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October 31, 2006
Corneal melting associated with topical diclofenac use after laser-assisted subepithelial keratectomy
Jcrs Pages 1570-1572 (September 2006)
We report a case of corneal melting associated with topically applied preservative-free diclofenac (Voltaren Ofta) after laser-assisted subepithelial keratectomy. Keratolysis was detected on day 5; further progression toward perforation was arrested by immediate suspension of diclofenac and prescription of topical dexamethasone with 24-hour patching. At the last follow-up, the visual acuity had improved from counting fingers to 20/20. Preservative-free diclofenac instillation had never been associated with keratolysis. Topical steroids may be useful in treating corneal melting associated with nonsteroidal antiinflammatory drugs
Posted by alireza habibollahi at 10:01 PM | Comments (0)
Bilateral ring scotomas following laser in situ keratomileusis
JCRS Pages 1062-1064 (June 2006)
A 53-year-old white man who had a history of transient ocular hypertension had bilateral LASIK for myopia. Subsequent computerized static perimetry revealed bilateral, persistent, repeatable midperipheral ring scotomas. The pre-LASIK visual fields were within normal limits, and the optic discs appeared stable and not diagnostic for glaucomatous optic neuropathy. A comprehensive baseline data set before laser refractive surgery aids subsequent assessment of individuals at high risk for developing glaucoma.
Posted by alireza habibollahi at 09:47 PM | Comments (0)
Intrastromal ring segment insertion using a femtosecond laser to correct pellucid marginal corneal degeneration
JCRS Pages 1710-1716 (October 2006)
Purpose
To assess the outcomes of intrastromal ring segment (Intacs, Addition Technology) implantation using a femtosecond laser in patients with pellucid marginal corneal degeneration.
In this retrospective noncomparative case series, 9 eyes of 6 patients with pellucid marginal corneal degeneration had implantation of Intacs segments by a femtosecond laser technique. Preoperative and postoperative evaluations included slitlamp examination, uncorrected (UCVA) and best corrected (BCVA) visual acuities, and keratometry by a Pentacam Scheimpflug camera (Oculus Opticgerate GmbH). All parameters were reviewed within 6 months.
Results
Intacs were successfully implanted in all eyes. The UCVA significantly improved from preoperatively to 6 months after Intacs implantation (mean 0.18 and 0.53 respectively). The mean difference between the preoperative and postoperative UCVA was 3.5 lines. The BCVA also significantly improved from preoperatively to 6 months after implantation (mean 0.63 and 0.85 ). The Snellen BCVA was 1.0 in 5 eyes postoperatively. The mean difference between preoperative and postoperative BCVA was 2.3 lines.The mean preoperative spherical refraction decreased from −3.86 diopters (D) to −2.77 and the mean cylindrical refraction, from −2.41 D to −0.94 D .The mean central corneal curvature decreased from 48.20 D preoperatively to 46.90 at 6 months and the mean posterior elevation, from 53.88 ±μm to 32.55 .
Conclusion
Intacs insertion using a femtosecond laser was safe and efficient in the correction of pellucid marginal corneal degeneration.
Posted by alireza habibollahi at 09:39 PM | Comments (0)
October 29, 2006
Late Onset Diffuse Lamellar Keratitisas a Result of the Toxic Effect of Ecballium Elaterium Herb
Journal of Refractive Surgery Vol. 22 No. 8 October 2006
To report a case of late onset diffuse lamellar keratitis (DLK) 11 months after LASIK due to Ecballium elaterium exposure.A 25-year-old man underwent bilateral LASIK. No complications were observed during the early postoperative period.Eleven months after LASIK surgery, grade II DLK was diagnosed after an Ecballium elaterium herb seed burst and splashed into the patient’s left eye. Topical steroid treatment was administered and DLK healed in 2 weeks without complication.Although DLK typically develops in the early postoperative period, it could occur months after surgery. Treatment should begin as soon as DLK is diagnosed.
Posted by mmiraftab at 12:08 PM | Comments (0)
Keratectasia After LASIK But Not After PRK in One Patient
Journal of Refractive Surgery Vol. 22 No. 8 October 2006
Mohammad Ali Javadi, MD; Mehrdad Mohammadpour, MD; Hossein Mohammad Rabei, MD
To report a case of keratectasia in a patient who underwent LASIK in the right eye and photorefractive keratectomy (PRK) in the left eye for correction of compound myopic astigmatism.A 30-year-old man underwent LASIK in the right eye and PRK in left eye for refraction of –1.75 –1.50 × 48° and –1.00 –1.75 × 100°, respectively. Preoperative corneal thickness was 447 µm in the right eye and 446 µm in the left eye.Postoperative corneal thickness decreased to 341 µm and 384 µm in the right and left eye, respectively. Uncorrected visual acuity in the left eye was 20/20, but the right eye developed keratectasia, which led to severe visual loss (20/400).Photorefractive keratectomy may be better than LASIK for ablative refractive surgery for low myopic astigmatism in eyes with low central corneal thickness.
Posted by mmiraftab at 12:05 PM | Comments (0)
Comparison of Laser Epithelial Keratomileusis With and Without the Use of Mitomycin C
Journal of Refractive Surgery Vol. 22 No. 8 October 2006
A retrospective analysis of 30 LASEK cases that received MMC 0.02% intraoperatively (MMC group) was performed and compared to the results obtained in 28 LASEK cases not receiving MMC (no MMC group). Mitomycin C was placed in contact with the ablation zone for 75 seconds with an imbibed microsponge. Both groups received postoperative fluorometholone for 3 months. Preoperative spherical equivalent refraction was –5.72±2.82 diopters (D) in the MMC group and –5.81±2.74 D in the no MMC group. Best spectacle-corrected visual acuity was 0.88±0.12 in the MMC group and 0.88±0.13 in the no MMC group.
RESULTS
Spherical equivalent refraction at 6 months postoperatively was +0.11±0.13 D in the MMC group and +0.09±0.37 D in the no MMC group. Best spectacle-corrected visual acuity was 0.90±0.13 in the MMC group and 0.88±0.13 in the no MMC group. Uncorrected visual acuity (UCVA) >20/40 was obtained in 93.3% of cases in the MMC group and in 89.3% of cases in the no MMC group; UCVA >20/25 was achieved in 76.6% of cases in the MMC group and in 71.4% of cases in the no MMC group. Haze incidence for the MMC group was: trace: 0%, Grades I: 0%, II: 0%, III: 0%, IV: 0%, and for the no MMC group: trace: 17.9%, Grades I: 3.6%, II: 0%, III: 0%, IV: 0%. A statistically significant difference (P<.001) was noted in haze intensity between the MMC group and no MMC group.
CONCLUSIONS
Prophylactic use of intraoperative MMC in LASEK significantly decreases haze incidence.
Posted by mmiraftab at 12:02 PM | Comments (0)
Effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus
British Journal of Ophthalmology 2006;90:1410-1413
Patients and methods: 13 patients (22 eyes) with strabismus underwent refractive surgery. Five of these patients presented with an esotropia and four of them with a small vertical deviation. Five patients had a manifest exotropia, of whom two presented with a small vertical deviation. Two patients had an intermittent exotropia with binocular vision, of whom one patient had a vertical deviation. One patient had a hypertropia with a dissociated vertical deviation.
Results: Ocular alignment and binocular function remained unchanged postoperatively in all except two patients with high anisometropia who experienced an improvement in binocular function. In these patients, the preoperative manifest deviation became intermittent or latent after surgery, allowing fusion and stereopsis. Vertical deviation was found preoperatively in 8 of the 13 patients. This vertical deviation remained unchanged postoperatively, but improved in one patient with anisometropia.
Conclusion: Preoperative intermittent or manifest strabismus is not a contraindication for refractive surgery provided some specific recommendations are taken into account, such as an adequate preoperative orthoptic examination and aiming at emmetropia for both eyes.
Posted by mmiraftab at 11:57 AM | Comments (0)
Influence of tobacco use on cataract development
British Journal of Ophthalmology 2006;90:1374-1377
3924 subjects from the Chennai Glaucoma Study conducted in rural south India underwent a comprehensive eye examination, including Lens Opacities Classification System II grading. Information on tobacco use, type of tobacco (smoking and smokeless), duration and quantity of use was collected.
Results: 1705 (male:female (M:F) 1106:599) people used tobacco and were significantly older (mean (standard deviation (SD)) age 55.80 (10.64) years) than non-users (52.23 (10.51); p<0.001). 731 (M:F 730:1) people smoked, 900 (M:F 302:598) used smokeless tobacco, and 74 (M:F, 74:0) used tobacco in both forms. The unadjusted and adjusted (age and sex) odds ratio (OR) for a positive history of tobacco use and cataract was 1.72 (95% confidence interval (CI) 1.51 to 1.96) and 1.39 (95% CI 1.15 to 1.68), respectively. The unadjusted OR for smokers and smokeless tobacco users was 1.04 (95% CI 0.88 to 1.23) and 2.74 (95% CI 2.31 to 3.26), respectively. The adjusted OR was 1.19 (95% CI 0.89 to 1.59) and 1.54 (95% CI 1.22 to 1.95), respectively. No significant association was noted between smoking and any particular type of cataract. Smokeless tobacco use was found to be significantly associated with nuclear cataract even after adjusting for age and sex (OR 1.67, p = 0.067, 95% CI 1.16 to 2.39).
Conclusion: Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.
Posted by mmiraftab at 11:54 AM | Comments (0)
The International Intravitreal Bevacizumab Safety Survey: using the internet to assess drug safety worldwide
British Journal of Ophthalmology 2006;90:1344-1349
70 centres from 12 countries reported on 7113 injections given to 5228 patients. Doctor-reported adverse events included corneal abrasion, lens injury, endophthalmitis, retinal detachment, inflammation or uveitis, cataract progression, acute vision loss, central retinal artery occlusion, subretinal haemorrhage, retinal pigment epithelium tears, blood pressure elevation, transient ischaemic attack, cerebrovascular accident and death. None of the adverse event rates exceeded 0.21%.
Conclusion: Intravitreal bevacizumab is being used globally for ocular diseases. Self-reporting of adverse events after intravitreal bevacizumab injections did not show an increased rate of potential drug-related ocular or systemic events. These short-term results suggest that intravitreal bevacizumab seems to be safe.
