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June 30, 2005
Circulating anti-retinal antibodies as immune markers in age-related macular degeneration
Immunology July 2005
Age-related macular maculopathy (ARM) and age-related macular degeneration (AMD) are the leading causes of blindness in the Western world. Despite the magnitude of this clinical problem, very little is known about the pathogenesis of the disease. In this study, we analysed the sera (using indirect immunohistochemistry and Western blot analysis) from a very large cohort of such patients and normal age-matched controls to detect circulating anti-retinal antibodies. Patients with bilateral drusen (n = 64) and with chorioretinal neovascularization (CNV) (n = 51) were recruited in addition to age-matched control subjects (n = 39). The sera were analysed for anti-retinal immunoglobulins on retinal sections. The data were then correlated with the clinical features graded according to the International Classification and Grading System of ARM and AMD. The sera of patients with drusen (93·75%) and CNV (82·27%) were found to have a significantly (P = 0·02) higher titre of autoantibodies to the retina in comparison with controls (8·69%), indicating significant evidence of involvement of the immune process in early stages of AMD. Subsequent statistical analysis of the drusen group showed significant progressive staining (P = 0·0009) in the nuclei layers from early to late stages of ARM. Western blotting confirmed the presence of anti-retinal immunoglobulins to retinal antigens. As anti-retinal immunoglobulins are present in patients with bilateral drusen and exudative AMD, these antibodies could play a significant role in the pathogenesis of AMD. Whilst we do not have evidence that these antibodies precede disease onset, the possibility that their presence might contribute to disease progression needs to be investigated. Finally, the eventual identification of the target antigens detected by these antibodies may permit the future development of new diagnostic methods for ARM and AMD.
Posted by mehdi khanlari at 11:21 PM | Comments (0)
Zeiss Releases Visucamlite
Glaucoma Today 2005
Carl Zeiss Meditec Inc. (Dublin, CA) released the Visucamlite, the most recent addition to the company’s line of retinal imaging devices. The camera can capture digital images of the retina and posterior segment in red, color, and fluorescein angiography modes. According to Group Product Director for Glaucoma Products Tony Moses, “It’s an aim-and-shoot concept. Very little light is needed to operate this system, and it provides great resolution. Pretty much anyone in the physician’s office can operate the Visucamlite, as opposed to a fundus camera, which requires a specialized technician to operate the equipment.”The Visucamlite is DICOM compliant, and it increases patients’ comfort by using a low light intensity.Additionally, the camera can accommodate small pupils, thereby reducing the need for dilating drugs. The device’s images may be exported in various formats.
Posted by mehdi khanlari at 11:18 PM | Comments (0)
Study Links IOP to Blood Pressure
Glaucoma Today June 2005
Recently published results from the Beaver Dam Eye Study1 show an association between decreased systemic blood pressure and reduced IOP at baseline and at the 5-year follow-up visits. For every 10-mm Hg increase in diastolic blood pressure, subjects’ IOP increased by 0.43 mm Hg. The study also showed a 0.21-mm Hg increase in IOP for each 10-mm Hg increase in systolic blood pressure.
Posted by mehdi khanlari at 11:16 PM | Comments (0)
Anterior chamber and sutured posterior chamber IOLs similarly effective in eyes with poor capsular support
Journal of Cataract & Refractive Surgery, May 2005
This retrospective case series of 181 eyes finds both lens types produced similar outcomes in terms of best-corrected visual acuity; however, final spherical equivalent trended toward more myopic values in the posterior chamber IOL group. Elevated IOP was the most common complication for both lenses. The incidence of other complications was similar between the two groups. The authors conclude recent advances in anterior chamber IOL design have yielded lenses that provide a safe, effective alternative to sutured posterior chamber IOLs.
Posted by kjalali at 04:44 PM | Comments (0)
Computer classification of nonproliferative diabetic retinopathy shows promise
Archives of Ophthalmology, June 2005
Current criteria for computer grading of the severity of this disease based on three types of early lesions – hemorrhages and microaneurysms, hard exudates and cotton-wool spots – produced results comparable to those provided by human experts. With additional research, the authors suggest this computer system can become a useful aid to physicians and a tool for screening, diagnosing and classifying nonproliferative diabetic retinopathy.
Posted by kjalali at 04:42 PM | Comments (0)
Visual loss from giant cell arteritis is most common in first six days and may not stop with steroid therapy
Ophthalmology, June 2005
This series of 34 consecutive patients shows visual deterioration occurs in approximately 27 percent of eyes despite high-dose IV methylprednisolone. It also finds recovery of visual acuity is not associated with visual field or color vision improvement, and that the greatest risk of visual deterioration occurs within the first six days.
Posted by kjalali at 04:40 PM | Comments (0)
Media influences parental choice of amblyopia treatment
Journal of the American Association for Pediatric Ophthalmology and Strabismus, June 2005
After reading media reports on the effectiveness of atropine, 66 percent of parents chose eye drops; 21 percent, two hours of patching; 2 percent six hours of patching and 11 percent, full-time patching. When provided additional information about the results of these studies – information not included in media reports – there was a strong shift in preference away from atropine. Only 30 percent chose the eye drops and 38 percent chose full-time patching.
Posted by kjalali at 04:38 PM | Comments (0)
Incidence of endophthalmitis with clear corneal incision phacoemulsification may be higher
American Journal of Ophthalmology, June 2005
A review of four years of surgical records at a single hospital reveals the incidence of infection after temporal clear cornea incision phacoemulsification is 0.05 percent. For cataract surgery by other methods, the infection rate is 0.02 percent. Potential risk factors for developing endophthalmitis may include intraoperative complications, relative immune compromise, application of lidocaine 2 percent gel before povidone-iodine preparation and inferior incision location. Of the seven cases identified in the review, visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients.
Posted by kjalali at 04:37 PM | Comments (0)
Risk factors vary in different types of open angle glaucoma
American Journal of Ophthalmology, June 2005
This observational study of 517 eyes, shows older age, advanced perimetric damage, smaller neuroretinal rim and larger area of ß zone of parapapillary atrophy are significantly associated with progressive optic nerve damage in patients with elevated IOP. In contrast, presence of disk hemorrhages at baseline is a significant risk factor for progression in patients with normal IOP. Among patients with elevated IOP, there was no difference in risk factors associated with progression in primary open-angle glaucoma and secondary open-angle glaucoma.
Posted by kjalali at 04:33 PM | Comments (0)
June 28, 2005
Outcomes of phacoemulsification and in-the-bag intraocular lens implantation in Fuchs' heterochromic iridocyclitis
Journal of Cataract & Refractive Surgery Volume 31, Issue 5 , May 2005, Pages 997-1001
Mohammad-Ali Javadi MD,
In this noncomparative interventional case series, existing data for 41 eyes of 40 consecutive patients clinically diagnosed with FHIC and cataract were studied retrospectively. Scleral tunnel PE and in-the-bag IOL implantation were performed in all cases. Preoperative and postoperative visual acuities and intraoperative and postoperative complications were evaluated.
Results
Twenty-four male and 16 female patients aged 12 years to 70 (SD) (mean 35 ± 12 years) were operated on and followed for 17.8 ± 8.7 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Twenty-two eyes (53.6%) achieved BCVA of 20/20. The major cause of postoperative visual acuity less than 20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, mild anterior chamber fibrin reaction occurred in 4 patients (9.7%), IOL deposits occurred in 11 eyes (26.8%), and decentration was observed in 1 eye. During follow-up, 6 eyes (14.6%) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy. There was 1 case of clinical cystoid macular edema that resolved with medication. There were no cases of posterior synechias, postoperative glaucoma, or retinal detachment.
Conclusion
Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract.
Posted by mmiraftab at 08:53 PM | Comments (0)
One or 2 Intacs segments for the correction of keratoconus
Journal of Cataract & Refractive Surgery Volume 31, Issue 5 , May 2005, Pages 943-953
Jorge L. Alió MD,
In this prospective comparative consecutive study, Intacs segments were implanted in 26 keratoconic eyes with clear central corneas of 19 consecutive patients (9 women and 10 men). Corneas were divided into 2 groups according to the topographic pattern of the cone. Group I included keratoconus not crossing the 180° meridian and Group II included keratoconus crossing the 180° meridian. The Intacs were horizontally placed through a lateral clear corneal incision. According to the corneal topography 1 segment was implanted 0.45 mm inferior in Group I, and 2 segments were implanted, 1 0.25 mm superior and the other 0.45 mm inferior, in Group II. All cases completed a minimum follow-up of 1 year. Differences between preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and keratometry were clinically and statistically evaluated.
Results
Spherical equivalent error and refractive astigmatism were significantly reduced. The mean keratometric values were reduced following Intacs insertion in both groups. At the end of the first year of the postoperative follow-up, Group I (1 segment) had an improvement in mean UCVA to 20/50 (0.4 ± 0.22 decimal value), which was statistically significant when compared to the preoperative UCVA of 20/100 (0.2 ± 0.13 decimal value) (P = .011). Mean BSCVA was 20/32 (0.62 ± 0.24 decimal value), which was also statistically significant when compared to the preoperative BSCVA, which was 20/50 (0.4 ± 0.21 decimal value) (P = .002). In Group II (2 segments), UCVA after 1 year was 20/63 (0.34 ± 0.17 decimal value), which was statistically significant when compared to the preoperative UCVA of 20/400 (0.06 ± 0.02 decimal value) (P = .001). Mean BSCVA was 20/32 (0.62 ± 0.27 decimal value), which was significantly better than the preoperative UCVA of 20/50 (0.38 ± 0.22 decimal value) (P = .001). In 4 eyes, the inferior segment was removed because of partial extrusion during the postoperative follow-up.
Conclusions
Treatment of keratoconus with 1 or 2 Intacs segments oriented by the preoperative corneal topography used in this study proved to be effective in decreasing the corneal steepening and astigmatism and improving BSCVA. Further follow-up is needed to determine the final effect of Intacs on the progression of the corneal disease.
Posted by mmiraftab at 08:44 PM | Comments (0)
Epi-LASIK: Preliminary clinical results of an alternative surface ablation procedure
Journal of Cataract & Refractive Surgery Volume 31, Issue 5 , May 2005, Pages 879-885
Ioannis G. Pallikaris MD
Forty-four eyes of 31 patients had epi-LASIK for the correction of low myopia. Mean preoperative spherical equivalent was 3.71 diopters (D) ± 1.2 (SD) (range −1.75 to −7.00 D) and the mean baseline logMAR best spectacle-corrected visual acuity was −0.01 ± 0.06 (range 0.10 to −0.10). All the epithelial separations were performed with the Centurion epikeratome (CIBA Surgical). The enrolled patients were followed daily until the epithelial healing was complete as well as at 1- and 3-month intervals. On the operative day, patients filled out a questionnaire grading visual performance and pain score of treated eyes every 2 hours for a total of 5 records.
