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July 28, 2006
The Course of Intermittent Exotropia in a Population-Based Cohort
In this population-based cohort of pediatric patients with intermittent exotropia, the deviation resolved in 4%, and more than half of the patients were expected to have an increase of 10 or more PD within 20 years of their diagnosis. Children who received surgery in this population were significantly more likely to have demonstrated an increase in their deviation during the preoperative period.
Posted by afarahi at 09:31 PM | Comments (0)
Incidence and Types of Childhood Hypertropia: A Population-Based Study
The incidence rates for childhood hypertropia in this population-based study(0.26%) are higher than published reports of prevalence. Fourth cranial nerve palsy and primary dysfunction of the inferior oblique muscle were the most common forms of vertical strabismus in this population.
Posted by afarahi at 09:27 PM | Comments (0)
Factors Associated with Childhood Strabismus: Findings from a Population-Based Study
One thousand seven hundred thirty-nine predominantly 6-year-old children resident in Sydney examined in 2003 and 2004.
Strabismus was diagnosed in 48 children (2.8% of the population), 5 of whom had previously undergone surgical correction; 26 children (54%) had esotropia, 14 (29%) had exotropia, 7 (15%) had microstrabismus, and 1 child had VIth cranial nerve palsy. Prematurity was associated with a 5-fold increase in the risk of esotropia .Visual impairment (with presenting correction) was significantly more common in children with (22.9%) than without (1.3%) strabismus .The presence of strabismus was significantly associated with hyperopia, astigmatism, anisometropia, and amblyopia .
Posted by afarahi at 09:10 PM | Comments (0)
July 27, 2006
Multifocal visual evoked potentials show promise in predicting progression to multiple sclerosis
Arch Neurol. 2006
MVEP was recorded in 46 patients with newly diagnosed optic neuritis. Over the course of the following year, 36.4 percent of patients with mVEP latency delays progressed clinically to MS, while no patient with normal latencies progressed.
Posted by kjalali at 11:10 PM | Comments (0)
Smoking increases risk of AMD, while omega-3 fatty acid intake reduces the risk
Archives of Ophthalmology, July 2006
Data from the Blue Mountains Eye Study shows that people who ate fish at least once a week were 40 percent less likely to develop early age-related maculopathy. People who ate fish three times per week had a substantially lower risk of advanced macular degeneration. Another study of 681 male twins finds current smokers had a 1.9-fold increased risk of developing AMD, while past smokers had about a 1.7-fold increased risk. Data from another study, the Women's Health Initiative clinical trial of hormone therapy finds postmenopausal hormone therapy doesn’t appear to affect the overall risk of AMD among women.
Posted by kjalali at 11:02 PM | Comments (0)
U.K. ophthalmologists vary in post-cataract surgery infection prophylaxis
European Journal of Ophthalmology, May/June 2006
A survey of ophthalmic surgeons, finds 99.5 percent used povidone iodine immediately after surgery. Other common measures included: subconjunctival antibiotics, usually cefuroxime (67.6 percent), intracameral antibiotics, (16.2 percent) and topical antibiotics, usually neomycin, (69.1 percent).
Posted by kjalali at 11:00 PM | Comments (0)
July 24, 2006
COMPLIANCE IN GLAUCOMA THERAPY
EYE WORLD SUPPLEMENT
The language of compliance is evolving. Two terms that appear frequently in the literature — and in compliance discussions — are persistency and adherence.
Persistency describes the regularity of refilling prescriptions. This is measured by tracking prescription refill rates in large managed care databases. The early persistency data suggests that the majority of patients stop refilling medications for all medical problems — including glaucoma — within 6-12 months of starting therapy. The concept of persistency has an important limitation: Persistency tells us how many patients stop refilling prescriptions, but doesn’t tell us why. For instance, persistency might be adversely affected by physician sampling, or by patients finding cheaper medications outside of their managed care plan.
Adherence describes the regularity of medication dosing. This is much harder to measure, and most data are from studies in the 1980s in which bottles of glaucoma drops were altered to record being uncapped and inverted. Little is known about adherence with modern glaucoma medications such as the prostaglandins.
Posted by aman at 11:34 PM | Comments (0)
Concentration of triamcinolone acetonide suspension may vary widely with each use
Retina, 2006 Mar
Decanting triamcinolone acetonide is important, but decanting concentrates the drug. In commercial vials, the concentration is 40 mg/ml. Without decanting, the concentration in 0.1 ml is 4 mg. If a shaken suspension is allowed to rest for five minutes before decanting, the concentration is 10 mg/0.1 ml. If the period of rest increases to 40 minutes, the concentration increases to 21 mg/0.1 ml.
Posted by kjalali at 06:59 PM | Comments (0)
July 23, 2006
Protein found to prevent corneal blood vessel growth
OSN SuperSite Breaking News 7/20/2006
In an experimental study involving mice, Reza Dana, MD, and colleagues at the Schepens Eye Research Institute and the Massachusetts Eye and Ear Infirmary discovered that VEFGR-3 (vascular endothelial growth factor receptor-3) and the gene that expresses it were present on the corneal epithelium. They also found that only corneas without epithelial layers developed new blood vessels, implicating the epithelium’s role in suppressing blood vessel growth.