Posted by mmiraftab at 11:53 AM | Comments (0)
October 26, 2006
Study identifies another possible technique for treatment of keratoconus and post-LASIK corneal problems
Eyeworld Ovt 2006
A study has found excimer laser-assisted anterior lamellar keratoplasty ALK to be an alternative technique for the treatment of keratoconus, post-LASIK corneal problems, and other corneal stromal opacities with anterior lamellar keratoplasty.Published in the August 2006 issue of the Journal of Cataract & Refractive Surgery, the study sought to evaluate excimer laser-assisted anterior lamellar keratoplasty to augment thin corneas as in keratoconus (less than 350 microns) and corneal ectasia after LASIK and to treat anterior stromal opacities.The researchers, led by Kamil Bilgihan, M.D., Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey, analyzed 13 eyes (five keratoconus, three macular dystrophies, one post-LASIK ectasia, one post-LASIK interstitial keratitis, and three post-herpetic keratitis sequelae) of 13 patients.
The patients were divided into two groups: corneal ectasia and stromal opacity groups. A 100-micron excimer laser ablation was performed on the endothelium of a donor stromal button, which was approximately 350 microns thick. The remaining cornea (epithelium, Bowman's membrane and stroma) was punched with a 7.5 or 7.7 mm trephine.Following transepithelial ablation of the host cornea to 200 micron thickness, the corneal button was sutured with interrupted 10-0 monofilament nylon. Sutures were removed between three and six months post-op. The researchers then compared pre-op and post-op simulated keratometric cylinders and corneal thickness values as well as the post-op spherical equivalent refraction and best spectacle-corrected visual acuity (BSCVA) between the groups.....Results of the study showed the mean post-op corneal thickness increased significantly. The mean pre-op simulated keratometric cylinder decreased from 7.44 ± 7.18 D to 2.61 ± 1.73 D (P < 0.05) postoperatively. The researchers found no significant difference in post-op spherical equivalent refraction or BSCVA between the groups (P > 0.05). ....results, the researchers concluded that additional studies with more patients and longer follow-up would help determine the role of excimer laser-assisted anterior lamellar keratoplasty as a substitute for penetrating keratoplasty in these patients
Posted by mehdi khanlari at 08:37 PM | Comments (0)
Central Corneal Thickness in Patients With Weill-Marchesani Syndrome
American Journal of Ophthalmology September 2006, Pages 507-508
Mohammad Reza Razeghinejad MD, a, and Homayoon Safavian MDa Shiraz University of Medical Sciences,
To investigate whether central corneal thickness (CCT) is affected in patients with Weill-Marchesani syndrome (WMS) and to focus on its clinical significance...Complete ocular examination was performed in case and control groups, and then the lowest reading of ten pachymetry measurements of the central cornea was taken as CCT...All participants, case and controls, were female and age matched (P = .7). The mean of central corneal thickness in twelve eyes of six patients with WMS was thicker (631.5 ± 25.9 μ) than 40 eyes of 20 normal persons (535.8 ± 25.9 μ) in the control group (P < .0001).ConclusionsIncreased CCT seems to be a previously unrecognized aspect of WMS. This may lead to overestimation of intraocular pressure by applanation tonometers. Therefore, unusually thick CCT should be considered in interpreting the Goldmann tonometric reading in diagnosis and management of glaucoma in this rare syndrome.
Posted by mehdi khanlari at 08:34 PM | Comments (0)
The spectrum of iris angiography abnormalities in pseudoexfoliation syndrome
Eye 15 September 2006
Conclusions Patients clinically affected only monolaterally by PES show microvascular changes, which are similar in both eyes. Glaucoma PES represents a more advanced stage of the disease, with more pronounced alterations, even though no typical microvascular pattern can be identified by iris angiography.
Posted by mehdi khanlari at 08:31 PM | Comments (0)
Ocular Decompression Devices: Liquid Mercury Balloon vs the Tungsten Powder Balloon
American Journal of Ophthalmology September 2006, Pages 500-501
....At a tertiary care center, both eyes of 24 volunteers with normal IOP were treated with an ocular compression device containing either liquid mercury or tungsten powder. The IOP was measured at baseline and after 10 minutes of ocular compression...The mean reduction in IOP was 3.6 mm Hg ± 2.0 with the mercury-containing device and 4.4 mm Hg ± 2.1 with the tungsten-filled apparatus. An equivalence study analysis using a paired t-test and a sequential analysis protocol did not demonstrate a statistically significant difference between the IOP-lowering effects of the two devices.Conclusions
The IOP-lowering effect produced by a tungsten powder-filled balloon ocular decompression device compared with a traditional mercury-containing device was not statistically different.
Posted by mehdi khanlari at 08:22 PM | Comments (0)
Phacoemulsification Associated Corneal Damage Evaluated by Corneal Volume
To determine the usefulness of the Pentacam corneal volume assay in the assessment of corneal endothelial damage caused by phacoemulsification and aspiration (PEA).PEA was performed in 85 eyes by three surgeons under different conditions. Central cell density (CD) was determined using a specular microscope before and one month after surgery. Pentacam was used before and one day, one week, and one month after surgery to determine 3- and 10-mm corneal volumes.For all surgeons, no significant differences in the 3-mm corneal volumes were noted between the before and one-month after surgery values. However, 10-mm corneal volumes at one month were significantly higher than preoperative levels. No correlation was noted between the increasing rate of the 10-mm corneal volume and decreasing rate of CD.
ConclusionsPentacam-determined corneal volumes may be useful in assessing PEA-caused corneal damage.
Posted by mehdi khanlari at 08:06 PM | Comments (0)
Phototherapeutic Keratectomy With Intraoperative Mitomycin C to Prevent Recurrent Anterior Corneal Pathology
American Journal of Ophthalmology
...To determine the safety and efficacy of the use of intraoperative mitomycin C (MMC) during phototherapeutic keratectomy (PTK) for anterior corneal disease...Conclusions: MMC is safe for intraoperative use during PTK and does not appear to inhibit epithelial healing and may help prevent recurrent anterior corneal disease...
Posted by mehdi khanlari at 07:09 PM | Comments (0)
October 16, 2006
How to best use mitomycin C while minimizing haze
EYEWORLD Oct 2006
Who to treat
Dr. Durrie
Of the seven of the 500 who developed haze, all needed above 6 D of myopic correction and were below the age of 30. Dr. Durrie accordingly held the treatment for those who need more than -6 D of treatment or who are below the age of 30 and likely to be aggressive healers.
“We’ve also found over the years that anybody who has had previous surgery is at risk for haze,” Dr. Durrie said. “We use it all patients that have had previous corneal surgery,” he said.
Dr. Majmudar
In the old days we used to say anything above -6 D would be more at risk,” he said.
Howver, with the new flying spot lasers and the added ability to expand the optical zone, a large amount of energy can be delivered with corrections as low as -4 D, for example, if a large optical zone is selected. For that reason, he now recommends using MMC in any case with more than 75 microns of ablation, as that number correlates with a -6 D treatment using a broadbeam laser.
Concentration and application time
Dr. Majmudar now has three groups of patients with a mean of one year follow up from which to compare – those in which the MMC was applied for two minutes, those at one minute, and those at 12 seconds.
“In any of the three groups no one has anything more than what I would call trace haze,” he said. “I think that 12 seconds is as effective as two minutes and I think certainly the lesser exposure time is better for safety reasons.”
Dr. Durrie has had similar experience in taking the MMC exposure time down from two minutes down to 30 seconds and then ultimately down to 12 seconds.
The concern is that we don’t know what it’s doing to the natural cornea,” Dr. Yee said. “This may result in inhibition of keratocyte repopulation – some people have suggested that MMC may decrease that absolute number to a point where it might be dangerous in the future.”
Posted by aman at 10:07 PM | Comments (0)
Intacs adjustment surgery
EYEWORLD Oct 2006
Researchers from the Enaim Refractive Surgery Center, Jerusalem, conducted a study to describe the visual outcome of one such method—additional Intacs surgery for keratoconic eyes managed with Intacs. Any combination of removal, exchange, addition, or shifting of an Intacs segment qualified as additional Intacs surgery.
Published in the Journal of Cataract & Refractive Surgery, the research authors studied 58 keratoconic eyes managed with Intacs. Seven of the eyes had additional Intacs surgery. After the initial Intacs surgery, six of these eyes had an uncorrected visual acuity (UCVA) of +20/100, and one had a UCVA of 20/50. After the final Intacs adjustment, three eyes achieved a UCVA +20/40, five had a UCVA of +20/70, and two remained <20/200.
For adjustment surgery, induced astigmatism and hyperopia were largely managed by removing the superior segment. One under-corrected eye, having initially received a single inferior segment, was treated by implanting a superior segment.
The team concluded in the study that Intacs adjustment surgery often has a good outcome.
“[Intacs are] easy to adjust in terms of exchanging segments or removing segments or putting additional segments in,” Dr. Boxer Wachler said.
He said that typical adjustment surgeries performed at his institute are in keratoconic patients with peripheral cones to begin with. In these cases, the upper segments are removed to give a better overall corneal shape because the upper segments are usually placed in an area that was already flat pre-operatively, Dr. Boxer Wachler said.
He has also seen cases where referred patients have had a thick superior segment placed and a thin inferior segment place, resulting in increased distortions. What is done in those cases is that the upper segment is removed and the lower segment is replaced with a thicker segment, he said.
Another surgeon who applies a similar method is Yaron S. Rabinowitz, M.D., director of ophthalmology research, Cedars-Sinai Medical Hospital, Los Angeles. He said if there are two segments in the eye, he will take out the top segment and then leaving the bottom segment in often gives a better effect.
The other method Dr. Rabinowitz typically applies is moving the segment along the channel a little to a different area to get a different effect or occasionally he will reinsert the Intac closer to the visual axis with a tighter channel to get more effect. This technique has proven to be very useful in patients where the intitial surgery has not been successful; using the tunnels made with the intralase makes this relatively simple to do.
Posted by aman at 09:28 PM | Comments (0)
Factors Predicting Intraocular Pressure Control After Phacoemulsification in Angle-Closure Glaucoma
ARCHIVES October 2006
Patients with PACG undergoing phacoemulsification were prospectively enrolled and received a complete ophthalmic examination. Diurnal IOP was measured 1 day before and 3 months after surgery. For comparison, patients with primary angle closure or angle closure suspect (PAC/S) undergoing phacoemulsification were also enrolled.
Conclusions The reduction of IOP 3 months after phacoemulsification is significant and is similar in extent in postiridotomy eyes with and without glaucomatous optic neuropathy. A higher postoperative IOP in PACG is associated with a higher preoperative IOP and with a deeper preoperative anterior chamber depth.
