Ophthalmology Review

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December 31, 2005

Encapsulated trabeculectomy blebs resolve in study

Ophthalmology Times Dec 1, 2005
Encapsulated trabeculectomy blebs, also called Tenon's capsule cysts, are complications of glaucoma filtering surgery that occur in a fair percentage of cases—from 8% to 28%," said Dr. Bazzaz, a resident in ophthalmology at the Cullen Eye Institute, department of ophthalmology, Baylor College of Medicine, Houston. "The IOP can be markedly elevated, causing further damage to ocular structures, and if left untreated, they can accelerate vision loss."
Several approaches have been used to manage encapsulated trabeculectomy blebs, Dr. Bazzaz recounted. Surgical management involving needling and direct injection of 5-fluorouracil are equally effective techniques, with success rates that range from 73% to 91%. However, these approaches carry the risks of hypotony, conjunctival leakage, and infection. Other management approaches include ocular massage, adjustment of topical steroids, and medical management, specifically, the use of beta-blockers and prostaglandin analogues as first-line agents.
In a retrospective case study, Dr. Bazzaz and colleagues sought to determine the comparative efficacies of medical management with prostaglandin analogues and beta-blockers for lowering the IOP and promoting regression of encapsulated filtering blebs after trabeculectomy in eyes with uncomplicated glaucoma.
The investigators reviewed the charts of 487 patients who underwent trabeculectomy by three surgeons.All procedures had been performed at the Cullen Eye Institute from April 1998 to October 2003 or at the Hermann Eye Center from January 1996 to March 2003. All patients had at least 2 months follow-up time when reviewed, Dr. Bazzaz explained.
Encapsulation developed in 39 (8%) of 487 eyes and identification of bleb encapsulation occurred at a mean follow-up time of 4.2 ± 2.5 weeks," Dr. Bazzaz reported. "The mean IOP levels before, during, and after the encapsulated bleb phase were 16.3 ± 7.5, 23 ± 6.7, and 16.9 ± 6.5 mm Hg, respectively.
Encapsulation resolved with medical management in 29 eyes (74.4%), of which 28.2% were treated with prednisolone acetate ophthalmic suspension [Pred Forte, Allergan] taper and multi-drug therapy; and 23.1% were treated with predniso-lone acetate ophthalmic suspension taper alone," Dr. Bazzaz continued. "Patient age and gender were not significantly related to the occurrence of encapsulated bleb formation
In the remainder of the eyes, the blebs resolved with revision and repeat trabeculectomy in one patient (2.6%) and remained unresolved in two patients (5.1%). Three patients (3.7%) had bleb recurrences. Four patients (10.3%) were lost to follow-up.
Filtering bleb encapsulation after trabeculectomy responds well to tapering topical corticosteroids alone or in conjunction with IOP-lowering agents. The effect of lowering IOP through steroid withdrawal appears beneficial over maintaining steroid use to prevent inflammation," the authors concluded.

Posted by aman at 01:30 AM | Comments (0)

Favorable outcomes persist with pediatric ICL

Ophthalmology Times Dec 1, 2005
With lengthening follow-up, the posterior chamber implantable collamer lens (ICL) (STAAR Surgical) continues to be associated with encouraging results in the management of refractive amblyopia in children who have not had a response to conventional therapy with contact lenses or spectacles, said Laurence C. Lesueur, MD.
Dr. Lesueur and Jean L. Arne, MD, with the department of ophthalmology, Purpan Hospital, University of Toulouse, France, began implanting this phakic IOL model in June 1997 in children with amblyopia associated with high myopia. Through June 2003, they have treated 18 children ages 3 to 16 years (mean, 9 years) with myopia ranging from –8 to –18 D (mean spherical equivalent [SE], –12.5 D). Initial results were published in 1999, a follow-up report was made in 2002, and the current analysis was based on data collected over 7.5 years (minimum, 22 months; mean, 55 months).
At last follow-up, mean cycloplegic SE was +0.05 D (range, –2.5 to +2.5 D), and mean uncorrected visual acuity (UCVA) was 20/100 (range, 20/200 to 20/50). Mean best-corrected visual acuity (BCVA) for the series had improved from 20/200 (range, 20/400 to 20/63) before surgery to 20/80 (20/200 to 20/32), with only a single eye losing more than 1 line, after a traumatic retinal detachment. One other eye had unchanged BCVA while the rest benefited with improved BCVA.
"More than half of the eyes had a gain of 2 or more lines, although the best results were seen in cases of low-level preoperative amblyopia without strabismus," Dr. Lesueur noted.
Within the series, nine children had strabismus prior to ICL implantation. Four of those children underwent strabismus surgery to reduce irreversible high-angle deviation (> 40 D) at 6 months after ICL implantation. Ten children recovered orthotropic position, and while only two (12%) children had binocular vision preoperatively, binocular vision was present in seven children (41%) after surgery.
Dr. Lesueur noted that in 1995, ophthalmologists started to perform refractive surgery using PRK or LASIK to reduce anisometropia in selected pediatric patients. However, compared with excimer laser ablation, phakic IOL implantation has benefits that include reversibility, better safety for correction of higher refractive errors, and avoiding the need for patient cooperation intraoperatively.
The ICL implantation is performed using general anesthesia with lens delivery through a temporal incision using two forceps. A surgical iridectomy is also performed in all eyes after the implantation, and postoperative care includes use of steroids and antibiotic drops. Amblyopia therapy is started at 8 days after surgery.

Posted by aman at 01:01 AM | Comments (0)

Obesity linked to four eye diseases

OSN BREAKING NEWS
A strong correlation between obesity and four major eye diseases has been found, according to Israeli researchers. After conducting a literature review, Michael Belkin and Zohar Habot-Wilner consistently found obesity linked to age-related macular degeneration, cataracts, glaucoma and diabetic retinopathy. They reported their findings in Refuah, an Israeli medical journal.

The researchers reviewed 20 studies comprising thousands of patients worldwide, they said, to determine the implications of obesity on eyesight. Where body mass indexes were significantly high (in the range of clinical obesity), the authors found both an increased risk factor for eye diseases and an increased progression of those diseases.

Posted by aman at 12:56 AM | Comments (0)

Ocular toxocariasis may cause uveitis

OSN BREAKING NEWS
Ocular toxocariasis may lead to uveitis in younger patients, according to a study. The authors note the inflammation is typically unilateral and tends to present in one of two ways.

Jay M. Stewart, MD, and colleagues at the University of California at San Francisco reviewed the charts of 22 patients with ocular toxocariasis who were diagnosed between 1977 and 1996. The toxocariasis occurred in 1% of the 2,185 uveitis patients seen during the same period. The mean patient age was 16.5 years, and inflammation was overwhelmingly unilateral, occurring in 90.9%.

Toxocara uveitis presented as a granuloma in the peripheral retina in 50% of the cases, as a granuloma in the macula in 25% of the cases and as a moderate-to-severe vitreous inflammation that mimicked endophthalmitis in the remaining 25%. Vitritis accounted for 52.6% of the vision loss, followed by cystoid macular edema (47.4%) and traction retinal detachment (36.8%).

Posted by aman at 12:52 AM | Comments (0)

December 30, 2005

Higher-order Aberrations in Children

American Journal of Ophthalmology Volume 141, Issue 1 , January 2006, Pages 67-70

setting: Clinical practice. patients: One hundred sixty-two eyes of 82 children were examined. The mean age of the children was 6.7 years (range, 4 to 14 years), and the mean manifest refractive spherical equivalent was 2.39 ± 3.35 diopters (range, −8.98 to +8.45 diopters). Aberrometry was performed with a wavefront analyzer (after cycloplegia and mydriasis with cyclopentolate 1%). Aberrometry was also conducted on a subgroup of 52 eyes of 27 children, both before and 30 minutes after the instillation of cyclopentolate 1% to investigate the effect of paralysis of accommodation.
Results
Mean root mean square values of total-, third-, fourth-, and fifth-order aberrations were 0.37 ± 0.13 μm, 0.23 ± 0.12 μm, 0.16 ± 0.11 μm, and 0.08 ± 0.12 μm, respectively. Mean root mean square values of total coma (Z3−1, Z31, Z5−1, Z51) and total trefoil (Z3−3, Z33, Z5−3, Z53) were 0.27 ± 0.31 μm and 0.21 ± 0.29 μm, respectively. Myopes had statistically significant greater levels of total (P = .005) and fourth order (P = .002) aberrations and Zernicke terms (Z3−3, Z3−1, Z33, Z4−4, and Z42) compared with hyperopes. Cycloplegia had minimal influence on higher-order aberrations.
Conclusion
Significant levels of higher-order aberrations were found in these children. They were influenced by refractive error, because myopes had significantly greater levels compared with hyperopes. Paralysis of accommodation with cyclopentolate appeared to have little effect on higher-order aberrations.

Posted by mmiraftab at 06:20 PM | Comments (0)

STAAR Surgical's Visian ICL Receives FDA Approval

CRST,Dec 29,2005

STAAR Surgical Company (Monrovia, CA) announced the FDA approval of its Myopic Visian Implantable Collamer Lens (ICL), which is indicated for the correction of myopia in adults. The lens is composed of a proprietary biocompatible material, and is the first foldable lens of its kind to be introduced in the US market. The lens' design allows for a minimally invasive procedure, as the ICL may be implanted through "an incision up to 50% smaller than competing technology, and its placement in the eye behind the iris provides a more aesthetically pleasing outcome," according to a STAAR press release. Additionally, the Visian ICL has been cleared for sale in 41 other countries and more than 40,000 successful implantations have been performed worldwide to date.
The indications of the approved models include: (1) correction in adults within the myopic range of -3.00D to less than or equal to -15.00D with astigmatism less than or equal to 2.50D; and (2) reduction of myopia in patients 21 to 45 years of age with myopia ranging from greater than -15.00 to -20.00D with astigmatism less than or equal to 2.50D, who have an anterior chamber depth 3mm or greater and have had a stable refractive history for at least 1 year prior to implantation.