In a series of studies, the researchers found that adding a VEGFR-3 substitute to corneas that were stripped of their epithelial layers prevented blood vessel growth. Additionally, intact corneas exposed to a VEGFR-3-blocking agent began to experience blood vessel growth.
Posted by aman at 11:43 PM | Comments (0)
Presbyopic LASIK correction stable and safe at 1 year
OCULAR SURGERY NEWS U.S. EDITION July 15, 2006
Multifocal presbyopic LASIK appears to be both safe and stable with at least 1 year of follow-up, according to an ongoing study.
This study included 82 eyes of 49 hyperopic presbyopic patients from three centers. All of the eyes underwent standard bilateral LASIK hyperopic treatments with no nomogram adjustments or re-treatments.
At 1 year postop, 76% of the patients were 20/20, 91% were 20/25 and 100% were 20/40 or better when tested for monocular uncorrected distance vision. Binocularly, 100% of the patients were 20/25 or better.
For monocular near vision, 61% were J1, 85% were J3 and 91% were J5 or better. Like distance vision, the percentages improved when tested for binocular near vision: 88% were J1 and 100% were J3 or better.
In addition, both distance and near vision improved over time. Dr. Jackson said he could not fully explain this but suggested it may be due to neural adaptation.
This is really the sweet spot,” Dr. Jackson said in his presentation. “At 12 months, 100% of the subjects can see 20/25 distance and J3 near, but 88% were at the 20/25 and J1 level.”
Dr. Jackson noted that some patients lost lines due to dry eye, and some coma was induced. No eyes were worse than 20/25 or J1, he said, and coma remained stable through the year.
Overall visual sharpness and clarity, they were very happy with these results. They were happy with their distance vision in bright light,” he said. “When we came to their near vision in bright light, it decreased a little bit at 12 months. This was partly due to the fact that they were losing a little of their near vision as they became slightly hyperopic at 1 year.”
Posted by aman at 11:29 PM | Comments (0)
Corneal sensitivity after LASEK may vary
JRS 7/19/2006
Ren Y. Chu, MD, and colleagues at the Eye and ENT Hospital in Shanghai, China, examined 50 patients divided into a low-moderate myopia group and a high myopia group. They measured corneal sensitivity using an esthesiometer with a maximal filament length of 60 mm, which corresponds to the lowest possible pressure, the authors said. Filament lengths were subsequently decreased in 5 mm steps until the patient could perceive the sensation.
Results indicated patients in the low-moderate myopia group recovered central corneal sensitivity to preoperative values at the 3-month follow-up. Patients in the high myopia group had a slower recovery, reaching preoperative values only at the 6-month follow-up.
The results suggest that ablation depth during surgery affects corneal sensitivity recovery, the authors said. The occurrence of post-LASEK corneal scarring may also influence recovery of central corneal sensitivity, they added.
Posted by aman at 01:04 AM | Comments (0)
Sodium hyaluronate improves post-trabeculectomy complications
OSN Breaking News
A dose of sodium hyaluronate after trabeculectomy significantly improves some typical early postoperative complications, according to researchers in Turkey.
Gokhan Gulkilik, MD, and colleagues prospectively studied 51 eyes of 51 patients treated with trabeculectomy for various glaucomas. Surgeons injected sodium hyaluronate in 24 eyes and injected balanced salt solution in 27 eyes.
Dr. Gulkilik and his colleagues found significant differences postoperative complications between the groups. Hypotony occurred in 40.7% of control eyes and in only 8.3% of sodium hyaluronate-treated eyes. Anterior chamber shallowing occurred in 37% of control eyes and 8.3% in sodium hyaluronate-treated eyes. Also, choroidal detachment occurred in 33.3% of control eyes but no sodium hyaluronate-treated eyes, according to the study.
Posted by aman at 01:00 AM | Comments (0)
Little vision improvement using posterior chamber IOLs for congenital cataract
OSN Breaking News
implanting a posterior chamber IOL to treat congenital cataracts in infants less than 1 year old is safe, but produces unsatisfactory final acuities, according to British researchers.
Pieter Gouws, MD, and colleagues at Bristol Eye Hospital retrospectively reviewed their results treating 8 infants with unilateral cataract and 10 with bilateral cataract. These children had an average age of 15 weeks and were followed for over 7 years on average.
Researchers found infants treated bilaterally had the best visual outcomes, with 50% achieving 6/18 or better and a best acuity of 6/9. Worse outcomes were seen in unilaterally treated infants, where 38% achieved 6/60 or better and the best acuity was 6/24, according to the study.
A mean refractive shift of –3.44 D occurred between the first postoperative refraction and refraction at 36 months, with a “very wide range” of +2 to –15.5. Unilateral cases showed a significantly greater myopic shift, the authors noted.
Amblyopia and posterior capsular opacification were the main complications, and unilateral patients in particular developed amblyopia.
