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January 31, 2005
The effects of depowered airbags on eye injuries in frontal automobile crashes
The purpose of this study was to investigate eye injuries resulting from frontal automobile crashes and to determine the effects of depowered airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a 3-part investigation of 22 236 individual crashes. Of the 2 103 308 occupants exposed to a full powered deployment, 3.7% sustained an eye injury compared to 1.7% of the 310 039 occupants exposed to a depowered airbag deployment. Occupants were at a significantly higher risk to sustain an airbag-induced eye injury when exposed to a full powered airbag compared with occupants exposed to a depowered airbag deployment (P = .04). Approximately, 90% of the eye injuries in full powered airbag deployments were caused by the airbag, compared to only 35% of the depowered airbag eye injuries.
Posted by saliakbari at 11:28 AM | Comments (0)
LASIK for treated anisometropic amblyopia in awake, autofixating pediatric and adolescent patients
Texas, USA.To establish the safety and efficacy of LASIK in pediatric and adolescent patients with anisometropic amblyopia who completed amblyopia therapy and had a visual acuity of 20/30 or better bilaterally.From August 2000 to March 2002, LASIK was performed in 21 eyes of 19 consecutive patients meeting eligibility requirements in the amblyopic eye for the correction of anisometropia or in both eyes. All patients were awake and autofixating during the procedure.Results The mean patient age was 13.14 years (range 8 to 19 years). Seventeen patients were treated in the amblyopic eye only to correct anisometropia; treatment was performed in both eyes of 2 patients who were older than 18 years.Anisometropia was greater than 2.00 diopters (D) in all cases (mean 4.43 D, range 13.25 to 2.25 D). Anisometropia decreased uniformly to less than 2.00 D in all patients (mean 1.52 D). The percentage of patients with stereo acuity increased from 63.0% preoperatively to 84.0% postoperatively.
Conclusions:LASIK safely and effectively reduced anisometropia in these patients. If stereo acuity is not possible preoperatively, it may be obtained postoperatively.
Posted by alireza habibollahi at 07:54 AM | Comments (0)
Improvement in BCVA in amblyopic adult eyes after LASIK
USA,The charts of consecutive patients with a diagnosis of amblyopia at the time of refractive evaluation who had LASIK were reviewed retrospectively. The preoperative and postoperative UCVA and BSCVA were analyzed.21 eyes of 19 patients were identified as having amblyopia and LASIK surgery.Conclusion:After LASIK, the postoperative BSCVA was better than preoperatively in 42.8% of eyes with a history of amblyopia and the postoperative UCVA was better than the preoperative BSCVA in 33.3%.
Posted by alireza habibollahi at 07:46 AM | Comments (0)
Efficacy of glaucoma filtration surgery in pseudophakic patients with or without conjunctival scarring
USA,To IOP glaucoma medication requirements, and visual acuity after glaucoma filtration surgery in pseudophakic eyes.
The results of glaucoma filtration surgery in 47 eyes of 40 pseudophakic patients with a minimum follow-up of 1 year were retrospectively reviewed. Eyes with previously surgically manipulated conjunctiva in the area of filtration were compared to eyes without previous manipulation.Conclusions:Glaucoma filtration surgery in pseudophakic eyes significantly improved IOP and reduced glaucoma medication requirements while maintaining stability of vision. There were no statistically significant differences in final IOP, glaucoma medication requirements, or visual acuity between eyes with virgin conjunctiva and eyes with previously surgically manipulated conjunctiva.
Posted by alireza habibollahi at 07:30 AM | Comments (0)
January 29, 2005
Severe Amblyopia of the Sound Eye Resulting From Atropine Therapy Combined With Optical Penalization
Journal of Pediatric Ophthalmology and Strabismus ,January/February, 2005
The potential amblyogenic effect to the sound eye of atropine combined with optical penalization is powerful, and frequent patient monitoring is necessary when using this therapy. We report two cases of amblyopia developing in the previously sound eye as a result of noncompliance during atropine therapy combined with optical penalization. Both cases required active treatment to correct the reverse amblyopia. Vision returned to normal in one patient, while the second patient was lost to follow-up with poor acuity.
Posted by afarahi at 03:35 PM | Comments (0)
Cataract and Ocular Hypertension in Children on Inhaled Corticosteroid Therapy
Journal of Pediatric Ophthalmology and Strabismus ,January/February, 2005
In this prospective study, a detailed history regarding corticosteroid therapy was obtained for children attending an asthma clinic. Ninety-five patients were enrolled in the study. Mean patient age was 7±3 years, and mean duration of inhaled steroid therapy was 2±1 years. Thirty-six percent of patients received inhaled steroids exclusively, 61% received inhaled steroids with a short course of oral steroids, and 3% received inhaled steroids with a long course of oral steroids. Only 3 (3%) patients had cortical changes that were not visually significant, and none had posterior subcapsular or nuclear cataract. None of the children had ocular hypertension or glaucoma. Ninety patients underwent eye examination 2 years later; none was found to develop posterior subcapsular cataract or increased IOP.
CONCLUSION:This study indicates the use of inhaled steroids in children with asthma is probably safe as far as not inducing posterior subcapsular cataract or ocular hypertension
Posted by afarahi at 03:31 PM | Comments (0)
Management of Duane Retraction Syndrome
Journal of Pediatric Ophthalmology and Strabismus January/February 2005
Duane retraction syndrome is the most common cause of congenital aberrant ocular innervation. Retrospective clinic-based study of 65 patients with Duane retraction syndrome seen between January 1994 and March 2004.The majority of patients were girls with type I Duane retraction syndrome associated with esotropia in primary gaze. Twenty percent of cases were complicated by absent binocular stereoacuity and 16.9% had amblyopia. Family history of any ocular disorder was reported in 38.5% of cases, while an associated congenital abnormality was found in 46% of patients. There was a significant delay between the age when ocular abnormalities were first noticed and the age when patients presented at our tertiary referral center (P < .001). Twenty-two percent of patients underwent surgical correction at a mean age of 6 years. Most procedures were unilateral or bilateral medial or lateral rectus recessions. Postoperative ocular alignment < 15 prism diopters (PD) was achieved in 86% of cases, with 50% of cases having < 5 PD.
Posted by afarahi at 03:20 PM | Comments (0)
Fractionated stereotactic radiotherapy for parasellar meningiomas: a preliminary report of visual outcomes
BJO,Feb,2005
Fractionated stereotactic radiotherapy (FSRT) is a new treatment for brain tumours that are close to critical structures, such as the visual apparatus. This study aims to assess the visual outcomes for 13 patients with parasellar meningioma following FSRT. patients followed for a mean of 2 years. Visual acuity improved in four eyes (12.5%), remained stable in 18 eyes (75%), and worsened in three eyes (12.5%). Visual field improved in 15 eyes (57%), remained stable in six eyes (23%), and worsened in four eyes (15%). No adverse visual outcome occurred as a result of radiation.
Conclusion: These preliminary findings suggest that FSRT is a safe and effective treatment for parasellar meningiomas.
Posted by afarahi at 03:15 PM | Comments (0)
Study suggests link between season and post-op endophthalmitis
Climate may influence conjunctival bacteria and therefore affect the success of cataract surgery, according to research published in Eye magazine.The Ophthalmic Institute Laboratory Department of Ophthalmology, “Gregorio Maranon” University General Hospital, Madrid, cultured conjunctival bacteria of 4,432 patients before cataract surgery, finding that total levels increased significantly in April, May, and June. During this period, Madrid’s average temperature increases from 12° C to 22° C, with a relative humidity of 45% to 60%. That led the author to conclude that post-op endophthalmitis may occur more frequently in patients that undergo cataract surgery in certain months. Studies in Switzerland and Scotland also have shown that post-op endophthalmitis was more likely during these months.read more...
Posted by mehdi khanlari at 01:03 PM | Comments (0)
Early results: Blue filter IOLs cut night vision
A pilot study that demonstrated for the first time that blue filters cut scotopic visual acuity has inspired both calls for surgeons to consider patient safety in using such lenses and criticism over its real-world applicability .This is the first study to identify visual performance impairment associated with tinted IOLs. It may be possible that we are impairing older adults’ night vision without any evidence that tinted IOLs prevent retinal damage or prevent age-related macular degeneration After allowing them to dark adapt for 40 minutes, test subjects viewed a Humphrey field analyzer projecting specific wavelengths of light: 410 nm, 450 nm, 500 nm, and 560 nm.Visual impairment of the central visual field, or mean log sensitivity difference between the blue filter and the clear lens, varied from 65% at 410 nm, to 27% at 450 nm, and 2% at 500 nm. Peripheral impairment at 18 degrees radius was even more severe, with 66% at 410 nm, 54% at 450 nm, and 26% at 500 nm.If we look at a light spectrum curve under mesopic or scotopic conditions, we can see that although there is as much as 65% less 410 nm light available in the environment under these conditions, there is significantly more wavelength 500 nm+ available, so the patient still sees well since the 500 +nm light transmits well through the AcrySof Natural IOL.The AcrySof IOL transmits about 14% more light at the 500 nm wavelength than does the normal human crystalline lens of a 30 year old.The study, said Dr. Olson, also raises concerns about the potential magnified impact on patients suffering from visually impairing conditions, including macular degeneration, which is much more likely among the Natural’s target population.
