Ophthalmology Review

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December 31, 2004

Near vision restoration with refractive lens exchange and pseudoaccommodating and multifocal refractive and diffractive intraocular lenses: Comparative clinical study

JCRS OCT 2004
To evaluate near visual performance after implantation of a pseudoaccommodating intraocular lens (IOL) (Crystalens® AT-45, eyeonics) or a multifocal IOL (refractive model, AMO Array®; diffractive model, AcriTec TwinSet) after lens surgery.
Forty patients were included in this prospective clinical comparative study. The patients were divided into 3 groups according to the type of IOL implanted. Group 1 included 24 eyes (12 patients) implanted with the Crystalens IOL; Group 2, 32 eyes (16 patients) with the Array IOL, and Group 3, 24 eyes (12 patients) with the TwinSet IOL. Bilateral phacoemulsification and IOL implantation were performed in all patients, and the follow-up was 1 year.
Conclusions
Implantation of multifocal and pseudoaccommodating IOLs provides adequate near vision restoration. The TwinSet IOL provided faster recovery of near vision than the other 2 IOLs. The Crystalens IOL provided less postoperative visual phenomena with favorable near vision. The Array IOL achieved the most comfortable distance and near vision.

Posted by alireza habibollahi at 01:26 PM | Comments (13)

Quality of vision after AMO Array multifocal intraocular lens implantation

To evaluate safety and efficacy of Array® SA40N multifocal IOL (AMO) implantation in cataract surgery.
Finland.In this prospective randomized comparative trial, 80 patients scheduled for cataract surgery were selected based on preoperative counseling and randomized to have multifocal or monofocal IOL implantation. Fifty-three eyes of 35 patients received a multifocal IOL and 67 eyes of 40 patients, a monofocal IOL. Contrast sensitivity values were slightly lower with multifocal IOLs at almost all spatial frequencies, but the difference was not significant. The change in the quality of life postoperatively, measured with the VF-7, was significant and identical in both groups.
ConclusionsPseudophakic eyes with multifocal IOLs had better distance and near acuity and range of accommodation than eyes with a monofocal IOL. Slightly lower contrast sensitivity and increased perception of halos by subjects with the multifocal IOL appear to be an acceptable compromise to enhanced near and distance vision.

Posted by alireza habibollahi at 01:21 PM | Comments (19)

Diamond iris retractor configuration for small-pupil extracapsular or intracapsular cataract surgery

We describe a technique that uses flexible iris retractors in a diamond configuration for small-pupil extracapsular or intracapsular cataract surgery in eyes with unusually dense nuclear sclerosis. Advantages of this technique include ease of conversion from phacoemulsification, optimal orientation of the maximum pupil diameter for nucleus expression or intracapsular lens removal, and conservation of iris tissue.

Posted by alireza habibollahi at 01:16 PM | Comments (0)

December 28, 2004

Corneal Topography of Neonates and Infants

Arch Ophthalmol. 2004;122:1767-1771 ( Vol. 122 No. 12, December 2004 )

Objective To evaluate corneal curvature by direct topographic analysis during the first 6 months of life.
Methods We evaluated corneal topography in 200 infants using a specialized handheld topographic instrument at a mean of 1.6 days after birth, and in some again at 3 and 6 months in the newborn nursery and ophthalmology clinic of a public hospital.
Results At birth, the mean central corneal power measured 48.5 diopters (D) (95% confidence interval [CI], 48.2-48.8 D; range, 41.4-56.0 D) and astigmatism measured 6.0 D (95% CI, 5.6-6.3 D), usually "with the rule" (80%) with a mean axis of 95°. The mean astigmatism on the semimeridian map at 3 mm was 6.4 D (95% CI, 6.0-6.8 D); and at 5 mm, 5.9 D (95% CI, 5.4-6.3 D). At birth, neonates delivered vaginally had a greater frequency of with-the-rule astigmatism than those delivered by cesarean section (P = .02). By 6 months, the mean central corneal power and astigmatism decreased to 43.0 (95% CI, 41.3-43.1) D and 2.3 (95% CI, 1.4-3.2) D, respectively (P<.005 for each).
Conclusions Newborns have steep, high, astigmatic (generally with-the-rule) corneas at birth that flatten significantly by the age of 6 months. The method of delivery can affect the astigmatic axis at birth.

Posted by mmiraftab at 08:56 PM | Comments (32)

Changes in axial length following trabeculectomy and glaucoma drainage device surgery

In a prospective, interventional case series, one eye of 39 patients undergoing trabeculectomy and 22 undergoing Baerveldt tube shunt implantation for uncontrolled glaucoma. These patients had AL measurements by non-contact, partial coherence interferometry preoperatively, at 1 week, 1 month, and >3 months after surgery. Main outcome measures(Axial length and intraocular pressure) were compared at preoperative and postoperative visits. The results showed that, there is a small but statistically significant decrease in AL after both trabeculectomy and GDD surgery, greater in eyes that are hypotonous after surgery.

Posted by kjalali at 08:35 PM | Comments (2)

Laser-assisted subepithelial keratectomy in children

Journal of Cataract & Refractive Surgery Volume 30, Issue 12 , December 2004, Pages 2529-2535

This prospective study comprised 36 eyes of 25 patients. The mean patient age at treatment was 8.27 years (range 1.0 to 17.4 years). Patients were divided into 3 groups: those with myopic anisometropic amblyopia (13 patients/13 eyes), those with bilateral high myopia (11 patients/22 eyes), and those with high myopia post-penetrating keratoplasty (1 patient/1 eye). All patients were treated with LASEK under general anesthesia using the Visx 20/20 B excimer laser and a multizone, multipass ablation technique. Although the myopia was as high as −22.00 diopters (D) spherical equivalent (SE) in some eyes, no eye was treated for more than −19.00 D SE.
Results
At 1 year, the mean SE decreased from −8.03 D to −1.19 D. Forty-four percent of eyes were within ±1.0 D of the targeted correction; 78% of eyes had clear corneas with no haze. In the entire group, the mean best corrected visual acuity improved from 20/80 to 20/50. A functional-vision survey demonstrated a positive effect on the patients' ability to function in their environments after LASEK.
Conclusions
Laser-assisted subepithelial keratectomy in children represents another method of providing long-term resolution of bilateral high myopia and myopic anisometropic amblyopia with minimal post-laser haze. The reduction in post-laser haze with LASEK compared to that with the standard PRK technique may represent an advantage in treating these complex patients.

Posted by mmiraftab at 05:43 PM | Comments (28)

Ultrasound biomicroscopic changes during accommodation in eyes with accommodating intraocular lenses

Journal of Cataract & Refractive Surgery Volume 30, Issue 12 , December 2004, Pages 2476-2482

Results
All surgical procedures were uneventful. The mean uncorrected distance acuity at 1 month was 0.8 ± 0.14 (SD) and remained stable at 6 months. Three of 20 eyes (15%) and 8 of 20 eyes (40%) had a Jaeger acuity of J1 and J3, respectively, without additional power correction. During accommodation, the mean reduction in ACD was 0.32 ± 0.16 mm at 1 month and 0.33 ± 0.25 mm at 6 months. The mean narrowing of the scleral–ciliary process angle was 4.32 ± 1.87 degrees at 1 month and 4.43 ± 1.85 degrees at 6 months. There was a correlation between accommodative amplitude and a decrease in the ACD (r = 0.404) and a decrease in scleral–ciliary process angle (r = 0.773).
Conclusions
Anterior displacement of the Crystalens IOL and corresponding anterior rotation of the ciliary body occurred during near vision. The IOL displacement and rotation were proportional to the accommodation capacity.

Posted by mmiraftab at 05:31 PM | Comments (24)

Surgical coverage of exposed hydroxyapatite implant with retroauricular myoperiosteal graft

BJO,Jan,2005
With the increasing use of hydroxyapatite orbital implants, the complication of exposure has become apparent to oculoplastic surgeons. Many kinds of patch grafts, such as sclera, dermis, and hard palate mucosa, have been used to cover exposed hydroxyapatite implants with inconsistent results. In this study, the authors use a newly developed technique, autogenous retroauricular myoperiosteal graft, and the results are reported.
Nine eyes with hydroxyapatite exposure more than 3 mm were managed with autogenous retroauricular myoperiosteal grafts. Seven cases were successfully treated with single graft surgery. The other two cases needed an additional graft surgery, and there was no re-exposure noted thereafter.
Conclusion: The thick composite nature of the myoperiosteal graft provides a durable and vascularised coverage for exposed hydroxyapatite implants. This technique offers an encouraging alternative for the management of exposed hydroxyapatite implants.

