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August 31, 2004

Cultured Human Corneal Endothelial Cell Transplantation with a Collagen Sheet in a Rabbit Model

Investigative Ophthalmology and Visual Science. 2004;45:2992-2997

PURPOSE. To evaluate the function of cultured human corneal endothelial cells (HCECs) in vivo and the feasibility of HCEC transplantation with a collagen sheet as the substitute carrier of HCECs.

METHODS. Adult human donor cornea derived from cultured HCECs was labeled with the fluorescent tracker DiI (1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate) and seeded on a collagen sheet. The pump function of the HCEC sheet was evaluated by measurement of the potential difference and short-circuit current. A 6-mm sclerocorneal incision and Descemetorhexis were performed on rabbit eyes. The HCECs on a collagen sheet was brought into the anterior chamber and fixed to the posterior stroma (HCEC group). Rabbit corneas with collagen sheet transplantation after Descemetorhexis (collagen group) and with only Descemetorhexis (no-transplantation group) were the control. Each group, observed for 28 days after surgery, underwent histologic and fluorescence microscopic examinations.

RESULTS. Pump function parameters of the HCEC sheets were 76% to 95% of those of human donor corneas. Mean corneal thickness in the HCEC group was significantly less than in the collagen and no-transplantation groups 1, 3, 7, 14, 21, and 28 days (P < 0.05) after surgery. DiI-labeled cells were spread over the rear corneal surface in the HCEC group. Marked stromal edema was present in the collagen and no-transplantation groups with hematoxylin-eosin staining, but none in the HCEC group with collagen sheets bearing monolayer cells.

CONCLUSIONS. The findings indicate that cultured HCECs transplanted from adult human donor cornea by means of a collagen sheet can retain their function of corneal dehydration in a rabbit model and suggest the feasibility of transplantation for CEC dysfunction using cultured HCECs with a collagen sheet.

Posted by mmiraftab at 11:21 PM

Mitomycin C-Induced Reduction of Keratocytes and Fibroblasts after Photorefractive Keratectomy

Investigative Ophthalmology and Visual Science. 2004;45:2978-2984

PURPOSE. To investigate the effects of mitomycin C (MMC) on the number of keratocytes and the proliferation of fibroblasts after photorefractive keratectomy (PRK) and exposure to ultraviolet B (UV-B) irradiation.

METHODS. The right eyes of New Zealand White rabbits in Groups 1, 2, and 3 (n = 18 each) underwent PRK to correct –10 diopters with 5 mm optical zone. Sponges soaked with 0.02% MMC were applied to the right eyes of Group 1 rabbits for 2 minutes. Antibiotic ointment was applied daily to all rabbits until the epithelium healed completely, after which 0.02% MMC eye drops were applied twice daily to the right eyes in Group 2 until 4 weeks after PRK. Three weeks after PRK, the right eyes of all the remaining rabbits were exposed to 100 mJ/cm2 C UV-B radiation. Corneal haziness was assessed biomicroscopically using the Fantes scale every 3 weeks. Six eyes of each group were each enucleated 3, 6, and 12 weeks after PRK, and tissue specimens were stained with hematoxylin and eosin and with TUNEL stain. The tissues were evaluated immunohistochemically with antibody to -smooth muscle actin (SMA). Cellular changes in the anterior stroma and epithelial basement membrane were evaluated by electron microscopy.

RESULTS. Corneal haze was observed after PRK and was aggravated by UV-B irradiation. A single intraoperative application of MMC immediately after PRK induced opacity and apoptosis of keratocytes. Twelve weeks after PRK, MMC significantly reduced corneal haze, the number of keratocytes, apoptotic cells, and fibroblasts, even after UV-B irradiation. Relatively large numbers of apoptotic and SMA-positive cells were found only in PRK-treated, non-MMC treated rabbits (Group 3), even after 12 weeks. Three weeks after PRK, dying stromal cells showed cell shrinkage, and chromatin condensation was observed in all treated groups by electron microscopy. Twelve weeks after PRK, fewer keratocytes and inflammatory cells were observed just beneath the epithelial layer in Group 1 than in any of the other groups.

CONCLUSIONS. MMC is a potent inhibitor of corneal haze induced by PRK. MMC reduced the number of keratocytes and fibroblasts after PRK and UV-B irradiation. Although MMC would improve the clinical results of PRK, it has significant toxicity on corneal keratocytes, which did not disappear until 3 months after PRK.

Posted by mmiraftab at 11:18 PM

IQ and the Association with Myopia in Children

Investigative Ophthalmology and Visual Science. 2004;45:2943-2948

METHODS. Cycloplegic refraction and ocular biometry parameters, including axial length, vitreous chamber depth, lens thickness, anterior chamber depth, and corneal curvature were obtained in 1204 Chinese school children aged 10 to 12 years from three schools who were participants in the Singapore Cohort Study Of the Risk Factors for Myopia (SCORM). Intelligence quotient (IQ) was assessed using the nonverbal Raven Standard Progressive Matrix test.

RESULTS. After controlling for age, gender, school, parental myopia, father’s education, and books read per week, myopia (spherical equivalent [SE]) of at least –0.5 D was associated with high nonverbal IQ (highest quartile) versus low IQ (lowest quartile) (odds ratio = 2.4; 95% confidence interval, 1.7–3.4). Controlling for the same factors, children with higher nonverbal IQ scores had significantly more myopic refractions (–1.86 D for children with nonverbal IQ in the highest quartile compared with –1.24 D for children with nonverbal IQ in the lowest quartile; P = 0.002) and longer axial lengths (24.06 mm versus 23.80 mm; P = 0.022). Nonverbal IQ accounted for a greater proportion of the variance in refraction compared with books read per week.

CONCLUSIONS. Nonverbal IQ may be an independent risk factor of myopia, and this relationship may not be explained merely by increased reading (books per week) among myopes. An interesting observation is that nonverbal IQ may be a stronger risk factor for myopia compared with books read per week. The complexity of the relationships between nonverbal IQ, reading, and myopia warrant additional studies to clarify any cause–effect relationship.

Posted by mmiraftab at 11:13 PM

August 30, 2004

Hyaluronidase allergy after peribulbar anesthesia with orbital inflammation

JCRS APRIL 2004



A 70-year-old woman previously exposed to hyaluronidase during ophthalmic surgery had excision of hypertrophic bulbar conjunctival tissue in the right eye. Hyaluronidase was added to the peribulbar anesthetic agent. Five days postoperatively, the patient presented with proptosis in the right eye, extraocular muscle restriction, and decreased visual acuity. She was apyrexial with a normalwhite cell count; computed tomography of the orbits showed a diffuse increase in soft tissue density. Clinical features were unchanged after 24 hours of intravenous antibiotics, but subsequent administration of high-dose oral steroids led to clinical improvement. MKH

Posted by alireza habibollahi at 07:44 PM

Central retinal artery occlusion after peribulbar

JCRS APRIL 2004



We describe the development of central retinal artery occlusion (CRAO) in 2 patients after peribulbar (periconal) anesthesia during uneventful phacoemulsification. Although peribulbar anesthesia avoids direct optic-nerve injury, indirect injury presenting as CRAO may occur from vasospasm in response to the injection. MKH

Posted by alireza habibollahi at 07:39 PM

Capsular peeling in anterior capsule contraction syndrome: Surgical approach and histopathological aspects

JCRS APRIL 2004



We present 4 cases of anterior capsule contraction syndrome in which progressive shrinkage of the anterior capsulorhexis developed after uneventful phacoemulsification. Three eyes were pseudophakic, and 1 eye remained aphakic. The newly formed membrane was surgically peeled from the anterior capsule, restoring the capsular bag.MKH

Posted by alireza habibollahi at 07:36 PM

Pupillary block glaucoma secondary to posterior chamber phakic intraocular lens implantation for high myopia

http://www.ascrs.org/publications/jcrs/caseapr04.html

JCRS APRIL 2004

We describe a complication of posterior chamber phakic intraocular lens (PCP IOL) implantation for high myopia. Both eyes of a 44-year-old patient were treated prophylactically with a neodymium:YAG laser iridotomy before PCP IOL implantation. Bilateral PCP IOL implantation was performed uneventfully, although a peripheral iridotomy was required immediately after implantation in the right eye because of early pupillary block glaucoma. Two months later, the left eye developed pupillary block glaucoma despite apparently patent iridotomies. The PCP IOLs were subsequently removed.