Posted by aman at 12:55 AM | Comments (0)
July 17, 2006
Intravitreal Toxicity of Levofloxacin and Gatifloxacin
OPHTHALMIC SURGERY, LASERS & IMAGING 2006
In this experimental, controlled study, levofloxacin (initial concentration = 25 mg/mL) and gatifloxacin (initial concentration = 2 mg/mL) were titrated using 5% dextrose solution to concentrations of 2,500 to 156 µg/0.1 mL and 400 to 50 µg/0.1 mL, respectively. Each concentration was injected intravitreally into two rabbit eyes (one eye per animal); two control eyes were injected with 0.1 mL of 5% dextrose solution. All animals were examined and electroretinography was performed before and 14 days after injection. The animals were killed at 14 days; the eyes were enucleated and prepared for light microscopy.
RESULTS
The levofloxacin group exhibited significant decreases in electroretinography in the eyes injected with 1,250 and 2,500 µg. No signs of retinal toxicity were observed on slit-lamp examination, indirect ophthalmoscopy, or light microscopy in all eyes injected intravitreally with 625 µg or less of levofloxacin or in any eyes given gatifloxacin.
Posted by aman at 11:51 PM | Comments (0)
Subconjunctival Placement of Human Amniotic Membrane During High Risk Glaucoma Filtration Surgery
OPHTHALMIC SURGERY, LASERS & IMAGING 2006
Retrospective review of 17 eyes of 15 patients who had amniotic membrane applied during glaucoma surgery with or without mitomycin C or 5-fluorouracil.
CONCLUSIONS
The results suggest that subconjunctival placement of amniotic membrane may improve filtration outcome in high risk eyes. It will be of interest to determine whether the anti-inflammatory, anti-angiogenic, and antifibrotic properties of amniotic membrane placed subconjunctivally and under the scleral flap will improve filtration surgery outcome by a prospective, randomized study.
Posted by aman at 11:44 PM | Comments (0)
Smoking may damage to the lipid layer of the ocular surface
OSN BREAKING NEWS
Dilek Dursun Altinors, MD, and colleagues studied the effects of smoking on ocular surface and precorneal tear film, corneal and conjunctival sensitivity measurements and tear function tests of 60 cigarette smokers and 34 healthy people. Ocular surface vital fluorescein staining, conjunctival impression cytology and DR-1 tear film lipid layer interferometry also were studied. A subjective questionnaire about foreign-body sensation, burning or stinging, photophobia and ocular fatigue was also administered to both groups.
Damage was observed in the lipid layer in cigarette smokers as grade 3 or 4 dry eye changes, assessed by interferometry and frequent areas where lipid does not spread over the corneal surface, the study authors said. Clinical questionnaire scores support this claim and other clinical parameters found in the results, according to the study. Those who smoked expressed dry eye clinical signs, such as scratchiness, foreign-body sensation, burning and grittiness, compared with non-smokers.
Posted by aman at 11:39 PM | Comments (0)
July 14, 2006
Anaphylaxis reactions reported with Macugen
SPECIALTY NEWS & VIEWS
The U.S. Food and Drug Administration recently issued an alert regarding this rare reaction on its Web site, MedWatch. Though a reliable estimate of the frequency is impossible, the prescribing label for pegaptanib sodium has been revised. Macugen is contraindicated for any patient with a known history of hypersensitivity to pegaptanib sodium or any other excipient in the product.
Posted by kjalali at 08:25 AM | Comments (0)
July 11, 2006
Iridocyclitis associated with angle-supported phakic intraocular lenses
JCRS Pages 1007-1010 (June 2006)
31 of 47
Iridocyclitis associated with angle-supported phakic intraocular lenses
To evaluate incidence, features, risk factors, and prognosis of iridocyclitis after angle-supported phakic intraocular lens (IOL) implantation.
This retrospective analysis comprised 356 consecutive eyes of 212 patients. In myopic eyes, the ZSAL-4 IOL (205 eyes of 125 patients) or the ZSAL-4 Plus IOL (106 eyes of 63 patients) was used. In hyperopic eyes (45 eyes of 24 patients), the Type 54 IOL was implanted. Haptic posterior angulation was 19 degrees (ZSAL-4), 23 degrees (ZSAL-4 Plus), and 14 degrees (Type 54).
Results
Clinically significant iridocyclitis occurred in 11 eyes (3.1%) of 11 patients. Mean patient age was 37.3 years .Iridocyclitis was observed in 4.4% of hyperopic eyes (OR, 1.6; 95% CI, 0.3 to 7.4; not statistically significant and in 2.9% of myopic eyes. In myopic eyes, it followed the implantation of ZSAL-4 IOL in 3.9% of eyes (OR, 4.1; 95% CI, 0.5 to 33.6; not statistically significant), and of ZSAL-4 Plus IOL in 1%. Mean time from surgery was 8.5 months). Presentation included aqueous flare (100%), posterior synechiae (82%), blurred vision (82%), redness (36%), pain (27%), IOL precipitates (18%), and angular synechiae (9%). Only 1 patient had recurrences, leading to IOL explantation and cataract surgery. After topical therapy, best spectacle-corrected visual acuity was fully recovered in 9 of 11 eyes.