Posted by afarahi at 12:28 AM | Comments (19)

A Randomized Trial of the Effects of Rigid Contact Lenses on Myopia Progression

Arch Ophthalmol.Dec, 2004
We randomly assigned 116 subjects to wear RGPs or SCLs. The mean ± SD spherical equivalent cycloplegic refractive error progressed –1.56 ± 0.95 diopters (D) for RGP wearers and –2.19 ± 0.89 D for the SCL wearers during the 3 years of the study . The axial growth of the eyes was not significantly different between treatment groups . The steep corneal meridian of the RGP wearers steepened 0.62 ± 0.60 D, and that of the SCL wearers steepened 0.88 ± 0.57 D during the 3 years .
Conclusions : The RGP wearers’ myopia progressed less than that of the SCL wearers. The corneal curvature of the SCL wearers steepened more than that of the RGP wearers, but the axial growth was not significantly different between the groups. Most refractive error treatment effect was limited to the first year of the trial. The results of the study provide information for eye care practitioners to share with their patients, but they do not indicate that RGPs should be prescribed primarily for myopia control.

Posted by afarahi at 12:02 AM | Comments (53)

December 25, 2004

Alcon Introducing Automatic Registration for CustomCornea Platform

Ophthalmology Management Dec 2004

Alcon is currently upgrading existing LADARWave units with the capability to automatically register wavefront measurements during capture. The upgrade eliminates several previously required steps to capturing wavefront measurements. By using new imaging software, the LADARWave aberrometer now automatically detects the unmoving landmarks of the eye, positioning limbal rings based on them. The company says automatic registration greatly reduces human error in the wavefront capture process and eliminates variabilility between technicians, enhancing outcomes and saving time.
This upgrade further enhances the previously integrated CustomCornea Surgery Planning Software, which provides ablation depth profiling, treatment offset capability, nomogram management, faster auto-fogging, and treatment planning summaries.

Posted by mmiraftab at 04:17 PM | Comments (14)

Latest Clinical, Financial Data on IntraLase Released

Ophthalmology Management Dec 2004

Daniel Durrie, M.D., presented 6-month results from his prospective, randomized study comparing visual acuity achieved by LASIK patients with an IntraLase FS-created flap with visual acuity achieved by patients whose flaps were created with a leading mechanical microkeratome.
The study followed 88 patients undergoing bilateral LASIK; one eye of each patient received an IntraLase FS-created flap, and the fellow eye received a mechanical microkeratome-created flap. Also, patients in the first arm of the study underwent wavefront-guided LASIK; patients in the second arm underwent standard LASIK.
Dr. Durrie reported that IntraLase eyes recovered vision more quickly (p<0.001), and:
► more patients with IntraLase-created flaps achieved 20/20 or better vision
► patients who stated a preference preferred the post-op vision in their IntraLase eye 3 to 1
► IntraLase-created flaps induced fewer low- and high-order aberrations
► IntraLase eyes achieved better contrast sensitivity
► visual acuity results were better in eyes that underwent standard LASIK with IntraLase flaps than they were in eyes that underwent wavefront-guided LASIK with a mechanical-microkeratome flap.
Dr. Durrie attributed the favorable IntraLase outcomes to flap architecture and consistency, and also to the dry, homogeneous surface the IntraLase leaves for the excimer laser to treat.
By the end of the third quarter of 2004, 180 IntraLase FS lasers were installed in the United States and abroad. Company executives said more than 15% of all U.S. LASIK procedures in the quarter involved a laser-created flap, a 70% higher rate than a year ago. They also reported that surgeons who use the laser increased their conversion-to-surgery rate by 20% and increased their LASIK volume by 42% compared with the industry average 16%.

Posted by mmiraftab at 04:10 PM | Comments (16)

December 24, 2004

VISX Expects Several Wavefront-Related FDA Approvals Soon

Ophthalmology Management Dec 2004

FDA approval of the VISX automatic iris registration technology was expected within weeks of the AAO meeting. The technology compensates for eye cyclotorsion that occurs when a LASIK patient goes from the WaveScan unit (upright) to the laser (supine). It calculates torsional angles from multiple measurements and reference points on the iris captured by the WaveScan aberrometer so the iris can be registered at the laser for treatment. In a study involving 69 eyes, Julian Stevens, FRCS, was able to capture more than 95% with iris registration, and he has assessed and treated patients where torsional error of up to 8 degrees has occurred.
Additionally, this technology automates the pupil centration process by compensating for pupil centroid shift as patients move from the WaveScan aberrometer to the laser, which is accomplished by using the outer boundary of the iris as a fixed landmark. Until now, manual adjustments and strict control of lighting conditions were used to compensate for any change in pupil centration.
The company has completed its FDA multicenter clinical trial of wavefront-guided treatment for hyperopic astigmatism. The range of treatment in the trial is up to +5D of sphere and +4D of cylinder. Nine-month data have been submitted to the FDA. Approval is possible this quarter.
VISX is also conducting an FDA multicenter trial of its wavefront-guided treatment for high myopia. The range of error being treated is up to -11D of myopia and up to -5D of astigmatism. At 6 months, 55% of the 184 eyes have achieved 20/16 UCVA and 76% have achieved 20/20 UCVA. Approval for the high-myopia application could come during the first half of 2005. An additional FDA trial, of the company's wavefront-guided treatment for hyperopic presbyopia, has begun. In the international trials, at 12 months of follow-up, 80% of patients achieved, simultaneously, 20/25 or better distance UCVA and J3 near vision.
The company also reported that Fourier Wavefront ablations are now FDA approved and the capability is now installed in most U.S. practices using the VISX platform

Posted by mmiraftab at 07:00 PM | Comments (1)

SITA SWAP

Ophthalmology Management Dec 2004

The Carl Zeiss Meditec's company says the availability of the SITA SWAP software is another step in the continual evolution of the HFA. Short-wavelength automated perimetry assesses the short-wavelength-sensitive color system. The SITA upgrade reduces test time to 4 to 6 minutes, one third of what it was previously, and decreases variability between test results.Studies have shown that SWAP picks up deficits 3 to 5 years before standard achromatic perimetry. Additionally, SWAP deficits are predictive of the onset of future visual field loss, and the upgrade improves the technology's ability to identify progression.
SITA SWAP is now available as an upgrade to HFA models 745, 745i, 750, 750i, and is included on all new 745i and 750i instruments.

Posted by mmiraftab at 06:56 PM | Comments (1)

Cyclosporine Studies Examine Long-Term Use and Use in Rosacea

Ophthalmology Management Dec 2004

In a study conducted by John Wittpenn, M.D., et al., Ophthalmic Consultants of Long Island, Stony Brook, N.Y., cyclosporine 0.05% (Restasis) effectively treated the signs and symptoms of active, chronic ocular rosacea in patients who had failed to respond to traditional treatments. A retrospective chart review identified 55 patients with chronic ocular rosacea refractory to traditional treatments who were subsequently treated with Restasis. Ages ranged from 30 to 78; 51% were male; 49% were female. At the time of the review, the patients had undergone a traditional treatment regimen (warm soaks, lid hygiene, oral tetracyclines, topical antibiotics, short courses of topical corticosteroids) for 1 to 2 weeks and then treatment with Restasis for 2 to 11 months (average 5.2 months).
Based on patient assessment and clinical examination, including supravital staining:
► 46% of patients (25 of 55) showed significant improvement or complete resolution
► 38% of patients (21 of 55) showed mild-to-moderate improvement
► Nine patients withdrew from the study. Five complained of burning, itching or tearing; four failed to improve
► At last follow-up, 39% of patients (18 of 46) required no medications in addition to Restasis; 61% (28 of 46) continued low-dose tetracyclines along with Restasis; two patients also continued topical steroids q.d.
The researchers said further research should evaluate Restasis as a first-line therapy for ocular rosacea.

Posted by mmiraftab at 06:53 PM | Comments (0)

A randomised controlled feasibility trial of vitrectomy versus laser for diabetic macular oedema

British Journal of Ophthalmology 2005;89:81-86

Aim: (1) To evaluate whether vitrectomy is preferable to further macular laser in improving visual acuity and resolving retinal thickening in patients with diabetic macular oedema (DMO) despite previous laser and no macular traction. (2) To determine the feasibility of further trials in this population in terms of magnitude of comparative clinical effect, rate of recruitment, and loss to follow up.
Methods: A randomised controlled feasibility study. Patients with DMO and a visual acuity of 0.3 logMAR (6/12) or worse after one or more macular laser treatments were randomised on a 1:1 basis to either pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or further macular laser. Patients with a posterior vitreous detachment, biomicroscopic evidence of retinal traction, or a taut thickened posterior hyaloid (TTPH) were excluded. Primary outcome measures were (1) best corrected logMAR visual acuity, (2) mean central macular thickness on optical coherence tomography, and (3) rate of recruitment and loss to follow up. Analysis was on an intention to treat basis.
Results: 19 patients were randomised to PPV and 21 to further macular laser. The mean baseline logMAR visual acuity was 0.65 (SD 0.28) for the group randomised to PPV and 0.60 (0.23) for the group randomised to laser. The mean change in best corrected visual acuity of the vitrectomy group was deterioration by 0.05 logMAR, while in the control group the mean change was an improvement of 0.03 logMAR. The median (interquartile range) baseline central macular thickness was 403 (337, 492) for the group randomised to PPV and 387 (298, 491) for the controls randomised to laser. The median change in central macular thickness from baseline to review in the vitrectomy group was a thinning by 73 µm (20%) and by 29 µm (10.7%) in the control laser group. This single centre was able to recruit 40 patients in 18 months with follow up of 82% at 1 year.
Conclusion: A randomised controlled trial was found to be potentially feasible in this population, the rate of recruitment was however slow and one in five patients were lost to follow up because of death and ill health. These data provide little evidence in terms of visual acuity and macular thickness of any benefit of vitrectomy over further macular laser in patients with an attached hyaloid, DMO despite previous laser, and no clinically evident macular traction or TTPH.

