Ophthalmology Review: November 2006 Archives

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November 30, 2006

Rates of bacterial endophthalmitis are similar for residents and experienced surgeons

Eyeworld Nov 2006

M.D. Patients that have cataract surgery performed by residents do not have to worry about an increased incidence of infection, according to a study published in the American Journal of Ophthalmology.The study investigators found that between 1983 and 2002, only three cases of bacterial endophthalmitis arose after 2,718 resident-performed cataract extractions at San Francisco General Hospital, falling within the accepted rate of one in 1,000 cases for experienced surgeons. ...All three cases of bacterial endophthalmitis had some commonalities. ... none of the three cases received pre-op antibiotics, and all three received a collagen shield soaked in ciprofloxacin (various manufacturers) immediately after the operation, instead of subconjunctival antibiotics consisting of usually two different antibiotics, as was the norm before 2000. The type of wound and use of a suture did not seem to be an issue, as one of the cases involved a scleral tunnel incision and two cases involved sutured clear corneal incisions....The study also examined whether vitreous loss, a more common complication of cataract surgery, was linked with higher rates of endophthalmitis. Although the study found that rates of vitreous loss were significantly higher for patients who had surgery performed by residents compared with those who had surgery performed by experienced cataract surgeons (6.7% compared with 0.5% to 1.4%), this increase was not associated with a higher rate of endophthalmitis.

Posted by mehdi khanlari at 11:55 PM | Comments (0)

The new challenge for Physicians

Eyeworld Nov 2006

by I. Howard Fine, M.D., Richard S. Hoffman, M.D., and Mark Packer, M.D., F.A.C.S.

....Over the past 20 years, physicians have found themselves in a market-based environment with respect to costs such as rent, salaries for personnel, and equipment and in a socialized environment with respect to reimbursement. This has been the worst of all scenarios. As expenses rose, reimbursement decreased. This was compounded by the effect of the malpractice crisis that continues today, unabated in most places. All of this has led to a dramatic change in physicians’ attitudes.e see physicians emerging from residency and fellowship training looking for jobs rather than careers. Many young physicians are more interested in time off and benefits than they are in being professionally challenged. Early practitioners are more reluctant to take on difficult cases and seem less interested in learning new techniques....There also has been a loss of choice in practice location as the need for access to patients through insurance “panels” restricts young physicians’ entry into certain marketplaces....All of these factors have led to frustration, cynicism, and early retirement. When I arrived in Oregon in 1970, the average age of retirement for ophthalmologists was 70. More recently, it has been 55.What is it going to take to meet the new challenge?
It will require a major change in thinking. Successful ophthalmologists will keep their minds open to new technologies and techniques and maintain a firm commitment to excellence, a desire to stay at the cutting edge, and a willingness to invest in the best facilities, personnel, and equipment.Successful ophthalmologists who will be in practice for the next five or 10 years will be best served by maintaining ownership in a free-standing ambulatory surgery center (ASC). They will use optical and immersion methods of biometry. Accurate IOL power calculations will be essential. They will ascertain their surgically induced astigmatism by vector analysis, and they will perform minimally invasive phacoemulsification using the best equipment, best microscopes, best viscoelastics, and best hand-held instruments, including knives. They will be willing to update their equipment, facilities, and personnel. Finally, they will obtain and maintain the knowledge and skill to achieve good results in spite of complications. These changes sound daunting, but they do not have to be accomplished all at once. Ophthalmologists can start by analyzing their results so they will know where they need to improve. A good place to start is learning how to address pre existing astigmatism, investing in appropriate biometry instrumentation, studying the various lenses available and patients’ responses to them, and approaching colleagues—and even competitors—for joint ventures in surgery centers, or trying to buy into existing free-standing ASCs.Physicians will have to monitor their outcomes, talk to their patients, and determine the best application in their own hands for each of these devices.This necessitates a dramatic change in the doctor-patient relationship. Ophthalmologists will be able to become physicians once again, not just surgeons or technicians. There is going to be a demand and a need for increased communication between doctors and patients. This will entail a new view of informed consent, the management of patient expectations, prolonged post-op follow-up care, a communicated commitment to helping patients achieve their goals, a willingness to go the extra mile, and the knowledge and skill to provide enhancements.
Ophthalmologists will optimally want to provide information regarding all the options for IOL choices. In addition to a discussion of the strengths, weaknesses, and compromises of each IOL, there should be a discussion of the possibility of mixing and matching IOLs and ultimately a recommendation by the ophthalmologist for a specific IOL for a particular patient.The discussions will necessarily contain a detailed analysis of the patient’s needs, desires, and expectations. In our practice, we give patients the statistical data on our ability to meet their demands by telling them what percentage of our patients achieve the goals that they desire.Finally, we still await better analyses of what to do with the new technologies in the presence of corneal disease, macular degeneration, and high myopia with its very confusing track record regarding post-op retinal detachment. These changes represent enormous challenges for the current generation of ophthalmologists who have practiced in the old modality for a number of years. They will have to meet these challenges or be left behind by the marketplace.In spite of all of this, we must never neglect the Medicare patient who cannot afford to pay the added premium for high technology devices. Arthur S.M. Lim, F.R.C.S., Singapore, iterated this very appropriately at the recent Pan Asian Academy of Ophthalmology meeting in Singapore.He said, “Quality eye care for everyone, including those who cannot afford to pay, is an ideal that everyone should support.”We will still be able to provide quality care for Medicare patients and should be willing and committed to do that.
Are you ready for your next challenge?