Posted by afarahi at 01:50 PM | Comments (0)

December 27, 2005

The IOL master

OSN OPHTHALMIC HYPERGUIDE
Warren E. Hill, MD, FACS
By optical coherence biometry (OCB), axial length measurements with the IOLMaster are the equivalent of upright, ultra-high-resolution immersion A-scan ultrasonography, approximately five times more accurate than standard applanation A-scan ultrasonography. The physics of OCB are discussed and several special applications of this device reviewed. Intraocular lens constants for OCB are typically higher than applanation A-scan ultrasonography but are very close to those for immersion A-scan ultrasonography. Because the IOLMaster is an optical device, measurements may not be possible in the presence of significant axial opacities, such as a central corneal scar, mature cataract, vitreous hemorrhage, or dense PSC plaque.
It has been well reported that the most common reason for incorrect IOL power calculations is an error in the measurement of axial length. Until recently, 10-MHz A-scan ultrasonography was the measurement technique most commonly available and limited the resolution of the exercise to approximately 0.10 mm. This translates to about ±0.25 diopters under optimal conditions, as when axial length is measured using an immersion technique.1 However, the accuracy of A-scan ultrasonography is less when carried out by the applanation technique, which produces a falsely short axial length and sometimes widely variable results due to varying degrees of corneal compression. The ideal axial length measurement technique should be one that can be carried out in an upright position, without corneal contact or compression, and with a level of accuracy high enough for outcomes consistently within 0.25 diopter of the target refraction.
The Zeiss IOLMaster was approved for use in Europe in 1999 and in the United States in 2000.During testing, the patient is seated upright and there is no corneal contact. Because optical coherence biometry (OCB) uses an infrared light source rather than a 10- MHzsound beam, measurement accuracy is increased from 0.10 mm to between 0.02 mm and 0.01 mm, an improvement of approximately five times.
OCB: The Technologic Basis
The use of OCB to measure the axial length of the human eye was first reported in 1986.The IOLMaster uses a modified Michelson interferometer to measure axial length with unprecedented accuracy. Interestingly, the use of OCB in ophthalmology is based on optical principles laid down more than 100 years ago by the German-American physicist Albert Michelson (1852-1931). Dr. Michelson’s original work in interferometry was so important that in 1907 he received the Nobel Prize in physics.
The Michelson interferometer portion of the IOLMaster is used to create a pair of coaxial 780-nm infrared light beams with a coherence length of approximately 130 nm. Unlike the classic Michelson interferometer, for which the eye would have to be kept perfectly still, the use of a dual coaxial beam allows the IOLMaster to be insensitive to longitudinal movements and makes axial length measurements mostly distance-independent.
IOLMaster vs. Ultrasound
Because OCB measures from the corneal vertex to the retinal pigment epithelium, and A-scan ultrasound measures from the corneal vertex to the vitreoretinal interface, some method of calibration is necessary to avoid a measurement error of 0.20 mm, or the approximate thickness of the retina at the center of the macula.
At the Eye Clinic at the University of Würzburg, Haigis and others calibrated axial length readings from the IOLMaster against immersion technique measurements with the exquisitely accurate Grieshaber Biometric System (GBS). The GBS is an ultra-high-resolution ultrasound biometer that employs four 40-Mhz counters and is capable of an astonishing accuracy of 20 µm.
Based on a comparison of the measurements obtained with the GBS, an internal algorithm for the IOLMaster was developed such that the axial length displayed by the IOLMaster mirrors that of the GBS. In essence, the IOLMaster is the equivalent of an upright, noncontact, ultrahigh-resolution immersion A-scan, consistently accurate to within 0.01 mm.
Limitations
Because the IOLMaster is an optical device, any significant axial opacity has the potential to be a problem. Clinical situations such as a mature or darkly brunescent lens, central posterior subcapsular plaques, anterior cortical spokes, corneal scars that pass through the visual axis, and vitreous hemorrhages may interfere with the partially coherent light beams and decrease the SNR to the point that may preclude a meaningful measurement. On the other hand, very difficult immersion ultrasonography measurements, such as eyes with posterior staphylomata or eyes in which the vitreous cavity has been temporarily filled with silicone oil, are almost routine with the IOLMaster. In the typical North American ophthalmology practice, approximately 90% of patients can be measured successfully using the IOLMaster. The remaining 10% of patients must be measured by A-scan ultrasonography for the reasons outlined above.
Other Features
The IOLMaster is pretty much an "all-in-one" IOL power calculation device. Not only will it do axial length measurements with great precision, but it will also measure the central corneal power by automated keratometry. The instrument takes five keratometry measurements within 0.5 seconds and averages them. The latest software revision (version 3.01) has an improved keratometry algorithm and will alert the operator if a keratometry measurement is questionable. Some operators have found that central corneal power measurements with the automated keratometry feature of the IOLMaster may run anywhere from 0.25 D to 0.50 D steeper than with manual keratometry.
The IOLMaster will also measure the anterior chamber depth (the distance between the optical section of the cornea and the anterior surface of the crystalline lens) using a lateral slit illumination at approximately 30 degrees to the optical axis. This measurement is helpful for IOL power calculation formulas, such as Haigis and Holladay 2, which require a measured anterior chamber depth.
Included in the standard IOLMaster software package are five popular IOL power calculation formulas (Holladay, SRK/T, Haigis, SRK II, and Hoffer Q). IOL power calculations can be carried for four IOLs at a time and to a precision of either 0.50 or 0.25 diopters. The IOLMaster software will accommodate as many as 20 surgeons, each with up to 20 preferred IOLs and corresponding personalized lens constants.
New IOL Constants
IOL constants for the IOLMaster will be closer to those normally seen for the immersion technique and are typically higher than what would normally be used for the applanation technique, which is based on a falsely short axial length due to corneal compression. In making the transition from applanation IOL constants to IOLMaster IOL constants, a good place to begin would be to increase already optimized applanation IOL constants by 0.50 for the SRK/T formula and by 0.29 for the Holladay and Hoffer Q formulas. Failure to make this initial adjustment may result in approximately 0.50 diopters of initial postoperative hyperopia. The IOLMaster software comes with an IOL constant optimization feature that can subsequently be used to refine postoperative outcomes. Some lenses, like the Alcon SA60AT, show very little difference when compared to immersion A-scan ultrasonography, while others, like the Bausch & Lomb U940A, show a larger difference.
To determine the best initial IOLMaster constant, Dr. Wolfgang Haigis at the University of Würzburg has recommended the following approach for calculating the initial IOLMaster SRK/T A-constant:
AIOLMaster = AUltrasound + 3 x (ALIOLMaster - ALUltrasound)
AIOLMaster = Optimized A-constant for IOLMaster
AUltrasound = Optimized A-constant for ultrasonography
ALIOLMaster = Average IOLMaster axial length
ALUltrasound = Average ultrasound axial length

Posted by aman at 12:39 AM | Comments (0)

Secondry piggyback IOL implant

OSN OPHTHALMIC HYPERGUIDE
Johnny L. Gayton, MD
In 1993, my colleagues and I first described the implantation of two intraocular lenses (IOLs) in the eye, piggybacking, to provide adequate power in a case of microphthalmos.1 Since then, piggybacking IOLs has become an acceptable method for addressing the power requirements of high hyperopes.
Piggybacking IOLs can also be used to correct pseudophakic refractive errors.6 Rather than subject a patient to the trauma of an IOL exchange, which increases the risk of retinal tears, cystoid macular edema, cyclodialysis, and posterior or anterior capsule rupture, a second IOL can be implanted anteriorly to the primary IOL. The power of a secondary piggyback IOL implant is also more predictable than an IOL exchange for three reasons. First, the surgeon can never be certain of the power of the original IOL. Second, the surgeon cannot be confident that an exchanged IOL would be placed in the same plane as the old IOL. Third, the power of the secondary implant is calculated purely by the patient's refraction.
Not only can pseudophakic patients with residual refractive error benefit from piggyback IOL implant strategy, but also, pseudophakic patients who subsequently undergo penetrating keratoplasty (PK) can have the often disabling refractive error created by PK and corrected with a secondary piggybacked implant.
have personally piggybacked silicone, PMMA, and acrylic IOLs. Although I have also used silicone, PMMA, and acrylic as the secondary IOL, my preferred IOL is the STAAR AQ5010V 3-piece silicone lens (STAAR Surgical, Monrovia, Calif.), which is available from -4 D to 4 D in 1 D increments. The STAAR Model AQ2010V is used for powers greater than 4 D. I also use the AcrySof MA50BM (Alcon Surgical, Ft. Worth, Texas) in cases requiring greater than 5 D of power. The AcrySof offers the advantage of a thinner, 6.5-mm optic. However, it appears that any lens type can be secondarily piggybacked over any other type of IOL.
The piggyback procedure can theoretically be more predictable than an IOL exchange. The accuracy of the power calculation for an exchange can be affected if the original IOL had been unknowingly mislabeled, or if the new IOL ends up at a different plane than the original. The power calculation for a second implant depends only on the postoperative refraction.
Clinical Experience
We have studied a consecutive series of 39 secondary piggyback IOL implant cases, including nine pseudophakic PK patients. Power calculation for the second IOL was based on the refraction. For moderate to high hyperopia, we added a second plus power IOL. For high myopia, we added a minus power IOL. For underpowered pseudophakic PK patients, we estimated the required power by multiplying the desired change in spherical equivalent by 1.5. For overpowered pseudophakic patients, we used the desired spherical equivalent change. For example, a patient who is pseudophakic by 3 D with a targeted spherical equivalent of -1 D would have been implanted with a 6 D IOL ([3 - (-1)] x 1.5 = 6 D). A patient with -3.5 D of pseudophakia with a target of -0.5 D would have been implanted with a -3 D IOL. All patients were targeted for a range of refraction between -2 D and 0.5 D. Calculations were verified using the Holladay IOL Consultant software.
Complications
Interlenticular opacity (ILO) has recently emerged as a late postoperative complication of piggyback IOL implantation. ILO refers to any visible intercellular growth between the lenses, which can present as a slight opacity, Elschnig pearls, or, in its severe form, a thick membrane. An ILO has been associated primarily with primary piggybacked acrylic lenses, although it has been seen in piggyback cases of PMMA and silicone lenses.
The complication has not been associated with secondary piggybacks, most likely because the secondary piggyback lens is normally implanted in the sulcus, avoiding the lens interface which attracts the growth. However, we have seen one case of ILO in a secondary piggyback.8 In that case, the second lens was successfully implanted in the bag, with the capsulorrhexis on the anterior optic at 360°. At the time, we believed that a bag implantation would be more desirable.
Seven months after the secondary piggyback was implanted, cellular growth between the lenses, or ILO, was noted. There was a hyperopic shift, resulting in a refraction of -0.50 sphere, with best-corrected visual acuity of 20/30.
One year after the ILO was noted, the patient underwent an Nd:YAG laser procedure. The Nd:YAG laser was focused on the interlenticular space in the area of cellular growth, using less than 2 mJ of energy. The area of opacification liquefied and moved inferiorly.
Pupillary Capture We have experienced two cases of pupillary capture in secondary piggybacks.11 A pupillary capture in a secondary piggyback is more likely than in a primary piggyback because the zonular lens complex has fibrosed and is not easily moved posteriorly with implantation of a secondary piggyback lens. As a result of the lens residing more anteriorly, when the pupil is dilated, it is easy for the iris to capture the lens optic. This event is more likely to occur with a silicone secondary piggyback because the index of refraction is smaller and the lens is thicker. It would also stand to reason that a myopic lens would be more likely to introduce resulting capture than the traditional lens due to the shape of the myopic lens with its thicker edge.
Optic capture cannot be avoided simply by placing the secondary lens in the capsule. In most cases, a bag implantation of a secondary piggyback lens cannot be easily performed even the day after surgery, and even if it could, would significantly increase the risk of ILO.8 It can be lessened, if not avoided, simply by using a miotic such as Pilopine gel, intraoperative Miochol (acetylcholine chloride, Iolab), and pilocarpine drops in the immediate postoperative period and not dilating these patients until 2 months or more postoperatively.
Optic capture is a newly reported finding. It is managed by using a topical anesthesia at the slit lamp and then using a 30-gauge needle inserted in a self-sealing fashion into the anterior chamber. The optic is pressed back into the ciliary sulcus and pilocarpine is instilled. After the optic is depressed back into the posterior chamber, the patient is placed on pilocarpine for 1 day and told not to have the eye dilated unless absolutely necessary for several months.