Posted by aman at 09:24 PM | Comments (0)
October 15, 2006
Disappointment of patients on antidepressant therapy after excimer laser treatment
JCRS 1775-1776 (October 2006)
We describe 2 patients who were receiving antidepressant therapy before excimer laser surgery, at the time of surgery, and after surgery. Both patients experienced the ocular side effects of antidepressant drugs, ie, symptoms due to dry eyes and mydriasis.
Posted by alireza habibollahi at 07:28 PM | Comments (0)
Increased crystalline lens thickness and phacomorphic glaucoma in patients with Fanconi anemia
JCRS Pages 1771-1774 (October 2006)
We describe 2 siblings with Fanconi anemia (FA). One developed phacomorphic glaucoma, and both had increased crystalline lens thickness, features that have not been reported in patients with FA. The possible pathogenesis and clinical implications of the findings are discussed.
Posted by alireza habibollahi at 07:24 PM | Comments (0)
Iris-cyst–simulating luxated lens
JCRS Pages 1768-1770 (October 2006)
A 2-month-old child was referred to our clinic for evaluation and management of a luxated lens. Under general anesthesia, an irregularly shaped iris was observed with the presence of a large iris cyst in the anterior chamber. Sector iridectomy with excision of the cyst was performed. Histopathologic examination confirmed the diagnosis of a stromal cyst of the iris. At the 3-year follow-up, there was no evidence of recurrence of the iris cyst or of a secondary cataract. This case report provides evidence that although a primary cyst of the iris stroma is uncommon, it should be considered in the differential diagnosis for an apparent lens luxation.
Posted by alireza habibollahi at 07:22 PM | Comments (0)
Persistent endocapsular hematoma following uneventful phacoemulsification and clear corneal incision cataract surgery
JCRS Pages 1764-1765 (October 2006)
We report the first case of persistent endocapsular hematoma following uneventful phacoemulsification and intraocular lens surgery through a clear corneal incision.
Posted by alireza habibollahi at 07:20 PM | Comments (0)
Inadvertent stromal dissection during mechanical separation of the corneal epithelium using an epikeratome
JCRS Pages 1759-1763 (October 2006)
Epithelial flap complications occurred in 2 patients during epithelial separation using a Centurion SES epikeratome (Norwood Eye Care) in epi-laser in situ keratomileusis (LASIK). The complications consisted of stromal dissection at the margin of the pupil and an epithelial free cap including the superficial stroma. The epithelial flaps were repositioned without laser ablation. Three months postoperatively, the best corrected visual acuity in both patients was 20/20 and neither complained of visual discomfort. Slitlamp biomicroscopic examination showed that both corneas were completely healed with trace opacity, and topographic examinations revealed that irregularities in the stromal cutting sites were decreased. The patients had successful photorefractive keratectomy after complete healing of the dissected stroma. Stromal dissection during mechanical separation of the epithelium with an epikeratome is a potential complication of the epi-LASIK procedure, but proper management can result in good recovery without severe visual impairment.
Posted by alireza habibollahi at 07:14 PM | Comments (0)
Dislocation of capsular bag with intraocular lens and capsular tension ring
JCRS Volume 32, Issue 10, Pages 1756-1758 (October 2006)
We report a case in which the capsular bag with an intraocular lens (IOL) and a capsular tension ring (CTR) dislocated into the vitreous. The dislocated foldable posterior chamber IOL and CTR were removed with a pars plana vitrectomy and exchanged with a scleral-fixated IOL. No complications occurred intraoperatively or postoperatively. Although insertion of a CTR decreases the risk for IOL dislocation, spontaneous capsular bag dehiscence can occur.
Posted by alireza habibollahi at 07:09 PM | Comments (0)
Ultrasound biomicroscopy in traumatic aniridia 2 years after phacoemulsification
JCRJCRS Pages 1753-1755 (October 2006)
A 45-year-old man with retinitis pigmentosa experienced total aniridia in the left eye due to direct blunt trauma 2 years after uneventful bilateral phacoemulsification via a 3.5 mm clear corneal incision. Ultrasound biomicroscopy (UBM) of the left eye revealed no missing or stretched zonular fibers extending from the ciliary body to the anterior capsule, a few iris root remnants, a normal ciliary body, an in-the-bag acrylic intraocular lens, and Descemet's membrane dehiscence at the corneal tunnel through which the iris extruded. The eye recovered 20/25 visual acuity after 1 week. Transient hyphema and a rise in intraocular pressure were recorded. This is the first report of traumatic aniridia 2 years after phacoemulsification with UBM evidence of undamaged zonular apparatus. A UBM examination may be clinically helpful, especially when blood prevents accurate slitlamp examination of the anterior segment
Posted by alireza habibollahi at 06:37 PM | Comments (0)
Biaxial Microincision versus Coaxial Small-Incision Clear Cornea Cataract Surgery
Ophthalmology Volume 113, Issue 10 , October 2006, Pages 1818-1826
With the biaxial microincision technique, EPT is shorter and BCVA improves more rapidly, with no difference in astigmatism, laser flare photometry results, or endothelial cell count relative to the coaxial small-incision technique for phacoemulsification.
Posted by mmiraftab at 11:25 AM | Comments (0)
Is Diabetes Mellitus a Risk Factor for Open-Angle Glaucoma?(The Rotterdam Study)
Ophthalmology Volume 113, Issue 10 , October 2006, Pages 1827-1831
Participants at risk for incident OAG (iOAG) underwent at baseline (1990–1993) and follow-up (1997–1999) the same ophthalmic examination including intraocular pressure (IOP) measurement, visual field testing, and simultaneous stereo optic disc photography. At baseline, diabetes mellitus was defined as the use of antidiabetic medication and/or a random or postload glucose value ≥11.1 mmol/l. The diagnosis of OAG was made with an algorithm based on optic disc measures and visual fields, independent of the IOP.
Results
In total, 3837 participants without OAG at baseline were reexamined. After a mean follow-up time of 6.5 years, iOAG developed in 87 persons. The relative risk of iOAG associated with baseline diabetes was 0.82 (0.33–2.05). After adjustment for age, gender, follow-up time, IOP, IOP-lowering treatment, body mass index, and systemic hypertension, the relative risk of iOAG was 0.65 (0.25–1.64).
Conclusions
In this prospective population-based study, diabetes mellitus was not a risk factor for OAG.
Posted by mmiraftab at 11:23 AM | Comments (0)
Efficacy of Topical Cyclosporine 0.05% for Prevention of Cornea Transplant Rejection Episodes
Ophthalmology Volume 113, Issue 10 , October 2006, Pages 1785-1790
Primary indications for transplantation were keratoconus, Fuchs’ dystrophy, or nonherpetic, nonvascularized scars. Subjects completely tapered off prednisolone acetate 1% by 13 weeks after transplantation and used topical cyclosporine 0.05% 4 times a day, beginning either 1 or 10 weeks posttransplant, with use continued until 1 year posttransplant. One subgroup supplemented cyclosporine use with pulsed prednisolone acetate 1% dosing, 4 times a day for 4 days every 6 weeks. The incidence of immunologic corneal graft rejection episodes was compared with that in Fuchs’ and keratoconus historical control subjects, who used topical steroids a median of 7 months after penetrating keratoplasty.
Results
Graft rejection episodes occurred earlier and with higher incidence in subjects using cyclosporine 0.05% compared with historical control subjects who used steroids for a longer period of time (P<0.0001). Cyclosporine subjects who pulse-dosed prednisolone had a significantly higher incidence of graft rejection compared with those who did not pulse steroids (P = 0.04).
Conclusion
The results suggest that 4 times daily dosing with topical cyclosporine 0.05% is not as effective as use of topical prednisolone acetate 1% for prevention of graft rejection episodes in low-risk corneal transplants, and that periodic pulsing with corticosteroids may increase the risk of rejection episodes.
Posted by mmiraftab at 11:19 AM | Comments (0)
The RPS Adeno Detector for Diagnosing Adenoviral Conjunctivitis
Ophthalmology Volume 113, Issue 10 , October 2006, Pages 1758-1764
To compare the sensitivity, specificity, and accuracy of the RPS Adeno Detector (Rapid Pathogen Screening Inc., South Williamsport, PA) against both viral cell culture with confirmatory immunofluorescence staining (CC-IFA) and the polymerase chain reaction (PCR) for diagnosing adenoviral conjunctivitis.One hundred eighty-six consecutive patients from 5 clinical centers seeking treatment within 1 week of developing a red eye and thought to have acute conjunctivitis.The RPS Adeno Detector is a 10-minute in-office lateral flow immunoassay. Patients were tested with the RPS Adeno Detector, CC-IFA, and PCR to detect the presence of adenovirus.Compared with CC-IFA, the RPS Adeno Detector was 88% sensitive and 91% specific at detecting adenoviral conjunctivitis. Using PCR as a reference method, the sensitivity of the RPS Adeno Detector increased to 89% and the specificity increased to 94%. Compared with PCR, CC-IFA was found to be 91% as sensitive and 100% as specific.The RPS Adeno Detector demonstrated sufficient sensitivity and specificity to be used in the physician’s office for the detection of adenoviral conjunctivitis.
Posted by mmiraftab at 11:15 AM | Comments (0)
Hyperglycemia after Repeated Periocular Dexamethasone Injections in Patients with Diabetes
Ophthalmology Volume 113, Issue 10 , October 2006, Pages 1720-1723
Each ocular injection with dexamethasone was followed around 6 hours later by an increase of blood glucose up to a median doubling from baseline (+100% increase) followed by falls until the next injection, toward a median 13% increase from baseline before the next ocular injection. Older age (P<0.05), duration of diabetes (P = 0.01), and microangiopathy or macroangiopathy (P = 0.01) were associated with higher blood glucose rises. Using a 14-mmol/l threshold for intervention, the probability of requiring additional hypoglycemic treatment during ocular steroid therapy in patients with HbA1c >7.5% and up to 7.5% was 100% and 60%, respectively.
Conclusions
Periocular injections with dexamethasone in patients with type 2 diabetes induce a marked hyperglycemic effect, similar to that observed during intravenous pulse methylprednisolone.
Posted by mmiraftab at 11:12 AM | Comments (0)
Intravitreal Bevacizumab (Avastin) in the Treatment of Proliferative Diabetic Retinopathy
Ophthalmology Volume 113, Issue 10 , October 2006, Pages 1695-1695
No significant ocular or systemic adverse events were observed. All patients with neovascularization demonstrated by fluorescein angiography (44/44 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 1 week after the injection. Complete resolution of angiographic leakage of neovascularization of the disc was noted in 19 of 26 (73%) eyes, and leakage of iris neovascularization completely resolved in 9 of 11 (82%) eyes. The leakage was noted to diminish as early as 24 hours after injection. In addition to the reduction in angiographic leakage, the neovascularization clinically appeared to involute in many patients with a reduction in the caliber or presence of perfused blood vessels. In 2 cases, a subtle decrease in leakage of retinal or iris neovascularization in the fellow uninjected eye was noted, raising the possibility that therapeutic systemic levels were achieved after intravitreal injection. Recurrence of fluorescein leakage varied. Recurrent leakage was seen as early as 2 weeks in one case, whereas in other cases, no recurrent leakage was noted at last follow-up of 11 weeks.
