Ophthalmology Review

Posted by kjalali at 05:18 PM | Comments (0)

lens calculations after refractive surgery

JCRS MARCH 2005
USA,To evaluate the effect of refractive surgery on IOL power calculation, compare methods of IOL power calculation after refractive surgery, evaluate the effect of pre-refractive surgery refractive error on IOL deviation, review the literature on determining IOL power after refractive surgery, and introduce a formula for IOL calculation for use after refractive surgery for myopia.

This retrospective noncomparative case series comprised 21 patients who had uneventful cataract extraction and IOL implantation after previous uneventful myopic refractive surgery. Six methods of IOL calculation were used: clinical history (IOLHisK), clinical history at the spectacle plane (IOLHisKs), vertex (IOLvertex), back-calculated (IOLBC), calculation based on average keratometry (IOLavgK), and calculation based on flattest keratometry (IOLflatK). Each method result was compared to an “exact” IOL (IOLexact) that would have resulted in emmetropia and then compared to the pre-refractive surgery manifest refraction using linear regression. The paired t test was used to determine statistical significance.

Results
The IOLHisKs was the most accurate method for IOL calculations, with a mean deviation from emmetropia of −0.56 diopter ±1.59 (D), followed by the IOLBC (+1.06 ± 1.51 D), IOLvertex (+1.51 ± 1.95 D), IOLflatK (−1.72 ± 2.19 D), IOLHisK (−1.76 ± 1.76 D), and IOLavgK (−2.32 ± 2.36 D). There was no statistical difference between IOLHisKs and IOLexact in myopic eyes. The power of IOLflatK would be inaccurate by −(0.47x+0.85), where x is the pre-refractive surgery myopic SE (SEQm). Thus, without adjusting IOLflatK, most patients would be left hyperopic. However, when IOLflatK is adjusted with this formula, it would not be statistically different from IOLexact.

Conclusions
For IOL power selection in previously myopic patients, a predictive formula to calculate IOL power based only on the pre-refractive surgery SEQm and current flattest keratometry readings was not statistically different from IOLexact. The IOLHisKs, which was also not statistically different from IOLexact, requires pre-refractive surgery keratometry readings that are often not available to the cataract surgeon.

Posted by alireza habibollahi at 01:45 PM | Comments (0)

Pupil response to tropicamide following LASIK

JCRS MARCH 2005
USA,To investigate the effect of corneal thinning after laser in situ keratomileusis (LASIK) on the corneal penetration of topical eye medication.
Methods
LASIK performed in 19 eyes in this prospective study. Measurements were made before surgery and 3 months postoperatively. After instillation of tropicamide 1%, the change in pupil size over time was measured with a Colvard pupillometer. Central corneal thickness (CCT) was measured with ultrasonic pachymetry before and 3 months after LASIK. The corneal epithelial condition was also examined by fluorescein dye staining.

Results
The mean CCT decreased significantly from 564 μm ± 33 (SD) before LASIK surgery to 514 ± 48 μm 3 months postoperatively (P<.0001). Pupil diameter 10, 15, and 20 minutes after tropicamide 1% instillation was significantly larger 3 months after surgery than preoperatively (P=.0083, P=.0043, and P=.0144, respectively). The mean time to reach a pupil diameter of 6.0 mm decreased significantly from 14.4 ± 4.3 minutes in preoperative eyes to 11.5 ± 2.3 minutes in postoperative eyes (P=.0281). Mild punctate corneal epithelial staining (fewer than 5 spots) were observed in 4 eyes at the 3-month postoperative examination.
Conclusions
Pupil dilation after tropicamide 1% instillation was significantly faster after LASIK surgery. Corneal thinning that resulted from LASIK enhanced corneal penetration of tropicamide 1%.

Posted by alireza habibollahi at 01:38 PM | Comments (0)

Topography-based intraocular lens power selection

JCRS MARCH 2005
Germany,To provide mathematical tools for selecting IOL power for normal eyes and for “odd” eyes, particularly after corneal refractive surgery.
The main difference between normal corneas and corneas after refractive surgery results from different asphericities. Normal corneas are prolate, with typical numerical eccentricities of 0.5, whereas corneas after laser surgery for myopia are oblate. This causes the main difference (hyperopic shift up to 2.0 diopters) in IOL power selection. Shifts in the posterior corneal radius and corneal thickness are of minor importance.
Conclusion
Intraocular power selection after corneal refractive surgery should be based on all the information corneal topography provides.

Posted by alireza habibollahi at 01:31 PM | Comments (0)

Traumatic cataract and other adverse events with the implantable contact lens

JCRS MARCH 2005
Finland,To evaluate the surgical outcome and adverse events associated with implantation of the implantable contact lens (ICL) for the correction of high myopia or high hyperopia.
In this nonrandomized prospective clinical trial, the ICL V4 was implanted in 26 eyes of 13 patients with normal enrollment criteria (younger than 45 years, a clinically clear crystalline lens) (Group 1) and the V2, V3, or V4 were implanted in 38 eyes of 22 patients with heterogeneous criteria (older than 45 years or opacities in the crystalline lens) (Group 2). The main outcome measures were lens opacity classification system (LOCS II) assessment and transparency analysis of the lens.
Results
In Group 1, microdensitometric assessment showed no decrease in crystalline lens transparency and no statistically significant increase in crystalline lens density at any follow-up examination (P>.05). The incidence of anterior subcapsular (AS) opacities was 7.7%, and no eye developed clinically significant cataract during the mean follow-up of 13.2 months ± 12.3 (SD). No myopic eye lost a line of best corrected visual acuity (BCVA); 50.0% of hyperopic eyes lost 1 line of BCVA. Sixty-eight percent of myopic eyes and 75.0% of hyperopic eyes were within ±1.0 diopter of the predicted refraction. In Group 2, the incidence of AS opacities was 47.4% and 10 eyes (26.3%) developed clinically significant cataract during the mean follow-up of 30.9 ± 18.0 months. The visual and refractive results were similar to those in Group 1 at 1 month, but due to progressive AS opacities in the crystalline lens, 23.4% of eyes lost BCVA lines during the follow-up. Intraoperative complications were few and insignificant.

Conclusions
Implantation of the ICL for correction of high myopia or high hyperopia appears to be a safe procedure with good visual and refractive results immediately. There was no decrease in the transparency or increase in the density of the crystalline lens with the latest generation of the ICL device in the normal group, indicating enhanced safety. Progressive lens opacification in the heterogeneous group shows there are risk factors for cataract formation; ie, type V3 ICL, preexisting lens opacities, and older patient age. Anterior subcapsular opacities are most likely the result of trauma.

Posted by alireza habibollahi at 01:23 PM | Comments (0)

Results of late flap removal after complicated LASIK

JCRS MARCH 2005
Purpose
To evaluate the effect of flap removal on complications after laser in situ keratomileusis (LASIK).
This retrospective interventional case series comprised 6 eyes of 6 patients at 4 centers. Flap removal occurred 2 to 41 weeks after the LASIK procedure. The corneal flaps were excised by 2 methods: In 2 eyes, the flap was lifted and excised manually. In 4 eyes, the thin flap was removed by excimer ablation using phototherapeutic keratectomy and/or photorefractive keratectomy. Postoperative measurements included uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, slitlamp evaluation, and computerized videokeratography. All patients had an 8-month or longer convalescence to assess visual recovery.

Results
After the initial flap complication, the BSCVA decreased in all 6 eyes (mean loss 3.0 lines ± 1.5 [SD]). After flap removal, it improved in all eyes (mean gain 2.2 ± 1.2 lines). All patients reported a reduction in or elimination of visual symptoms. Despite the improvements, a minor loss of BSCVA (mean −0.8 lines [range 0 to 2 lines]) remained in 4 patients.

Conclusion
In carefully selected patients, flap removal is a viable surgical option to improve visual function.

Posted by alireza habibollahi at 01:10 PM | Comments (0)

April 27, 2005

Family history has impact on the onset of myopia

Eyeworld April 2005
In the cross-sectional study, patients were divided into four groups of normal, mild, moderate, and high myopia. Among the participants were 185 normal subjects, 170 mild, 140 moderate, and 392 high myopes.
Results showed that when there was at least one highly myopic parent, individuals had an odds ratio between 2.5 and 3.7 of developing mild to moderate myopia and of greater than 5.5 of having high myopia.
Investigators also discovered a strong association between the myopic state of the parents and the axial length of the subjects, but not on anterior chamber depth or corneal curvature.Also, earlier onset of myopia tended to be found in highly myopic patients that had highly myopic parents. This was also true for those with moderate myopia.
In addition, there was a weaker association found between siblings and level of myopia, although the presence of myopia in siblings appeared to have no effect on age of onset of myopia.When it came to environmental factors, only education level and television viewing were significant.

