibollahi at 02:47 PM
Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses
J Cataract Refract Surg 2004; 30:115–122 nd review
Mana Tehrani, Mainz, Germany.
6 cases of opacification of MemoryLens® IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopathologic analysis including scanning electron microscopy and energy dispersive x-ray spectroscopy (EDX). Microscopic analysis revealed multiple, fine, granular deposits of various sizes on the surface of the lens optics. The EDX analysis showed the presence of calcium within the deposits. Conclusions:
Our cases show that hydrophilic acrylic IOLs can opacify even years after implantation. Analysis of the explanted IOLs revealed calcification.
Posted by alireza habibollahi at 02:38 PM
Outcomes of LASIK in patients with pigment dispersion syndrome
J Cataract Refract Surg 2004; 30:110–114
22 eyes who had clinical features consistent with PDS at the time of the initial preoperative refractive evaluation and had LASIK surgery. Results: 20 eyes had an uneventful course after LASIK and a good final uncorrected visual acuity (mean follow-up 26 months). One patient (2 eyes) with PDS and suspicion of glaucoma on topical â-blocker therapy had delayed healing, fluctuations in vision, and a lengthy visual recovery. Conclusions: Corneal findings of PDS do not appear to affect the intraoperative or postoperative outcomes of LASIK. However, patients who have PDS in the context of glaucoma and therapy with an intraocular-pressure-lowering agent may experience delayed healing and a less predictable visual outcome.
Posted by alireza habibollahi at 02:32 PM
Completion rate of continuous curvilinear capsulorhexis in pediatric cataract surgery using different viscoelastic materials
J Cataract Refract Surg 2004; 30:85–88
California, USA, 25 eyes of children who had cataract surgery by 1 surgeon. The type of viscoelastic agent used for the CCC portion of the surgery was obtained from surgical dictations and nursing charts and information on complications during the CCC, from surgical dictations. The patient's age, type of cataract, and intraocular lens placement were also obtained. Conclusion:The superviscous properties of Healon5 under low turbulence conditions appear to lead to a higher CCC completion rate in children.
Posted by alireza habibollahi at 02:24 PM
LASEK and PRK versus conventional treatment of myopic anisometropic amblyopia in children
J Cataract Refract Surg 2004; 30:74–84
Czech Republic,27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC-5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2-year follow-up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The VA&and BNVA in both groups were analyzed and compared. PRK and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. VA&and BNVA were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.
Posted by alireza habibollahi at 02:18 PM
Tissue damage at anterior capsule edges after continuous curvilinear capsulorhexis, high-frequency capsulotomy, and erbium:YAG laser capsulotomy
J Cataract Refract Surg 2004; 30:67–73
To compare the effect of erbium:YAG laser photocapsulotomy (ELC), continuous curvilinear capsulorhexis (CCC), and high-frequency capsulotomy (HFC) on anterior capsule edges using light microscopy (LM) and transmission electron microscopy (TEM).
Austria. 5 anterior capsule membranes were obtained experimentally by ELC, which was performed with the Oertli MicroLaser photoemulsification tip in eyes from 5 human cadavers. Thirty anterior capsule membranes were obtained during cataract surgery by CCC (n = 15) or, in cases with poor or missing red fundus reflexes, by HFC (n = 15). Continuous curvilinear capsulorhexis was performed conventionally with a manual, bent, 27-gauge cannula, and HFC was performed according to Klö ti. Membranes were processed and examined by LM and TEM according to standard procedures. Conclusions:Of the 3 techniques, CCC produced the mildest tissue damage. The histological damage at ELC edges was relatively mild and intermediate compared with that seen at CCC and HFC edges. These observations suggest that ELC is an appropriate option for anterior capsulotomy in cataract surgery.
Posted by alireza habibollahi at 02:07 PM
Retinal breaks and detachment after neodymium:YAG laser posterior capsulotomy: Five-year incidence in a prospective cohort
J Cataract Refract Surg 2004; 30:58–66
Finland,350 eyes referred for a first Nd:YAG laser posterior capsulotomy between October 1994 and February 1996, 220 eyes were examined for retinal breaks before and after capsulotomy (stage 1 of study). Asymptomatic breaks were prophylactically photocoagulated. Of the 220 eyes 113 were examined at stage 2 a median of 4.9 years after Nd:YAG capsulotomy. The charts of all 341 patients were reviewed for development of RD and retinal breaks.Results: By 5 years RD in the 341 patients was 2.0% Of the 211 eyes enrolled in stage 1, 2 (1.2%) developed an RD (95% CI, 0.3-4.7). Of 51 fellow eyes that had a capsulotomy and 120 eyes that had a capsulotomy but were not enrolled in stage 1 and were not prophylactically treated, RD occurred in 6 eyes (5.8%; 95% CI, 2.6-13).