Conclusions
Short-term results suggest that intravitreal bevacizumab is well tolerated and associated with a rapid regression of retinal and iris neovascularization secondary to PDR. A consistent biologic effect was noted, even with the lowest dose (6.2 μg) tested, supporting proof of concept. The observation of a possible therapeutic effect in the fellow eye raises concern that systemic side effects are possible in patients undergoing treatment with intravitreal bevacizumab (1.25 mg), and lower doses may achieve a therapeutic result with less risk of systemic side effects. Further study is indicated.
Posted by mmiraftab at 11:09 AM | Comments (0)
Lucentis more effective than verteporfin therapy in treating predominantly classic wet AMD
NEJM, Oct. 5, 2006
After two years of monthly injections, this multi-center trial shows that 94.3 percent of patients given 0.3 mg of ranibizumab and 96.4 percent given 0.5 mg lost fewer than 15 letters, compared to 64.3 percent in the verteporfin group. Mean visual acuity increased by 8.5 letters in the 0.3-mg group and 11.3 letters in the 0.5-mg group, while the verteporfin group experienced a mean decrease of 9.5 letters.
Posted by kjalali at 04:13 AM | Comments (0)
Two-year results: Lucentis prevents vision loss in more than 90 percent of patients with wet AMD
NEJM, Oct. 5, 2006
Maintaining vision was defined in this phase 3 clinical study as a loss of less than 15 letters of visual acuity. In contrast, 52.9 percent of placebo-treated patients maintained vision. Mean increase in visual acuity was 5.4 letters in the group receiving 0.3 mg of ranibizumab and 6.6 letters in the 0.5 mg group, while placebo-treated patients lost an average 14.9 letters.
Posted by kjalali at 04:03 AM | Comments (0)
October 13, 2006
Five-year results in one cohort show CK effect regressed in hyperopes
OSN U.S. EDITION September 15, 2006
Jason S. Ehrlich, MD, PhD discussed the results in the Stanford University cohort of the multicenter clinical trial for Food and Drug Administration premarket approval of CK with the ViewPoint CK system from Refractec. The multicenter study, the results of which were published in 2002 in Ophthalmology, included 355 eyes at 13 centers. At 1 year, results from the trial were “very promising,” Dr. Ehrlich said during his presentation. The FDA-approved labeling of CK calls CK a temporary procedure, with treatment of presbyopia lasting 1 to 3 years.
Uncorrected visual acuity was better than 20/40 in 92% of patients, with a mean manifest refraction spherical equivalent within ±1 D of emmetropia in 90% of patients. About 90% of patients were within ±1 D of the intended refraction of plano.
Stanford cohort results
The prospective Stanford University study looked at surgeries performed by a single surgeon. The university enrolled 25 eyes of 14 patients in the initial multicenter study. Mean age of the patients was 55.5 years.
At 24 months post-op, 64% of those tested had 20/20 or better uncorrected visual acuity; 95% had 20/40 or better uncorrected visual acuity, Dr. Ehrlich said.
As we get out to 60 months, there’s a significant regression toward the preop spherical equivalent refraction,” he said.
Regarding safety, Dr. Ehrlich said 27% of the 11 patients at the last follow-up were seeing 20/20 or better uncorrected and 64% were seeing 20/30 or better. One eye had developed a significant cataract, which is not surprising considering the cohort’s age group, Dr. Ehrlich said. The mean cylinder was more than ±0.25 D, he said.
Posted by aman at 10:34 PM | Comments (0)
Aloe-vera-derived sugar inhibits corneal scarring
OSN EUROPE/ASIA-PACIFIC EDITION October 2006
Dr. Angunawela, of St. Thomas’s Hospital, London, studied the use of the aloe-vera-derived sugar, mannose-6-phosphate (M6P) in refractive surgery.
Key to the scarring and haze formation following corneal injury is the transformation of passive keratocytes into fibroblasts and in particular myofibroblasts,” he said. “This process is typical of the human adult organism, while in the embryo healing occurs without scarring.”
The balance between scar-free regenerative healing and healing with scarring hinges on the mix of cytokines released during tissue injury, and in particular on the TGF-beta family of cytokines, he explained
TGF is an obvious target for the modulation of corneal wound healing.
The M6P, which binds competitively to the same cell receptor as the TGF-beta family, competitively antagonizes its pro-scarring actions and therefore reduces or stops scarring in the skin.”
The effects of M6P were investigated in cultured human corneal cells.
M6P proved to significantly inhibit the effect of TGF-beta on corneal keratocytes, suppressing their differentiation to myofibroblasts. The difference between groups was statistically significant, Dr. Angunawela said.
Posted by aman at 10:13 PM | Comments (0)
SLT still effective in 50% of eyes at 5 years
OSN U.S Edition OCT2006
SLT successfully reduces IOP as a primary or secondary treatment,” Dr. Yadav said. “IOP reduction is very strongly related to baseline IOP, and the probability that an eye will successfully complete 5 years after one treatment of SLT is 0.5.”
Dr. Yadav reported the results of a retrospective study of all 546 eyes treated with SLT at Clayton Hospital in Wakefield, England, from 2000 to 2006. He said IOP before SLT averaged 26.6 mm Hg. IOP decreased an average of 24% at 1 week, 29% at 6 months, 28% at 1 year and 33.8% at 5 years follow-up.
As a primary treatment in 279 eyes with “virgin trabecular meshworks,” there was a 33% mean IOP reduction from baseline at a mean follow-up of 32 months, he said. As a secondary treatment in 167 eyes of patients with glaucoma uncontrolled using one medication, there was a 29% mean IOP decrease at a mean follow-up of 24.6 months.
The researchers also found a 50% probability of survival at 5 years for SLT-treated eyes. “Although there was a steep attrition rate in the early period … after 3 years, the rate drops to less than 5% per year,” Dr. Yadav said.
Posted by aman at 09:56 PM | Comments (0)
White-to-white distance potential predictor of pupil size changes
OCULAR SURGERY NEWS U.S. EDITION October 15, 2006
Eyes were divided into two groups based on white-to-white measurements. Thirty-four eyes had a white-to-white measurement of less than 12.5 mm, and 12 eyes had a white-to-white measurement of 12.5 mm or more. All measurements were made using the IOLMaster (Carl Zeiss Meditec) under scotopic, mesopic low and mesopic high illumination conditions both pre- and postoperatively, with an enclavation distance of 8.5 mm, she said.
The researchers found that eyes with a white-to-white distance less than 12.5 mm had a 6.1% mean pupil size reduction, compared to a 14% mean reduction in eyes with a white-to-white distance of 12.5 mm or more.
The difference was particularly pronounced under mesopic low illumination, Dr. Buchner noted.
“A restriction of the pupil size in eyes with larger white-to-white distance under mesopic low and high illumination conditions can be expected and, therefore, may potentially reduce incidence of photic phenomena,” she said.
Posted by aman at 09:48 PM | Comments (0)
Vitreous may contribute to accommodation in 1CU IOL, study suggests
OCULAR SURGERY NEWS U.S. EDITION October 15, 2006
Ms. Hancox and coworkers analyzed the movement of the HumanOptics 1CU lens in 20 eyes during a postoperative period of 18 to 24 months. The purpose of the study was to investigate the effects of previous vitrectomy on the movement of the lens, as well as the effects of capsular fibrosis, postoperative time and Nd:YAG laser capsulotomy.
Seven of the 20 patients had undergone vitrectomy before cataract surgery, and their results were compared to those of patients who had not undergone vitrectomy, Ms. Hancox said.
Significantly more pilocarpine-induced forward movement (268 µm) was seen in the nonvitrectomized eyes, compared with movement of 80 µm in the vitrectomized eyes, Ms. Hancox said.
Vitrectomized eyes had significantly less IOL movement than nonvitrectomized eyes, suggesting a contribution of the vitreous to accommodation in pseudophakic eyes,
The study also found more movement of the lens in eyes with a YAG capsulotomy than in those without .
There was no significant change in the amount of IOL movement over time, she said, suggesting that the 1CU has limited movement even before capsular fibrosis takes place.
Posted by aman at 09:41 PM | Comments (0)
October 10, 2006
Surgical-glove–related diffuse lamellar keratitis after laser in situ keratomileusis: Long-term outcomes
JCRS Pages 1702-1709 (October 2006)
To study the long-term refractive results in eyes that developed surgical-glove–related diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK).
This retrospective review analyzed an epidemic of surgical-glove–related DLK over a 5-month period at a single hospital. Twenty-four eyes (24 patients) that developed DLK (DLK group) were compared to 30 eyes (30 consecutive patients) that had surgery during the same time but had an uneventful postoperative course (control group). Follow-up was 12 months in all cases.
Conclusions
Early diagnosis and appropriate treatment of glove-related DLK provided visual outcomes that were similar to those in eyes with an uneventful postoperative course. These good results are consistent with those in studies of classic DLK
Posted by alireza habibollahi at 11:23 PM | Comments (0)
Effect of lens epithelial cell aspiration on postoperative capsulorhexis contraction with the use of the AcrySof intraocular lens: Randomized clinical trial
JCRS Pages 1621-1626 (October 2006)
28 of 59
United Kingdom,To determine whether aspiration of lens epithelial cells (LECs) from under the anterior capsule reduces postoperative contraction of the capsulorhexis apertures and anterior capsule opacification (ACO) .
Conclusion
Aspiration of LECs from the anterior capsule was a safe procedure that reduced capsulorhexis aperture contraction 3 months after cataract surgery.
Posted by alireza habibollahi at 11:17 PM | Comments (0)
Cataract surgery management in patients taking tamsulosin: Staged approach
JCRS Pages 1611-1614 (October 2006)
To demonstrate a progressive approach to the problems of intraoperative floppy-iris syndrome (IFIS) in cataract surgery caused by tamsulosin.
patients who were using tamsulosin had cataract surgery.Patients received standard preoperative eyedrops consisting of topical cyclopentolate, phenylephrine, and diclofenac. When necessary, intracameral phenylephrine, iris hooks, or both were used. All cases were videotaped and analyzed for surgical complications.