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

Smoking and Body Mass Index important factors for progression to advanced AMD

Eyeworld Nov 2006

A recent study, conducted by the Age-Related Eye Disease Study Research Group, suggests that smoking and BMI (body mass index) are modifiable factors associated with the progression to advanced age-related macular degeneration (AMD) among patients with early or intermediate AMD.Published in a recent issue of Ophthalmology, the study also suggests that other factors, such as the use of antacids and anti-inflammatory medications are also associated with the progression of the disease among these patients.Using a clinic-based prospective cohort study, the research group set out to explain the relationship between demographic, behavioral, medical as well as non-retinal ocular factors, and the incidence of neovascular AMD and central geographic atrophy (CGA) in the Age-Related Eye Disease Study (AREDS), a randomized trial of antioxidants and zinc supplementation prophylaxis for development of advanced AMD.

Posted by mehdi khanlari at 11:34 PM | Comments (0)

Smoking and Body Mass Index important factors for progression to advanced AMD

Eyeworld Nov 2006

Posted by mehdi khanlari at 11:34 PM | Comments (0)

New sleeve design aims to reduce cataract surgery complications

Eyeworld Nov 2006

A cataract surgeon has created a new sleeve for phacoemulsification that he said will reduce turbulence, help prevent intra-operative floppy iris syndrome (IFIS), and contribute to clearer corneas clearer post-op.John C. Hart Jr., M.D., F.A.C.S., Beaumont Hospital, Royal Oak, Mich., has created a new single-port sleeve in which the fluid comes out of one port instead of two ports. Before he created the new sleeve he slightly modified the sleeve he already was using and discovered that changing the direction of irrigation flow can improve day one visual acuity by reducing trauma to the corneal endothelium.

Posted by mehdi khanlari at 11:22 PM | Comments (0)

Controversies about Endophthalmitis risk reduced with intracameral cefuroxime

Eyeworld Nov 2006

Although many physicians said they find the study magnitude impressive, its results have raised questions—especially in the United States—about the use of an older antibiotic such as levofloxacin and the preparation of the cefuroxime.Study investigators said they used levofloxacin because it was the most widely available fluoroquinolone in Europe when the study began. In the United States, it is more common to use fourth-generation fluoroquinolones gatifloxacin (Zymar, Allergan, Irvine, Calif.) and moxifloxacin (Vigamox, Alcon Laboratories, Fort Worth, Texas).
Investigators also said they feel strongly that newer quinolones should be reserved for treatment of endophthalmitis—not prophylaxis, said David Allen, F.R.C.S., F.R.C.Ophth., Sunderland Eye Infirmary, United Kingdom. Dr. Allen’s center participated in the study.
This counters what might be done in the United States because of problems with methicillin resistant Staphylococcus aureus (MRSA), Dr. Allen said.“We seem to have different populations,” he said.
Practitioners also worry about the off-label use of cefuroxime, which is not available from manufacturers in the dilution that was used in the study. Such a use is also off label in the United States. Investigators received a regulatory exemption for its use in the study. Hospitals typically may have a large volume of cefuroxime, but surgeons only need 1 mg for intracameral injection. “There are concerns about errors with dilution,” Dr. Allen said. “At my hospital, the pharmacy has facilities to prepare it in a sterile way in small syringes, and it has a 15-day shelf life.”,,,,,“If you have a hospital pharmacy, it’s not a problem. If you’re in a surgical center, and if someone is not trained in making dilutions of drugs, errors are possible,” ...“The simplest way of utilizing the antibiotic is going to be the best because reports of devastating complications such as TASS have occurred with dilutional errors and mislabeling of intracameral antibiotics. This involves less mixing, [fewer] recipes, [fewer] suppliers/manufacturers of the drug, and [fewer] people involved in the process,” said Francis S. Mah, M.D., co-medical director, Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh School of Medicine....“The principle of the study will survive for many years, but the antibiotic will change over time. Maybe an intracameral quinolone could be developed now that we have shown it’s easy to implement technique,” Dr. Seal said....“We may be headed toward a shift in paradigm of how we [prevent infections] during cataract surgery,” Dr. Mah said. “This may be something for three to five years down the road, but I don’t think we can say ‘intracameral’ is the standard of care yet.”....“While there are questions about their investigation, the data are clear that we can reduce the chance for infection by placing an agent inside the eye,” Dr. Masket said.