Posted by mmiraftab at 06:39 PM | Comments (0)

British guidance on LASIK surgery provokes controversy

OSN DEC 2004
An advisory group to U.K. government regulators recently issued a guidance on laser eye surgery that raises questions about the long-term safety of LASIK. The group’s report was preceded by premature newspaper reports that caused deep concerns among ophthalmologists in the United Kingdom and elsewhere. Many ophthalmologists have expressed criticism of the document since its release in late December.The report from the National Institute for Clinical Excellence (NICE) recommends that, if the procedure is to be used in the U.K. National Health Service (NHS), practitioners should raise patients’ awareness of potential risks and should audit and review their own long-term clinical outcomes more closely.We know that vision gets worse in a few people after LASIK, and eye specialists are also concerned about possible long-term side effects. We need to know more about these potential problems,” said Prof. Bruce Campbell, chairman of the Interventional Procedures Advisory Committee of NICE, in a statement. The guidance is based on a yearlong literature review of LASIK studies, as well as expert opinions. Eight studies were analyzed, including one systematic review of previous reports. The NICE emphasized that the guidance applies only to LASIK for treatment of refractive errors. According to the NICE guidance, the studies reviewed showed that the effects of LASIK on vision were more predictable in eyes with mild to moderate myopia than in those with moderate to high myopia. The length of follow-up was not great enough to make assessments about long-term efficacy, the document said. “In general, the studies weren’t run for long enough to see how well the effects of LASIK treatment lasted,” the guidance said.
The experts consulted for the guidance said that the primary problem with LASIK surgery is the long-term risk of corneal ectasia.
Ophthalmologists in the United Kingdom expressed concern and disappointment regarding the contents of the NICE document. Critics of the report noted that the experts consulted were not named in the report released to the public. Other problems cited by ophthalmologists included confusion as to whether the guidance prevents U.K. ophthalmologists from treating NHS patients and a lack of consultation with specialist societies.
From across the Atlantic, George O. Waring, III, MD, FACS, FRCOphth, sent a letter to NICE stating that he is “appalled” by the use of his decade-old LASIK study in the literature review, saying it is out of date and “has essentially no bearing on conditions of safety in 2004.” Excerpts of his letter were reproduced in a press release.
“The inappropriate and inaccurate conclusions drawn by NICE ignore ongoing laser eye surgery development,” said Dr. Waring, the editor of the Journal of Refractive Surgery. “That the British National Institute for Clinical Excellence would cite these data in an attempt to guide patients and physicians in their evaluation of LASIK in 2004 belies apparent ignorance of the enormous progress that has been made in both the technology and the clinical application of LASIK in the 9-10 years since our study was done,” the letter stated.

Posted by mmiraftab at 06:33 PM | Comments (46)

Efficacy of various drugs in the prevention of posterior capsule opacification: Experimental study of rabbit eyes

Journal of Cataract & Refractive Surgery Volume 30, Issue 12 , December 2004, Pages 2598-2605

Lens material was removed using phacoaspiration or phacoemulsification through a microcapsulorhexis according to the hardness of the crystalline lens correlated with the weight and age of the rabbits. A mixture of an ophthalmic viscosurgical device (sodium hyaluronate 1.4% [SHA]) and a drug was injected into the empty capsular bag, allowed to remain inside for 3 minutes, and removed. The capsular bag was rinsed with balanced salt solution (BSS®) and refilled with SHA. In a group of rabbits, the capsulorhexis was sealed with a minicapsulorhexis valve (MCV). Rabbits were treated with 1 of the following: SHA (control), BSS, mitomycin-C (MMC, 0.2 mg/mL), ethylenediaminetetraacetic acid (EDTA) (10 mM and 15 mM), 5-fluorouracil (5-FU, 33 mg/mL), acetic acid (3%, 0.3%, and 0.003%), and distilled water.
Results
Upon completion of the study, the control and treated eyes had PCO and new lens material (not residual). Anterior capsule proliferation was observed in eyes treated with 5-FU. The order of PCO appearance (earliest to latest) was as follows: 15 mM EDTA, SHA, MMC, acetic acid 0.3%, acetic acid 3%, BSS, distilled water (small animals; no MCV), acetic acid 0.003%, 5-FU, 10 mM EDTA, and distilled water (large animals; MCV). The earliest appearance was day 1 postoperatively and the latest, day 47.
Conclusions
Distilled water and 10 mM EDTA treatments were the most efficient in retarding the appearance of PCO.

Posted by mmiraftab at 06:21 PM | Comments (5)

Continuous monitoring of corneal thickness changes during LASIK with online optical coherence pachymetry

Journal of Cataract & Refractive Surgery Volume 30, Issue 12 , December 2004, Pages 2559-2568

In this prospective nonrandomized comparative clinical case series of consecutive patients, 32 eyes having LASIK for myopia, myopic astigmatism, or hyperopia were continuously monitored intraoperatively in real time with online OCP integrated into a clinical excimer laser. The intraoperative values were compared to the postoperative flap and residual stromal thicknesses measured with corneal optical coherence tomography (OCT) as well as the calculated myopic ablation depth.
Results
Continuous monitoring with online OCP enabled intraoperative visualization of the CCT changes during LASIK. The CCT, flap thickness after the microkeratome pass, time-resolved ablation, and residual stromal thickness were assessed. Intraoperatively, the mean flap thickness was 135 μm ± 38 (SD) and the mean residual stromal thickness, 286 ± 59 μm. The mean intraoperative flap and residual stromal thickness values were 43.7 μm and 15.4 μm lower, respectively, than the postoperative values assessed with corneal OCT (P<.001 and P = .005, respectively). The optically determined myopic ablation depth was 118 ± 37 μm, which was 28 μm higher than the nominal ablation depth. There was a significant correlation (P<.001) between the postoperative flap (r = 0.79) and residual (r = 0.88) thickness measured with corneal OCT as well as the calculated myopic ablation depth (r = 0.95).
Conclusions
Intraoperative online OCP could be an important safety feature to monitor the flap and residual stromal thicknesses during LASIK. The individual ablation depth and possible dehydration effects were also monitored continuously.

Posted by mmiraftab at 06:14 PM | Comments (0)

December 23, 2004

Deepening of the Superior Sulcus After Isolated Lower Transconjunctival Blepharoplasty.

Ophthalmic Plastic & Reconstructive Surgery., November 2004.
Retrospective case review and prospective measurement of the amount of fat resected in isolated laser lower blepharoplasty in 39 patients.
Significant deepening of the superior sulcus occurred in 10% of CO2 laser lower transconjunctival blepharoplasties. The amount of fat resected ranged from 0.4 to 0.9 ml per eyelid, with an average of 0.55 ml.
Conclusions: Upper eyelid changes may be an overlooked result of CO2 laser lower transconjunctival blepharoplasty.

Posted by afarahi at 08:22 PM | Comments (0)

December 22, 2004

Incidence of Postblepharoplasty Orbital Hemorrhage and Associated Visual Loss.

Ophthalmic Plastic & Reconstructive Surgery., November 2004.
Orbital hemorrhage, especially when associated with visual loss, is a significant complication of cosmetic eyelid surgery. We investigated the incidence of this complication among cases handled by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery.
Two hundred thirty-seven responses were received ,representing 269,433 cases. Among these cases, there were 149 orbital hemorrhages, 48 cases associated with temporary visual loss, and 12 cases associated with permanent visual loss. The majority of these cases occurred within the first 3 hours of surgery, and the risk decreased significantly after 24 hours after surgery. Common comorbidities were hypertension, perioperative aspirin use, postoperative vomiting, and increased physical activity. Treatment commonly consisted of wound drainage with cauterization of active bleeders, lateral canthotomy, intravenous steroids, and intraocular pressure-lowering drugs. Orbital decompression was infrequently used; anterior chamber paracentesis was not used. This study is limited by recall biases regarding the number of cases performed by each responding surgeon and the number of relevant cases of orbital hemorrhage.
Conclusions: The incidence of orbital hemorrhage associated with cosmetic eyelid surgery is 0.055% (1:2,000), and orbital hemorrhage with permanent visual loss is 0.0045% (1:10,000). Development of orbital hemorrhage is most common within the first 24 hours after surgery, especially within the first 0 to 3 hours, but can occur as late as several days after surgery.