Posted by alireza habibollahi at 07:32 PM

Family Aggregation of High Myopia: Estimation of the Sibling Recurrence Risk Ratio

Investigative Ophthalmology and Visual Science. 2004;45:2873-2878

METHOD. The recurrence risks for myopia and high myopia were estimated in the siblings of 296 randomly selected high myopes ascertained from an optometric practice population. A model using an age of onset of spectacle wear for myopia of 9.1 ± 0.7 years or younger was developed as a surrogate for high myopia. The influence of parental myopia on the sibling recurrence risk for high myopia was also evaluated.

RESULTS. KS was estimated (95% confidence limits) to be 10.0% (5.9, 14.8) and S to be 4.9 (2.8, 7.6). High myopes without myopic parents were surprisingly common (40%) and were less likely to have highly myopic siblings (KS 6%) than those with at least one myopic parent (KS 14%).

CONCLUSIONS. The sibling recurrence risk ratio reported herein (S 4.9) implies that the high penetrance autosomal dominant loci for high myopia identified to date account for only a minority of cases of high myopia in the United Kingdom. Furthermore, high-penetrance autosomal dominant inheritance or even high-penetrance recessive inheritance, per se, cannot account for most cases of high myopia. Instead, it may be necessary to consider high myopia as a "complex disease" resulting from the influence of either alleles of reduced penetrance ("susceptibility genes"), environmental factors, or both.

Posted by mmiraftab at 12:33 PM

August 28, 2004

New risk factors may contribute to night vision complaints

Eyeworld Aug 2004



Night vision complaints, marked by glare, halos, and other vexing aberrations are an ongoing concern in treating many prospective LASIK patients.The retrospective study included 795 myopic patients that underwent bilateral LASIK in 1999 with the Nidek EC-5000 slit-scanning excimer laser (Nidek, Gamagori, Japan) and the Moria LSK One microkeratome (Moria, Antony, France).At the 12-month mark, results showed that those with initial myopia of more than 5 D had a 2.8 times increase in night vision complaints; for those with an optical zone of less than 6 mm, there was a 2.5 times increase; and for those with a post-operative spherical equivalent (SE) outside of 0.5 D of emmetropia, there was a 2.9 times increase.However, pupil size was not found to be predictive.“I think that ophthalmologists have to be aware not to hide behind the small pupil and tell the patient that if ‘your pupil is less than six and the optical zone is bigger, then you won’t have any glare and halos,’” Dr. Pop said. Study results indicated that the most important factor in night vision complaints is pre-operative refraction.Age is another important factor in predicting night vision complaints. The study indicated that the optical zone is also key. “If you treat a patient with a 5-mm optical zone, whatever refraction he has, he’ll have more chances of having halos and glare then if you treat with a 6-mm or 6.5-mm optical zone,” Dr. Pop said. but“Dr. Pop’s results are most likely due to the specific laser and the algorithms he used in the study that produced a very large treatment zone with a sophisticated blend zone,” Dr. Klyce said. “Certainly some of the lasers in use will not be able to create such a good optical result and the pupil diameter in those cases will certainly remain an important consideration.”



Posted by mehdi khanlari at 11:59 PM

Prepare for IOP rise in OAG patients after phacoemulsification

Eyerworld Aug 2004



For three days after cataract surgery, patients with open-angle glaucoma experienced a rise in intraocular pressure on average, compared to a decrease in IOP on day one post-operatively in a non-OAG control group, a new study has found In fact, a substantial increase in IOP (exceeding 30 mm Hg) occurred in four of 32 OAG eyes (12.5%) on the first post-op day, said Hitoshi Yasutani, Although the short-term IOP was greater for the OAG group than the control group, the increased IOP did not worsen final visual acuity, Dr. Yasutani said.But because significant increases in IOP occur within one day of surgery for OAG phacoemulsification patients, it may be wise to measure IOP a few hours post-operatively, he said.

Posted by mehdi khanlari at 11:48 PM

Novel surgical techniques emerge for treatment of glaucoma

Eyeworld Aug 2004

Despite the rapid development of new drugs to lower intraocular pressure (IOP) in the past 10 years, many patients with glaucoma still require incisional surgery to control the disease.

George Baerveldt described the technique and initial outcomes using a device called the

Posted by mehdi khanlari at 11:36 PM

Endothelial cell loss minimal with Verisyse IOL, study suggests

Eyeworld Aug 2004



Three-year clinical data from the Verisyse phakic IOL (Ophtec USA, Boca Raton, Fla..) has found endothelial cell loss quickly stabilizes post-operatively and is minimal thereafter.

Verisyse’s interim endothelial cell counts, performed three times at each patient visit, found the mean ECC was 2,663 at baseline, 2,632 at six months, 2,596 at one year, 2,575 at two years, and 2,562 at three years. Dr. Hardten pointed out that the endothelial cell count drop, by 101, is only about 3%, and well within the standard deviation of plus or minus 5%.. “It shows you that it’s probably not significantly different from just normal physiologic loss of endothelial cells, which is about 1% per year anyway.”





Posted by mehdi khanlari at 11:05 PM

Radiologists may be at increased cataract risk

Eurotimes Aug 2004



INTERVENTIONAL radiologists appear to have an increased risk of developing cataracts because of on-the-job radiation exposure, warned researchers at the annual meeting of the Society for Interventional Radiology. The cataracts interventional radiologists are at risk for differ markedly from agedrelated cataracts and can be identified by their location, reported Ziv Haskal MD, Professor of radiology and surgery at Columbia University, NewYork."The characteristic changes and injury that we get is a posterior subcapsular cataract (PSC)," he said.Age-related cataracts occur between the nucleus and the capsule instead of in the posterior aspect of the lens.



Posted by mehdi khanlari at 10:26 AM

Eye jewelry debuts in Europe

Eyeworld ug 2004





A sparkle in the eye has taken on a whole new meaning since eye jewelry emerged in Europe last fall.JewelEye implants, tiny platinum designs implanted within the conjunctiva, are available in a variety of shapes, including hearts, half moons, dollar or euro signs, or custom designs.JewelEye implant six months after implantation.The fashion trend was conceived at The Netherlands Institute for Innovative Ocular Surgery in Rotterdam. Patents are pending for the extraocular device, produced by Hippocratech, Rotterdam.

Posted by mehdi khanlari at 10:18 AM

August 27, 2004

How oxygen can improve vision

Eyeworld Aug 2004



Increased oxygen supply can reverse vision losses from diabetic macular edema, according to a pilot study by scientists at Johns Hopkins University, Baltimore, and the National Eye Institute, Bethesda, Md.Researchers found reduced fluid buildup and swelling in the macula and, in some cases, improved visual acuity. Despite an average of 2.7 treatments per eye, all eyes except one had persistent edema.Patients were given four liters per minute of oxygen through small nasal tubes; instructed to use the oxygen continuously every day for three months; and allowed to remove the tube only when showering. Researchers provided a stationary oxygen concentrator for home use and portable oxygen tanks for outside use.After three months, excess thickness of the macula was reduced by an average of 43% in all nine eyes. Excess thickness of the fovea, responsible for the sharpest vision, was reduced by 42%, and macular volume dropped by 54%. Additionally, three eyes improved in visual acuity, with the ability to see two lines higher on a standard eye chart.Once oxygen therapy was discontinued, vision slowly worsened in some eyes. In four eyes in which retinal thickness returned to the normal range while on oxygen, the improvement continued even after oxygen was stopped. Since the patients all had previous laser therapy, it is possible that the reduced thickening of the macula achieved by oxygen allowed the laser to exercise a stabilizing effect, said the researchers.Supplemental oxygen reduces production of VEGF and similar proteins, which in turn reduces the amount of leaking in retinal vessels and lessens the severity of macular edema.