Posted by mehdi khanlari at 12:11 AM | Comments (0)

Airbag dislocates crystalline lens

Eyeworld Nov 2006

While airbags have been known to cause serious eye injuries, a new case of an airbag dislocating a crystalline lens itself shows just how profoundly deployment of the safety measure can affect the eye.
Scott M. Blackmon, M.D., Duke University Eye Center, Durham, N.C., and colleagues reported a case of a 41-year-old woman involved in a head-on collision in her motor vehicle. During the accident, an airbag deployed and struck her in her left eye, posteriorly dislocating her crystalline lens. The case was reported in a recent issue of the Journal of Cataract & Refractive Surgery.
“To minimize devastating visual impairment, physicians should be aware that posterior crystalline lens dislocation, although rare, can occur during airbag deployment,” the authors wrote.

Posted by mehdi khanlari at 12:01 AM | Comments (0)

November 29, 2006

A Double-Masked Study of Nepafenac 0.1% and Ketorolac 0.4% for Pain and Epithelial Healing Following PRK

Eyeworld Nov 2006

To compare two topical NSAIDs for epithelial wound healing and pain control following PRK.Methods: Forty patients received nepafenac 0.1% or ketorolac 0.4%, one dro/contralateral eyes t.i.d., dosed on top of the contact lens for three days. Patients graded pain, burning, irritation, comfort, and photophobia at days 1, 3, 4, 5, and 7Results: Interim results showed no significant difference in pain control and healing. Nepafenac patients had less irritation (1.95 vs. 2.65, P = .0168), burning and stinging (1.86 vs. 3.00, P = .0150), and more comfort at day 3 (2.05 vs. 3.18,Conclusion: Both NSAIDs had similar effects on wound healing and pain control. Nepafenac patients showed greater tolerability following PRK. Additional studies are indicated

Posted by mehdi khanlari at 11:35 PM | Comments (0)

November 27, 2006

NSAID reduces CME, improves vision after cataract surgery

OSN
In a multicenter study, the effect of perioperative application of Acular LS (ketorolac tromethamine 0.4%, Allergan) plus a topical steroid was evaluated and compared to steroid alone, in patients without apparent risk factors undergoing cataract surgery. The study included 546 eyes of 546 patients randomly assigned to receive either ketorolac or placebo pre- and postoperatively. All patients also received prednisolone acetate. The presence of cystoid macular edema was assessed by the masked investigators and by a masked retina specialist who reviewed optical coherence tomography images. The researchers found that ketorolac reduced the incidence of postop retinal thickening, which therefore improved visual outcomes.

Posted by kjalali at 09:10 PM | Comments (0)

November 26, 2006

Valsalva-like Retinopathy Following Hyperopic Laser In Situ Keratomileusis

Ophthalmic Surg Lasers Imaging
A 50-year-old woman presented with unilateral acute loss of vision 15 hours after undergoing bilateral hyperopic laser in situ keratomileusis (LASIK). She denied “straining.” Fluorescein angiography showed no retinal vascular abnormalities but demonstrated blocked fluorescence corresponding with subhyaloid, intraretinal, and subretinal hemorrhages seen clinically in the left eye. YAG laser vitreolysis was performed after noting posterior cortical vitreous thickening with a loculated subhyaloid hemorrhage. Best spectacle-corrected visual acuity was restored to 20/20 by the 2-month follow-up examination. Valsalva-like retinopathy, possibly the result of the rapid rise and fall of intraocular pressure during the microkeratome and suction ring operation, may occur following hyperopic LASIK surgery.