Posted by afarahi at 12:48 AM | Comments (0)

Radiosurgery Versus Conventional Surgery for Dermatochalasis.

Ophthalmic Plastic & Reconstructive Surgery. , November 2004.
A prospective study of 13 patients with dermatochalasis who underwent radiosurgery in one upper eyelid and conventional surgery with scalpel and scissors in the contralateral eyelid ,was performed. Hemorrhage and wounds were evaluated after surgery the same day, 1 week later, and 3 months after surgery by a masked observer.A tendency toward better wound healing and a higher Hollander score at 1 week after radiosurgery (p = 0.014) and no significant differences in wound healing and hemorrhage between radiosurgery and the conventional technique was found.
Conclusions: Both radiosurgery and conventional surgery for dermatochalasis showed good results at the 3-month follow-up.

Posted by afarahi at 12:28 AM | Comments (0)

December 21, 2004

NeoSoniX ultrasound versus ultrasound alone for phacoemulsification: Randomized clinical trial

jcrs
To evaluate the difference in consumption of ultrasound (US) energy required with NeoSoniX® (Alcon) in conjunction with US (NeoSonix US) versus US alone.
This prospective randomized study comprised 120 consecutive eyes having phacoemulsification with the Alcon Legacy® 20000® Two groups of 60 eyes each were formed based on cataract grade according to the Emery classification: grade 2 and 3 nuclear sclerosis (Group A) and grade 4 and 5 nuclear sclerosis (Group B). In each group, 30 eyes had phacoemulsification using NeoSoniX US and 30 eyes, using US alone. The main parameters were intraoperative US time and mean US power. Effective phaco time (EPT) was calculated by multiplying the US time and mean US power and dividing the product by 100. The unpaired Student t test was used to evaluate the differences between NeoSoniX US and US alone. The corresponding 95% confidence intervals were calculated.Conclusions: Ultrasound energy consumption with NeoSoniX was significantly less than with US alone, indicating the value of NeoSoniX in emulsifying cataracts of optimum density and dense hard cataracts. Combining NeoSoniX and US significantly reduced the consumption of US energy.

Posted by alireza habibollahi at 11:00 PM | Comments (0)

Complications associated with anterior basement membrane dystrophy after LASIK

To evaluate the complications associated with anterior basement membrane dystrophy(ABMD)LASIK.
In this noncontrolled retrospective case series, the medical records of all patients with LASIK complications seen in the Cornea Service at Wills Eye Hospital from January 1, 1998, to December 31, 2002, were reviewed. All patients who presented with ABMD changes after LASIK were included in the study. Patients with a history of trauma before or after surgery were excluded.Conclusions: ABMD changes post LASIK were associated with visual complaints and/or recurrent erosions. Patients should be carefully screened for ABMD. Those who have ABMD signs or symptoms may not be ideal candidates for LASIK.

Posted by alireza habibollahi at 10:50 PM | Comments (0)

Addition Technology, Inc. Reports Significant Increase in Keratoconus Inserts for Surgical Correction

Optometry and visual science Dec 2004
Addition Technology, Inc. announced that third quarter 2004 sales of Intacs prescription inserts in the U.S. increased 61% as compared with the same quarter of the prior year. “Since the July FDA approval of Intacs for the treatment of keratoconus, we have seen strong growth and a significant increase in the number of surgeons performing the procedure,” said William M. Flynn, President and Chief Executive Officer of Addition Technology. In 20% of keratoconus cases, a corneal transplant has been the only medical course of action.

Posted by mmiraftab at 05:50 PM | Comments (0)

Corneal Melt After Amniotic Membrane Transplant

Cornea. 24(1):106-107, January 2005
Methods: Retrospective review of the clinical and surgical records of a 43-year-old man who developed melting of his corneal graft after amniotic membrane transplantation.
Results: Melting of a corneal graft after amniotic membrane transplantation was arrested by utilizing a tectonic, full-thickness corneal button denuded of endothelium in conjunction with a temporary tarsorraphy and systemic steroids.
Conclusions: To the best of our knowledge, this is the first report of an eye-threatening complication associated with amniotic membrane grafting. Caution should be exercised in utilizing amniotic membrane in patients who have undergone multiple ophthalmologic surgical procedures, which may sensitize the ocular immune system or lead to localized ischemia

Posted by mmiraftab at 05:31 PM | Comments (0)

Pathologic Findings in Postmortem Corneas After Successful Laser In Situ Keratomileusis

Cornea. 24(1):92-102, January 2005
Purpose: To examine the histologic and ultrastructural features of human corneas after successful laser in situ keratomileusis (LASIK).
Methods: Corneas from 48 eyes of 25 postmortem patients were processed for histology and transmission electron microscopy (TEM). The 25 patients had LASIK between 3 months and 7 years prior to death. Evaluation of all 5 layers of the cornea and the LASIK flap interface region was done using routine histology, periodic acid-Schiff (PAS)-stained specimens, toluidine blue-stained thick sections, and TEM.
Results: In patients for whom visual acuity was known, the first postoperative day uncorrected visual acuity was 20/15 to 20/30. In patients for whom clinical records were available, the postoperative corneal topography was normal and clinical examination showed a semicircular ring of haze at the wound margin of the LASIK flap. Histologically, the LASIK flap measured, on average, 142.7 [mu]m (range, 100-200). A spectrum of abnormal histopathologic and ultrastructural findings was present in all corneas. Findings at the flap surface included elongated basal epithelial cells, epithelial hyperplasia, thickening and undulations of the epithelial basement membrane (EBM), and undulations of Bowman's layer. Findings in or adjacent to the wound included collagen lamellar disarray; activated keratocytes; quiescent keratocytes with small vacuoles; epithelial ingrowth; eosinophilic deposits; PAS-positive, electron-dense granular material interspersed with randomly ordered collagen fibrils; increased spacing between collagen fibrils; and widely spaced banded collagen. There was no observable correlation between postoperative intervals and the severity or type of pathologic change except for the accumulation the electron-dense granular material.
Conclusions: Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK

Posted by mmiraftab at 05:24 PM | Comments (0)

Small-Incision Deep Lamellar Endothelial Keratoplasty (DLEK): Six-Month Results in the First Prospective Clinical Study

Cornea. 24(1):59-65, January 2005

Purpose: To evaluate the visual, topographic, and endothelial survival results in 25 consecutive patients who have received small-incision deep lamellar endothelial keratoplasty (DLEK) transplant surgery.
Methods: DLEK surgery was performed in 25 patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy utilizing a 5-mm scleral access incision. Snellen visual acuities, refractive astigmatism, endothelial cell counts, and corneal topography were prospectively measured at preop and at 6 months after small-incision DLEK endothelial replacement surgery.
Results: Best spectacle-corrected visual acuity improved from an average of 20/90 (range 20/25 to 2'/200) before surgery to an average of 20/44 (range 20/25 to 20/200, P < 0.001) 6 months after surgery, with 56% of patients 20/40 or better at 6 months. Average refractive astigmatism at 6 months was 1.31 +/- 0.59 diopters (range 0.25 to 2.50 diopters), representing an average increase in astigmatism of 0.45 diopters from preop. Despite folding of the donor graft for placement into the recipient posterior lamellar bed, the average postoperative endothelial cell count at 6 months was 2122 +/- 510 cells/mm2 (range 1097 to 3202 cells/mm2) or an average 24% cell loss from donor eye preop measurements, a level of cell loss comparable to that reported after PK or after large-incision DLEK surgery.
Conclusion: Small-incision DLEK surgery preserves the recipient corneal topography, resulting in very little change in astigmatism from preop. The excellent postoperative donor endothelial cell counts attest to the survival of donor endothelium despite folding of the graft for insertion. The small-incision DLEK technique may become the standard for endothelial replacement surgery in the future.