Posted by mehdi khanlari at 03:34 PM | Comments (0)

Cyclosporine deemed effective in treatment of ocular rosacea

Eyewprld April 2005
A recent study has determined that cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan, Irvine, Calif.) is an effective method for treating ocular rosacea in patients that failed to respond to other treatments.The study was presented as a poster at the most recent meeting of the American Academy of Ophthalmology.Of the 55 patients investigators studied over an average 5.2-month period, 46% showed significant improvement or complete resolution of their ocular rosacea, and 38% showed mild to moderate improvement At the last follow-up, 65% were still taking low-dose tetracycline (various manufacturers) to treat their ocular rosacea, but 39% required no additional medications, said investigators.It also showed that long-term control of rosacea can be achieved by using Restasis twice a day.
Traditional treatments for signs and symptoms of active and chronic ocular rosacea have included hot compresses, oral tetracyclines, topical antibiotics, and topical corticosteroids

Posted by mehdi khanlari at 03:26 PM | Comments (0)

April 26, 2005

Prognosis of pseudophakic retinal detachment

Journal of Cataract & Refractive Surgery Volume 31, Issue 2 , February 2005
This retrospective review comprised 120 pseudophakic patients and 280 phakic patients who had RD surgery during a 4-year period. An identical scleral buckling procedure was used for primary surgery in both groups. Cataract surgery had been performed using extracapsular cataract extraction (ECCE) in most eyes; phacoemulsification was used in 67.5% of the pseudophakic eyes. The mean follow-up was 13.5 months.
ResultsPseudophakic patients with RDs presented with significantly worse preoperative visual acuity than phakic patients due to a higher frequency of total RDs and macula-off RDs. Retinal breaks were found significantly less frequently and reoperations were performed with a higher frequency in pseudophakic patients than in phakic patients. At 6 months, no differences between pseudophakic and phakic patients were found. The overall anatomic reattachment rate was 94% and 96% in the 2 groups, and the visual outcome was also identical, with a visual acuity better than 0.4 in about 60% of patients.ConclusionsPseudophakic patients presented with more extended RDs and with the macula detached more frequently. Retinal breaks were found less frequently. Despite these findings, the anatomic and visual prognosis of pseudophakic detachments was identical to that of phakic detachments

Posted by mehdi khanlari at 06:16 PM | Comments (0)

Long-term Nutrient Intake and 5-Year Change in Nuclear Lens Opacities

Archives of Ophthalmology Vol. 123 No. 4, April 2005
A sample of 408 Boston, Mass–area women from the Nurses’ Health Study aged 52 to 74 years at baseline participated in a 5-year study related to nutrition and vision. Usual nutrient intake was calculated as the average intake from 5 food frequency questionnaires that were collected over a 13- to 15-year period before the baseline evaluation of lens nuclear density. Duration of vitamin supplement use before baseline was determined from 7 questionnaires collected during this same period. We assessed the degree of nuclear density (opacification) using computer-assisted image analysis of digital lens images with amount of nuclear density measured as a function of average pixel gray scale, ranging from 0 (clear) to 255 (black).Conclusion Our results suggest that long-term use of vitamin E supplements and higher riboflavin and/or thiamin intake may reduce the progression of age-related lens opacification.

Posted by mehdi khanlari at 06:09 PM | Comments (0)

Optical coherence tomography assessment of capsule closure after cataract surgery

JCRS April 2005
This prospective study comprised 33 eyes of 33 patients with age-related cataract who were scheduled to have cataract surgery. All eyes had phacoemulsification with implantation of 1 of 3 types of open-loop IOLs: 1-piece acrylic (SA60AT, Alcon), 3-piece acrylic (AcrySof MA60BM, Alcon), or 3-piece silicone (911A, AMO). Each group included 11 eyes. One and 3 days and 1, 2, 3, and 4 weeks after surgery, contact between the lens capsule and IOL optic as well as capsule bend formation were evaluated using optical coherence tomography (OCT). The postoperative times at which the capsule came into contact with the IOL optic and when the capsule bend formed were determinedConclusions :Optical coherence tomography produced cross-sectional tomograms of capsule–IOL contact in the early postoperative period. There was no significant difference in the time to capsule bend formation between the 3 IOLs. However, capsule bend formation at the optic edge occurred earlier with the 1-piece acrylic IOL than with the 3-piece silicone IOL.

Posted by mehdi khanlari at 06:03 PM | Comments (0)

April 24, 2005

CRSToday Online Cataract Virtual Textbook

David F. Chang, MD, Editor

The First Virtual Textbook of Cataract Surgery
If your home office is anything like mine, limited shelf space results in stacks of periodicals and journals that barricade your desk. Although I maintain a library of textbooks and peer-reviewed journals, I have never quite known what to do with the piles of trade journals that arrive each week. Many accumulate in my inbox. Once I read them, I throw most away (in keeping with the familiar throwaway moniker). Some I have trouble discarding because of excellent articles that I want to read later or save. Perhaps naively, I plan to find time to clip and file important articles for future reference.
We are proud to launch our Virtual Textbook of Cataract Surgery. I personally combed through every past issue of CRSToday to select and categorize all of the cataract articles. I hope that through word of mouth, the international community will also learn about this free educational resource. Take a moment to check it out. If you think it is useful, e-mail the link to a resident, fellow, or international colleague and help us to spread the word.
Read this Book....

Posted by mmiraftab at 10:18 AM | Comments (0)

LASIK volume up more than 25%, ASCRS survey finds

OSN April 2005

WASHINGTON — The volume of LASIK procedures grew 26% from 2003 to 2004, according to an annual survey of practice preferences presented here at the American Society of Cataract and Refractive Surgery meeting. Other notable findings of the survey of U.S. members of ASCRS included an overwhelming preference for acrylic IOLs, a unanimous interest in accommodating IOLs and a near-doubling of the use of clear corneal incisions from 5 years ago. According to Dr. Leaming, in 2004, 62% of survey respondents used topical plus intracameral anesthesia in cataract surgery. Over a 5-year period, from 1999 to 2004, the use of clear corneal incisions almost doubled, from 40% to 72%, according to survey responses. Surgeons said they prefer a metal blade to a diamond blade by a two-to-one ratio, Dr. Leaming reported. As in recent years, acrylic IOLs remained the preferred IOL material among respondents, followed by silicone, PMMA and hydrogel. More than half the respondents — 57% — said they prefer a single-piece foldable IOL .For use with ultrasmall-incision cataract surgery in the future, 38% of respondents said an acrylic lens is the most promising IOL, and 29% of respondents said an injectable lens material holds the most promise. In a change from last year, 61% of respondents said they prefer implanting a clear IOL rather than a blue-light-filtering IOL. In 2003 47% reported preferring clear lenses. The survey also addressed refractive surgery topics. As noted above, respondents reported an increase in LASIK volume by 26% in the year since the 2003 survey. Seventy-five percent of respondents said 250 µm is the threshold for the residual stromal bed below which they would not perform LASIK.
Asked about what refractive procedures they were interested in adopting, 84% of respondents said they were not interested in scleral expansion, 49% were not interested in conductive keratoplasty, 54% were not interested in LASEK and 50% were interested in phakic IOL implantation. Respondents said they charge an average $500 additional to perform customized LASIK over their fee for conventional LASIK. Dr. Leaming noted that in 2003 respondents said only 9% of patients were offered wavefront LASIK. In 2004, every patient was offered the option of wavefront, he said. The survey respondents reported an overall post-LASIK ectasia rate of 9%.
Regarding glaucoma, the survey posed a series of scenarios and asked what drug the respondents would prescribe. For first-line therapy in a 45-year-old patient, 60% said they would prescribe prostaglandins if the patient was blue-eyed with no cardiopulmonary complications, and 77% would prescribe prostaglandins if the patient had brown eyes and no cardiopulmonary complications. For a blue-eyed patient with a history of cardiopulmonary complications 83% would prescribe prostaglandins, and for a brown-eyed patient, 94%.
Regarding medical liability, 17% of respondents said they pay a malpractice insurance premium of $10,000 per year; 14% each said they pay $7,500, $12,500 or $15,000.

Posted by mmiraftab at 10:01 AM | Comments (0)

April 22, 2005

Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses

jcrs February 2005
There were no significant differences in tilt and decentration between 1-piece and 3-piece hydrophobic acrylic IOLs in eyes with capsular bag IOL implantation and an intact CCC.

Posted by mehdi khanlari at 08:04 PM | Comments (0)

FDA approves intravitreal implant for treatment of chronic noninfectious uveitis affecting the posterior segment

INDUSTRY NEWS
The FDA approved Retisert as an orphan drug, which grants Bausch & Lomb seven-year exclusivity on the product. The company says Retisert is the world's first intravitreal drug implant for the treatment of this condition which affects an estimated 175,000 people in the United States and an estimated 800,000 people worldwide. The company says the FDA’s approval was based on 34-week results from two, three-year randomized trials that showed recurrence of uveitis dropped significantly after treatment. In addition, patients had a statistically significant decrease in the use of adjunctive therapy and a statistically significant improvement of three or more lines of visual acuity.

Posted by kjalali at 02:16 PM | Comments (0)

Verteporfin therapy recommended for AMD patients with relatively small minimally classic lesions

Archives of Ophthalmology, April 2005
Phase II results of a randomized trial showed the treatment safely reduced the risks of losing at least 15 letters (3 lines) of visual acuity and progression to predominantly classic CNV for at least two years in patients with subfoveal minimally classic lesions measuring 6 MPS disc areas or less.

Posted by kjalali at 02:14 PM | Comments (0)

Pathogenesis of keratoconus may involve chronic inflammatory events

Ophthalmology, April 2005
This prospective, case-control study found Interleukin-6, TNF-a, and MMP-9 to be over-expressed in the tears of patients with keratoconus. The extent of the increase appears associated with the severity of keratoconus.

Posted by kjalali at 02:12 PM | Comments (0)

Patching appears effective in older children

Archives of Ophthalmology, April 2005
This large nationwide, randomized trial showed that 53 percent of children ages 7 to 12 who were prescribed both glasses and patching combined with near visual activities improved their vision by at least two lines. Only 25 percent of children in that age group who received glasses alone experienced such an improvement. Of the children between 13 and 17 who were not previously treated for amblyopia with patching, 47 percent experienced improved visual acuity by at least two lines. The study involved 507 children ranging in age from 7 to 17, including 103 children between 13 and 17 years old. A follow-up study to assess the long-term benefits in these older children is planned.

Posted by kjalali at 01:59 PM | Comments (0)

Despite problems, most patients still recommend LASIK to others

Eyeworld April 2005

Arecent study has found that some patients that report dissatisfaction with their vision after LASIK would still recommend the procedure to others.The study, titled “Reasons patients recommend laser in situ keratomileusis,” was published in a recent issue of the Journal of Cataract & Refractive Surgery.In the study, the categories of reasons for patients recommending LASIK to others were similar to the reasons patients gave for seeking the procedure themselves.That most patients that were not satisfied with their post-LASIK vision would still recommend the procedure to a friend (57%) suggests that the recommendation of LASIK to others is not necessarily a measurement of how patients view the quality of their own vision after undergoing the procedure.“One of the things that we uncovered is that there are a few patients that would say that they don’t like their vision, but they would recommend LASIK to others because they’ve known so many other people who were satisfied with it,” she said.