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

Visual Loss Following Dacryocystectomy

Ophthalmic Surg Lasers Imaging
Dacryocystectomy is the surgery of choice for elderly patients with chronic dacryocystitis with a fibrotic sac. Although a simple procedure, it can cause serious complications (however rare) such as visual impairment. A 65-year-old woman who underwent bilateral dacryocystectomy is described. On the first postoperative day, she complained of pain in her left eye. Her visual acuity was light perception in the left eye. Computed tomography scan of the orbit revealed a retrobulbar hematoma on the left eye. The hematoma was drained, but the patient did not regain vision.

Posted by kjalali at 08:16 PM | Comments (0)

Optical Coherence Tomography Findings in Central Retinal Artery Occlusion

Ophthalmic Surg Lasers Imaging
This article describes optical coherence tomography (OCT) findings in patients with central retinal artery occlusion by conducting a retrospective review of two cases. Central retinal artery occlusion shows a distinct pattern on OCT images. In the acute phase, OCT images demonstrate the increased reflectivity and thickness of the inner retina and a corresponding decrease of reflectivity in the outer layer of the retina and retinal pigment epithelium/choriocapillaris layer. Follow-up OCT images demonstrate a decrease in the reflectivity and thickness of the inner retinal layers and a corresponding increase of reflectivity in the outer retina and retinal pigment epithelium/choriocapillaris layer compared with the baseline OCT image, suggesting a generalized atrophy of the neurosensory retina as a late finding. Therefore, the use of OCT may help facilitate prompt recognition of acute and chronic central retinal artery occlusion.

Posted by kjalali at 08:13 PM | Comments (0)

A Surgical Technique to Protect the Macular Hole in Indocyanine Green-Assisted Vitrectomy

Ophthalmic Surg Lasers Imaging
To prevent indocyanine green (ICG) toxicity during macular hole repair, a surgical technique was designed in which the hole is protected by a viscoelastic material before injecting ICG to stain the internal limiting membrane. The area covered by the viscoelastic material was not stained by ICG. The internal limiting membrane was peeled without difficulty by taking advantage of the ICG stain outlining it. After surgery, all holes closed and the postoperative outcomes were favorable. Only a small amount of residual ICG remained in the macular area. This surgical technique does not interfere with internal limiting membrane peeling and reduces the residual ICG postoperatively.

Posted by kjalali at 08:10 PM | Comments (0)

Monoscopic Versus Stereoscopic Photography in Screening for Clinically Significant Macular Edema

Ophthalmic Surg Lasers Imaging
The purpose of the study was to determine whether monoscopic photography could serve as an accurate tool when used to screen for clinically significant macular edema. In a masked randomized fashion, two readers evaluated monoscopic and stereoscopic retinal photographs of 100 eyes. The photographs were evaluated first individually for probable clinically significant macular edema based on the Early Treatment Diabetic Retinopathy Study criteria and then as stereoscopic pairs. These results indicate that the use of monoscopic retinal photography may be an accurate screening tool for clinically significant macular edema.

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

ZB5M Anterior Chamber and Fyodorov’s Posterior Chamber Phakic Intraocular Lenses: Long-term Follow-up

Journal of Refractive Surgery Vol. 22 No. 9 November 2006

Sixty-two eyes of 37 patients implanted with the ZB5M anterior chamber PIOL (anterior chamber group) and 22 eyes of 14 patients implanted with Fyodorov’s posterior chamber PIOL (posterior chamber group) were examined. Complications were compared after a mean follow-up of 71.15±32.17 months (range: 24 to 145 months) in the anterior chamber group and 84.14±26.43 months (range: 24 to 132 months) in the posterior chamber group (P=.07).
RESULTS
At last follow-up, pupil ovalization was present in 32 (51.6%) eyes in the anterior chamber group and 1 (4.5%) eye in the posterior chamber group (P<.001), and cataract in 5 (8.1%) eyes in the anterior chamber group and 7 (31.8%) eyes in the posterior chamber group (P=.007). Phakic intraocular lens decentration, glaucoma, retinal detachment, corneal decomposition, and monocular diplopia were additional complications encountered in both groups, with no statistically significant difference.
CONCLUSIONS
Proper understanding of these outdated PIOLs may be helpful in developing better PIOL designs.