Conclusion
Iridocyclitis can occur months or years after the implantation of angle-supported phakic IOLs. No statistically significant risk factors were identified. Functional prognosis is generally good.
Posted by alireza habibollahi at 11:31 PM | Comments (0)
Intacs adjustment surgery for keratoconus
JCRS Pages 986-992 (June 2006)
To describe the visual outcome of keratoconic eyes managed with Intacs that required additional Intacs surgery (defined as any combination of removal, exchange, addition, or shifting of an Intacs segment).
This retrospective noncomparative interventional consecutive small case series studied all eyes of a cohort of 58 keratoconic eyes managed with Intacs that had additional Intacs surgery. UCVA,BCVA , manifest refraction, videokeratography, and patient questionnaires on visual function were assessed. These outcome measures were compared before Intacs implantation, before Intacs adjustment, and 1 year after the final Intacs adjustment. Eyes having any intervention other than Intacs surgery were excluded.
Results
Of 58 keratoconic eyes managed with Intacs, 7 had additional Intacs surgery. After the initial Intacs surgery, 6 of these eyes had UCVA ≤20/100 and 1 had UCVA of 20/50. After the final Intacs adjustment, 3 eyes achieved UCVA ≥20/40, 5 achieved UCVA ≥20/70, and 2 remained <20/200. The indications for Intacs adjustments were increased astigmatism in 4 eyes, induced hyperopia (overcorrection) in 3, and undercorrection in 1. One eye had both surgically induced astigmatism and hyperopia. Induced astigmatism and hyperopia were most often managed by removing the superior segment. The undercorrected eye, having initially received a single inferior segment, was treated by implanting a superior segment.
Conclusions
Approximately 10% of keratoconic eyes managed with Intacs may require Intacs adjustment surgery, which often has a good outcome.
Posted by alireza habibollahi at 11:23 PM | Comments (0)
Visual and refractive results of combined PTK/PRK in patients with corneal surface disease and refractive errors
JCRS June 2006
To investigate the changes in symptoms,REF, and VA in patients with corneal surface disease and refractive errors who had PTK combined with photorefractive keratectomy (PRK).
Patients with myopia or astigmatism and map-dot-fingerprint dystrophy or recurrent erosions were treated. The corneal epithelium was removed with a 64 blade, and laser was performed using a Visx Star S3 laser.
Conclusion
Patients with myopia and astigmatism and symptomatic epithelial basement membrane disorders who had PTK/PRK had resolution of their symptoms and nearly achieved emmetropia. Therefore, this procedure is safe and effective for patients with corneal surface disease and myopia.
Posted by alireza habibollahi at 11:19 PM | Comments (0)
July 10, 2006
Disease Severity of Familial Glaucoma Compared With Sporadic Glaucoma
ARCHIVES July 2006Results One thousand twelve (59.5%) of 1700 subjects had familial glaucoma. The mean ± SD age at examination was greater in the sporadic POAG group compared with the familial group (72.6 ± 10.3 years vs 70.6 ± 12.6 years; P = .001). The family group was significantly younger at diagnosis than the sporadic group (mean ± SD, 61.4 ± 13.0 years vs 64.0 ± 12.6 years; P<.001). The GIST severity scores were significantly skewed toward greater disease severity in the familial group compared with the sporadic group (P<.001).
Posted by aman at 11:57 PM | Comments (0)
Posterior polar cataract: minimizing risk of posterior capsule rupture
H Siatiri1 and S Moghimi
Purpose To study a preferred technique of phacoemulsification in eyes with posterior polar cataract and report its outcome.
Methods Under topical anesthesia, phacoemulsification was carried out after hydrodelination in 23 cases (38 eyes) with ages ranging from 19 to 65 years (mean=33.5 years). Hydrodissection was not performed.
Results Mean duration of follow-up was 9.5 months. None of the eyes developed posterior capsule rupture, but seven eyes (18.4%) revealed posterior capsule plaque postoperatively, which needed neodymium : YAG laser capsulotomy. Mean visual acuity improved significantly after surgery (P=0.0001, paired t-test); In all, 34 eyes achieved a best-corrected visual acuity of 20/40 or more (89.4%). However, the postoperative visual acuity was less than 20/25 in 11 eyes (28.9%). The causes of the low acuity were amblyopia in eight eyes (21.0%) and macular degeneration due to retinitis pigmentosa in two others (5.2%).
Conclusion Phacoemulsification is an effective and safe method to treat posterior polar cataract with gentle hydrodelination 'hydrodissection free phacoemulsification technique'. This is especially true when great attention is paid to the 'floppy' posterior capsule. Although previous amblyopia might interfere with excellent surgical outcome in patients with a unilateral or highly asymmetric bilateral cataract, visual acuity improved significantly in most cases.
Posted by mmiraftab at 01:44 PM | Comments (0)
July 09, 2006
The Influence of Incision-Induced Astigmatism and Axial Lens Position on the Correction of Myopic Astigmatism with the Artisan Toric Phakic Intraocular Lens
AAO July 2006
To evaluate postoperative astigmatism with regard to incision-induced astigmatism and deviation in axial alignment with the use of preoperative limbal marking with the Javal keratometer in eyes implanted with the Artisan toric phakic intraocular lens (IOL)
Fifty-four eyes of 33 patients with myopia (mean, –9.67 diopters [D]) and astigmatism (mean, –3.44 D).
