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June 29, 2004
Clear corneal incision linked to rising endophthalmitis risk
Ophthalmology Times June 1, 2004
Mehran Taban
There has been a rise in the occurrence of acute endophthalmitis following cataract surgery during the last decade ,and that uptrend in endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions, according to Mehran Taban, MD who is working on his internship at University of California-Irvine and reported the results of a systematic review covering more than 40 years from January 1963 to March 2003.Over the entire study period, the rates of endophthalmitis were 0.38% for PK and 0.13% for cataract surgery. Plotting rates of postcataract surgery endophthalmitis versus time, the researchers found there was a gradual downward trend between 1963 and 1991 that reversed thereafter, while the analyses of the PK publications revealed an opposite temporal pattern.Rates of postoperative endophthalmitis during the period from 2000 to 2003 were 0.27% for cataract surgery and nearly 0.2% for PK. The rate in the cataract surgery papers was nearly 2.5 times higher than that calculated for the preceding years while for PK, there was an approximate 50% reduction.The researchers also analyzed endophthalmitis rates for the cataract surgery papers from 1992 to 2003 with the data divided according to incision type. Those calculations showed the risk of endophthalmitis after clear corneal surgery was significantly higher compared with both scleral incision (about 2.5-fold) and limbal incision (more than 3-fold). The rates of endophthalmitis after limbal incision versus scleral incision cataract surgery were not significantly different,
Posted by mehdi khanlari at 10:53 PM
spray for allergies
Ophthalmology Times June 1, 2004
Fort Worth, TX-A nasal formulation of olopatadine HCl ophthalmic solution 0.1% (Patanol, Alcon) reduced seasonal allergic rhinitis symptoms compared with placebo, according to phase III study results. According to the study, 30.1% of patients felt better over the course of the day with the 0.6% solution, compared with 27.6% with the 0.4% solution and 18.7% with placebo. Some 26.2% of patients taking the 0.6% nasal solution said they felt better instantly, compared with 24.3% of patients taking the 0.4% solution and 15.8% of patients taking placebo.
Posted by mehdi khanlari at 10:53 PM
OCT shows flap thickening after LASIK
OSN June 2004
Optical coherence tomography of corneas after LASIK showed thickening of the epithelium and the stromal flap at 1 week and 1 month postop,After surgery, the corneal epithelium changes were not significant at day 1. By 1 week postop, there was statistically significant thickening when compared with day 1. Corneal epithelial thickening remained statistically significant at 1 month when compared with all other follow-up times The corneal flap became statistically significantly thicker between 1 week and 1 week and between 1 week and 1 month postop.The researchers said there was a strong correlation between the difference of preop and postop corneal thickness and the predicted laser ablation depthThe study is published in the June issue of Investigative Ophthalmology & Visual Science.
Posted by mehdi khanlari at 10:23 PM
June 28, 2004
Outcomes of Laser in situ Keratomileusis in a Refractive Surgery Fellowship Program
Journal of Refractive Surgery Vol. 20 No. 3 May/June 2004
PURPOSE
The purpose of this study was to document the learning curve and evaluate the success of laser in situ keratomileusis (LASIK) performed by fellows in a Cornea/External Disease and Refractive fellowship program.
METHODS
Two surgeons performed LASIK within a fellowship training program between July 2000 and August 2001. A retrospective review was conducted to determine the visual outcomes and operative complications from this non-comparative case series of 755 consecutive eyes. All LASIK procedures were performed using a Bausch & Lomb Technolas 217A laser and the Bausch & Lomb Hansatome or the Automated Corneal Shaper microkeratome. All eyes were evaluated for operative complications. Visual acuity was reported with a minimum of 1 month follow-up.
RESULT
Data analysis revealed that uncorrected visual acuity of 20/40 or better was attained in 99.4% of treated eyes, and 20/20 or better in 77.2%. With both eyes open, 100% of patients saw 20/30 or better, 94% saw 20/20 or better, 70% saw 20/15 or better, and 5.5% saw 20/10. Flap related complications occurred in 7 of 755 eyes (0.9%) and all were successfully treated. Forty-two eyes (5.6%) were lost to follow-up prior to the 1-month examination and were excluded from analysis of visual acuity.
CONCLUSIONS
Favorable operative and visual acuity 1-month results in 755 eyes after LASIK with the Bausch & Lomb Technolas 217A laser were in part due to a well organized system of education, patient examination, execution of surgery, and postoperative care. A team approach was essential.
Posted by mmiraftab at 07:34 PM
Prospective, Randomized, Paired Comparison of Laser Epithelial Keratomileusis and Photorefractive Keratectomy for Myopia Less Than -6.50 Diopters
Journal of Refractive Surgery Vol. 20 No. 3 May/June 2004
Hassan Hashemi, MD; Akbar Fotouhi, MD, MPH; Hamid Foudazi, MD; Navid Sadeghi, MD; Saeed Payvar, MD
PURPOSE
We compared predictability, efficacy, safety, and patient satisfaction following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) for low to moderate myopia with either the Nidek EC-5000 excimer laser or the Technolas 217C excimer laser.
METHODS
Forty-two patients with spherical equivalent refraction in the range -1.00 to -6.50 D were enrolled in this prospective study, each randomized for choice and sequence of LASEK and PRK on each of their eyes. Patients were examined daily for 7 days, and at 1 and 3 months. Patient satisfaction and quality of vision were assessed using a subjective questionnaire.
RESULTS
Mean baseline refraction was -3.57 ± 1.25 D in LASEK eyes and -3.44 ± 1.13 D in PRK eyes. Follow-up rates were 100% up to 1 month and 76% at 3 months. At 3 months, 32 (100%) of LASEK eyes and 31 (97%) of PRK eyes had uncorrected visual acuity >20/40, 25 (79%) of LASEK eyes and 26 (82%) of PRK eyes had uncorrected visual acuity >20/20, mean refraction was 0.08 ± 0.53 D in LASEK eyes and 0.12 ± 0.50 D in PRK eyes, 26 (81%) of LASEK eyes and 23 (72%) of PRK eyes had a refraction within ±0.50 D and 29 (91%) of LASEK eyes and 30 (94%) of PRK eyes had refraction within ±1.00 D. Epithelial healing time and pain in LASEK and PRK eyes were not statistically different, and patients were equally satisfied.
CONCLUSION
LASEK had similar predictability, efficacy, safety, and patient satisfaction to PRK in the treatment of low to moderate myopia.
Posted by mmiraftab at 07:29 PM
Determination of Excimer Laser Ablation Rates of Corneal Tissue Using Wax Impressions of Ablation Craters and White-Light Interferometry
Ophthalmic Surgery, Lasers and Imaging Vol. 35 No. 1 January/February 2004
BACKGROUND AND OBJECTIVE
Efforts to better understand the processes of corneal ablation are aided by a means to precisely measure corneal tissue ablation rates.
MATERIALS AND METHODS
A white-light interferometer was used to measure the depth of argon fluoride laser ablation craters and wax impressions of the ablation craters. The technique was validated using polymethylmethacrylate (PMMA), and was then used to measure the ablation rate of bovine corneal tissue.
RESULTS
The ablation rate was measured as 0.47 µm/pulse from direct measurement of the PMMA ablation craters and as 0.48 µm/pulse from measurement of the corresponding wax impressions. The ablation rate of bovine corneal tissue was found to be 0.90 µm/pulse.
CONCLUSIONS
Wax impressions provide a valid representation of ablation craters. The ablation depth of corneal tissue and PMMA was found to increase linearly with increasing number of laser pulses, and the slope of the regression lines provided a measure of the laser ablation rate.