Posted by aman at 12:19 AM | Comments (0)

December 26, 2005

Vertical Rectus Muscle Transposition for Bilateral Duane Syndrome

Journal of AAPOS,Oct,2005
Augmented transposition of the superior and inferior rectus muscles to the lateral rectus muscle is effective surgical treatment for esotropia in unilateral Duane syndrome. Medial rectus muscle recession in bilateral Duane syndrome may increase the risk of consecutive exotropia and cause limitation to adduction postoperatively. Vertical rectus muscle transposition may be useful in bilateral Duane syndrome with esotropia.We undertook a retrospective review of 11 patients with bilateral Duane syndrome and esotropia in primary position. All patients had vertical rectus muscle transpositions. The preoperative esotropia at distance was 22.8 ± 6.3 prism diopters (PD). It reduced to 2.0 ± 6.7 PD postoperatively. (P < 0.001) Esotropia at near changed from 21.0 ± 5.8 PD preoperatively to 1.2 ± 8.1 PD postoperatively. (P < 0.001) Conclusion: Vertical rectus muscle transposition in patients with bilateral Duane syndrome and esotropia is an effective procedure to improve ocular alignment and motility while preserving adduction.

Posted by afarahi at 11:42 PM | Comments (0)

Effect of hinge location on corneal sensation and dry eye after laser in situ keratomileusis for myopia

JCRS,Oct,2005
This prospective randomized masked study included 47 patients having bilateral myopic LASIK surgery. The first eye was randomly assigned to have a nasal or superior hinge flap; the fellow eye had the alternate location. Dry eye occurred with the same frequency in both groups. However, eyes with the nasal hinge had significantly better nasal sensation than those with the superior hinge (P<.05) at 1 month.
Conclusion:Better nasal corneal sensation was found at 1 month in the nasal hinge group but there was no difference in any other parameters measured.

Posted by afarahi at 11:12 PM | Comments (0)

December 25, 2005

Long-Term Results of Macular RPE Translocation Surgery in AMD “Disappointing”

A five- to six-year follow-up of four of nine patients with age-related macular degeneration who originally underwent macular retinal pigment epithelium (RPE) translocation surgery for choroidal neovascularization has revealed a further decline in visual acuity and loss of foveal fixation —problems that occurred after the original two-year follow-up results were published.

MacLaren et al. also observed late changes in autofluorescence, increasing over the graft donor site and virtually disappearing over the graft itself. Yet the RPE graft seemed viable when assessed by optical coherence tomography, fluorescein angiography and indocyanine green angiography, and no patient suffered a recurrence of CNV.

The authors conclude that while the long-term results of this pilot study were “disappointing,” a detailed analysis of the events occurring after the initial surgery could provide key insight into the mechanisms of AMD and how RPE grafting could be optimized to achieve future success.

Posted by mriazi at 10:54 PM | Comments (0)

Photodynamic Therapy for Acute Central Serous Chorioretinopathy Associated With Improved Vision

A small case series by Ober et al. has demonstrated that photodynamic therapy with verteporfin in patients with focal fluorescein leaks secondary to central serous chorioretinopathy (CSCR) can cause prompt resolution of leakage from CSCR, which in turn can be associated with rapidly improved vision.

The series involved nine eyes of nine symptomatic patients with acute focal retinal pigment epithelial leaks secondary to CSCR. These individuals were treated with PDT, with BCVA recorded at presentation and follow-up visits. The investigators found that neurosensory detachment and fluorescein leakage resolved in all patients within one month. At six months, mean visual acuity improved from 20/80 to 20/40. Additionally, no patient lost vision or experienced any treatment-related complications.

The authors say that the results warrant further investigation to better understand the risks and benefits of this therapy for individuals with CSCR.

Posted by mriazi at 10:44 PM | Comments (0)

Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography

IOVS current issue
Sixty-six eyes with PCO and 20 eyes with a normal posterior capsule were analyzed. A 3-mm-long horizontal scan of the posterior capsule was obtained. Measurements at three points and their average were recorded. Intraoperator and interoperator reliabilities were assessed. Investigated was peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes, with an approximate axial resolution of 10 µm. Results were compared with visual acuity (VA) and PCO type.
RESULTS. Intraoperator reliability was 0.59 and 0.97 for average PI and PCT, respectively. The interoperator concordance correlation coefficient was 0.70 and 0.82 for average PI and PCT, respectively. Median (interquartile range) intensities of the reflectivity spike were 16.88 (dB) (range, 12.88–20.41) and 11.9 (8.58–14.28), respectively, in the PCO and control eyes (P = 0.001). PCT was found in PCO eyes (median: 86.13 µm; range, 46.33–115.33), whereas no second spike appeared in control eyes (P = 0.001). The area under the receiver operating characteristic curve of the average PCT for differentiating pearl-type from fibrosis-type PCO was 0.87 (P = 0.001). For a cutoff point of 55.3 µm, the sensitivity was 97.5%, and the specificity was 69%. Worse VA correlated significantly only with larger PCT (ro= 0.66; P = 0.01).
CONCLUSIONS. OCT-1 appears useful to quantitate PCO. In addition, this system seems to discriminate between different types of PCO. PCT may be a previously unrecognized factor in VA degradation.

Posted by aman at 01:41 AM | Comments (0)

Tetracaine for Post-PRK Patients

CRS TOday Current Issue
By Richard Maw, MD
I have used topical Tetracaine to control pain after PRK in all of my patients during the last 2 years. In that time, I have treated 541 eyes of 293 patients without any serious complications. One of my patients experienced delayed epithelialization in both eyes (see sidebar, Case of Delayed Wound Healing, on page 86), but he sustained no visual loss and eventually recovered fully. All of the other eyes I have treated have achieved complete epithelialization within 1 week of surgery.
My postoperative regimen for PRK is as follows. Immediately after surgery, I instill a fluoroquinolone antibiotic in the patient’s surgical eye and place a bandage contact lens (Bausch & Lomb, Rochester, NY). Next, I instruct patients that they may use Tetracaine q.i.d. for the first 4 days postoperatively to help control their eye pain. Because I supply them with a single, 2-mL bottle, patients who use the medication too often will run out of it before they injure themselves. I also tell patients that they may use a topical NSAID q.i.d. for the first 4 days after surgery to help control their eye pain.
CONCLUSION
Without topical anesthetics, only a minority of PRK patients’ pain is well controlled on topical NSAIDs and/or oral pain medication. In contrast, an overwhelming majority of my PRK patients have reported that topical Tetracaine effectively controlled their pain. Many have said to me that, in retrospect, they would be genuinely fearful of undergoing PRK without having Tetracaine as an option to control their pain postoperatively.

Posted by aman at 01:20 AM | Comments (0)

Artificial vision device implanted; clinical testing to start in January

OSN BREAKING NEWS
A retinal implant designed to provide artificial vision for patients with incurable vision loss has been implanted in two humans, according to the makers of the device. Clinical testing of the 50-electrode Learning Retinal Implant in these two patients will begin next month, said Intelligent Medical Implants in a press release.
The company said that in a previous European multisite study of a one-electrode version of the device in 20 people classified as totally blind, 19 were able to see a small point of light after implantation.
The implant replaces the signal-processing functions of a healthy retina and provides input to the retinal nerve cells that provide input to the optic nerve and brain, according to Intelligent Medical Implants. The system consists of three parts: the implant, a pair of spectacles for the user and a device worn at the patient’s waist to replace the information-processing function of the retina.
The company said a 231-electrode version of the implant is on schedule to begin pivotal clinical testing in 2006.

Posted by aman at 01:14 AM | Comments (0)

LASEK leads to greater forward shift of posterior cornea than LASIK, study finds

OSN BREAKING NEWS
LASEK resulted in a greater forward shift of the posterior corneal surface than LASIK, a study using corneal mapping found. The posterior surface gradually shifted back toward its original position over time but never returned to its preoperative position, the study authors said.
Hyojin Kim and colleagues at The Catholic University of Korea studied 22 eyes of 14 patients who underwent LASIK and 19 eyes of 10 patients who underwent LASEK to compare the degree of forward shift of the posterior corneal surface as a function of time after surgery. Uncorrected visual acuity, spherical equivalent and pachymetry were obtained before and 1 or 2 weeks and 2, 6, 12 and 24 months after surgery. Corneal elevation was assessed using the Bausch & Lomb Orbscan II.
At 1 or 2 weeks postop, the posterior corneal surface had shifted forward by 18 µm in eyes that underwent LASIK. At the same time point, the posterior corneal surface had shifted forward by 25.9 µm in eyes that underwent LASEK. The mean posterior corneal shift was reduced by 3.05 µm in the LASIK group and by 12.4 µm in the LASEK group at 2 years postop. In neither group did the forward shift return to the elevation observed before surgery.

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

December 24, 2005

AlphaRx initiates animal study for cataract prevention, treatment eye drops

INDUSTRY NEWS
The company reports that it will begin investigating Acusolin using an established cataract animal model to determine its ability to prevent and treat cataracts. AlphaRx hopes to begin clinical studies by the end of 2006 and is seeking financial resources to support clinical development, either by out-licensing or a co-development arrangement.

Posted by kjalali at 09:29 PM | Comments (0)

Complications of 25-Gauge Pars Plana Vitrectomy

Annual Meeting of the AAO, October 17, 2005
To describe experience using 25-gauge vitrectomy. Surgeons treated 250 eyes for several vitreoretinal diseases and studied intraoperative and postoperative complications. Follow-up ranged from six months to three years. Seventeen sclerotomies were sutured by the end of the procedure. The day after surgery, IOP was <10 mm Hg in 27%. Two cases with hypotony required a second operation. One persistent bleb was sutured four weeks later. They had three postoperative detachments and two endophthalmitis cases. In conclusion, hypotony due to leaking sclerotomies is a complication of this new type of vitrectomy and rate of postoperative endophthalmitis was higher than in 20-gauge vitrectomies.

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

Passive smoking almost doubles risk of developing AMD

British Journal of Ophthalmology, January 2006
Researchers studied 435 people with end-stage AMD and 280 people who lived with them. They find that non-smokers who lived with smokers for five years or more had nearly double the risk of developing AMD. The study also finds that people who regularly smoked a pack of cigarettes or more a day for 40 years had nearly triple the risk of developing AMD compared with non-smokers. Smoking increased the risk of both geographic atrophy and choroidal neovascularisation. Giving up smoking for 20 years or more cut the risk to levels comparable with those for non-smokers.