Results
The mean epithelial healing time was 4.86 ± 0.56 days (range 3 to 5 days). The mean logMAR uncorrected visual acuity on the day of reepithelization was 0.19 ± 0.09 (range 0.40 to 0.10). At 1 month, the mean was spherical equivalent of the treated eyes (N = 44), −0.3 ± 0.6 D (range −1.0 to 0.87 D), and at 3 months it was (N = 37), −0.10 ± 0.4 D (range −0.75 to 0.75 D); 97% of eyes had clear corneas or trace haze 3 months after treatment.
Conclusions
Preliminary clinical results suggest that epi-LASIK is a safe and efficient method for the correction of low myopia. Further studies will establish this method as an alternative surface ablation procedure.
Posted by mmiraftab at 08:40 PM | Comments (0)
Rates of Epithelial Ingrowth After LASIK for Different Excimer Laser Systems
Journal of Refractive Surgery Vol. 21 No. 3 May/June 2005
A chart review of patients who had undergone LASIK between April 1999 and December 2001 was performed. Patients having known risk factors for epithelial ingrowth were excluded from the study. Both eyes of patients who were operated with both laser systems were included in a paired analysis. The first operated eyes of the remaining patients were included in an unpaired analysis. The outcomes studied were epithelial ingrowth (a region of epithelial growth under the flap that was contiguous with the flap edge and extended at least 0.7 mm in the radial direction) and epithelial ingrowth requiring treatment (extending into the pupillary zone, causing reduced vision, causing nighttime glare, or inducing any melting of the flap edge).
RESULTS
In the paired study, 11 (61.1%) of 18 eyes treated with the VISX 20/20B had epithelial ingrowth, and 7 (38.9%) eyes required treatment. None of the eyes treated with the VISX Star S3 had epithelial ingrowth. In the unpaired study, 39 (37.1%) of 105 eyes treated with the VISX 20/20B were noted to have epithelial ingrowth and 14 (13.3%) eyes required treatment. None of the eyes treated with the VISX Star S3 had epithelial ingrowth. The incidence of epithelial ingrowth was significantly different for the VISX 20/20B and the VISX Star S3 in both analyses (paired: P<.001, McNemar's test; unpaired: P<.001, Fisher's exact test).
CONCLUSIONS
The laser system used in LASIK is a risk factor for the development of epithelial ingrowth????????
Posted by mmiraftab at 08:33 PM | Comments (0)
Optical Quality and Depth-of-field of Eyes Implanted With Spherical and Aspheric Intraocular Lenses
Journal of Refractive Surgery Vol. 21 No. 3 May/June 2005
Corneal, total, and internal aberrations were measured in 19 eyes implanted with spherical (n=9) and aspheric (n=10) IOLs. Corneal aberrations were estimated by virtual ray tracing on corneal elevation maps, and total aberrations were measured using a second-generation laser ray tracing system. Corneal and total wave aberrations were fit to a Zernike polynomial expansion. Internal aberrations were measured by subtracting corneal from total wave aberrations. Optical performance was evaluated in terms of root-mean-square (RMS) wavefront error and Strehl ratio (estimated from the modulation transfer function). Depth-of-field was obtained from through-focus Strehl estimates from each individual eye.
RESULTS
Corneal aberrations increased after IOL implantation, particularly astigmatism and trefoil terms. Third and higher order RMS (and the corresponding Strehl ratio) were significantly better in eyes with aspheric IOLs than with spherical IOLs; however, this tendency was reversed when astigmatism was included. Spherical aberration was not significantly different in eyes with aspheric IOLs, whereas it was significantly positive in eyes with spherical IOLs. Third order aberrations were not significantly different across groups. Depth-of-field was significantly larger in eyes with spherical IOLs. Spherical IOLs showed better absolute optical quality in the presence of negative defocus >1.00 D.
CONCLUSIONS
Our study shows a good degree of compensation of the corneal spherical aberration in eyes implanted with aspheric IOLs, as opposed to eyes implanted with spherical IOLs. Other sources of optical degradation, both with aspheric and spherical IOLs, are non-symmetric preoperative corneal aberrations, incision-induced aberrations, and third order internal aberrations. Although best corrected optical quality is significantly better with aspheric IOLs, tolerance to defocus tended to be lower.
Posted by mmiraftab at 08:30 PM | Comments (0)
Intraocular Lens Calculation in a Patient With Previous Penetrating Keratoplasty and LASIK
Cornea. 24(5):629-631, July 2005
Purpose: To report a case of a patient who underwent cataract extraction with intraocular lens (IOL) implantation after previous penetrating keratoplasty (PK) followed by laser in situ keratomileusis (LASIK).
Methods: Case report and literature review of cataract surgery after PK and LASIK. Cataract surgery was successfully performed in a patient with previous PK and LASIK. This paper outlines our method of calculating the correct power IOL for implant.IOL power was derived in the following manner:
Using pre-LASIK keratometry values, the IOL power is calculated using the SRK/T formula. This IOL power is then corrected by adding the change in spherical equivalent achieved by the refractive surgery, corrected to the corneal plane from the spectacle plane by dividing the change in spherical equivalent by 0.7 4: SRK/T using A-constant of 118.4; Ks: 42.50/50.0 (Pre-LASIK Ks) and axial length of 24.85 mm yields IOL for emmetropia of 16.77 D. 3.25 D (change in SE pre- versus post LASIK)/0.7 = 4.64D 16.77D + 4.64D = 21.41D the corrected IOL power: 21.5 D IOL chosen.
Results: The patient's 1-month postoperative uncorrected visual acuity was 20/70 and best spectacle-corrected visual acuity was 20/30+ with -0.75 +0.50 x 180.
Conclusions: We report the case of a patient with cataract extraction with IOL implantation after PK and LASIK as well as a description of the method used to calculate IOL power after PK and LASIK. While the IOL selection can be difficult, using the appropriate nomogram can result in good visual outcomes.
Posted by mmiraftab at 08:25 PM | Comments (0)
Fibrin Sealant in Corneal Stem Cell Transplantation
Cornea. 24(5):593-598, July 2005
Purpose: To determine if transplanted corneal epithelial stem cells are safely and efficiently attached to the deficient limbal niche with use of fibrin sealant. The primary outcome is measured with respect to the stability of the transplant, with secondary qualitative evaluations of inflammation, patient comfort, speed of operation, and incidence of complications.
Methods: This retrospective case study examined a total of 114 corneal stem cell reconstructions performed in 95 patients from 1996 to 2004 using corneal stem cells primarily, with a minority of amnion alone, or both. Fibrin sealant was used as the only technique of stem cell adhesion for limbal reconstruction for primary or recurrent pterygia and various stem cell-deficient diseases from 2000 to 2004.
Results: The fibrin sealant group showed 1 small recurrence of pterygium but no complications. With sutures, there were 3 recurrences in the pterygia group. After completion of all surgical procedures, all patients were free of pterygia. Miscellaneous stem cell deficiencies were included to demonstrate that corneal stem cell transplants can be used in other corneal procedures in addition to pterygia.
Conclusions: Fibrin sealant alone effectively and safely attached corneal stem cell transplants to the limbal niche. The additional qualitative observations of a reduction in operation time, postoperative pain, and inflammation augurs for more extensive use of fibrin sealants in ophthalmology.
Posted by mmiraftab at 08:18 PM | Comments (0)
Deep Lamellar Endothelial Keratoplasty: Surgery in Complex Cases With Severe Preoperative Visual Loss.
Cornea. 24(5):587-592, July 2005.
Purpose: This study was designed to report the use of deep lamellar endothelial keratoplasty (DLEK) in combination with other intraocular surgeries in the treatment of eyes with severe bullous keratopathy and visual loss.
Methods: DLEK surgery was performed in six patients with severe bullous keratopathy and preoperative vision with a range of between count fingers and light perception only. DLEK was combined with vitrectomy and placement of a ciliary sulcus sutured intraocular lens in four patients and with cataract surgery in one patient. Two patients with vitreoretinal disease underwent pars plana vitrectomy within only 4 months after the DLEK donor tissue had been placed. Graft clarity, Snellen visual acuities, refractive astigmatism, endothelial cell counts, and corneal topography were prospectively measured at 6 and 12 months postoperatively.
Results: At 6 months after DLEK surgery, all grafts were clear and vision improved in all patients. Best spectacle-corrected visual acuity improved from count fingers level (or worse) before surgery to a range of 20/40 to 20/200 after surgery. Average refractive astigmatism at 6 months was 2.0 diopters (range, 0.50-4.00 diopters). The average postoperative endothelial cell count was 1,679 +/- 380 (range, 1,200-2,298) cells/mm2 at 6 months and 1,449 +/- 365 (range, 1,105-2,043) cells/mm2 at 12 months. Vitreoretinal surgery subsequent to graft placement did not affect corneal clarity or dislodge the grafted tissue.
Conclusions: DLEK surgery can be used in cases with severe visual loss caused by bullous keratopathy with transfer of healthy donor endothelium, clearing of the central cornea, and restoration of useful vision. DLEK also can be successfully combined with other intraocular surgeries such as vitrectomy, intraocular lens exchange, and sutured intraocular lens surgery. The DLEK graft can tolerate subsequent intraocular surgery performed as early as 3 months after placement of the donor tissue.
Posted by mmiraftab at 08:16 PM | Comments (0)
Limits of Agreement Between the Optical Pachymeter and a Noncontact Specular Microscope.
Cornea. 24(5):545-549, July 2005.
Purpose: To determine the limits of agreement between central corneal thickness (CCT) measurements made with the slit lamp-attached optical pachymeter and the SP2000P noncontact specular microscope.
Methods: Triplicate readings for CCT were obtained for each of 130 (right) eyes of 130 patients, using the slit lamp-attached optical pachymeter and then the SP2000P noncontact specular microscope. The average CCT measured by each method was compared. Subsequently, the mean difference between both sets of measurements was assessed, and the 95% confidence interval (limits of agreement) between both techniques was determined.