Posted by mehdi khanlari at 12:47 PM | Comments (0)
Early Treatment of Cystoid Macular Edema Secondary to Branch Retinal Vein Occlusion With Intravitreal Triamcinolone Acetonide
OSN 2005
To determine the efficacy of intravitreal triamcinolone acetonide (IVTA) in the early treatment of severe cystoid macular edema (CME) related to acute branch retinal vein occlusion, twelve eyes with severe CME (foveal thickness > 450 µm) secondary to acute branch retinal vein occlusion received IVTA. Visual acuity improved by 3 lines or greater in 42% of patients at 1 week, 50% at 1 month, and 42% at last follow-up. Average foveal thickness was 589 µm (range, 460 to 840 µm) at baseline, 237 µm at 1 week, 196 µm at 1 month, and 235 µm at last follow-up. All eyes showed reduction of foveal thickness as measured by optical coherence tomography. Eight eyes developed recurrent CME at an average of 5.5 months after initial IVTA injection. Ten eyes required additional intervention during the follow-up period. The results showed that, early treatment of severe CME secondary to branch retinal vein occlusion with IVTA is effective in reducing foveal thickness as measured by optical coherence tomography and improving visual acuity. However, monotherapy with IVTA can be associated with a significant rate of recurrent CME.
Posted by kjalali at 09:10 AM | Comments (0)
Multifocal exams newest options in the search for objective structural testing in glaucoma
OSN 2005
There is an urgent need to detect glaucomatous structural damage earlier than currently possible. There are problems with our standard visual fields in terms of test duplication being difficult, some patients not being too cooperative, and [our] not being able to interpret the data. In addition, with subjective perimetry there is a learning curve. Multifocal VEP is an objective method for recording visual fields. There appears to be reasonable agreement in at least some of the studies between VEP with standard perimetry and [Heidelberg Retina Tomograph] testing. Patient acceptance seems to be very high. They thus far seem to prefer this testing over standard perimetry. Multifocal, objective assessments of retinal function may have advantages over current subjective perimetry tools in the diagnosis of glaucoma.
Posted by kjalali at 08:57 AM | Comments (0)
January 28, 2005
Continuous monitoring of corneal thickness changesduring LASIK with online optical coherence pachymetry
Source
To assess the continuous intraoperative monitoring of central corneal thickness (CCT) changes during laser in situ keratomileusis (LASIK) using online optical coherence pachymetry (OCP).
Germany,ConclusionsIntraoperative 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 alireza habibollahi at 07:02 PM | Comments (0)
Artisan lens implantation to correct aphakia after vitrectomy for retained nuclear lens fragments
Source
To report the results of pars plana vitrectomy (PPV) for retained lens fragments with implantation of an Artisan® intraocular lens (IOL) (Ophtec) to correct aphakia.
In this retrospective case-controlled study, patients who had had a PPV to remove dislocated lens fragments and implantation of an Artisan IOL for pseudophakic correction during initial cataract surgery or PPV were reviewed.
Results
Thirteen patients were identified. The preoperative visual acuity was better than 20/200 in 5 patients and the intraocular pressure (IOP) was higher than 21 mm Hg in 8 patients; 3 patients had normal corneas. In 4 patients, an Artisan IOL was implanted during cataract surgery. Postoperative complications included recurrent erosion (1 eye), premacular fibrosis (2 eyes), and a retinal tear (1 eye). Elevation of the IOP occurred in 2 patients and was controllable with medication. Pupillary block developed in 1 patient and persistent cystoid macular edema in another. All but 2 patients gained more than 2 lines of visual acuity postoperatively, and all corneas remained clear during the follow-up (mean 28.9 months)Conclusions
After the removal of dislocated lens fragments with a PPV, Artisan IOL implantation in aphakic patients without capsule support led to few complications and good visual acuity. Placement of an Artisan IOL requires fewer manipulations than transscleral suture fixation of a posterior chamber IOL.
Posted by alireza habibollahi at 06:53 PM | Comments (0)
January 25, 2005
Studies show Photrex (SnET2) slows progression of CNV, preserves vision
OCULAR SURGERY NEWS
The light-activated drug Photrex, formerly known as SnET2 and developed for use in photodynamic therapy, was found to effectively slow the progression of age-related macular degeneration while preserving vision. Patients with both classic and occult lesions associated with wet age-related macular degeneration benefited from Photrex-PDT.
Posted by kjalali at 12:48 PM | Comments (0)
HSV-1 extremely common, with important clinical implications
OSN,Jan,2005
During Hawaii 2005, The Royal Hawaiian Eye Meeting, Herbert E. Kaufman, MD, said there is a dire need for a better antiviral drugs to treat herpetic eye diseases such as necrotizing stromal disease or iritis more effectively.
Dr. Kaufman and colleagues conducted a study to assess the prevalence of herpes simplex virus-1 in volunteers who had never exhibited herpes symptoms. They found that 98% of these asymptomatic subjects shed the virus in their tears or in their saliva at least once when tested twice daily during a 30-day period.
These findings have important implications for clinicians when it comes to treatments that involve the trauma of surgery or large doses of steroids. The physician must question the patient about herpes history.
By taking extra precautions and considering the possible presence of herpes in all patients, “maybe we can prevent the bad strands (of the virus) from wandering around the community and affecting others,” Dr. Kaufman said.
Posted by afarahi at 12:43 AM | Comments (0)
Pre-operative stability of infantile esotropia and post-operative outcome
AJO,Dec,2004
57% of newly diagnosed patients with infantile esotropia (N = 208) had an esodeviation on the second visit that was within 10 prism diopters (p.d.) of the deviation measured on the initial visit (stable group), 33% had an increase of 10 p.d. or more (unstable group), and 11% had a decrease of 10 p.d. or more. Among the 127 patients with additional preoperative visits, many switched between the stable and unstable categories during follow-up. Long-term, stable and unstable preoperative alignment groups had similar postoperative motor alignment, re-operation rates, rates of prescription of hyperopic, or bifocal spectacle correction and stereoacuity.
Conclusions:It may not be necessary to wait for a “stable” angle of esodeviation before surgery since both alignment and sensory outcomes were similar for stable and unstable groups.
Posted by afarahi at 12:35 AM | Comments (0)
January 23, 2005
Post-LASIK myopic shift after a trek in the North Pole
What happens when refractive patients participate in extreme activities such as trekking to the North Pole? In one recent case this led to a temporary shift in refractive results. Approximately eight weeks after undergoing bilateral LASIK a 37-year-old Chinese adventurer ascended to the geographic North Pole, where he was exposed to a temperature of -50 degrees Celsius, 0% humidity, and winds of up to 55 kilometers per hour. Over a two-week period in this environment, he experienced a myopic shift of more than -1.5 D in both eyes. Once the patient returned to a tropical climate this shift resolved over a two-month period. Investigators here theorize that it was biomechanical changes in the cornea resulting from corneal dehydration in the Arctic environment that caused the myopic shift.
Posted by mehdi khanlari at 11:26 PM | Comments (0)
Prediction of Flap Response
To determine the induced optical effects of lamellar flap creation on the cornea and find predictors of the systemic changes, investigators here launched a prospective study in 29 eyes of 15 patients, over a three-month period following the flap creation. Investigators found that with wavefront data there were significant changes in 90/180 astigmatism, vertical and horizontal coma, and spherical aberration. With topography, they determined that in the early stages stromal bed, thickness was significantly predictive of biomechanical response. In the late follow-up period it was total corneal pachymetry and flap diameter that was predictive here. Investigators concluded that with creation of an uncomplicated flap come changes in corneal topography and induction of higher order aberrations. Stromal bed thickness, flap diameter and total corneal pachymetry are the predictive factors here.
Posted by mehdi khanlari at 11:11 PM | Comments (0)
PRK may be effective in children with severe anisometropia
Eyeworld Jan 2005
Preliminary research suggests that photorefractive keratectomy (PRK) may be a promising treatment to correct anisometropia in children.
said Evelyn A. Paysse, M.D., associate professor of ophthalmology and pediatrics, Baylor College of Medicine, Houston.Dr. Paysse and her colleagues performed PRK in eight myopic and three myopic children in a pilot study. Patients, whose ages ranged from 2 to 11 years, had anisometropic amblyopia and were unwilling or unable to comply with conventional therapy of glasses or contact lenses and occlusion therapy. Patients were required to have at least 6 D of anisomyopia or 4 D of anisohyperopia as these levels uniformly lead to amblyopia if not treated.At the 3-year follow-up, 50% of myopes and all hyperopes were within 3 D of the fellow eye, Dr. Paysse said.
“Our goal was to either reduce the anisometropia to within 3 D of the other eye or achieve emmetropia if possible. “Some of these children were so myopic (range -10 to -21 D) that we could not treat their full refractive error“In the myopic group, at 3 years out, 63% were within 2 D of the target refractive treatment,”Two of the three hyperopes were within 2 D of the target Uncorrected visual acuity improved by at least two lines in 71%, and one child’s acuity improved by seven lines. When BCVA was assessed, 57% improved by at least two lines. Stereoacuity improved in 55%. Corneal haze was negligible. Dr. Paysse concluded that PRK for severe anisometropic amblyopia is safe and effective at 3 years out, and visual acuity and stereopsis can improve in children with anisometropia, even in older children who are not expected to improve. Improvements, however, were not marked in older children.“
Posted by mehdi khanlari at 10:56 PM | Comments (0)
Patients with ABMD symptoms may not be good LASIK candidates
EyeWorld jan 2005
Patients who have anterior basement membrane dystrophy symptoms may not be great LASIK candidates, as they often suffer from visual complaints and other problems after LASIK surgery The study, titled “Complications associated with anterior basement membrane dystrophy after laser in situ keratomileusis,” was published in the November 2004 issue of the Journal of Cataract & Refractive Surgery. Dr. Rezende and colleagues studied ABMD changes in 35 eyes of 18 patients. Most of the patients came to the clinic because of visual complaints (77.8%) related to reduced visual acuity, ghost and double images and glare. Five patients (27.8%) had visual complaints with painful recurrent erosions. Two patients experienced visual complaints with dry-eye symptoms like foreign body sensation.
“If a patient develops a large epithelial slough or defect (greater than 25% to 50%) during LASIK in the first eye, we recommend that the surgeon not proceed with LASIK in the fellow eye that day knowing the potential complications Surgeons should consider discussing a surface-ablation procedure such as PRK or LASEK for these patients.”