Posted by mehdi khanlari at 01:51 AM | Comments (0)

Pre-op tear function affects early functional visual acuity after LASIK

Eyeworld April 2005
LASIK patients with low basal tearing and full uncorrected distance Landolt acuity could notice a short-lived decrease in functional visual acuity (FVA) that returns to baseline in one week’s time, according to a new study published in the November issue of the Journal of Cataract & Refractive Surgery.Investigators analyzed the effect of pre-operative and post-operative tear functions on FVA in 15 patients (30 eyes) that underwent LASIK. FVA was defined by researchers, led by Mari Tanaka, M.D., Department of Ophthalmology, Tokyo Dental College, Japan, as the binocular recognition acuity measured by the FVA tester during a 10-second, blink-free period.
Eyes with a Schirmer test reading of less than 5 mm and a tear-film breakup time (BUT) of less than five seconds were grouped as definite dry eye (DDE). Eyes with a normal Schirmer test and a shortened BUT were labeled as probably dry eye (PDE). Researchers found that in the DDE group, the average FVA declined from 1.2 pre-operatively to 0.75 at one day and increased to 1.2 at one week. Meanwhile, researchers observed no change in FVA post-operatively for the PDE group.

Posted by mehdi khanlari at 01:45 AM | Comments (0)

CK leading non-laser refractive surgery

Eyeworld April 2005
Conductive Keratoplasty is the leading U.S. non-laser refractive procedure, according to the research firm Market Scope.The 2004 Annual Survey of Refractive Surgeons found the non-laser refractive procedure market, as a whole, grew 55% since 2003, fueled in part by the expanded indication for NearVision CK. The CK procedure leads the segment with a 73% market share and refractive intraocular lens implantation is 23% of this market.NearVision CK is the only procedure approved by the FDA for the treatment of presbyopia. The technology is set to begin a phase III clinical trial to study the procedure’s ability to improve near vision in patients that previously had LASIK, according to the manufacturer

Posted by mehdi khanlari at 01:38 AM | Comments (0)

Blinks are positive during pachymetry, prevent cornea thinning, false readings

Eyeworld April 2005
Corneas that thin in such a manner would provide false pachymetry readings, and that could influence a person’s applanation reading, which determines intraocular pressure. The study, titled “Effect of corneal drying on central corneal thickness,” was published in a past issue of the Journal of Glaucoma.Study author Volkan Dayanir, M.D., said that a cornea could also thin during applanation itself by short-term drying — again by not blinking — although that assertion was not tested....Five years ago, pachymetry readings were not used routinely for glaucoma examinations, but now they have become an integral part of the evaluation, Dr. Dayanir said.As a result, Dr. Dayanir said ophthalmologists may want to heed some new recommendations related to taking pachymetry readings in light of his study results.When technicians take the pachymetry measurements, tell them to let patients blink voluntarily between the measurements, he said. Don’t situate a patient right next to an air conditioning outlet during testing because this could have a similar drying effect on the eyes, Dr. Dayanir said.Lastly, take applanation pressure as quickly as possible because drying also can affect IOP readings directly, he said.“If that is not possible and the process is getting longer, allow patients to blink a few seconds to make the cornea go to its original thickness, and then measure again,” Dr. Dayanir said.

Posted by mehdi khanlari at 01:24 AM | Comments (0)

Tip design may affect corneal wound trauma during bimanual phacoemulsification

Eyeworld April 2005
When the 0.9-mm Turbosonics Round Microtip (Alcon, Fort Worth, Texas) was tested against the 0.9-mm Microphaco Mackool Tapered Round Tip (Alcon), the 0.9-mm Microphaco Tapered Round Tip (Alcon), and the 0.9-mm Hydrodynamic Straight Tip (MicroSurgical Technology, Redmond, Wash.; Advanced Medical Optics, Irvine, Calif.) tears in Descemet’s membrane occurred in various sizes, the study showed.“Out of the different bimanual tip designs, the Mackool tips with a polyimide sleeve had the smallest Descemet’s membrane tears,” When compared to bare tips, the sleeve around the Mackool tip may add protection and facilitate their movement within the wound....Overall, cataract cases with the Microphaco Mackool Tapered Round Tip resulted in the least tearing during bimanual phacoemulsification. The ratios for these cases were 0.24 and 0.31.The Turbosonics Round Microtip was a close runner-up, with ratios of 0.24 and 0.64, while the Hydrodynamic Straight Tip produced measurements of 0.37 and 0.58. The Microphaco Tapered Round Tip yielded ratios of 0.62 and 1.23....Drs. Weikert and Koch also measured the effects of the various tips on endothelial cell loss surrounding the operative wounds, but found no significant difference between the bimanual tip type styles. The also found no correlation between the magnitude of Descemet’s membrane tears and the area of endothelial cell loss. ...Dr. Weikert noted that endothelial loss surrounding the corneal wounds was greater with bare bimanual phacoemulsification tips than with a standard ABS tip with coaxial infusion. ...Dr. Hoffman said surgeons just learning bimanual may see more cell loss. That’s because surgeons beginning to learn bimanual may inadvertently direct irrigation flow at corneas and may be more likely to perform phaco in the anterior chamber both of, which could lower the endothelial cell count.

Posted by mehdi khanlari at 12:45 AM | Comments (0)

Single-piece IOL shifts less post-operatively

Eyeworld April 2005
The single-piece AcrySof intraocular lens (Alcon Inc., Fort Worth, Texas) shifts less in the anterior chamber than the multipiece AcrySof, according to a study in the January issue of the Journal of Cataract & Refractive Surgery.The prospective randomized bilateral study of 104 eyes of 52 consecutive patients with age-related cataracts found single-piece AcrySof IOLs shifted minimally after the first post-operative day.The study authors concluded the minimal movement allows patients to obtain the prescription for spectacles soon after surgery. Single-piece IOLs shifted significantly less post-operatively than multipiece IOLs. The study found the multipiece IOLs shifted forward, especially from one day to one month.The change in the capsulorhexis area was similar between IOL types. Anterior chamber depth measurements and evaluation were performed during the first six months post-operatively using partial coherence laser interferometry. The amount of change in capsulorhexis size during the first six post-operative months was assessed using standardized retro-illumination photographs.

Posted by mehdi khanlari at 12:41 AM | Comments (0)

April 21, 2005

Hydrophilic acrylic IOLs may offer better biocompatibility

Eyeworld April 2005
Dr. Ursell and his colleagues studied the hydrophilic acrylic lenses Centerflex (not available in the U.S.; Rayner Ltd., Brighton Hove, U.K.) and Akreos Fit (not available in the U.S.; Bausch & Lomb, Rochester, N.Y.), and compared them with the hydrophobic AcrySof SA30 (Alcon). The investigators performed a prospective randomized trial that enrolled 60 patients; 20 patients received each lens.After surgery, patients were examined at two weeks, two months, six months, and 12 months to assess vision and perform specular microscopy of the anterior lens surface. This compared the biocompatibility of the lenses by determining the numbers of small cells, giant cells, and lens epithelial cells.“The hydrophobic acrylic — the AcrySof — had more lens epithelial cells on the surface in the first two months compared with the other two lenses, and the AcrySof also had more giant cells at the six-month period compared with the hydrophilic acrylic lenses,” Dr. Ursell said. “Between the two hydrophilic lenses, the Akreos appeared to have fewer small cells, fewer lens epithelial cells compared with the Centerflex lens, but this did not achieve significance.”

Posted by mehdi khanlari at 10:59 PM | Comments (0)

Notice of allowance for antibody uveitis treatment

Eyeworld April 2005
Advanced Biotherapyd Inc. (Woodland Hills, Calif.) has received a “Notice of Allowance” from the U.S. Patent and Trademark Office (PTO) for the use of inhibitors, including antibodies, to interferon-gamma to treat uveitis, according to the company.The patent to treat the autoimmune condition, which causes inflammation inside the eye, is expected within 120 days and will extend through 2020. The company performed an investigational study at the Research Institute of Pediatric Hematology of Moscow, Russia, where six children (ages 2 to 15) with juvenile rheumatoid arthritis (JRA)-associated uveitis were given a short-course of treatment with antibody to interferon-gamma in the form of eye drops. When compared with 15 patients with JRA-associated uveitis treated with standard therapy (non-steroidal anti-inflammatory drugs) the company found its product as an adjuvant to standard therapy was more effective than standard therapy alone

Posted by mehdi khanlari at 10:47 PM | Comments (0)

Trypan blue isn’t right for all lenses

Eyeworld April 2005
.....The conclusion was that in cases in which trypan blue was used in conjunction with implantation of the Acqua hydrophilic expandable hydrophilic acrylic IOL, patients did significantly worse in glare visual testing than in cases where no staining was used.Investigators urged practitioners to avoid use of trypan blue with the lens until further studies could be done to either confirm or contradict the findings......The message to draw from the study is to avoid using hydrophilic lenses in cases where dyes are present, Dr. Packer said. “A lot of these lenses like the Memory lens (Novartis Ophthalmics, East Hanover, N.J.) and the Hydroview lens (Bausch & Lomb, Rochester, N.Y.) have been dogged by problems with opacification because they not only absorb fluid, but they precipitate material inside them and they turn white,” Dr. Packer said.One possible exception may be the Rayner C-flex lens (East Sussex, England).

Posted by mehdi khanlari at 10:41 PM | Comments (0)

Trypan blue may affect capsule strength

Eyeworld April 2005
By helping make the capsule more rigid, trypan blue makes it easier to tear. Trypan blue may facilitate cataract surgery beyond just being visually helpful, according to a recent study.The use of trypan blue under the right conditions could increase the elastic stiffness of the anterior lens capsule, according to the study’s lead author, Gregor Wollensak, M.D., Department of Ophthalmology, Technical University of Dresden, Germany.The study, published in the July 2004 issue of the Journal of Cataract & Refractive Surgery, noted that light irradiation of the capsule for at least one minute combined with trypan blue dye led to an increase in elastic stiffness at 25% strain by up to 50% and a decrease of the tear point by up to 13%.
In other words, the combination of light irradiation and dye would decrease the capsule’s extensibility, making the capsulorhexis easier, said Dr. Wollensak .....The elastic stiffness increased even more (a 70.1% increase) for the specimens treated with trypan blue and light for 30 minutes compared with that of the non-treated group... “Remarkably, there was no such effect after trypan blue staining in the darkness and after trypan blue staining and light exposure for only 30 seconds, indicating a light dependent process as is typically the case with photosensitized collagen crosslinking,” Dr. Wollensak wrote. “If the incubation with the dye is shorter than one minute, the biomechanical effect might be absent or weaker, which might be the case for some surgeons.”“The so-called reactive oxygen species (ROS) lead to physical crosslinking of collagen,”. That collagen crosslinking causes a stiffening effect, similar to the UV-induced crosslinking of the crystalline proteins of the lens that leads to cataract formation .