Posted by mmiraftab at 07:16 PM
Wrong-Site Eye Surgery
Ophthalmic Surgery, Lasers and Imaging Vol. 35 No. 3 May/June 2004
Wrong-site surgery is described as a surgical procedure intended for a particular body part that is mistakenly performed on another structure. As Dr. H. M. Traquair wrote regarding surgery, “there is much evidence that paired or multiple organs can easily be confused. . . . The wrong eye has been operated on for cataract, the wrong kidney and the wrong finger have been operated on, and the wrong leg has been amputated.”1 The preceding quotation appeared in Traquair’s 1947 article entitled “Removal of the Wrong Eye.” To the best of our knowledge, wrong-site surgery has not been discussed in the published ophthalmic literature since then. Although the focus of Traquair’s essay was wrong-site enucleation, many of his comments and ideas may be applied to the examination of other forms of ophthalmic and general wrong-site surgeries.
Posted by mmiraftab at 07:09 PM
June 27, 2004
Efficacy of amblyopia therapy initiated after 9 years of age
Eye,June,2004
A total of 16 amblyopes of 9 years or older (range, 9.0-14.5 years; mean, 10.5 years) with a difference in visual acuity of over two lines between the eyes alter 4 weeks of first full-time spectacle wear were included. None of the children had undergone a previous ocular examination, had ever worn spectacles, received occlusion therapy, or had strabismus surgery. Full-time occlusion was performed in 14 patients and part-time occlusion in two patients.
The final visual acuity of 15 out of 16 patients (94%) improved at least two lines.
Conclusions Occlusion therapy for anisometropic and strabismic amblyopia can be successful even if initiated after the age of 9 years.
Posted by afarahi at 09:28 PM
A single transcutaneous injection with Botox for dysthyroid lid retraction
Eye,May,2004
A total of 15 patients (21 eyes) with a stable condition, and a euthyroid state, were enrolled into the study. A single injection, at the centrally superior tarsal border transcutaneously, aiming at the levator aponeurosis and Müller muscle, was administered into each eyelid with 5-6 U of Botox. All patients, except one, experienced much reduction of palpebral fissure. There were temporary complications of ptosis in three patients and vertical diplopia in two patients, lasting 3-4 weeks.
Conclusions: A single transcutaneous injection with BotoxÒ for the treatment of thyroid lid retraction is safe and effective. Some minor complications may occur, such as ptosis and diplopia; however, it may offer an alternative and temporary method for patients with dysthyroid lid retraction, who are waiting for a staged operation of either an orbital decompression or a strabismus surgery or both.
Posted by afarahi at 09:14 PM
Therapy restores visual field lost to brain injury in some patients
OSN.6/15/2004
A novel treatment that employs patterns of visual stimuli is helping some patients restore visual field lost to damage to certain areas of the brain, researchers say.The treatment, called NovaVision VRT (Vision Restoration Therapy), is being marketed in the United States and Germany by Boca Raton, Fla.-based NovaVision Inc.According to the company, after a stroke or traumatic brain injury, there remains a zone of residual vision that exists among regions in the brain’s vision processing areas. VRT is a computer-based therapy that helps diagnose and improve visual function in such patients.
VRT is intended to stimulate the brain to facilitate the functioning of remaining, undamaged neural networks. As reconnections are made, the remaining neurons begin functioning to improve the visual field. Dr. Schatz said patients treated with VRT have shown on average a 30% increase in visual field, a statistically significant improvement.
At present, VRT is only indicated for patients with homonymous field defects due to damage of visual pathways in the geniculocalcarine system. In the future, though, the therapy may benefit patients with optic nerve injuries, who could have more potential for plasticity because there is no injury to the brain.
Posted by afarahi at 09:02 PM
June 26, 2004
Long-term results of deep sclerectomy with collagen implant
collagen implant (DSCI).
JCRS JUNE 2004
Switzerland. patients with medically uncontrolled primary and secondary open-angle glaucoma. Results: At 96 months, the qualified success rate (ie, patients who achieved IOP <21 mm Hg with and without medication) was 91%, and the complete success rate (ie, IOP <21 mm Hg without medication) was 57%. At 96 months, 34% of patients had an IOP <21 mm Hg with medication. Fifty-one patients (49%) achieved an IOP ?15 mm Hg without medication.No shallow or flat anterior chamber, endophthalmitis, or surgery-induced cataract was observed. Injections of 5-fluorouracil were administered to 25 patients (23%) who underwent DSCI to salvage encysted blebs. Mean number of medications per patient was reduced from 2.3 to 0.5 Conclusion: Deep sclerectomy with collagen implant appears to provide stable and reasonable control of IOP at long-term follow-up with few immediate postoperative complications.
Posted by alireza habibollahi at 11:58 PM
LASIK for myopia and the contrast sensitivity function(CSF).
JCRS JUNE 2004
A Hansatome® microkeratome (Bausch & Lomb) and a Technolas® 217C excimer laser (Bausch & Lomb) driven by the PlanoScan program were used. The monocular CSF for spatial frequencies of 3, 6, 12, and 18 cycles per degree (cpd) for both day and night vision simulations were made with a CSV-1000E system (Vector Vision) before and 1 month and up to 9 months after LASIK. In a subgroup of eyes that had corneal microstriae, however, there was a significant reduction in the photopic and mesopic CSF at 6, 12, and 18 cpd (ANOVA, P<.05) despite normal Snellen visual acuities. The CSF normalized in 6 to 9 months as the microstriae became less visible. Conclusions:Subtle central corneal microstriae after LASIK can reduce the baseline CSF at medium to high spatial frequencies even with 20/20 visual acuity. The CSF normalizes as the microstriae fade over time.
Posted by alireza habibollahi at 11:32 PM
Light scattering and optical aberrations as objective parameters to predict visual deterioration in eyes with cataracts
JCRS JUNE 2004
JAPAN,To predict the visual deterioration of eyes with cortical (CC) or nuclear (NC) cataract from objective data on ocular higher-order aberration (HOA) and forward (FLS) and backward light scattering (BLS). HOA were calculated with the Zernike polynomials using the Hartmann-Shack aberrometer. Forward light scattering was calculated from the size of the aberrometer spot images for the central 4 mm, and backward light scattering (BLS) was calculated from the optical density of the Scheimpflug images. Conclusions:
Loss of contrast sensitivity was predominantly due to BLS and HOA in eyes with NC and FLS and HOA in eyes with CC. Higher-order aberrations, FLS, and BLS, variables that are obtained objectively, can be used to predict quantitatively the visual deterioration in cataractous eyes.
Posted by alireza habibollahi at 11:23 PM
Phakic refractive lens implantation in high myopic patients: One-year results
JCRS JULY 2004
Crete, Greece. patients were treated for high myopia with implantation of a silicone PRL in the posterior chamber.Conclusion: The PRL showed encouraging results in treating high myopia. Additional patients and longer follow-up period are needed to detect the long-term efficacy and safety of this refractive lens.
Posted by alireza habibollahi at 11:12 PM
Intraocular telescopic lens evaluation in patients with age-related macular degeneration
JCRS JULY 2004
To evaluate the improvement of distance and near visual acuity after removal of cataract and implantation of an 3.0× intraocular miniaturized telescope (IMT) in patients with stable atrophic type age-related macular degeneration (ARMD).Standard phaco followed by enlargement of the incision to 10 mm and implantation in the capsular bag of an 3.0× IMT was carried out in all the cases. The differences between pre- and postoperative distance and near visual acuities were statistically significant. Conclusion: Implantation of IMT is feasible and plays an effective role in improving far and near visual acuity in patients with stable dry-type ARMD.