Posted by mehdi khanlari at 10:48 PM | Comments (0)
Optic nerve compression by normal carotid artery in patients with normal tension glaucoma
British Journal of Ophthalmology 2005;89:174-179
Aim: To determine whether compression of the optic nerve by the intracranial carotid artery (ICA) can be a causative factor of normal tension glaucoma (NTG).
Methods: The medical records of 103 eyes of 54 Japanese patients with NTG and 104 eyes of 52 age matched control patients were reviewed. The neuroradiological findings of magnetic resonance images (MRI) were evaluated to determine the relation between the optic nerve and ICA. The clinical characteristics and general medical conditions, such as diabetes and systemic hypertension, were also compared between the two groups.
Results: The prevalence of optic nerve compression by the ICA in patients with NTG was 49.5%, which was significantly higher than that in control group with 34.6% (p = 0.035). Bilateral compression of the optic nerve was detected in 22 patients with NTG (40.7%), and this was also significantly higher (p = 0.029) than that in the control group (11 patients, 21.2%). In the NTG group, eyes with cup/disc ratio (C/D ratio) 0.7 showed a higher percentage of compression (52.6%) compared with eyes with C/D ratio of <0.7 (12.5%; p = 0. 042). The presence of diabetes and hypertension did not affect the incidence of optic nerve compression by ICA significantly.
Conclusions: The significantly higher percentage of NTG patients who had optic nerve compression by the ICA suggests that compression of the optic nerve by ICA may be a possible causative factor or a risk factor for optic nerve damage in some patients with NTG.
Posted by mmiraftab at 08:29 PM | Comments (0)
Transplantation of corneal endothelium with Descemet’s membrane using a hyroxyethyl methacrylate polymer as a carrier
British Journal of Ophthalmology 2005;89:134-137
Aims: To evaluate the histology and function of Descemet’s membrane transplanted with intact endothelium.
Methods: Japanese white rabbits and human eyebank eyes were used as donors and recipients of Descemet’s membrane transplantation. Donor endothelium was hydrodissected by injecting indocyanine green from a limbal incision, and then processed as a corneal scleral button. A 6 mm diameter donor sheet was trephined, and folded in half using a 6 mm diameter polymer as a carrier. Recipient endothelium was also hydrodissected from the limbus using trypan blue to stain the Descemet’s membrane. Continuous curvilinear descemetorhexis (CCD) was performed to remove a circular section of the Descemet’s membrane using a 27 gauge cystotome. Donor tissue was inserted into the anterior chamber through a 5 mm limbal incision and apposed to the host stroma. Polymers were removed following transplantation. Similar surgical procedures were performed in both rabbits and eyebank eyes. Haematoxylin eosin stains were performed after 28 days in rabbits, and eyebank eyes were fixed immediately following surgery for endothelial cell counts.
Results: Rabbit control eyes demonstrated stromal oedema caused by loss of Descemet’s membrane, whereas transplanted eyes had clear corneas. The mean (standard deviation) pachymetry of operated eyes was 376.6 (SD 32.5) µm compared with 389.6 (SD 25.1) µm in the unoperated eye. Mean endothelial density immediately following surgery in eyebank eyes was 2749 (SD 288) cells/mm2.
Conclusions: Transplantation of Descemet’s membrane by CCD produces a functional graft with an optically clear interface similar to control cornea.
Posted by mmiraftab at 08:26 PM | Comments (0)
Use NSAID preoperatively to minimize CME after cataract surgery
Calvin W. Roberts, MD, told attendees at The Royal Hawaiian Eye Meeting preop use of NSAIDs can help preserve macular function in cataract patients.Preoperative use of a nonsteroidal anti-inflammatory drug can help preserve macular function and reduce the incidence of cystoid macular edema in cataract patients, said Calvin W. Roberts, MD.Cataract surgery can trigger inflammation throughout the eye, Dr. Roberts said here at Hawaii 2005, The Royal Hawaiian Eye Meeting. He described a study he conducted with colleagues, in which patients who were given an NSAID for the three days prior to surgery had less swelling than patients not given an NSAID. The researchers found no correlation between macular swelling and visual acuity in the study, but they did find a correlation between macular thickness and contrast sensitivity.We found that contrast sensitivity was a much better way to evaluate if there was macular swelling. Today we are redefining CME to mean any decrease in visual function as a result of macular edema,” Dr. Roberts said. He recommended beginning a treatment regimen 3 days before cataract surgery with Acular LS (ketorolac tromethamine ophthalmic solution 0.5%, Allergan) and Zymar (gatifloxacin, Allergan), each four times daily. Beginning 1 hour before surgery, he said, the patient should be treated with Acular LS, Zymar, phenylephrine 2.5% and tropicamide 1%.Postoperatively, the patient should receive Zymar, Pred Forte (prednisolone acetate, Allergan) and Acular LS, first in the recovery room, and then four times a day for 1 week.After 1 week, assuming there is minimum inflammation, stop the steroids, but continue with the NSAIDs to prevent CME by controlling the development of prostaglandins,” Dr. Roberts said.
Posted by mmiraftab at 08:22 PM | Comments (0)
January 20, 2005
Earring Auriculotherapy For Congenital Nystagmus
Medical Acupuncture,Vol. 16,No.1
Congenital nystagmus is an inherited disorder that has been treated with various modalities in an effort to ameliorate symptoms, with varying degrees of success. Auriculotherapy has a wide variety of uses, and it is possible that auriculotherapy has an application in the treatment of congenital nystagmus.
This study reports a 56-year-old man who presented for acupuncture treatment of congenital nystagmus. Prior to the application of magnets on the patient's oculomotor ear point, the patient's visual acuity was 20/50 to 20/60. Following the placement of earrings on that point, the patient's visual acuity was measured as 20/30 in both eyes. Congenital nystagmus in this study was successfully ameliorated by the application of varying modalities involving auriculotherapy.
Posted by afarahi at 07:27 PM | Comments (0)
January 18, 2005
Risks for major eye diseases increased by obesity
OCULAR SURGERY NEWS December 15, 2004
Millions of obese Americans are at increased risk of AMD, cataract, retinopathy and glaucoma.
Obesity and overweight have reached what may be called epidemic proportions in the United States. Nearly two-thirds of U.S adults are overweight, and nearly a third are obese, according to data gathered by government researchers in 1999 and 2000. The prevalence of obesity has doubled since 1960, most of that increase coming in the past 20 years.The effects of obesity and overweight on systemic health are well known to physicians. A report from the Centers for Disease Control in March indicated that obesity is catching up to smoking as the No. 1 cause of death in the United States. Diet and physical inactivity caused 400,000 deaths, or 16.6% of total deaths, in 2000, up from 300,000, or 14% of deaths, in 1990, according to the CDC report.
Almost 130 million adult Americans are overweight or obese — about 64% of the population — putting them at increased risk for cardiovascular disease, diabetes, some types of cancer and some forms of disability, according to the CDC. Americans need to understand that overweight and obesity are literally killing us,” said Health and Human Services Secretary Tommy Thompson at a news conference announcing the release of the CDC report.But less well known to physicians and the general public are the effects of overweight and obesity on the eye. Recent research shows that obesity puts people at increased risk for at least four major, blinding eye diseases. The risks of age-related macular degeneration, diabetic retinopathy, cataract and glaucoma can be increased in individuals either through the presence of obesity-related systemic diseases such as diabetes or directly due to a high body mass index (BMI), abdominal circumference or waist-hip ratio, research has shown.
Posted by mmiraftab at 09:01 PM | Comments (0)
Smoking: The universal risk factor
OCULAR SURGERY NEWS December 15, 2004
Smoking is a risk factor for numerous ocular diseases. Studies have shown a strong association with cataract and AMD.Smoking is not only a cause of diseases of the heart and lungs, it is also a trigger for the development of age-related macular degeneration and cataract and is associated with increased risk for other major ocular diseases, many clinicians agree.Although the exact mechanisms of damage are unknown, it is thought that smoking may increase the number of free radicals in the blood, molecules that are capable of corroding tissue in the macula and elsewhere throughout the body, said Lylas Mogk, MD, chairwoman of the Visual Rehabilitation Committee for the American Academy of Ophthalmology. It may also induce an immune system response, causing ocular irritation, inflammation and nuclear opacification, and it may affect ocular circulation. Evidence exists for correlations between smoking and both AMD and cataract, but studies have also associated smoking with an increased risk for glaucoma, diabetic retinopathy, Graves’ ophthalmopathy and other ocular conditions including uveal melanoma, conjunctival intraepithelial neoplasia, strabismus, ocular sarcoidosis and retinal detachment. The risk of disease may depend on how much a person has smoked and for how long, and the risk may be reduced by smoking cessation but not brought down to zero, Dr. Mogk told Ocular Surgery News.Although the risk for developing these diseases is greater for smokers in general, the mechanisms of the pathologies for certain conditions are still unknown. Much research is being conducted into the mechanisms linking smoking to so many ocular and systemic diseases.
Posted by mmiraftab at 08:43 PM | Comments (0)
Flomax use in male cataract patients associated with floppy iris
Surgeons should always obtain a history of the use of tamsulosin in male cataract patients, said David F. Chang, MD, because of that drug’s association with a newly identified syndrome that can complicate cataract surgery. Dr. Chang’s warning echoes a physician advisory statement issued by the American Society of Cataract and Refractive Surgery last week regarding intraoperative floppy iris syndrome (IFIS), which has been found to be associated with the use of Flomax (tamsulosin, Boehringer Ingelheim). The ASCRS advisory was based on the results of studies by Dr. Chang and colleagues. Patients who have used Flomax were found to have a marked tendency to have a billowing, prolapsed iris,” Dr. Chang said in a presentation here at Hawaii 2005, The Royal Hawaiian Eye Meeting.