Results
The degree of IFIS manifested varied widely in the patients: 53% had good mydriasis preoperatively ; however, in 43%the pupils constricted later during surgery (type 2 pupils). 38% had a mid-dilated pupil that sometimes constricted later (type 3 pupils), and 3 eyes (9%) had poor dilation at the beginning of surgery (type 4 pupils). There were no surgical complications attributed to IFIS. Full IFIS manifestation varied between eyes of the same patient. Some eyes required no intervention. Intraoperative pupil constriction was reversed with intracameral phenylephrine, which also prevented iris prolapse and billowing and further pupil constriction in patients who had medium to small pupils preoperatively.
Conclusion
A staged approach in managing pupils in IFIS and using phenylephrine intracamerally when necessary effectively prevented serious intraoperative complications.
Posted by alireza habibollahi at 11:12 PM | Comments (0)
Using endoscopy to teach cataract surgery
JCRS Pages 1606-1610 (October 2006)
Current methods of teaching cataract surgery include lectures, wet-lab sessions, and participation in real surgery. We describe a new method using a microendoscopic cyclophotocoagulation device during phacoemulsification cataract extraction and posterior chamber intraocular lens (IOL) implantation in 4 eyes of 4 patients. Endoscopic visualization during surgery aided in construction of the corneal incision, location of the capsulorhexis edge, and estimation of the lens groove depth. It also demonstrated clinical findings not observable with the surgical microscope such as misplaced IOL haptics and residual lens cortex. Use of the endoscope enhanced the educational value of the surgery and the final surgical outcome.
Posted by alireza habibollahi at 11:09 PM | Comments (0)
Preoperative use of atropine to prevent intraoperative floppy-iris syndrome in patients taking tamsulosin
JCRS Pages 1603-1605 (October 2006)
Intraoperative floppy-iris syndrome (IFIS) is a recently identified condition associated with phacoemulsification in patients using the α1-antagonist tamsulosin (Flomax). Patients with IFIS manifest a triad of symptoms during cataract surgery: fluttering and billowing of iris stroma due to normal fluid movement, propensity of iris prolapse to phaco and side-port incisions, and progressive constriction of the pupil. Prevention of IFIS by withdrawing tamsulosin preoperatively has not shown consistent benefit. preoperative administration of atropine,effectively prevented the occurrence of IFIS in patients receiving tamsulosin.
Posted by alireza habibollahi at 11:02 PM | Comments (0)
October 09, 2006
Effect of Topical Prednisolone and Diclofenac on the Short-Term Change in Morphology of Posterior Capsular Opacification
AJO OCT 2006
Thirty-nine eyes of 32 patients with pronounced, regeneratory posterior capsule opacification (PCO) were included. The patients were treated topically with prednisolone and diclofenac (verum) or with lubricating eye drops (placebo) four times daily for one week. After a wash-out period of two weeks the patients received the contrary treatment also four times daily for one week. Digital retroillumination images were taken at day one, three, five, eight, and 15 of each medication period. The changes in the size of 4675 Elschnig pearls were analyzed.
Results
The mean cumulative area of all marked pearls/eye and follow-up was 1.2 mm2 (range: 0.1 mm2 to 3.2 mm2). The mean pearl size was 12809 μm2 (range: 60 μm2 to 1.08 × 106 μm2). Between the follow-up examinations, 1274 pearls disappeared (mean: 33 pearls/eye, range: five to 69 pearls; 27%) and 777 newly formed pearls appeared (mean: 20 pearls/eye, range: three to 53 pearls; 20%). There was no statistically significant difference in pearl size change and in number of disappeared and newly appeared pearls between the verum and the placebo treatments.
Conclusions
Topical prednisolone and diclofenac do not influence the short-term change of Elschnig pearls. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly among eyes.
Posted by aman at 11:48 PM | Comments (0)
Evaluation of Lens Epithelial Cell Migration In Vivo at the Haptic-Optic Junction of a One-Piece Hydrophobic Acrylic Intraocular Lens
Posted by aman at 11:38 PM | Comments (0)
Is Diabetes Mellitus a Risk Factor for Open-Angle Glaucoma?: The Rotterdam Study
OPHTHALMOLOGY OCT 2006
Participants ages ≥55 years from the Rotterdam Study, The Netherlands
Participants at risk for incident OAG (iOAG) underwent at baseline (1990–1993) and follow-up (1997–1999) the same ophthalmic examination including intraocular pressure (IOP) measurement, visual field testing, and simultaneous stereo optic disc photography. At baseline, diabetes mellitus was defined as the use of antidiabetic medication and/or a random or postload glucose value ≥11.1 mmol/l. The diagnosis of OAG was made with an algorithm based on optic disc measures and visual fields, independent of the IOP.
Results
In total, 3837 participants without OAG at baseline were reexamined. After a mean follow-up time of 6.5 years, iOAG developed in 87 persons. The relative risk of iOAG associated with baseline diabetes was 0.82 (0.33–2.05). After adjustment for age, gender, follow-up time, IOP, IOP-lowering treatment, body mass index, and systemic hypertension, the relative risk of iOAG was 0.65 (0.25–1.64).
Conclusions
In this prospective population-based study, diabetes mellitus was not a risk factor for OAG.
Posted by aman at 11:32 PM | Comments (0)
Management of Complications after Insertion of the SmartPlug Punctal Plug: A Study of 28 Patients
OPHTHALMOLOGY OCT 2006
Twenty-eight patients were included in the study; 13 had bilateral involvement. On initial presentation, 18 patients had inflammation, including 17 with canaliculitis and 1 with recurrent acute dacryocystitis. Ten patients had little or no inflammation; all 10 had tearing of the involved eye(s). In 5 patients, complications resolved after office irrigation of the lacrimal drainage system; in a sixth patient, silicone intubation was performed as well. Canaliculotomy was performed in 13 patients (bilateral in 3) and combined with silicone intubation (3 patients). Canaliculotomy was planned in an additional 2 patients. Canaliculitis in 1 patient responded to a course of oral antibiotics; the plug was massaged out of the punctum in a retrograde fashion in another patient. In still another patient, the plugs expressed themselves at the time of planned canaliculotomy. In 4 patients, dacryocystorhinostomy (DCR) with silicone intubation was necessary. Two additional patients refused further treatment including DCR and canaliculotomy; both were lost to follow-up.
Posted by aman at 11:24 PM | Comments (0)
Efficacy of Topical Cyclosporine 0.05% for Prevention of Cornea Transplant Rejection Epis 0.05% for Prevention of Cornea Transplant Rejection Episodes
OPHTHALMOLOGY October 2006
Fifty-two cornea transplant recipients considered low risk for graft rejection.
Primary indications for transplantation were keratoconus, Fuchs’ dystrophy, or nonherpetic, nonvascularized scars. Subjects completely tapered off prednisolone acetate 1% by 13 weeks after transplantation and used topical cyclosporine 0.05% 4 times a day, beginning either 1 or 10 weeks posttransplant, with use continued until 1 year posttransplant. One subgroup supplemented cyclosporine use with pulsed prednisolone acetate 1% dosing, 4 times a day for 4 days every 6 weeks. The incidence of immunologic corneal graft rejection episodes was compared with that in Fuchs’ and keratoconus historical control subjects, who used topical steroids a median of 7 months after penetrating keratoplasty.
Conclusion
The results suggest that 4 times daily dosing with topical cyclosporine 0.05% is not as effective as use of topical prednisolone acetate 1% for prevention of graft rejection episodes in low-risk corneal transplants, and that periodic pulsing with corticosteroids may increase the risk of rejection episodes.
Posted by aman at 11:01 PM | Comments (0)
Efficacy of Laser Trabeculoplasty in Phakic and Pseudophakic Patients With Primary Open-Angle Glaucoma
OPHTHALMIC SURGERY, LASERS & IMAGING 2006; 37(5):394
Retrospective comparative case–control series of 42 eyes (21 pseudophakic eyes and 21 phakic eyes of patients matched for age and gender) with POAG not controlled using medical therapy and treated with laser trabeculoplasty. Success was reduction of intraocular pressure (IOP) of at least 3 mm Hg from baseline and no additional glaucoma surgery or laser treatment.
RESULTS
One year and 2 years after laser trabeculoplasty, there was no significant difference between pseudophakic and phakic eyes in the mean IOP and change from baseline IOP. Success at 12 months was 78% for pseudophakic and 80% for phakic eyes. Kaplan–Meier survival analysis showed no statistically significant difference in success after laser trabeculoplasty comparing phakic to pseudophakic eyes (P = .87).
Posted by aman at 10:45 PM | Comments (0)
Intracameral phenylephrine may aid cataract surgery in patients with floppy iris syndrome
OSN Breaking News
Preoperative treatment with phenylephrine and the addition of intracameral phenylephrine when necessary effectively prevented serious complications in a series of patients, the authors reported.
David Allen, evaluated the efficacy of this approach in 32 eyes of 20 patients undergoing cataract surgery. All patients had been using Flomax (tamsulosin, Boehringer-Ingelheim) for at least 6 months before surgery, according to the study.
Based on the study results, the researchers proposed this "interim algorithm" for managing IFIS patients:
-53% of patients will have large pupils
-half of these will constrict during surgery; phenylephrine will -redilate these pupils and either prevent or reduce re-constriction.
-38% of patients will have a mid-dilated pupil; phenylephrine will not enlarge most of these pupils, but it will either prevent further constriction or will moderately redilate the pupil.
-Roughly 9% of patients will have small pupils, which experienced surgeons can manage using intracameral phenylephrine without using hooks or pupil expanders.
Posted by aman at 10:38 PM | Comments (0)
October 08, 2006
Persistent serous retinal detachment after radial optic neurotomy
Clinical and Experimental Ophthalmology
We report the case of a patient presenting with serous retinal detachment following radial optic neurotomy for central retinal vein occlusion. Initially, the retinal detachment was successfully treated by a second vitrectomy and laser coagulation. After reabsorption of the gas tamponade, a recurrence of the retinal detachment was seen with no detectable retinal break...
Posted by mehdi khanlari at 11:08 PM | Comments (0)
Mutations in the NDP gene: contribution to Norrie disease, familial exudative vitreoretinopathy and retinopathy of prematurity
Clinical and Experimental OphthalmologyOctober , 2006
Two novel mutations within the coding region of the NDP gene were found, one associated with a severe disease phenotypes of Norrie disease and the other with FEVR. A deletion within the non-coding region was associated with only mild-regressed ROP, despite the presence of low birthweight, prematurity and exposure to oxygen...