Conclusions
Implantation of the myopic toric IOL leads to safe, efficacious, and predictable results. The level of unpredictability caused by minor axis IOL misalignment has minimal effects on the residual refractive error. The procedure of axis alignment with the Javal keratometer seems to be an accurate method of marking the eye for toric IOL implantation. Incision-induced astigmatism can result in an overcorrection of the cylinder. A systematic undercorrection of −0.50 D for attempted cylindrical outcome could result in an achieved correction closer to emmetropia.
Posted by aman at 11:10 PM | Comments (0)
Efficacy of Subconjunctival 5-Fluorouracil and Triamcinolone Injection in Impending Recurrent Pterygium
AAO July 2006
One hundred nine patients who had undergone pterygium excision within the previous 6 months and developed grade 3 characteristics (impending recurrent pterygium).
A total of 109 eyes with impending recurrent pterygium were stratified randomly into 3 groups by treatment: 35 eyes served as the control group, 39 eyes received a 5-mg intralesional injection of 5-FU weekly for 2 weeks, and 35 eyes received one 20-mg intralesional injection of triamcinolone. All groups received 1% prednisolone acetate eye drops 4 times daily for 8 weeks.
Results
With a mean follow-up time of 10.9±5.5 months (range, 6–26 months), the success rates of the 5-fluorouracil and triamcinolone groups were higher than the control group (87.2%, 71.4%, and 48.6%, respectively). 5-fluorouracil was significantly (P = 0.001) more effective in inhibiting the recurrence of pterygium compared with the control group at all time points during follow-up. Kaplan–Meier survival analysis showed that the recurrence-free period of pterygium in the 5-FU group was significantly (P = 0.005) longer than that of the control group but not in the triamcinolone group compared with the controls (P = 0.063). There was no significant difference between the 5-FU group and the triamcinolone group (P = 0.362). Minimal reversible complications such as steroid-induced glaucoma and superficial punctate epitheliopathy developed during the study.
Conclusions
Intralesional injection of 5-FU and triamcinolone was more effective in inhibiting the recurrence of pterygium than topical steroid alone, with the results in the 5-FU group reaching statistical significance.
Posted by aman at 11:04 PM | Comments (0)
Long-term Outcomes in Fellow Eyes after Acute Primary Angle Closure in the Contralateral Eye
AAO July 2006
Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals.
Conclusions
Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5%) fellow eyes and developed in an additional 5 (6.5%) with a mean follow-up of 6 years. More than 80% of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.
Posted by aman at 11:00 PM | Comments (0)
Changes in refraction and ocular dimensions after cataract surgery and primary intraocular lens implantation in infants
JCRS JULY 2006
Investigators considered the effect of cataract extraction and IOL implantation on children younger than age one. This retrospective study included 34 eyes of 20 children. While in the immediate postoperative period mean acuity was at +4.53 D at the three year mark it was measured at -2.49 D. Investigators divided the children into two groups — those who underwent surgery during the first six months of life and those who underwent the procedure in the second six months. They found that while the younger patients had a shorter axial length at the time of surgery, with a mean of 18.92 mm compared with a mean of 20.29 mm, this had changed by the three year mark. The younger patients ultimately had a mean axial length of 22.67 mm compared with 21.23 mm for the older group. Ultimately they determined that while IOL implantation is a viable option for children undergoing cataract extraction in the first year of life to optimize refractive outcomes new IOL power calculations may be needed. These would take into account the significant myopic shift that seems to occur in the youngest of patients.
Posted by aman at 12:05 AM | Comments (0)
Objective measurement of intraocular lens movement and dioptric change with a focus shift accommodating intraocular lens
Jcrs July 2006
To determine whether an IOL shift is taking place with the 1 CU accommodating IOL (HumanOptics IOL, Erlangan, Germany), investigators compared movement of that lens in the eye to that of the monofocal AcrySof MA 30 (Alcon, Fort Worth, Texas) in the fellow eye. The thirty patients in the study were randomly assigned to receive the Human Optics 1CU IOL in one eye and an AcrySof MA 30 monofocal IOL in the other. Complete measurements were obtained for 20 patients. With the 1CU, during accommodation, investigators detected a small anterior movement of 0.010 mm. Meanwhile, when investigators instilled 4% pilocarpine they saw a forward movement with the 1CU of 0.010 mm compared with a backward movement with the MA 30 of 0.028 mm. They concluded that while the movement of the 1CU was not enough to account for useful near vision with the lens it does substantiate the validity of the accommodating IOL’s engineering.
Posted by aman at 12:03 AM | Comments (0)
July 08, 2006
A diagnosis and treatment primer for TASS
EYEWORLD JULY 2006
It's easy to confuse TASS with bacterial or infectious endophthalmitis,
1. TASS almost always has a sudden onset, within 12 to 24 hours post-op, said Terry Kim .This contrasts with the onset of endophthalmitis, which is usually three to seven days post-op.