Posted by mehdi khanlari at 05:54 PM

New ocular syndrome surfaces with IntraLase

Eyeworld Aug 2004



A new ocular syndrome has caused chatter among femtosecond laser users because of an unusual trademark: 20/20 patients with extreme light sensitivity after LASIK.

Facts about TLS• After a procedure with the IntraLase,

This article primarily uses the name TLS for clarity, except in quotations where an alternative name was spoken.Using hourly steroids for a week, the patient got better and the phenomenon never recurred, Dr. Binder said.According to the abstract, the track “acts as a conduit that allows inflammatory cytokines produced by the healing interface and sidewall to gain access to the perilimbal sclera and iris base. These inflammatory cytokines create a scleritis and associated inflammation of the iris base with resulting photophobia.”“ But like the other physicians interviewed, Dr. Woodhams said the syndrome is not dangerous and foresaw no long-term complications resulting from it.A chart review of all the patients by Dr. Stonecipher with TLS revealed an average onset of the photosensitivity at 65 days and an average resolution by 133 days. There was no predilection to eye color or sex. As well, degree of refractive error (myopia, hyperopia, or astigmatism) or pre-operative scotopic and photopic pupil size showed no appreciable trends.

TLS does not respond to nonsteroidal anti-inflammatory drugs, cycloplegics, or pupil constriction, Dr. Stonecipher said. Rather, it primarily responds to a combination of topical steroids and Restasis (Allergan, Irvine, Calif.), he said.“I will usually place the patients on a combination of Pred Forte 1% (Allergan) four to six times a day and Restasis two to four times a day, depending on the severity of the photosensitivity,” he said. “I will discontinue the Pred Forte at one to two weeks and continue the Restasis until resolution.”



Posted by mehdi khanlari at 05:54 PM

August 26, 2004

Smokers have unique dry eye conditions, study finds

Eyeworld Aug 2004



Refractive surgery patients that smoke may have more severe dry eye symptoms and should be evaluated beforehand for lipid-deficient dry eye, according to investigators that conducted a study on smokers and dry eye conditions.The study involved 66 patients that were smokers. Each patient was placed in one of three groups: Those that smoked less than one pack a day; those that smoked one pack a day; and those that smoked more than one pack a day.Schirmer values were determined and the ocular surface sensation was evaluated with the Cochet-Bonnet esthesiometer. The ocular surface also was assessed with fluorescein staining, tear break-up time, and impression cytology. Findings were compared with values for 10 age- and sex-matched controls.There were no significant differences in Schirmer values and impression cytology results between groups of smokers.Although Schirmer values and tear breakup times usually are low in typical dry eye patients, Schirmer values were normal and the break-up time was very low in smokers, Dr. Dursun said. Because the Schirmer values indicated that the aqueous layer was normal and impression cytologic studies showed that the mucin layer was normal, the researchers theorized that the lipid layer was the problem.Using kinetic images obtained by the DR-1 lipid layer interferometry, researchers found that people that started smoking recently or were exposed to smoke passively began to have problems with the spread of the lipid layer.Treating dry eye patients

Posted by mehdi khanlari at 04:35 PM

August 24, 2004

Influence of donor storage time on corneal allograft survival

Ophthalmology, Aug 2004



Purpose: To investigate the influence of graft storage time on corneal allograft survival in high-risk and low-risk patients.

Results

High-risk corneal allograft recipients had a significantly prolonged allograft survival when the tissue was stored for 7 days or greater, compared with recipients receiving fresh tissues. Patients at low risk of corneal allograft rejection also showed a tendency for prolonged survival, although not statistically significant (P = 0.06).

Conclusions Storage of corneal tissue may reduce the frequency of allograft rejection, especially in high-risk patients.

Posted by pakravanmd at 08:48 PM

Identifying early glaucoma with optical coherence tomography.

Am J Ophthalmol. 2004 Feb

Nouri-Mahdavi K, Hoffman D, Tannenbaum DP, Law SK, Caprioli J.



PURPOSE: To evaluate performance of optical coherence tomography (OCT) for detection of early glaucoma. METHODS: Study Population: One eye from 50 normals, 42 glaucoma suspects, and 59 early glaucoma. Outcome Measures: Average nerve fiber layer thickness (NFLT) and NFLT in each of four quadrants and 12 clock-hour sectors. RESULTS: Average NFLT was 128.4 +/- 15.4, 102.0 +/- 25.4, and 86.5 +/- 31.5 microm in normal, GS, and EGVF eyes, respectively. Normal eyes were different from both glaucoma groups (P <.001); NFLT in the superior quadrant and at the 11 o'clock position had the highest area under the receiver operating characteristic curve (.840 and.933) in the GS and EGVF groups (P =.03). The sensitivity of the OCT for detection of glaucoma was 71% and 85% for the GS and EGVF groups with specificity fixed at 90%. CONCLUSION: 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 pakravanmd at 08:17 PM

August 17, 2004

Retinal venous pulsation in glaucoma and glaucoma suspects

Ophthalmology, Aug 2004



Purpose: To determine whether changes in central retinal vein pulsation characteristics occur in glaucoma, and how these are related to indices of glaucoma severity. Results: Significantly fewer (chi-square, 27.7; P<0.001)>Conclusions: Spontaneous venous pulsation is less common in glaucoma. The ODF required to induce venous pulsation is increased in glaucoma, and this ODF is greater in those with more severe field loss.

Posted by pakravanmd at 09:37 PM

Exfoliation syndrome angle characteristics: a lack of correlation with amount of disc damage

British Journal of Ophthalmology 2004;88:1002-1003



ABSTRACT: The exact pathogenesis of glaucoma in exfoliation syndrome is unclear. There has been some suggestion that narrow angles are more common in exfoliation syndrome and that this may be a component in the disease. The degree of pigmentation has also been shown to influence the intraocular pressure. Methods: 78 patients with exfoliation syndrome were examined, and underwent gonioscopy and dilated funduscopy.

Results: Anterior chamber angle, level of iris insertion, degree of pigmentation and the presence or absence of a Sampaolesi line were not correlated with the degree of disc damage.

Conclusions: There was no apparent association between angle characteristics and the severity of glaucoma in patients with exfoliation syndrome.

Posted by pakravanmd at 08:06 PM

August 16, 2004

Early corneal edema following topical application of mitomycin-C

Journal of Cataract & Refractive Surgery Volume 30, Issue 8 , August 2004, Pages 1742-1750

Methods: Mechanical epithelium debridement of the central 10.0 mm of the cornea was performed in 63 pigmented rabbits. One group of corneas (MMC1, N = 42) was soaked with MMC 0.01% solution for 2 minutes; the second group (MMC2, N = 42) was soaked with MMC 0.02% solution for 2 minutes. Control corneas (n = 42) were soaked with balanced salt solution for 2 minutes. Changes in the central corneal thickness, clarity, epithelial defect size, endothelial cell density, and endothelial apoptosis in the 3 groups were examined on days 0, 1, 2, 3, 5, 7, and 14.

Results: There was a dose-dependent increase in corneal thickness, decrease in corneal clarity, and increase in endothelial apoptosis after a single intraoperative application of MMC. The endothelium was significantly swollen and became pleomorphic and polymegethic with a concomitant decrease in endothelial cell density, also in a dose-dependent manner.

Conclusions: A single application of MMC on the corneal surface caused dose-dependent corneal edema and endothelial apoptosis in the rabbit model. Further clinical study of human eyes is warranted.

Posted by mmiraftab at 06:31 PM

New formula for calculating intraocular lens power after laser in situ keratomileusis

Journal of Cataract & Refractive Surgery Volume 30, Issue 8 , August 2004, Pages 1711-1715

Method: This studied comprised 34 eyes that had LASIK surgery. Refraction and an automated K-reading (auto-K) were performed preoperatively. Refraction, auto-K, and K-reading assessment by the clinical history method and the proposed formula were performed 4 to 12 weeks postoperatively. The proposed formula is Kpostop = Kpreop – [(Nc – 1) × (Ra-postop – Ra-preop)/(Ra-postop × Ra-preop)], where Kpostop is the K-reading after LASIK, Kpreop is the K-reading before LASIK, Nc is the index of refraction of the cornea (1.376), Ra-postop is the radius of curvature of the anterior corneal surface after LASIK, and Ra-preop is the radius of curvature of the anterior corneal surface before LASIK.