Posted by kjalali at 09:19 PM | Comments (0)

December 23, 2005

Flap tearing during lift-flap laser in situ keratomileusis retreatment

JCRS Pages 2016-2018 (October 2005)
51 of 57
A flap tear occurred during laser in situ keratomileusis (LASIK) retreatment using a flap-lifting technique in 1 eye of 2 patients 4 to 5 months after the primary procedure. In the first case, the tear occurred in a decentered, standard thickness flap (168 μm) in a location close to the corneal limbus and limbal vessels. In the second case, the tear occurred in a well-centered thin flap (116 μm) that involved a peripheral corneal pannus. The false track was identified early, and central extension of the tear was averted. After the flap was successfully dissected, retreatment was performed without further complications. This report suggests that flaps with margins near the limbus or a corneal pannus may be prone to an earlier and stronger healing process at the edge that may lead to a flap tear during LASIK retreatment. This may be of increasing importance because of the trend toward larger flap diameters.

Posted by alireza habibollahi at 08:45 PM | Comments (0)

Nocardia keratitis after laser in situ keratomileusis

JCRS Pages 2012-2015 (October 2005)
A case of Nocardia asteroides keratitis occurring 3 weeks after LASIK in a nontraumatized eye is reported. The patient presented with decreased vision, inflammation, and stromal melting of the LASIK flap, discrete infiltrates, and an anterior chamber cellular reaction. Cultures for acid-fast bacteria grew Nocardia asteroides after 5 days. Infection progressed despite treatment with topical antibiotics and eventually required penetrating keratoplasty (PKP). Postoperatively, the patient was placed on moxifloxacin, a fourth-generation flouroquinolone. The patient experienced a recurrence of Nocardia keratitis at the graft–host interface 2 months after the PKP. This eventually resolved with a combination of topical moxifloxacin and imipenem therapy.

Posted by alireza habibollahi at 08:40 PM | Comments (0)

Severe corneal epithelial sloughing during laser in situ keratomileusis as a presenting sign for silent epithelial basement membrane dystrophy

JCRS Pages 1932-1937 (October 2005)
Alicante, Spain.To report the occurrence of large intraoperative epithelial sloughing during LASIK as a first diagnostic sign for silent epithelial basement membrane dystrophy (EBMD).
In this retrospective case series, the medical records of all patients with large corneal epithelial sloughing/defects during LASIK from January 1995 to December 2004 were reviewed. All patients who presented normal corneas before LASIK and EBMD changes after LASIK were included in this study. The surgical procedures and postoperative course were recorded. The follow-up period was 12 months for all patients.
Results
Eleven eyes of 6 patients were included. The mean age was 35 years ± 6.1 (SD). Mean preoperative uncorrected visual acuity (UCVA) was 20/500 (0.04 ± 0.02); 12 months after surgery, mean UCVA increased to 20/27 (0.74 ± 0.21). Postoperatively, clinical manifestations of EBMD were observed in all eyes and complications were common. In the early postoperative period, diffuse lamellar keratitis was observed in 6 of 11 eyes (54.5%) and flap microfolds were noted in 2 of 11 (18.2%). One year after surgery, epithelial ingrowth was present in 8 of 11 eyes (72.7%) and flap melting was noted in 4 of 11 (36.4%).
Conclusion
Occurrence of large intraoperative epithelium sloughing/defects during LASIK might be a diagnostic sign for subclinical EBMD. These patients are predisposed to multiple postoperative complications. Because of the high risk for epithelial sloughing in the second eye, LASIK should not be performed

Posted by alireza habibollahi at 08:34 PM | Comments (0)

Effect of cytochrome c peroxidase on corneal epithelial healing process after photorefractive keratectomy

JCRS Pages 1928-1931 (October 2005)
36 of 57
Italy.To evaluate the role of commercially prepared cytochrome c peroxidase eyedrops in corneal epithelial healing after photorefractive keratectomy (PRK).
Seventy-two eyes of 36 patients affected by low to moderate refractive error (myopia and myopic astigmatism) had uneventful bilateral PRK. In each patient, 1 eye (32 eyes) received standard postoperative therapy plus cytochrome c peroxidase eyedrops (3 times a day for 1 week or until corneal reepithelialization was completed, corresponding to 15 000). The fellow eye served as the control and received standard postoperative therapy plus placebo. Conclusions
cytochrome c peroxidase significantly accelerates epithelial healing after PRK,No side effects or toxic effects were documented. Further clinical study should be performed to prove the results obtained in this pilot study and the long-term efficacy of cytochrome c peroxidase to prevent corneal haze.

Posted by alireza habibollahi at 08:27 PM | Comments (0)

Simultaneous laser in situ keratomileusis on the stromal bed and undersurface of the flap in eyes with high myopia and thin corneas

JCRS Pages 1921-1927 (October 2005)

Seoul, Korea.To evaluate simultaneous LASIK on the stromal bed and the undersurface of the flap in eyes with high myopia and insufficient corneal thickness for conventional LASIK ablation.
Using intraoperative pachymetry, the residual stromal bed thickness was evaluated and simultaneous LASIK was performed on the stromal bed and undersurface of the flap without compromising the posterior 300 μm of the stromal bed. In a prospective series, outcomes in 43 eyes of 27 patients with mean spherical equivalent refraction ranging from −12.5 to −3.75 diopters were analyzed 1, 3, and 6 months after surgery.
Results
Postoperative uncorrected visual acuity was 20/30 or better in 35 eyes (81.4%) at 1 month, 36 eyes (83.7%) at 3 months, and 34 eyes (79.1%) at 6 months. During surgery and follow-up, no vision-threatening complications occurred.
Conclusion
Simultaneous LASIK appears to be a useful surgical aid in LASIK treatment in eyes with high myopia with or without astigmatism when an adequate residual stromal bed does not exist.

Posted by alireza habibollahi at 08:20 PM | Comments (0)

December 20, 2005

Longitudinal glaucoma screening for siblings of patients with primary open angle glaucoma: the Nottingham Family Glaucoma Screening Study

BJO January 2006
Between 1994 and 2003, a group of siblings of OAG probands underwent both initial and follow up standardised ophthalmic examinations. Siblings were classified as "definite glaucoma" (primary OAG (POAG) and normal tension glaucoma (NTG)), "glaucoma suspects" (NTG suspects or ocular hypertension (OHT)), and normal. The prevalence and cumulative incidence of OAG over the follow up interval were calculated.
Results: At the initial study, 271 siblings (mean age 63.6 years; female to male ratio 1.2) from 156 probands were examined. 32 (11.8%) were classified as definite glaucoma and 15 (5.5%) as suspects. In the follow up study, 157 of the 224 "normal" siblings from the initial study were examined (mean interval from initial study 7.0 (SD 1.0) years). 11 (7%) were classified as definite glaucoma and 30 (19.1%) as suspects. There were significant trends of increasing prevalence and incidence of OAG with age and a lifetime risk estimated at approximately 20% by age 70.

Posted by aman at 12:59 AM | Comments (0)

Epithelial proliferative potential of organ cultured corneoscleral rims; implications for allo-limbal transplantation and eye banking

BJO January 2006
To determine the epithelial proliferative capacity of organ cultured limbal tissue and correlate this with various donor and eye banking factors.
24 corneoscleral limbal (CSL) rims left over from penetrating keratoplasty were split in half and set up as in vitro explant cultures. Corneal epithelial proliferative potential (CEPP) was assessed by the number of "cycles" of growth achieved before explants underwent exhaustion and failure to generate an epithelium to subconfluence. The dependence of CEPP on the age of the donor, time of death to enucleation, time of enucleation to organ culture, and time in organ culture in the eye bank was determined.
Results: CSL rims were capable of up to four cycles of culture with a wide variation between tissue samples. Of the various factors examined, death to enucleation time was the only statistically significant factor affecting the CEPP (regression coefficient: –0.062 (cycles/hour), CI –0.119 to –0.004, p = 0.037). Time in organ culture had little effect on CEPP.
Conclusions: Preselected organ cultured CSL rims from eye banks may offer a viable alternative tissue source for use in allo-limbal transplantation.

Posted by aman at 12:49 AM | Comments (0)

Cystoid macular oedema in paediatric aphakia and pseudophakia

BJO January 2006
To assess the incidence of cystoid macular oedema (CMO), following lensectomy, anterior vitrectomy (limbal and pars plicata), and primary posterior capsulorhexis following surgery for congenital and developmental cataract.
A prospective study was carried out involving 30 eyes (20 children) with cataract. Lensectomy, primary posterior capsulorhexis, and anterior vitrectomy were performed on all eyes. Vitrectomy was performed using either a limbal or pars plicata approach. Fluorescein angiography was carried out 4–7 weeks after surgery. Fluorescein was administered intravenously and visualised using the Retcam.
Conclusion: CMO was not detected in the early postoperative period irrespective of approach to anterior vitrectomy or presence of an intraocular lens. Intravenous fluorescein angiography was performed without complication

Posted by aman at 12:42 AM | Comments (0)

Five year follow up of laser in situ keratomileusis for all levels of myopia

BJO January 2006
This was a retrospective study of visual and refractive outcome of patients who had LASIK surgery performed in 1998 and 1999. All levels of myopia were included in the study. 49 patients attended for follow up. The main outcome measures were safety, predictability, efficacy, and stability. Postoperative complications and aberrations were also recorded. The mean preoperative spherical equivalent was –4.85.
Results: At 2 months postoperatively 67% of eyes were within plus or minus 0.5D of attempted correction with 81% within plus or minus 1.0D. At 5 years postoperatively 60% of eyes were within plus or minus 0.5D of attempted correction with 83% within plus or minus 1.0D. 88% of eyes had a vision of 6/12 or better at 2 months compared to 89% of eyes at 5 years. Best spectacle corrected visual acuity (BSCVA) was unchanged or improved in 51%. No eye lost more than one line of BSCVA. Overall, there was regression towards myopia with a mean change in refraction of –0.5D over the 5 years. As expected, severely myopic patients regressed more with a mean change of –1.06D. However, there was a high level of patient satisfaction with the surgery.
Conclusion: LASIK surgery offers predictable results in terms of refractive and visual outcome with mild regression in refraction over time.