Posted by mehdi khanlari at 10:29 PM | Comments (0)

Medical control of intraocular pressure after phacoemulsification

JCRS MARCH 2005
To compare the effectiveness of oral acetazolamide, topical brinzolamide 1%, and no ocular hypotensive medication after phacoemulsification.
This prospective randomized double-blind study comprised 60 eyes of 52 patients having phacoemulsification under topical anesthesia. There were no intraoperative complications. Eyes were randomized to receive oral acetazolamide 500 mg 1 hour preoperatively followed by 250 mg acetazolamide every 6 hours, 1 drop of brinzolamide 1% every 12 hours starting immediately after speculum removal, or no ocular hypotensive medication. Intraocular pressure (IOP) was measured using a Perkins tonometer preoperatively and 4 to 6 hours and 18 to 24 hours postoperatively.
Conclusion:Brinzolamide was as effective as acetazolamide in preventing IOP elevation 4 to 6 hours after phacoemulsification and more effective than acetazolamide at 18 to 24 hours

Posted by alireza habibollahi at 02:48 PM | Comments (0)

Combined pars plana vitrectomy and phacoemulsification to restore visual acuity in patients with chronic uveitis

To report the outcomes of combined phacoemulsification and pars plana vitrectomy (PPV) to restore visual acuity in patients with cataract and posterior segment involvement secondary to chronic uveitis.
This study comprised 34 patients (20 women, 14 men; 36 eyes) with posterior segment involvement secondary to chronic uveitis who had combined phacoemulsification and PPV. The main outcome measures were visual acuity, intraocular pressure, and cystoid macular edema.

Results
The mean patient age was 45 years The mean duration of uveitis before surgery was 56 months. In 24 eyes (66.7%), an intraocular lens (IOL) was implanted during surgery; 12 eyes (33.3%) were left aphakic. Five eyes (13.8%) received an intraocular steroid injection intraoperatively. Visual acuity improved in 26 eyes (72.2%), deteriorated in 5 (13.9%), and was unchanged in 5 (13.9%). The main reason for decreased visual acuity was refractory macular edema. During the follow-up, 2 IOLs were explanted secondary to lens intolerance. One IOL was repositioned because of iris capture by the haptics, and 1 dislocated inferiorly, causing monocular diplopia. The mean follow-up was 23.4 months.
Conclusions
Results indicate that combined phacoemulsification and PPV is a feasible technique for the removal of cataract and pathologic vitreous in eyes with chronic uveitis. Although the exact role of vitrectomy in patients with uveitis remains to be determined, the combined surgery successfully restored useful vision in most cases.

Posted by alireza habibollahi at 02:38 PM | Comments (0)

Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients

JCRS MARCH 2005
Methods
345 patients who had uneventful sutureless clear corneal phaco-IOL . Included were 58 patients with medically controlled open-angle glaucoma and 287 normal controls. Follow-up was 1 to 2 years.
Results
Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.5 mm Hg ± 4.4 (SD) at 12 months and 1.9 ± 4.9 mm Hg at 24 months. The mean number of medications decreased significantly at 12 months (0.53 ± 0.86) and at 24 months (0.38 ± 0.9) (P=.04). The control group also had a significant decrease in IOP, with a mean decrease of 0.72 ± 3.7 mm Hg at 12 months (P=.01) and 1.33 ± 3.2 mm Hg at 24 months (P<.0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups.
Conclusions
These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively simple and efficient surgical option in patients with cataract and well-controlled glaucoma. The approach combines long-term IOP control with fewer medications and leads to rapid visual rehabilitation

Posted by alireza habibollahi at 02:31 PM | Comments (0)

Late-onset repetitive traumatic flap folds and partial dehiscence of flap edge after LASIK

JCRS MARCH 2005

A 25-year-old woman had traumatic flap folds and partial dehiscence of the flap edge in the right eye 5 and 30 months after laser in situ keratomileusis. The period from injury to treatment was 4 hours and 9 days, respectively. With the first injury, the flap was lifted and stretched with moistened sponges to clear the folds. With the second injury, the folds were hard so the flap was lifted and sutured to stretch the folds. The patient recovered visual acuity within 2 weeks.

Posted by alireza habibollahi at 02:24 PM | Comments (0)

Retained ophthalmic viscosurgical device material in the capsular bag 6 months after phacoemulsification

JCRS MARCH 2005
We present a 63-year-old man who developed low-grade endophthalmitis 6 months after phacoemulsification and implantation of a foldable posterior chamber intraocular lens (IOL). The capsular bag was distended, but shallowing of the anterior chamber was not observed. Chemical analysis of the clear fluid aspirated from the capsular bag behind the IOL revealed the presence of an ophthalmic viscosurgical device.

Posted by alireza habibollahi at 02:21 PM | Comments (0)

April 19, 2005

New tonometers poised to challenge the gold standard

Eyeworld April 2005
The place of the current gold standard in tonometry — Goldmann Applanation tonometer (Haag Streit, Mason, Ohio) — may not be as secure as it once was.Dimitrios Siganos developed the Pascal Dynamic Contour Tonometer (Ziemer Ophthalmic Systems, Port, Switzerland) and co-authored an article that compared the two tonometers in the April 2004 issue of Journal of Cataract & Refractive Surgery.Approved by the Food and Drug Administration in November 2003, the Pascal is heralded by Ziemer as the only instrument of its kind with an internal digital pressure sensor. It claims the device provides a better way to measure IOP and allows for a more-detailed assessment of pressure because of its sensor. But ophthalmologists want data before switching.An alternate approach now in FDA trials, called the Eric Tonometer System (Eric Corp., Calgary, Canada), relies on the application of sonic vibrations.When sonic energy passes into the eye, it vibrates at different frequencies. The frequencies begin to make the eye move back and forth. The resistance to these vibrations relate to the pressure inside. The device makes the eye vibrate about 1 micron amplitude or less, and it relies less on the corneal curvature and elasticity by changing the corneal shape about 99 microns less than GAT. Two models are now under development. A small, lower-cost homecare device slated to be on the market within a year and a professional laser-based non-contact model is planned for release within two years. The home care model will look like a pair of binoculars and be placed over the eyelids.The advantages of the new system are that the volume of the eye is not changed because vibrations occur along the entire eye. Tonometers that bend the cornea or touch the eye change the volume.A study in the August issue Clinical & Experimental Ophthalmology found that another option, the Tonosafe (Haag-Streit AG) disposable prism head, provides accurate IOP measurement, even in the higher range.The study assessed the accuracy of the Tonosafe disposable prism tonometer head through a randomized controlled prospective trial.Researchers concluded there was a high level of correlation between the IOPs obtained with the Goldmann and Tonosafe heads.

Posted by mehdi khanlari at 10:40 PM | Comments (0)

Treatment of presbyopia with conductive keratoplasty: six-month results of the 1-year United States FDA clinical trial.

Cornea. 2004 Oct;23(7):661-8.

USA. To provide 6-month results of a 1-year clinical trial evaluating conductive keratoplasty (CK) for the treatment of presbyopic symptoms in emmetropic and hyperopic eyes. METHODS: A total of 143 patients with presbyopic symptoms were enrolled in this 1-year United States FDA clinical trial and treated to improve near vision in 1 eye (unilateral treatment). In addition, 33 fellow eyes were treated to improve distance vision (bilateral treatment). For near vision correction, the target refraction was up to -2.0 D in the nondominant eye, and for distance vision correction, 0.0 D. Enrolled patients had a preoperative spherical equivalent of plano to +2.00 D, no more than 0.75 D of refractive astigmatism, and were 40 years of age or older. No retreatments were performed. RESULTS: Of the eyes treated for near, 77% had uncorrected near vision of J3 or better at 6 months postoperatively. A total of 85% of all patients had binocular distance UCVA of 20/25 or better along with J3 or better near, a combination that represents functional acuity for a presbyope. Sixty-six percent of eyes treated for near had a manifest refractive spherical equivalent (MRSE) within +/- 0.50 D of intended at 6 months. In 89% of eyes, the MRSE changed 0.05 D or less between 3 and 6 months postoperatively. After month 1, the incidence of variables associated with safety was 1% or lower. Seventy-six percent were very satisfied or satisfied with their procedure. CONCLUSIONS: CK appears to be very safe and effective in producing functional visual acuity in presbyopic eyes up to 6 months following the procedure. Patient satisfaction with the procedure is similar to that of monovision LASIK.

Posted by alireza habibollahi at 09:50 PM | Comments (0)

Health News. 2004 Jun;10(6):8-9. Related Articles, Links

FDA approves help for aging eyes. Conductive keratoplasty may improve vision for people older than 40 who need reading glasses to see "the fine print".

Posted by alireza habibollahi at 09:45 PM | Comments (0)

Conductive Keratoplasty Take a Closer Look

EYE-NET JULY/AUGUST 2003

From hyperopia to presbyopia, how is conductive keratoplasty faring in the eyes of ophthalmologists?
A little more than a year after CK received FDA approval for the treatment of hyperopia in patients aged 40 and older, the verdict is still out. Here’s a look at the issues.

Window of Opportunity
What most ophthalmologists do agree on is that the safety profile for CK is outstanding—and the window for its use is narrower than that seen with LASIK.
LASIK is labeled for use for up to +6 D, but it can effectively treat hyperopia up to only about +4 D. As for CK, while it is labeled for use in up to +3 D, its effectiveness begins to drop off in patients over +2.5 D.