Posted by alireza habibollahi at 11:02 PM
Should You Switch to Micro Phaco?
REVIEW OF OPHTHALMOLOGY
Some surgeons believe the future of cataract surgery is here already in the form of micro phaco, while others think the true benefits of this technique, and the technology that support it, still lie on the horizon. In this edition of Face-off, Randall Olson, MD, of the Moran Eye Center at the University of Utah, and Robert Osher, MD, of the Cincinnati Eye Institute and the University of Cincinnati, exchange their differing views of the topic in a forum moderated by Minneapolis surgeon David Hardten.
Posted by mmiraftab at 10:35 PM
Menstrual cycle in diabetics affects visual field sensitivity
OSN June 2004
Women with diabetes showed a significant depression in visual field threshold sensitivity during the luteal phase of the menstrual cycle. Researchers recommended that physicians should take this variability into consideration in their clinical assessment of women with advanced diabetes who are at risk of glaucomatous optic neuropathy. The visual field analyses were divided into superotemporal, inferotemporal, superonasal .The study is published in the June issue of Clinical & Experimental Ophthalmology.
Posted by mehdi khanlari at 08:27 PM
Diet high in fruit associated with lower risk of neovascular AMD
OSn June 2004
Consumption of fruit — specifically bananas and oranges — may help ward off the development of neovascular age-related macular degeneration, data from a large cohort study suggest.Other dietary elements tracked in the study — intake of vegetables, antioxidant vitamins and carotenoids — were not strongly associated with either early or neovascular AMD, the study’s authors said. These findings were similar for both sexes. In examining whether specific fruits were related to the risk of neovascular AMD, “only higher intakes of oranges and bananas achieved statistical significance,” the authors said in the June issue of Archives of Ophthalmology. Banana intake was also inversely related to early AMD, the researchers found. The pooled multivariate relative risk for participants who consumed three or more servings per week of banana was 0.67 compared with those who consumed less than two servings per month, they reported In this study, the authors said, intakes of antioxidant vitamins or carotenoids either from food or from food and supplements were not strongly related to AMD risk. Vegetable intake was also not related to development of either early or neovascular AMD in men or women.
Posted by mehdi khanlari at 08:13 PM
June 25, 2004
Kelman :
OSN June 2004
“Ophthalmology is a field I really love. I may have given some to ophthalmology, but it’s given a lot back to me.”
Posted by mehdi khanlari at 06:46 PM
Fast Facts about Kelman
CRST June 2004
• Pioneered the Kelman Phacoemulsification procedure in 1967
• Named Ophthalmologist of the Century by an ASCRS poll of over 20,000 ophthalmologists worldwide
• Shared the 1992 National Medal of Technology, given by President George Bush, with Bill Gates
• Has written an autobiography, Through My Eyes, and a musical, “The Right Pair of Shoes”
• Has appeared on television programs hosted by Johnny Carson, Barbara Walters, Merv Griffin, David Letterman, and Oprah Winfrey
• Former president of ASCRS
• Has performed in concert with Lionel Hampton, Dizzy Gillespie, The Spinners, Glen Campbell, James Darren, and Regis Philbin
• Awarded Doctor of Letters distinction by the Wills Eye Hospital Retina Service of Thomas Jefferson
Posted by mehdi khanlari at 06:28 PM
One of the Most Influential Physicians,Charles Kelman, MD, Dead at 74
CRST June 2004
Cataract surgery pioneer, Charles Kelman, MD, died June 1 of lung cancer.Best known for inventing phacoemulsfication and making cataract surgery anoutpatient procedure, Dr. Kelman was instrumental in the evolution of cataractsurgery. Aside from improving the lives of millions of patients and indirectly prompting advancements in all of the surgical specialties, Dr.Kelman was also responsible for the reduction of surgery incisions from large to small; replacing hospital stays withoutpatient surgeries; introducing the practice of allowingpatients to resume full physical activity immediately after surgery; popularizing the use of the microscope; developing and teaching nonuniversity courses for which he charged a fee; and welcoming publicity for the medical profession.In 1992, Dr. Kelman was honored by President GeorgeH.W. Bush with the National Medal of Technology, and he was inducted to the National Inventors Hall of Fame inAkron, Ohio, last month May.For more on Dr. Kelman and his life-long achievements,please see the March 2004 issue of Cataract & RefractiveSurgery Today, or visit:www.crstoday.com/03_archive/0304/00011.html.One of the Most Influential Physicians,Charles Kelman, MD, Dead at 74
Posted by mehdi khanlari at 05:57 PM
Custom-CAP successfully treats postsurgical decentrations
Eyeworld June 2004
Custom-CAP’s primary indication is for the treatment of decentered ablations in eyes that have had previous keratorefractive surgery, either with LASIK or PRK. Its purpose is to enhance patients’ overall quality of vision, regularize the corneal surface, and optimize best-corrected visual acuity.The treatment can be done with either the VISX Star S3 or S4 excimer laser system (Santa Clara, Calif.), he said. Surgeons also need the Zeiss Humphrey topographer and VisionPro Ablation Planning Software (Carl Zeiss Meditec, Dublin, Calif.), as well as certification from VISX, he said.To perform the procedure, Manche first uses the Humphrey Topography System to identify the appropriate treatment area. He then selects ablation parameters, such as size, shape, location, and elevation.Of the 10 eyes treated, eight have gained two or more lines of best-corrected visual acuity, and nine eyes have gained or maintained lines of uncorrected visual acuity. One eye lost one line of uncorrected visual acuity; however, no eyes lost any lines of best-corrected visual acuity. All eyes showed improved centration on corneal topography, and all eyes demonstrated a statistically significant reduction in higher-order RMS values.
Posted by mehdi khanlari at 11:35 AM
Eric Corp. to introduce new tonometer system
Eyerworld June 2004
Two models are now under development. A small, lower-cost homecare device slated to be on the market within a year and a professional laser-based non-contact model is planned for release within two years. The homecare model will look like a pair of binoculars and be placed over the eyelids The Eric System relies on the application of sonic vibrations. When sonic energy passes into the eye, it vibrates at different frequencies. “This is similar to what happens when a singer sings in front of glass,” . The frequencies begin to make the eye move back and forth. The resistance to these vibrations relate to the pressure inside (IOP). The device makes the eye vibrate about 1-micron amplitude or less. This makes it rely less on the corneal curvature and elasticity by changing the corneal shape about 99 microns less than the Goldmann tonometer, he said.Advantages are that the volume of the eye is not changed because vibrations occur along the entire eye. Tonometers that bend the cornea or touch the eye change the volume.For more information, contact 403-714-5684 or www.Ericcorp.ca.
Posted by mehdi khanlari at 11:15 AM
HIV not contraindication to LASIK
Eyeworld June 2004
Posted by mehdi khanlari at 10:03 AM
June 24, 2004
Is early surgery for congenital cataract a risk factor for glaucoma?
BJO,July,2004
A retrospective case notes review was conducted of all patients who had lensectomy for congenital cataract during their first year of life at Great Ormond Street Hospital between 1994 and 1997. 80 patients, undergoing 128 lensectomies were eligible. Of these, six patients (nine eyes) were lost to follow up. Based on eye count, the risk of glaucoma by 5 years after lensectomy was 15.6% .Based on patient count, the 5 year risk of glaucoma in at least one eye following bilateral surgery was 25.1% .After early bilateral lensectomy, within the first month of life, the 5 year risk of glaucoma in at least one eye was 50% compared to 14.9% with surgery performed later .There was no significant difference in 5 year visual outcomes between eyes operated before and after 1 month of age.