2. TASS is limited to the anterior segment, . Endophthalmitis often has involvement of the posterior segment.
3. Cases of TASS tend to occur in clusters, . For example, a surgeon may see two cases in one day or 15 cases over a year. Endophthalmitis cases often occur individually.
4. TASS is always culture and Gram-stain negative. Infectious endophthalmitis results with these tests are positive, although there are cases of sterile endophthalmitis, he said. However, the other symptoms and signs should help distinguish sterile endophthalmitis from TASS.
5. TASS cases usually present with limbus-to-limbus edema, little to no pain, blurry vision, and severe inflammation that can result in hypopyon formation.
6. The patient's IOP can vary with TASS,. It may initially be low but then rise suddenly within several days following the initial insult, she said.
7. TASS cases will improve with the use of topical and if necessary, oral steroids.
Treatment plan for patients and the practice
When a surgeon still is not certain if a patient has TASS or endophthalmitis—and this will occasionally happen—they should treat it as the latter.
The first line of treatment for TASS should be topical prednisolone acetate 1% every hour to two hours, Dr. Mamalis said. Check that the patient's condition is improving within the first day of treatment and watch the eye closely the first couple of days to make sure the condition is not getting worse.
If the patient is not improving, surgeons can consider adding oral steroids, Dr. Kim said.
If there's a severe reaction initially, you can still have a poor outcome.” TASS could lead to severe glaucoma or the need for a corneal transplant, said Dr. Mamalis.
Posted by aman at 11:16 PM | Comments (0)
Corneal Higher Order Aberrations: A Method to Grade Keratoconus
JRS June 2006
A prospective observational comparative study of 80 eyes was performed. The eyes were divided into two groups. Group A comprised 40 eyes of 20 asymptomatic individuals with no ocular pathology. Mean sphere was -0.03 diopters (D) (range: +0.75 to -0.75 D), mean cylinder was -0.27 D, mean average K was 43.28 D, and mean uncorrected visual acuity (UCVA) was 1.01. Group B comprised 40 eyes of 25 patients with keratoconus. Mean sphere was -3.70 D (range: +2.00 to -10.00 D), mean cylinder was -3.82 D, mean average K was 49.29, and mean best spectacle-corrected visual acuity (BSCVA) was 0.61.
RESULTS
In group A, mean root-mean-square (RMS) of spherical (Z4 and Z6), coma-like (Z3, Z5, and Z7), and higher order aberrations (Z3-7) were 0.38 µm, 0.35 µm, and 0.52 µm, respectively. In group B, mean RMS of spherical, coma-like, and higher order aberrations were 1.06 µm, 2.90 µm, and 3.14 µm, respectively, for a 6.0-mm simulated pupil diameter. Mean RMS differences between the two groups were 0.68 µm (P<.0002), 2.55 µm (P<.0001), and 2.61 µm (P<.0001) for spherical, coma-like, and total higher order aberrations, respectively. In group B, according to Amsler-Krumeich classification, the mean RMS of coma-like aberration was 1.87 µm in grade I (14 eyes), 2.97 µm in grade II (11 eyes), 3.46 µm in grade III (12 eyes), and 5.20 µm in grade IV (3 eyes).
CONCLUSIONS
Corneal higher order aberrations, especially coma-like aberrations, are significantly higher in eyes with keratoconus than normal eyes. Coma-like aberrations, with the aid of a corneal aberrometry map, are good indicators for early detection and grading of keratoconus
Posted by aman at 11:08 PM | Comments (0)
July 07, 2006
Unilateral Lateral Rectus Muscle Recession and Medial Rectus Muscle Resection With or Without Advancement for Postoperative Consecutive Exotropia
Journal of AAPOS,June,2006
We performed a retrospective review on 31 patients with consecutive exotropia who were treated with unilateral lateral rectus muscle recession and medial rectus muscle resection (17 patients) or unilateral lateral rectus muscle recession and medial rectus muscle partial resection combined with advancement (14 patients). All patients had exotropia with a less than 10 prism diopters (PD) distance near-disparity. The mean preoperative exodeviation was 47.3 PD. Overall 21 (67.7%) of 31 patients achieved a successful postoperative result (alignment within 10 PD of orthophoria).
Conclusions: Unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement is an effective alternative for treating postoperative consecutive exotropia.
Posted by afarahi at 02:13 PM | Comments (0)
Acanthamoeba keratitis
During the years1994-2004, 45 contact lens wearers and 3 non-contact lens wearers presenting with symptoms and signs of keratitis underwent corneal sampling.Acanthamoeba was isolated from contact lenses and contact lens disinfecting solutions in all 19 cases of Acanthamoeba keratitis studied.
Conclusions: The main risk factorfor corneal infection in contact lens wearers is the use of contact lens disinfecting systems ineffective at killing Acanthamoeba cysts and trophozoites, as well as bacteria and fungi. Improvement or development of new contact lens disinfecting systems by manufacturers is needed to prevent Acanthamoeba keratitis
Posted by afarahi at 02:00 PM | Comments (0)
Smoking and high body mass index increase genetic risk of AMD
Human Heredity, July 2006
Analysis of data from the Age-Related Eye Disease Study finds current cigarette smoking was associated with a five-fold increased risk and high BMI (30 or higher) was associated with a two-fold higher risk. The homozygous risk genotype plus smoking conferred a ten-fold higher risk of AMD, while the risk genotype plus higher BMI increased risk almost six-fold.