Marguerite B. McDonald, MD, a strong advocate of CK, noted that “in patients between +2.5 D and +3 D, the enhancement rate goes up with CK, and many need to be brought back for a touch-up. While some doctors have decided to stay away from the procedure in these patients, I will sometimes go for +3 D—for instance, in dry eye patients who would not do well with LASIK—and inform the patient that there is a somewhat increased chance of needing an enhancement.”
In contrast, Ernest W. Kornmehl, MD, will not perform the procedure on any patient who is +3 D and would prefer to perform LASIK in the vast majority of patients under +3 D. Dr. Kornmehl states that he is “not currently recommending conductive keratoplasty because the FDA has only approved it as a temporary procedure for mild to moderate farsightedness and only 50 percent of the patients in the study were very satisfied. In addition, the long-term effects of radio frequency energy on the eye are not known at this time.” Hyperopic patients should have the highest satisfaction rate of all refractive patients, Dr. Kornmehl said, “and a rate of only 50 percent being ‘very satisfied’ is low.”

How It Works
Dr. McDonald is the lead author on two studies reporting on the one-year trial results on 54 and 355 eyes, respectively.1,2 In the reports, Dr. McDonald and her colleagues remark that thermal techniques to shrink peripheral corneal collagen and thereby steepen the central cornea have been the subject of investigation for more than a century.
One attempt occurred during the 1980s with the development of hot-wire thermokeratoplasty, which produced thermal burns that penetrated to 95 percent of corneal depth in hyperopic eyes. However, it was discarded because of its lack of predictability and stability.
Enter CK, the latest approach. The low-energy, high-frequency current (350 kilohertz) is delivered directly into the peripheral corneal stroma by means of a proprietary tip3 inserted at eight to 32 treatment points. (The number depends on the level of hyperopia—the higher the needed correction, the greater the number of treatment points.) Collagen within the treatment zone is heated in a gentle, controlled fashion as a result of the natural resistance of stromal tissue to the flow of the current.
“A thermal model predicts protein denaturation at each treated spot that results in a cylindrical footprint approximately 150 microns to 200 µ wide and 500 µ deep extending to approximately 80 percent of the midperipheral cornea,” Dr. McDonald and the other researchers explain. “Striae form between the treated spots, creating a band of tightening that increases the curvature of the central cornea, thereby decreasing hyperopia.”1
Unlike the hot-wire keratoplasty technique, the CK delivery needle stays cool as collagen is heated.
Clinical Trial Results
In the CK trial, 20 surgeons at 13 centers treated eyes (355 total at one-year follow-up) ranging from +0.75 D to +3 D of hyperopia and <0.75 D of cylinder. The mean age and mean hyperopia of the participants was 55 and +1.86 D, respectively, and more than half of the patients—58 percent—were female.

At 12 months, uncorrected visual acuity was <20/20 in 56 percent of eyes, <20/25 in 75 percent of eyes and <20/40 in 92 percent of eyes. The major safety outcome of the trial was to preserve BCVA: At 12 months, no participant lost more than 2 lines of BCVA, and no participant had a BCVA worse than 20/40. Refractive stability seemed to be attained by six months and remained stable through 12 months. As for patient satisfaction, 81 percent of patients reported being satisfied and 50 percent reported being very satisfied. There were no re-treatments.

For Dr. McDonald, the results speak for themselves. “There were no dry eyes and the patients recovered quickly.”

Posted by alireza habibollahi at 09:21 PM | Comments (0)

April 18, 2005

Theoretical Elastic Response of the Cornea to Refractive Surgery: Risk Factors for Keratectasia

Journal of Refractive Surgery Vol. 21 No. 2 March/April 2005

PURPOSE
To explore the role that mechanical elastic factors may have in post-refractive surgery corneal phenomena, from mild curvature changes to keratectasia.
METHODS
The central cornea near the apex was modeled as an elastic spherical thin shell loaded by the intraocular pressure (IOP). Equations for myopic laser in situ keratomileusis (LASIK) were obtained to estimate shifts and curvature changes of the posterior corneal surface at the apex. The effect of every parameter was studied, identifying potential risk factors for ectasia.
RESULTS
Theoretically, corneal thinning by ablation will produce an elastic deformation of the posterior surface that depends on the corneal parameters (curvature, Young’s modulus, Poisson ratio, and thickness), the IOP, and the ablation profile. In particular, a forward shift and an increase in power of the posterior surface was predicted for myopic LASIK, in agreement with previous experimental findings. These changes rise non-linearly with the attempted correction, and are greater for thinner preoperative corneas, higher IOP, smaller Young’s modulus, and thicker flaps. Corneas with Young’s modulus half the average or less, or thickness <500 µm, may present high risk of ectasia, especially for high IOP and thick flaps.
CONCLUSIONS
Some postoperative effects may be explained in part by elasticity. Research efforts are needed to explain other biomechanical behaviors. The accepted criterion of 250 µm residual bed is insufficient for fine patient screening—depending on the individual ocular parameters, it could be more restrictive. Advances in technology are needed to create a preoperative examination including two-dimensional maps of topography, pachymetry, and Young’s modulus.

Posted by mmiraftab at 12:38 PM | Comments (0)

Topical Tacrolimus Ointment for Treatment of Refractory Anterior Segment Inflammatory Disorders

Cornea. 24(4):417-420, May 2005
Purpose: To report 4 cases of patients treated with topical tacrolimus ointment 0.03% for ocular inflammatory conditions refractory to traditional treatment.
Methods: Four patients were treated topically with tacrolimus 0.03% ointment twice daily: 2 patients with blepharokeratoconjunctivitis, 1 patient with severe atopic keratoconjunctivitis, and 1 patient with chronic follicular conjunctivitis.
Results: Three patients had a dramatic improvement of their ocular condition as early as 2 weeks after starting tacrolimus ointment. One patient developed a herpes simplex virus dendrite after 1 week of tacrolimus use.
Conclusion: Tacrolimus ointment appears to be an effective alternative for certain ocular inflammatory conditions refractory to traditional treatments. There may be an increased risk of herpes simplex virus keratitis associated with topical use. Our results support previous literature of patients benefiting from topical tacrolimus use.

Posted by mmiraftab at 12:29 PM | Comments (0)

Outcome of Penetrating Keratoplasty Performed by Cornea Fellows Compared With That of an Experienced Staff Surgeon

Cornea. 24(4):410-416, May 2005.
Methods: Retrospective review of cases of penetrating keratoplasty performed over a 4-year period with corneal topography performed on a clear graft. Overall, 202 cases from 184 patients were included: 108 performed by an experienced staff surgeon and 94 cases by 9 cornea fellows. Charts were reviewed for topographic astigmatism, other topographic indices, refractive astigmatism and best-corrected visual acuity (BCVA), all recorded after removal of the 10-0 sutures while the 11-0 suture remained in place. Graft clarity was assessed at final follow-up.
Results: Mean postoperative topographic astigmatism was 4.60 +/- 2.7 diopters in the fellow group and 4.08 +/- 2.41 diopters in the staff group. The mean postoperative time at which corneal topography was obtained was 9.53 +/- 4.4 months in the fellow group and 9.22 +/- 4.6 months in the staff group. Mean refractive astigmatism was 3.77 +/- 1.97 diopters (fellows) and 3.49 +/- 1.93 diopters (staff). Mean surface asymmetry index (SAI) was 1.89 +/- 1.42 (fellows) and 1.61 +/- 1.08 (staff). Mean surface regularity index (SRI) was 1.43 +/- 0.72 (fellows) and 1.45 +/- 0.61 (staff). Mean BCVA was 0.49 logMAR (20/61) +/- 4.3 lines (fellows) and 0.47 logMAR (20/59) +/- 3.9 lines (staff). In the fellow group, 85 (90%) cases remained clear over a mean follow-up of 32 months and in the staff group 100 (93%) grafts remained clear over a mean follow-up of 38 months. Simple and multiple regression analyses indicated no difference between the 2 groups in all outcome measures.
Conclusions: Properly supervised cornea fellows in training achieved favorable penetrating keratoplasty results that were comparable to those of an experienced staff surgeon.

Posted by mmiraftab at 12:27 PM | Comments (0)

April 17, 2005

Comparison of Fibrin Glue and Sutures for Attaching Conjunctival Autografts After Pterygium Excision

Ophthalmology Volume 112, Issue 4 , April 2005, Pages 667-671

MethodsA superior conjunctival autograft was harvested and transferred onto bare sclera after pterygium excision. Fibrin glue (Beriplast P) was used to attach the autograft in 11 eyes and nylon 10-0 suture was used to attach the autograft in 11 eyes. The patients were followed up for 2 months.

ResultsAll conjunctival autografts in both groups were successfully attached and were intact after 2 months. The average operating time for the fibrin glue group was significantly shorter (P<0.001). Postoperative symptoms were fewer for the fibrin glue group than the suture group. One patient (9%) from the fibrin group experienced subconjunctival hemorrhage, and 1 patient (9%) from the suture group experienced partial graft dehiscence.

ConclusionsFibrin glue is a safe and effective method for attaching conjunctival autografts. The use of fibrin glue results in shorter operating times and less postoperative discomfort.

Posted by saliakbari at 12:20 AM | Comments (0)

Comparison of Amniotic Membrane Graft Alone or Combined With Intraoperative Mitomycin C to Prevent Recurrence After Excision of Recurrent Pterygia.

Cornea. 24(2):141-150, March 2005

Methods: Patients with recurrent pterygia were randomly assigned to receive excision of pterygia followed by AMG alone or AMG combined with intraoperative 0.025% mitomycin C for 3 minutes (AMG-mitomycin C). Patients who could be followed up for more than 12 months were entered for data analysis. Conjunctival (potential) and corneal (true) recurrence of pterygia and other complications were recorded.

Results: The group receiving AMG alone was made up of 48 eyes in 48 patients, and the group receiving AMG-mitomycin C consisted of 47 eyes in 46 patients. No significant difference was found in age distribution, sex distribution, or duration of follow-up between the 2 groups. Regarding the recurrence rates of each group, 6 conjunctival (12.5%) and 6 corneal (12.5%) recurrences developed in the AMG group, and 4 conjunctival (8.5%) and 6 corneal (12.8%) recurrences developed in the AMG-mitomycin C group. No significant difference was found in the conjunctival and corneal recurrence rate between the 2 groups (P = 0.623 and 0.966, respectively; log rank test), and no major complications developed in either group.