According to company product information on tamsulosin, the alpha-1 antagonist relaxes the muscle in the bladder neck and prostate, improving urinary flow in patients undergoing treatment for symptomatic benign prostatic hypertrophy. Dr. Chang described two studies, one prospective and one retrospective, with a combined total of more than 1,600 patients. Dr. Chang said he and colleagues looked at the causes, incidences and possible treatment of IFIS in cataract patients who have used tamsulosin.We found a 2.3% incidence [of IFIS], and 95% of those patients had a history of Flomax use,” Dr. Chang said at the meeting. He also said there was a 12.5% of incidence of posterior capsule rupture in the patients with IFIS in the retrospective study. If a patient stops using tamsulosin 1 to 2 weeks prior to surgery, the risk of IFIS is reduced, “but it doesn’t always prevent it,” Dr. Chang said. To prevent IFIS from occurring, Dr. Chang recommended the use of iris hooks, iris expansion rings and Healon5 (sodium hyaluronate, Advanced Medical Optics) during cataract surgery. He also said that using bimanual microincision phacoemulsification could help because of the smaller incision, but he said that “there is still a remarkable propensity for the iris to prolapse.” Dr. Chang said further study of the syndrome is warranted.
Posted by mmiraftab at 08:37 PM | Comments (1)
January 17, 2005
Refractive error with optimum intraocular lens power calculation after glaucoma filtering surgery
JCRS OCT 2004
To assess the possibility of deriving an optimum intraocular lens (IOL) power after previous successful trabeculectomy.
Taiwan,The retrospective study included 1 eye of 22 patients who had cataract surgery after successful trabeculectomy performed by 1 surgeon. Twenty-two eyes that had cataract surgery only performed by the same surgeon were paired as a control group. The IOL power was calculated by the SRK regression analysis formula based on the data derived after trabeculectomy. The postoperative refractive error at least 1 month after cataract surgery was recorded, and the difference was analyzed by a paired t test and 2-sample t test.
Conclusion,Although the fluctuation in pseudophakic axial length measurement after glaucoma filtering surgery was logical, a predictable pseudophakic refractive outcome was derived clinically once the intraocular pressure stabilized after trabeculectomy.
Posted by alireza habibollahi at 03:44 PM | Comments (0)
Effect of instrument rotation on handheld keratometry
JCRS OCT 2004
To study the effect of instrument rotation on handheld automated keratometry.
Hong Kong,China.In 33 recruited subjects, corneal curvature in 1 eye (randomly selected) was measured using a Medmont topographic keratometer and a Nidek handheld keratometer. In handheld keratometry, measurements were obtained holding the instrument in the upright position and rotating it anticlockwise 5 degrees, 10 degrees, and 15 degrees and then clockwise 5 degrees, 10 degrees, and 15 degrees. The sequence of measurements was randomly assigned. The steepest and flattest corneal curvatures as well as the axis along the flattest meridian were compared in different conditions. The corneal power was converted to vector representation (M, J0, J45) for a second comparison.Conclusions,Handheld keratometry was in agreement with topographic keratometry. However, practitioners should adjust the axis manually according to the direction and amount of rotation. The difference between handheld and topographic keratometry increased with the rotational effect, which was seen with vector representation. Practitioners are advised to use the handheld keratometer in the upright position
Posted by alireza habibollahi at 03:39 PM | Comments (0)
Quality of vision after AMO Array multifocal intraocular lens implantationH
JCRS OCT 2004
To evaluate safety and efficacy of Array® SA40N multifocal intraocular lens (IOL) (AMO) implantation in cataract surgery.
patients had multifocal or monofocal IOL implantation.The incidence of complications and visual outcome in the multifocal and monofocal IOL groups were compared.Quality of vision was measured by comparing the severity of visual symptoms (glare, halos,and cataract symptoms score),changes in functional impairment measured by a 7-item visual function test (VF-7), changes in global measures of vision (trouble and satisfaction with vision), and range of accommodation and contrast sensitivity.
Conclusions
Pseudophakic 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 03:20 PM | Comments (0)
January 16, 2005
Flexiring prevents anterior capsule opacification, capsule shrinkage
OCULAR SURGERY NEWS 1/1/2005
A new model of capsular tension ring effectively prevents anterior capsule opacification and capsule shrinkage. The Flexiring (IOLTECH) is particularly indicated in eyes at risk of capsular phimosis, a complication that leads, within less than a month from cataract surgery, to a rhexis constriction in front of the IOL optic.
Posted by kjalali at 08:32 PM | Comments (17)
January 15, 2005
Rosiglitazone-Induced Proptosis
Arch Ophthalmol. 2005;123:119-121
Rosiglitazone maleate belongs to the class of thiazolidinedione drugs used to maintain glycemic control in patients with type 2 diabetes mellitus. The molecules in these drugs sensitize tissues to insulin activity through their ligation of the peroxisome proliferator-activated receptor-gamma (PPAR) and byincreasing expression of the glucose transporter 4 receptor. Peroxisome proliferator-activated receptor-gamma is a nuclear receptor that provokes adipocyte differentiation.The thiazolidinediones stimulate adipogenesis thus producing well-described weight gain by the generalized increase in subcutaneous fat volume.
One case of reactivated thyroid associated ophthalmopathy (TAO) has been reported in a patient whose TAO had previously entered the stable phase of the disease within 3 months of instituting treatment with rosiglitazone.3 We now describe a patient without concurrent or historic thyroid disease who developed new-onset proptosis after treatment with this medication.
Posted by mmiraftab at 11:04 PM | Comments (26)
Occult Hypotony Maculopathy Diagnosed With Optical Coherence Tomography
Arch Ophthalmol. 2005;123:113-114
Three patients with hypotony had decreased vision and normal ocular examination results. Evaluation of the macula by optical coherence tomography (OCT) demonstrated hypotony maculopathy, which resolved after increasing the intraocular pressure (IOP). Several weeks after normalization of intraocular pressure, OCT showed resolution of folds in the neurosensory retina and choroid. The anatomic resolution corresponded well with the clinical findings of an increase in IOP and improved visual acuity. Optical coherence tomography is a valuable tool for diagnosing hypotony maculopathy and assessing restoration of normal anatomy following appropriate treatment to raise the IOP.
Posted by mmiraftab at 10:57 PM | Comments (22)
January 14, 2005
A Randomized Clinical Trial of a Single Dose of Ramosetron for the Prevention of Vomiting After Strabismus Surgery in Children
Arch Ophthalmol.Jan, 2005
Postoperative vomiting (POV) after pediatric strabismus surgery remains a major problem.
In a prospective, randomized, double-masked, placebo-controlled study, 80 children (38 boys and 42 girls), aged 4 to 10 years, scheduled for strabismus surgery, received intravenously either placebo or ramosetron (a new serotonin antagonist) at 1 of 3 different doses (3 µg/kg, 6 µg/kg, or 12 µg/kg) (n = 20 each) at the end of the surgical procedure. A standard general anesthetic technique was used.
Conclusions : A 6-µg/kg dose of ramosetron is sufficient, but a 3-µg/kg dose is insufficient for preventing POV during the 0- to 48-hour period after anesthesia in children undergoing strabismus surgery. Increasing the dose to 12 µg/kg of ramosetron provides no demonstrable additional benefit.
Posted by afarahi at 06:27 PM | Comments (18)
A Randomized Clinical Trial of Treatments for Convergence Insufficiency in Children
Arch Ophthalmol.Jan, 2005
In a randomized, multicenter clinical trial, 47 children 9 to 18 years of age with symptomatic convergence insufficiency were randomly assigned to receive 12 weeks of office-based vision therapy/orthoptics, office-based placebo vision therapy/orthoptics, or home-based pencil push-ups therapy.
In this pilot study, vision therapy/orthoptics was more effective than pencil push-ups or placebo vision therapy/orthoptics in reducing symptoms and improving signs of convergence insufficiency in children 9 to 18 years of age. Neither pencil push-ups nor placebo vision therapy/orthoptics was effective in improving either symptoms or signs associated with convergence insufficiency.
Posted by afarahi at 05:37 PM | Comments (19)
Post-LASIK dry eye can be reduced with prevention strategies
OSN,Jan,2005
Refractive surgeons can take steps to help reduce the occurrence of dry eye syndrome in their patients after LASIK surgery, according to Frank A. Bucci Jr., MD.
A reduction in tear production can be expected in every LASIK patient during the months after surgery,but preoperative, perioperative and postoperative measures can be taken to prevent severe dry eye and to relieve symptoms if dry eye occurs.
During the preoperative work-up, the surgeon should assess the patient’s risk of developing post-LASIK dry eye. Careful history-taking, focusing on factors such as contact-lens intolerance and chronic use of anti-anxiety medication can help identify patients at increased risk for dry eye syndrome. Other factors that can influence postoperative results include irregular astigmatism, punctate epithelial keratopathy and allergic conjunctivitis.
Patients who appear to be at risk for dry eye can be treated preoperatively with transiently preserved or nonpreserved tears and ointment or punctal plugs. Before surgery, patients should undergo thorough lid cleansing to decrease endotoxins and should receive a course of anti-inflammatory drugs to reduce the occurrence of postoperative swelling. Additional ointments and nonpreserved tears can also be administered.
When selecting a microkeratome, the surgeon should consider the epithelial defect rate of the device. The microkeratome head should be lubricated, as should the cornea before the microkeratome pass, and the surgeon should limit the use of markers on the corneal surface. After flap creation and corneal ablation, a tear lubricant should be placed on the flap. Patients at risk for dry eye should use tear supplements every hour for 24 hours after surgery. Punctal plugs can be implanted as needed.
Posted by afarahi at 04:27 PM | Comments (15)
Blinding keratoconjunctivitis and child abuse
American Journal of Ophthalmology Volume 139, Issue 1 , January 2005, Pages 190-191
Purpose
To report an unusual, blinding inflicted eye injury in young children.
Retrospective study in an institutional clinical practice of two families in whom the probands had inferior half keratoconjunctivitis and additional signs of child abuse.