Posted by mmiraftab at 10:40 AM | Comments (0)

Probability Model of the Inaccuracy of Residual Stromal Thickness Prediction to Reduce the Risk of Ectasia After LASIK Part II: Quantifying Population Risk

Journal of Refractive Surgery Vol. 22 No. 9 November 2006

PURPOSE
To derive a statistical model to estimate the rate of excessive keratectomy depth below a selected cut-off residual stromal thickness (RST) given a minimum target RST and specific Clinical Protocol; apply the model to estimate the RST below which ectasia appears likely to occur and back-calculate the safe minimum target RST that should be used given a specific Clinical Protocol.

METHODS
Myopia and corneal thickness distribution were modeled for a population of 5212 eyes that underwent LASIK. The probability distribution of predicted target RST error (Part I) was used to calculate the rate of excessive keratectomy depth for this series. All treatments were performed using the same Clinical Protocol; one surgeon, Moria LSK-One microkeratome, NIDEK EC-5000 excimer laser, Orbscan pachymetry, and a minimum target RST of 250 µm—the Vancouver Clinical Protocol. The model estimated the RST below which ectasia appears likely to occur and back-calculated the safe minimum target RST. These values were recalculated for a series of microkeratomes using published flap thickness statistics as well as for the Clinical Protocol of one of the authors—the London Clinical Protocol.

RESULTS
In the series of 5212 eyes, 6 (0.12%) cases of ectasia occurred. The model predicted an RST of 191 µm for ectasia to occur and that a minimum target RST of 329 µm would have reduced the rate of ectasia to 1:1,000,000 for the Vancouver Clinical Protocol. The model predicted that the choice of microkeratome varied the rate of ectasia between 0.01 and 11,623 eyes per million and the safe minimum target RST between 220 and 361 µm. The model predicted the rate of ectasia would have been 0.000003:1,000,000 had the London Clinical Protocol been used for the Vancouver case series.

CONCLUSIONS
There appears to be no universally safe minimum target RST to assess suitability for LASIK largely due to the disparity in accuracy and reproducibility of microkeratome flap thickness. This model may be used as a tool to evaluate the risk of ectasia due to excessive keratectomy depth and help determine the minimum target RST given a particular Clinical Protocol.

Posted by mmiraftab at 10:38 AM | Comments (0)

Have You Seen the 10-year Long-term Safety Data on LASIK?

Journal of Refractive Surgery Vol. 22 No. 9 November 2006
Dan Z. Reinstein, MD, MA(Cantab), FRCSC; George O. Waring III, MD, FACS, FRCOphth

Most refractive surgeons are confident about the long-term safety of LASIK; the problem is that no one has yet published the long-term safety. There are currently only 303 eyes that had LASIK with 5- to 6-year follow-up in 4 papers in the literature, despite the fact that as of 2004 there had already been over 17 million LASIK procedures performed since the early 1990s, with over 8 million in the United States alone. It is therefore not surprising that the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom declared that “There are concerns about the procedure’s safety in the long term, and current evidence does not appear adequate to support its use without special arrangements for consent and for audit or research” in its interim “Guidance Document” entitled “Laser in situ keratomileusis for the treatment of refractive errors” published in December 2004. This conclusion was based on a review of seven randomized controlled trials, one systematic review, and four large case series with detailed reporting of complications, many cited in the Cochrane library.

Posted by mmiraftab at 10:34 AM | Comments (0)