Conclusions:
In addition to the capsulotomy, other known risk factors predicted RD after Nd:YAG laser posterior capsulotomy. Close follow-up and prophylactic photocoagulation of preexisting retinal breaks are worth considering, especially in high-risk eyes.
Posted by alireza habibollahi at 01:56 PM
[ Fri Mar 05, 01:35:23 PM | alireza habibollahi | edit ]
Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan
J Cataract Refract Surg 200433?44
A phakic IOL was implanted in 217 highly myopic eyes . 59 eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. . Results: The BCVA&UCVA improved in all eyes. No significant differences in visual acuity improvement were observed with the 3 materials, although the improvement was somewhat greater in eyes with the Artisan and Staar IOLs. Anterior cataract formation was higher in the Adatomed group (44.06%) than in the Staar group (9.52%); nuclear cataract developed in 2 Adatomed eyes (1.46%) only. Conclusions: There was a higher incidence of anterior subcapsular cataract formation in the Adatomed group than in the Staar group. Delayed cataract development and the cataract type in patients with Artisan IOLs indicate that age and axial length may be prognostic factors. Factors such as IOL design, material, and placement probably affect cataract formation in eyes with posterior chamber IOLs for high myopia, particularly the Adatomed IOL.
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[ Fri Mar 05, 01:27:05 PM | alireza habibollahi | edit ]
Posted by alireza habibollahi at 01:40 PM
Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan
J Cataract Refract Surg 200433?44
A phakic IOL was implanted in 217 highly myopic eyes . 59 eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. . Results: The BCVA&UCVA improved in all eyes. No significant differences in visual acuity improvement were observed with the 3 materials, although the improvement was somewhat greater in eyes with the Artisan and Staar IOLs. Anterior cataract formation was higher in the Adatomed group (44.06%) than in the Staar group (9.52%); nuclear cataract developed in 2 Adatomed eyes (1.46%) only. Conclusions: There was a higher incidence of anterior subcapsular cataract formation in the Adatomed group than in the Staar group. Delayed cataract development and the cataract type in patients with Artisan IOLs indicate that age and axial length may be prognostic factors. Factors such as IOL design, material, and placement probably affect cataract formation in eyes with posterior chamber IOLs for high myopia, particularly the Adatomed IOL.
href="http://www.ascrs.org/publications/jcrs/absjan04.html#binder">
Posted by alireza habibollahi at 01:35 PM
Flap dimensions created with the IntraLase FS laser
J Cataract Refract Surg 2004; 30:26–32
In the first 103 eyes in which flaps were created with the IntraLase laser, the flap thickness was measured by the ultrasonic difference between the preoperative and post-flap-creation central corneal thickness and the flap diameter was measured with calipers. Conclusions: The IntraLase laser, while adding technical complexity to the laser in situ keratomileusis procedure, is able to predictably create flap diameters, hinge location, and flap thickness while eliminating the risk for cap perforations. The technique of flap elevation affects rapidity of visual recovery. J Cataract Refract Surg 2004; 30:26–32 © 2004 ASCRS and ESCRS
Posted by alireza habibollahi at 01:27 PM
Case series: Orthokeratology caused permanent vision loss
OSN Feb 2004
Some Chinese children who wore contact lenses overnight as part of an orthokeratology regimen developed corneal ulcers that resulted in corneal scarring and vision loss, according to a published case series. Alvin L. Young and colleagues at the Chinese University of Hong Kong reported this consecutive series of children with orthokeratology-related corneal ulcers who presented to their tertiary care center. The six children between the ages of 9 and 14 wore rigid contact lenses 8 to 12 hours a night for the correction of myopia. All of the children developed bacterial eye infections that warranted medical treatment. All the infections were unilateral. Infection onset was between 3 and 36 months after initiating orthokeratology contact lens wear. Five of the six cases were positive for Pseudomonas aeruginosa. All of the affected eyes lost best corrected visual acuity, according to the published report. Orthokeratology is a process by which the corneal curvature is flattened by sequentially fitting rigid gas permeable lenses of decreasing central curvature. According to the American Academy of Ophthalmology, optometrists developed the procedure in the 1960s. Although not in wide use in the United States, the procedure is gaining in popularity in China and other countries, the AAO noted in a press release describing the Hong Kong study. According to the AAO press release, the study authors could not determine whether the contact lenses worn by the patients in their report were designed for orthokeratology. It was not clear whether the lenses used were designed for high oxygen transmission or if they had been properly fitted for the patients, the AAO said.