Posted by mehdi khanlari at 11:07 PM | Comments (0)
Supraorbital nerve block in trabeculectomy surgery: an observational case series
Clinical & Experimental Ophthalmology September/October 2006
Thirteen patients completed a visual analogue pain scale after trabeculectomy with topical anaesthesia and a supraorbital nerve block with 2 mL of lignocaine 2%. Ease of surgery was graded on a scale of 0-5. Inadvertent eye movements and episodes of orbicularis spasm were recorded. Statistical analysis was performed usingstatasoftware. Median pain score (range) during delivery of anaesthesia was 2 (1-5), during surgery was 0 (0-4) and postoperatively was 0 (0-3). Pain scores after surgery were significantly lower than during delivery of anaesthesia (Wilcoxon signed rank test, P = 0.0289). Three subjects had inadvertent eye movements with ease of surgery recorded as 1 of 5 in 12 cases and 2 of 5 in one case. The novel application of this anaesthetic technique offers adequate analgesia in trabeculectomy surgery. However, a larger scale comparative trial is needed to further evaluate the value of this technique.
Posted by mehdi khanlari at 10:56 PM | Comments (0)
Evaluation of the Influence of Corneal Biomechanical Properties on Intraocular Pressure Measurements Using the Ocular Response Analyzer
Journal of Glaucoma
Medeiros, Felipe A. MD, et al. - The Ocular Response Analyzer (ORA) proposes to measure corneal biomechanical properties in vivo by monitoring and analyzing the corneal behavior when this structure is submitted to a force induced by an air jet...Conclusions: ORA IOPCC measurements seem to provide an estimate of IOP that is less influenced by corneal properties than those provided by GAT...
Posted by mehdi khanlari at 10:54 PM | Comments (0)
Use of Triamcinolone Acetonide in the Posterior Capsule Rupture During Cataract Surgery.
Techniques in Ophthalmology. 4(3):96-101, September 2006.
colon; The rupture of posterior capsule during cataract surgery is always the cause of potential severe complications for the patient. This paper reports the use of triamcinolone acetonide crystal powder injected into the anterior chamber in the management of cataract surgery complications, when posterior capsule rupture occurred. The corticosteroid powder is useful in these situations because of its capability to link prolapsed vitreous fibrils in the anterior chamber and so helping to remove those radically. Triamcinolone is a valid aid in the postsurgical time because of its antiphlologistic and antiedemigenous properties. Aside from these, a new personal surgical technique, with a 25-gauge infusion into the anterior chamber (reflow technique), will be shown to better manage this event.
Posted by mehdi khanlari at 10:49 PM | Comments (0)
Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions
Clinical and Experimental Ophthalmology
Chandrasekaran, Sujatha, et al. - Conclusions:?Optic nerve sheath fenestration is safe and effective in stabilizing or improving VF and VA in the short to medium term. Patients with mild VF loss improved following surgery, and patients with severe VF loss stabilized following surgery...
Posted by mehdi khanlari at 10:48 PM | Comments (0)
EXERCISE AND GLAUCOMA
GLAUCOMA TODAY OCT 2006
Regular exercise improves cardiovascular fitness and can lower systemic blood pressure. Because systemic hypertension is often cited as a risk factor for glaucoma,30,31 one may hypothesize that regular exercise could modify this risk. Exercise can cause an immediate elevation and subsequent decline of IOP to below baseline.32-34 In normal eyes, autoregulation during exercise seems to maintain a consistent rate of blood flow to the optic nerve.32 It is unknown whether glaucomatous eyes have similar abilities. Chronic exercise probably contributes to a modest lowering (1 to 2 mm Hg) of IOP35-39 in one-third of normal eyes,36 although one study reported as much as a 4-mm Hg lowering effect.On the other hand, one cautionary report described three young adults with advanced glaucomatous optic neuropathy who had exercise-induced visual loss, possibly due to a vascular steal phenomenon.41 Despite this hypothetical risk, it appears that regular exercise can be mildly effective in lowering IOP in some people. There are obviously many additional health-related reasons to maintain a regular exercise regimen
Posted by mehdi khanlari at 10:18 PM | Comments (0)
Scleral melting 16 years after pterygium excision with topical Mitomycin C adjuvant therapy
Contact Lens and Anterior Eye
Conclusion: Long-term complication of pterygium excision with adjuvant topical Mitomycin C may occur. The case shows that early detection and recognition of the complication can be sight saving...
Posted by mehdi khanlari at 10:17 PM | Comments (0)
Phase 3 studies show ranibizumab prevents vision loss in wet AMD patients
OSN SuperSite Top Story 10/5/2006
Two phase 3 clinical studies of ranibizumab show that the drug prevents vision loss in more than 90% of patients who have exudative age-related macular degeneration....Researchers randomized 716 patients to receive either 0.3 mg or 0.5 mg of ranibizumab (Lucentis, Genentech) or placebo injections once monthly over 2 years. All patients had minimally classic or occult choroidal neovascularization (CNV), according to the study....investigators found that 90% of ranibizumab-treated patients maintained vision, defined as a loss of less than 15 letters of visual acuity (VA). In contrast, 53% of placebo-treated patients maintained vision....Additionally, 24.8% of 0.3 mg-treated patients and 33.8% of 0.5 mg-treated patients gained at least 15 letters of VA, vs. 5% of the control group (P < .001). Patients receiving 0.3 mg of ranibizumab gained an average 5.4 letters of vision, and those receiving 0.5 mg gained an average 6.6 letters. In contrast, placebo-treated patients lost an average 14.9 letters of VA, according to the study.....
Posted by mehdi khanlari at 10:13 PM | Comments (0)
Does PXF Necessitate a CTR?
JCRS today Sep 2006
There remains a controversy among leading surgeons with respect to the indications for the capsular tension ring (CTR) in the patient with pseudoexfoliation (PXF) undergoing cataract surgery. Although some recommend that every PXF patient have a CTR, others believe that a ring should be inserted only when there is clear evidence of zonular weakness. I am in the latter group for several reasons.
First, the primary defect in PXF is located within the zonules. A ring within the capsular bag just does not seem likely to arrest progressive zonular damage. Advocates of the CTR state that its resistance to contracture of the bag decreases the chance of zonulysis. They add that the device may also make repositioning a dislocated IOL/bag complex easier, which may be true. The facts, however, are that we have operated on many thousands of PXF patients and that IOL/bag dislocation is extremely rare. Is it worth the extra time, effort, and cost to treat all for the sake of a few? While we endorse this prophylactic approach for endophthalmitis, there is an enormous difference in the degree of devastation to the eye when comparing a subluxated IOL to infection.
Moreover, there is a slight downside to implanting the CTR. Brian Little, MD, and colleagues in Sidcup, UK, have published a case of a CTR inadvertently placed in the anterior chamber.1 Ricardo Gliken, MD, of Argentina has published on a capsular break during the CTR's insertion.2 Moreover, Iqbal Ike Ahmed, MD, of Toronto and colleagues have demonstrated the stress on the remaining zonules that can occur during the ring's insertion,3 which is why the capsular bag must be fully inflated with viscoelastic to facilitate the CTR's safe advancement. A famous European surgeon, who shall remain nameless, told me that he has dehisced the remaining zonules during the CTR's insertion. The complication resulted in the loss of the entire capsular bag. In addition, Lisa Arbisser, MD, of Davenport, Iowa, has presented a case in which the ring fractured during insertion.4 Furthermore, the mere presence of a CTR makes cortical removal a bit more difficult.
Certainly, every OR should have a stock of CTRs, because the devices can truly save the day when the surgeon encounters zonular dialysis. The question of implanting a CTR in every PXF eye warrants further discussion, however, and I have invited three of my esteemed colleagues to share their perspectives.
–Robert H. Osher, MD
I. HOWARD FINE, MD
I believe that a CTR should be standard in every patient with PXF. When placed prior to phacoemulsification, but immediately following the capsulorhexis and gentle cortical cleaving hydrodissection, the presence of the ring helps to stabilize the lens during the phaco procedure itself. It also delays capsular phimosis by countering the narrowing forces in the postoperative period.
The biggest advantage of having a CTR in the bag is that it may delay the decentration of the bag/ring/IOL complex as a result of the progressive deterioration of the zonular apparatus. If decentration occurs, one may suture the CTR to the ciliary sulcus to recenter the IOL complex more easily than suturing the haptics to the ciliary sulcus. The technique is noninvasive and atraumatic, and the surgeon may perform the procedure while the IOL is within the capsular bag, whether or not there is a posterior capsulotomy.
ROGER F. STEINERT, MD
Logically, a CTR will reduce the risk of long-term subluxation of the IOL/bag complex in PXF pseudophakia if part of the pathophysiology is progressive contracture of the capsulorhexis. We do indeed see shrinkage of the anterior capsule in cases of late dislocation. We do not know, however, whether this contracture is a cause of progressive zonular loss or only a secondary manifestation of that loss. It is a classic chicken-versus-egg question, and no one knows the answer. Additionally, a CTR is not necessarily benign in asymptomatic, uncomplicated, PXF cataract surgery, because it adds weight to the IOL/bag complex.
The bottom line is that only a long-term, prospective, randomized study can fully elucidate the issue. The other important unknown is natural history. No one knows the rate of late subluxation in uncomplicated surgery. Even if a CTR prevents late subluxation, what rate of this phenomenon justifies the expense and surgical complexity of using the device in every caseŃ1:1,000, 1:100, 1:10?
SAMUEL MASKET, MD
Unfortunately, one cannot rely upon the established literature to help answer whether all cases with PXF syndrome should have a CTR placed at the time of otherwise routine cataract surgery. What is apparent, however, is that a traditional CTR will not reduce the chances for anterior capsular contraction following surgery in most cases of PXF. What, then, would be an advantage? One might speculate that a CTR, if previously placed, would allow the IOL/bag/CTR complex to be easily affixed to the sclera by "lasso" sutures of the ring to the eye wall. Although I have used that technique for a given case, my overall sense is that the number of eyes that would benefit from that maneuver is likely to be low. Moreover, there is no literature available to let us know the rates of complications from inserting CTRs for prophylactic purposes. All in all, I do not consider the costs and risks versus the potential benefits as supporting the routine use of CTRs in all eyes undergoing cataract surgery in the presence of PXF.
Posted by mmiraftab at 11:36 AM | Comments (0)
October 07, 2006
Viscocanalostomy versus trabeculotomy ab externo in primary congenital glaucoma: 1-year follow-up of a prospective controlled pilot study
BJO OCT 2006
Eight patients with bilateral primary congenital glaucoma were enrolled in the study.