November 25, 2006

Smooth moves for surface ablation

Eyeworld Nov 2006

Time was before the advent of LASIK when a lot of practitioners’ energy was being spent trying to make laser treatment smoother. But after LASIK became popular in the early 1990s, much of these early efforts were forgotten. However, now that many practitioners are returning to the surface, the importance of using the smoothest treatment is reemerging, said Daniel S. Durrie,...At the heart of the reason why a smooth surface is important is wound healing.“If the epithelium sees a rougher surface, it’s going to activate the keratocytes more, and you’re more likely to get haze, regression and slow healing,” ...Ophthalmologists were putting a lot of pressure on the laser manufacturers to try to develop the smoothest laser, Dr. Durrie said. Then when LASIK came along, they were essentially hiding the ablation underneath a flap and did not pay enough attention to this.As a result, much of the research on this stopped, he said. However, in Europe investigators such as Paolo Vinciguerra, M.D., , continued to look into ways to use smoothing treatments at the end of the procedure, using an advanced PTK technique.In his talk, Dr. Durrie hopes to point to the fact that the difficulty for American practitioners is that other than the original VISX (Advanced Medical Optics, AMO, Santa Ana, Calif.) and Summit Autonomous (Waltham, Mass.) lasers, no company has pursued phototherapeutic keratectomy (PTK) approval.“You can’t do this with any flying spot lasers because they don’t have FDA [Food and Drug Administration] approval in the United States to do PTK, whereas worldwide you can do it on any of the lasers,” he said. In addition, masking fluid commonly used elsewhere isn’t available in the United States, where smoothing to this point has not been a priority.Improvised smoothing techniqueWhile limited by the American system, Dr. Durrie still does what he can to ensure a smooth ablation.“I’m very critical about using lasers that have the smoothest surfaces, and that’s why I use flying spot lasers,” he said. “I use the Alcon [Fort Worth, Texas] and the WaveLight [Erlangen, Germany] lasers and they are the smoothest that I’ve seen.”Dr. Durrie said he also is careful about his technique, and so he recommends making sure that the surface is equally dry. He also removes the epithelium in surface ablation with alcohol because it gives him a better way to remove the basement membrane and split the basement membrane. Following the alcohol application, Dr. Durrie recommends being very careful about removing the epithelium and starting the ablation with a smooth, dry surface. In addition, Dr. Durrie said he likes to cool the surface of the eye for 10 seconds with a frozen balanced salt solution (BSS) popsicle both before and after the ablation to keep the temperature down. While not a smoothing factor, this does keep the keratocytes from activating, he finds.He also uses 0.02% of mitomycin C (MMC) for 12 seconds in those patients that have above +6 D or who are younger than 30-years-old.“It’s also very important to make sure that the patients epithelialize very consistently so that they don’t have chronic epithelial defects or lose their contact lens, et cetera, that may cause slow healing because that can lead to haze,” Dr. Durrie said.Despite these measures, Dr. Durrie said he cannot smooth surface quite the way that he would like because he does not have the PTK software available elsewhere.“During his talk, Dr. Durrie said he hopes to encourage those who have the VISX laser to look seriously into using Dr. Vinciguerra’s technique. However, even that laser does not make it as easy as some of the lasers used in Europe.....

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

Eyes on Epi-LASIK

Eyeworld Nov 2006

Unlike the mentality in LASIK where the flap needs to be perfectly positioned, with Epi-LASIK it’s rare that you have a flap that you can perfectly position because you do tend to have about a 1 mm stretch,” he said. “So, what I do is I make sure that I’m smooth and that I don’t have any wrinkles, but I don’t mind keeping it overlapped.” By about six hours post-op, Dr. Soloway said the flap often has retracted into place.Overall, Dr. Soloway said he hopes practitioners will come away from his talk with the understanding that when it comes to refractive surgery, safety is the best course. “I think that ultimately from a safety standpoint, it’s not just the pain and recuperation of the first three to five days, but the whole potential for sub-epithelial haze formation with the irregular collagen,” Dr. Soloway said.And he said he thinks Epi-LASIK helps to avoid this problem.Also, when it comes to visual results, Epi-LASIK is now providing a ready alternative to LASIK in getting the next morning “Wow” factor. It is not unusual for patients to see 20/20 to 20/25 the next day and feel comfortable.“We certainly get people who are doing really well visually, and we do get some people who are in no pain at all,” he said. “While usually patients are in the 20/30 range for the first couple of days, ultimately at the six month point, typically they’re doing better with Epi-LASIK than with LASIK.”

Posted by mehdi khanlari at 10:55 PM | Comments (0)