Results: The mean +/- SD CCT measured by the optical pachymeter was 543 +/- 34 [mu]m and 532 +/- 34 [mu]m for the specular microscope. We found a statistically significant (P < 0.001) mean bias of 10 [mu]m between CCT values measured with both types of equipment, with the optical pachymeter returning the higher values. The coefficient of variation was 6.3% for the optical pachymeter and 6.4% for the specular microscope.
Conclusions: The right eye CCT measurements made by the optical pachymeter are, on average, 10 [mu]m thicker than those made with the SP2000P specular microscope, which suggests that both pieces of equipment cannot be used interchangeably to monitor CCT changes in patients. Excluding left eye measurements, the reliability of the optical pachymeter is identical to that of the noncontact specular microscope.
Posted by mmiraftab at 08:13 PM | Comments (0)
June 26, 2005
Octreotide inhibits growth factor–induced and basal proliferation of lens epithelial cells in vitro
Journal of Cataract & Refractive Surgery May 2005, Pages 1059-1064
Confluent LEC cultures were kept in serum-free defined medium containing [3H]-thymidine in the presence of octreotide alone at the concentration range of 10−7 M to 10−10 M or in combination with either basic fibroblast growth factor or insulin-like growth factor 1. Additionally, the expression of somatostatin receptors (1–5) in LECs were analyzed by reverse transcription–polymerase chain reaction.ResultsOctreotide decreased the proliferation of human LECs in a dose-dependent manner, exhibiting a maximal inhibitory concentration at 10−9 M (P<.03). Moreover, octreotide (10−9 M) potently inhibited basic fibroblast growth factor- and insulin-like growth factor 1–induced bovine lens epithelial cell proliferation (P<.0001). The respective products of all 5 subtypes of somatostatin receptors were found in human LECs and somatostatin receptor type 2 in bovine LECs.ConclusionThe data show that, depending on the concentration, octreotide is able to decrease proliferative responses of LECs. Moreover, the cell proliferation induced by growth factors was potently inhibited by octreotide. Therefore, octreotide could be a potential drug after cataract surgery in prevention of growth factor–dependent proliferative disorders such as posterior capsule opacification and anterior capsule contraction in diabetic patients.
Posted by mehdi khanlari at 11:15 PM | Comments (0)
Leaming notes...
Although the majority of practitioners make clear corneal incisions these days, there is a trend back to the vascular or near clear region of the cornea, according to the 2004 survey of U.S. ASCRS members.In 2004, 73% of practitioners said that they were making “clear corneal” incisions. However, of these, 38% actually made the incisions in the vascular, near clear, tissue.
This is likely the result of concerns over endophthalmitis with clear corneal incisions, said David V. Leaming, M.D., Palm Springs, Calif., Dr. Leaming sees this as one this year’s most telling findings, from his Another key issue this year was the number of practitioners that performed bimanual phacoemulsification.“The percentage that were actually doing bimanual phaco was smaller than I thought it might have been,” Dr.Of 3.3% of practitioners that use the procedure, 62% rely on it only 10% of the time, while just 35% use the bimanual approach all the time.A trend that has been pretty remarkable over the last five years is the changing method of obtaining A-scans, Dr. Leaming said.In the past five years, use of partial coherence interferometry has jumped from 3% to 35% and the immersion technique has almost doubled from 7% to 16%, all at the expense of the applanation technique, which dropped from 90% to just 49%.“I think that partial coherence interferometry will certainly be the number one technique within the next year or so, for measuring the axial length of the eye,” Dr. There has also been a recent expansion in the rate of LASIK growth, which had been relatively stagnant since 2001. This climbed 26% between 2003 and 2004.“That was a little bit surprising because the last three years it had been kind of level and all of a sudden it has taken off,” Dr. Leaming said. “However, the volume of cataract surgery dropped a little bit last year.”
This is something that mirrors what happened in the late 1990s when LASIK first took off. “From 1997 to 2000, there was a big growth rate in LASIK and at that time there was also a dip in cataract surgery,” In 2004, cataract surgeons showed a mounting preference for metal blades to use in making their clear corneal cataract incisions.
“Of those that perform less than 50 procedures per month, only 12.5% use diamond blades, while of those that perform between 50 and 75 cataract surgeries per month, 53% use diamond blades,” Dr. Leaming said. Also among cataract surgeons, when it came to interest level in the different multifocal IOLs, the multifocal Array (Advanced Medical Optics, Santa Ana, Calif.) lens ranked lowest, while the pseudoaccomodating lenses such as the ReSTOR (Alcon, Fort Worth, Texas) ranked highest.Dr. Leaming said next year it will be interesting to follow whether the new pseudo-accommodative lenses continue to grab practitioners’ attention.For refractive surgeons, there was a significant increase in wavefront procedures.Dr. Leaming said the technique is starting to takeoff.“We found that 48% of practitioners offered it to 100% of their eligible patients,” Dr. Leaming said. “Of that, 12% of patients were treated with wavefront, which is up from 1% in 2003.”When it came to future refractive surgery plans, there was a really strong showing for phakic IOLs; close to 70% of practitioners said they hoped to begin using the lenses. Practitioners were also excited about refractive lens exchange — about 36% of those not doing it now plan to start. There was also interest in CK; 28% of those not doing it plan to start.
Practitioners currently appear to be least interested in scleral expansion bands, intracorneal rings, and LASEK.In the glaucoma drop arena, prostaglandins were the first choice for most practitioners.
“The prostaglandins were the first across all different patient categories,” .Another trend noted was practitioners’ increasing propensity to measure corneal thickness.“We found that 87% of practitioners routinely measured the corneal thickness, which is up from 61% in 2003,” .Dr. Leaming was also struck that almost three quarters of practitioners said that they owned an optic nerve head analyzer.On the socioeconomic front, only 14% of responders said that they currently used computerized medical records. Dr. Leaming said this is likely an economic issue.When it came to malpractice insurance, 59% of ophthalmic practitioners said they paid between $7,500 and $15,000 per year, however up to 2% said they paid over $50,000 per year or more
Posted by mehdi khanlari at 11:04 PM | Comments (0)
In vitro influence of vancomycin on adhesion of a Staphylococcus epidermidis strain encoding intercellular adhesion locus ica to intraocular lenses
Journal of Cataract & Refractive Surgery May 2005, Pages 1050-1058
Staphylococcus epidermidis clinical strain N890074 containing the intercellular adhesion locus ica was used as the infectious agent. Vancomycin was used at 20 μg/mL. A sterile biocompatible, biodegradable vancomycin insert, releasing 230 μg of antibiotics over 100 minutes, was designed especially for this study. To obtain bacterial killing curves, experiments were first performed in a 103 colony-forming units (CFU/mL) bacterial suspension containing no intraocular lenses (IOL). Then IOLs were incubated in the suspension, and bacterial adherence was determined using bacterial counting with and without antibiotic.ResultsVancomycin (solution and insert) had an anti-adhesion effect after 1 hour and a relevant bactericidal effect after 6 hours of incubation.ConclusionsVancomycin used with irrigating solutions does not remain in the anterior chamber long enough to develop bactericidal effect. Even if it initially reduces bacterial adhesion, used at a drug level dropping below the bacterial minimal inhibitory concentration, it could result in a secondary increase of the adhesion of slime-producing bacteria. A sufficiently high concentration was obtained in vitro by the new sustained-release system, thereby overcoming the theoretical drawback of a short half-life within the anterior chamber. Anti-adhesion and bactericidal action of vancomycin inserts remains to be confirmed in clinical studies.
Posted by mehdi khanlari at 10:59 PM | Comments (0)
Scanning laser polarimetry of nerve fiber layer thickness in normal eyes after cataract phacoemulsification and foldable intraocular lens implantation
Journal of Cataract & Refractive Surgery May 2005
Forty-eight eyes were evaluated prospectively the day before and 30 days after cataract phacoemulsification and foldable IOL implantation. In each eye, lens opacity grading according to the Lens Opacities Classification System III (LOCS III), and axial length (AL) measurements were performed. Retinal nerve fiber layer thickness was quantified at baseline by means of SLP and anterior segment birefringence compensation was evaluated acquiring macular retardation map (MRM). Acrylic and silicone IOLs were implanted randomly. After surgery, RNFL thickness was reevaluated, and MRM was reacquired. Macular retardation map pattern variations regarding baseline profile were classified into 3 groups: no variation, bow-tie profile enhancement, or attenuation. Distribution of IOL power, AL, and cataract type in the 3 groups was assessed, as were presurgery and postsurgery SLP parameters with mean values (±SD) compared by paired t test.Twenty-two eyes (Group 1, 45.8%) showed no MRM variation, 14 (Group 2, 29.2%) an enhancement, and 12 (Group 3, 25%) an attenuation. In Group 1, no significant RNFL thickness variation occurred. In Group 2, variation 10% to 15% was measured, whereas thickening a 8% to 15% thinning appeared in Group 3. Variations occurred irrespective of IOL material, AL, or cataract type.ConclusionsCataract surgery with IOL implantation was associated with an MRM profile change and RNFL thickness variations in 54.2% of eyes. Variations are probably related to opacified lens removal. A new baseline SLP reading is mandatory after cataract surgery.
Posted by mehdi khanlari at 10:45 PM | Comments (0)
New ratio may help predict corneal haze
Many ophthalmologists believe laser-assisted subepithelial keratomileusis (LASEK) has gained in popularity among the various refractive surgeries, but corneal haze continues to present a challenge.Now some researchers have found that assessing an ablation depth/corneal thickness ratio before performing LASEK on a patient may be useful in preventing corneal haze.It found that patients with an ablation depth/corneal thickness (AD/CT) ratio of 0.18 or more have a high risk of developing clinically significant haze (1+ or more) after LASEK.Researchers found that 92.5% of eyes with an AD/CT ratio of 0.18 or more developed clinically significant haze (1+ or more). Meanwhile, they found that 94% of eyes with an AD/CT ratio of 0.18 or lower developed no more than 1+ corneal haze.We found this to be true even when excluding hyperopic patients from statistical analysis. However, the number of hyperopic patients we treated was too small a sample for a meaningful comparison between myopic and hyperopic patients.”....But Dr. Durrie also said that all seven of his patients were under 30 years old, and so there also may be some correlation between age and haze.“I found that the younger patients have much more active corneas, too,” Dr. Durrie said. “The age factor seems to come into play also.”
So far, nobody knows exactly what causes corneal haze, Dr. Lin said. Therefore, it is important to predict who will get haze and avoid surgery in high-risk patients.