Posted by aman at 12:38 AM | Comments (0)

December 19, 2005

Ciliary Body Edema after Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Ophthalmology
Choroidal detachment and anterior chamber (AC) shallowing develop in some cases after scleral buckling surgery for rhegmatogenous retinal detachment (RD). Postoperative angle-closure glaucoma has been reported to occur in 4% of cases. It is supposed that compression by the local scleral buckling induces ciliary body edema and angle narrowing. This study aimed to evaluate quantitatively the time course of changes in ciliary body thickness and AC depth (ACD) before and after the scleral buckling procedure using ultrasound biomicroscopy. In a prospective consecutive case series, forty-six eyes of 44 patients (43.7±18.1 years old [mean ± standard deviation]) undergoing rhegmatogenous RD surgery. The surgery caused significant increases in ciliary body thickness at 3, 7, and 14 days postoperatively (P<0.0001, Bonferroni multiple comparison). Ciliary body edema reached its peak 3 days after surgery, followed by a gradual decrease thereafter. Ciliary body thickness in the encircling group was statistically greater than in the segmental buckling group at 3 and 7 days postoperatively (P<0.001, Student's t test). The ciliary body was significantly thicker in the direction of buckling than on the opposite side 3 days after surgery (P = 0.0079). In the encircling group, retinal reattachment surgery significantly decreased ACD 3 days after surgery (P = 0.018), whereas no significant fluctuations were found in the buckling group. Even without apparent choroidal detachment and a shallow AC, subclinical ciliary edema existed in all directions of all eyes for at least 1 month after the scleral buckling procedure. The ciliary body in the direction of scleral buckling showed greater edema than the other areas. Eyes treated with the encircling band showed greater ciliary edema than those treated with segmental buckling alone.

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

Incidence of Intraocular Pressure Spike and Other Adverse Events after Vitreoretinal Surgery

Ophthalmology
To determine the incidence of significant postoperative intraocular pressure (IOP) elevation and other adverse medical events during the first postoperative day in patients undergoing inpatient vitreoretinal surgery, in a noncomparative interventional case series, two hundred two consecutive patients were admitted prospectively as inpatients after vitreoretinal surgery (vitrectomy and/or scleral buckling). Intraocular pressure was measured preoperatively, 5 to 12 hours postoperatively, and on postoperative day 1. Additionally, pain, nausea, and serious systemic adverse events were monitored. Seventeen patients (8.4%) had a 5- to 12-hour IOP measurement above 29 mmHg. Thirty patients (14.8%) had a postoperative day 1 IOP measurement above 29 mmHg. Three patients (1.5%) required a parenteral narcotic to achieve adequate analgesia. Nine patients (4.5%) utilized a parenteral antiemetic for nausea control. Six patients (3.0%) had a hyperglycemic event. No serious systemic adverse events occurred in the early postoperative period.

Posted by kjalali at 10:57 PM | Comments (0)

Anecortave Acetate (15 Milligrams) versus Photodynamic Therapy for Treatment of Subfoveal Neovascularization in Age-Related Macular Degeneration

Ophthalmology
In a prospective, masked, randomized, multicenter, parallel group, active control, noninferiority clinical trial, five hundred thirty patients with predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration were randomized to treatment with either anecortave acetate 15 mg or PDT. In the anecortave acetate group, the drug was administered under the Tenon's capsule as a periocular posterior juxtascleral depot (PJD) at the beginning of the study and at month 6. Before the first administration of anecortave acetate, patients in this treatment group received a sham PDT treatment, and sham PDT treatments were repeated every 3 months if there was evidence of leakage on fluorescein angiography (FA). Patients assigned to PDT received up to 4 PDT treatments at 3-month intervals, as needed based upon FA, and a sham PJD procedure at the beginning of the study and at month 6. Best-corrected visual acuity was determined at baseline and all follow-up visits. Safety data were regularly reviewed by an independent safety committee. Main outcome measure was percent responders (patients losing <3 lines of vision) at month 12. Percent responders in the anecortave acetate and PDT groups were 45% and 49%, respectively (not statistically different, P = 0.43). The confidence interval (CI) for the difference ranged from −13.2% favoring PDT to +5.6% favoring anecortave acetate. The month 12 clinical outcome for anecortave acetate was improved in patients for whom reflux was controlled and who were treated within the 6-month treatment window (57% vs. 49%; 95% CI, −4.3% favoring PDT to +21.7% favoring anecortave acetate). No serious adverse events related to the study drug were reported in either treatment group. The safety and efficacy outcomes in this study demonstrate that the benefits of anecortave acetate for the treatment of choroidal neovascularization outweigh the risks associated with either the drug or the PJD administration procedure.

Posted by kjalali at 10:51 PM | Comments (0)

Unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy: Benign exophthalmos syndrome (BES). A description of a new clinical condition

Eur J Ophthalmol 2005; 15: 800 - 803
The relationship between the feature of paranasal sinus disease and the development of ipsilateral exophthalmos has been described in the literature. The four cases described herein appear peculiar for the slow progressive onset of the exophthalmos, without inflammatory and mass effect signs. This condition associated in all cases with ipsilateral hypertrophy of the nasal mucosa provides a guide to a hypothetical mechanism for BES. According to these hypothesis, the therapy should be devoted to the nasal disease more than the orbital.

Posted by afarahi at 12:04 AM | Comments (0)

December 18, 2005

Posterior sub-tenon triamcinolone for refractory diabetic macular edema: A randomized clinical trial

Eur J Ophthalmol 2005; 15: 746 - 750

M. Entezari1, H. Ahmadieh2, M.H. Dehghan2, A. Ramezani1, N. Bassirnia1, A. Anissian3
1Department of Ophthalmology, Emam Hossein Medical Center University of Medical Sciences, Tehran - Iran
2Department of Ophthalmology, Labbafinejad Medical Center University of Medical Sciences, Tehran - Iran
3Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran - Iran

In a double-masked placebo-controlled clinical trial, 64 eyes were randomly assigned to two groups. The treatment group (32 eyes) received 40 mg posterior sub-tenon injection of TA and the placebo group (32 eyes) received subconjunctival injection of a placebo. The injections were repeated after 2 months in both groups. Complete ophthalmologic examination, fluorescein angiography, and OCT were performed before intervention and after 4 months. No statistically significant difference was detected between the two groups.
CONCLUSIONS:Two injections of posterior sub-tenon TA had no therapeutic effect on refractory DME.

Posted by afarahi at 11:57 PM | Comments (0)

The effect of hyperopic laser in situ keratomileusis on refractive accommodative esotropia

Eur J Ophthalmol 2005; 15: 688 - 694
A. Farahi1, H. Hashemi2

1Noor Vision Correction Center, Tehran - Iran
2Noor Vision Correction Center and Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran - Iran

PURPOSE. To evaluate the efficacy of laser in situ keratomileusis (LASIK) for discarding spectacles and simultaneously correcting ocular alignment in patients with refractive accommodative esotropia.
METHODS. LASIK was performed on 20 eyes of 10 patients (mean age, 24.3 years; range, 11 to 43 years) using a Technolas 217C excimer laser. The target refraction was emmetropia. Visual acuity (uncorrected and best-corrected), refractive error, and ocular alignment were recorded before and after LASIK. Minimum follow-up was 12 months.
RESULTS. The mean preoperative uncorrected and corrected angle of deviation was 37.1 prism diopters (PD) (range, 17 to 80; standard deviation (SD), 19.8)) and 14.74 PD (range, 0 to 50; SD, 12.9) of esotropia, respectively, which changed to 7.2 PD (range, 0 to 50; SD, 15.78) without correction postoperatively (p=0.005). Of 20 eyes, 15% lost one line of best-corrected visual acuity, 10% gained two lines, and 75% showed no change.
CONCLUSIONS. LASIK could be considered an alternative treatment for patients with refractive accommodative esotropia with intolerance to glasses and contact lenses.

Posted by afarahi at 11:48 PM | Comments (0)

Cystoid macular oedema in paediatric aphakia and pseudophakia

BJO,Jan,2006
A prospective study was carried out involving 30 eyes (20 children) with cataract. Lensectomy, primary posterior capsulorhexis, and anterior vitrectomy were performed on all eyes. Vitrectomy was performed using either a limbal or pars plicata approach. Fluorescein angiography was carried out 4–7 weeks after surgery. Fluorescein was administered intravenously and visualised using the Retcam. CMO was not detected in any eye. Conclusion: CMO was not detected in the early postoperative period irrespective of approach to anterior vitrectomy or presence of an intraocular lens. Intravenous fluorescein angiography was performed without complication

Posted by afarahi at 11:39 PM | Comments (0)

Smoking and age related macular degeneration: the number of pack years of cigarette smoking is a major determinant of risk for both geographic atrophy and choroidal neovascularisation

BIO,Jan,2006
There is evidence that smoking is a risk factor for age related macular degeneration (AMD). However, not all studies have demonstrated this association and several key questions about the role of smoking in AMD have still to be determined. The aim of this study was to further investigate this relation for both choroidal neovascularisation (CNV) and geographic atrophy (GA).
Conclusions: The authors have demonstrated a strong association between the risk of both GA and CNV and pack years of cigarette smoking. This provides support for a causal relation between smoking and AMD. They also show an increased risk for AMD in non-smokers exposed to passive smoking. Stopping smoking appears to reduce the risk of developing AMD.

Posted by afarahi at 11:28 PM | Comments (0)

December 17, 2005

Herpetic Eye Disease in Diabetic Patients

OPHTHALMOLOGY December 2005
Observational historical cohort study.
We reviewed the electronic medical records of all patients older than 50 years (159634 patients) in the district, and of these, 22382 (14.0%) patients had diabetes mellitus.
All filled prescriptions for acyclovir eye ointment between January 1, 2001 and December 31, 2003 (1483 tubes) and all hemoglobin A1c laboratory tests during 2003 (41910 tests) were documented. An ocular surface HED event was defined when a patient consumed at least 1 tube of topical acyclovir per month, whereas no acyclovir use was documented 3 months before and 3 months after that event.
Incidence of ocular surface HED events in diabetics compared with nondiabetics adjusted for age and gender.
Results
After age and gender adjustment, significantly more diabetics had ocular surface HED (5.21‰) compared with nondiabetics (4.27‰; P<0.0001). Stratification by age revealed a significantly higher prevalence of HED in diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual hemoglobin A1c > 9%) consumed significantly more ocular acyclovir (P = 0.01). Multivariate analysis revealed this effect to be independent of age, gender, place of birth, or place of residency.

Posted by aman at 11:36 PM | Comments (0)

Benefits and Side Effects of Bandage Soft Contact Lens Application after LASIK: A Prospective Randomized Study

OPHTHALMOLOGY December 2005
Prospective, randomized, bicenter comparative investigational trial.
One hundred patients (200 eyes) with myopia and/or myopic astigmatism.
Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours.
Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients’ subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal–Wallis 1-way analysis of variance on ranks test.
Conclusion
The majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.