Results
Two unrelated infants presented with bilateral, asymmetrical, external eye disease affecting the lower half of the cornea and conjunctiva. One eye had perforated. All eyes recovered quickly while the patients were in the hospital with no specific treatment. There were other signs of child abuse detected by further studies on the patients, and in one case, the younger sibling was the subject of severely damaging physical abuse.
Conclusions
Inflicted corneal injuries are nonspecific, and unexplained keratoconjunctivitis, especially in the lower half of the conjunctiva and cornea in infants should alert the clinician to the possibility child abuse, but, by itself cannot be taken as being pathognomonic of abuse.
Posted by mmiraftab at 04:04 PM | Comments (31)
Comparison of three optical coherence tomography scanning areas for detection of glaucomatous damage
American Journal of Ophthalmology Volume 139, Issue 1 , January 2005, Pages 39-43
Several cross-sectional studies have demonstrated the capability of optical coherence tomography (OCT) to detect glaucomatous changes. OCT enables posterior pole scanning of three regions: macula, peripapillary, and optic nerve head (ONH). This study compared the ability of each region to detect glaucomatous damage.
Methods
The study included 37 normal (37 subjects) and 37 glaucomatous eyes (26 subjects) that had comprehensive ocular examination, reliable and reproducible Swedish interactive thresholding algorithm standard 24–2 perimetry, and Stratus OCT scanning of macula, peripapillary, and ONH regions on the same visit. Optical nerve head (ONH) appearance did not form part of the inclusion criteria. The main outcome measure, was area under receiver operating characteristic curves (AROCs) that was calculated for each scanning region for distinguishing between normal and glaucomatous eyes.
Results
The highest AROCs for distinguishing between groups were for ONH parameters (rim area = 0.97, horizontal integrated rim width = 0.96, vertical integrated rim area = 0.95) and peripapillary nerve fiber layer (NFL) thickness (0.94) followed by macular volume and thickness (both 0.80). A statistically significant difference existed in ONH and NFL AROCs when compared with macular AROCs (P ≤ .007, for both)
Conclusions
OCT ONH and NFL parameters provided similar discrimination capabilities between healthy eyes and those of glaucoma patients and superior discrimination capabilities when compared with macular parameters.
Posted by mmiraftab at 03:58 PM | Comments (28)
January 10, 2005
Acute bilateral vitreo-retinal hemorrhages following oxygen-ozone therapy for lumbar disk herniation
A 45-year-old woman complained about acute bilateral visual loss after intradiscal and periganglionic injection of gas mixture (O(2)O(3)) for lumbar disk herniation. Detailed ophthalmologic examination and magnetic resonance imaging (MRI) of brain and spinal cord was performed. Ophthalmoscopy revealed a premacular hemorrhage involving the left macula. In the right eye multiple, flat, retinal hemorrhages around the optic disk and the posterior pole were observed. The MRI scan for intracranial hemorrhage was unremarkable.Drainage of the left premacular hemorrhage by pulsed Nd:YAG laser was obtained a few weeks later. Retinal hemorrhages seem to be an uncommon but significant complication of intradiscal O(2)O(3) infiltration, and we suggest that it should be carefully considered when recommending this procedure.
Posted by kjalali at 08:27 PM | Comments (14)
Endoscopic visualisation to aid deep anterior lamellar keratoplasty
The aim of this study was to assess the value of endoscopy during deep anterior lamellar keratoplasty (DALK) by visualising the posterior cornea. This allows the surgeon to determine whether air injection had succeeded in stripping Descemet's membrane and endothelium from the posterior corneal stroma. Four whole globes for research were obtained from the eye bank with consent. A 2 mm incision was placed at the limbus and the endoscope was introduced through this into the anterior chamber. A 26-gauge needle was introduced into the cornea with the bevel positioned as deep as possible and air injected into the corneal stroma. Air was injected until the whole cornea became opaque and repeated air injections were made even after an opaque cornea was noted. The endoscopic camera was used to visualise the posterior corneal surface during this procedure. The view of the posterior corneal surface was clear and introduction of the probe did not interfere with the air dissection. In all four eyes, despite ease of air injection and diffuse corneal air infiltration, no large air bubble dissection of Descemet's membrane from adjacent stroma occurred. Instead multiple blistering of the posterior corneal surface could be seen. Endoscopy provides an effective tool to visualise the posterior corneal surface during DALK, using air dissection. This technique may become a standard adjunctive procedure during DALK.
Posted by kjalali at 08:20 PM | Comments (3)
Presence of the abducens nerve according to the type of Duane's retraction syndrome
Ophthalmology,Jan,2005
Ophthalmologic examination and thin-sectioned magnetic resonance imaging (MRI) at the brain stem level were performed in 23 DRS patients. To confirm the accuracy of the procedure, we compared the results obtained with those of a control group of 30 individuals using the same technique.
The abducens nerve on the affected side could not be observed using MRI in 18 (100%) of 18 eyes (16 patients) with type 1 DRS and in 3 of 5 eyes with type 3 DRS. Conversely, the abducens nerve was observed in 2 of 2 eyes with type 2 DRS and 2 of 5 eyes with type 3 DRS. The abducens nerve was observed in 60 (100%) of 60 eyes screened as controls.
Conclusions:The abducens nerve on the affected side was absent in type 1 DRS patients and some type 3 DRS patients, but present in type 2 DRS patients as well as in some type 3 DRS patients. In terms of the presence or absence of the abducens nerve, type 1 and type 2 DRS were homogenous, and type 3 DRS was heterogenous.
Posted by afarahi at 12:02 AM | Comments (16)
January 09, 2005
Factors influencing stereoacuity outcomes in adults with acquired strabismus
Conclusion
Surgical correction of acquired strabismus is associated with recovery of stereopsis. Factors associated with stereoacuity outcomes include duration of strabismus and presurgical binocular vision capacity. A postsurgical correction of orthotropia or intermittent orthotropia supports better stereoacuity than a larger residual angle of strabismus subtending up to 8 PD of deviation.
Posted by afarahi at 11:32 PM | Comments (6)
Spontaneous Regression of a Large-Cell Lymphoma in the Conjunctiva and Orbit.
Ophthalmic Plastic & Reconstructive Surgery. , November 2004.
Spontaneous and complete regression of malignant neoplasms is extremely unusual. To our knowledge, this case report is the first description of spontaneous regression of an extranodal malignant lymphoma occurring in the conjunctiva and orbit. A 40-year-old woman noticed a pink conjunctival mass at the medial aspect of her left eye that had been present for 3 weeks. She presented on May 5, 2003. Ophthalmologic examination showed a salmon-colored mass along the lateral side of the caruncle. CT revealed a mass in the medial orbit. Surgical biopsy exhibited a malignant lymphoma, diffuse large B-cell type. After biopsy, the tumor spontaneously decreased in size and completely disappeared in 5 weeks. At 6 months' follow-up, the tumor had not recurred.
Posted by afarahi at 10:53 PM | Comments (48)
Phototoxic maculopathy after secondary intraocular lens implantation
We report phototoxic maculopathy in 2 aphakic patients after secondary, scleral-sutured intraocular lens implantation. This rare complication may have been triggered by drugs that increased the photosensitivity of the tissue. Careful preoperative assessment is necessary to question the receipts of photosensitizing drugs and identify diseases that predispose patients to phototoxic injuries.
Posted by alireza habibollahi at 03:57 PM | Comments (2)
PRK versus LASIK to prevent keratectasia after corneal ablation
A 27-year-old man had excimer photoastigmatic keratectomy in the right eye and LASIK in the left eye for the treatment of equivalent myopia. Preoperative slitlamp examination did not reveal evidence of keratoconus, central corneal pachymetry was 485 μm in the right eye and 500 μm in the left eye, and corneal topography revealed asymmetric bow-tie astigmatism with inferior steepening in the right eye and a small area of inferior steepening in the left eye. Twenty-two months after surgery, the patient complained of poor vision in the left eye. Slitlamp examination of the left eye revealed central corneal thinning and protrusion, with a Fleischer ring within the flap. Corneal topographic evaluation revealed a stable map in the right eye and central corneal steepening indicative of keratectasia in the left eye.
Posted by alireza habibollahi at 03:51 PM | Comments (1)
Choroidal neovascularization after LASIK in a patient with low myopia
We report a case of choroidal neovascularization after laser in situ keratomileusis in a 37-year-old man with low myopia.
Posted by alireza habibollahi at 03:42 PM | Comments (1)
Retrobulbar hemorrhage after sub-Tenon's anesthesia
We present a case of retrobulbar hemorrhage from uneventful, infranasal, sub-Tenon's anesthesia before cataract surgery. To our knowledge, this is the first report of such a complication.
Posted by alireza habibollahi at 03:35 PM | Comments (0)
Retrobulbar hemorrhage after sub-Tenon's anesthesia
We present a case of retrobulbar hemorrhage from uneventful, infranasal, sub-Tenon's anesthesia before cataract surgery. To our knowledge, this is the first report of such a complication.
Posted by alireza habibollahi at 03:35 PM | Comments (0)
Early bacterial keratitis after laser-assisted subepithelial keratectomy
We report a case of bacterial keratitis that occurred after LASEK. The patient presented with a decrease in visual acuity and pain 2 days after the procedure. Culture was positive for Staphylococcus haemolyticus. The infiltrate slowly resolved with topical antibiotics, and the best corrected visual acuity improved to 20/20. Although bacterial keratitis occurs rarely after refractive surgery, patients should be informed of the potential risk for visual loss caused by this infection.
Posted by alireza habibollahi at 03:30 PM | Comments (0)
postoperative endophthalmitis caused by Actinomyces neuii
JCRS OCT 2004
Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid–antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.