Conclusion: Bilateral lensectomy during the first month of life is associated with a higher risk of subsequent glaucoma than with surgery performed later. The reason for this is unclear but it may be prudent, in bilateral cases, to consider delaying surgery until the infant is 4 weeks old. As the incidence of glaucoma is similar for each year after surgery, long term glaucoma surveillance is mandatory.
Posted by afarahi at 09:49 PM
Autogenous temporalis fascia patch graft for porous polyethylene (Medpor) sphere orbital implant exposure
BJO,July,2004
Temporalis fascia has been recommended for hydroxyapatite sphere exposure. The aim of this study was to identify potential risk factors for exposure of porous polyethylene (Medpor) sphere implants and evaluate the use of autogenous temporalis fascia as a patch graft for exposure.
Exposed porous polyethylene sphere implants were treated successfully with autogenous temporalis fascia graft in three of four patients. This technique is useful, the graft easy to harvest, and did not lead to prolonged socket inflammation, infection, or extrusion.
Posted by afarahi at 09:33 PM
Uveitis and the menstrual cycle
Eye,May,2004
The onset of acute anterior uveitis is partially dependent on the levels of either oestrogen or progesterone, or both. The withdrawal of the proven anti-inflammatory effects of these hormones may provoke the onset of uveitis.
Posted by afarahi at 09:27 PM
June 21, 2004
Effect of alcohol on the efficacy of excimer laser power
Journal of Cataract & Refractive Surgery Volume 30, Issue 7 , July 2004, Pages 1545-1548
Methods: The fluency of the Technolas 217z laser (Bausch & Lomb) was calibrated according to the standard calibration procedure. The effect of ethanol 20%, 40%, 60%, and 80% and sodium hypochlorite 0.06% solutions on laser fluency was assessed in 5 experiments.
Results: Ethanol concentrations of 20% and 40% had no significant effect on laser fluency. Ethanol concentrations of 60% and 80% reduced fluency to 97.6%. Sodium hypochlorite had no effect on laser fluency.
Conclusions: A high concentration of ethanol affected laser fluency and should be avoided in the operating theater. Ethanol 20%, which is commonly used during laser-assisted subepithelial keratectomy, did not affect laser fluency.
Posted by mmiraftab at 06:40 PM
Cataract surgery with the AlphaCor artificial cornea
Journal of Cataract & Refractive Surgery Volume 30, Issue 7 , July 2004, Pages 1486-1491
Methods: AlphaCor devices were implanted under an approved protocol. Extracapsular cataract extraction with intraocular lens implantation was concurrently performed in 5 cases; an additional case had a displaced cataractous lens removed after severe blunt trauma subsequent to AlphaCor implantation.
Results: Cataract surgery was difficult because the view was restricted and residual soft lens matter was retained. There was an increased incidence of postoperative complications (eg, melt, glaucoma) in cataract cases compared with noncataract AlphaCor cases. The mean best corrected visual acuity was worse in cases with cataract than in cases without.
Conclusions: The technique for cataract surgery in AlphaCor cases needs to be refined. Imaging studies performed postoperatively may help ascertain whether soft lens matter remains so additional antiinflammatory medication can be considered. Melting appears to be preventable by topical medroxyprogesterone 1% therapy.
Posted by mmiraftab at 06:31 PM
June 18, 2004
Medial rectus pulley posterior fixation is as effective as scleral posterior fixation for acquired esotropia with a high AC/A ratio
AJO,June,2002
Nine patients underwent MR scleral posterior fixation surgery, seven in combination with MR recessions for distance ET. Postoperatively, the distance-near disparity decreased an average of 11.8 prism diopters, stereoacuity improved in six patients, and eight patients no longer needed bifocals. Thirteen patients underwent MR pulley posterior fixation surgery, 10 in combination with MR recessions for distance ET. Postoperatively the distance-near disparity decreased an average of 14.4 prism diopters, stereoacuity improved in eight patients, and 12 patients no longer required bifocals. Statistically, the two procedures were equivalent.
Conclusion:Traditional MR scleral posterior fixation and MR pulley posterior fixation are equally effective in treating acquired ET with a high AC/A ratio.
Posted by afarahi at 08:41 PM
IOL innovations to expect in the next year and beyond.
OPHTHALMOLOGY MANAGEMENT June 2004
When my father had cataract surgery years ago, controversy over "the implant" caused him to opt out; he chose to remain aphakic. I remember watching him put in his contact lens in the bathroom mirror, using a special pair of glasses with only one lens.
Cataract patients today have a whole new world of choices and options to consider. Far from not having an implant, our patients learn about accommodative technology and improved functional vision via the Internet. One patient recently walked into our offices asking if we were investigators "for either the Tecnis multifocal or the dual optic accommodative lens." Current patients may engage us in a discussion about blue light toxicity or the effect of multifocality on contrast sensitivity. With today's patients so well-informed, it's essential for us to understand the options we have at our disposal, and to be able put them to work for the greatest benefit of our patients.
The article on the following pages lists new products you can look forward to in the next 12 months. But first, I'd like to talk about some of the issues behind these new products, and mention some of what lies ahead beyond the next year.Read More...
Posted by mmiraftab at 06:56 PM
Cut and paste: a no suture, small incision approach to pterygium surgery
British Journal of Ophthalmology July 2004;88:911-914
Aim: Evaluation of the benefits of a new technique for pterygium surgery with respect to postoperative pain and surgery time.
Methods: A prospective randomised clinical trial was carried out in 43 patients. 43 eyes were operated for primary nasal pterygium. Autologous conjunctival graft taken at the superotemporal limbus was used to cover the sclera after pterygium excision. After randomisation, in 20 patients the transplant was attached to the sclera with a fibrin tissue adhesive (Tisseel Duo Quick) and in 23 patients with absorbable sutures (7–0 Vicryl Rapid). The Mann-Whitney test was used as statistical analysis. Postoperative pain was graded according to the visual analogue scale (VAS) twice daily during the first week after surgery. Surgery time was noted from the first incision until the lid speculum was removed.
Results: The average pain was significantly lower when glue had been used, p<0.05. Average surgery time was 9.7 minutes (range 6–13) for glue and 18.5 minutes (range 12–30) for sutures, p<0.001. No complications occurred.
Conclusion: Using glue instead of sutures when attaching the conjunctival transplant in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.
Posted by mmiraftab at 06:40 PM
Extraocular muscle enlargement with tendon involvement in thyroid-associated orbitopathy
AJO,June,2002
The authers retrospectively evaluated the preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans, or both, of 125 consecutive patients with previously diagnosed TAO. A ratio of tendon to muscle width greater than 0.5 was considered as tendon involvement.Eight patients (6.4%) with TAO demonstrated tendon involvement on axial CT or MRI.
Conclusion:The configuration of extraocular muscle enlargement on imaging studies has traditionally been used to differentiate TAO from other inflammatory processes because the tendon is typically spared (fusiform configuration) in TAO. However, we found that the configuration of tendon involvement (cylindrical configuration) can occasionally be noted in TAO and may be more frequently associated with primary gaze diplopia. Tendon involvement does not eliminate the diagnostic possibility of TAO.