Posted by mehdi khanlari at 10:39 PM | Comments (0)
June 24, 2005
Migraine with aura increases stroke risk in women
Specialty News and Views: Neuro-Ophthalmology/Orbit - June 2005
A population-based case-controlled study by the Stroke Prevention in Young Women Study was conducted at the University of Maryland. The study included 963 women, 542 of whom had suffered a stroke.Women who saw spots and lines during or just prior to migraine had a 25% increased risk of stroke over women without migraine, and women with visual loss during or before migraine had a 70% higher risk of stroke.
When female migraine sufferers with visual impairment were compared to women without migraine, the women with migraine were 1.7 times more likely to have a stroke. Women who had migraine without visual symptoms had no increased risk of stroke.
Posted by afarahi at 06:50 PM | Comments (0)
Threshold Amsler grid appears an effective screening tool for asymptomatic patients on hydroxychloroquine therapy
British Journal of Ophthalmology, May 2005
Among the 56 rheumatological patients on this therapy, the threshold Amsler grid revealed a significantly higher number of scotomas caused by hydroxychloroquine toxicity compared to the standard Amsler grid or the red Amsler grid. Also, the average area of each scotoma detected by all three methods expanded from 34.5 square degrees of central field loss on Amsler grid testing to 71 square degrees on red Amsler grid and 117 on threshold Amsler grid.
Posted by kjalali at 09:41 AM | Comments (0)
Premature birth without ROP increases risk for poorer vision
Archives of Ophthalmology, June 2005
This large, population-based study finds that, at age 10, children born prematurely had reduced distance and near visual acuities – even after children with ROP and neurologic disorders were excluded from the analysis (P < .001). Children who had been treated with cryotherapy had the highest risk of reduced visual acuity. Of the children born prematurely, 2 percent were visually impaired by World Health Organization definitions and 5.3 percent of the preterm children had visual acuity of less than 20/60 in either eye.
Posted by kjalali at 09:36 AM | Comments (0)
June 21, 2005
Ocular hypertensive and anti-inflammatory responses to different dosages of topical dexamethasone in children: a randomized trial
Clinical & Experimental Ophthalmology Volume 33 Issue 3 Page 252 - June 2005
The purpose of the present study was to investigate the ocular hypertensive and anti-inflammatory responses to two different dosage schedules of 0.1% topical dexamethasone in a population of Chinese children undergoing strabismus surgery.
Methods: Children undergoing bilateral strabismus surgeries were randomly assigned to receive topical 0.1% dexamethasone eye drops four times daily (group A) or twice daily (group B) for 4 weeks. Intraocular pressure (IOP) and anti-inflammatory responses were monitored for 8 weeks.
Results: A total of 137 children with mean age 6.5 years (SD, 1.9 years; range, 310 years) participated in the study. The IOP increased significantly after 4 weeks in both groups compared to the preoperative values (P < 0.001). Peak IOP ranged from 14.0 to 50.3 mmHg in group A and 11.041.3 mmHg in group B. Cases in group A (mean, 13.8 mmHg; SD, 8.4 mmHg) had a greater net increase in IOP than cases in group B (mean, 10.2 mmHg; SD, 6.2 mmHg; P = 0.004). Younger-aged children had higher peak IOP (r = 0.244, P = 0.048), and attained the peak IOP earlier (r = 0.252, P = 0.041) in group A. There was no significant difference in ocular inflammatory response between the two groups.
Conclusion: Ocular hypertensive effect to topical 0.1% dexamethasone is dose and age dependent in children. Twice-daily 0.1% topical dexamethasone eye drops control inflammation after strabismus surgery as effectively as four-times-daily dosage, but induces less increase in IOP, and may be a better treatment schedule.
Posted by mmiraftab at 09:52 PM | Comments (0)
Steroid response in children
Clinical & Experimental Ophthalmology Volume 33 Issue 3 Page 229 - June 2005
The ocular-hypertensive response to steroids in adults is a
well documented and commonly encountered clinical problem.
It has been reported following the use of corticosteroids
in every mode of administration in susceptible adults. The
hypertensive response is usually reversible following discontinuation
of short courses of corticosteroids. However, prolonged
schedules of usage, if not identified, can result in
sight-threatening glaucomatous optic neuropathy.
The use of corticosteroids in children is less well documented
in terms of the ocular-hypertensive response but
there is now a growing body of evidence that the effects in
children are more severe in relation to the peak in intraocular
pressure, time to reach peak intraocular pressure and dosage
of steroids used.
Posted by mmiraftab at 09:45 PM | Comments (0)
Effect of Refractive and Topographic Astigmatic Axis on LASIK Correction of Myopic Astigmatism
Journal of Refractive Surgery Vol. 21 No. 3 May/June 2005
PURPOSE
To evaluate whether agreement or disagreement between the axis of astigmatism as determined by refraction and corneal topography has any influence on the outcome of laser in situ keratomileusis (LASIK) correction of astigmatism.
METHODS
Charts of 122 consecutive eyes of 75 patients (46 women and 29 men) who underwent uncomplicated, primary LASIK for myopic astigmatism were reviewed. The series was divided into two groups—group 1, “agreement” (77 eyes) with a difference between refractive and topographic axis of astigmatism ≤15°, and group 2, “disagreement” (45 eyes) with a difference >15°.
RESULTS
The mean difference in axis of astigmatism was 10°±17.20° (range: 0° to 86°), and 63.11% of eyes were within a 15° difference. A significant negative correlation was found between the percentage of corrected astigmatism and the degree of disagreement. The percentage of corrected astigmatism differed significantly between the two groups (P=.002) with better results in group 1 (agreement).
CONCLUSIONS
Disagreement between refractive and topographic astigmatic axis is common. Approximately one third of eyes with astigmatism have >15° disagreement. Disagreement between refractive and topographic determination of the astigmatic axis can be considered a prognostic factor for LASIK correction of myopic astigmatism.
Posted by mmiraftab at 09:28 PM | Comments (0)
Reducing Endophthalmitis Risk Factors: Where We Stand
American Journal of Ophthalmology Volume 139, Issue 6 , June 2005, Pages 1097-1098
Miller and associates 1 present data concerning the incidence and clinical settings of acute-onset endophthalmitis after cataract surgery at a single university-affiliated hospital. This is the third installment in a series that covers the time periods 1984 to 1994, 2 1995 to 2001, 3 and January 2000 to November 2004. 1 It is interesting to note that the risk of acute endophthalmitis after cataract surgery has remained very low and relatively stable during this 20-year period, .082%, .04%, and .04%, respectively. The intriguing part of the current offering surrounds the clinical settings of infected cases and the authors’ speculation regarding significance. Inferior incision location, more frequently employed by right-handed surgeons on right eyes, was present in 86% of cases. Four (57%) of seven cases had an intraoperative complication (vitreous loss, iris prolapse). Five (71%) of seven patients had relative immunosuppression (diabetes mellitus-4, polymyalgia rheumatica-1). All of the patients had preoperative preparation with povidone-iodine. These observations deserve additional thought regarding their relevance to current clinical practice.
Clear cornea phacoemulsification by temporal clear cornea incision has emerged as the procedure of choice for most surgeons performing cataract surgery. With the evolution away from extracapsular cataract extraction and more recently phacoemulsification by scleral tunnel, there has been concern that the incidence of postoperative endophthalmitis may rise. The risk for clear cornea cases was .05% vs .02% for nonclear cornea phacoemulsification. In this study, there was no statistically significant increase in risk with clear cornea incision; however, there may have been insufficient power to identify a difference. The relevant literature offers conflicting data with regard to incision type and location. Cooper and associates reported a 3-fold greater risk of endophthalmitis with clear cornea incisions compared with scleral tunnel incisions. 4 Negaki and coworkers found an increased risk of infection with temporal clear cornea incisions (.29%) vs superior sclerocorneal incisions (.05%). 5 An additional study found that although there was a higher incidence of endophthalmitis with clear cornea incisions (.129%) compared with scleral tunnel incisions (.05%), the difference was not statistically significant. 6 The reader must interpret the new data offered by this study in the context of the existing literature, as this issue still seems unresolved.
The authors point out that right-handed surgeons operating on right eyes often displace the incision location farther inferiorly. The right hand-right eye combination was present in 86% of infected cases. This observation raises several questions. It would be very interesting to know the rate of infection for left-handed surgeons working on left eyes in this and similar series. The statistical significance of this observation could be tested by determining the incidence of infection in right hand/right eye cases compared with right hand-left eye cases.
It has been proven that clear corneal incisions may be unstable based on wound architecture and variations in intraocular pressure. 7 The authors state that none of the infected patients had postoperative wound leaks based on the lack of visible leakage and hypotony on the first postoperative day. These findings do not confirm wound integrity. It is unclear whether these wounds were checked with fluorescein dye (Seidel’s test). Additionally, these eyes may have been hypotonous overnight, or conversely, suffered from elevated intraocular pressure so that a “normal” pressure on the first postoperative day reflected relative hypotony. The wound integrity of infected eyes in this series is unknown.
The authors note that five (71%) of seven patients with endophthalmitis had relative immune compromise attributable to diabetes mellitus (4) or polymyalgia rheumatica (1). It is debatable whether patients with well-controlled type II diabetes have immune compromise. Additionally, the total number of patients in the series with relative immune compromise is not documented. It is reasonable to assume that immunocompromised patients have a greater risk of infection; however, the relative risk cannot be evaluated in this study data.
Similarly, Miller and associates note that two of the seven infected patients had topical placement of lidocaine 2% gel prior to preparation with povidone-iodine. Establishing the incidence rate with lidocaine gel anesthesia may be an important additional step to determine the safety of this form of anesthesia.
The issue of endophthalmitis rates with foldable vs injectable intraocular lenses remains unresolved in the current study. There were twice as many endophthalmitis cases with foldable lenses; however, the significance of this finding is unknown. There is a commonly held belief that injectable lenses may be safer because they do not contact the tear film during insertion. Perhaps additional investigation of this data set might add more meaningful information for the clinician attempting to decide which lens type offers less risk for his or her patients.
The authors are to be commended for a well-written article that documents the safety of cataract surgery at a single university-affiliated hospital. Although the risk of endophthalmitis is quite low and stable compared with prior studies, we should continue to examine the variables to further limit the risk of this potentially devastating complication. The authors point out multiple potential risk factors for infection that raise intriguing questions. Further study in multiple areas may help to better answer the questions raised here.