Posted by mehdi khanlari at 10:48 AM
Conjunctival nevi usually remain stable over years
OSN Feb 2004
Over time, a conjunctival nevus may change color or size, but it tends to remain stable, according to a long-term study.
Carol Shields, MD, and colleagues at Wills Eye Hospital in Philadelphia retrospectively reviewed the charts of 410 patients diagnosed with conjunctival nevi. The two main outcome measures were alterations in tumor size and color.
Of the 410 patients, a majority (89%) were white. Irides were brown in 229 of 418 eyes (55%), blue in 85 (20%), green in 20% and eye color was not indicated in 21 eyes (5%). At baseline, the nevus was brown in 65%, tan in 19% and completely nonpigmented in 16%. Anatomically, the location of the nevus was the bulbar conjunctiva in 302 eyes (72%), the caruncle in 61 eyes and the plica semilunaris in 44 eyes. Other locations included the fornix, tarsus and cornea. The bulbar conjunctival lesions most commonly abutted the corneoscleral limbus. Cysts were clinically detected in 70% of the histopathologically confirmed compound nevi, 58% of the subepithelial nevi, 40% of the junctional nevi and in none of the blue nevi. Of the original patient group, 149 were observed for a mean of 11 years. In these patients, the lesion color grew darker in seven, lighter in 12 and was stable in 130. The lesion grew in 10 patients, appeared smaller in one patient and remained stable in 137 patients. Three patients developed malignant melanoma from an existing compound nevus or blue nevus over a mean of 7 years.
The study is published in the February issue of Archives of Ophthalmology.
Posted by mehdi khanlari at 10:46 AM
Daclizumab shows potential in uveitis trials
OSN March 2004
Once-monthly intravenous injections of daclizumab controlled uveitis and were well-tolerated in a long-term preliminary study by the National Institutes of Health Robert Nussenblatt, MD, and colleagues at the National Eye Institute also found initial evidence that a formulation of daclizumab that can be injected under the skin had similar results, according to an NEI press release. In theory, patients might be able to administer this treatment themselves.In the current study, one intravenous infusion per month was administered to 10 patients with uveitis. Over the 4-year follow-up, seven patients tolerated the drug well. In addition, they were able to reduce their reliance upon corticosteroids and immunosuppressive drugs while on daclizumab treatment. “Daclizumab offers the promise of a safe, well-tolerated and effective long-term therapy for uveitis,” Previous studies have found that T helper cells, which normally help fight harmful bacteria and viruses, initiate an immune response in the eye. Daclizumab, which blocks interleukin-2 receptors, preventing the immune response triggered by T helper cells, is approved in the United States for use in preventing organ rejection in kidney transplant patients.
Posted by mehdi khanlari at 10:41 AM
NTG called ?cancer? of glaucoma
OSN Jan 2004
Normal tension glaucoma manifests in sometimes unclear presentations, and treatment options are limited, according to one glaucoma specialist. ?Normal tension glaucoma ? really is the ?cancer? of glaucoma. It is the toughest patient to treat, as many of us know,? said Martin B. Wax, MD, of Washington University?s School of Medicine. Dr. Wax recommends that physicians be clinically vigilant and offer patients individualized treatments. Even though pressures appear physiologic in normal tension glaucoma (NTG), the disease is often pressure-dependent, and IOP must be minimized as much as possible, Dr. Wax noted. Pressure-lowering treatment is still the standard of care, but regardless of treatment, glaucomatous damage may continue to progress. There is ongoing debate over whether NTG can be distinguished from high pressure glaucoma on visual fields. Dr. Wax noted that while this might be accomplished, in the later stages of the disease, ?it?s very hard.? Dr. Wax outlined what he dubbed subsets of NTG: the atherosclerotic variant, the hypotensive variant and autoimmune glaucoma.