Posted by afarahi at 06:29 PM
Persistent diplopia after retrobulbar anesthesia
JCRS,June,2004
Prism and alternate cover tests in the diagnostic positions of gaze and ductions/versions were performed in 28 patients with persistent diplopia 6 months after retrobulbar anesthesia. Fifty percent of the cases of diplopia were associated with either direct trauma or anesthetic myotoxicity to the extraocular muscles, in which overactions were more common than underactions. Thirty-two percent of the patients were presumed to have sensory strabismus, which suggested the importance of preoperative examination for strabismus as well as providing an explanation about the risk of postoperative diplopia before surgery.
Posted by afarahi at 06:21 PM
MMP inhibition prevents human lens epithelial cell migration and contraction of the lens capsule
British Journal of Ophthalmology July 2004;88:868-872
Purpose: The development of posterior capsule contraction following cataract surgery is caused by the activity of residual lens epithelial cells. Matrix metalloproteinases (MMPs) are a group of proteolytic enzymes, which are essential for cell migration and cell mediated contraction following wound healing. The authors investigated whether inhibiting MMP activity can reduce lens epithelial cell migration and as a result, lead to a reduction in cell mediated capsule contraction.
Methods: Human donor lens capsules were cultured and treated with a broad spectrum MMP inhibitor, Ilomastat (GM6001). MMP-2 and MMP-9 production were determined by ELISA. Cell migration onto the posterior capsule and capsule contraction were digitally measured.
Results: MMP inhibition significantly reduced lens epithelial cell migration onto the posterior capsule (p<0.05), and a reduction in capsule contraction was observed (p<0.05).
Conclusions: Ilomastat significantly reduced lens epithelial cell migration onto the posterior capsule surface and inhibited capsule contraction. MMP inhibition may have a role in the therapeutic treatment of posterior capsule opacification.
Posted by mmiraftab at 06:20 PM
June 12, 2004
Optimization of contact lens fitting in keratectasia patients after laser in situ keratomileusis
JCRS MAY 2004
Korea,Keratectasia was diagnosed based on abnormal topographic findings, progressive myopic changes, and uncorrected visual acuity with glasses. Conclusion:Proper contact lens fitting based on topographic data and slitlamp evaluation allowed good visual rehabilitation and comfortable extended daily wear in patients with keratectasia after LASIK.
Posted by alireza habibollahi at 10:45 PM
Scleral fixation of dislocated PC-IOL: Temporary haptic externalization through a clear corneal incision
JCRS MAY 2004
USA, by externalizing the haptics through a clear corneal incision in which a dislocated PC IOL was managed with pars plana vitrectomy. With this method, the dislocated PC IOL is retrieved and stabilized in the anterior chamber. The haptic is externalized through a clear corneal incision for suture knot placement and then reinserted. A scleral
Conclusions:
This technique allowed easier placement of the opposite haptic over residual capsule, if available. Stable fixation was achieved without dislocation or IOL-related complications recurring.
Posted by alireza habibollahi at 10:33 PM
Axial length and age at cataract surgery
JCRS MAY 2004
There was strong evidence of a weak association between a decrease in age at surgery with an increase in axial length (P<.001). The mean patient age at surgery was 74 years for eyes with an axial length less than 25.0 mm, 67 years for eyes with an axial length between 25.0 mm and 30.0 mm, and 61 years for eyes with axial length greater than 30.0 mm.Conclusion:An increase in the axial length of the eye was associated with a lower mean age at time of cataract surgery.
Posted by alireza habibollahi at 10:21 PM
June 08, 2004
Bullous keratopathy treated with honey
Acta Ophthalmologica Scandinavica Volume 82 Issue 3 Page 312 - June 2004
Honey was used by ancient Egyptians 5000 years ago to treat inflammations and burns of the cornea and conjunctiva (Nunn 1996). This practice continued through the Greco-Roman period and the Middle Ages, right up to the modern era (Nunn 1996). Honey is mentioned as a remedy in the Old Testament (I Samuel 14 : 27), the Talmud (Shabbath 77b78a) and the Koran (Nahl 96). It is described in the Talmud as having a propitious effect on the eyes: 'Honey enlightens the eyes of man' (Yoma 83b). This prompted a prospective study of topical honey as a hyperosmotic and healing agent in the medical therapy of bullous keratopathy.We carried out a prospective study of 24 consecutive patients with bullous keratopathy, who were not immediate surgical candidates and who attended a private clinic from January 2000 to September 2003. One drop of honey was applied to the cornea after informed consent had been obtained. Patients were instructed to use topical honey 3-4 times daily.All corneas had clearing of epithelial oedema with collapse of corneal bullae. Median Snellen best corrected visual acuity (VA) improved from finger counting at 50 cm to finger counting at 2 metres (p = 0.001) (Fig. 1). After topical application of honey, anterior segment details could be seen and fundus evaluation was possible in two cases. Patients experienced stinging but with repeated usage the discomfort became minimal. Visual acuity improvement and corneal clearing lasted for around 1 hour after topical honey.
Posted by mmiraftab at 07:26 PM
A spectrum of clinical manifestations of gelatinous drop-like corneal dystrophy
American Journal of Ophthalmology Volume 137, Issue 6 , June 2004, Pages 1081-1084
Typical manifestations of gelatinous drop-like corneal dystrophy (GDLD) have been documented in past studies. In practice, however, we see few typical cases and encounter many with atypical clinical manifestations. Moreover, there have been no detailed reports about the various clinical presentations. The purpose of this study is to describe a clinical subclassification for GDLD.A retrospective, observational case series study was conducted at a single institution, Osaka University Hospital. Examined were 18 eyes of ten patients with GDLD with no prior surgery. All were found to have M1S1 mutations. Using slit-lamp examinations we performed a phenotypic classification.
Results
We classified GDLD patients into four groups. They included band keratopathy type (seven eyes of four patients), stromal opacity type (five eyes of three patients), kumquat-like type (four eyes of two patients), and typical mulberry type (two eyes of two patients).
Conclusions
Gelatinous drop-like corneal dystrophy is thought to be the result of mutations in M1S1; however, it has various clinical manifestations. To our knowledge, this study is the first to report the range of clinical phenotypes of GDLD in a Japanese population. As most clinicians have no criteria for diagnosing GDLD, many cases are likely to be overlooked or be mistaken for other conditions. We believe that our present classification will be useful for the diagnosis of GDLD.
Posted by mmiraftab at 06:31 PM
Surface calcification of silicone plate intraocular lenses in patients with asteroid hyalosis
American Journal of Ophthalmology Volume 137, Issue 6 , June 2004, Pages 979-987
In the three instances, the deposits were observed at least 2 years after uneventful cataract surgery. All of the patients had unilateral mild asteroid hyalosis in the concerned eye. After explantation of the lenses, gross and light microscopic analyses were performed. The posterior optic surfaces of the lenses also underwent scanning electron microscopy coupled with energy dispersive x-ray spectroscopy for analysis of the elemental composition of the deposits.
Results
Gross and light microscopic analyses revealed well-demarcated areas of whitish deposits on the posterior optic surface of the lenses, as well as multiple pits caused by Neodymium:yttrium aluminum garnet laser treatments. The deposits formed an amorphous layer with a "crustlike" appearance, which was confirmed by scanning electron microscopy. X-ray spectroscopy analyses demonstrated the composition of the deposits to be similar to hydroxyapatite.