After establishing the diagnosis, the more severely affected eye was randomly selected to undergo either trabeculotomy ab externo or viscocanalostomy, whereas the second eye underwent the other surgery 2 weeks after the first. The patients were examined on day 1, week 1, week 4 and thereafter every 4 weeks. Intraocular pressure (IOP) and corneal diameter measurements were obtained at week 1, month 6 and at the last reported follow-up.
Results: The mean (standard deviation (SD)) follow-up period was 12.5 (1.86) months. Preoperative IOP of eyes undergoing trabeculotomy (34.0 (2.6) mm Hg) and that of eyes undergoing viscocanalostomy (32.3 (4.1) mm Hg) showed no significant difference (p>0.1). A drop in IOP was noted in both groups at week 1, month 6 and at the last follow-up visit (p<0.001). Similarly, a decrease in the postoperative vertical and horizontal corneal diameters was noted in the two study groups.
Conclusion: Viscocanalostomy proved to be as effective as trabeculotomy ab externo in lowering IOP. Moreover, it is likely to be a good surgical alternative with a higher long-term success rate in eyes with more aggressive disease.
Posted by aman at 09:30 PM | Comments (0)
Microbiological diagnosis of infective keratitis: comparative evaluation of direct microscopy and culture results
BJO OCT 2006
3298 eyes of 3295 consecutive patients with infective keratitis were evaluated, of which 1138 (34.51%) eyes had fungal growth alone, 1069 (32.41%) had bacterial growth alone, 33 (1%) had Acanthamoeba growth alone, 83 (2.5%) had mixed microbial growth and the remaining 975 (29.56%) had no growth. The sensitivity of KOH wet mount was higher (99.3%; 95% confidence interval (CI) 98.6 to 99.6) in the detection of fungi, 100% (95% CI 90.4 to 100) in the detection of Nocardia and 91.4% (95% CI 75.8 to 97) in the detection of Acanthamoeba) than that of Gram-stained smears (89.2% (95% CI 87.3 to 90.8) in fungi, 87% (95% CI 73.0 to 94.6) in Nocardia and 60% (95% CI 42.2 to 75.6) in the detection of Acanthamoeba) in the detection of fungi, Nocardia and Acanthamoeba. 1764 of 3295 (53.54%) patients presented more than 7 days after onset of illness and 84.69% of the eyes had corneal ulcers with size >2 mm in diameter. Positivities of KOH (44.46%; p<0.001) and Gram-stained smears (77.37%; p<0.001) were found to be higher among eyes with larger ulcers (>2 mm) than among eyes with smaller ulcers (<2 mm).
Conclusion: KOH smear is of greater diagnostic value in the management of infective keratitis, and it is recommended in all clinics without exception for establishing timely treatment.
Posted by aman at 09:26 PM | Comments (0)
Influence of cataract on optical coherence tomography image quality and retinal thickness
BJO OCT 2006
In 29 patients scheduled for cataract surgery, preoperative and postoperative OCT scans were obtained. Cataracts were categorised as nuclear, posterior or cortical. Parameters for image quality (signal-to-noise ratio (SNR)) and signal strength and macular thickness were compared. A three-level expert grading scale was used to evaluate the discriminative abilities of SNR and signal strength.
Results: Nuclear cataracts (n = 12) provided better preoperative scans (higher SNR/signal strength) than posterior (n = 7) and cortical (n = 10) cataracts (p<0.004). Postoperatively SNR and signal strength increased significantly in all patients (p<0.001). The SNR was better at discriminating poor from acceptable and good scans than signal strength (area under the receiver operating curve: 0.879 and 0.810, respectively). Postoperative macular thickness overall showed a significant increase (p = 0.005), most evident in patients with posterior cataracts (p = 0.028).
Posted by aman at 09:17 PM | Comments (0)
Surgical embolus removal in retinal artery occlusion
BJO OCT 2006
Prospective study of seven patients with RAO of <36 h duration. All eyes underwent pars plana vitrectomy and a longitudinal incision of the anterior wall of the occluded arteriole in an attempt to remove the embolus. Outcome measures included visual acuity and arteriolar reperfusion, as evaluated with fluorescein angiography.
Results: Surgical removal of the embolus was achieved in six of the seven (87.5%) patients, visual acuity improved from a median of 20/400 (range: hand movements 20/25) to 20/40 (range: hand movements 20/25), and reperfusion of the occluded vessel was angiographically confirmed in four of the six patients in whom the embolus was successfully removed.
Posted by aman at 09:12 PM | Comments (0)
The course of surface deposits on a hydrophilic acrylic intraocular lens after implantation through a hexagonal cartridge
BJO OCT 2006
Surface deposits were observed on the posterior surface of the ACR6D SE IOLs that were injected through a hexagonal cartridge filled with sodium hyaluronate 1%. All the patients were examined 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. The location of the deposits was recorded and photographed. The patients were questioned about blurred vision, glare or halos.
Results: Linear or curly deposits were detected on the posterior surface of the IOL in six patients. In four patients, the deposits were peripheral and were observed 1 week postoperatively. In two patients, the deposits were noticed immediately after implantation. In one eye, they were misinterpreted as a crack in the IOL’s optic and were left in the eye. In the second patient the deposits were removed immediately after implantation with forceps. The deposits that were left after implantation (five eyes) did not resolve during 1 year of follow-up. None of the eyes developed abnormal inflammatory reaction. In three eyes the best-corrected visual acuity (BCVA) was 6/6. In the other three eyes the BCVA was 6/12. None of the patients experienced any visual disturbance.
Posted by aman at 09:07 PM | Comments (0)
Moraxella keratitis: predisposing factors and clinical review of 95 cases
BJO OCT 2006
A retrospective analysis was carried out of culture-proved cases of Moraxella keratitis from hospital records during a 10-year period .
95 episodes of Moraxella keratitis were identified in 92 patients. 3 (3.2%) patients had recurrent keratitis. The mean age of the patients was 70 (range 17–93) years. Multiple predisposing factors were identified in 23 (24%) eyes, including corneal graft (n = 15), previous herpes keratitis (n = 15) and eye lid diseases (n = 15). Adjunctive procedures were carried out in 42 eyes. These included botulinum toxin injection (n = 17), tarsorraphy (n = 12), penetrating keratoplasty (n = 8), enucleation (n = 3), tissue adhesive and bandage contact lens (n = 4), and conjunctival flap (n = 5). Polymicrobial infection was present in 17 eyes. Final visual acuity was counting finger or less in 25 (26%) eyes.
Conclusions: Local ocular predisposing factors play a major role in Moraxella keratitis. This infection has a poor visual outcome attributable to both the nature of the infection and the predisposing factors.
Posted by aman at 09:01 PM | Comments (0)
October 06, 2006
Comparison of Complication Rates and Postoperative Astigmatism Between Nylon and Mersilene Sutures for Corneal Transplants in Patients with Fuchs Endothelial Dystrophy
Cornea. 25(5):533-539, June 2006
Conclusions: During the first years after corneal transplant surgery, Mersilene sutures are associated with a higher risk of complications and more interventions to correct suture-related problems. However, after 2 years, the grafts seem to be able to retain Mersilene sutures with less risk of suture-related complications as compared with grafts with retained nylon sutures. These favorable long-term effects of Mersilene sutures may outweigh its short-term disadvantage in patients with Fuchs endothelial dystrophy.
Posted by mmiraftab at 02:29 PM | Comments (0)
Wound Dehiscence After Penetrating Keratoplasty: Clinical Characteristics of 51 Cases Treated at Bascom Palmer Eye Institute
Cornea. 25(5):524-529, June 2006
All dehiscence occurred at the graft-host junction with an average of 5 hours of dehiscence, but no site preference was identified. Dehiscence occurred because of trauma (53%), suture-related complications (27%), infectious keratitis (8%), and spontaneous wound separation (12%). Twelve patients had either intraocular lens dislocation or expulsion; 42 patients underwent primary repair; 7 patients underwent primary PK; and 1 patient underwent primary evisceration. Surgical details were unavailable for 1 patient. Final visual acuity ranged from 20/20 to no light perception. Acuity was unavailable for 2 patients. Visual acuity was 20/200 or better in 23 patients (47%) and less than 20/200 in 26 patients (53%). Two patients (4%) had no light perception. The visual acuity of 13 patients (27%) was 20/40 or better at their last clinic visit. Comparison of predehiscence and postdehiscence visual acuity showed that 23 eyes (54%) had comparable vision after dehiscence, 11 eyes (25%) had improved vision, and 9 eyes (21%) had worsening of vision.
Conclusions: These observations show that graft dehiscence can occur for a variety of reasons after PK, including trauma, infectious keratitis, suture failure, or spontaneous wound separation. The graft-host interface remains vulnerable after corneal transplant and is a potential area for wound dehiscence even many years after keratoplasty. Nevertheless, comparable or even improved vision is possible after wound dehiscence.
Posted by mmiraftab at 02:27 PM | Comments (0)
Corneal Endothelium Evaluation With 2 Noncontact Specular Microscopes and Their Semiautomated Methods of Analysis
Cornea. 25(5):501-506, June 2006
Average cell size (ACS), endothelial cell density (ECD), coefficient of variation (CV), and hexagonality values were independently calculated by two examiners with the Topcon SP 2000P Image-NET retraced method and the Konan CC7000 center method in 49 normal subjects. Interexaminer reproducibility and correlation between instruments/methods were assessed through 95% limits of agreement, intra-class correlation coefficient (ICC), Pearson correlation coefficient, and Spearman rank test.
Results: Interexaminer reproducibility was good for ACS and ECD measurements (ICC> 0.85) but weak for CV and hexagonality (ICC < 0.65). Significantly higher ACS and lwer ECD values (P <0.05) were obtained with the Topcon in comparison with the Konan method by both examiners. ACS and ECD mean differences were respectively, +26[mu]m2 and -184 cell/mm2 for examiner 1 and +36[mu]m2 and -228 cell/mm2 for examiner 2. No significant difference (P > 0.05) between instruments/methods was found in CV or hexagonality values; however, the correlation for these parameters was low (r < 0.20).
Conclusions: Either instrument or method allows reproducible and accurate ACS and ECD measurements on normal corneas, but the difference between the two instruments is systematic and significant. The difference found were not clinically meaningful however for research/longitudinal study purposes, the data collected with the two systems cannot be used interchangeably.