Posted by mmiraftab at 09:20 PM | Comments (0)
Celecoxib, a Selective Inhibitor of Cyclooxygenase 2 for Therapy of Diffuse Anterior Scleritis
American Journal of Ophthalmology Volume 139, Issue 6 , June 2005, Pages 1086-1089
Twenty-four patients suffering from diffuse anterior scleritis were seen in the Interdisciplinary Uveitis Center in Heidelberg between April 2001 and April 2003. All patients were treated with a 200- to-800 mg dose of celecoxib per day, in divided doses, depending on the degree of discomfort and clinical severity.
Results
Twenty-two patients experienced significant clinical improvement within an average of 5 days of starting celecoxib. These patients reported a complete loss of pain and scleral redness. As they experienced complete symptomatic remission, the dose of celecoxib was tapered. Three of these patients suffered from a second attack of scleritis, with one patient requiring long-term low-dose therapy, one patient showing a nodular form, and the third showing no improvement. Treatment with celecoxib was associated with no side effects apart from allergic exanthema in two patients.
Conclusion
Due to its anti-inflammatory potency and low rate of side effects, celecoxib is an effective drug for the treatment of diffuse anterior scleritis. Compared with other NSAIDs it shows minimal gastrointestinal side effects, so its high cost is justified. It represents an alternative drug therapy before systemic immunosuppressive treatment.
Posted by mmiraftab at 08:53 PM | Comments (0)
Acute-onset Endophthalmitis After Cataract Surgery (2000–2004): Incidence, Clinical Settings, and Visual Acuity Outcomes After Treatment
American Journal of Ophthalmology Volume 139, Issue 6 , June 2005, Pages 983-987
Annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiologic records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at a single university-affiliated hospital between January 2000 and November 2004. main outcome measures: Operative technique, intraoperative complications, and visual acuity.
Results
The incidence of acute-onset endophthalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by clear cornea phacoemulsification, and 0.02% (1/4,458) for cataract surgery by methods other than clear cornea phacoemulsification (P = .681, Fisher’s exact test). Six of seven (86%) cases occurred in the right eye, and all cases were performed by right-handed surgeons through temporal incisions. Five of seven (71%) patients had relative immune compromise. Four of seven (57%) patients had an intraoperative complication: vitreous loss in three patients and iris prolapse in one patient. Two patients had topical placement of lidocaine 2% gel before povidone-iodine preparation. The visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients.
Conclusions
The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemulsification is low (0.05%). Potential risk factors for endophthalmitis may include intraoperative complications, relative immune compromise, application of lidocaine 2% gel before povidone-iodine preparation, and inferior incision location.
Posted by mmiraftab at 08:49 PM | Comments (0)
Amblyopia Treatment Outcomes
Journal of AAPOS,April,2005
Six hundred patients fit the inclusion criteria(unilateral amblyopia secondary to strabismus, anisometropia, or a combination of the two)and were retrospective reviewed. All patients had full-time occlusion encompassing 24 hours per day or all waking hours, followed to a defined endpoint. Success was defined as 20/30 or better or equal visual acuity by fixation pattern between the two eyes. Mean follow-up after the cessation of full-time patching was 7.2 years.Ninety-six percent of patients attained a successful visual result. Sixty percent attained equal visual acuity. The incidence of occlusion amblyopia was 25.8%.
Conclusions: Full-time occlusion produces excellent visual acuity results. It was shown to be effective with no long-term complications if patients proceed as directed.
Posted by afarahi at 01:12 AM | Comments (0)
Correction of Large Amblyopiogenic Refractive Errors in Children Using the Excimer Laser
Journal of AAPOS,June,2005
Thirty-six eyes in 35 amblyopic children, who ranged in age from 4 to 16 years ,received treatment for large magnitude ametropia. Seventy-two percent of the children had a neurobehavioral disorder and/or were noncompliant with spectacle or contact lens wear. Myopia ranged from −3.25 to −24.25 D , one patient had hyperopia of +5.87 D. VISX Star S2/S3 excimer lasers were used in manual or auto-tracking modes, and corneal centration was achieved using brief, general anesthesia. Mean follow-up was 29.2 months. Eighty-nine percent were corrected to within ± 1.00 D of goal refraction and the remaining 11% to within 2.0 D of the goal (most were undercorrected). Acuity improved postoperatively in 97%; by 1 optotype line in 37% and by 2 or more in 60%. No child lost acuity. Binocularity improved in 69% (24/35) and remained the same in 31%. Corneal haze measured grade 0–1 in 78%, grade 2 in 14%, and grade 3–4 in 8%. Myopic regression exceeding 1.0 D/year (0.08 D/month) occurred in 50% (18/36) of eyes treated. No substantial differences were observed in PRK- (n = 18) versus LASEK- (n = 17) treated children.
Conclusions: Laser refractive surgery is effective for correcting anisometropic myopia in amblyopic children. Recurrence of myopia is common. Further study is indicated to determine long-term stability and safety of the procedure in this population.
Posted by afarahi at 12:44 AM | Comments (0)
June 19, 2005
Bariatric surgery can lead to serious ocular complications
Ophthalmology, June 2005
Based on one case study and a review of the literature, the authors conclude this procedure can cause vitamin A deficiency, leading to complications such as xerophthalmia, nyctalopia and blindness. As the obesity rate increases and gastric bypass procedures become more popular, patient and physician education on the importance of strict adherence to vitamin supplements is imperative to preventing a potential epidemic of ocular complications from this procedure.
Posted by kjalali at 08:13 PM | Comments (0)
Single intravitreal triamcinolone injection induces posterior subcapsular cataract
American Journal of Ophthalmology, June 2005
This study of 42 phakic eyes of 37 patients injected one, two or three times for various indications also found that multiple injections resulted in all-layer cataract progression. Visual acuity did not change after single injection but decreased after multiple injections. Corticonuclear and posterior subcapsular cataract progression significantly correlated with follow-up time (P = .003 and P = .02, respectively) and number of injections (P = .01 and P = .04, respectively).
Posted by kjalali at 08:06 PM | Comments (0)
June 18, 2005
Pterygium, Pinguecula, and 5-year Incidence of Cataract
AJO June 2005
To assess longitudinal associations between pterygium, pinguecula, and 5-year incident cataract.The Blue Mountains Eye Study examined 3,654 residents aged ≥49 years during 1992 to 1994 and reexamined 2,335 (75.1% of survivors) 5 years later. Slit-lamp examination recorded pterygium and pinguecula. Cataract was assessed using masked grading of lens photographs. Incidence was assessed in participants without cataract at baseline. Eye-specific data were analyzed using generalized estimating equation models, adjusting for age, sex, smoking, diabetes, and corticosteroid use.Pinguecula was associated with a borderline-significant, increased risk of developing cortical cataract (adjusted odds ratio, 1.3; 95% confidence interval, 1.0 to 1.7). We found no significant association between baseline pterygium and the incidence of cortical, nuclear, or posterior subcapsular cataract.ConclusionsLongitudinal data from the same study population provide weak support for cross-sectional associations between pinguecula and cortical cataract previously reported from our study.
Posted by mehdi khanlari at 11:56 AM | Comments (0)
Multiple Elements in the Deposits of Opacified Hydroview Intraocular Lens
The explanted IOLs were evaluated by light microscopy, scanning electron microscopy, and energy-dispersive x-ray spectroscopy.Brownish granular and scattered crystal-like deposits were found in case 2, whereas only fine white granular deposits were found in case 1. Using EDX spectroscopy, the elements of deposits on IOL optics were calcium and phosphorus in case 1, but in case 2, fluorine, magnesium, and sodium were demonstrated in addition to calcium and phosphorus.Conclusions Our study indicated a difference in morphology and elements of deposits on opaque IOL optics between these two cases. It was suggested that multiple elements may contribute to the formation of deposits.
Posted by mehdi khanlari at 11:54 AM | Comments (0)
Possible plasma level alterations may be associated with POAG, study finds
Eyeworld June 2005>
Results from a preliminary study suggest that the possible alterations of plasma MDA levels may be associated with the pathogenesis of POAG, according to a new study in the May issue of Eye. Investigators in the Department of Ophthalmology, Mersin University, Mersin, Turkey, set out to investigate the role of oxidative stress and lipid peroxidation in the pathogenesis of primary open-angle glaucoma (POAG).The activities of myeloperoxidase (MPO), catalase (CAT), and the levels of plasma malondialdehyde (MDA) were measured in 40 (15 men and 25 women) patients with POAG and 60 (30 men and 30 women) healthy controls.There was no significant difference in the activities of CAT and MPO between the POAG patients and the controls. However, the plasma MDA level was significantly higher in patients than the controls.The study suggests that the possible alterations of plasma MDA levels may be associated with the pathogenesis of POAG.However, further research is needed to understand the role of oxidative damage in this important disorder of aging.
Posted by mehdi khanlari at 11:45 AM | Comments (0)
Single Intraocular Pressure Measurements and Diurnal Intraocular Pressure Profiles
....Intraocular pressure measurements were highest at 7 am, noon, 5 pm, 9 pm, and midnight, respectively, in 20.4%, 17.8%, 21.3% 13.9%, and 26.7% of the profiles, respectively. The measurement taken at 7 am was significantly (P < .001) closest to the maximal value of the profile.ConclusionsAny single intraocular pressure measurement taken between 7 am and 9 pm has a higher than 75% chance to miss the highest point of a diurnal curve. Intraocular pressure may be measured at different times of the day to have the best chance of observing the maximal value.
Posted by mehdi khanlari at 11:41 AM | Comments (0)
Predictive Factors for Progressive Optic Nerve Damage in Various Types of Chronic Open-angle Glaucoma
American Journal of Ophthalmology June 2005, Pages 999-1009
For patients with elevated intraocular pressure, significantly predictive factors for eventual progression were older age, advanced perimetric damage, smaller neuroretinal rim, and larger area of β zone of parapapillary atrophy. In contrast, in the normal intraocular pressure group, a significant predictive factor was presence of disk hemorrhages at baseline. Within the patients with elevated intraocular pressure, the primary open-angle glaucoma group and the secondary open-angle glaucoma group did not differ in predictive factors for progression of glaucoma.ConclusionsOpen-angle glaucoma patients with normal intraocular pressure and open-angle glaucoma patients with elevated intraocular pressure differ in predictive factors for eventual progression of glaucomatous optic nerve damage. It may have clinical importance and may be helpful in the discussion of the pathogenesis of the glaucomas.