Results: Twenty patients (10 men, 10 women) were included in the study. The mean age of the patients was 30.58 years ± 17.68 (SD) (range 18 to 44 years). Preoperatively, the mean spherical equivalent (SE) was –4.99 ± 2.82 diopters (D) (range –1.12 to –15.00 D), the mean Ra was 7.76 ± 0.32 mm (range 7.33 to 8.50 mm), and the mean auto-K reading was 43.45 ± 1.73 D (range 39.62 to 46.00 D). Postoperatively, the mean SE was +0.02 ± 0.63 D (range –2.75 to +1.00 D), the mean Ra was 8.63 ± 0.53 mm (range 7.80 to 9.92 mm), and the mean K-reading assessed by auto-K, clinical history method, and the proposed formula was 39.17 ± 2.35 D (range 34.00 to 43.25 D), 38.79 ± 2.52 D (range 33.1 to 42.78 D), and 38.69 ± 2.51 D (range 33.1 to 43.0 D), respectively. The results obtained by the proposed formula were similar to those obtained by the clinical history method (P = .098). Auto-K readings significantly overestimated the K-values (P<.0001) when compared to the proposed formula and clinical history method.

Conclusion: The proposed formula was simple, objective, not dependent on refraction, and as accurate as the clinical history method in determining K-readings after LASIK.

Posted by mmiraftab at 06:24 PM

Single Intacs segment for post-laser in situ keratomileusis keratectasia

Journal of Cataract & Refractive Surgery Volume 30, Issue 8, August 2004, Pages 1685-1695

Methods: This retrospective, noncomparative, interventional, consecutive, small case series studied 5 eyes of 5 patients with post-LASIK keratectasia.

Results: Intacs implantation was performed 17 to 32 months post LASIK with no intraoperative complications and no loss of visual acuity. After implantation, the UCVA improved 8, 4, 3, 0.5, and 5 lines and the BSCVA, 2, 2.5, 1, 0.5, and 2 lines. The mean manifest refraction spherical equivalent improved from ?1.60 diopters (D) ± 1.67 (SD) to ?0.80 ± 1.05 D. The mean manifest astigmatic correction decreased from ?3.9 ± 2.96 to ?2.46 ± 2.77 D. Corneal topography showed improved inferior steepening and less irregular astigmatism. The mean inferior?superior asymmetry improved from 7.88 ± 4.59 to 2.46 ± 2.77 D. Selfreported visual symptoms improved significantly in Cases 1, 2, and 5 and slightly in Cases 3 and 4.

Conclusions: Implantation of a single Intacs segment inferiorly appeared to improve progressive myopia and regular and irregular astigmatism in eyes with corneal ectasia after LASIK. With further study, this technique may prove to be an effective, relatively noninvasive approach.

Posted by mmiraftab at 06:18 PM

Effect of a modified optic edge design on visual function :Textured-edge versus round-anterior, slope-side edge

Journal of Cataract & Refractive Surgery Volume 30, Issue 8 , August 2004, Pages 1668-1674

Methods: Fifty-four patients had implantation of an IOL with a textured edge (Alcon MA60AC) in 1 eye and an IOL with a round-anterior, sloped-sided edge (AMO AR40e) in the opposite eye. Visual acuity was measured at 5 contrast visual targets (100%, 25%, 10%, 5%, and 2.5%) (contrast visual acuity) under photopic and mesopic conditions with and without a glare source approximately 1 month after surgery using the Contrast Sensitivity Accurate Tester (Menicon CAT-2000).

Results: The mean mesopic contrast visual acuity at moderate- to low-contrast visual targets was significantly worse in the presence of a glare source in both groups, whereas photopic contrast visual acuity did not change significantly. There were no significant differences between the 2 groups in the mean visual acuity or in photopic or mesopic lighting contrast visual acuity with and without a glare source. Furthermore, there was no significant difference in loss of contrast visual acuity in the presence of glare.

Conclusion: Mesopic contrast sensitivity with both acrylic IOLs was impaired significantly in the presence of glare, but the impairment of contrast sensitivity from glare was approximately the same between eyes with a textured-edge IOL and eyes with a round-anterior, sloped-sided edge IOL.

Posted by mmiraftab at 06:11 PM

Effect of a silicone intraocular lens with a sharp posterior optic edge on posterior capsule opacification

Journal of Cataract & Refractive Surgery Volume 30, Issue 8 , August 2004, Pages 1661-1667

Methods: This prospective randomized patient- and examiner-masked study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients had cataract surgery in both eyes and received a sharp-edged IOL in 1 eye and a round-edged IOL in the other eye. Postoperative examinations were at 1 week, 1 and 6 months, and 1 year. Digital slitlamp and retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using Automated Quantification of After-Cataract (AQUA) automated-image analysis software.

Results: The sharp-edged IOL group had significantly less regeneratory and fibrotic PCO 1 month, 6 months, and 1 year after surgery. The mean AQUA PCO score (scale 0 to 10) was 0.71 in the sharp-edged IOL group and 1.40 in the round-edged IOL group (P<.001). The sharp-edged IOL group had less peripheral fibrotic PCO. There was no significant difference between the 2 IOL groups in patient reports of edge glare.

Conclusion: The sharp-edged design of the ClariFlex OptiEdge silicone IOL led to significantly less PCO than the round-edged PhacoFlex SI-40 IOL 1 year postoperatively.

Posted by mmiraftab at 06:06 PM

August 13, 2004

Histology and immunohistochemistry of fibrous PCO in an infant.

JCRS FEB 2004



We report the histological findings in PCO in 2 eyes of a 10-month-old infant 8 months after cataract/IOL. The PCO in the right eye had a regenerated lenticular structure; in the left eye, it was fibrotic. The PCO in the right eye was soft and aspirated with Simcoe's irrigation/aspiration cannula; in the left eye, it was excised surgically. Paraffin sections of the fibrous PCO tissue from the left eye were examined histologically. Hematoxylin-eosin staining showed extracellular matrix (ECM) accumulation and the presence of elongated fibroblastic cells, presumed to be lens epithelial cells (LECs). Immunohistochemistry revealed the presence of fibrous collagen types and cellular fibronectin. The presumed LECs amid the ECM were positive for vimentin and ?-smooth muscle actin. Histology of the fibrous PCO tissue from this infant was similar to that in adult patients.

Posted by alireza habibollahi at 09:47 PM

Retained anterior chamber cilium causing endophthalmitis after phacoemulsification .

JCRS FEB 2004



An 81-year-old white man had uneventful cataract surgery by an experienced surgeon. Three days postoperatively, he presented with endophthalmitis and was treated in accordance with the standard departmental protocol. During the recovery, a curvilinear foreign body was identified and subsequently removed from the interior anterior chamber. Histological examination confirmed the foreign body as an eyelash. The patient improved to a final corrected visual acuity of 6/9. The relevant literature is reviewed, and ways to prevent this potentially blinding but avoidable complication of intraocular surgery are presented.

Posted by alireza habibollahi at 09:42 PM

Opacification of a silicone IOL caused by calcium deposits on the optic.

JCRS FEB 2004



We describe opacification of a plate-haptic silicone IOL by calcification in a diabetic patient with asteroid hyalosis. The IOL was explanted 48 months after uneventful phacoemulsification because opacification of the posterior surface was causing significant visual disturbance. Light and scanning electron microscopy and x-ray spectrometry of the explanted IOL showed the opacification consisted mainly of calcium and phosphate, presumably hydroxyapatite, in the form of precipitations on the posterior surface of the optic.