Posted by afarahi at 01:45 PM | Comments (0)
July 04, 2006
Clinical Characteristics of Bilateral Duane Syndrome
Journal of American Association for Pediatric Ophthalmology and Strabismus June 2006
Conclusions: Unlike unilateral Duane syndrome, bilateral Duane syndrome may be more common in males and associated with a higher prevalence of strabismus in primary gaze position. The prevalences of amblyopia, positive strabismus family history, and associated congenital abnormalities in this series of bilateral cases is similar to the reported prevalence.
Posted by afarahi at 12:21 AM | Comments (0)
Superior Oblique Posterior Tenectomy in Patients With Brown Syndrome with Small Deviations in the Primary Position
Journal of American Association for Pediatric Ophthalmology and Strabismus June 2006
Procedures used to weaken the superior oblique muscle (SO) tendon in the treatment of patients with Brown syndrome, may result in severe complications, including complete SO palsy, overcorrections, foreign body extrusion, and scarring with limitation to ocular rotations. SO posterior tenectomy moderately weakens abduction and depression while preserving most of the torsional action of the SO muscle. We retrospectively analyzed 12 consecutive patients with unilateral Brown syndrome who underwent a 15 mm tenectomy of the posterior four-fifths fibers of the ipsilateral SO tendon.
Conclusion: The use of SO posterior tenectomy improves alignment and ocular rotations in patients with Brown syndrome, resulting in fusion, small vertical deviation in primary position, and minimal-to-no anomalous head posture, in whom the most important finding is a disfiguring downshoot on attempted adduction. Other advantages include minimal-to-no postoperative SO muscle underaction and no risk of foreign body extrusion, fibrosis, and scarring.
Posted by afarahi at 12:13 AM | Comments (0)
July 03, 2006
Hydrostatic Pressure as an Office Procedure for Congenital Nasolacrimal Duct Obstruction
Journal of American Association for Pediatric Ophthalmology and Strabismus , June 2006
The estimated incidence of congenital nasolacrimal duct obstruction (CNDO) is 5% to 20%. We examined our success rate of treating CNDO with hydrostatic pressure (the Crigler method) as an office procedure.A total of 742 children with CNDO initially were treated noninvasively with hydrostatic pressure. The procedure was safely repeated up to 3 times, with an interval of at least 1 week, if the condition persisted. Success was defined as no epiphora or discharge. The success rate for the entire study group was 45% for children up to 1 year of age. The ducts were opened in 46% (343/742) at the first attempt of hydrostatic pressure, in 35% (42/120) at the second attempt, and in 38% (8/21) at the third attempt. When the maneuver was performed in patients younger than 2 months of age, the success rate of the first attempt was 56%, decreasing to 46% in children 2 to 6 months of age and to 28% older than 6 months of age.
Conclusions: Hydrostatic pressure is an effective way of resolving infant CNDO and shortening the duration of the associated morbidity. The success rate is higher when the procedure is conducted in patients up to 2 months of age. Nevertheless, we recommend this approach for every infant presenting with CNDO at the first office visit, even after 6 months of age. Procedures can be repeated safely and successfully.
Posted by afarahi at 11:53 PM | Comments (0)
Corneal thickness measurements in normal and keratoconic eyes: Pentacam comprehensive eye scanner versus noncontact specular microscopy and ultrasound pachymetry
JCRS Pages 970-977 (June 2006)
To compare central corneal thickness (CCT) measurements taken with the Pentacam .noncontact specular microscopy (SM), and ultrasound pachymetry (U/S P) in normal and keratoconic corneas.
Conclusions
Results suggest that whereas Pentacam and U/S P may be used interchangeably in normal eyes in the clinical setting for the measurement of CCT, one should be cautious interpreting corneal thickness data from Pentacam, U/S P, and particularly SM in eyes with keratoconus. Whereas, in normal and mildly keratoconic eyes, Pentacam and UP demonstrated very high and comparable reproducibility, in moderately keratoconic eyes, Pentacam readings showed better reproducibility than U/S P.
Posted by alireza habibollahi at 10:41 PM | Comments (0)
One thousand consecutive IntraLase laser in situ keratomileusis flaps
JCRS Pages 962-969 (June 2006)
To measure LASIK flap dimensions created with the IntraLase FS (IL) Consecutive LASIK flaps created with the IL were measured with subtraction ultrasound at primary and enhancement surgeries.
The mean achieved flap thickness exceeded the attempted by 9.4 to 34.3 μm.Preoperative corneal thickness and power did not affect achieved flap thickness. Seventy-three percent of mate eye flaps were within ±15 μm of each other for the 90 μm attempted. The same flaps measured at enhancement were thicker than the primarily measured flaps (n = 58). Diffuse lamellar keratitis and slipped flaps were eliminated with experience. There were no decentered or irregular flaps, epithelial defects, or flap perforations.