Posted by mmiraftab at 05:22 PM | Comments (0)

December 20, 2004

Prediction of postoperative visual outcome based on hole configuration by optical coherence tomography in eyes with idiopathic macular holes

To evaluate whether an index based on hole configuration can be used to predict visual outcome in eyes with idiopathic macular holes, in a prospective interventional case series, thirty-five eyes of 32 patients with idiopathic stage 2 or 3 macular hole were enrolled. The best-corrected visual acuity (BCVA), cross-sectional image of the macular hole by optical coherence tomography (OCT), and retinal thickness in the central (<1000 μm), inner (1000 to 2220 μm), and outer ring areas (2220 to 3450 μm) as defined by the OCT retinal mapping program were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively. The change in retinal thickness of the inner ring area at the 6-month postoperative period was used to evaluate the degree of preoperative retinal deformation. The macular hole index (MHI) (ratio of hole height to base diameter of hole) was calculated and correlated with minimum diameter of hole, base diameter of hole, the postoperative decrease in macular thickness, and the postoperative BCVA.The results showed that, postoperative BCVA in the MHI ≥0.5 group was better than that in the MHI <0.5 group (P = .032, Mann-Whitney test). The MHI represents the preoperative configuration of a macular hole and is a prognostic factor for visual outcome.

Posted by kjalali at 10:45 PM | Comments (73)

December 19, 2004

Corneal edema and intraocular pressure after cataract surgery: Randomized comparison of Healon5 and Amvisc Plus

To compare the protective effect of Healon®5 (sodium hyaluronate 2.3%) and Amvisc Plus® (sodium hyaluronate 1.6%) against corneal edema and their association with postoperative intraocular pressure (IOP) spikes in patients having phacoemulsification and intraocular lens (IOL) implantation.
One hundred forty patients were randomly assigned to have surgery with Healon5 (n = 70) or Amvisc Plus (n = 70). One eye of each patient was analyzed. Data collected preoperatively included best corrected visual acuity (BCVA) and IOP. Central ultrasonic pachymetry was performed in all patients. The same ophthalmologist performed all surgeries. The IOP and central corneal thickness (CCT) were measured 1 and 4 days and 1 month after surgery. The BCVA was also assessed at 1 month.Conclusions: Both OVDs were beneficial in a wide range of cataract patients. However, the results suggest a tendency toward a higher complication rate with Healon5.

Posted by alireza habibollahi at 10:34 PM | Comments (49)

Incidence of and risk factors for residual posterior capsule opacification after cataract surgery

To evaluate the incidence of and determine the risk factors for residual posterior capsule opacification (PCO).

Conclusions: Results indicate that aggressive polishing of peripheral or adherent residual capsule opacities is not advisable as only 5 eyes with central residual capsule opacities developed visually significant PCO

Posted by alireza habibollahi at 10:23 PM | Comments (0)

Incidence of and risk factors for residual posterior capsule opacification after cataract surgery

To evaluate the incidence of and determine the risk factors for residual posterior capsule opacification (PCO).

Conclusions: Results indicate that aggressive polishing of peripheral or adherent residual capsule opacities is not advisable as only 5 eyes with central residual capsule opacities developed visually significant PCO

Posted by alireza habibollahi at 10:23 PM | Comments (16)

Incidence of and risk factors for residual posterior capsule opacification after cataract surgery

To evaluate the incidence of and determine the risk factors for residual posterior capsule opacification (PCO).

Conclusions: Results indicate that aggressive polishing of peripheral or adherent residual capsule opacities is not advisable as only 5 eyes with central residual capsule opacities developed visually significant PCO

Posted by alireza habibollahi at 10:23 PM | Comments (0)

December 18, 2004

Intacs OK’d for treating keratoconus

OSN 2004
Intacs corneal ring segments have been granted a humanitarian device exemption by the Food and Drug Administration for use in patients with keratoconus, the device’s manufacturer announced yesterday.
The FDA approval is “based on Intacs’ excellent safety record, the relatively low number of U.S. patients affected by the disease and the fact that no other treatment options exist for these patients other than an invasive corneal transplant procedure,” Addition Technologies said in a press release. Intacs was granted the humanitarian exemption for the “reduction or elimination of myopia and astigmatism in patients with keratoconus, where functional vision is no longer achievable with their contact lenses or eyeglasses,” the release said.
Brian S. Boxer Wachler, MD, said in a separate press release that procedure guidelines he and colleagues published last year were adopted for the technique by the FDA. Dr. Boxer Wachler said between 1 in 1,000 and 1 in 2,000 people in the United States are affected by keratoconus.

Posted by mmiraftab at 10:21 PM | Comments (0)

Microperimetry — comparison between the micro perimeter 1 and scanning laser ophthalmoscope — fundus perimetry

American Journal of Ophthalmology

Purpose
To compare microperimetry using the scanning laser ophthalmoscope (SLO, Rodenstock, Germany) and the recently introduced Micro Perimeter 1 (Nidek Technologies, Italy).
Methods
Fundus perimetry with static threshold perimetry was performed using the SLO and the MP1 in 68 eyes of 40 consecutive patients with different retinal diseases for example, central serous chorioretinopathy, macular dystrophy, and age-related macular degeneration. With both instruments, an automated 4–2-1 staircase strategy with Goldmann III stimuli and a comparable number of stimuli were applied. The depth and size of the detected scotomata as well as the location and stability of fixation were compared between both instruments.
Results
There was good concordance of results, with 75% (51 of 68 eyes) showing an equal defect. Whereas the MP1 showed larger defects (depth and size) in 23.5% (16/68) of eyes studied than the SLO, the defects appeared larger with the SLO in 1 eye. Concerning fixation analysis, similar results were found for fixation stability with stable fixation in 47.1% (MP1: 32/68) and 48.5% (SLO: 33/68) and likewise for the location of fixation with foveal fixation in 54.4% (37/68) with the MP1 and the SLO. Whereas the average number of stimuli was similar for both instruments (MP1 56.8 ±16.1, SLO 62.9 ± 17.0), examination time was prolonged with the MP1 (MP1: 11m35s ± 3m47s, SLO: 10m29s ± 3m23s). Throughout all examinations, fundus visualization with the SLO was superior to the MP1.
Conclusions
For automated threshold microperimetry the MP1 provides results comparable to our SLO perimetry. Both instruments enable detection of sensitivity loss of the central visual field and an analysis of fixation behavior during microperimetry. Nevertheless, the MP1, with its automated real-time image alignment, facilitates examination. Additionally, the enlarged field allows testing in an area of 44 × 36 degrees instead of the 33 × 21 degree-area of the SLO. However, in comparison to our SLO-software, the current software of the MP1 requires improvements before exact measurements of defined retinal diseases are possible.

Posted by mmiraftab at 10:14 PM | Comments (34)

December 17, 2004

Mycobacterium chelonae Wound Ulcer After Clear-Cornea Cataract Surgery

Arch Ophthalmol. 2004;122:1888-1889

An 81-year-old woman developed a wound infiltrate 3 weeks after clear-cornea cataract surgery in the right eye. Initial improvement with topical ofloxacin and corticosteroid was followed by development of a satellite lesion. On consultation, a corneal infiltrate with a crystalline appearance was seen near the surgical wound. Acid-fast stain showed acid-fast bacilli and cultures grew Mycobacterium chelonae, which is sensitive to the following (in order of sensitivity, from greatest to least): clarithromycin, ciprofloxacin, tobramycin, and amikacin. The ulcer improved with topical amikacin sulfate and oral clarithromycin. Six weeks after diagnosis, a pars plana vitrectomy was performed for severe vitreous inflammation. Smears and culture of the vitreous body were negative for microorganisms. Two months later, the patient developed iritis, which responded to low-dose topical corticosteroids. As of this report, the cornea has remained quiet after 1 year of follow-up

Posted by mmiraftab at 07:19 PM | Comments (28)

Dreams of Canalostomies

Arch Ophthalmol. 2004;122:1868-1869

Despite the paucity of sound clinical data, partial-thickness trabeculosclerectomy continues to tantalize the glaucoma surgeon with the hope of blebless, dropless control of intraocular pressure. Some surgeons argue that a higher pressure is safe for some patients, but unfortunately, we cannot yet positively identify the chosen few. Other surgeons concentrate on further technical modifications by enlarging and maintaining the intrascleral reservoir, separated by microns from the anterior chamber by a window of anterior trabeculum and Decemet membrane. When accompanied by a postoperative laser puncture of the window, this "deep sclerectomy" seems to produce better results, but a recent survey of the European Glaucoma Society suggested that most of its members (80%) continue to rely on conventional trabeculectomy.6 None surveyed were using viscocanalostomy (confirmed in a written communication with Andre Mermoud, 2004).
The experimental data from 4 monkeys reported by Tamm and colleagues7 in this issue seem to confirm the clinical impression that viscocanalostomy is capricious.

Posted by mmiraftab at 06:33 PM | Comments (33)

December 16, 2004

SUDDEN VISUAL LOSS AFTER REMOVAL OF SILICONE OIL

Seven patients with visual loss after removal of silicon oil were investigated with best-corrected Snellen visual acuity (BCVA) assessment, fundus biomicroscopy, fluorescein angiography, optical coherence tomography, and electrophysiologic examination. Six men and one woman (average age, 42.8 years.) presented with profound BCVA loss, averaging 4.7 Snellen lines (SD 1.4), after silicon oil removal. No other complications associated with oil removal were noted. The retina remained attached in all cases, no patient developed cystoid macular edema or epiretinal membrane, and optical coherence tomographic and fluorescein angiographic findings remained normal. Electrodiagnostic testing showed a range of abnormalities, with the majority of patients showing severe macular dysfunction. The pathogenesis remains obscure.