Posted by mehdi khanlari at 11:34 AM | Comments (0)
Selective Laser Trabeculoplasty (SLT) Complicated by Intraocular Pressure Elevation in Eyes With Heavily Pigmented Trabecular Meshworks
American Journal of Ophthalmology June 2005, Pages 1110-1113
Conclusions
This case series suggests that post-SLT IOP elevations can be a serious adverse event in some glaucomatous patients. It is recommended by the authors that patients with a deeply pigmented trabecular meshwork, taking multiple topical medications and having previous ALT treatment, should be considered at higher risk for this complication.
Posted by mehdi khanlari at 11:31 AM | Comments (0)
phacoemulsification and corneal endothelial cell count
American Journal of Ophthalmology June 2005
Thirty patients planned for routine phacoemulsification cataract surgery were included. Ultrasonic pachymetry and specular microscope endothelial photography of the central and nasal portions of the cornea and Orbscan II slit-scan tomography were performed preoperatively and the day after surgery. The 30 patients were selected from 41 patients based on their increase in central corneal thickness: the first 10 cases with a <5% increase, the first 10 with a 6% to 20% increase, and the first 10 with a ≥20% increase. The same measurements were repeated after 1, 2, and 3 months. The primary outcome measures were corneal endothelial cell loss and increase in pachymetry. Several other parameters were also registered, including age, degree of cataract, visual acuity, phacoemulsification time and energy, total operation time, and the amount of infusion fluid used.
ConclusionsIn this series, with large variations in the corneal swelling at the first postoperative day, the degree of permanent corneal endothelial damage was reflected in the degree of early postoperative corneal swelling. Measuring the difference in pachymetry at postoperative day 1 is a useful way to assess the effects on the corneal endothelium exerted by the phacoemulsification procedure.
Posted by mehdi khanlari at 11:24 AM | Comments (0)
June 17, 2005
Strabismus Surgery Under Augmented Topical Anesthesia
Journal of AAPOS, June, 2005
Conclusion: Lidocaine jelly in combination with intravenous nalbuphine is an effective topical anesthesia strategy that provides for the patient’s comfort and the surgeon’s ability to fine-tune ocular alignment on the operating
Posted by afarahi at 07:58 PM | Comments (0)
Prophylactic Dexamethasone for Postoperative Nausea and Vomiting in Pediatric Strabismus Surgery: A Dose Ranging and Safety Evaluation Study
Anesthesia and Analgesia, 2005;100:1622-1626
In this double-blind, randomized, placebo-controlled study, we evaluated the efficacy and safety of different doses of prophylactic IV dexamethasone for postoperative nausea and vomiting (PONV) in 168 children (aged 2–15 yr) scheduled for strabismus surgery. Patients received IV dexamethasone 0.25 mg/kg (D 0.25), 0.5 mg/kg (D 0.5), 1.0 mg/kg (D 1), or saline (S) immediately after induction of general anesthesia. Patients were discharged 24 h after surgery. Nausea and vomiting were assessed at 0–2, 2–6, and 6–24 h after surgery. Fewer patients in the dexamethasone groups (6, 3, and 6 in D 0.25, D 0.5, and D 1, respectively) had severe PONV compared with group S (P = 0.001). The results suggest that dexamethasone 0.25 mg/kg is more effective than saline and equally effective compared with larger doses for preventing PONV for pediatric strabismus surgery.
Posted by afarahi at 07:26 PM | Comments (0)
Perioperative Posterior Ischemic Optic Neuropathy as a Rare Complication of Blepharoplasty
Ophthalmologica,Vol. 219, No. 3, 2005
Blindness is a rare but feared complication of blepharoplasty and is reported to occur in about 0.04% of cases. Although intraorbital hemorrhage is thought to be the leading cause for optic nerve damage in most of the patients with this devastating condition, we present a case with perioperative posterior ischemic optic neuropathy leading to visual loss after blepharoplasty. The mechanism leading to optic nerve damage in this patient may include compromised small arteries perfusing the optic disk due to direct mechanical compression and a probable vasoconstrictive activity of the anesthetic agent.
Posted by afarahi at 07:22 PM | Comments (0)
Anti-MuSK Myasthenia Gravis Presenting With Purely Ocular Findings
Archive of Neurolgy,June, 2005
Antibodies to a muscle-specific receptor tyrosine kinase (MuSK) have been found in approximately 40% of patients with generalized myasthenia gravis who are seronegative for the antiacetylcholine receptor antibody. Many of the patients with anti-MuSK antibodies have prominent oculobulbar symptoms or weakness of the neck and respiratory muscles, but patients with ocular myasthenia have not been described. In this case report in a young woman with ocular myasthenia, anti-MuSK antibody was detected by radioimmunoassay using highly purified MuSK recombinant antigen.
Conclusion : Ocular myasthenia gravis is a presentation of the anti-MuSK antibody syndrome.
Posted by afarahi at 07:12 PM | Comments (0)
Uveitis-associated Flap Edema and Lamellar Interface Fluid Collection After LASIK
American Journal of Ophthalmology June 2005, Pages 1137-1139
A 47-year-old man and a 50-year-old woman who experienced vision loss and corneal changes associated with acute anterior uveitis after LASIK were examined.The 47-year-old man, who had undergone LASIK for low myopia developed an interlamellar fluid pocket at the level of the flap interface, whereas the 50-year-old woman, who underwent LASIK for hyperopia, developed marked flap edema without interface fluid collection.ConclusionsThese two cases demonstrated acute corneal fluid accumulation associated with episodes of acute anterior uveitis in eyes that had undergone LASIK. Uveitis should be considered a risk factor for vision threatening corneal complications after LASIK
Posted by mehdi khanlari at 05:27 PM | Comments (0)
Negative Dysphotopsia
Review of Ophthalmology Jan 2005
....Temporal darkness or negative dysphotopsia, is the most prevalent postcataract surgery photic symptom today. In this case, the patient detects a black shadow temporally, in the periphery of vision.This is the result of ring scotoma, a phenomenon frequently experienced by people who wear so-called “cataract glasses.” When the central area in our field of vision is magnified, there’s a circle of missing information where the magnified view meets the nonmagnified view. Although this ring extends all the way around the visual field, the patient only perceives it as a black region on the temporal side because the nose blocks vision nasally.This ring of missing information is often associated with a high-plus IOL, and seems to be accentuated when the lens has a high refractive index. Many people don’t notice it, but others are immediately bothered by it. It can be severe enough that some people require replacement of the lens.
Posted by mehdi khanlari at 05:01 PM | Comments (0)
June 16, 2005
To investigate the corneal endothelial cytotoxicity of dyes for capsule staining in cataract surgery.
JCRS Pages 792-798 (April 2005)
Taiwan,Cultured corneal endothelial cells of New Zealand white rabbits were exposed for 1 minute to 1 of the following dyes (various concentrations): indocyanine green (ICG), methylene blue (MB), gentian violet (GV), trypan blue (TB), and fluorescein sodium (FS). The effect of longer exposure (up to 10 minutes) to ICG 0.25% was also investigated. Structural changes in corneal endothelial cells after dye exposure were evaluated by light microscopy and transmission electron microscopy (TEM).
Conclusion
One minute of exposure to ICG 0.25%, MB 0.20%, GV 0.01%, TB 0.40%, and FS 10% appeared to be safe as determined by no cytotoxic effects on rabbit corneal endothelial cells in culture.
Posted by alireza habibollahi at 08:03 AM | Comments (0)
Comparison of dyes for cataract surgery: Efficacy of capsule staining in a rabbit model
JCRS Pages 799-804 (April 2005)
Taiwan,To investigate the efficacy of various dyes for anterior capsule staining to facilitate capsulorhexis during cataract surgery.
Various concentrations of indocyanine green (ICG), methylene blue (MB), gentian violet (GV), trypan blue (TB), and fluorescein sodium (FS) were used to stain rabbit lenses in vitro. After 1 minute of exposure, The lowest concentration of dye with a score of 4 was considered the lowest effective concentration for capsulorhexis.
Based on our scoring system, the lowest effective concentrations for capsulorhexis were ICG 0.25%, MB 0.10%, GV 0.01%, TB 0.10%, and FS 1.25%. The lowest effective concentrations of the 5 dyes provided comparable contrast. Increased concentrations of dye decreased contrast between the capsule and the cortex and were considered less effective for capsulorhexis.
Conclusion
Any of the following concentrations of dyes can be used for optimal enhancement of anterior capsule visibility for capsulorhexis: ICG 0.25%, MB 0.10%, GV 0.01%, TB 0.10%, and FS 1.25%.
Posted by alireza habibollahi at 07:53 AM | Comments (0)
Comparison of tropicamide and cyclopentolate for cycloplegic refractions in myopic adult refractive surgery patients
JCRS Pages 694-700 (April 2005)
USA,To compare tropicamide 1%, a shorter-acting cycloplegic agent, with cyclopentolate 1% for cycloplegic refractions in adult refractive surgery patients.
The study was prospective, single center, with randomized sequencing of cycloplegic agent; each patient received both agents. Thirty consecutive myopic adult refractive surgery patients (mean age 35.4 years) participated. A complete preoperative examination, including cycloplegic refraction, was obtained twice, 1 week apart. The patient and the examiner were masked to the medication. Main outcome measures included cycloplegic and manifest refractions, best corrected distance acuity, near-point accommodation, pupil diameters, and subjective appraisal of experience with cycloplegic agents.
Conclusions
There was no statistically significant difference in mean cycloplegic refractions. Cyclopentolate was more effective than tropicamide in reducing accommodative amplitude in adult myopes (near-point testing). Patients strongly preferred tropicamide.
Posted by alireza habibollahi at 07:41 AM | Comments (0)
June 11, 2005
Imaging interface fluid after LASIK with corneal OCT
JCRS Pages 853-856 (April 2005)
A 41-year-old myopic patient who had LASIK 6 months earlier was treated for a complete retinal detachment (RD) with proliferative vitreoretinopathy. Surgical treatment consisted of an encircling band, pars plana vitrectomy, and silicone oil filling. Postoperatively, the patient developed marked corneal edema with no increase in intraocular pressure (IOP) as measured by applanation tonometry. Interface fluid was confirmed by corneal OCT. Quantification of the corneal structures revealed that corneal edema was in the residual posterior stroma predominantly. The epithelial and flap thickness did not change significantly. The case demonstrated that after vitreoretinal surgery for RD repair, transient corneal endothelial cell dysfunction developed, causing marked edema of the posterior corneal stroma and interface fluid accumulation. However, an increase in IOP cannot be excluded.