Conclusions
Compared with published results of mechanical microkeratomes, the IL reduced the standard deviation of flap thickness as well as the achieved range. It eliminated physical complications associated with mechanical flap creation, and the impact of preoperative pachymetry and corneal power, thereby permitting more myopia to be corrected without risking deep ablations.
Posted by alireza habibollahi at 10:36 PM | Comments (0)
Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: Report of 500 consecutive cases
JCRS Pages 929-943 (June 2006)
To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs).
After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia.
Results
The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing.
Conclusion
Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up.
Posted by alireza habibollahi at 10:14 PM | Comments (0)
Correction of post-keratoplasty astigmatism with keratotomies in the host cornea
JCRS Pages 923-928 (June 2006)
We evaluated the effects of astigmatic keratotomy performed in the host cornea to treat astigmatism after penetrating keratoplasty. In 11 patients with high post-keratoplasty astigmatisms (mean 9.02 diopters [D]; range 5.5 to 17.4 D), an arcuate keratotomy was performed in the host cornea. The mean incision depth was 575 μm (range 500 to 600 μm). The refractive data were analyzed using the Alpins method for vector analysis. The mean keratometric cylinder decreased to 3.41 D (range 0.9 to 5.3 D). The mean surgically induced astigmatism achieved was 7.3 ± 3.89, with a mean correction index of 0.82 ± 0.34. No microperforations were observed, and neither graft decompensation nor rejection occurred. Astigmatic keratotomy performed in the host cornea was a safe procedure to reduce post-keratoplasty astigmatism. The procedure offers the potential for correction of the astigmatism and has satisfactory predictability.
Posted by alireza habibollahi at 10:11 PM | Comments (0)
Rescue of failed filtering blebs with ab interno trephination
JCRS Pages 918-922 (June 2006)
19 of 47
We evaluated the effectiveness of ab interno automated trephination as a technique for rescuing failed mature filtering blebs. A retrospective chart review of 40 failed blebs of 38 patients who had a posttrephination follow-up period of at least 3 months was done. With success defined as intraocular pressure (IOP) <21 mm Hg and at least a 20% reduction from baseline on the same or fewer number of pretrephination medications, 30/40 eyes (75%) fit these criteria over the entire course of follow-up. Among all 40 eyes, there was a significant reduction of IOP from pretrephination to 3 months (P<.001). The percentage of patients requiring 2 or more medications declined from 90% pretrephination to 21% at 3 months (P<.0001), and was stable thereafter. Some patients were able to eliminate all medications. Patients who did not meet the criteria of success regained successful IOP control with other modalities of management. Complications were few. We believe that ab interno trephination is an excellent option for rescuing selected failed filtering blebs.
Posted by alireza habibollahi at 10:07 PM | Comments (0)
Bimanual microphaco for posterior polar cataracts
JCRS Pages 914-917 (June 2006)
18 of 47
We describe a technique in which bimanual microphacoemulsification technique through 2, 1.4 mm incisions is performed for posterior polar cataract extraction. The low-infusion and low-vacuum system provides good anterior chamber stability and followability. The irrigation and aspiration handpieces are interchangeable, enabling removal of the lens fragments without hydrodissection or nucleus rotation. Only 1 (12.5%) of the 8 cases presented here was complicated by posterior capsule rupture. This occurred after epinucleus removal without any vitreous disturbance. The bimanual microphacoemulsification technique appears to minimize the risk for complications, allowing posterior polar cataract extraction to be performed more safely.
Posted by alireza habibollahi at 10:05 PM | Comments (0)
July 02, 2006
Functional Outcome and Patient Satisfaction After Artisan Phakic Intraocular Lens Implantation for the Correction of Myopia
AJO July 2006
One hundred twenty eyes of 60 patients who had undergone Artisan PIOL implantation to correct myopia were analyzed. A validated questionnaire that consisted of 66 satisfaction items were self-administered by patients 12 months after surgery. Clinical parameters (PIOL decentration, the difference between pupil size and PIOL optical zone, and optical aberrations) were measured. Main outcome measures of satisfaction scale scores (global satisfaction, quality of uncorrected and corrected vision, night vision, glare, day and night driving) were analyzed. Correlations with clinical parameters were obtained.
Results
After surgery, 98.3% of patients were satisfied, and 73.3% of patients considered their night vision to be the same or better; 44.1% of patients reported more bothersome glare. The night vision score correlated with spheric aberration (r = −0.303; P = .020). The glare score correlated with the difference between scotopic pupil size and PIOL optical zone (r = −0.280; P = .030) and vertical coma (r = −0.337; P = .009). The night driving score correlated with postoperative spheric equivalent (r = 0.375; P = .009), total root mean square aberrations (r = −0.337; P = .017), higher order root mean square aberrations (r = −0.313; P = .027), and vertical coma (r = −0.297; P = .036).
Conclusion
Overall satisfaction after Artisan PIOL implantation for myopia is excellent. The quality of night vision and night driving were related to scotopic pupil size, individual higher order aberrations, and residual refractive error.
Posted by aman at 12:09 AM | Comments (0)