Posted by kjalali at 02:41 PM | Comments (23)

INTRAVITREAL CONCENTRATION AND CLEARANCE OF TRIAMCIN

To determine the intravitreal concentration and clearance of triamcinolone acetonide at various intervals after intravitreal injection into nonvitrectomized eyes, six participants were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. All six eyes underwent therapeutic pars plana vitrectomy with membranectomy at various post injection intervals ranging from 1.25 to 5 months from the intravitreal injection. Undiluted specimens of vitreous overlying the macula and of aqueous humor were submitted for analysis. Vitreous and aqueous humor concentrations of triamcinolone were measured by high performance liquid chromatography.The study showed that intravitreal concentration of triamcinolone acetonide is detectable up to 2.75 months post a single 4 mg injection in nonvitrectomized eyes. A reinjection interval of 3 months may be needed to achieve sustained measurable levels of triamcinolone in nonvitrectomized patients.

Posted by kjalali at 02:37 PM | Comments (17)

RETROBULBAR INJECTION OF METHYLPREDNISOLONE IN DIFFUSE DIAB

To study some aspects of locally and extraocularly administered methylprednisolone on diffuse diabetic macular edema. In 13 diabetic subjects, one eye received treatment, and the other eye served as control. Standardized visual acuity as well as the presence of clinically significant macular edema was recorded before and several times after retrobulbar injection of methylprednisolone. The follow-up period was at least 6 months. The study showed that retrobulbar injection of methylprednisolone increased visual acuity significantly in diabetic subjects with diffuse macular edema. A significant reduction in the number of eyes with clinically significant macular edema was also observed.

Posted by kjalali at 02:26 PM | Comments (24)

December 15, 2004

Early postop cloudiness of IOLs attributed to storage conditions

Recently performed analyses of explanted silicone IOLs led to the conclusion that environmental factors in storage areas may be responsible for changes in IOLs, leading to their opacification shortly after implantation. Significant opacification of the lenses’ optical component was observed as early as 7 hours after the surgery. It has been postulated that, during the cleaning and disinfection of storage rooms, aerosolized or volatile solutions may be inadvertently introducing chemicals through the package and onto the lenses.

Posted by kjalali at 08:14 PM | Comments (25)

December 13, 2004

xsorb plug

CRS Today DEC 2004

Medennium, Inc.(Irvine, CA), introduces its new Xsorb punctal plug for the temporary occlusion in cataract and refractive surgery patients. The synthetic,absorbable plugs are manufactured in three sizes,all 2mm in length,with diameters of either 0.3, 0.4, or 0.5mm.

Posted by mmiraftab at 06:44 PM | Comments (15)

December 11, 2004

Incision site key to corneal aberrations after cataract surgery

OSN Dec 2004

Small-incision cataract surgery does not degrade the optical quality of the anterior corneal surface, but it induces changes in some orders of optical aberration. The location of the incision is a key factor in optical changes in the cornea after surgery. Antonio Guirao and colleagues obtained corneal topography maps of 70 eyes of 70 patients before and after cataract surgery. All eyes were implanted with a monofocal foldable IOL after phacoemulsification through a clear corneal 3.5-mm incision without suture. Pre- and postoperative aberrations, calculated by ray tracings from the topography images, were compared in each patient, and the optical changes induced by surgery were investigated. The root mean square of the wave aberration slightly increased on average after surgery, from 0.65 µm to 0.85 µm. Most of the individual aberration terms (coma, trefoil, etc.) were similar before and after surgery when averaged across the 70 eyes. Taken individually, however, each patient had changes after surgery in the magnitude of aberrations or in the orientation of the aberrations. The mean induced astigmatism was –1 D at the orientation of the surgical meridian, and induced trefoil also showed a predominant pattern at this direction. Patients who had nasal incisions demonstrated larger changes.

Posted by mehdi khanlari at 11:45 PM | Comments (20)

Cataract surgery in sympathetic ophthalmia requires inflammation control

OSN Dec 2004

Vigilant control of inflammation preoperatively and postoperatively is needed for a successful visual outcome of cataract surgery in patients with sympathetic ophthalmia, according to a study in India. Even with careful planning and meticulous technique, final visual outcomes depend on the posterior segment complications of the disease.Research Foundation in Chennai studied 132 eyes of 66 patients with sympathetic ophthalmia, of which 42 eyes (31.8%) had cataract. The patients were seen over the course of 11 years, from 1990 to 2001. Cataract surgery was performed in 17 sympathizing eyes and one exciting eye of 17 patients. Three of the eyes underwent extracapsular cataract extraction with IOL implantation, six underwent ECCE without IOL implantation and nine underwent phacoemulsification with IOL implantation. Follow-up ranged from 3 to 60 monthsPenetrating trauma was the leading cause of the sympathetic ophthalmia, followed by ocular surgery, perforated corneal ulcer and cyclocryotherapy. The most common cataract type, occurring in seven eyes, was mixed posterior subcapsular and posterior polar.Visual acuity improved in 13 eyes after surgery (72.2%). The main factors impeding visual recovery were submacular scar and optic atrophy, which were sequelae of the sympathetic ophthalmia. Posterior capsular opacification occurred in 14 eyes (77.7%) and was visually significant in six eyes, the authors said.

Posted by mehdi khanlari at 11:39 PM | Comments (36)

New vehicle based on a microemulsion for topical ocular administration of dexamethasone

Clinical & Experimental Ophthalmology Volume 32 Issue 6 Page 626 - December 2004

Aim:Eye drops are the most used dosage form by the ocular route, in spite of their low bioavailability. Due to their properties and numerous advantages, microemulsions are promising systems for topical ocular drug delivery. They can increase water solubility of the drug and enhance drug absorption into the eye. The present study describes the development and characterization of an oil-in-water microemulsion containing dexamethasone and the evaluation of its pharmacokinetics in rabbits after topical ocular application.
Methods:The microemulsion was prepared by the titration technique. Its physico-chemical characteristics and stability were determined. The ocular irritation test and the pharmacokinetics of this system were studied in white rabbits.
Results:The developed system showed an acceptable physico-chemical behaviour and presented good stability for 3 months. The ocular irritation test used suggested that the microemulsion did not provide significant alteration to eyelids, conjunctiva, cornea and iris. This formulation showed greater penetration of dexamethasone in the anterior segment of the eye and also release of the drug for a longer time when compared with a conventional preparation. The area under the curve obtained for the microemulsion system was more than twofold higher than that of the conventional preparation (P < 0.05).
Conclusions:The microemulsion-based dexamethasone eye drop is advantageous for ophthalmic use because it is well-tolerated in the eye and seemed to provide a higher degree of bioavailability. The developed system shows greater penetration in the eye, allowing the possibility of decreasing the number of applications of eye drops per day.

Posted by mmiraftab at 06:28 PM | Comments (46)

Wavefront-guided LASIK with the Zyoptix 3.1 system for the correction of myopia and compound myopic astigmatism with 1-year follow-up(Clinical outcome and change in higher order aberrations)

Ophthalmology Volume 111, Issue 12 , December 2004, Pages 2175-2185

Objective
To assess safety, efficacy, predictability, stability, and change in aberrations after wavefront-guided LASIK for myopia and myopic astigmatism.
Design
Prospective, nonrandomized, self-controlled trial.
Participants
Wavefront-guided LASIK was performed in 97 eyes in a 1-year trial. Treated eyes had a mean subjective manifest spherical equivalent (SE) of −5.22±2.07 diopters (D), with a range of −0.25 to −9.00 D of myopia and 0 to −3.25 D of astigmatism.
Intervention
After a microkeratome cut, a wavefront-based excimer ablation (Zyoptix 3.1) was performed. The full treatment to achieve emmetropia of an early nomogram provided by the system manufacturer was used in all procedures.
Main outcome measures
Safety, efficacy, predictability, and stability were evaluated at 1, 3, and 12 months postoperatively. Wavefront changes of higher order aberrations (HOAs) at 1 year were determined for pupil sizes of 3.5 and 6 mm.
Results
At 1 year postoperatively, uncorrected visual acuity (VA) was 20/20 or better in 83% of the eyes, and 20/40 or better in 98%. The mean subjective manifest SE at 1 year was −0.25±0.43 D; it was within 0.50 D in 77% and within 1.0 D in 95%. No eye lost ≥2 lines of best spectacle-corrected VA (BSCVA) at 1 year postoperatively; 40 eyes gained 1 line of BSCVA, and 5 eyes gained 2 lines. The total HOA root mean square (RMS) increased on average by a factor of 1.23±0.57 with a 3.5-mm pupil; for the 6 mm pupil, the increase factor was 1.52±0.36. No change or reduction in the total HOA RMS was observed in 45.5% of the eyes for a 3.5-mm pupil and in 20.6% for a 6-mm pupil. There was a significant increase of primary spherical aberration (Z 4,0) by a factor of 4.11±10.17 for 3.5-mm pupils and 4.31±6.76 for 6-mm pupils.
Conclusions
Wavefront-guided LASIK using Zyoptix 3.1 is an effective and safe procedure for the treatment of myopia and myopic astigmatism. Although in close to half of the eyes HOAs could be reduced, there was still undercorrection and induction of HOAs with the algorithm employed.