Conclusions: AMG alone can be considered an effective alternative adjunctive treatment of recurrent pterygia. The addition of intraoperative mitomycin C did not further reduce the recurrence rate.

Posted by saliakbari at 12:13 AM | Comments (0)

April 15, 2005

Two bandage contact lenses

JCRS Jan 2005
In this prospective study of 100 bilateral PRK patients, investigators compared the efficacy of two types of bandage contact lenses. Following PRK patients, received an Acuvue (Johnson & Johnson, New Brunswick, N.J.) bandaged contact lens made of etafilcon A in one eye and a Focus Night & Day lens (Novartis Ophthalmics, East Hanover, N.J.) made of lotrafilcon A in the other. Investigators found that on post-op days one and two, the mean defect size was significantly smaller in eyes with the Night & Day lens. Eyes re-epithelized faster with this lens. By day two, 20 eyes had completely re-epithelized with the Night & Day lens compared with 13 with the Acuvue. On the first two post-op days, mean discomfort was also higher with the Acuvue lens. Investigators determined that for the first two days after PRK, patients experienced less discomfort and had significantly faster rates of re-epithelialization with the Night & Day lotrafilcon A lens

Posted by mehdi khanlari at 11:07 PM | Comments (0)

New Dual-optic IOLs

Eyeworld April 2005
These lenses have minus-powered lens posteriorly placed from a positive-powered lens joined by compressible, flexible haptics, which allow for close proximity between the two lenses in a non-accommodative state.Dual-optic lenses include the Synchrony by Visiogen (Irvine, Calif.) and the Sarfarazi Accommodating IOL, licensed by Bausch & Lomb. The data from early studies on the Synchrony lens are excellent.In addition, there are other deformable IOLs that promise larger amplitudes of accommodation. The Power Vision IOL (Power Vision Inc., Santa Barbara, Calif.) has a fluid reservoir which in a non-accommodative state is in the periphery of the lens, but on accommodation moves centrally increasing the plus-power of that lens.An extremely promising new IOL technology by NuLens (Herzliya, Israel) is a piston-like in configuration with a soft polymer encased in a flexible membrane. On accommodative effort, it can be deformed by bulging in such a way as to dramatically increase the lens power.This lens has been demonstrated to achieve up to 30 D of accommodation in primates that have undergone implantation. In my opinion, this is an extremely promising technology.Another new IOL is the FlexOptic IOL (Quest Vision Technologies, Tiburon, Calif.), which not only has an axial travel, but also an optic shape change on accommodative effort, which promises up to 4.5 D of accommodation (Figure 5).

Posted by mehdi khanlari at 10:26 PM | Comments (0)

Study recommends longer RGP lens discontinuance before LASIK

EyeWorld,April,2005
A recent study has suggested that rigid contact lens wearers should discontinue use of the contacts and switch to glasses three to six weeks prior to having pre-LASIK examinations, instead of the traditional three weeks.The study authors found that 56% of eyes achieved a stable refraction after three weeks, while 78% achieved stability after six weeks.
Rigid contact lenses — which are made from inflexible or minimally flexible plastic — can cause a warping of the cornea. This warping can result in improper calculations for laser treatments, a problem ophthalmologists routinely manage by having their patients stop using their rigid contacts several weeks before evaluation to allow the cornea to return to its normal shape.

Posted by afarahi at 09:59 PM | Comments (0)

The prevalence and associated features of posterior embryotoxon in the general ophthalmic clinic

Eye April 2005, Volume 19, Number 4, Pages 396-399
Over 700 consecutive patients of all ages were examined with the slit lamp during their routine eye clinic appointment. Patients with posterior embryotoxon were invited to return for full ocular examination including keratometry, corneal topography, and gonioscopy.Results In all, 49 out of 723 patients were found to have PE. This gives a prevalence of 6.8% with an age range of 18 months to 95 years. There was a higher prevalence in the younger age group of 22.5% (age range 18 months to 20 years) compared to 5.9% in the older age range (21-95 years).A total of 29 patients with PE returned for further examination. Six patients had glaucoma (two with Axenfeld's syndrome and one with aniridia), and one had ocular hypertension. In all, 20 patients had bilateral PE on slit-lamp examination, which increased to 24 with gonioscopy. The majority of the PE was seen temporally (97.9%) and limited to a few clock hours. Gonioscopy showed that eight patients with PE had associated inferior pigmentation of schwalbes line.Conclusion This large series found the prevalence of PE the general ophthalmic clinic to be 6.8%. Its presence should prompt careful anterior segment examination, including gonioscopy, to identify any associated abnormalities that may carry a risk of glaucoma. Children should also be assessed for any associated systemic or genetic abnormality.

Posted by mehdi khanlari at 09:41 PM | Comments (0)

Relationship between corneal thickness and optic disc damage in glaucoma

Clinical & Experimental Ophthalmology Volume 33 Issue 2 Page 158 - April 2005
The vertical cup/disc ratio (VCDR) was used as a single objective measure of glaucoma severity. Vertical cup diameters and vertical disc diameters were measured using a graticule attached to a 60 D Volk lens, in consecutive patients presenting to a single ophthalmologist. Measurements were corrected for magnification. The difference between corrected VCDR and 95% probability of VCDR normality was compared to CCT, which was measured with an ultrasonic pachymeter.A univariate linear regression model revealed that an increase of 10 µm in CCT resulted in a 0.009 decrease in the difference between true VCDR and the predicted normal VCDR. The R2 value for the regression was 0.04 (P < 0.0001).Conclusion: There is a highly statistically significant, albeit small, negative correlation between corneal thickness and glaucoma severity. This study supports the notion that CCT should be measured in the assessment of patients with glaucoma. Progressive thinning or presence of a thin cornea may have pathogenic or prognostic roles in some types of glaucoma.

Posted by mehdi khanlari at 09:32 PM | Comments (0)

Optical Coherence Tomography Longitudinal Evaluation of Retinal Nerve Fiber Layer Thickness in Glaucoma

Arch Ophthalmol. 2005;123:464-470.

Retrospective evaluation of 64 eyes (37 patients) of glaucoma suspects or patients with glaucoma participating in a prospective longitudinal study. All participants underwent comprehensive clinical assessment, visual field (VF) testing, and OCT every 6 months. Field progression was defined as a reproducible decline of at least 2 dB in VF mean deviation from baseline. Progression of OCT was defined as reproducible mean retinal nerve fiber layer thinning of at least 20 µm Each patient had a median of 5 usable OCT scans at median follow-up of 4.7 years. The difference in the linear regression slopes of retinal nerve fiber layer thickness between glaucoma suspects and patients with glaucoma was nonsignificant for all variables; however, Kaplan-Meier survival curve analysis demonstrated a higher progression rate by OCT vs VF. Sixty-six percent of eyes were stable throughout follow-up, whereas 22% progressed by OCT alone, 9% by VF mean deviation alone, and 3% by VF and OCT.Conclusions A greater likelihood of glaucomatous progression was identified by OCT vs automated perimetry. This might reflect OCT hypersensitivity or true damage identified by OCT before detection by conventional methods.

Posted by mehdi khanlari at 09:12 PM | Comments (0)

Cataracts and Cataract Surgery in Mentally Retarded Adults.

Eye & Contact Lens: Science & Clinical Practice. 31(2):50-53, March 2005.

Methods. The prevalence of cataracts and cataract surgery was examined in a retrospective chart review. A total of 119 consecutive patients from the Southside Virginia Training Center for mentally retarded adults were seen in the authors' ophthalmology clinic during a 3-year period from January 1, 1999 to December 31, 2001. Intraocular lens (IOL) implantation and postoperative complications were noted in patients who had undergone previous cataract surgery.

Results. Of the 119 patients seen, 64 (54%) had cataracts or a history of cataract surgery. Thirteen (20%) of these 64 patients had a history of cataract surgery (21 eyes total). Seventeen (81%) of these 21 eyes had IOL implantation (14 posterior-chamber IOLs [PCIOLs] and three anterior-chamber IOLs). Postoperative surgical complications occurred in 7 (33%) of 21 eyes and included anterior uveitis in three (14%) eyes, posterior capsular opacification in two (10%) eyes, rhegmatogenous retinal detachment in one (5%) eye, dislocated PCIOL in one (5%) eye, pseudophakic bullous keratopathy in one (5%) eye, and cystoid macular edema in one (5%) eye. There were no cases of postoperative endophthalmitis or retained lens fragments.

Conclusions. The prevalence of cataracts in adult mentally retarded patients is higher in this series (P<0.001) than in the world literature. However, if only visually significant cataracts are considered, the results are consistent with previous studies. Postoperative complications were common. Patients experienced higher rates of anterior uveitis (P=0.001) and pseudophakic bullous keratopathy (P=0.002) in this study than in previous studies. In this population, careful preoperative screening is recommended to select those patients most likely to benefit from cataract surgery and least likely to experience severe postoperative complications.

Posted by saliakbari at 09:01 PM | Comments (0)

Cataracts and Cataract Surgery in Mentally Retarded Adults.

Eye & Contact Lens: Science & Clinical Practice. 31(2):50-53, March 2005.

Methods. The prevalence of cataracts and cataract surgery was examined in a retrospective chart review. A total of 119 consecutive patients from the Southside Virginia Training Center for mentally retarded adults were seen in the authors' ophthalmology clinic during a 3-year period from January 1, 1999 to December 31, 2001. Intraocular lens (IOL) implantation and postoperative complications were noted in patients who had undergone previous cataract surgery.

Results. Of the 119 patients seen, 64 (54%) had cataracts or a history of cataract surgery. Thirteen (20%) of these 64 patients had a history of cataract surgery (21 eyes total). Seventeen (81%) of these 21 eyes had IOL implantation (14 posterior-chamber IOLs [PCIOLs] and three anterior-chamber IOLs). Postoperative surgical complications occurred in 7 (33%) of 21 eyes and included anterior uveitis in three (14%) eyes, posterior capsular opacification in two (10%) eyes, rhegmatogenous retinal detachment in one (5%) eye, dislocated PCIOL in one (5%) eye, pseudophakic bullous keratopathy in one (5%) eye, and cystoid macular edema in one (5%) eye. There were no cases of postoperative endophthalmitis or retained lens fragments.