Posted by alireza habibollahi at 03:23 PM | Comments (33)
January 08, 2005
Comparison between the Role of Intraoperative Mitomycin C and Doxorubicin in Preventing the Recurrence of Primary Pterygium
Ophthalmic Research 2005;37:1-6
Purpose: The purpose of this study was to compare the role of intraoperative mitomycin C (MMC) and doxorubicin in preventing the recurrence of primary pterygium. Materials and Methods: Fifty-six patients including 22 males and 34 females in the age range of 22-55 years (mean age 38.1 years ± 10.7) having primary pterygium of progressive type were randomly divided into two groups. The first group of patients was treated with intraoperative MMC (0.02% for 3 min) and in the second group intraoperative doxorubicin (0.02% for 3 min) was used. The patients were regularly followed until 1 year postoperatively for examining visual acuity, wound condition, adverse events and recurrence of pterygium. Results: The mean age of patients of MMC group was 37.4 ± 11.0 years and of doxorubicin group was 38.8 ± 10.8 years (difference statistically not significant). All these patients had pterygium on the medial side of cornea. The side effects experienced by our patients from the use of these agents were conjunctival hyperemia, conjunctival necrosis, corneal epithelial defect, subconjunctival hemorrhage, episcleritis, increased pain, foreign body sensation, lacrimation, irritation, diminution of vision and photophobia. Recurrence was seen in 4 patients of MMC group (14.3%) and 3 patients of doxorubicin group (10.7%) (difference statistically not significant; 2 = 0.16, p = 0.68). The recurrence of pterygium was not associated with age of patients, laterality of eye involved, amount of encroachment of pterygium over cornea, width of pterygium, preoperative complaints and postoperative adverse events. Conclusions: The two antimitotic agents, MMC and doxorubicin, when used intraoperatively along with primary pterygium excision, had a comparable role both in terms of adverse events and prevention of recurrence of pterygium.
Posted by mmiraftab at 08:25 PM | Comments (30)
January 07, 2005
Decreased Thickness and Integrity of the Macular Elastic Layer of Bruch's Membrane Correspond to the Distribution of Lesions Associ
Age-related macular degeneration (AMD) is a leading cause of blindness in the elderly. In its severest form, choroidal neovessels breach the macular Bruch's membrane, an extracellular matrix compartment comprised of elastin and collagen laminae, and grow into the retina. Researchers sought to determine whether structural properties of the elastic lamina (EL) correspond to the region of the macula that is predilected toward degeneration in AMD. Morphometric assessment of the macular and extramacular regions of 121 human donor eyes, with and without AMD, revealed a statistically significant difference in both the integrity (P < 0.0001) and thickness (P < 0.0001) of the EL between the macular and extramacular regions in donors of all ages. The EL was three to six times thinner and two to five times less abundant in the macula than in the periphery. The integrity of the macular EL was significantly lower in donors with early-stage AMD (P = 0.028), active choroidal neovascularization (P = 0.020), and disciform scars (P = 0.003), as compared to unaffected, age-matched controls. EL thickness was significantly lower only in individuals with disciform scars (P = 0.008). The largest gaps in macular EL integrity were significantly larger in all categories of AMD (each P < 0.0001), as compared to controls. EL integrity, thickness, and gap length in donors with geographic atrophy did not differ from those of controls. These structural properties of the macular EL correspond spatially to the distribution of macular lesions associated with AMD and may help to explain why the macula is more susceptible to degenerative events that occur in this disease.
Posted by kjalali at 02:17 PM | Comments (16)
Safety of intravitreal high-dose reinjections of triamcinolone acetonide
To report side effects after intravitreal high-dose reinjections of triamcinolone acetonide. A clinical interventional case series performed on forty-six patients (47 eyes) received at least two intravitreal injections of approximately 20 to 25 mg triamcinolone acetonide for treatment of diabetic macular edema (n = 6 eyes), exudative age-related macular degeneration (n = 23), and other diseases. Intervals between injections were 6.7 +/- 3.4 months, 8.0 +/- 4.6 months, and 10.2 months, respectively, before the second (n = 47 eyes), third (n = 9), and fourth (n = 2) injection. Mean follow-up was 20.7 +/- 8.9 months. After no reinjection were complications detected, other than those known to occur after a single intravitreal injection. After the first, second, and third injection, respectively, intraocular pressure remained normal in 24 (51%), 25 (53%), and 5 (56%) eyes.
Posted by kjalali at 02:04 PM | Comments (0)
January 05, 2005
IOP drop during pregnancy recorded best by noncontact tonometer
Women in the third trimester of pregnancy showed significantly decreased IOPs when compared to control subjects using three methods of tonometry, according to Turkish researchers. Of the three methods, noncontact tonometry achieved the best intraobserver agreement during the third trimester, leading the researchers to suggest that ophthalmologists should use that method to monitor IOP levels in pregnant patients at risk for glaucoma.Yusuf Akar, MD, and colleagues at the Akdeniz University School of Medicine measured IOP levels in the right eyes of 88 healthy women who were likely to become pregnant and of 94 healthy age-matched control patients. IOP measurements were taken using Goldmann, Schiötz and noncontact tonometry during a 3-week examination period within 6 weeks of conception and during each trimester of pregnancy, and at similar time intervals in the control subjects. Three readings with each tonometer were obtained at each interval, at least 1 day apart.Keratometry, refractive error and mean visual acuity did not change in either control or pregnant subjects over the course of the study.Pregnant women showed significant decreases in IOP measurements using all three tonometry methods during the third trimester. Intraobserver agreement also decreased significantly at this interval in the pregnant women using the Schiötz and Goldmann methods, but noncontact tonometry had perfect intraobserver agreement.Both intraobserver and intertechnique agreement in IOP measurements of control subjects were not found to change significantly during the study.The study is published in the January issue of Ophthalmologica.
Posted by mehdi khanlari at 03:48 PM | Comments (10)
Development of a Critical Flicker/Fusion Frequency Test for Potential Vision Testing in Media Opacities
Optometry & Vision Science. 81(12):905-910, December 2004
To determine whether critical flicker/fusion (CFF) thresholds fulfill the criteria for a potential vision test (PVT) by being unaffected by media opacity yet affected by retinal disease. CFF thresholds for three different stimulus sizes (0.5, 1.0, and 1.5[degrees]) were measured in 72 patients (mean age, 78.43 +/- 7.07 years) comprising 31 subjects with media opacity, 21 with macular disease, and 20 with pseudophakia.There were no statistically significant differences between CFF values from the media opacity and the pseudophakia groups for any target size (p > 0.10). However, CFF values were significantly lower in patients with macular disease for all the target sizes (p < 0.05). Analysis of a subset of six subjects with media opacity and seven subjects with macular disease and visual acuity of 20/200 or worse showed the media opacity group still had similar CFF values as the pseudophakia group and had significantly higher CFF than the macular disease group.Conclusions. CFF testing is shown to fulfill the requirements for a PVT and may prove to be particularly useful for patients with dense media opacity.
Posted by mehdi khanlari at 05:39 AM | Comments (32)
Central Serous Chorioretinopathy: A Complication of Glucocorticoid Excess
The Endocrinologist
Central serous chorioretinopathy (CSCR) is a disorder characterized by the accumulation of subretinal fluid at the posterior pole of the fundus resulting in diminished visual acuity and distortions of visual perception. Although most reported cases are idiopathic, CSCR is also a recognized rare complication of the hypercortisolemia of pituitary-adrenal disease or, more commonly, of exposure to synthetic corticosteroids or adrenocorticotrophic hormone
Posted by mehdi khanlari at 05:32 AM | Comments (6)
January 04, 2005
One-year multicenter, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopia
Ophthalmology Volume 112, Issue 1 , January 2005, Pages 84-91
Objective
To evaluate the safety and efficacy of the relatively selective M1-antagonist, pirenzepine ophthalmic gel (gel), in slowing the progression of myopia in school-aged children.
Design
Parallel-group, placebo-controlled, randomized, double-masked study.
Participants
Three hundred fifty-three healthy children, 6 to 12 years old, with a spherical equivalent (SE) of −0.75 to −4.00 diopters (D) and astigmatism of ≤1.00 D. Subjects underwent a baseline complete eye examination, and regular examinations over a 1-year period. The study was conducted at 7 academic centers and clinical practices in Asia.
Intervention
Subjects received 2% gel twice daily (gel/gel), 2% gel daily (evening, placebo/gel), or vehicle twice daily (placebo/placebo) in a 2:2:1 ratio, respectively, for 1 year.
Main outcome measure
Spherical equivalent under cycloplegic refraction.
Results
At study entry, mean SE refraction was −2.4±0.9 D. At 12 months, there was a mean increase in myopia of 0.47 D, 0.70 D, and 0.84 D in the gel/gel, placebo/gel, and placebo/placebo groups, respectively (P<0.001 for gel/gel vs. placebo/placebo). Discontinued from the study for adverse events were 11% (31/282) of pirenzepine-treated subjects. Of the 15 serious adverse events reported in 12 subjects (all in the active groups), none was ophthalmic in nature, all subjects recovered, and only 1 (abdominal colic preceded by a flu) was judged possibly related to treatment.
Conclusions
Gel (2% twice daily) was effective and relatively safe in slowing the progression of myopia over a 1-year treatment period.
Posted by mmiraftab at 09:07 PM | Comments (60)
Femtosecond laser–assisted posterior lamellar keratoplasty(Initial studies of surgical technique in eye bank eyes)
Ophthalmology Volume 112, Issue 1 , January 2005, Pages 44-49
The femtosecond laser was used to make the posterior corneal lamellar interface and trephine (side) cut in 20 eye bank globes and 9 eye bank corneoscleral buttons. Laser parameters were energy 7.4±0.1 μJ (lamellar cut) and 8.7±0.1 μJ (trephination cut), spot size 2.4 μm, firing rate 15 kHz, and trephination diameter 6.0 to 8.0 mm. The thicknesses of the excised corneal discs were measured with a digital micrometer and compared with values calculated from the laser treatment parameters and the preoperative ultrasound pachymetric readings. The cut surfaces were examined by light microscopy and scanning electron microscopy. In globes, the corneal disc was removed from the eye after laser treatment through a blade incision in the peripheral cornea. In corneoscleral buttons, the posterior disc was peeled off the cornea with forceps after laser treatment on an artificial anterior chamber device. In simulated transplantation, the excised corneal disc was placed into the posterior stromal bed in 7 globes.