Posted by mehdi khanlari at 10:35 AM
March 04, 2004
Ruboxistaurin reduces visual loss in diabetic retinopathy
Ophthalmology Times January 15, 2004
New Orleans-Ruboxistaurin mesylate, a protein kinase C (PKC) beta inhibitor, reduces loss of vision in patients with moderately severe to very severe nonproliferativediabetic retinopathy, "This agent targets at the molecular level the microvascular diabetic complications that leads to diabetic retinopathy, and it could eventually change the lives of people with endangered vision worldwide," . "The results so far have led to aggressive phase III clinical research." Ruboxistaurin inhibits PKC beta, an enzyme implicated in the underlying process of microvascular damage, which, in turn, leads to diabetic microvascular complications such as diabetic retinopathy. Since type II diabetes is often not diagnosed until years after its onset, many patients have developed diabetic microvascular complications at the time of diagnosis. And three-quarters of all patients with diabetes develop at least one complication within 15 years of diagnosis. Ruboxistaurin is under study as a potential therapy for diabetic peripheral neuropathy, diabetic retinopathy, and diabetic nephropathy, the three major diabetic microvascular complications.
Posted by mehdi khanlari at 11:45 PM
March 02, 2004
Axial length, refractive error, and keratometry in patients with branch retinal vein occlusion
Eur J Ophthalmol 2004; 14: 37 - 39
The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.No difference was found between the two eyes in mean subjective refraction or mean keratometry readings.
Posted by mehdi khanlari at 11:24 PM
The effects of corneal parameters on the assessment of endothelial cell density in the elderly eye
British Journal of Ophthalmology 2004;88:325-330
The study suggests that in an older population, lower ECD values would be expected in thinner and/or steeper corneas.
Posted by mehdi khanlari at 11:18 PM
Efficacy of Bunazosin Hydrochloride 0.01% as Adjunctive Therapy of Latanoprost or Timolol.
Journal of Glaucoma. 13(1):73-80, February 2004.
Bunazosin hydrochloride 0.01% may provide an additional intraocular pressure reduction in patients already receiving latanoprost or timolol. Since adding bunazosin to eyes treated with latanoprost caused a relatively small hypotensive response at 2 weeks and provided a further reduction from 2 weeks to 12 weeks, longer than 4 weeks may be required to evaluate a clinically meaningful response to treatment. Further investigation on more cases and longer follow-up are needed.
Posted by mehdi khanlari at 11:11 PM
A Direct Method to Measure the Power of the Central Cornea After Myopic Laser In Situ Keratomileusis
Arch Ophthalmol. 2004;122:159-166.
Six central areas in 6 corneal power maps were studied using the Orbscan II statistical analysis device in 26 eyes that underwent myopic LASIK. Refractive and corneal power changes were compared. Factors related to wrong corneal power measurement were evaluated. Total corneal power is more positive and refractive change is underestimated when deduced from the anterior surface radius and keratometric refractive index. The anterior-posterior power ratio is not a fixed value. The best area to estimate the refractive change depends on the method used to obtain the power in diopters. Refractive change tended to be underestimated in larger areas and higher preoperative myopia. Orbscan II total-mean and total-optical power maps accurately assess the corneal power after myopic LASIK independent of preoperative data or correcting factors, and should improve intraocular lens calculation.
Posted by mehdi khanlari at 11:03 PM
Endoscopic visualisation to aid deep anterior lamellar keratoplasty
Eye (2004) 18, 188-191. doi:10.1038/sj.eye.6700601
Endoscopy provides an effective tool to visualise the posterior corneal surface during DALK, using air dissection. This technique may become a standard adjunctive procedure during DALK.
Methods Four whole globes for research were obtained from the Florida eye bank with consent. A 2 mm incision was placed at the limbus and the endoscope was introduced through this into the anterior chamber. A 26-gauge needle was introduced into the cornea with the bevel positioned as deep as possible and air injected into the corneal stroma. Air was injected until the whole cornea became opaque and repeated air injections were made even after an opaque cornea was noted. The endoscopic camera was used to visualise the posterior corneal surface during this procedure.
Posted by mehdi khanlari at 10:54 PM
Longitudinal study of the normal eyes in unilateral keratoconus patients
Ophthalmology, Volume 111, Issue 3, Pages 440-446 (March 2004)
Approximately 50% of clinically normal fellow eyes will progress to KC within 16 years. The greatest risk is during the first 6 years of the onset. Quantitative indices (I-S and KISA values) and qualitative patterns (AB/SRAX) might predict this progression.