Conclusions. The prevalence of cataracts in adult mentally retarded patients is higher in this series (P<0.001) than in the world literature. However, if only visually significant cataracts are considered, the results are consistent with previous studies. Postoperative complications were common. Patients experienced higher rates of anterior uveitis (P=0.001) and pseudophakic bullous keratopathy (P=0.002) in this study than in previous studies. In this population, careful preoperative screening is recommended to select those patients most likely to benefit from cataract surgery and least likely to experience severe postoperative complications.

Posted by saliakbari at 09:01 PM | Comments (0)

Use of Polymyxin as an Endotoxin Blocker in the Prevention of Diffuse Lamellar Keratitis in an Animal Model

JOURNAL OF REFRACTIVE SURGERY Vol. 21 No. 2 March/April 2005

Laser in situ keratomileusis (LASIK) flaps were created in rabbit eyes. The stromal bed was treated with 20 µg of Burkholderia cepacia LPS or balanced salt solution (BSS). Development of DLK, histological degree of inflammation, and presence of LPS detected by anti-LPS antibody were evaluated after 48 hours. In a second experiment, all eyes received LPS and were randomly assigned to receive either polymyxin in the form of two drops of Polytrim (Allergan, Irvine, Calif) on the stromal bed or two drops of BSS.

RESULTS
In the animal model study, LPS was significantly associated with the development of DLK (P<.05, n=30). Infiltration with polymorphonuclear cells and presence of DLK were found in LPS treated eyes but not in controls. In the second experiment, 4 (27%) of 15 eyes that received polymyxin in addition to LPS developed DLK compared to 18 (95%) of 19 eyes that received only LPS (P<.05, n=34). There was a trend towards higher flap displacement in polymyxin treated eyes but this was not significant (P=.07).

CONCLUSIONS
Diffuse lamellar keratitis in a rabbit model can be caused by bacterial endotoxin (LPS). Endotoxin blockers, such as polymyxin, are effective in decreasing the incidence of endotoxin-induced DLK in a rabbit model.

Posted by saliakbari at 08:54 PM | Comments (0)

Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population

Eye April 2005, Volume 19, Number 4, Pages 392-395

Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP>21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR.

Conclusion Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.

Posted by saliakbari at 08:49 PM | Comments (0)

Using povidone-iodine to reduce risk of postoperative endophthalmitis

Arch Ophthalmol,Feb 2005
Investigators in Germany have shown that irrigating the fornices with 10 ml of 5 percent povidone-iodine, compared to application of two drops on the conjunctiva, significantly reduces the conjunctival bacterial load in patients undergoing anterior segment surgery. The authors conclude this inexpensive yet effective antiseptic should decrease the risk of developing postoperative endophthalmitis.

Posted by kjalali at 02:28 PM | Comments (0)

Persistent diabetic macular edema associated with elevated hemoglobin A1c

American Journal of Ophthalmology, April 2005
Patients with type 2 diabetes and persistent clinically significant macular edema have higher HbA1C at the time of their disease than patients with resolved disease. Patients with bilateral disease have more elevated HbA1C than those with unilateral disease.

Posted by kjalali at 02:24 PM | Comments (0)

Sub–Tenon's capsule injection of local anesthetic appears as effective as retrobulbar injection in vitreoretinal surgery

Ophthalmology, April 2005
In terms of controlling intraoperative pain, this prospective, randomized, double-masked clinical trial showed no significant difference in patient-reported pain scores between the two types of injection when assessed immediately after surgery. Patients in each group required supplemental local anesthesia or IV medication for pain control at about the same rate.

Posted by kjalali at 02:21 PM | Comments (0)

Estrogen replacement therapy associated with narrower retinal vessel diameters

Ophthalmology, April 2005
After adjusting for age, blood pressure, body mass index, smoking and other vascular factors, women on ERT had narrower retinal arteriolar and venular diameters than past ERT users or those never on ERT. There was a significant trend of increasing narrowing for both arterioles (P trend, 0.01) and venules (P trend, 0.007) the longer the patient was on ERT.

Posted by kjalali at 02:17 PM | Comments (0)

April 12, 2005

Severe keratitis more common in patients who sleep in contact lenses

British Journal of Ophthalmology, April 2005
Those who choose to sleep in extended wear lenses should be advised to wear silicone hydrogel lenses, which carry a five times decreased risk of severe keratitis compared with extended wear hydrogel lenses.

Posted by kjalali at 07:21 PM | Comments (0)

Yellow filter improves contrast sensitivity in LASIK patients

Journal of Refractive Surgery, March/April 2005
Under mesopic conditions, log contrast sensitivity without glare decreased by 0.14 log units in the LASIK group. When the yellow filter was used, this variable showed a significant increase of 0.04 log units, and the proportion of patients able to discriminate the mesopic contrast limit of 1:5 rose from 70 percent to 78 percent. The filter had no effect under photopic conditions.

Posted by kjalali at 07:19 PM | Comments (0)

Smoking and obesity associated with advanced AMD

Ophthalmology, April 2005
This report from the Age-Related Eye Disease Study, a randomized trial investigating the role of antioxidants and zinc supplements in preventing advanced AMD, suggests that patients with early or intermediate AMD might lower their risk of progression by quitting cigarettes and losing weight. The study also found a higher incidence of advanced AMD among whites and those with less education, and identified other associations, such as antacids and anti-inflammatory medications that warrant further study.

Posted by kjalali at 07:17 PM | Comments (0)

Photoablative inlay laser in situ keratomileusis (PAI-LASIK) in the rabbit model

Journal of Cataract & Refractive Surgery Volume 31, Issue 2 , February 2005, Pages 389-397

Gholam A. Peyman MD
Eight rabbits (1 eye each) underwent the PAI-LASIK procedure; 4 eyes had a disk-shaped inlay and 4, a donut-shaped inlay. Preoperatively, the hydrogel material was ablated with a programmed correction of 5.0 diopters of hyperopia or myopia.
Results
The eyes were followed for 1 to 16 months. No eye showed signs of rejection or extrusion of the PAI. There was no significant difference in corneal clarity or the healing rate between eyes with donut-shaped PAIs and those with disk-shaped PAIs. One eye with a donut-shaped PAI had minimal corneal haze. The remaining inlays did not opacify or fracture during ablation.
Conclusion
The hydrogel material can be used for the proposed PAI-LASIK procedure.

Posted by mmiraftab at 06:54 PM | Comments (0)

Biometry accuracy using zero- and negative-powered intraocular lenses

Journal of Cataract & Refractive Surgery Volume 31, Issue 2 , February 2005, Pages 280-290

This retrospective analysis comprised 78 eyes of 54 patients having cataract surgery with zero- or negative-powered IOLs. Axial lengths were measured with A-scan, B-scan, applanation, or optical methods. Differences between SRK/T-predicted and actual postoperative refraction were analyzed for 75 eyes having cataract surgery. Ocular comorbidity, visual acuity, and biometry readings were also compared.
Results
Forty-one percent of 75 patients analyzed were within ±1.00 diopter (D) of the predicted refraction, although there was a significant tendency toward a hyperopic overcorrection by 1.14 D (95% confidence interval, 0.89-1.39 D). This overcorrection error was consistent across all 3 biometry methods used to estimate axial length and increased with the use of stronger (more negative) IOLs.
Conclusion
Surgeons should be aware of the tendency for negative-powered lenses to overcorrect and lead to a hyperopic outcome when using the SRK/T biometry formula in highly myopic eyes. A weaker-powered negative IOL is recommended to aim for a more myopic postoperative outcome by about 1.00 to 2.00 D.

Posted by mmiraftab at 06:50 PM | Comments (0)

Chronic and Delayed-Onset Mustard Gas Keratitis

Ophthalmology Volume 112, Issue 4 , April 2005, Pages 617-625

Mohammad-Ali Javadi MD
Of 48 patients, 31 (64.6%) had chronic symptomatology, whereas 17 (35.4%) experienced delayed-onset lesions. Visual acuity at referral ranged from hand motions to 20/20. Ocular surface changes included chronic blepharitis and decreased tear meniscus in all patients, limbal ischemia (81.3%), and conjunctival vascular abnormalities (50%). Corneal signs in order of frequency were: scar or opacity (87.5%), neovascularization (70.8%), thinning (58.3%), lipoid deposits (52.1%), amyloid deposits (43.8%), and epithelial defects and irregularity (31.3%). Many patients received conservative treatment; others underwent allograft stem cell transplantation (20 eyes of 17 patients), penetrating keratoplasty (12 eyes of 12 patients), and lamellar keratoplasty (4 eyes of 3 patients). Conjunctival specimens were evaluated by light microscopy. Decreased goblet cell density, attenuated or thickened epithelium, scarring in the substantia propria associated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessels were noted. Excised corneal buttons disclosed absence of epithelium and Bowman's layer, fibrovascular pannus, stromal scarring, and vascularization.
Conclusions
Mustard gas causes chronic and delayed destructive lesions in the ocular surface and cornea, leading to progressive visual deterioration and ocular irritation. The pathophysiologic features of these changes are not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory response without any specific features. Based on the clinical appearance of the lesions and the histopathologic findings, an immune-mediated component seems possible.

Posted by mmiraftab at 06:35 PM | Comments (0)

Long-Term Physiologic Changes of Intraocular Pressure(A 10-year longitudinal analysis in young and middle-aged Japanese men )

Ophthalmology Volume 112, Issue 4 , April 2005, Pages 609-616

Intraocular pressure tended to decrease with age in all age groups. The mean linear regression coefficient (right eye/left eye) = −0.076/−0.060 (95% confidence interval [CI]: (−0.094 to −0.057)/(−0.078 to −0.041), −0.073/−0.060 [95% CI: (−0.084 to −0.062)/(−0.071 to −0.049)], and −0.060/−0.050 [95%CI: (−0.075 to −0.046)/(−0.064 to −0.036)] (mmHg/year) in the 20s, 30s, and 40s, respectively). In investigating correlations between the10-year mean values of IOP and factors examined in this study, multivariate analysis showed a significantly inverse correlation with spherical power (partial regression coefficient [B] = −0.155/−0.144) and positive correlation with esophoria (B = 0.536/0.521), systolic blood pressure (B = 0.021/0.022), heart rate (B = 0.024/0.024), and hematocrit (B = 0.041/0.043) with IOP. The trend of IOP was significantly positively associated with the trends of systemic factors: body mass index (BMI) (B = 0.117/0.119), blood pressure (systolic) (B = 0.020/0.020), and hematocrit (B = 0.057/0.045), but not with any ophthalmologic factor.
Conclusions
The long-term observation clearly demonstrated that, in normal eyes, the IOP decreased with aging. The IOP value was negatively associated with spherical power and positively with esophoria, blood pressure, heart rate, and hematocrit. The change of IOP could be affected mainly by the change of body mas index, blood pressure, and hematocrit.