Conclusions
The material opacifying the lenses was probably derived from the asteroid bodies or from a similar process that results in this vitreous condition. We were unaware of this association between asteroid hyalosis and late postoperative dystrophic calcification of silicone lenses.0.bmp
Posted by mmiraftab at 06:12 PM
Diffuse lamellar keratitis and corneal edema associated with viral keratoconjunctivitis 2 years after laser in situ keratomileusis
Journal of Cataract & Refractive Surgery Volume 30, Issue 6 , June 2004, Pages 1366-1370
A 47-year-old woman with a history of laser in situ keratomileusis (LASIK) 2 years previously for myopia and astigmatism, presented with bilateral loss of vision due to diffuse lamellar keratitis (DLK) with corneal edema in the context of a pseudomembranous viral keratoconjunctivitis. After intense and early treatment with topical corticosteroids, the corneal edema and DLK resolved and corneal transparency was achieved with complete restoration of visual acuity. This case shows that DLK may occur associated with a viral pseudomembranous keratoconjunctivitis in patients who have had LASIK. Diffuse lamellar keratitis may present up to 2 years after lamellar surgery, which would indicate that the plane created by the microkeratome at the interface may remain unhealed for at least this period of time. Early diagnosis and treatment with topical corticosteroids can achieve complete resolution without visual loss.
Posted by mmiraftab at 06:08 PM
Retained IOL fragment and corneal decompensation after pseudophakic IOL exchange
Journal of Cataract & Refractive Surgery Volume 30, Issue 6 , June 2004, Pages 1362-1365 A 72-year-old man had exchange of a foldable silicone multifocal intraocular lens (IOL) by transection, removal, and monofocal IOL replacement. One month after the exchange, irreversible corneal edema developed and penetrating keratoplasty was performed. At the time of the corneal transplant, a small silicone fragment was discovered in and removed from the anterior chamber. Histologic evaluation of the patient's cornea demonstrated an absence of corneal endothelium, suggesting the fragment was the etiology of the corneal decompensation
Posted by mmiraftab at 06:03 PM
Subtle signs of zonular damage
Journal of Cataract & Refractive Surgery Volume 30, Issue 6 , June 2004, Pages 1295-1299
Methods: Three patients with a history of ocular trauma and 1 patient with Marfan's syndrome are described. During the preoperative examination, subtle signs of zonular damage were detected. As a result of the early recognition, critical modifications in cataract surgery technique and technology were made.
Results: The signs of zonular damage identified in the patients were visibility of the lens equator during eccentric gaze, decentered nucleus in primary position, iridolenticular gap, changes in the contour of the lens periphery, and focal iridodonesis.Conclusion: Identification of subtle but important signs of zonular damage will better prepare the surgeon for a challenging surgical procedure.
Posted by mmiraftab at 05:53 PM
June 07, 2004
OPHTEC FOLDABLE PHAKIC INTRAOCULAR LENS
From Erik Jan Worst, President of OPHTEC BV June 3, 2004
(GRONINGEN, NETHERLANDS)OPHTEC, a privately held medical
device manufacturer and Advanced Medical Optics, Inc. (AMO) [NYSE: AVO]
located in Santa Ana, California, a global leader in ophthalmic surgical
devices and eye care products, announced today that both companies will
begin joint development of a foldable phakic IOL. This new lens will be
manufactured by OPHTEC, but will be made of AMO's proprietary silicone
material. The lens model will be based on the current design of OPHTEC's
foldable phakic IOL, the ARTIFLEX?. This joint product will be distributed
worldwide exclusively by AMO and consist of a joint effort in materials and
technology between the two companies. "Once available, the product will
demonstrate the benefits of synergy that can be achieved as a result of
cooperation between two progressive companies", stated Erik Jan Worst,
OPHTEC's President and CEO.
The ARTIFLEX? Lens is the latest evolution of OPHTEC's original ARTISAN?
phakic lens (nonfoldable) and has been available in Europe for over 14
years. ARTIFLEX? Lenses are scheduled for release in Europe in mid 2005,
following the completion of clinical studies. The launch of AMO's new
product is expected to take place in the next 12 months. "Once available,
we expect the reception of the AMO lens to enjoy the same enthusiasm from
the market as we have received from the ARTIFLEX? Lens", said Erik Jan
Worst, " and the combination of both lenses to make a dramatic impact in
market share for this unique lens concept."
According to the latest published independent report, OPHTEC's original
ARTISAN? phakic IOL enjoys approximately 60% of the growing phakic lens
market. The introductions of the ARTIFLEX? lens and AMO lens are expected
to increase the phakic lens market share for the ARTISAN? concept as well
as develop an increased interest from potential LASIK patients seeking an
alternative method of refractive error correction.
Posted by mmiraftab at 04:18 PM
June 06, 2004
Capsular opacificatoin after IOL implantation of a new accommodating IOL in rabbit eyes
JCRS MAY 2004
USA.anterior capsule opacification (ACO), and posterior capsule opacification (PCO) were qualitatively assessed using slitlamp retroillumination photographs of the dilated eyes. The rate of ACO and PCO was significantly higher in the control group. Fibrosis and ACO were almost absent in the study group; the control group exhibited extensive capsulorhexis contraction, including capsulorhexis occlusion. Post-OP IOL dislocation into the anterior chamber and pupillary block syndrome were observed in some eyes in the study group.ConclusionsComplications in the study group were probably caused by the increased posterior vitreous pressure in rabbit eyes compared to human eyes and the relatively large size of the study IOL relative to the anterior segment of rabbit eyes
Posted by alireza habibollahi at 11:58 PM
Legacy AdvanTec and Sovereign WhiteStarA wound temperature study
JCRS MAY 2004
USA.PE using 20-gauge, 30-degree straight tips with the L-ADV and S-WS systems was performed in fresh cadaver eyes. Results:The mean temperature was significantly higher with L-ADV than with S-WS The highest temperature recorded was 57.5°C with the L-ADV and 38.6°C with the S-WS.Conclusions:There was less increase in wound temperature over time with the S-WS than with the L-ADV system in sleeved and unsleeved simulated surgery in human eye-bank eyes.
Posted by alireza habibollahi at 11:41 PM
Peripheral corneal relaxing incisions after excimer laser refractive surgery
(PCRIs) for correcting corneal astigmatism after excimer laser refractive surgery.
JCRS MAY 2004
USA,PCRIs were performed in patients that had residual astigmatism after PRK/LASIK according to a nomogram based on age and preoperative refractive astigmatism. The percentage of eyes with a UCVA of 20/20 or better increased significantly from 6% (2/33) preoperatively to 61% (20/33) postoperatively (P<.001). Refractive astigmatism was reduced significantly, and the effect was stable up to 1 year after PCRIs. Conclusion: PCRIs are an effective approach for correcting low amounts of corneal astigmatism in eyes that have had excimer laser refractive surgery.
Posted by alireza habibollahi at 11:28 PM
Reproducibility of LASIK flap thickness using the Hansatome microkeratome
JCRS MAY 2004
Using 2 Hansatome® microkeratomes 160/180 ?m.preoperative central pachymetry, and intraoperative stromal pachymetry.180 ?m(group 1), 160?m (Group 2). The difference between the actual and the expected flap thickness in each group was statistically significant (P<.001). There was no significant difference in the actual flap thickness between the 2 Hansatomes. The preoperative SE and central pachymetry were the only factors that influenced the actual flap thickness (P<.05); thin flaps were more common with increasing myopia and increasing corneal thickness. Conclusions:SE and pre-op pachy were the principal factors that influenced flap thickness. Preoperative keratometry values and patient age did not influence the actual flap thickness.