Posted by aman at 11:30 PM | Comments (0)

Side-Effect Profile of Brimonidine Tartrate in Children

OPHTHALMOLOGY December 2005
Single-center, prospective, interventional, noncomparative case series
Eighty-three children (mean age, 7.84 years) met the inclusion criteria.
Medical records were reviewed to identify children with primary infantile or other forms of secondary pediatric glaucoma from birth to 15 years who received brimonidine as adjunctive therapy for glaucoma. The parents of the children who met the inclusion criteria completed a detailed questionnaire-based interview. The children were examined to assess weight, major systemic effects, and efficacy of adjunctive brimonidine therapy.
Results
Parents reported symptoms in 70 of 83 children (84%). The most common side effects were excessive sleepiness and lethargy (76%), eye itching and rubbing (49%), and stinging and burning of the eyes (39%). Logistic regression analysis showed a statistically significant independent association between age and weight with lethargy and sleepiness. In symptomatic patients, symptoms’ frequency increased with low weight (<20 kg) and in the young (<6 years). Mean IOP reduction after initiation of brimonidine, mainly as an adjunct, was 5±6.7 mmHg (P<0.001).
Conclusions
Side effects after the use of brimonidine in children were frequent. The weight and age of the child were important factors in predicting central nervous system side effects, especially excessive sleepiness and lethargy. Although brimonidine is effective in lowering IOP in children, alternative glaucoma therapy should be considered especially in children weighing <20 kg and those younger than 6 years.

Posted by aman at 10:43 PM | Comments (0)

Blepharokeratoconjunctivitis in Children

ARCHIVES December 2005
In a retrospective case series, we reviewed the medical records of all new pediatric patients from January 1, 1997, through December 31, 2002, noting the reason for referral and subsequent diagnosis. We further noted the history, clinical characteristics, and treatment outcomes of the patients with blepharokeratoconjunctivitis.
Results Review of 195 medical records revealed that blepharokeratoconjunctivitis was the most common single diagnosis at consultation, accounting for 15% of referrals. Of the 29 cases identified, there were 16 girls (55%) and 13 boys (45%). The mean age at consultation was 6 years (age range, 2-12 years). On initial ophthalmologic examination, 11 (38%) of 29 patients were taking full-strength steroids and 4 patients (14%) were taking oral erythromycin. Oral therapy, in the form of erythromycin (n = 21) and doxycycline (n = 1), was prescribed to most patients (22/29 [76%]). Therapy with topical steroids was tapered at the initial visit in all patients. Follow-up was available for 15 of 29 patients, with a mean follow-up of 5.4 months (range, 2-25 months). The condition of all patients showed clinical improvement. Recurrences were noted in 6 (40%) or 15 patients; all were successfully managed with low-potency steroid therapy.
Conclusions Blepharokeratoconjunctivitis is a common reason for cornea referral in children. Oral erythromycin therapy is an effective treatment with a steroid-sparing effect. Recurrences are common and may be successfully managed with low-potency steroid therapy.

Posted by aman at 10:38 PM | Comments (0)

Eyes can recover well after flap removal, study says

EYEWORLD December 2005
Supporters of surface ablation have often suggested that the LASIK-only complications of free caps and buttonholes are disastrous.
But a study analysis of six eyes that underwent flap removal suggests that such eyes still can recover well — even retain their preoperative 20/20 best-corrected visual acuity back.
The cases in detail

Of the six eyes that Dr. Epstein reviewed retrospectively, two had free caps. Two had buttonholes and two had epithelial ingrowth, all of which eventually led to flap removal two to 41 weeks after the initial LASIK procedures.
The flaps were removed in two ways. In two cases, the flap was excised manually. In four cases, the flap was removed via PTK and/or PRK. Surgeons used masking agents in all cases except one.
“They all dropped off from one to five lines of acuity, which is not what you want to see after a LASIK patient has surgery,” Dr. Epstein said. Some continued to regress after subsequent corrective surgeries that failed, he said.
In time the overall mean loss of BSCVA was only 0.8 lines, Dr. Epstein said. Each patient had a pre-op BSCVA of 20/20, except for one, which had 20/15 BSCVA.
“These were sort of disaster cases in the making,” Dr. Epstein said. “But in the end most of these patients gained back almost everything that they lost.”

Flap removal recommended?

When asked whether he would recommend flap removal to surgeons in certain circumstances, Dr. Epstein said he would not.
“As a general answer ‘no,’” Dr. Epstein said. “It’s not a recommended technique.”
But, in certain situations if a surgeon has no other choice but to remove a flap or the flap comes off itself, ophthalmologists can be confident that the visual outcomes likely won’t necessarily be poor, he said.
According to Dr. Epstein’s study, circumstances that could lead to flap removal with good results include:
• Stromal flap melting, which involves the visual axis, that develops irregular astigmatism;
• Intractable irregular astigmatism unresolved by other flap-repositioning techniques;
• Small, thin free caps, irregular flaps or buttonholes with epithelial ingrowth or central scarring;
• Small, thin flaps in which the orbital anatomy puts the patient at significant risk if cut with a microkeratome again.
This doesn’t necessarily mean LASIK is as safe as surface ablation, Dr. Epstein said.

Posted by aman at 01:52 AM | Comments (0)

Laser In-Situ Keratomileusis in Patients with Corneal Guttata and Family History of Fuchs’ Endothelial Dystrophy

JCRS December 2005
In this study, investigators considered how patients with corneal endothelial guttata and a family history of Fuchs’ endothelial dystrophy fared one year after undergoing LASIK. Investigators here performed a retrospective chart analysis on four post-LASIK patients (7 eyes) with a family history of Fuchs dystrophy, who prior to undergoing LASIK, had trace to 1+ endothelial guttata. In the early postoperative period, transient corneal edema had been found in three eyes of two patients. At the one year mark, investigators found that 86% of eyes had lost two lines of BSCVA. These patients also showed a significant decrease in endothelial cell density of 12.4%, as well as an increase in corneal thickness and a statistically significant myopic shift in spherical equivalent. Investigators concluded that prospective LASIK patients with mild corneal guttata and a family history of Fuchs’ dystrophy are more prone to suboptimal outcomes. These patients are more likely to suffer loss of BSCVA, and have transient corneal edema, and endothelial cell loss.

Posted by aman at 01:21 AM | Comments (0)

New glaucoma risk assessment tool helps identify patients in need of treatment

OSN EUROPE/ASIA-PACIFIC EDITION December 2005
A handheld calculator designed to predict the risk of glaucoma progression in patients with ocular hypertension could change the standard of care for glaucoma specialists, according to one of its developers.
Robert N. Weinreb, MD, described the risk calculator at a press briefing sponsored by Pfizer Ophthalmics during the American Academy of Ophthalmology’s annual meeting.
He said the aim of the device is to determine which patients are at high, moderate and low risk for progressing to glaucoma from ocular hypertension and, of those who will go on to develop glaucoma, which ones are likely to sustain functional impairment.
In its current form, the device calculates risk based on a simplified version of a formula derived from findings in two independent study populations: the Ocular Hypertension Treatment Study and a subset of patients in the Diagnostic Innovations in Glaucoma Study at the Hamilton Glaucoma Center in San Diego, where Dr. Weinreb is director.
The physician assesses six factors for each hypertensive patient: age, baseline IOP, central corneal thickness, pattern standard deviation on perimetry, vertical cup-to-disc ratio and whether diabetes is present. These data are configured on the calculator using sliding tabs, and the combined result shows the calculated risk of glaucoma development in 5 years for that particular patient.
Because every specialist’s threshold of treatment is different, the risk calculator specifies that patients shown to have a progression risk of less than 5% should be monitored, those with a risk of 5% to 15% should be considered for treatment, and those with a risk greater than 15% should be recommended for treatment.
Those with moderate risk fall into a “gray zone,” Dr. Weinreb said, and the decision to treat them or not depends on many factors, including overall health status, life expectancy, commitment to treatment, and the adverse events and costs associated with treatment.
This calculator should be an adjunct to, and not a substitute for, the expertise and judgment of the physician,” he said. “It is a tool, and not meant to replace judgment.”

Posted by aman at 01:06 AM | Comments (0)

Comparison of Ablation Centration After Bilateral Sequential Versus Simultaneous LASIK

JRS November/December 2005
A retrospective randomized case series was performed of 670 eyes of 335 consecutive patients who had undergone either bilateral sequential (group 1) or simultaneous (group 2) myopic LASIK between July 2000 and July 2001 at the China Medical University Hospital, Taichung, Taiwan. The ablation centrations of the first and second eyes in the two groups were compared 3 months postoperatively.
RESULTS
Of 670 eyes, 274 eyes (137 patients) comprised the sequential group and 396 eyes (198 patients) comprised the simultaneous group. Three months postoperatively, 220 eyes of 110 patients (80%) in the sequential group and 236 eyes of 118 patients (60%) in the simultaneous group provided topographic data for centration analysis. For the first eyes, mean decentration was 0.3960.26 mm in the sequential group and 0.4160.19 mm in the simultaneous group (P=.30). For the second eyes, mean decentration was 0.2860.23 mm in the sequential group and 0.3060.21 mm in the simultaneous group (P=.36). Decentration in the second eyes significantly improved in both groups (group 1, P=.02; group 2, P<.01). The mean distance between the first and second eyes was 0.3160.25 mm in the sequential group and 0.3260.18 mm in the simultaneous group (P=.33). The difference of ablation center angles between the first and second eyes was 43.2648.3o in the sequential group and 45.1650.8o in the simultaneous group (P=.42).
CONCLUSIONS
Simultaneous bilateral LASIK is comparable to sequential surgery in ablation centration

Posted by aman at 12:56 AM | Comments (0)

RPE cell implants show promise as Parkinson’s disease therapy

OSN TOP STORY for December 16, 2005
Natividad P. Stover, MD, and colleagues treated six patients with advanced Parkinson’s disease with unilateral implantation of human retinal pigment epithelial (RPE) cells attached to gelatin microcarriers. The implants appear to be safe, and they improved motor symptoms in patients with Parkinson’s disease, the study authors reported.
Cultured RPE cells had previously been shown to produce levodopa and to improve motor deficits in animal models of Parkinson’s. Dr. Stover and coworkers noted that in previous studies, human RPE cells have been extracted from postmortem eyes, grown in culture, attached to gelatin microcarriers and implanted into the brain in animals. They performed this study to evaluate the procedure’s safety in humans.
The implants were well tolerated, with an average improvement of 48% on the disease scale motor subscore at 1 year after implantation. The improvement was sustained through 2 years, according to the researchers. Improvement was also observed in activities of daily living, quality of life and motor fluctuations. No off-state dyskinesias were observed.

Posted by aman at 12:50 AM | Comments (0)

Wavefront-guided spectacle lenses improved night driving

OSN BREAKING NEWS
Night driving vision was “greatly improved” in patients wearing spectacles with wavefront-guided lenses, according to a recently presented study.
Ophthonix’s iZon lenses “improve a driver’s ability to identify pedestrians by an average of 330 ms” when compared to conventional lenses, the company said in a press release. That translates to seeing something about 30 feet sooner at an average speed of 55 mph, according to the company.
In a night driving simulator, 30 patients viewed computer-controlled targets in a night driving scenario while either wearing iZon lenses, which included correction of third- to sixth-order aberrations based on wavefront measurements, or conventional lenses that included lower-order corrections for sphere and cylinder.
Ophthonix introduced the lenses at the American Academy of Optometry meeting , and it plans to introduce the lenses nationally throughout 2006.