Posted by alireza habibollahi at 09:37 PM

Goniosynechialysis,lens aspiration and PC-IOL implantation for glaucoma in spherophakia

JCRS FEB 2004



A 17-year-old girl presented with bilateral angle-closure glaucoma associated with spherophakia. A previous YAG PI failed to control IOP. Goniosynechialysis with lens aspiration and PC-IOL in both eyes. Peripheral iridoplasty was performed 3 days later. The postoperative IOP was controlled without medication for 12 months in the right eye and 24 months in the left eye. By restructuring the physiologic aqueous outflow route, goniosynechialysis safely and effectively treated secondary glaucoma from spherophakia .

Posted by alireza habibollahi at 09:26 PM

Ulcerative keratitis caused by Serratia marcescens after LASIK .

JCRS FEB 2004



We report 3 cases of severe corneal infections caused by Serratia marcescens after LASIK . Twenty-four hours after LASIK, corneal flap was edematous, ulcerated, and detached from the stromal bed. Treatment included removal of the necrotic flap and aggressive antibiotic therapy. Cultures from corneal exudates were positive for S marcescens. After 1 year, both patients had a loss of BCVA ranging from 20/40 to 20/22 because of irregular astigmatism. Overrefraction with a hard contact lens resulted in a BCVA of 20/20 in the 3 affected eyes. Slitlamp examination showed trace subepithelial haze without severe corneal scarring. Videokeratography disclosed areas of paracentral inferior steepening resembling keratoconus. Refraction and videokeratography remained stable after 6 months of follow-up. Ulcerative keratitis caused by S marcescens is a potential complication of LASIK. Bilateral involvement may occur if bilateral simultaneous surgery is performed.

Posted by alireza habibollahi at 09:17 PM

Capsular tension ring use in a patient with congenital coloboma of the lens

JCRS FEB 2004



Cataract surgery was performed in a 63-year-old man with bilateral coloboma of the lens. There was no traumatic history, but the patient had lower zonule deficiency and zonular weakness in both eyes, leading us to suspect congenital coloboma of the lens. In the first eye having cataract surgery, it was impossible to rotate the cataractous lens and place the intraocular lens (IOL) centrally in the capsular bag because the lens capsule was not round. The second eye had similar problems, and capsular tension ring implantation improved cataract lens rotation and phacodonesis, enabling central IOL implantation in the capsular bag. The visual acuity recovered to 20/20 in both eyes. Capsular tension ring implantation can facilitate cataract surgery in coloboma of the lens, even in long-term and continuous lens capsule deformity.

Posted by alireza habibollahi at 09:05 PM

Implantation of a toric phakic IOL to correct high corneal astigmatism in a patient with bilateral marginal corneal Degeneration

JCRS FEB 2004





We present a patient with marginal corneal degeneration and corneal astigmatism of more than 10.0 D . A toric phakic IOL of 7.0 D cylindrical power was implanted in both eyes to correct the high astigmatism. UCVA of 20/40 was achieved in both eyes, and BCVA improved by 4 Snellen lines to 20/20 in both eyes. Refraction and visual acuity remained stable at 1.5 years postoperatively. Implantation of a toric phakic IOL can be an option to correct high corneal astigmatism even when the full corneal astigmatism cannot be treated.

Posted by alireza habibollahi at 08:55 PM

Anterior stromal puncture for recurrent corneal erosion after LASIK

JCRS FEB 2004





A 55-year-old woman had bilateral LASIK . An epithelial defect was observed in the left eye after the flap was cut and developed recurrent corneal erosion related to the traumatic epithelial defect during LASIK and led to secondary DLK . Anterior stromal puncture was required to treat the erosion after conventional treatment failed. The secondary DLK resolved quickly after the erosion healed, without the need for topical corticosteroids. Anterior stromal puncture may be a useful treatment for recurrent corneal erosions that do not respond to conventional therapy.

Posted by alireza habibollahi at 08:47 PM

Detection of LASIK in a postmortem eye using optical coherence tomography

JCRS FEB 2004

With more individuals having LASIK , eye banks are challenged to detect prior refractive surgery in donor tissue. We report the case of a donor who had LASIK 9 months before his death. Slitlamp biomicroscopy, corneal topography, and optical coherence tomography (OCT) were performed to evaluate the corneas. Few changes were detected under slitlamp examination and corneal topography. We demonstrate that OCT is capable of detecting LASIK-induced structural changes in the immediate postmortem evaluation and during the early and late period of organ culture. We recommend OCT screening of potential donor corneas before organ culture and between days 9 and 12 of organ culture.

Posted by alireza habibollahi at 08:32 PM

August 10, 2004

Nasopharyngeal carcinoma with orbital invasion

Eye,August,2004



In this observational case series, we examined 406 patients, who were diagnosed with orbital tumour at Taipei Veterans General Hospital between January 1974 and December 2001. In all, 13 of the patients (11 males, two females) were found to have NPC with orbital invasion. One patient presented with eyelid tumour and three other patients presented with proptosis as the initial manifestation of NPC. The other nine cases, already diagnosed to have NPC, visited our department with a variety of ocular symptoms and signs, such as proptosis, diplopia, visual impairment, and orbital pain. Palliative treatment with radiotherapy alone or in combination with chemotherapy was given in 12 cases. During the follow-up period ranging from 4 to 64 months, six patients died, one was lost during follow-up, and six were still alive.

Conclusions: Although orbital invasion in NPC is rare, we found a 5-year survival rate of 28% in our patients, indicating that orbital invasion with NPC confers a particularly poor prognosis.

Posted by afarahi at 08:06 PM

August 07, 2004

Nattrassia mangiferae keratitis after laser in situ keratomileusis

Jabbarvand, MD, Mohammad Rasool Hashemian, MD, Zohreh Abedinifar, MS, Ali Amini, MD

JCRS JAN 2004





A 32-year-old man had photophobia and blurred vision 2 weeks after uneventful LASIK to correct myopia. He was treated with steroids for suspected diffuse lamellar keratitis, antiherpetics, and antibiotic eyedrops, but the condition worsened and the patient developed further blurred vision, an inflamed eye, and pain. When referred to us, the patient had an extensive corneal ulcer with hypopyon and mycelia were reported in scrapings of the ulcer bed. Nattrassia mangiferae (Hendersonula toruloidea) was cultured from the specimen. The patient was treated with antifungal agents and 2 penetrating keratoplasties. At the last examination, the uncorrected visual acuity was 20/200.

Posted by alireza habibollahi at 09:46 PM

Acremonium fungal infection in 4 patients after LASIK

JCRS JAN 2004



We present 4 patients who had LASIK and were referred to our clinic with a diagnosis of infectious keratitis.LASIK was performed in all cases in the same operating room by different surgeons between April and May 2002. A partial penetrating keratoplasty was performed in all patients to control the process. A study of the corneas demonstrated the presence of the fungus Acremonium in all cases. Rigid asepsis during the surgical procedure is important to prevent this serious complication

Posted by alireza habibollahi at 09:40 PM

Phakic toric IOL implantation after flap decentration in LASIK

JCRS JAN 2004



We describe a patient with flap decentration after LASIK and subsequent phakic toric IOL implantation. A 19-year-old man with mixed astigmatism had LASIK in the left eye complicated by flap decentration. Laser ablation was abandoned and implantation of a phakic toric IOL was done. Ten months after IOL implantation, the UCVA was 20/25 and BCVA was 20/20 with +0.25 –0.50 × 90. Simulated keratometry values were 44.30@150 and 42.00@60 before LASIK and 45.00@150 and 41.90@60 after IOL implantation. Phakic toric IOL implantation may be adequate treatment for flap decentration after LASIK in cases of mixed astigmatism.