Posted by alireza habibollahi at 11:08 PM
Visual field changes after LASIK in myopic eyes
JCRS MAY 2004
Visual field performed twice before LASIK and 1 day and 24 months after LASIK. 76 points,6 degrees apart, in the central visual field (Central 30-2) were tested for threshold sensitivity (Humphrey). The mean visual field sensitivity at baseline and the 2 follow-up examinations was 25.97 dB, 25.70 dB, and 27.17 dB, There was no difference between preoperative and postoperative visual field clusters The MD of the visual fields was ?3.53 dB, ?3.61 dB, and ?2.61 dB at the preoperative and 2 postoperative examinations, respectively (P = .495). The mean CPSD of the visual fields was 1.76 dB, 1.42 dB, and 1.74 dB.Conclusion:LASIK did not cause visual field defects in mild to moderate myopic patients who had no risk factors that might render the optic nerve more vulnerable to damage.
Posted by alireza habibollahi at 10:50 PM
LASIK to correct residual myopia and astigmatism after penetrating keratoplasty .
JCRS MAY 2004
USA,26 eyes had LASIK at least 1 year after PKP.the mean SE was ?4.94 D the mean astigmatism was 2.71 mean postoperative UCVA was 20/30, the mean SE was ?0.35 D, and the mean residual astigmatism was 1.06 D. Eighty-six percent of patients had an SE within ±1.00 D of emmetropia and a UCVA of 20/40 or better. Significant complications such as wound dehiscence, epithelial ingrowth, and corneal decompensation did not occur. . Conclusion: Laser in situ keratomileusis appeared to be a reliable and safe procedure to correct residual myopia and astigmatism after PKP.
Posted by alireza habibollahi at 10:34 PM
June 04, 2004
Ablation Depth: LASIK vs. PRK
J Cataract Refract Surg 2004; 30:321-325
Using thickness measurements done with confocal microscopy, investigators at the Mayo Clinic demonstrated that the mean central ablation depth after LASIK is significantly greater than the predicted ablation depth. They showed that the difference between the measured and the predicted ablation depths increased as the ablation depth increased. In contrast, this study showed no significant difference between the measured and the predicted ablation depths after PRK performed with the same excimer in the same environment.In LASIK, the measured ablation depth (81 µm ±34) was 25 percent greater than the predicted ablation depth (65 µm ±13; P = .007). The difference between the measured and predicted depths was positively associated with the mean ablation depth (r = 0.81, P < .001).In PRK, there was no difference between the measured ablation depth (48 µm ±19) and the predicted ablation depth (47 µm ±18; P = .84).
Posted by mehdi khanlari at 11:23 PM
Restylane :A New Filler for Soft Tissue Augmentation
Review of Ophthalmology May 2004
Restylane (Q-med, Uppsala, Sweden) has recently been approved by the Food and Drug Administration in the United States for the treatment of facial rhytids. It has been recommended for use in the glabellar, nasolabial and periorbital regions, and lower facial areas. Restylane is a non-animal, bacterially derived, highly crossed-link stabilized glycosaminoglycan. It is a derivative of the naturally occurring polysaccharide components of hyaluronic acid, N-acetyl-glucosamine and D-glucuronic acid. It plays a role in lubrication, stabilization and hydration of dermal cells contained within the connective tissue.
Hyaluronic acid is a major constituent of the matrix surrounding collagen of the skin and is extremely hydrophilic. As the number of crossed-links increases so does the viscosity and molecular weight, resulting in a reduced absorption rate . Hyaluronic acids should be deposited in the middle dermis with a 27- or 30-ga. needle with its bevel up. Prior to injection topical anesthetic cream or nerve blocks may be performed, and this is recommended when treating the perioral and lip areas.Optimally, the needle should be at a 40 to 45 degree angle to the skin and injection should proceed directly along the rhytid to be treated. The needle should be completely inserted and, while withdrawing, the material should be deposited along the rhytid. Restylane offers the clinician yet another non-permanent, dermal filling alternative for facial rejuvenation.
Posted by mehdi khanlari at 11:08 PM
E-pill MedAlarm
Review of Ophthalmology May 2004
This is a mini-computer that can store up to 24 alarm times for taking various medications. It’s unique in that it may be the only dosage-alarm device that accommodates a holder for an eye-drop bottle. To use, the patient enters in start and end times, and the number of doses, and the MedAlarm spaces out the dose times
Posted by mehdi khanlari at 10:39 PM
Efficacy and safety of adjunctive mitomycin C during Ahmed Glaucoma Valve implantation
A prospective randomized clinical trial
Ophthalmology Volume 111, Issue 6 , June 2004, Pages 1071-1076
60 patients with refractory glaucoma were randomized to receive intraoperative MMC (0.5 mg/ml for 5 minutes) (n = 34) or balanced salt solution (n = 26) during Ahmed Glaucoma Valve implantation.
Main outcome measures
Surgical success was defined according to 2 different criteria: (1) postoperative intraocular pressure (IOP) between 6 and 21 mmHg, with or without antiglaucoma medications, and (2) IOP reduction of at least 30% relative to preoperative values. Eyes requiring additional glaucoma surgery, developing phthisis, or showing loss of light perception were classified as failures. Success rates in both groups were compared using Kaplan–Meier survival curves and the log rank test. Other outcome measures were mean IOP, number of glaucoma medications, and complications.
Results
After a mean follow-up of 12.3 months, Kaplan–Meier survival analysis showed a probability of success of 59% at 18 months for the MMC group and 61% for the control group when the first criterion for success was used (IOP between 6 and 21 mmHg). When an IOP reduction of at least 30% was used as the criterion to define success, the Kaplan–Meier survival analysis demonstrated a probability of success at 18 months of 62% for the MMC group and 67% for the control group. There were no significant differences in survival rates between the 2 groups with either criterion (P = 0.75 and P = 0.37, respectively). After 15 days postoperatively, the mean IOP did not significantly differ for both MMC and control eyes. Mean numbers of postoperative antiglaucoma medications were similar in MMC-treated eyes and controls. There was no significant difference between the incidences of postoperative complications in both groups.
Conclusion
Mitomycin C did not increase the short- or intermediate-term success rates of Ahmed Glaucoma Valve implantation.
Posted by mmiraftab at 04:36 PM
Transient Dysfunction of the Retinal Ganglion Cells after Laser In Situ Keratomileusis
J Jpn Ophthalmol Soc 107:355–362, 2003
Purpose To evaluate the influence of high intraocular pressure (IOP) on the retinal ganglion cell function induced by suction during laser in situ keratomileusis (LASIK) using Frequency Doubling Technology (FDT).
Methods Twenty-seven eyes of 15 patients were studied. Threshold values of 19 targeted areas, mean deviation (MD), and pattern standard deviation (PSD) were measured before LASIK, and 2 hours, 1 day, and 1 week after LASIK. These parameters obtained by N-30 program of FDT were compared between before and after LASIK.
Results Significant decrease of MD and threshold value in all areas was recognized at 2 hours, but MD and threshold value in 6 of the 19 areas showed significant increase at 24 hours. Significant increase of PSD value at 2 hours was recognized. After 7 days, there were no significant differences in any parameters between before and after LASIK.
Conclusions These results indicated that a transient dysfunction of the magnocellular pathway might be induced by high IOP during LASIK procedure.
Posted by mmiraftab at 04:31 PM
Strauss Marker (K3-8580)
Review of Ophtahlmology May 2004
Katena introduces the Strauss Marker (K3-8580) designed by Dr. Glenn Strauss of Tyler, Texas. The Strauss Marker imprints a symmetrical pattern of 24 dots or “pilot holes” on the cornea in preparation for performing a conductive keratoplasty procedure. Katena says the instrument is produced with a radius to conform to the curvature of the cornea and the 24 points are arranged in three rings of eight points each at the 6-, 7- and 8-mm optic zones. The instrument also features a 2.5-mm targeting ring for centering it over the cornea. Visit katena.com.