Posted by alireza habibollahi at 10:59 PM | Comments (0)
Negative dysphotopsia associated with implantation of the Z9000 intraocular lens
JCRS Pages 846-847 (April 2005)
Uneventful small-incision cataract surgery was performed in a 70-year-old man and a 62-year-old woman with implantation of a Tecnis Z9000 intraocular lens (IOL) (Pharmacia). No ocular pathology was present in the patients preoperatively. Unsolicited complaints of negative dysphotopsia were made postoperatively, and the symptoms have persisted for more than 1 year in both patients. Symptomatic negative dysphotopsia may be seen in association with the Z9000 IOL.
Posted by alireza habibollahi at 10:54 PM | Comments (0)
Cataract surgery in Stevens-Johnson syndrome
JCRS Pages 860-862 (April 2005)
Cataract surgery can be safely performed in patients with Stevens-Johnson syndrome (SJS) with visually significant cataracts. Maintaining ocular surface integrity improves the prognosis of cataract surgery in this high-risk population. We present the outcome of cataract surgery in a retrospective chart review of 3 eyes in 2 patients with SJS. Uneventful extracapsular cataract extraction with intraocular lens implantation was performed. Follow-up ranged from 3 to 24 months. The visual acuity and ocular surface integrity were reviewed. The preoperative visual acuity was counting fingers at 1 meter in all 3 eyes. The best corrected visual acuity (BCVA) improved to 20/40 in 2 eyes and 20/50 in 1 eye postoperatively. A drop in BCVA ranging from 20/100 to 20/200 was noted during follow-up.
Posted by alireza habibollahi at 10:51 PM | Comments (0)
LASIK induced corneal perforation and recurrent corneal epithelial ingrowth
JCRS Pages 857-859 (April 2005)
We report a rare complication of recurrent corneal epithelial cell ingrowth after corneal perforation induced by LASIK . A corneal flap was made uneventfully with an automatic SCMD microkeratome.During laser ablation, instead of random burning over the stromal bed, repeated ablation at a single location occurred because of a machine malfunction, resulting in corneal perforation. The flap was replaced and sutured to prevent leakage of aqueous humor. As the cornea healed, the patient's vision was compromised by scar formation, high irregular astigmatism, and epithelial ingrowth. The flap was reopened, and the epithelial cells were removed by thoroughly scraping the flap and stromal bed. However, corneal epithelial ingrowth recurred within a week. The recurrent and progressive epithelial ingrowth further decreased vision, and penetrating keratoplasty was recommended.
Posted by alireza habibollahi at 10:45 PM | Comments (0)
Complicated removal of corneal foreign bodies 18 months after LASIK
JCRS Pages 851-852 (April 2005)
We present a 39-year-old young engineer who developed flap complications after removal of corneal foreign bodies 18 months after successful LASIK . The right eye had a flap scar and debris in the interface, and the left eye had a central rust ring and debris in the interface. Attempted removal of the flap in the left eye lifted off a large area around the rust ring, and the ring was left in place. One week after treatment with topical antibiotics, the eye was white and the rust ring had begun to disappear. The ring was successfully removed without complications the following week.
Posted by alireza habibollahi at 10:41 PM | Comments (0)
Use of preservative-free lidocaine for cataract surgery in a patient allergic to “caines”
JCRS Pages 848-850 (April 2005)
Although many patients have been labeled allergic to local anesthetics (LAs), true allergic reactions to LAs are rare. An 81-year-old woman with a history of procaine (Novocaine) allergy presented for cataract surgery. Skin testing showed sensitivity to amide and ester LAs. Further testing with preservative-free lidocaine was negative, suggesting the patient was allergic to ester LAs and preservatives found in amide anesthetic preparations. Cataract extraction was subsequently and uneventfully performed in both eyes with topical anesthesia using preservative-free lidocaine.
Posted by alireza habibollahi at 10:37 PM | Comments (0)
Utility assessment among cataract surgery patients
JCRS Pages 785-791 (April 2005)
Purpose
Singapore.To evaluate the utility values (time trade-off, standard gamble for death, standard gamble for blindness) of patients scheduled for cataract surgery.
Questions on time trade-off, standard gamble for death, standard gamble for blindness utilities, and visual function from an adapted version of the VF-14 were asked in a clinic interview of 217 Chinese patients.
Conclusions
The utilities of cataract patients scheduled for surgery were comparable to those in patients with other chronic ocular diseases. Cataract surgery patients with lower utilities tended to have worse visual function and greater difficulty seeing in bright light.
Posted by alireza habibollahi at 10:30 PM | Comments (0)
Laser in situ keratomileusis for primary hyperopia
JCRS Pages 776-784 (April 2005)
USA.To evaluate the efficacy, predictability, stability, and safety of H-LASIK over a 24-month period and analyze topographic changes after H-LASIK to assess topographic pseudokeratectasia (TPKE) following H-LASIK.
This prospective study included 139 eyes of 77 patients having H-LASIK for primary hyperopia. The mean follow-up was 15.6 months (TPKE) was defined as 1 or more positive keratoconus screening findings in an eye with topographic central or inferior steepening detected by the Topography Modeling System but without corneal thinning or progressive change.
Results
The MRSE was +2.39 (D) preoperatively and −0.05 D at the last visit. 99%of eyes were within ±1.00 D of emmetropia and 71% of the eyes were within ±0.50 D. Uncorrected visual acuity of 20/20 or better was present in 42%, 20/25 in 63%, and 20/40 or better in 93% of eyes. Loss of 2 lines of BSCVA occurred in 2 eyes (1.4%). In 1 eye, ischemic optic neuropathy occurred, and in another, choroidal neovascularization developed postoperatively. Topographic pseudokeratectasia was detected in 28% to 56% of eyes postoperatively. No significant difference between postoperative visual and refractive outcome, regression, or irregularity was found between the eyes with or without TPKE.
Conclusion
Hyperopic LASIK appears to be an effective, predictable, and safe procedure to correct low to moderate primary hyperopia. Topographic pseudokeratectasia, which was observed after H-LASIK with a keratoconus-like topographic pattern in otherwise normal eyes, may represent a relatively static condition.
Posted by alireza habibollahi at 10:19 PM | Comments (0)
TOP 50
CRST May 2005
Results of the "Top 50 Opinion Leaders in Cataract and Refractive Surgery" as voted by the readers of Cataract & Refractive Surgery Today
Akahoshi, Takayuki MD
Alió, Jorge L. MD
Apple, David J. MD
Azar, Dimitri T. MD
Brint, Stephen F. MD
Buratto, Lucio MD
Carones, Francesco MD
Chang, David F. MD
Chu, Y. Ralph MD
Cionni, Robert J. MD
Crandall, Alan S. MD
Dell, Steven J. MD
Doane, John F. MD
Donnenfeld, Eric D. MD
Durrie, Daniel S. MD
Fine, I. Howard MD
Fishkind, William J. MD
Gills III, James P. MD
Gimbel, Howard V. MD
Hardten, David R. MD
Hill, Warren E. MD
Holladay, Jack T. MD
Kim, Terry MD
Knorz, Michael C. MD
Koch, Douglas D. MD
Kohnen, Thomas MD
Krueger, Ronald R. MD
Lane, Stephen S. MD
Lindstrom, Richard L. MD
Mackool, Richard J. MD
MacRae, Scott M. MD
Majmudar, Parag A. MD
Maloney, Robert K. MD
Mamalis, Nick MD
Masket, Samuel S. MD
McDonald, Marguerite MD
Murali, Sai MD
Nagahara, Kunihiro MD
Neuhann, Thomas F. MD
Nichamin, Louis D. MD
Nordan, Lee T. MD
O'Brien, Terrence P. MD
Olson, Randall J. MD
Osher, Robert H. MD
Packer, Mark MD
Pallikaris, Ioannis MD
Pardos, George J. MD
Probst, Louis E. MD
Salz, James J. MD
Schallhorn, Steven C. MD
Slade, Stephen G. MD
Solomon, Kerry D. MD
Srinivasan, M. DO
Steinert, Roger F. MD
Stonecipher, Karl G. MD
Vasavada, Abhay MD
Vukich, John A. MD
Wallace III, R. Bruce MD
Waring III, George O. MD
Posted by mehdi khanlari at 10:55 AM | Comments (0)
Enucleation With Primary Implant Insertion for Treatment of Recalcitrant Endophthalmitis and Panophthalmitis.
Ophthalmic Plastic & Reconstructive Surgery, May, 2005
A prevalent conception exists that a two-stage operation (i.e., primary enucleation or evisceration with delayed secondary orbital implant insertion) is necessary when enucleation is required for recalcitrant endophthalmitis or panophthalmitis. The purpose of this study was to assess the utility of single-stage enucleation and primary reconstruction in this setting.
In a retrospective interventional case series, 22 consecutive patients with advanced endophthalmitis or panophthalmitis refractory to prior medical treatment underwent enucleation and primary implant placement . Eleven patients received hydroxyapatite implants; 11 patients received silicone implants. No cases of persistent orbital cellulitis or meningitis occurred in any of the patients. Two patients with silicone orbital implants had extrusions. None of the patients with hydroxyapatite orbital implants had complications.
Conclusions: This study suggests that enucleation with primary orbital reconstruction and implant insertion for recalcitrant, fulminant ocular infection is an acceptable and advantageous treatment strategy. The risks and expenses associated with two separate surgeries are decreased, hospitalization time is potentially reduced, and subsequent rehabilitation can be initiated in a more timely fashion.
Posted by afarahi at 12:46 AM | Comments (0)
Local Versus General Anesthesia for External Dacryocystorhinostomy in Young Patients.
Ophthalmic Plastic & Reconstructive Surgery, May, 2005
Conclusions: Local anesthesia in DCR is safe and comfortable when proper anatomical approach to nerve blocks is performed correctly. Local anesthesia in young patients undergoing external DCR is a good alternative because it is cost-effective and it eliminates the complications of general anesthesia.
Posted by afarahi at 12:42 AM | Comments (0)
Incidence of Infraorbital Hypesthesia and Sinusitis After Orbital Decompression for Thyroid-Related Orbitopathy: A Comparison of Surgical Techniques
Ophthalmic Plastic & Reconstructive Surgery, May, 2005
In this retrospective review of all orbital decompressions from January 1994 to January 2001 performed by one surgeon, transconjunctival orbital decompression results in a statistically significant decrease of early and late postoperative infraorbital hypesthesia and early postoperative sinusitis when compared with the transantral approach.