Posted by mmiraftab at 06:24 PM | Comments (39)

December 09, 2004

Modified Hughes flap: Division at 7 days

Ophthalmology,December,2004
Twenty-nine eyelids of 29 consecutive patients operated using the modified Hughes flap and full-thickness skin graft for lower eyelid reconstruction after Mohs micrographic surgery, over a 4-year period.
In all patients, the pedicle of the Hughes flap was divided 1 week after the primary operation.
The mean follow-up period was 14±6 months .There were no cases of lower eyelid retraction, flap ischemia, or necrosis after division. Postoperative complications included lower eyelid margin erythema in 2 patients (6.9%), upper eyelid lash ptosis in 3 patients (10.3%), and upper eyelid lateral retraction in 1 patient (3.4%).
Conclusion:Early division of the tarsoconjunctival pedicle of a modified Hughes flap at 1 week does not compromise the viability of the reconstructed lower eyelid and results in a good functional and cosmetic outcome.

Posted by afarahi at 01:54 PM | Comments (20)

Sutureless Transconjunctival Repair of Orbital Blowout Fractures.

Ophthalmic Plastic & Reconstructive Surgery. , November 2004.
Twenty-six patients (16 male, 10 female) underwent repair of isolated orbital floor blowout fractures with placement of nonfixed implants through a transconjunctival and sutureless incision and were followed after surgery for 1 to 26 months. No eyelid malposition, infection, or implant extrusion occurred. However, 1 patient (3.8%) had early migration of the orbital implant that did not require further intervention.
Conclusions: Repair of orbital floor blowout fractures with a nonfixed implant through the transconjunctival approach and sutureless closure provides an excellent functional and cosmetic result.

Posted by afarahi at 01:38 PM | Comments (26)

Blindness From Acute Angle-Closure Glaucoma After Blepharoplasty

Ophthalmic Plastic & Reconstructive Surgery. , November 2004.
An elderly man had acute angle-closure glaucoma soon after undergoing bilateral lower eyelid blepharoplasty that resulted in complete loss of vision in one eye. Glaucoma is a rare complication of blepharoplasty surgery; only two previous cases have been reported to our knowledge

Posted by afarahi at 01:33 PM | Comments (28)

December 08, 2004

Pupil Size Before and After Phacoemulsification in Nondiabetic and Diabetic Patients

JCRS Dec 2004

Investigators in this study considered whether there is an association between pre-operative and post-operative pupil size in nondiabetic and diabetic patients. The consecutive study included 315 nondiabetic patients and 71 diabetic patients scheduled to undergo phacoemulsification. One association investigators found was that in both groups, following phacoemulsification pupil size decreased, but by the one month mark had returned to pre-operative levels. Also, post-operatively diabetic patients had smaller pupils than their nondiabetic counterparts, although pre-operatively there was no significant difference. With increasing severity of diabetic retinopathy pupil size also became smaller. In the nondiabetic group, there was also a weak association between younger age and larger pupils.

Posted by mehdi khanlari at 11:31 PM | Comments (40)

Improvement in Best Corrected Visual Acuity in Amblyopic Adult Eyes after Laser in Situ Keratomileusis

JCRS Dec 2004

In this study, charts of 19 consecutive adult amblyopic patients (21 eyes) were retrospectively reviewed, to evaluate improvement in best spectacle-corrected visual acuity. Of these patients, eight were diagnosed with amblyopia only, six with anisometropic amblyopia, four with strabismic amblyopia and one with anisometropic and strabismic amblyopia. In the study 52.4% of patients had myopic astigmatism, 33.3% were hyperopic and 14.3% had mixed astigmatism. Investigators ultimately found that following LASIK, in 33.3% eyes post-operative UCVA improved by one line compared with pre-operative BSCVA (best spectacle corrected visual acuity). Also, in 42.8% of eyes there was more than a one line improvement in postoperative BSCVA compared with preoperative BSCVA. Following the LASIK procedure vision remained unchanged in 52.4% of eyes and decreased by two lines in 4.1% of eyes.

Posted by mehdi khanlari at 11:27 PM | Comments (44)

Diquafosol reduced signs, symptoms of dry eye in randomized trial

OSN Dec 2004

In a double-masked, parallel group trial, reaserchers randomized 527 patients with dry eye to receive either diquafosol 1%, diquafosol 2% or placebo, instilled four times daily for 24 weeks. The main study outcomes included corneal staining, conjunctival staining, Schirmer tests and subjective symptoms of dry eye. Patients were allowed to use artificial tears if necessary. Patients treated with 2% diquafosol had significantly lower corneal staining scores at the 6-week primary efficacy time point compared with patients taking placebo. This superiority was maintained throughout the study. Reductions in corneal staining were seen as early as the 2-week mark and were observed to worsen slightly after treatment cessation at week 25. Similar results were seen for conjunctival staining. Schirmer test scores were statistically significantly higher at week 6 with diquafosol treatment than with placebo (P < .03). The percentage of patients treated with 2% diquafosol with clearing of foreign body sensation at week 6 (21%) was higher than the percentage of those receiving placebo (15%), but the difference did not achieve statistical significance. The 2% concentration was shown to provide “significantly lower corneal staining scores earlier in treatment than the 1% concentration and had a more pronounced effect on symptom reduction. Although 2% diquafosol had a slightly higher incidence of burning and stinging on instillation than 1% diquafosol, the differences were not compelling and rarely led to withdrawal from therapy.

Posted by kjalali at 08:44 AM | Comments (65)

December 05, 2004

IOPac Advanced

Eyeworld Dec 2004

The original IOPac has been available for more than a year now, but its twin sibling, the IOPac Advanced, just hit the markets in October. Both the IOPac Standard and IOPac Advanced, offered by Heidelberg Engineering (Vista, Calif.), are small, lightweight pachymeters based on Palm technology that can measure a patient’s corneal thickness. “It’s small enough to fit in a doctor’s pocket literally or the technician’s lab coat pocket,” Meanwhile, many other pachymeters weigh substantially more—5 lbs. or so—and patients usually come to them instead of vice versa The IOPac allows the doctor or technician to go right to the patient, and from an office efficiency standpoint it is always better to leave the patient in one place and get everything done rather than to move the patient from station to station,” . According to company officials, the IOPac Advanced can offer the following new features:
• Offers five different IOP calculation formulas. In other words, although it does not read IOP, you can plug a patient’s IOP into the IOPac Advanced and based on the machine’s reading of the pachymetry, it will calculate the corrected IOP;
• Store patient data;
• Prints; and
• Offers a refractive module, which would allow one to measure the corneal thickness in more than the central location (to determine if a patient is a good LASIK candidate, for instance).
Dr. Berlin said he has had a very favorable experience with the standard IOPac.

Posted by mehdi khanlari at 10:50 PM | Comments (12)

Effect of anterior capsule polishing on fibrotic capsule opacification: Three-year results

JCRS NOV 2004
Austria.
To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO).
Conclusions: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.

Posted by alireza habibollahi at 09:31 PM | Comments (15)

Early changes in corneal sensation, ocular surface integrity, and tear-film function after laser-assisted subepithelial keratectomy

JCRS NOV 2004

Austria,To investigate the changes in corneal sensation, ocular surface integrity, and tear-film function after LASEK.
The subjective score for dry-eye symptoms was not statistically significantly higher after the procedure. Corneal sensation was reduced up to 1 month after LASEK (P<.05). There were obvious decreases in BUT at 1 week and 1 month (P<.01) and no significant changes in Schirmer test results. In fluorescein staining of the cornea, dots were more concentrated at 1 week (P<.05). In lissamin-green staining, no significant changes were found at any follow-up examination.Conclusions: LASEK induced a short-term reduction in corneal sensation and affected the ocular surface and tear film slightly. Epithelial flap repositioning in LASEK may have a positive influence on tear-film and ocular-surface factors.