Collagen crosslinking treats causes of ectasia

Eyeworld Nov 2006

As collagen crosslinking emerges from the experimental shadows of ophthalmic research into a more practical solution for ectasia, one researcher suggests a specific form is more viable than others presently.“The one that seems to be the most practical for clinical use is the riboflavin method,” said Ronald R. Krueger, ...“Riboflavin is a natural component [vitamin B2], and hence a preferable therapeutic agent. Also, some of the other ones are not quite as ....Whether ectasia results from surgery or occurs naturally as with progressive keratoconus, it is a problem that arises from time to time and needs to be addressed,....Collagen crosslinking, meanwhile, is a process well known in material sciences, he said. It is an enzymatic process that adds molecular bonds to increase the mechanical strength of tissue – just what an ectasia patient needs.
Dr. Krueger said he believes using a photosensitizer and ultraviolet light so far has proven the most effective crosslinking method. Specifically, he said, the use of riboflavin and 365 nm light is “the most effective and least harmful.” ....Other methods that have been examined for usage include chemical fixatives, such as glutaraldehyde 0.1% and Karnovsky’s solution 0.1% (4% paraformaldehyde and 2% glutaraldehyde in phosphate buffer). Aldehyde sugars also have been employed, such as glyceraldehyde 0.2M, methylglyoxal 0.2M, ribose 0.5M, and glucose 0.5M.‘The aldehyde sugar method is very interesting,” Dr. Krueger said. “People who have diabetes have a natural elevation in sugar. That makes their cornea slightly stiffer. Nature is kind of verifying for us what we can learn about crosslinking But so far, he said, the riboflavin method appears to be emerging as the method of choice, both experimentally and clinically.....One difficulty in getting commercial support for larger studies involving this procedure, ironically, is its simplicity in terms of materials required.....“That may be why there is some slow movement going on,” Dr. Krueger said.
But faster movement by regulatory authorities to approve collagen crosslinking would be helpful to ophthalmologists, Dr. Krueger said.
That’s because collagen crosslinking treats the root cause of ectasia – weakened corneas – whereas other methods, such as Intacs (Addition Technology, Des Plaines, Ill.) only treat the effect.
“In the case of Intacs, what you’re trying to do is control the mechanical deformation of a cornea that’s weaker, in terms of biomechanical strength,” Dr. Krueger said. “The ring segments just stabilize the shape, so you’re treating the effect rather than the cause.”.....Overall, corneal crosslinking does seem safe, Dr. Krueger said.However, he said, certain exposure levels of ultraviolet light could be toxic to the endothelial cells. Rabbits certainly have thinner corneas than humans. A rabbit’s cornea is less than 400 microns thick while humans have 500-600 micron corneas. But, he said, at least one patient has experienced transient corneal endothelial decompensation after collagen crosslinking.....In a German study by Wollensak et al published in the American Journal of Ophthalmology in 2003, 26 eyes were treated with 0.1% riboflavin and 365 nm UVA with one to four years follow-up. Topographic progression of keratoconus was halted in every case, and in 70% of eyes there was a mean reduction of maximal keratometry of 2 diopters, he said. Endothelial cell density was unchanged with the cornea and lens remaining clear as well.

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

November 23, 2006

More evidence supporting possible association between cataract surgery and an increased risk of developing late ARM

Ophthalmology, November 2006
Using data from the Blue Mountains Eye Study, researchers assessed the 10-year risk of progression to late ARM in eyes that had cataract surgery before baseline examination. Nonphakic eyes had a three-fold increased risk of developing late-stage ARM or neovascular ARM compared with phakic eyes.

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

November 18, 2006

Factors Predicting Unsuccessful Big Bubble Deep Lamellar Anterior Keratoplasty

Ophthalmologica

Paolo Michieletto, et al. - To evaluate the role of corneal structural resistance as a surgical failure factor in deep lamellar keratoplasty (DLK)...Since the weakening of the DM is related to end-stage keratoconus corneal thinning, the preoperative corneal thickness rather than the surgeon's ability can play a major role in surgical failure of DLK. Our study reveals a very high risk of perforation of the DM when pre-operative total pachymetry is below limit of 250 Mum...

Posted by mehdi khanlari at 11:43 PM | Comments (0)

Take a New Shot at Shingles

Review of Optometry

Paul C. Ajamian, O.D - In May, the FDA approved a new vaccine, Zostavax (live attenuated zoster vaccine, Merck) to prevent herpes zoster (shingles). The vaccine is approved for adults ages 60 and older who have had chickenpox but have not yet had shingles. Nearly 1 million Americans develop herpes zoster each year, primarily those ages 50 and older, according to the Varicella Zoster Virus (VZV) Research Foundation...

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

Trabeculectomy with Mitomycin C for Treatment of Neovascular Glaucoma in Diabetic Patients

Ophthalmologica

Yoshiaki Kiuchi, et al. - To assess the efficacy and to determine the risk factors of trabeculectomy with mitomycin C (MMC) in eyes with neovascular glaucoma (NVG) secondary to diabetic retinopathy...Conclusions: Trabeculectomy with MMC can effectively reduce the elevated IOP associated with NVG. The extent of peripheral anterior synechia and a history of vitrectomy are significant negative predictors of surgical outcome...