Results
The femtosecond laser was successful in making posterior lamellar and trephination cuts in cornea. The cut surfaces were of very good quality with straight, orthogonal edges, albeit with a mild stucco texture of the lamellar stromal surfaces. In 3 globes, the lamellar surface showed shallow concentric ridges. The measured thickness of the excised discs was 55±61 μm thicker than the preoperatively predicted values.
Conclusions
These preliminary studies show that the femtosecond laser can make nonmechanical cuts for posterior lamellar keratoplasty with relative ease and reliability, thus facilitating the most technically difficult step in this surgery.
Posted by mmiraftab at 08:59 PM | Comments (19)
Increase in lens stiffness with age may cause presbyopia
An increase in the stiffness of the human lens with age may diminish the ability of the lens to accommodate, contributing to the onset of presbyopia, Australian researchers suggest. Karl Robert Heys and colleagues at the Australian Cataract Research Foundation used a custom-made probe to measure stiffness at 1 mm increments across equatorial sections of human lenses from individuals ranging in age from 14 to 78 years. A “pronounced” increase in lens stiffness was noted over this age range, the researchers said. Within the nucleus, the stiffness values varied almost 1,000-fold over the age range, with the largest changes observed in lenses between the ages of 20 and 60. On average, nuclear stiffness values increased by a factor of 450. In the cortex, the average increase in stiffness was approximately 20-fold over the same time period, the researchers said. All lenses older than 30 years had nuclear stiffness values higher than those of the cortex; the crossover age when the cortical and nuclear stiffness values were similar was in the 30s. The researchers noted that the physical changes in the lens are part of a host of age-related ocular alterations, all of which may contribute to presbyopia. The increases in stiffness could also be the result of other factors “that over time may affect lens biochemical processes,” the researchers said. “A quite unexpected finding was that the nuclei of young lenses (prior to age 30), were less stiff than those of the cortices. Given the requirement for substantial nuclear deformation during accommodation, one is tempted to suggest that such a difference may be present to facilitate the process of lenticular shape change,” the researchers speculated in Molecular Vision.
Posted by mehdi khanlari at 06:01 AM | Comments (0)
Changes in Mechanical, Chemical, and Thermal Sensitivity of the Cornea after Topical Application of Nonsteroidal Anti-inflammatory Drugs
Investigative Ophthalmology and Visual Science
Conclusion: Flurbiprofen had a very limited effect on sensations evoked by corneal stimulation, whereas diclofenac reduced the intensity of sensations evoked by stimuli of different modality, suggesting a mild local anesthetic effect of this drug on all types of corneal sensory fibers. Such anesthetic action could explain the analgesic effect that has been reported after topical application of diclofenac in inflamed human eyes
Posted by mehdi khanlari at 05:36 AM | Comments (1)
January 03, 2005
Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion
To evaluate the safety and efficacy of surgical induction of chorioretinal venous anastomosis in the management of ischaemic central retinal vein occlusion (CRV, in a comparative clinical trial, 28 patients with ischaemic CRVO were included, of whom 18 who declined surgery were considered as controls. The 10 surgical cases underwent standard vitrectomy with incisions into the choroids adjacent to the partially cut major retinal veins. Mersilene suture insertion was done to induce chorioretinal venous shunt. Mild endolaser was applied. Patients were followed up for 6-18 (mean 10) months. Clinical success in shunt development was 90%. Surgical cases had a significantly better visual acuity improvement compared with controls (mean difference: 1.5 logMAR, p = 0.001) with 80% of them showing improvement (compared with 28% of the controls, p = 0.016). Neovascularisation developed in 39% of the control group compared with 0% of the surgical cases (p = 0.03). In multivariate analysis, surgery remained the sole significant predictor of visual improvement. There were three re-operations for vitreous cavity haemorrhage, cataract, and retinal detachment..
Posted by kjalali at 10:03 PM | Comments (6)
Awaiting Approval
Alcon announced that the FDA has issued an “approvable” letter for Extravan ophthalmic solution for the treatment of glaucoma. Extravan solution is a fixed combination of travoprost 0.004% and timolol 0.5%.
U.S. regulators issued an “approvable” letter for a combination drug for the treatment of glaucoma, manufacturer Allergan announced. The drug, a combination of Lumigan (bimatroprost) and timolol, merges two already-approved drugs, the company noted.
The FDA issued an “approvable” letter to Bausch & Lomb for the combination drug ZyLet (loteprednol etabonate, tobramycin ophthalmic suspension, Pharmos). The drug was approved for the treatment of patients with steroid-responsive inflammatory ocular conditions who have or are at risk of developing superficial bacterial ocular infections.
Miravant announced that the FDA has issued an “approvable” letter for SnET2 PDT, a light-activated drug designed to selectively destroy abnormal blood vessels and stabilize vision loss in patients with wet AMD.
STAAR Surgical Co.’s Visian ICL has received a recommendation for approval with conditions from the Ophthalmic Devices Panel.
Posted by mehdi khanlari at 05:14 AM | Comments (21)
Recent Premarket Approvals
OCULAR SURGERY NEWS 12/15/2004
¤ The Rostock Cornea Module, a cornea laser microscope, has received U.S. regulatory clearance, according to manufacturer Heidelberg Engineering. The microscope allows clinicians to view corneal cell layers and individual cells in real time.
¤ Norwood EyeCare, a subsidiary of Norwood Abbey Ltd., announced the FDA approval of an additional EPI-LASIK suction ring, beneficial to Asian patients. The ring is available in a 9-mm size, in addition to the current 10-mm size.
¤ Oasis Medical has received FDA approval for its new Form Fit long-term intracanalicular plug.
Posted by mehdi khanlari at 05:10 AM | Comments (13)
Incision site key to corneal aberrations after cataract surgery
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, a study found. The location of the incision is a key factor in optical changes in the cornea after surgery, a group of Spanish researchers said. 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, the researchers found. 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, the authors said. The study is published in the December issue of Investigative Ophthalmology & Visual Science.
Posted by mehdi khanlari at 05:02 AM | Comments (0)
New therapies for AMD
These new treatments to control -- and possibly even to prevent -- neovascular AMD have one thing in common: All aim to interrupt the angiogenesis cascade that heralds the progression of dry AMD to wet AMD.
Eyetech Pharmaceuticals (New York) has completed Phase III testing of pegaptanib sodium, which -- if approved -- will be marketed under the name Macugen. "Macugen is a highly selective inhibitor of VEGF," or vascular endothelial growth factor, which drives the angiogenesis process in wet AMD The Macugen molecule is an aptamer -- a piece of nucleic acid (like DNA or RNA) that binds to VEGF and blocks it from binding to its receptor, thus neutralizing VEGF.Macugen binds specifically to VEGF-165, the isoform that stimulates AMD pathology, but not to isoforms needed for physiologic processes, he said."The aptamer allows physiologic vascularization to proceed unchecked." Because of this specificity, "Macugen has a remarkable safety profile
"Macugen had virtually the same effect in all lesion subtypes" -- predominantly classic, minimally classic, and occult lesions -- Genentech San Francisco) also has an anti-VEGF drug in development. Ranibizumab (to be marketed as Lucentis pending regulatory approval) is a fragment of a humanized monoclonal antibody that, like Macugen, binds to and neutralizes VEGF. Also like Macugen, Lucentis is administered by intravitreal injection, but more often (once every four weeks). Human clinical trials aren't as far along as with Macugen, but the early data looks promising.Genaera Corp. (Plymouth Meeting, Pa.) is conducting Phase II testing of a drug called squalamine lactate, a small molecule aminosterol. Squalamine lactate was originally derived in experimental quantities from the dog fish shark (Squalus acanthias) from which it is named. Genaera produces squalamine synthetically in commercial quantities by patented processes."It acts directly on activated endothelial cells, inducing apoptosis and vessel regression,Finally, Alcon (Fort Worth, Texas) has anecortave acetate under development. "Anecortave acetate is a steroid derivative, but it has lost all of its steroid properties," "It inhibits the proteolytic cascade in angiogenesis. Most importantly it is not injected inside the eye." Instead, the drug is injected into the retrobulbar space as a posterior juxtascleral depot using a specially designed cannula."With a single depot administration," therapeutic drug levels are achieved in the retina and choroid for six months. In Phase II/III testing, eyes receiving anecortave acetate lost an average of 1.5 lines of vision over two years, compared with 3 lines lost in eyes receiving placebo.
Posted by mehdi khanlari at 04:32 AM | Comments (37)
Assessment of Central Visual Function in Stargardt's Disease/Fundus Flavimaculatus with Ultrahigh-Resolution Optical Coherence Tomography
Investigative Ophthalmology and Visual Science
Conclusion: Ultrahigh-resolution OCT demonstrates excellent visualization of intraretinal morphology and enables quantification of the photoreceptor layer. Thus, for the first time, an in vivo visualization and quantification of transverse, central photoreceptor loss and correlation with visual function is possible. Lower VA corresponds to a greater transverse photoreceptor loss, which also correlates with the extent of changes seen in fluorescein angiography and in fundus autofluorescence. Furthermore, reduced retinal thickness (i.e., atrophy of retinal layers) does not correlate with the transverse extent of PR loss. Thus, it seems that although there may be progressive atrophy of intraretinal layers, an intact photoreceptor layer leads to better VA. UHR-OCT may present a viable alternative to the assessment of central visual function, due to the easy, objective, and noninvasive data acquisition. Therefore, UHR-OCT could be of future use in judging patients' prognoses in Stargardt's disease...