Posted by mehdi khanlari at 10:43 PM
Patient preferences for anaesthesia management during cataract surgery
BJO,March,2004
When given the choice of four different anaesthesia management strategies, 72% of the study subjects preferred block anaesthesia to topical anaesthesia. More patients chose to have oral sedation than intravenous sedation. These findings indicate that patients may prefer anaesthesia management approaches other than the ones they are currently being offered.
Posted by afarahi at 01:21 AM
What patients want to know before they have cataract surgery
BJO,March,2004
A written questionnaire was answered by 190 patients prior to cataract surgery. The five pieces of preoperative information rated most important were: chance of visual improvement; when vision would improve; overall risk of losing vision from the operation; effect of not having the operation, and the types of serious complications. When asked "should you be warned of a serious complication if it has a risk of happening", 93.5% said yes to a risk of 1 in 50 and 62.4% to 1 in 1000. Written information was requested by 85.7%. There were few differences between the sexes, and between those having their first or second operation.
Conclusions: Patients most wanted to know benefits and risks, even very small risks. Written information should be provided to ensure coverage and reinforce verbal information.
Posted by afarahi at 01:15 AM
Functional results and complications of Mersilene mesh use for frontalis suspension ptosis surgery
BJO,March,2004
This retrospective case series include 32 eyelids of 20 patients (12 children and eight adults) with follow up of 1–69 months (mean 32). Children: eight patients had bilateral and four unilateral surgery (20 eyelids). Good long term functional results were achieved in 73% and 77% eyelids. Two children had early postoperative wound infection requiring removal of mesh in one; the other was lost to follow up following medical treatment. Adults: four patients had bilateral and four unilateral surgery (12 eyelids). Good long term functional results were achieved in 75% .One postoperative wound infection and one mesh exposure were treated definitively by surgical excision of mesh.
Conclusion: Mersilene mesh provides good functional results but up to 20% of patients have early soft tissue complications. Other materials such as monofilament suture or autogenous fascia lata should be considered.
Posted by afarahi at 01:08 AM
March 01, 2004
Topical Cyclosporine in the Management of Shield Ulcers
Cornea: Volume 23(2) March 2004 pp 194-200
Topical cyclosporine is an effective treatment alternative in the management of shield ulcers in patients with vernal keratoconjunctivitis. The 1% concentration seems to be the minimal effective concentration in such cases in our experience, but further controlled studies are needed to support our findings.
Complications such as central epithelial keratitis and shield ulcer may be vision threatening. 6,7 Shield ulcers form when superficial punctate keratitis progresses to a macroerosion. In addition to possible permanent vision loss, the longer the shield ulcer persists, the greater the likelihood of bacterial keratitis, strabismus, amblyopia, sterile ulceration, and even globe perforation. Therefore, even though VKC is likely to subside around puberty, patients with shield ulcers that do not respond to routine therapy should be treated aggressively to avoid complications and permanent vision loss.The standard protocol for treating VKC includes antihistamines, inhibitors of mast-cell degranulation, and topical and/or systemic steroids. However, most of these agents yield disappointing results in patients with severe VKC and complications. Due to serious side effects, systemic corticosteroids are not preferred as first-line treatment in VKC.The 2% formulation of cyclosporine is an immunomodulating therapy that has been proven safe and effective for topical treatment of severe or steroid-resistant VKC cases. The efficacy and safety of this agent have already been investigated in other ocular inflammatory conditions, such as ligneous conjunctivitis, rheumatoid corneal ulceration, Mooren ulcer, ulcerative keratitis, and high-risk corneal transplants.
Posted by mehdi khanlari at 10:24 PM
Can patients guess their intraocular pressure?
American Journal of Ophthalmology, Volume 137, Issue 2, Pages 350-351(February 2004)
Patients who believe they can guess their IOP appear as often inaccurate as accurate in assessing their IOP related to a symptom threshold and as accurate as patients who claim they cannot guess their IOP.
Posted by mehdi khanlari at 10:11 PM
Influence of intraoperative epithelial defects on outcomes in LASIK for myopia
American Journal of Ophthalmology, Volume 137, Issue 2, Pages 244-249(February 2004)
Intraoperative epithelial defects during LASIK predispose eyes to increased wound healing, leading to myopic regression, irregular wound healing with loss of visual acuity, and increased need for enhancement procedures.