Posted by mmiraftab at 02:25 PM | Comments (0)
Effect of Latanoprost on the Diurnal Variations in the Intraocular and Ocular Perfusion Pressure in Normal Tension Glaucoma
Journal of Glaucoma. 15(5):354-357, October 2006
Patients and Methods: Twenty-two eyes from 22 patients with NTG were used for the study. The diurnal variations in the IOP and blood pressure (BP) were measured every 3 hours without therapy, and then the patients were treated with latanoprost (0.005%) once daily for more than 12 weeks. The diurnal variations in the IOP and BP under medication were again measured every 6 hours. The diurnal variation of IOP for 24 hours, mean diurnal IOP, maximum IOP, minimum IOP, range of variation in IOP, OPP, and BP were compared between the baseline and after treatment by means of a paired t test.
Results: At 3 months after the start of the latanoprost treatment regimen, the IOP showed a statistically significant decrease at every assessed time point over 24 hours (P<0.001). Latanoprost significantly reduced the mean diurnal IOP, maximum IOP, minimum IOP, and mean range of variation in the IOP values from baseline (P<0.001, <0.001, <0.001, and 0.009, respectively). OPP after treatment showed no significant difference at any assessed time points from the baseline (P>0.1). Latanoprost did not significantly alter the mean diurnal OPP (P>0.1), and BP (P>0.5) from the baseline.
Conclusions: Latanoprost was thus found to significantly reduce IOP over 24 hours, whereas it does not affect OPP and BP in NTG patients. Therefore, it may be a useful medication for NTG.
Posted by mmiraftab at 02:23 PM | Comments (0)
Effect of Sublingual Application of Cannabinoids on Intraocular Pressure: A Pilot Study
Journal of Glaucoma. 15(5):349-353, October 2006
Patients and Methods: A randomized, double-masked, placebo-controlled, 4 way crossover study was conducted at a single center, using cannabis-based medicinal extract of [DELTA]-9-THC and CBD. Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM of 5 mg [DELTA]-9-THC, 20 mg CBD, 40 mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects.
Results: Two hours after sublingual administration of 5 mg [DELTA]-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P=0.026). The IOP returned to baseline level after the 4-hour IOP measurement. CBD administration did not reduce the IOP at any time. However, the higher dose of CBD (40 mg) produced a transient elevation of IOP at 4 hours after administration, from 23.2 to 25.9 mm Hg (P=0.028). Vital signs and visual acuity were not significantly changed. One patient experienced a transient and mild paniclike reaction after [DELTA]-9-THC administration.
Conclusions: A single 5 mg sublingual dose of [DELTA]-9-THC reduced the IOP temporarily and was well tolerated by most patients. Sublingual administration of 20 mg CBD did not reduce IOP, whereas 40 mg CBD produced a transient increase IOP rise.
Posted by mmiraftab at 01:41 PM | Comments (0)
October 05, 2006
Intracameral phenylephrine may prevent tamsulosin-associated IFIS during cataract surgery
JCRS, October 2006
Although the degree of intraoperative floppy-iris syndrome (IFIS) varied widely in 20 patients (32 eyes), intraoperative pupil constriction was reversed with intracameral phenylephrine. In patients with medium to small pupils preoperatively it also prevented iris prolapse and billowing and prevented further pupil constriction. No surgical complications attributed to IFIS occurred in this series.
Posted by kjalali at 04:39 AM | Comments (0)
Lilly weighs options following FDA request for additional trial for new diabetic retinopathy treatment
INDUSTRY NEWS
Eli Lilly and Company announced in a press release that an additional, Phase III clinical trial would take up to five years to complete and that the future of the drug is now in doubt. The U.S. Food and Drug Administration wants additional efficacy data before it will consider approving Arxxant (Ruboxistaurin) for the treatment of moderate to severe nonproliferative diabetic retinopathy.
Posted by kjalali at 04:37 AM | Comments (0)
Optic disk size measurements using HRT II, Stratus OCT and funduscopy are not interchangeable
AJO, September 2006
Among the 48 patients in this prospective nonrandomized study, there was a large range of differences in estimating disk size with the three methods. There was also poor agreement in classifying disk size as small, average or large. Currently, estimates of absolute and relative disk size can only be defined separately for each method.
Posted by kjalali at 04:33 AM | Comments (0)
October 02, 2006
Bacterial contamination in the anterior chamber after povidone–iodine application and the effect of the lens implantation device
JCRS Pages 1691-1695 (October 2006)
To assess the incidence of anterior chamber bacterial contamination during cataract surgery, and compare results of injector implantation and forceps implantation of foldable intraocular lenses (IOLs).
Antibiotic eyedrops were not used; however, povidone–iodine 10% solution was used to prepare the eyebrow and eyelids and povidone–iodine 5% to disinfect the ocular surface. A Steri-Drape (3M) was used to surround the eye. Aqueous fluid samples were aspirated from the anterior chamber at the beginning and the end of surgery. The samples were cultured for 14 days under aerobic and anaerobic conditions simultaneously. Cataract surgery was performed using a sutureless, superotemporal, clear corneal phacoemulsification technique. The IOL was implanted with an injector (n = 47) or a forceps (n = 50), with the instrument randomly selected. The frequency of positive bacterial cultures with each implantation method was compared using the Fisher exact test.
Results
Bacteria were found in the conjunctival samples in 21 eyes (21.65%) before povidone–iodine application and in 4 eyes (4.12%) after disinfection. The anterior chamber sample before surgery was culture positive for Staphylococcus epidermidis in 2 eyes and for Micrococcus luteus in 1 eye. After surgery, the culture was positive for S epidermidis in 1 eye (2.15%) in the injector group and 1 eye (2.00%) in the forceps group (P = .74). Neither sample came from an eye that had a positive culture preoperatively. There were no intraoperative complications.
Conclusions
In uneventful clear corneal phacoemulsification, meticulous technique can prevent antibiotic use during surgery. No difference in anterior chamber bacterial contamination was found between IOL implantation using an injector or a forceps.
Posted by alireza habibollahi at 11:37 PM | Comments (0)
Primary intraocular lens implantation in infants: Complications and visual results
JCRS Pages 1672-1677 (October 2006)
This retrospective study comprised 28 children (31 eyes) who had cataract surgery with primary IOL implantation.
The median age at surgery was 2.5 months (range 8 days to 10 months). The median follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV) who had surgery at 8 days and 17 days, respectively, developed intraoperative vitreous hemorrhage; a retinal detachment developed in 1 of the eyes. Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of eyes developed opacification of the visual axis that required additional surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye. Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100). In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1 achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of 20/200 and the rest achieved CF or worse.
Conclusions
After-cataract with membrane formation was the main complication in infants with primary IOL implantation. The glaucoma incidence was low at the last follow-up.
Posted by alireza habibollahi at 11:33 PM | Comments (0)
Effect of total higher-order aberrations on accommodation in pseudophakic eyes
JCRS Pages 1643-1649 (October 2006)
Inclusion criteria included no other eye disorder and a best corrected distance acuity of 20/20 or better 1 month after cataract surgery. All patients had small-incision phacoemulsification followed by in-the-bag implantation of a monofocal intraocular lens (SA60AT, Alcon). All incisions were self-sealing. Accommodation in pseudophakic eyes was measured by the lens-loading method in an examination room under constant illumination. Ocular HOAs were measured using the KR-9000PW Hartmann-Shack wavefront analyzer (Topcon).
Conclusions
Measurement of accommodation in pseudophakic eyes by the lens-loading method using the 1.0 near-vision optotype showed that eyes with larger vertical coma aberrations achieved a larger range of accommodation. In contrast, eyes with larger spherical aberrations had smaller amounts of accommodation. The size of the near-vision optotype may affect accommodation analysis in pseudophakic eyes.
Posted by alireza habibollahi at 11:27 PM | Comments (0)
Correction of hyperopia by intracorneal lenses: Two-year follow-up
JCRS Pages 1657-1660 (October 2006)
patients who had a mean hyperopia of 4.3 diopters (D) (range +2.5 to +6.0 D) received Permavision lenses (Anamed Inc.), which are made of a highly permeable hydrogel with a water content of 78% and a refractive index close to that of corneal tissue (1.376). The Moria M2 microkeratome was used to make a 160 μm corneal flap with a diameter of ±8.5 mm. The intracorneal lens was placed beneath the flap after minimal interface irrigation.
Results
Clinical examination showed mild corneal edema and a myopic shift during the first week postoperatively. the postoperative uncorrected visual acuity was similar to the preoperative best corrected visual acuity (BCVA);various degrees of lens opacification with some degree of corneal haze were seen after uneventful follow-up. Decentration of 0.5 to 1.0 mm was seen in 8.6%, 1 of which had the lens explanted because of significant opacification. Induced astigmatism was evident in 1 eye (−1.5 D). 69.6% were within ±0.5 D of target, and 86.9% were within ±1.0 D (87%). No flap melting or extrusion of the lens was recorded in 24 months of follow-up. Night halos and glare were reported in 3 eyes; all had a lens diameter of 5.0 mm.
Conclusions
Intracorneal hydrogel lenses were tolerated relatively well by stromal tissue, providing a reasonably stable and predictable way to correct moderate hyperopia. However, induced astigmatism, stromal opacification, decentration, and night halos and glare occurred in a significant number of eyes. To ensure safety, deep flap cuts are preferred and these eyes should be watched carefully to avoid decentration of the lens in the early postoperative period.
Posted by alireza habibollahi at 11:16 PM | Comments (0)
Depth of focus in eyes with diffractive bifocal and refractive multifocal intraocular lenses
JCRS Pages 1650-1656 (October 2006)
To evaluate monocular and binocular depth of focus in eyes with different multifocal intraocular lens (IOLs) systems.
Binocular implantation of multifocal IOLs was performed in 3 groups. In the first group received asymmetric Acri.Twin (Acri.Tec) IOLs, a near-weighted 733D in 1 eye and a distance-weighted 737D in the fellow eye. In the second group received a diffractive 811E IOL (Pharmacia). In the third group received a refractive Array IOL (AMO). The visual acuity was tested monocularly and binocularly starting at 6 m in 0.50 diopter (D) defocusing steps.
Results
Distance visual acuity was best in eyes with the distance-dominated 737D IOL; eyes with the other IOLs had comparable results. Binocular distance visual acuity was comparable between the Acri.Twin group and the 811E group. The Acri.Twin group had better distance visual acuity than the Array group (P≤.048). Near visual acuity was best in eyes with the near-weighted 733D, followed by the 737D and the 811E. Patients with Array IOLs had worse visual acuities at reading distance (between 33 cm and 40 cm) (P≤.001). Patients with diffractive bifocal IOLs had better results than patients with refractive multifocal IOLs at reading distance (P≤.018).
Conclusion
The diffractive IOLs performed better than refractive IOLs. Asymmetric-weighted IOLs provided better binocular depth of field.
Posted by alireza habibollahi at 11:11 PM | Comments (0)