Posted by alireza habibollahi at 09:22 PM | Comments (22)

Effect of preoperative tear function on early functional visual acuity after laser in situ keratomileusis

JCRS NOV 2004

Tokyo, Japan,the effect of preoperative tear function on early changes in functional visual acuity (FVA) after laser in situ keratomileusis (LASIK).
Conclusion: LASIK patients with low basal tearing and full uncorrected distance Landolt acuity may experience a transient decrease in FVA that returns to baseline within 1 week

Posted by alireza habibollahi at 09:15 PM | Comments (45)

December 04, 2004

Clinical Photoablation With a 500-Hz Scanning Spot Excimer Laser

Journal of Refractive Surgery Vol. 20 No. 6 November/December 2004

PURPOSE
The aim of this study was to use a 500-Hz scanning spot laser (Concept500, WaveLight Laser Technologie AG, Erlangen, Germany) to investigate potential side effects that might be associated with the use of a high repetition rate laser platform.
METHODS
Seven eyes were treated using a 500-Hz scanning spot laser for laser in situ keratomileusis (LASIK). The local frequency of the ablation was kept below 40 Hz to avoid local heating of corneal tissue. With the exception of the high repetition rate (500 Hz), all other laser parameters such as fluence, algorithm, ablation profile, and spot diameter were identical to a standard WaveLight Allegretto laser system. Patients were examined at 1 month and 1 year after initial treatment. Preoperative and postoperative examination included manifest sphere and cylinder, uncorrected and best spectacle-corrected visual acuity (BSCVA).
RESULTS
All eyes were treated for myopia or myopic astigmatism. Five eyes received sphero-cylindrical and two eyes spherical ablation only. No adverse events correlated with the use of a high repetition rate laser system were observed during surgery or at any point during follow-up. All eyes maintained or had improved BSCVA at 12 months after treatment when compared to preoperative values.
CONCLUSION
The use of an excimer laser with a maximal repetition rate of 500 Hz and a local repetition rate of less than 40 Hz was free of any specific side effect that might be associated with the use of such a high repetition rate.

Posted by mmiraftab at 08:33 PM | Comments (40)

Wavefront Aberrations Associated With the Ferrara Intrastromal Corneal Ring in a Keratoconic Eye

Journal of Refractive Surgery Vol. 20 No. 6 November/December 2004

METHODS
A 32-year-old man with bilateral keratoconus had a Ferrara intrastromal corneal ring implanted in his right eye. Surgery was uneventful and both uncorrected (UCVA) and best spectacle-corrected (BSCVA) visual acuity improved. Corneal topography was performed before and after surgery. Wavefront measurements were performed 1 month after the procedure in both eyes for comparison. The point spread function, modulation transfer function (MTF), and convolved acuity chart were analyzed.
RESULTS
The right eye—implanted with the intrastromal Ferrara ring—had high root-mean-square (RMS) values for higher order aberrations. The left eye—keratoconus without an intrastromal ring—had moderate values. Point spread function, MTF, and convolution acuity charts are presented for each eye, with the latter two showing improved visual function in the implanted eye, despite a higher aberration value.
CONCLUSION
The wavefront measurement device captured aberrations even in a highly aberrated eye. Despite better UCVA and BSCVA, the Ferrara ring notably increased higher order aberrations compared to the fellow eye, but with a more uniform central pattern. In this case, the larger RMS value was a poor predictor of good visual function; other metrics better predicted the patient's subjective response. Metrics other than RMS error may be necessary to better correlate aberration value with visual satisfaction in some eyes.

Posted by mmiraftab at 08:24 PM | Comments (29)

Femtosecond lasers gain ground

Eyeworld December 2004
Additionally, investigators are looking at the devices as tools for creating astigmatism correction in the cornea and for incisions for cataract and phakic IOL surgery for creating pockets for plastic materials to go in the cornea for the correction of presbyopia. So it has multiple uses.
The major differences between the IntaLase and the Femtec devices are three-fold:
1.With a speed of 20 kilohertz versus 12.5 kilohertz, the IntraLase is a faster machine than the Femtec.
2.The other major difference between the two devices is how each one applies energy to the eye. “With the IntraLase laser, you have a little ring that has a glass cone attached to it, and that glass is flat,” he said. “The glass is touched to the cornea so that the cornea is flattened. Then the IntraLase laser creates its energy at a fixed distance from the bottom of that glass to achieve whatever it wants to achieve.The Femtec uses a curve surface and it measures the distance from that curve surface as well,” he said. “The physics of applying that energy are a little more challenging to the Femtec people, and that may be what’s slowing them down.”
3.There are other differences between the two machines, particularly in terms of the diameter of the flap that can be created. The diameter of the flap that can be created with the IntraLase is slightly larger than that of the Femtec.

Posted by mmiraftab at 08:17 PM | Comments (27)

Statins may reduce glaucoma risk

Eyeworld December 2004
Long-term use of statins, medications commonly prescribed to lower cholesterol, may be associated with a reduced risk of glaucoma among patients with cardiovascular diseases and high cholesterol, according to a recent article in the Archives of Ophthalmology.
According to information in the article, the use of statins has been associated with a lowered risk of developing age-related macular degeneration.

Posted by mmiraftab at 08:06 PM | Comments (16)

Corneal thickness may be a predictor of wavefront errors

Eyeworld December 2004
A recent study shows that low residual corneal thickness may be a predictor of increased higher-order root-mean-square (RMS) wavefront errors. The findings were presented by Gregory J. McCormick, M.D., and Scott MacRae, M.D., both of University of Rochester Medical Center, Rochester, NY. The findings were derived from a post-op aberration measurement for 33 symptomatic post-op LASIK and/or PRK eyes, which were obtained using the Zywave (Bausch & Lomb, Rochester, NY) over 6 mm pupils.
The investigators averaged measurements across patients’ eyes with similar corneal topographic diagnoses and compared those measurements with 46 successful post-op LASIK eyes. Next the investigators computed point spread functions and Strehl ratios for each group. Fourteen eyes had ultrasound corneal pachymetry measured. The average higher-order RMS wavefront errors for symptomatic patients was 1.31 ± 0.58 microns and was significantly elevated (P<.001) relative to both normal pre-op (0.38 ± 0.14 microns 3 increase) and successful post-op LASIK eyes (0.58 ± 0.21 microns 2 increase).

Posted by mmiraftab at 08:06 PM | Comments (0)

Researchers find OVDs have different silicone oil content

Eyeworld December 2004
Finding is notable considering silicone’s reputation for causing IOL complications.
Knowing that the inadvertent introduction of silicone oil into the eye during cataract surgery may be harmful, researchers recently tested the oil content of ophthalmic viscosurgical devices (OVDs).
Silicone oil an “unnecessary risk”
Surgeons know that silicone oil is used in syringes to facilitate OVD insertion into the eye, the researchers said.
“However, the OVD injected into the eye should not be contaminated with this oil,” Dr. Ohrstrom said. “Experience from vitreoretinal surgery has shown that silicone oil reacts adversely with silicone IOLs, for example, by adhering to the surface.”
Researchers concluded that Amvisc and Viscoat could be labeled as having high silicone oil content. Meanwhile, they said, Healon GV, Viscorneal and Allervisc had low silicone oil content.

Posted by mmiraftab at 02:26 PM | Comments (51)

New accommodating lens data presented SynchronyIOL is the first dual-optic accommodating IOL to be implanted in clinical trials

Eyeworld December 2004

Clinical data is now available on a new design of accommodating lens, said David F. Chang, M.D., clinical professor, University of California, San Francisco.
Preliminary clinical results with the Synchrony (Visiogen, Inc., Irvine, Calif.) accommodating IOL, which Chang said is the first dual optic accommodating lens to undergo human implantation, was presented at the most recent meeting of the American Academy of Ophthalmology meeting.
“Visiogen scientists designed a dual optic lens, in order to be able to use a very high plus-powered mobile optic in every patient,” Chang said. “This is accomplished by making the second optic a minus power lens that is varied in order give every individual the specific net dioptric IOL power that they need.”

Posted by mmiraftab at 01:59 PM | Comments (18)

December 03, 2004

Is it time yet for intravitreal triamcinolone to be used in routine clinical practice?

Clinical & Experimental Ophthalmology Volume 32 Issue 6 Page 561 - December 2004

It is not yet time, however, to recommend that IVTA be used routinely in conditions for which double-masked, randomized, placebo-controlled trials are feasible and must be conducted. These include subretinal neovascularization, diabetic retinopathy and retinal veno-occlusive disease.

Posted by mmiraftab at 06:02 PM | Comments (42)

PRECHOPPER

Ophthalmology Management Nov 2004

The new Lu Phaco PreChopper is a single-handed cross-action instrument that has been designed for nucleus division through a small incision without the need for sculpting. The blades follows the anatomical contour to prevent injury to the posterior capsule while its sharp tips facilitate easy insertion into the core of the nucleus.

Katena Products
Phone: (973) 989-1600
www.katena.com

Posted by mehdi khanlari at 12:08 PM | Comments (61)