Posted by alireza habibollahi at 09:32 PM

Recurrent interface infiltration with hypopyon after astigmatic laser in situ keratomileusis on a penetrating corneal graft

JCRS JAN 2004



A 56-year-old woman was referred with recurrent interface infiltration and hypopyon after astigmatic LASIK on a corneal graft. Pseudomonas aeruginosa was isolated as the causative pathogen. Penetrating keratoplasty had been performed 2 years before refractive surgery. After the antibiotic medication was tapered, 3 recurrences of interface infiltration with hypopyon were observed. Penetrating rekeratoplasty was deemed appropriate. Histological examination of the explanted corneal graft revealed anterior stromal neutrophil infiltration. This case illustrates that microbial pathogens brought underneath the flap by LASIK can persist months later despite antimicrobial treatment



Posted by alireza habibollahi at 09:27 PM

Late traumatic dislocation of LASIK flaps

JCRS JAN 2004





We present 2 patients with late traumatic laser in situ keratomileusis flap dislocation 8 months and 17 months after surgery. One patient had a sharp trauma that caused a partial laceration and the second patient had a blunt trauma that caused a dislocation of the flap. The corneas were examined with slitlamp microscopy, computed corneal topography, and confocal microscopy. One flap was repositioned surgically; the other was treated conservatively with an eye patch. The final visual outcomes were good and illustrate the benefit of immediate attention and flap repositioning

Posted by alireza habibollahi at 09:24 PM

Brown haze in an Allergan SI-40NB silicone intraocular lens

JCRS JAN 2004



We report a case of brown haze in an 83-year-old Japanese man with an Allergan silicone intraocular lens (IOL). The day after surgery, the IOL in the capsular bag was opaque. The patient subsequently had an IOL exchange. Microscopic examination of the extracted IOL showed numerous spheroid structures on the optic. Although the exact cause of this complication is unknown, water incorporated into the material may have had a role in the development of the sphere-like structures.

Posted by alireza habibollahi at 09:16 PM

IOL exchange assisted by preoperative neodymium:YAG laser haptic fracture

JCRS JAN 2004





We present 3 cases of IOL exchange in which a neodymium:YAG (Nd:YAG) laser was used before surgery to fracture a haptic and make intraocular manipulations easier and safer. Strategic placement of the fracture facilitates maneuvering to explant the IOL segments. Delaying pupil dilation until after the Nd:YAG laser is used and prudent positioning of the patient's head minimize the risk that freed IOL segments will damage the cornea or subluxate posteriorly into the vitreous cavity. Neodymium:YAG laser IOL fracture before explantation/ exchange is a viable combined procedure .

Posted by alireza habibollahi at 09:05 PM

Keratoglobus and posterior subcapsular cataract:

JCRS JAN 2004



We report sporadic, bilateral keratoglobus associated with posterior subcapsular cataract in a 43-year-old man. Slitlamp biomicroscopy showed symmetric arcus senilis-like deposits, a polygonal appearance resembling crocodile shagreen, an unusual endothelial appearance, and posterior subcapsular cataract. Orbscan® II pachymetry maps demonstrated bilateral diffuse corneal thinning (359.53 ?m and 379.61 ),confirmed by ultrasound pachymetry. In vivo confocal microscopy showed multiple criss-crossing dark lines and no identifiable cellular elements within the stroma. There were mild to moderate, guttata-like endothelial changes surrounded by pleomorphic cells. Phacoemulsification was performed in the left eye after careful consideration of the presenting features and modification of the surgical technique. Minimal structural alteration was observed during microstructural analysis 7 months after surgery. The endothelial morphology postoperatively was similar to that at baseline

Posted by alireza habibollahi at 08:51 PM

Intacs for early pellucid marginal degenerationGeorge

JCRS JAN 2004



A 42-year-old man had Intacs (Addition Technology Inc.) implantation for early pellucid marginal degeneration (PMD). Two Intacs segments (0.45 mm thickness) were inserted uneventfully in the fashion typically used for low myopia correction (nasal–temporal). Eleven months after the procedure, the uncorrected visual acuity was 20/200, compared with counting fingers preoperatively, while the best spectacle-corrected visual acuity improved to 20/25 from 20/50. Corneal topographic pattern also improved. Although the results are encouraging, concern still exists regarding the long-term effect of this approach for the management of patients with PMD

Posted by alireza habibollahi at 08:48 PM

Iridoschisis and bilateral lens subluxation associated with periocular eczema

JCRS JAN 2004



We present a 53-year-old man with bilateral lens subluxation, unilateral iridoschisis, and a long-standing history of periocular eczema. Although a case of unilateral lens subluxation and ipsilateral iridoschisis has been described recently, the pathogenesis of this simultaneous occurrence remains unclear. Our case raises questions about the relationship among these clinical observations and suggests that these findings may exist as part of an unrecognized oculodermal syndrome

Posted by alireza habibollahi at 08:42 PM

August 06, 2004

A PHASE III, MULTICENTER, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL OF TOPICAL AMINOCAPROIC ACID (CAPROGEL) IN THE MANAGEMENT OF TRAUMATIC HYPHEMARESULTS

Evidence Based Eye CareVolume 5(3) ,July 2004 , pp 160-161

Results:Rebleeding occurred in 30% of the placebo group [8 of 27; 95% confidence interval (CI) = 14%–50%], versus 8% of the treatment group (2 of 24; 95% CI = 1%–27%), for an estimated continuity-corrected difference in percentage of patients with bleeding of 17% (95% CI = -3%–38%). Secondary efficacy variables were similar in the groups, except that there was a trend toward more visual improvement in the topical aminocaproic acid group (54%) than in the placebo group (30%) at the last measurement (P = 0.08). Adverse events were similar.

CONCLUSIONS

This study provides evidence that topical aminocaproic acid is safe and demonstrates trends toward reducing the rebleeding rate in the management of traumatic hyphema. However, because the study was terminated before complete enrollment, more definitive recommendations will require a larger trial.

COMMENT

The seminal study by Crouch and Frenkel published in 1976 1 firmly established aminocaproic acid as the treatment of choice in significantly reducing the 20%–25% rate of recurrent bleeding well known to cause more frequent and more severe ocular complications than the trauma associated with the initial hyphema. It soon became apparent that the rebleed preventive effect of aminocaproic acid required large administered doses, at high cost, associated with systemic side effects of nausea, vomiting, hypertension, dizziness, and syncope along with ocular side effects of delayed blood absorption and elevated intraocular pressure. Because of these side effects, aminocaproic acid did not gain widespread acceptance in the ophthalmic community. At our institution, Louisiana State University Health Sciences Center–Shreveport, after initial experience with this medication, we limited its use to only those patients with recurring hyphema.

A second seminal publication by Crouch et al 2 suggested that topical administration of aminocaproic acid may have an efficacy similar to that of oral administration in reducing secondary hyphema but without systemic side effects. This topical application appeared to be the panacea to the problem of recurrent hyphema, but this required further substantiation before widespread acceptance.

The above well-designed, double-blind, collaborative multicenter, controlled study was uniquely positioned to adequately determine the role of topical aminocaproic acid in the treatment of traumatic hyphema. To the investigators’ consternation and the ophthalmic community’s loss, the protocol was discontinued by the sponsoring pharmaceutical company because at the end of 14 months only 41% of anticipated study subjects were recruited by only 8 of 13 participating study sites. By my calculation, each of the 8 contributing study sites recruited only 1 subject on an average of every 2.2 months, and 5 sites contributed no subjects over the same study period. The general inclusion criteria did not appear unduly stringent to limit recruitment: subjects 4 years of age or older, layered hyphema less than total, presenting within 36 hours of occurrence, and without prior treatment. The reasons for this unexpected low recruitment rate can only remain speculative. Is it possible that the incidence of hyphema is decreasing in the general population?

In any event, the authors conclude from their study that aminocaproic acid appears to have a promising role in preventing rebleed. We can also conclude from their experience that the definitive study will be an expensive undertaking, requiring a larger group of study sites and a longer recruitment period to obtain the requisite 124 study subjects. Because of the public health importance of the problem, I strongly urge the study be revisited, with financing perhaps obtained through the Orphan Drug Funding Program.

Posted by mmiraftab at 05:06 PM

Analysis of the Optical Quality of Intraocular Lenses

Investigative Ophthalmology and Visual Science. 2004;45:2682-2690

METHODS. An optical test bench and suitable software were used to assist in analysis of the optical Fourier transform (OFT) of a test image and to determine the quality of the lens in terms of spatial frequency response. The OFT was automatically converted, by means of an optical–electronic calibration procedure, into a modulation transfer function (MTF) for each lens. The passband value calculated by computer analysis of the MTF is an objective index of the lens quality. Three randomly acquired samples of 24 different models of foldable IOLs were compared. Statistical analysis was performed with two-way and one-way ANOVA for repeated measurements and with the Ryan-Einot-Gabriel-Welsch multiple F test.