Posted by mehdi khanlari at 04:00 AM | Comments (0)
January 02, 2005
Unhappy LASIK Patients Still Recommend It
Review of Optometry
Most patients who have undergone LASIK and are not satisfied with their vision afterwards would still recommend the procedure to a friend, says a recent study.The dual purpose of the study was to determine why LASIK patients recommend the procedure, and to evaluate the disparity between high levels of satisfaction and reports of post-op problems (dry eye and/or night-vision issues). Overall, 604 patients with a mean age of 43 were included in the study-63% of whom were women. Results showed that 586 of the participants would recommend LASIK to a friend, though only 434 of them answered the "why or why not" question...
Posted by mehdi khanlari at 07:03 AM | Comments (0)
Comparison of Tilt and Decentration between Phacoemulsification and Phacotrabeculectomy
To determine the extent of intraocular lens (IOL) tilt and decentration values after combined surgery in patients with cataract and glaucoma...Conclusion: There is no increased effect of phacotrabeculectomy on tilt and decentration of IOLs in eyes with POAG when compared with eyes which underwent phacoemulsification surgery...
Posted by mehdi khanlari at 07:01 AM | Comments (0)
Frequency and Assortment of Self-Reported Occupational Complaints Among Iranian Ophthalmologists: A Preliminary Survey
Hormoz Chams, MD; Seyed Farzad Mohammadi, MD; Alireza Moayyeri, MD
Medscape General Medicine™
Background: Ophthalmology is unique in that its practitioners are exposed to a host of ergonomic (eg, indirect ophthalmoscopy), ergo-ophthalmologic (laser), infectious (adenovirus), and allergic (topical anesthetics) hazards. The purpose of this study is to provide a preliminary occupational health profile of Iranian ophthalmologists.
Methods: A comprehensive list of occupation-related entities was incorporated into a questionnaire, which was distributed among 350 ophthalmologist participants of the Annual Iranian Congress of Ophthalmology (November 2000, Tehran) and was mailed twice to the 1050 nation's registered ophthalmologists. Independent Samples t and chi-square tests were used to assess the relationships.
Results: One hundred sixty-two questionnaires were returned. The mean career time was 15.7 (range, 1-40) years. Twenty (12.3%) of the participants were women. The reported prevalences were as follows: history of infectious conjunctivitis, 49.4%; contact dermatitis, 43.2%; back pain, 80%; chronic headache, 54.9%; and laser or operating microscope-related visual disturbances, 15%. Psychological indispositions were reported by two thirds. Age and career time were inversely related to contact dermatitis, chronic headache, and stress-related problems (P < .05). Visual complaints were more prevalent in vitreoretina surgeons (P < .004). Psychosocial disorders were significantly more reported by women (P = .026; odds ratio = 4.4). Only 3% of participants reported to have none of the listed problems.
Conclusion: Our preliminary survey disclosed a high prevalence of diverse complaints from back and neck pain, contact dermatitis, visual disturbances, and infectious conjunctivitis to stress-related and psychosocial disorders among the participants. Younger age, being a woman, and vitreoretina practice were the complaints correlates. Due to the low response rate, uncertainty over the representativeness and coverage of the sample, and lack of control groups, the findings have to be interpreted conservatively.
Posted by mehdi khanlari at 06:40 AM | Comments (43)
January 01, 2005
Visual field changes after cataract extraction: The AGIS experience
American Journal of Ophthalmology Volume 138, Issue 6 , December 2004, Pages 1022-1028
Purpose
To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of glaucomatous scotomas.
Design
Experimental study with no control group.
Methods
One hundred fifty-eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study with at least two reliable visual fields within a year both before and after cataract surgery were included. Average mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD) were compared before and after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < .05) on the pattern deviation plot was compared before and after surgery. We described an index (“scotoma depth index”) to investigate changes of scotoma depth after surgery.
Results
Mean values for MD, PSD, and CPSD were –13.2, 6.4, and 5.9 dB before and –11.9, 6.8, and 6.2 dB after cataract surgery (P ≤ .001 for all comparisons). Mean (± SD) number of abnormal points on pattern deviation plot was 26.7 ± 9.4 and 27.5 ± 9.0 before and after cataract surgery, respectively (P = .02). Scotoma depth index did not change after cataract extraction (–19.3 vs –19.2 dB, P = .90).
Conclusions
Cataract extraction caused generalized improvement of the visual field, which was most marked in eyes with less advanced glaucomatous damage. Although the enlargement of scotomas was statistically significant, it was not clinically meaningful. No improvement of sensitivity was observed in the deepest part of the scotomas.
Posted by mmiraftab at 04:59 PM | Comments (39)
Rate of axial growth after congenital cataract surgery
American Journal of Ophthalmology Volume 138, Issue 6 , December 2004, Pages 915-924
Rate of axial growth in children operated at ≤ 1 year (23.5%) was significantly higher than in those at ≤ 3 years (4.8%; P = .0001, confidence interval [CI] 1.05–3.2) and at ≤ 10 years (4.3%; P = .0001, CI 1.3–3.1). In children operated at ≤ 1 year, temporal profile of RAG was higher in the first 2 years after surgery. Rate of axial growth was higher in patients with unilateral pseudophakia at ≤ 1 year (25.53%) than in age-matched patients with bilateral pseudophakia (18.50%; P = .001, CI −13 to −0.2). Rate of axial growth was negligible in children with visual axis obscuration in any group.
Conclusion
Rate of axial growth is higher in children ≤ 1 year and increases until the second year after surgery. Unilateral pseudophakia revealed accelerated growth compared with bilateral pseudophakia. Visual axis obscuration does not influence rate of axial growth.
Posted by mmiraftab at 04:54 PM | Comments (40)
CLE vs Corneal refractive surgery
....Dr dodick said In refractive lens extraction we’re held to a higher accountable standard than cataract surgery alone. So if we look at what are the basic needs of refractive surgery, to me, there are four in number. They are accuracy, stability, safety, and quality of vision.Now, as I look at it, clear lens extraction comes out a clear winner in two of them, and is still behind with our current technology in two of them.So what do I mean by that? I still think that for accuracy, to achieve a correction rate of +/-.25D, LASIK and PRK still win out, according to my accounting.As far as safety, I still think that PRK and any corneal procedure are probably safer than a clear lens extraction, but I think clear lens extraction wins out on the issue of stability. Once you put a lens into the capsular bag, that refractive error is stable, at least for the spherical component. Quality vision in my mind is simply such that the quality of vision in an eye that has not been operated on the cornea is better than an eye that has had a cornea operated on, and specifically had an interface come into play.
So at the present time, clear lens extraction wins out on stability and quality of vision. We’ve still got a little way to go on accuracy and safety.
Posted by mehdi khanlari at 06:52 AM | Comments (12)
Blade of the future:Atomic Edge blade
"This blade may revolutionize the way cataract surgeons think of disposable blades, as well as reduce the risk of sharps injuries in the operating room," says Dr. Mah. He concludes, "These blades are clinically indistinguishable from diamond blades, yet are remarkably produced at a fraction of the cost. Furthermore, with the risk of deadly blood borne pathogens including hepatitis C, HIV and CJD, the safety feature is a welcome addition to disposable blades."
Posted by mehdi khanlari at 06:31 AM | Comments (0)
Zylet
Surgeons are expected to soon have a new combination drug option in Zylet (loteprednol etabonate, tobramycin ophthalmic suspension, Pharmos Corp., Iselin, N.J.), for which the FDA issued an “approvable” letter in 2004. It is designed to treat patients with steroid-responsive inflammatory ocular conditions that are at risk of developing superficial bacterial ocular infections.
The drug, which is very similar to already-approved Tobradex (tobramycin dexamethasone, Alcon), has the same antibiotic but replaces dexamethasone with loteprednol. “You are theoretically going to have fewer complications with long-term use of Zylet, as opposed to Tobradex. That is going to be the difference—the efficacy of the stronger anti-inflammatory agent, dexamethasone vs. the potential reduction of long term steroid complications.”He said the combination drug will likely increase compliance. However, he said the drug may be hurt by its weaker antibiotic, poor penetration, and gram-negative focus.
Posted by mehdi khanlari at 06:11 AM | Comments (12)
Glaucoma tool(The Eyepass)
Bi-Directional Glaucoma Implant (GMP Vision Solutions, Fort Lauderdale, Fla.), The Eyepass, a Y-shaped tube with one end in the anterior chamber and the other two ends in Schlemm’s canal, is designed to bypass the trabecular meshwork.“The only thing you are bypassing is the meshwork, which is the point of most resistance to outflow, so it makes sense on that ground,” Dr. Packer said.Patients that receive the device do not require a bleb, negating the risk of problems such as hypotony, choroidal detachment, and a long-term risk of increased infection, Dr. Robin said.Eyepass is technically demanding surgery, and best suited for surgeons familiar with deep sclerectomy. Glaucoma surgeons whose experience is limited to trabeculectomies will face a learning curve in dissecting the deep flaps needed and gaining access to Schlemm’s canal.
Posted by mehdi khanlari at 06:07 AM | Comments (16)
Macugen(pegaptanib sodium ) approval....?
One of the more anticipated advances in ophthalmic medicine is the pending decision of the Food and Drug Administration (FDA) on Macugen (pegaptanib sodium injection, Eyetech Pharmaceuticals Inc., New York).Macugen will provide a much-needed alternative in the management of age-related macular degeneration (AMD)Macugen is the first anti-VEGF, or vascular endothelial growth factor, treatment for the eye to apply for regulatory approval. The drug aims to disrupt the angiogenesis process of wet AMD.While Macugen does not appear to overwhelmingly stop or reverse AMD progression, Eyetech studies indicate the drug at least slows AMD progression.Eyetech’s one-year study of 1,281 patients in a randomized, double-blind, dose-ranging study with sham-controlled dosing found about 70% of those receiving intravitreous injections of 0.3 mg solutions met treatment goals, compared with about 55% of sham-treated patients.The main concern with Macugen has been the rate of endophthalmitis early in the studies, when the rate was around 1% because of these intravitreal injections,
Posted by mehdi khanlari at 05:45 AM | Comments (4)