Posted by mehdi khanlari at 02:21 PM
June 03, 2004
Recent Applications
OSN May 2004
Alcon has filed New Drug Application with the Food and Drug Administration for a combination of Travatan (travaprost 0.004%) and timolol 0.5% in a once-daily medication for the treatment of glaucoma.Alcon officials announced that the company is initiating two new phase-3 clinical trials for Retaane (anecortave acetate), which has received a “fast track” FDA designation as a therapy for choroidal neovascularization.EyeKon’s Hydroflex II has received FDA approval to begin phase 1 clinical trials on this hydrophilic acrylic IOL in the United States.The FDA has cleared GMP Companies Inc. to initiate a phase-3 clinical trial of its Eyepass Glaucoma Implant. The trial is being conducted by GMP Vision Solutions Inc., a subsidiary of GMP.InSite Vision will begin a pivotal clinical trial of its broad-spectrum antibiotic ISV-401 in the 3rd quarter of this year. The drug is for the treatment of bacterial conjunctivitis.Ista Pharmaceuticals Inc. filed an NDA to begin phase 3 study of bromfenac, a topical, twice-daily, nonsteroidal anti-inflammatory solution, for the treatment of ocular inflammation following cataract surgery.Ista Pharmaceuticals Inc. has announced that the FDA plans to complete a review of Ista’s Vitrase for use as a spreading agent NDA by May 5, 2004, a 90-day extension of the original date.Rayner has entered clinical trials for its C-flex IOL, an injectable hydrophilic acrylic lens designed to help reduce posterior capsular opacification. The lens is packaged with a single-piece, single-use injector and a sterile protective eye shield.U.S. regulators have granted approval for initiation of a phase 2 trial of Refocus Group’s scleral implants and spacing procedure for the treatment of presbyopia.Sucampo Pharmaceuticals Inc. has initiated a multicenter, phase-2 safety and efficacy study for the treatment of dry eye syndrome, also known as keratoconjunctivitis sicca (KCS), with the agent FK-506, tacrolimus, a potent immunosuppressive agent.¤ ThromboGenics Ltd. has been granted orphan drug designation by the FDA for use of its compound microplasmin in pediatric eye surgery to treat retinal disorders that cause visual impairment and blindness in children.
Posted by mehdi khanlari at 07:21 AM
Awaiting Approval
OSN May 2004
The Artisan/Verisyse phakic IOL was recommended for approval, with conditions, by an advisory panel to the Food and Drug Administration, according to Ophtec and Advanced Medical Optics.Allergan Inc.’s Combigan, the combination brimonidine tartarate 0.2%-timolol maleate 0.5% ophthalmic solution, received an approvable letter from the FDA. The FDA response requires that an additional clinical trial on Combigan be conducted.Alcon Inc. and Landec Corp.’s Port Punctum Occluder has completed clinical trials, and 510(k) has been filed.Ista Pharmaceuticals Inc.’s Istalol, the once-a-day liquid formulation of timolol, has been developed for the treatment of glaucoma, and the company has received an FDA approvable letter.STAAR Surgical Co.’s Visian ICL has received a recommendation for approval with conditions from the Ophthalmic Devices Panel.
Posted by mehdi khanlari at 07:17 AM
AMO plans to buy Pfizer’s surgical ophthalmology business
OCULAR SURGERY NEWS 5/15/2004
Advanced Medical Optics Inc. will buy Pfizer Inc.’s surgical ophthalmology business for $450 million in cash, the two companies announced.Under the agreement, AMO will acquire the Healon (sodium hyaluronate) line of viscoelastic products, the CeeOn and Tecnis IOLs and the Baerveldt glaucoma shunt. According to Pfizer, these products generated sales of approximately $150 million in 2003.In addition to the product lines, AMO will acquire manufacturing and research and development facilities in Groningen, Netherlands; Uppsala, Sweden; and Bangalore, India.Mr. McKinnell was quoted in a press release in July 2003 saying, “Pfizer remains firmly committed to its ophthalmology medicines business,” which includes Xalatan (latanoprost) and Macugen (pegaptanib sodium), a drug it is co-developing with Eyetech Pharmaceuticals, as well as “a dedicated pharmaceutical ophthalmology research and development effort.”In an interview with Ocular Surgery News, Mr. Mazzo said the viscoelastic Healon fills a product gap for the company and represents the majority of the business purchased.He said the acquisition of the Tecnis IOL is also a strategic fit. It complements AMO’s existing line of IOLs and is the only IOL designed with a prolate anterior surface to provide improved contrast sensitivity and functional vision, he said.The acquisition of the Baerveldt glaucoma shunt will mark AMO’s entrance into the glaucoma device market
Posted by mehdi khanlari at 06:47 AM
Development of MS by numberof brain lesion
OSN Nov 2003
Posted by mehdi khanlari at 06:43 AM
COX-2 inhibitors associated with visual impairment
OSN May 2004
Use of a popular class of anti-inflammatory drugs can be associated with severe, although temporary, visual disturbances, usually within the first week of drug therapy initiation, according to a recent publication. Adverse reaction to the selective cyclo-oxygenase-2 inhibitors, or COX-2 inhibitors, may be under-reported and under-recognized, the authors of the report said.David Morris Coulter and colleagues in the Intensive Medicines Monitoring Programme in New Zealand reported two cases of acute severe temporary visual disturbances in patients taking the COX-2 inhibitors celecoxib and rofecoxib. Monitoring of those drugs began in New Zealand in December 2000.In one case, an 81-year-old man was prescribed 100 mg of celecoxib for analgesia. Three weeks after beginning the COX-2 inhibitor treatment, he reported central loss of vision. Once celecoxib was discontinued, the disturbance was rectified. Seven months after discontinuing treatment, vision loss had not recurred.In the second case, a 78-year-old man was treated for shoulder pain with rofecoxib. Over a 24-hour period, he took 100 mg of the drug and awoke with blurred vision. His visual acuity was rated “nil useful vision” in one eye and 6/18 in the other eye, according to his general practitioner. An ophthalmologist found he had minor cataract and retinal degeneration consistent with age; visual acuity was normal. Five months after discontinuing rofecoxib use, the patient had no recurrences of visual loss.“Inhibition of either COX-1 or COX-2 may alter the cyclo-oxygenase pathway and in turn alter regulation of retinal blood flow with potential changes in vision,”
Posted by mehdi khanlari at 06:33 AM
Keratoconus higher among Asians than white patients, study in Britain finds
OSN May 2004
Asians were significantly more likely than white patients to have keratoconus in a retrospective study at an English hospital.A total of 74 cases of keratoconus were diagnosed in this 6-year period. Of these patients, 29 (39%) were white and 45 (61%) were Asian. This factored to an incidence of keratoconus of 1 in 4,000 per year for Asians, compared with 1 in 30,000 per year for whites (P < .001), the researchers said. Asians presented with keratoconus significantly younger than white patients. The incidence of atopic disease was found to be significantly higher in whites compared to Asian keratoconic patients, according to the study.The researchers said that Asians, mostly of northern Pakistani origin, were significantly more likely to present with keratoconus than whites. The authors noted that this community has a tradition of interfamilial relationships, especially first-cousin marriages. The higher incidence in this population was highly suggestive of a genetic factor being significant in the etiology of keratoconus, the researchers said. Atopic disease was significantly less common in Asians than white people, supporting the theory of a different etiology in these patients, the authors said.
Posted by mehdi khanlari at 05:54 AM