Posted by aman at 12:44 AM | Comments (0)

Healthy eye in amblyopes has depressed contrast sensitivity, study finds

OSN BREAKING NEWS
In patients with amblyopia, the fellow eye behaves abnormally when evaluated for contrast sensitivity functions, according to a study, even after successful treatment for amblyopia in the affected eye.
“Neither the previously amblyopic nor the fellow eyes of successfully treated subjects were comparable with controls,” said Klio I. Chatzistefanou, MD, and colleagues. The researchers tested contrast sensitivity monocularly in both eyes of 48 patients with amblyopia and compared these results with 22 participants who had been successfully treated for amblyopia. The mean age in both groups was about 11 years. For inclusion in the study, visual acuity in the eye with amblyopia had to be 20/40 or better, and 20/20 or better in the fellow eye. Twenty eyes of 20 healthy age-matched participants were used as controls.
Contrast sensitivity functions in the fellow eye of the patients with amblyopia — including those who had never been treated with occlusion therapy — were significantly decreased compared with the control eyes. Eyes that had undergone successful treatment for amblyopia also had significantly lower values compared with the control eyes.
Occlusion therapy may not be implicated for depressed contrast sensitivity of the fellow eye in amblyopia,” the authors said.

Posted by aman at 12:39 AM | Comments (0)

RPE cell implants show promise as Parkinson’s disease therapy

OSN
Cultured RPE cells had previously been shown to produce levodopa and to improve motor deficits in animal models of Parkinson’s. In previous studies, human RPE cells have been extracted from postmortem eyes, grown in culture, attached to gelatin microcarriers and implanted into the brain in animals. They performed this study to evaluate the procedure’s safety in humans. Reaserchers treated six patients with advanced Parkinson’s disease with unilateral implantation of human retinal pigment epithelial (RPE) cells attached to gelatin microcarriers. The implants appear to be safe, and they improved motor symptoms in patients with Parkinson’s disease.

Posted by kjalali at 12:25 AM | Comments (0)

December 16, 2005

PRK&LSIK in refractive accommodative ET

JCRS Pages 1899-1903 (October 2005)

After a simulation of the cycloplegic correction with contact lenses over a 30-day period, 18 patients (6 men, 12 women, mean age 32.4 years ± 9.4 [SD]) affected by fully refractive accommodative esotropia had refractive surgery using an excimer laser; 8 patients had photorefractive keratectomy (PRK), and 10 patients had laser in situ keratomileusis (LASIK).
Results
The correction of the refractive error with excimer laser allowed a reduction of the angle of deviation in all but 1 patient, who presented with a regression of refractive error and of the angle of deviation 2 years posttreatment. The 2-year follow-up showed that the mean angle of deviation in PRK was 2Δ esophoria at near and 0.4Δ esophoria at distance (P<.06); in LASIK, it was 1.7Δ esophoria at near and 0.2Δ esophoria at distance (P<.06). The difference between the 2 groups was not statistically significant at near .at distance,or for spherical equivalent.
Conclusion
Excimer laser refractive surgery seems to be useful in the correction of fully refractive accommodative esotropia.

Posted by alireza habibollahi at 05:55 PM | Comments (0)

Laser in situ keratomileusis in patients with diabetes

JCRS Pages 1895-1898 (October 2005)
31 of 57
To study the outcomes of laser in situ keratomileusis (LASIK) in patients with well-controlled diabetes mellitus.
Gimbel Eye Centres, Calgary and Edmonton, Canada.
The charts of all patients with diabetes who had LASIK surgery at the Gimbel Eye Centres were reviewed retrospectively. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), final refraction, and complications were assessed.
Results
Twenty-four patients,Mean 42 years (range 24 to 57 years). 17 patients had diabetes type II, and 7 had diabetes type I.Mean preoperative SE was −4.88 D .Median F/U 6 months.No eye lost BSCVA. Twenty-nine eyes (63%) achieved UCVA 20/25 or better, and 31 eyes (67%) were within ±0.5 D of the intended refraction after the first LASIK surgery. Retreatment was required in 13 eyes (28.3%) because initial surgery was not adequate to correct the refractive error. At the last follow-up visit, 40 eyes (87%) achieved UCVA of 20/25 or better and 43 eyes (93.5%) were within ±0.5 D of the intended refraction. Three eyes (6.5%) developed an epithelial defect after surgery, and secondary epithelial ingrowth developed in 2 of these eyes. No advancement of diabetic retinopathy was noticed in any eye at the end of the follow-up period.

Conclusions
Laser in situ keratomileusis surgery was safely performed in patients with well-controlled diabetes. Enhancement may often be required for optimal correction.

Posted by alireza habibollahi at 05:37 PM | Comments (0)

Cataract surgery in eyes with iridoschisis using the Perfect Pupil iris extension system

JCRS Pages 1877-1880 (October 2005)
To evaluate the use of the Perfect Pupil system (Milvella Pty. Ltd.) in 3 eyes in cataract surgery with iridoschisis..
Methods
Patient 1 was an 83-year-old man with a nuclear cataract, pseudoexfoliation syndrome, and iridoschisis. He was also having systemic anticoagulation therapy. Preop BCVA was 0.05 in the right eye and 0.08 in the left eye. Patient 2 was a 73-year-old mentally retarded man with a brunescent cataract in the right eye. Preoperative BCVA was 0.1.

Results
In the first patient, cataract surgery was performed under topical anesthesia in both eyes through a clear corneal incision. Intraoperative pupil size was 3.0 mm. The Perfect Pupil device was inserted manually and fixated at the iris rim, leading to pupil dilation of 6.0 mm. Uneventful cataract surgery was performed without damage to the iris. Hydrophobic acrylic foldable intraocular lenses (IOLs) were implanted with forceps. Postoperative BCVA was 0.5 in the right eye and 0.4 in the left eye. The second patient was operated on under general anesthesia. Pupil dilation was successfully achieved. The brunescent cataract was removed and a hydrophobic acrylic IOL was implanted with an injector, resulting in postoperative uncorrected visual acuity of 0.3.

Conclusion
In iridoschisis patients, there is risk of aspiration of iris fibers during cataract surgery. In these 2 patients, this was prevented using the Perfect Pupil system.

Posted by alireza habibollahi at 05:32 PM | Comments (0)

Treating astigmatism after a free laser in situ keratomileusis cap by rotating the cap

JCRS Pages 1870-1876 (October 2005)
Induced astigmatism and loss of best corrected visual acuity are complications of inadvertently rotating a free cap of laser in situ keratomileusis. It is possible to determine the angle of rotation from the induced astigmatism and correct the astigmatism by lifting and rotating the cap to an astigmatically neutral position.

Posted by alireza habibollahi at 05:29 PM | Comments (0)

Use of trypan blue for penetrating keratoplasty was developed to facilitate the procedure.

JCRS Pages 1867-1869 (October 2005)
26 of 57

Trypan blue is injected before and after the addition of 0.25 mL of an ophthalmic viscosurgical device (OVD), sodium hyaluronate, to stain the internal and external cut edge of the cornea as well as the OVD, enabling the surgeon to improve visualization of the incision and suture depth, improve alignment of host and donor tissues, and ensure that all OVD is removed.

Posted by alireza habibollahi at 05:26 PM | Comments (0)

Side-Effect Profile of Brimonidine Tartrate in Children

Ophthalmology Volume 112, Issue 12 , December 2005, Pages 2143.e1-2143.e7

Parents reported symptoms in 70 of 83 children (84%). The most common side effects were excessive sleepiness and lethargy (76%), eye itching and rubbing (49%), and stinging and burning of the eyes (39%). Logistic regression analysis showed a statistically significant independent association between age and weight with lethargy and sleepiness. In symptomatic patients, symptoms’ frequency increased with low weight (<20 kg) and in the young (<6 years). Mean IOP reduction after initiation of brimonidine, mainly as an adjunct, was 5±6.7 mmHg (P<0.001).
Conclusions
Side effects after the use of brimonidine in children were frequent. The weight and age of the child were important factors in predicting central nervous system side effects, especially excessive sleepiness and lethargy. Although brimonidine is effective in lowering IOP in children, alternative glaucoma therapy should be considered especially in children weighing <20 kg and those younger than 6 years.

Posted by mmiraftab at 12:21 PM | Comments (0)

Otago Glaucoma Surgery Outcome Study:Follow-up of Young Patients Who Underwent Molteno Implant Surgery

Ophthalmology Volume 112, Issue 12 , December 2005, Pages 2137-2142

Insertion of a Molteno implant controlled IOP at ≤21 mmHg with probabilities of 0.89 (95% confidence interval [CI], 0.81–0.97) at both 1 and 2 years and 0.85 (95% CI, 0.75–0.95), 0.78 (95% CI, 0.66–0.90), and 0.71 (95% CI, 0.58–0.85) at 5, 10, and 15 years, respectively. Mean VA was 20/100 preoperatively; improved to 20/60 at 1 year; and stabilized at 20/120 at 5, 10, and 15 years postoperatively. Twenty-nine eyes had their preoperative VA maintained or improved at final follow-up, and the VAs of 17 eyes deteriorated but were at least light perception at final follow-up.
Conclusion
The use of Molteno implants in cases of nonneovascular juvenile glaucoma controlled IOP with a probability of 0.71 15 years postoperatively, whereas 53% maintained or improved their vision from their preoperative VA at final follow-up.

Posted by mmiraftab at 12:18 PM | Comments (0)

Deep lamellar keratoplasty by deep parenchyma detachment from the corneal limbs

British Journal of Ophthalmology 2005;89:1597-1600

Method: For the easy and reliable perfomance of deep lamellar keratoplasty (DLKP), detachment of Descemet’s membrane through the corneal limber flap was improved. To expose Descemet’s membrane, the parenchyma was detached by hydrodelamination through a sclerocorneal flap made in the corneal limbs. The parenchyma was removed after the pseudochamber between it and Descemet’s membrane was maintained with viscoelastic material. The corneal graft was placed with a running suture. 22 eyes were treated.
Results: Complete exposure of Descemet’s membrane was obtained in 20 of the 22 eyes (91%). The membrane was perforated in five of the 22 eyes (23%) during surgery, and two of the 22 eyes (9%) were converted to penetrating keratoplasty. These two eyes developed keratoconus after acute corneal hydrops.
Conclusion: Compared with the conventional procedure, this new method provides easy, reliable exposure of Descemet’s membrane.

Posted by mmiraftab at 12:11 PM | Comments (0)

December 14, 2005

Immersion-Capable A-Scan

Products & Services
The A-Plus immersion-capable A-Scan has been introduced by Accutome.
The A-Plus has the ability to measure different eye types, including those with dense cataracts and those filled with silicone oil. According to Accutome, the A-Plus meets the challenge of post-refractive patients by including software for the Double K, Shammas Clinical and Clinical History methods. The device can display IOL calculations in 0.25-D increments. The company states the device can also evolve with future biometry demands through its eye-type adjustability, independent velocities and IOL material features. The A-Plus contains storage for 100 patient records and 45 different IOLs. Information, including full waveform data, can be downloaded to a PC.