Posted by afarahi at 12:31 AM | Comments (0)
June 10, 2005
Dr. Donald M. Gass Dies
Ophthalmology Management May 2005
Dr. Gass was selected as one of the 10 most influential ophthalmologists of the 20th century by his peers and inducted into the American Society of Cataract and Refractive Surgery (ASCRS) Hall of Fame in 1999. His work combined his interest in pathology with new techniques for viewing the fundus with the fundus camera and fluorescein angiography.Dr. Gass was well known for his research on diseases of the retina, macula, and uvea, much of which was done at the University of Miami School of Medicine. In his later years, Dr. Gass continued to practice, and was a professor of ophthalmology at Miami and Vanderbilt University in Nashville.r. "He contributed much to ophthalmology because of his work, his outstanding teaching, and his clinical applications. Many of us have learned a great deal from him and are thankful for it,"
Posted by mehdi khanlari at 11:29 PM | Comments (0)
Cancer Drug Tried in AMD
Ophthalmology Management May 2005
The University of Miami's Bascom Palmer Eye Institute said early results from the Systemic Avastin for Neovascular Age-Related Macular Degeneration (SANA) study showed that the recently approved antiangiogenic cancer drug bevacizumab (Avastin) was able to substantially reduce the leakage from abnormal blood vessels in eyes of patients with wet AMD. Within 1 week, vision improvement occurred in patients treated with Avastin given through an intravenous infusionThe presentation highlighted the outcomes in the first nine patients treated with Avastin through 3 months. Overall, average vision improved in both eyes because most of the patients had wet AMD in both eyes. At the beginning of the study, one eye of each patient was designated as the "study eye" and the other eye as the "fellow eye." At 3 months, the average vision improved just over 2 lines in the "study eyes" (p=0.008) and just over 3 lines in the "fellow eyes" (p=0.001) as measured by the number of letters used on a standard eye chart. The improvement in vision correlated with a decrease in the leakage of fluid from the abnormal blood vessels in these eyes."A potential advantage of Avastin over other therapies for wet AMD is that vision improvement can occur within 1 week of treatment," "In addition to the improved vision, Avastin causes a reduction in leakage from the abnormal blood vessels, and we observed a restoration of normal macular anatomy."Avastin, which was developed by Genentech, was approved by the FDA last year for the treatment of colorectal cancer. Ranibizumab (Lucentis), a Genentech/Novartis drug that's closely related to Avastin and given intravitreally, is currently in clinical trials as a treatment for wet AMD.
Posted by mehdi khanlari at 11:24 PM | Comments (0)
B & L Implant Approved for Uveitis
Ophthalmology Management May 2005
The FDA has approved Bausch & Lomb's single-indication orphan drug fluocinolone acetonide intravitreal implant (Retisert) for the treatment of chronic noninfectious uveitis affecting the posterior segment of the eye.Retisert is the first intravitreal drug implant for the treatment of a condition that affects an estimated 175,000 people in the United States and approximately 800,000 people worldwide. The product received FDA Fast Track status and Orphan Drug designation for this indication. Bausch & Lomb's patented drug-delivery microtechnology in Retisert consists of a tiny drug reservoir designed to deliver sustained levels of the anti-inflammatory corticosteroid fluocinolone acetonide for approximately 30 months directly to the back of the eye.FDA approval of the drug was based on 34-week results from two 3-year, randomized, double-masked, multicenter clinical studies demonstrating that in eyes with Retisert there was:
► a significant decrease in the recurrence of uveitis from approximately 40% to 54% for the 34-week period pre-implantation to approximately 7% to 14% for the 34-week period post-implantation
► a significant decrease in the use of adjunctive therapy, including systemic corticosteroid and/or immunosuppressive therapy, from approximately 47% to 63% at the time of implantation to approximately 5% to 10% at 34 weeks post-implantation, and for patients needing periocular corticosteroid injections from approximately 50% to 65% for the 34-week period pre-implantation to approximately 3% to 6% for the 34-week period post-implantation
► statistically significant improvement of 3 or more lines of visual acuity in approximately 19% to 21% of study eyes at 34 weeks post-implantation.
The most common adverse events attributed to Retisert, which were anticipated given the nature of the disease and the type of drug used, include cataract progression, which is managed by standard cataract surgery; increased intraocular pressure, which is managed with the use of IOP-lowering eye drops or filtering surgery; and procedural complications and eye pain.
Posted by mehdi khanlari at 11:19 PM | Comments (0)
Treating Keratoconus With Intacs Corneal Ring Segments
JOURNAL OF REFRACTIVE SURGERY May/June 2005
In a nonrandomized prospective clinical trial, 50 eyes of 37 patients with mild to moderate keratoconus were implanted with asymmetrical pairs of Intacs segments. Patients were interviewed and observed preoperatively and 24 hours, 1 week, 1, 3, 6, and 12 months postoperatively. Main outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, satisfaction with vision and trouble with vision, Visual Function-7 score, and surgically induced change in corneal astigmatism.Of the 50 operations performed, 92% were successful. Mean follow-up was 6.3±3.2 months. In 4 (8%) eyes, both Intacs segments were removed. In addition, 7 refractive adjustments in 7 eyes were performed successfully to improve visual and surgical outcome. Both BSCVA and UCVA improved throughout follow-up. Visual functioning index improved from 61.6±21.1 to 80.8±22.5, and the percentage of satisfaction with vision improved from 24.3% to 87.5% at 12 months. Vector analysis of astigmatism correction showed that the mean change in corneal astigmatism was 2.9±2.9 D at 6 months postoperatively. By selecting patients in whom astigmatism correction was best (index of success >0.5), an analysis was performed to determine individual factors important in successful surgery. Preoperatively these 11 (22%) eyes did not differ significantly from the remaining eyes and the only significant value was low K readings in the flat axis.CONCLUSIONS Asymmetric Intacs placement improves BSCVA and UCVA and reduces astigmatism in patients with mild to moderate keratoconus. The procedure of Intacs placement is safe and effective. The change in astigmatism correction is unpredictable.
Posted by mehdi khanlari at 10:39 PM | Comments (0)
Broad application of mitomycin over flaps recommended
Eyeworld Jun 2005
No matter what type of flap you choose to use during trabeculectomy, apply mitomycin C broadly over it.“If you apply a small area of mitomycin, your more apt to develop a focal small cystic bleb, as opposed to if you use a very large area of application,” said Ike K. Ahmed, M.D.,Dr. Ahmed considers a 1-mm by 2-mm area of mitomycin application small.“The reason for that is to make a diffuse bleb as opposed to a focal larger area where you get a thin tissue that could cause a leak later,” “The problem is most surgeons apply it on a cellulose sponge and the rate of absorbance of the mitomycin varies from type of sponge to type of sponge,” “The amount of mitomycin you might deliver might be totally different than what I might deliver because of the sponge.”
Posted by mehdi khanlari at 09:45 PM | Comments (0)
The presence of Propionibacterium spp. in the vitreous fluid of uveitis patients with sarcoidosis
Acta Ophthalmologica Scandinavica Volume 83 Issue 3 Page 364 - June 2005
Purpose: An immunological reaction to a bacterial antigen, such as Mycobacterium tuberculosis or Propionibacterium spp., is suspected to be an initial mechanism in the disorder known as sarcoidosis. We investigated whether or not P. acnes, P. granulosum or M. tuberculosis are present in the vitreous fluid of eyes suffering from uveitis with sarcoidosis.
Methods: Using polymerase chain reaction, we analysed the presence of P. acnes, P. granulosum and/or M. tuberculosis DNA in vitreous samples taken from six eyes with sarcoidosis and six control eyes.
Results: Among the six uveitis eyes with sarcoidosis, we detected P. acnes DNA in two eyes, P. granulosum DNA in four eyes, and both P. acnes and P. granulosum DNA in one eye, but no Propionibacterium spp. in the control eyes. M. tuberculosis DNA was not present in any of the patient or control eyes.
Conclusions: This is the first report indicating the presence of Propionibacterium spp. and/or its DNA in the vitreous fluid of sarcoidic eyes with uveitis. This, therefore, supports the idea that Propionibacterium spp. are involved in the aetiology of uveitis in sarcoidosis.
Posted by mmiraftab at 09:11 PM | Comments (0)
Intraocular lens power prediction for triple procedures in Fuchs' dystrophy using multiple regression analysis
Acta Ophthalmologica Scandinavica Volume 83 Issue 3 Page 312 - June 2005
Purpose: To develop a correcting term for intraocular power (IOLP) prediction for penetrating keratoplasty combined with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure).
Methods: As part of a prospective clinical study, triple procedures were performed in 42 eyes with Fuchs' dystrophy. Only eyes with readable preoperative K-values were included in this study. Differences (DEV) between achieved and target refraction (TR) depending on the values of the theoretical-optical formula according to HAIGIS were investigated using multiple regression analysis in a linear anova model: DEV = a + b CP + c AL + d IOLP + e TR. CP represents central corneal power, AL represents axial length.
Results: Spherical equivalent after suture removal was 1.39 ± 2.86 D (TR: 1.64 ± 1.72 D). A multiple regression formula was developed for correction of conventionally calculated IOL power. CP (b = 1.391, p = 0.028), AL (c = 4.733, p = 0.007), IOLP (d = 1.301, p = 0.009) and TR (e = 1.804, p = 0.005) correlated significantly with DEV (a = 198.684).
Conclusion: Proposed correcting multiple regression formula for IOL power prediction may help to improve the postoperative refractive outcome in patients undergoing triple procedures.
Posted by mmiraftab at 09:05 PM | Comments (0)
The cut-and-paste method for primary pterygium surgery: longterm follow-up
Acta Ophthalmologica Scandinavica Volume 83 Issue 3 Page 298 - June 2005
Participants: The study included 461 eyes of 381 patients operated for primary nasal pterygium by the same surgeon between 1994 and 2003 and followed for 23 ± 20 months (range 6112 months).
Methods: Autologous conjunctival grafts harvested at the superotemporal limbus were used to cover the sclera after pterygium excision. Using a retrospective chart review, the outcome after attaching the transplant to the sclera with a fibrin tissue adhesive (n = 325) was compared to the outcome after graft attachment using absorbable sutures (n = 136).
Main outcome measures: Recurrence rate, reoperation rate and complications.
Results: The recurrence rate was 5.3% in the glue group and 13.5% in the suture group (p = 0.01). The reoperation rates were 1.2% and 3.3%, respectively (p = 0.31). Complications, such as transient transplant oedema and persistent corneal epithelial defects, occurred equally in both groups.
Conclusion: Using a fibrin tissue adhesive instead of sutures when attaching the conjunctival transplant in primary pterygium surgery results in a significantly lower recurrence rate.