RESULTS. The method was demonstrated to be precise and accurate. A large range of passband values was found. Statistically significant differences between the mean passband values for different lenses were found. The lowest passband value (125.60 line pairs [lp]/mm) was measured for the IOL (Lenstec LH3000; Lenstec, Inc., St. Petersburg, FL) and the highest (191.48 lp/mm) for the Acrysof SA30AL (Alcon, Fort Worth, TX).

CONCLUSIONS. Different IOLs can transmit different spectra of spatial frequencies. The best frequency response was provided by acrylic IOLs, particularly those with an asymmetrically biconvex profile. This could be due to a reduction of optical degradation provided by this type of profile. A lens with a higher frequency response should determine a better quality of vision once implanted and the frequency response should therefore be considered when choosing the intraocular lens model.

Posted by mmiraftab at 04:50 PM

Pediatric Eye Exam

OSN,1/8/2004



Timeline according to joint guidelines from the American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Ophthalmology and the American Academy of Pediatrics.

Birth to 1 year

Evaluation of vision is recommended in the first 3 months of life and again between 6 months and 1 year. Exams at the pediatrician’s office should include these evaluations as age-appropriate:

Visual fixation “fix and follow” assessment

External eye and eyelid assessment

Ocular motility assessment

Pupil examination

Red reflex examination

Noncompliant children; children with a family history of strabismus, amblyopia or other eye disease; and those with suspected ocular abnormalities should be referred to an ophthalmologist for a comprehensive eye examination.

1 to 3 years

Yearly exams in the pediatrician’s office should include ophthalmoscopy when possible. In preverbal children, Teller acuity cards and picture tests are useful. As the child becomes verbal, visual acuity assessment is necessary. Children over age 4 may read the Snellen chart. Noncompliant children; children with a family history of strabismus, amblyopia or other eye disease; and those with suspected ocular abnormalities should be referred to an ophthalmologist for a comprehensive exam.

3 to 5 years

First comprehensive ophthalmic eye exam in the ophthalmologist’s office should be carried out between ages 3 and 5 years. Relevant family history regarding eye disease and spectacle use in parents or siblings is required. Parental observations are important. Questions to ask:

Does your child seem to see well?

Does your child hold objects close to his or her face when trying to focus?

Do your child’s eyes appear straight, or do they seem to cross or drift or seem lazy?

Do your child’s eyes appear unusual?

Do your child’s eyelids droop, or does one eyelid tend to close?

Have your child’s eyes ever been injured?

Children in whom eye abnormalities or refractive errors are detected should be managed appropriately.

Initial comprehensive eye exam to adulthood

Depending on the child’s health and family history, he or she should undergo comprehensive eye exams every 1 to 2 years. Children may undergo additional photoscreening examinations while in the classroom. Children diagnosed with refractive errors during this time should undergo visual acuity testing every 6 to 12 months (depending on the severity of their refractive errors) after initial spectacle prescription.

Posted by afarahi at 12:27 PM

Cutaneous horns of the eyelid: a clinicopathological study of 48 cases

Jurnal of Cutaneus Pathology,Volume 31: Issue 8,2004



Cutaneous horn (cornu cutaneum) is a morphological designation for a protuberant mass of keratin that resembles the horn of an animal. It results from unusual cohesiveness of keratinized material from the superficial layers of the skin or implanted deeply in the cutis. This lesion may be associated with a benign, premalignant, or malignant lesion at the base, masking numerous conditions.

Twenty-four men and 19 women, with a mean age of 62 years (range 16–90), were treated by surgery. Histologically, 77.1% were associated with benign specimens at the base pathology, 14.6% were premalignant, and finally, 8.3% were caused by malignant skin tumors. The most common lesion was seborrheic keratosis among the benign lesions, actinic keratosis among the premalignant ones, and basal cell carcinoma and squamous cell carcinoma among the malignant ones.

Conclusion: Cutaneous horns usually appear on exposed skin areas in elderly men. The important issue in this condition is not the horn itself, which is just dead keratin, but rather the nature of the underlying disease, although the horns are usually benign

Posted by afarahi at 12:18 PM

Sebaceous Carcinoma of the Eyelid: A Review of 14 Cases

.Dermatologic Surgery,July,2004



Fourteen patients had sufficient follow-up data available for review. Mean follow-up was 57 months . Treatment included wide local excision with frozen and permanent section control (9 patients, 64%), Mohs micrographic surgery (2 patients, 14%), external beam radiation (2 patients, 14%), and exenteration and total parotidectomy with cervical lymph node dissection (1 patient, 7%). Two patients (14%) had local recurrence of the tumor after wide local excision, and 1 patient (7%) had tumor recurrence after Mohs micrographic surgery.

Conclusion:Treatment should be chosen on the basis of the extent of the tumor and the specific needs of the patient. The mainstay of treatment of tumors without orbital involvement has been wide local excision, with the margins checked in both permanent and frozen sections, in combination with conjunctival map biopsies when warranted. Mohs micrographic surgery is an alternative that may provide tissue conservation and lower recurrence rates. Recurrence rates between treatments are difficult to assess because of the small number of cases reported in the literature. In cases with orbital involvement, exenteration may be warranted. Radiation may be useful when surgery cannot be tolerated.

Posted by afarahi at 12:09 PM

August 03, 2004

Dorzolomide HCI OK for use in children

Ophthalmology Times Jul 1, 2004



The FDA has approved Merck Human Health's dorzolomide HCI (Trusopt) ophthalmic solution 2% for use in pediatric patients. The drug is used to treat elevated IOP in patients with ocular hypertension or open-angle glaucoma

Posted by mehdi khanlari at 11:24 PM

Histological observation of complete closure of anterior capsulotomy in 2 cases

JCRS JUNE 2004



We report the histological finding of complete closure of the anterior capsulotomy window in 2 cases. The cases were successfully treated with surgery after neodymium:YAG laser anterior capsulotomy failed. Histology and immunohistochemistry were performed to determine the pathogenesis. Histology revealed the presence of elongated, fibroblast-like lens epithelial cells in association with extracellular matrix accumulation, which were positive for collagen types, fibronectin, and osteopontin. The cells were labeled with anti-?-smooth muscle actin antibody. The finding indicates that phenotypic modulation in lens epithelial cell to contractile cell type and accumulation of matrix are involved in closure of the anterior capsulotomy

Edited by M.Khanlari

Posted by alireza habibollahi at 11:18 PM

Complete bilateral PVD after LASIK

JCRS JUNE 2004



We describe a case of a 47-year-old woman who underwent bilateral LASIK for the correction of myopia and astigmatism. Two months later a residual refractive error was present in both eyes. LASIK retreatment was decided and performed the following day. Twenty-four hours after the procedure, the patient reported myodesopsia in both eyes. Funduscopic examination revealed a complete bilateral posterior vitreous detachment confirmed by kinetic ultrasound. Visual disturbance in both eyes continued to be present after 10 months of follow-up. Sudden changes in intraocular pressure related to suction ring use might be the cause of posterior vitreous detachment in this patient

Posted by alireza habibollahi at 11:12 PM

AMO to work with Quest Vision on presbyopic IOLs

Ophthalmology Times Jul 1, 2004





(AMO) has forged a 1-year research and evaluation licensing agreement with Quest Vision Technologies Inc. to develop accommodating IOL designs. Under the agreement, which was announced May 3, AMO will own a minority interest in Quest Vision, with an option to buy the company after 1 year . Quest Vision is developing two accommodating IOL designs, FocusIOL and FlexOptic, to address presbyopia. The designs were originally patented by ophthalmologist Randy Woods, MD, in 1988. The IOLs are designed to mimic the crystalline lens by accommodating in response to changes in the eye's ciliary muscle.The deal also gives AMO access to issued and pending patents for various design approaches for axial movement and shape-changing technology

Posted by mehdi khanlari at 11:09 PM

Eccentric capsulorhexis and postoperative dysphotopsia following phacoemulsification

JCRS JUNE 2004



We report a case of troublesome visual symptoms or dysphotopsia in a 68-year-old patient after right phacoemulsification and implantation of a 3-piece AcrySof® MA60BM acrylic intraocular lens (IOL) (Alcon) in the capsular bag. The patient described multiple horizontal streaks in dim lighting conditions with light sources in the right temporal visual field. The anterior capsulorhexis was eccentric, leaving the nasal optic edge and site of polypropylene haptic insertion uncovered by the semi-opaque anterior capsule and the probable source of the flare images. Miotic therapy was poorly tolerated and IOL exchange declined. The case illustrates the importance of creating a central capsulorhexis smaller than the IOL optic to reduce the risk photic phenomena and edge effect with square-edged IOLs.