Posted by kjalali at 09:50 AM | Comments (0)

December 12, 2005

Benefits and Side Effects of Bandage Soft Contact Lens Application after LASIK

Ophthalmology Volume 112, Issue 12 , December 2005, Pages 2180-2183

One hundred patients (200 eyes) with myopia and/or myopic astigmatism.
Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours.Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients’ subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal–Wallis 1-way analysis of variance on ranks test.ConclusionThe majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.

Posted by mehdi khanlari at 06:26 AM | Comments (0)

Penetrating keratoplasty combined with posterior Artisan® iris-fixated intraocular lens implantation

Acta Ophthalmologica Scandinavica
Online Early

Purpose: To present a new surgical technique combining penetrating keratoplasty and open-sky posterior iris fixation of the Artisan® iris-claw intraocular lens (IOL) for treatment of pseudophakic bullous keratopathy in a case series of five patients.Methods: A graft diameter of 8.25 mm was chosen. The formerly implanted angle-supported IOL was removed. The IOL was enclosed, entrapping a fraction of the mid-peripheral iris within the haptics whilst being held firmly with the implantation forceps. The corneal button was sutured to the recipient bed with 10–0 nylon sutures. A specular microscope was used for making an endothelial cell count. Patients underwent an ultrasound biomicroscope (UBM) scan before and 6 months after surgery and postoperative macular oedema was assessed by optical coherence tomography (OCT). The minimum follow-up was 12 months.Results: Visual acuity (VA) improved in all five cases (mean best corrected VA was 0.4 postoperatively versus 1.28 preoperatively). No complications were noted. The mean endothelial cell density obtained after 1 year was 1508 cells/mm2. The UBM study showed a deep anterior chamber and an open iridocorneal angle of 360 degrees in all cases.Conclusion: The implantation of the Artisan device behind the iris better preserves the anatomy of the anterior segment with respect to the iridocorneal angle.

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

December 11, 2005

LASIK for High Myopic Astigmatism Resulting From Perforating Ocular Injury

JRS November/December 2005
To present a case of successful treatment of high myopic astigmatism after a perforating injury with significant corneal laceration and pupil ectopia using excimer LASIK.
A 30-year-old man presented for treatment of high myopic astigmatism in his right eye resulting from perforating ocular trauma, which occurred 8 years prior to presentation. The corneoscleral wound repair was performed with posterior chamber intraocular lens implantation. Uncorrected visual acuity (UCVA) in the right eye was counting fingers at 1 m, best corrected to 20/30 with –7.00 +5.00 x 110. Visual acuity in the left eye was 20/20 with –1.5 D. The patient was unable to tolerate spectacles and contact lenses because of asthenopia and high astigmatism, respectively. As an alternative, LASIK with the Allegretto Wave excimer laser was performed.
RESULTS
Three months postoperatively, UCVA was 20/25 in the right eye and 20/15 in the left eye.

Posted by aman at 12:26 AM | Comments (0)

Excimer Laser Phototherapeutic Keratectomy for Granular and Lattice Corneal Dystrophy: A Comparative Study

JRS November/December 2005
Phototherapeutic keratectomy was performed in 62 eyes of 40 patients (granular dystrophy [n=50] and lattice dystrophy [n=12]) after epithelial debridement and pannus removal. Data regarding pre- and postoperative best spectacle-corrected visual acuity, changes in spherical equivalent of manifest refraction, Zeiss keratometry, astigmatism, and corneal topography were analyzed and compared between granular and lattice dystrophy. Recurrence, if any, was noted during a mean follow-up of 3.0±2.7 years.
RESULTS
Best spectacle-corrected visual acuity improved in 79% and 62% of eyes with granular and lattice dystrophy, respectively. Spherical equivalent refraction increased by a mean of 1.3±1.7 diopters (D) (median: 1.0 D) for granular dystrophy and a mean of 1.0±1.8 D (median: 0.5 D) for lattice dystrophy. The keratometric central power decreased by a mean of –0.8±4.3 D (median: –1.6 D) for granular dystrophy and a mean of –0.3±1.6 D (median: –0.7 D) for lattice dystrophy. No significant changes were noted regarding keratometric astigmatism in either granular or lattice dystrophy. The proportion of “regular” and “mild irregular” keratometry mires increased (39% vs 67% for granular dystrophy and 0% vs 50% for lattice dystrophy). In granular dystrophy, the surface regularity index/surface asymmetry index (SRI/SAI) decreased significantly from 2.14/2.24 preoperatively to 1.31/0.80 postoperatively (P=.006/P=.01). In contrast, decrease of SRI/SAI from 1.97/1.65 preoperatively to 1.35/1.16 postoperatively did not reach statistical significance in lattice dystrophy. Recurrences were observed in 10 (20%) eyes with granular dystrophy and 2 (17%) eyes with lattice dystrophy.

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

Comparison of Topographic Corneal Irregularity After LASIK and Intrastromal Corneal Ring Segments in the Same Patients

JRS November/December 2005

To retrospectively compare the irregularity of the corneal surfaces of 14 patients after LASIK in 1 eye and placement of intrastromal corneal ring segments (ICRS) in the other eye.
In a within-patient comparison, Orbscan corneal topography was used to retrospectively compare the corneal surface irregularity of LASIK-treated and ICRS-treated eyes at an outpatient tertiary-care ophthalmology clinic in Sao Paulo, Brazil. For the anterior corneal surface, irregularity measurements were compared for both the central and peripheral areas of the cornea. The differences between each group were analyzed for statistical significance.
RESULTS
The corneal surfaces of eyes treated with ICRS were found to be more irregular than the corneal surfaces of eyes treated with LASIK, the mean irregularity being 1.91 for LASIK-treated eyes and 3.12 for ICRS-treated eyes in the anterior corneal surface and 0.51 for LASIK-treated eyes and 0.87 for ICRS-treated eyes in the posterior corneal surface. A statistically significant difference was noted only in the posterior surfaces.

Posted by aman at 12:03 AM | Comments (0)

December 10, 2005

Case series: Sodium hyaluronate injection reversed hypotony

OSN BREAKING NEWS
Gian Marco Tosi, MD, and colleagues at New York Presbyterian Hospital reported the effects of intraocular use of sodium hyaluronate 1.4% and 2.3% in five eyes. Three eyes underwent intravitreal injection of sodium hyaluronate 1.4% for the treatment of persistent hypotony after successful repair of retinal detachment. One eye with uveitis was also treated with injection of 1.4% sodium hyaluronate. One eye received injection with 2.3% sodium hyaluronate after successful repair of retinal detachment with removal of silicone oil. Follow-up ranged from 2 to 16 months.
IOP increased to at least 5 mm Hg in all eyes that underwent injection, with a range of 5 mm Hg to 14 mm Hg. IOP increased to 38 mm Hg on postoperative day 1 in the eye injected with the 2.3% solution and was 10 mm Hg at 3 months. All patients had improved vision.

Posted by aman at 11:57 PM | Comments (0)

New measuring device more sensitive than standard dry eye tests

OSN BREAKING NEWS
A device that detects and grades ocular tissue dryness may be more useful in detecting dry eye than Schirmer’s test or tear film breakup time, according to investigators.
Yogesh Gupta and colleagues at Aligarh Muslim University in India created the device with the aim of detecting dry eye at an early stage. The xerosis meter is an electronic device that can detect and grade tissue dryness.
The device is based on the principle that the electrical conductivity of any tissue is directly proportional to its wetness. The sensitivity of the meter was compared with Schirmer’s test and tear film breakup time. The meter readings in healthy eyes and in dry eyes were compared; the sensitivity of the xerosis meter was much higher (86.11%) than either the Schirmer’s test (80.55%) or tear film break-up test (66.66%), according to the investigators.

Posted by aman at 11:46 PM | Comments (0)

Treatment of Congenital Nasolacrimal Duct Obstruction With High-Pressure Irrigation Under Topical Anesthesia.

Ophthalmic Plastic & Reconstructive Surgery, November ,2005
High-pressure irrigation (HPI) was applied under topical anesthesia to 39 eyes of 32 consecutive patients with congenital nasolacrimal duct obstruction. If obstructive symptoms persisted after the first attempt, treatment was repeated within 1 month. Patients were divided in two age groups: 7 to 12 months and 12 to 18 months. Thirty-nine eyes that had failed conservative treatment underwent high-pressure irrigation. The overall success rate was 31 of 39 (79.48%) at the first attempt; complete success (8/8, 100%) was achieved at the second attempt. There was no statistically significant difference between the two groups regarding the number of attempts needed to relieve the symptoms (p > 0.05). There was no statistically significant difference in massage times and age between cases resolved at the first and second attempts (p > 0.05).
Conclusions: HPI can be attempted as an alternative second-step treatment or as a transition procedure between conservative and invasive methods. HPI has the advantage of being less invasive than other secondary methods, and its application under topical anesthesia seems to be safe and effective.

Posted by afarahi at 11:38 PM | Comments (0)

Corrugator Superciliaris Muscle Excision for Tension and Migraine Headaches.

Ophthalmic Plastic & Reconstructive Surgery,November,2005We present a prospective study of 12 patients with chronic and frequent tension and/or migraine headaches. Patients who had already elected to undergo corrugator excision for cosmesis (n = 64) were given questionnaires to evaluate for the presence of chronic, recurrent migraine and/or tension headaches. Patients who answered in the affirmative went on to answer questions such as onset, location, frequency, severity, and duration of their headaches. Patients were grouped by types of headaches: tension, migraine, and combined headaches. Twelve patients who met all criteria were entered into the study and underwent corrugator excision in combination with blepharoplasty. All 12 patients had less frequent headaches and said they would have the procedure performed again for headache. Eleven of 12 patients (92%) had less intense headaches after corrugator superciliaris excision. Overall, 58% noted complete relief of their headaches. Follow-up ranged from 6 to 19 months.
Conclusions: Corrugator superciliaris muscle excision provides significant relief for headaches emanating from or localizing to the frontal and glabellar regions. Although improvement of migraine headaches has been previously described with this technique, this is the first report, to our knowledge, of effective surgical treatment of tension headaches by corrugator excision.

Posted by afarahi at 11:33 PM | Comments (0)

Verisyse™ is one of the first implantable contact lenses (ICL’s) approved by the FDA for use in the United States

Verisyse™ Lenses
The Verisyse™ lens is classified as a “Phakic IOL” (intraocular lens) because it does not disturb the natural lens of the eye. The Verisyse™ Phakic IOL covers the natural lens of the eye rather than replacing it.

Verisyse™ implantable contact lenses are currently approved for the treatment of myopia, and are awaiting approval for the treatment of hyperopia, and astigmatism. Verisyse™ lenses are not appropriate for the treatment of cataracts, as cataract surgery requires the removal and replacement of the natural lens of the eye. An intraocular lens such as Crystalens® is used for the replacement of the natural lens during cataract surgery. The Verisyse™ i