Posted by mehdi khanlari at 10:08 PM
Identifying early glaucoma with optical coherence tomography
American Journal of Ophthalmology Feb 2004
Kouros Nouri-Mahdavi
The OCT discriminates well between eyes with early perimetric glaucoma and normal eyes. However, its performance is less adequate in eyes with suspicious disk and normal VFs.
Posted by mehdi khanlari at 10:06 PM
Confocal microscopy(A report by the American Academy of Ophthalmology)
Ophthalmology Volume 111, Issue 2 , February 2004, Pages 396-406
Confocal microscopy is a new technology with clinical applications in ophthalmology. Although confocal microscopy has been used in other fields of medicine, the optical transparency of the cornea and other structures of the eye provides a unique opportunity to apply this technology. The targeted literature review of 24 articles found no level I studies to support the use of confocal microscopy in the management of eye disorders. Three level II studies pertained to promising clinical applications of the confocal microscope and provided evidence that supports the use of confocal microscopy as an adjunctive modality for diagnosing Acanthamoeba keratitis. The remaining 21 articles, rated as level III evidence, focus on the use of confocal microscopy to facilitate the diagnosis of infectious keratitis, including amoebic and fungal, but currently there are no definitive studies of its role in the differential diagnosis of this condition. There are also level III studies that support the use of the confocal microscope in refractive surgery. Facilitating the diagnosis of infectious keratitis and applying the confocal microscope to refractive surgery may hold the greatest promise of this new technology.
Posted by mmiraftab at 06:43 PM
Relative afferent pupillary defect in patients with asymmetric cataracts
J Cataract Refract Surg 2004; 30:132–136
Conclusions: More than half the patients with asymmetric cataract had an RAPD that resolved in the eye with less severe cataract after cataract extraction. All patients with a unilateral totally opaque lens had an RAPD. The presence of a preoperative RAPD was not related to postoperative visual acuity.
Posted by mehdi khanlari at 07:22 AM
Outcomes of laser in situ keratomileusis in patients with pigment dispersion syndrome
J Cataract Refract Surg 2004; 30:110–114
To analyze the outcome of laser in situ keratomileusis (LASIK) in patients with pigment dispersion syndrome (PDS)
This noncomparative case series reviewed the medical records of 12 patients (22 eyes) who had clinical features consistent with PDS at the time of the initial preoperative refractive evaluation and had LASIK surgery.Twenty eyes (90.9%) of 11 patients had an uneventful course after LASIK and a good final uncorrected visual acuity (mean follow-up 26 months). One patient (2 eyes) with PDS and suspicion of glaucoma on topical â-blocker therapy had delayed healing, fluctuations in vision, and a lengthy visual recovery. Conclusions:Corneal findings of PDS do not appear to affect the intraoperative or postoperative outcomes of LASIK. However, patients who have PDS in the context of glaucoma and therapy with an intraocular-pressure-lowering agent may experience delayed healing and a less predictable visual outcome.
Posted by mehdi khanlari at 07:20 AM
Effect of haptic design on change in axial lens position after cataract surgery
J Cataract Refract Surg 2004; 30:45–51
To compare the postoperative changes in anterior chamber depth (ACD) between single-piece and multipiece AcrySof® intraocular lenses (IOLs) (Alcon Laboratories, Inc.) and their effect on the postoperative refractive shiftnThis prospective randomized bilateral study with intraindividual comparison comprised 104 eyes of 52 consecutive patients with age-related cataract. All patients had standardized cataract surgery with a temporal self-sealing incision, phacoemulsification, and IOL implantation in the capsular bag. The first 30 patients received a single-piece, 5.5 mm optic IOL (AcrySof SA30) in 1 eye and a multipiece IOL (AcrySof MA30) in the other eye. Another 22 patients received the corresponding 6.0 mm optic models (AcrySof SA60 and AcrySof MA60, respectively). Anterior chamber depth measurements and evaluation of the change in ACD during the first 6 postoperative months were performed using partial coherence laser interferometry. The amount of change in capsulorhexis size during the first 6 postoperative months was assessed using standardized retroillumination photographs. Single-piece IOLs shifted significantly less postoperatively than multipiece IOLs. The multipiece IOLs shifted forward, especially from 1 day to 1 month. The change in the capsulorhexis area was similar between IOL types. Conclusions:Single-piece AcrySof IOLs shifted minimally after the first postoperative day; therefore, the prescription for spectacles in eyes with this IOL can be obtained soon after surgery.
Posted by mehdi khanlari at 07:11 AM