Posted by alireza habibollahi at 11:05 PM

Unusual presentation of angle-closure glaucoma treated by phacoemulsification:

JCRS JUNE 2004



We report the case of a 70-year-old woman with a history of acute primary angle-closure glaucoma (PACG) in the left eye who, 2 hours after a fundus examination and mydriasis, experienced acutely elevated intraocular pressure (IOP) up to 40 mm Hg in the presence of fully dilated pupil and a patent iridotomy. Gonioscopy revealed appositional angle closure in 3 quadrants. After medical control of the IOP, sutureless cataract surgery was performed, including clear corneal incision, phacoemulsification, and soft acrylic posterior chamber intraocular lens (IOL) implantation. Eighteen months after the operation, improvement of visual acuity, widening of anterior chamber angle, and deepening of anterior chamber depth were found. Intraocular pressures are now normal without medication, even after mydriasis. Modern cataract surgery is an effective treatment for selected patients with appositional angle closure and IOP elevation after acute PACG.

Posted by alireza habibollahi at 11:00 PM

DLK and corneal edema associated with viral keratoconjunctivitis 2 years afterLASIK

JCRS JUNE 2004



A 47-year-old woman with a history of 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 alireza habibollahi at 10:52 PM

Retained IOL fragment and corneal decompensation after pseudophakic IOL exchange:

JCRS JUNE 2004



A 72-year-old man had exchange of a foldable silicone multifocal 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 alireza habibollahi at 10:47 PM

Single-piece hydrophobic acrylic IOL explanted within the capsular bag:

JCRS JUNE 2004



A 74-year-old woman had uneventful phaco with implantation of a single-piece hydrophobic acrylic IOL (SA30AL) left eye. Two weeks later, the patient reporting pseudophakic dysphotopsia , since surgery. Explantation/exchange of the IOL was performed 3 months later. The IOL was strongly attached to the capsule, which was fibrotic and contracted; explantation of the capsular bag complex in toto was done. To our knowledge, this is the first case of explantation of this IOL design with clinicopathological correlation.

Posted by alireza habibollahi at 10:28 PM

August 02, 2004

Monitor diurnal fluctuation for clues to progression

OSN supersite, 6/15/04



John R. Samples, MD, advised Physicians to track diurnal curves in their glaucoma patients more often, despite the difficulty in doing so. Diurnal fluctuation helps to track progression in glaucoma.Dr. Samples explained the circadian rhythm of aqueous flow. He said it is highest in the morning; slightly lower in the afternoon; about one-half of the morning level during sleep. Normal flow is about 2.75 µL/minute during the day.Dr. Samples added that the beta-blocker timolol is “remarkably consistent on suppressing flow during the day but has no effect in sleeping subjects.”Other factors influencing diurnal variation in IOP include corticosteroids and melatonin levels. Stress can cause an increase in catecholamines, which cause the curve to fluctuate.

Posted by pakravanmd at 07:58 PM

Latanoprost exposure in pregnancy

American Journal of Ophthalmology Volume 138, Issue 2, August 2004, Pages 305-306

To observe pregnancies exposed to latanoprost, a prostaglandin analog administered in the treatment of glaucoma. Its prescription is limited in pregnancy, because reproduction studies in animals report a high incidence of abortion and human investigations are not adequate. As a consequence it is classified as category C drug according to the United States Food and Drug Administration's use-in-pregnancy ratings. We collected data, referred to our Teratology Information Service, relative to latanoprost exposure in pregnancy. We followed by phone interviews women treated with latanoprost during the first trimester, and we evaluated whether there had been any adverse effects on the fetus.

Results

Eleven cases of latanoprost exposure in pregnancy were referred to our Teratology Information Service. One case was lost to follow-up, and one case was complicated by miscarriage. Nine cases had a complete follow-up without congenital anomalies.

Conclusions

Our series is too small to perform statistical significance; however, we found no evidence of adverse effects of latanoprost on pregnancy or neonatal outcomes.

Posted by mmiraftab at 07:21 PM

Endothelial cell density after posterior lamellar keratoplasty (Melles techniques): 3 years follow-up

American Journal of Ophthalmology Volume 138, Issue 2 , August 2004, Pages 211-217

Fifteen consecutive eyes of 15 patients in whom a posterior lamellar keratoplasty procedure was performed for pseudophakic bullous keratopathy or Fuchs' endothelial dystrophy were evaluated. In 11 corneas the donor tissue was inserted through a 9.0-mm sclerocorneal pocket incision (technique A); in four cases the donor was folded and inserted through a 5.0-mm incision (technique B). Specular microscopy was performed at 6, 12, 24, and 36 months after surgery, to measure the endothelial cell density.

Results

Mean postoperative endothelial cell density averaged 2,126 cells/mm2 (±548) at 6 months, 1,859 cells/mm2 (±477) at 12 months, 1,385 cells/mm2 (±451) at 24 months, and 1,047 cells/mm2 (±425) at 36 months.

Conclusion

In posterior lamellar keratoplasty, the donor corneal endothelium showed a decrease in cell density similar to that after conventional full-thickness penetrating keratoplasty.

Posted by mmiraftab at 07:08 PM

The effect of corneal flap on optical aberrations

American Journal of Ophthalmology Volume 138, Issue 2, August 2004, Pages 190-193

This study included 15 patients who were scheduled for laser in situ keratomileusis. A nasal hinge flap was created, using the Nidek MK-2000 microkeratome and then replaced without performing laser ablation. The ocular aberrations were measured before and after flap creation using the Nidek Optical Path Difference Scanning System ARK-10000.

Results

The root mean square wavefront errors of the higher-order optical aberrations (third-, fourth-, fifth-, and sixth-order aberrations) were not significantly altered at 1 week postsurgery compared with the preoperative values (P > .35).

Conclusions

Creating a corneal flap with the Nidek MK-2000 microkeratome did not induce changes in higher-order optical aberrations as measured with the Nidek Optical Path Difference Scanning System ARK-10000 during the early postoperative period

Posted by mmiraftab at 07:02 PM

Outcomes of LASIK in patients with pigment dispersion syndrom:

JCRS JAN 2004

90.9% patients had an uneventful course after LASIK and a good final uncorrected visual acuity . One patient with PDS and suspicion of glaucoma on topical ?-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.http://www.ascrs.org/publications/jcrs/absjan04.html

Posted by alireza habibollahi at 12:47 AM

Cataract surgery in patients with Vogt-Koyanagi-Harada:

JCRS JAN 2004

India. ECCE-IOL implantation was performed in 15 eyes and without IOL implantation in 31 eyes. Small pupils were managed by synechiolysis with an iris spatula or iris hooks Visual acuity improved by 1 or more lines in 80.0%. Subretinal gliosis and optic atrophy, sequelae of the syndrome, restricted improvement in vision in the remaining eyes. Posterior capsule opacification developed in 76.0%, of which 42.0% required a neodymium:YAG laser posterior capsulotomy. There were no significant differences in postoperative inflammation or syndrome reactivation between the types of surgery.

The results show that cataract extraction in patients with VKH syndrome can be safely and successfully performed if there are good preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical technique. The final visual outcome depends on the posterior segment complications of the syndrome.

http://www.ascrs.org/publications/jcrs/jcrsjul04.html

Posted by alireza habibollahi at 12:18 AM