Posted by mmiraftab at 06:27 PM | Comments (0)

Full thickness eyelid transsection (blepharotomy) for upper eyelid lengthening in lid retraction associated with Graves’ disease

BJO,April,2005
A prospective consecutive interventional case series. 41 patients, 38 women and three men, with a mean age of 55 years (range 32–75 years) were included. Full transsection of the upper eyelid with optional transsection of the lateral horn was performed in 60 lids. A central bridge of conjunctiva was left intact in the pupillary axis. The result was considered "perfect" in 43 and "acceptable" in 14 of 60 lids after one or two surgical approaches. In three lids, the surgery had failed.
Conclusion: In contrast with other surgical techniques the surgical approach presented here is easy to perform and still leads to very satisfying and predictable

Posted by afarahi at 10:44 AM | Comments (0)

Primary Placement of a Titanium Sleeve in Hydroxyapatite Orbital Implants

Eye,April 2005
A standard enucleation or cornea preserved evisceration was performed, followed by preplacement of a titanium sleeve into the hydroxyapatite implant by a hand drill sleeve driver. Care must be taken to ensure that the titanium sleeve is positioned centrally when the implant is put inside the orbital socket or eviscerated shell. The Tenon capsule and conjunctiva were meticulously closed with minimal tension. In all, 30 patients were treated in the above fashion with 10 enucleation and 20 evisceration procedures. Three of the sleeves were found to have exposed spontaneously at 5 and 7 weeks following original surgery. They had no further complication except one sleeve loosening. The remaining 27 sleeves that did not spontaneously expose pursued secondary exposure of the titanium sleeve and peg insertion by conjunctival cutdown procedure 3 months after original surgery. Two sleeves were found to be oblique positioned after the conjunctival cutdown procedure. Fortunately, all the 30 patients were successfully fit with a peg-coupled prosthesis with good motility.
Conclusion: Primary placement of a titanium sleeve into hydroxyapatite implants has several advantages, including high patient acceptance, technical simplicity, and office-based conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging study and additional prosthetic modification, a more rapid and efficient rehabilitation is possible.

Posted by afarahi at 10:37 AM | Comments (0)

April 08, 2005

Asthma medication may relieve severe eye allergies

OCULAR SURGERY NEWS , 3/15/2005
In a small study, researchers have successfully treated severe ocular allergies, including atopic keratoconjunctivitis, with a drug usually used to treat asthma.Patricia B. Williams, PhD, FCP, and colleagues have enrolled a total of nine patients in a clinical study of Xolair (omalizumab, Genentech/Novartis) to assess the drug’s efficacy in severe ocular allergies. The drug was shown to reduce itching, rhinitis, lid swelling and other signs and symptoms of ocular allergy.Omalizumab was administered to the patients subcutaneously, once or twice a month, with dosing dependent on the severity of the disease, the patient’s weight and serum immunoglobulin-E (IgE). Relief is seen in a couple of months.It is a gradual improvement.
The compound is a monoclonal antibody with IgE receptor binding sites on it.The drug binds up the IgE before it can bind to the mast cells in the body.

Posted by afarahi at 03:35 PM | Comments (0)

Visual Results after Primary Intraocular Lens Implantation or Contact Lens Correction for Aphakia in the First Year of Age

Ophthalmologica, Vol. 219, No. 2, 2005
This study included 41 children with unilateral congenital cataract who underwent cataract surgery with posterior capsulorhexis and anterior vitrectomy, coupled with (IOL group, n = 18) or without (CL group, n = 23) primary IOL implantation. All infants underwent the first surgery during the first 12 months of their life .The mean age at surgery was 3.11 ± 2.65 months .All patients were prescribed the same half-time reduced occlusion therapy. The mean final visual acuity (logarithm of the minimum angle of resolution) of the operated eye was 0.43 ± 0.33 for the IOL group and 0.58 ± 0.39 for the CL group (p = 0.14). The mean interocular difference in visual acuity was 0.22 ± 0.29 for the IOL group and 0.56 ± 0.31 for the CL group (p = 0.042). The reoperation rate was 78% in the IOL group compared with 35% in the CL group (p = 0.017). Esotropia or exotropia of more than 8 prism diopters were present in 55% of children (10/18) in the IOL group compared with 83% of children (19/23) in the CL group (p = 0.039). Conclusions: We suggest that correction of aphakia after unilateral congenital cataract surgery with primary IOL implantation results in improved visual acuity, improved binocular vision outcome and less occurrence of strabismus, but a higher rate of complications requiring reoperation. Further studies with a larger pediatric patient group are necessary to confirm the optimal treatment of aphakia after unilateral congenital cataract extraction.

Posted by afarahi at 03:12 PM | Comments (0)

Long-Term Patient Satisfaction of External Dacryocystorhinostomy

Ophthalmologica,Vol. 219, No. 2, 2005
A postal questionnaire was sent to 139 patients who had undergone external dacryocystorhinostomy. The only parameter for success of the treatment was the improvement of patient's subjective pre- and postoperative symptoms score. According to the patient's own evaluation, external dacryocystorhinostomy is a successful operation. After 1 year the success percentage was 89%, after 2-3 years it was 79% and after 4-5 years it was 71%.
Conclusion: External dacryocystorhinostomy is appreciated by the patients and considered a successful operation. The subjective evaluation of this operation should yield more creditability than objective methods.

Posted by afarahi at 03:07 PM | Comments (0)

April 03, 2005

Treatment of Multiple Apocrine Hidrocystomas With Trichloroacetic Acid.

Ophthalmic Plastic & Reconstructive Surgery. , March 2005
The apocrine hidrocystoma is a benign adenomatous cystic proliferation derived from apocrine glands, which frequently occurs in periocular tissues. These cystadenomas may occur bilaterally, in multiple disfiguring confluent groups on both the upper and lower lids. Although these lesions have been treated successfully with meticulous surgical extirpation and electrosurgery, this report describes the successful treatment of two patients, each with multiple large (>7 mm) periocular apocrine hidrocystomas by either chemical ablation of the cystic epithelium with trichloroacetic acid (TCA) or surgical excision. Examination of the cysts at 1, 3, and 6 months after TCA treatment revealed well-healed lesions without cyst recurrence. Most of the TCA-treated cysts resolved completely, without leaving any trace to clinical examination. Treatment of cysts with TCA was technically simpler and much less time-consuming than surgical excision. The treatment of large apocrine hidrocystomas with TCA is an effective and expeditious method of treating these disfiguring and recalcitrant lesions.

Posted by afarahi at 11:14 PM | Comments (0)

Intralesional Steroid Injection for Management of Acute Idiopathic Dacryoadenitis: A Preliminary Result.

Ophthalmic Plastic & Reconstructive Surgery., March 2005
Five patients with unilateral isolated acute idiopathic dacryoadenitis were included in the study. In 2 patients, the pathology was recurrent. Intralesional injection of 2 to 4 ml betamethasone suspension (1 ml contains 2 mg betamethasone sodium phosphate and 5 mg betamethasone dipropionate) was followed by cold compression for 6 hours. Systemic nonsteroidal anti-inflammatory drugs were given for 2 weeks after the injection.Dramatic response was achieved within 7 days after injection in all cases. No patient had recurrence during the follow-up period of 8 to 19 months.
Conclusions: The excellent preliminary results make this new line of therapy highly promising. However, more study and long-term follow-up are recommended.

Posted by afarahi at 11:11 PM | Comments (0)

Monocanalicular Versus Bicanalicular Silicone Intubation for Nasolacrimal Duct Stenosis in Adults.

Ophthalmic Plastic & Reconstructive Surgery. , March 2005.

In a retrospective, nonrandomized comparative case series, 48 eyes of 44 adult patients with nasolacrimal duct stenosis underwent endoscopic probing and either bicanalicular (BCI; n = 22 eyes) or monocanalicular (MCI; n = 26 eyes) nasolacrimal duct intubation under general anesthesia. "Complete success" was defined as complete disappearance of the symptoms, "partial success" as improvement with some residual symptoms, and "failure" as absence of improvement or worsening of symptoms at last follow-up. MCI had virtually the same complete success rate as BCI, a higher partial success rate than BCI, and a lower failure rate than BCI in treatment of nasolacrimal duct stenosis in adults.

Posted by afarahi at 11:04 PM | Comments (0)

April 02, 2005

Long term effect on IOP of a stainless steel glaucoma drainage implant (Ex-PRESS) in combined surgery with phacoemulsification

British Journal of Ophthalmology 2005;89:425-429

Aim: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS R50) for the surgical treatment of primary open angle glaucoma (POAG) and cataract when combined with phacoemulsification.
Methods: Clinical, prospective, multicentre, single treatment arm, non-randomised, non-masked study. The Ex-PRESS device was implanted at the limbus under a conjunctival flap. Phacoemulsification cataract extraction and in the bag IOL implantation were performed through clear cornea temporally. Primary outcome: IOP change; secondary outcomes: side effects and VA changes.
Results: 26 eyes of 25 patients were implanted with the device. The mean (SD) follow up was 23.9 (10.4) months and the mean age was 75.1 (7.1) years. 17/26 eyes have more than 3 years of follow up. One case was discontinued because of device removal, one because of death, and three were lost to follow up. Efficacy: preoperative IOP was 21 (4) mm Hg; at 1, 2, and 3 years IOP was 15.3 (3.1) mm Hg (35% reduction), 16.6 (2.7) mm Hg (29% reduction), and 16 (2.6) mm Hg (22% reduction) respectively. Kapl