Posted by mehdi khanlari at 11:27 PM | Comments (0)

Axial Length, Myopia, and the Severity of Lens Opacity at the Time of Cataract Surgery

Archives of Ophthalmology

E. Kubo, MD, PhD, et al. - To investigate the relationship between axial length, myopia of the eye, and the severity of lens opacity at the time of cataract surgery...Conclusion An increase in axial length or myopia of the eye was associated with a lower mean age at the time of surgery and higher grade of nuclear cataract...

Posted by mehdi khanlari at 11:22 PM | Comments (0)

Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser

Eye

The purpose of this article is to provide safety and efficacy of sub-Tenon's local anaesthesia (LA) for laser treatment of threshold retinopathy of prematurity (ROP)...Conclusions: Sub-Tenon's LA with oral sedation appears to be a safe and effective alternative to general anaesthesia for laser treatment of ROP, with the potential for lower morbidity...

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

November 17, 2006

Determining when to hop off the custom-wavefront bandwagon

Eyeworld Nov 2006

....When it comes to comparing patient outcomes with custom wavefront-guided LASIK and custom topography-guided, Dr. Lin said determining which procedure will likely work best depends on which of three groups patients fall into.For normal corneas, Dr. Lin said regular procedures usually work just as well as the wavefront-guided approach. In the case of irregular corneas, outcomes depend upon whether or not good wavefront measurements can be obtained. “If you have good reproducible wavefront measurements and good topography measurement, I would say the results are very equal,” Dr. Lin said. “In these cases, custom wavefront-guided works well, because it picks up the corneal coma or tilt, or other aberrations and that correlates with the topographical coma and then that works very well.”
The third group involves cases where corneal wavefront does not correlate with the topography, and as a result, wavefront worsens this group. The problem is that the custom wavefront-guided changes the shape of the cornea when it is not a corneal problem.
In these cases, Dr. Lin said patients actually do better with a regular non-custom treatment or with the custom topography-guided approach.“When in doubt, keep it simple; that’s my motto,” Dr. Lin said. “Just do a standard wavefront-optimized non-custom treatment and that way you can’t be too far off.”Overall, Dr. Lin said he hopes practitioners come away from his talk with the idea that the custom wavefront-guided approach is not for everyone and can actually make things worse in some cases. Likewise, the corneal topography-guided technique is not ubiquitous, but also may cause fewer problems than custom wavefront in severely distorted eyes.He also hopes practitioners will keep in mind, that custom treatments can raise patient expectations a lot.“They want 20/10 vision and they’re not always going to get it,” Dr. Lin said. “I think all practitioners should not over promise the results, and the patients seeking these procedures should also have realistic expectations as to what they can achieve

Posted by mehdi khanlari at 10:58 PM | Comments (0)

November 11, 2006

The Additive Effect of Topical Dorzolamide and Systemic Acetazolamide in Pediatric Glaucoma

Journal of American Association for Pediatric Ophthalmology and Strabismus , October 2006, Pages 464-468

Kourosh Sabri MB, ChB, FRCOphtha and Alex V. Levin MD, MHSc, FRCSC, a, aDepartment of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada

Conclusions
The addition of oral acetazolamide to topical dorzolamide may provide additional reduction in IOP in some children already being treated with topical carbonic anhydrase inhibitors. This possible additive effect has not been observed in adults treated with a combination of topical and systemic carbonic anhydrase inhibitors.

Posted by mehdi khanlari at 01:04 PM | Comments (0)

Pupillographic Measurements with Pattern Stimulation: The Pupil’s Response in Normal Subjects and First Measurements in Glaucoma Patients

.. This study was undertaken to characterize the influence of contrast, luminance, and spatial frequency of a pattern stimulus on the pupil reaction of healthy subjects. First measurements with this technique in patients with glaucoma were compared with those in a control group..... Grating patterns were presented using a Maxwellian-view system to study series of contrast, luminance, and spatial frequency in three healthy subjects. The best two stimulus conditions were determined and were then used to examine 19 patients with open-angle glaucoma and 16 control subjects.RESULTS. In healthy subjects, an increasing contrast led to an increase in amplitude and a decrease in latency of the pupil reflex. Increasing luminance also resulted in an increase in the amplitude. The offset component of the pupil reflex was most pronounced at low spatial frequencies and the onset component at high spatial frequencies. When healthy subjects were compared with patients with glaucoma, control subjects generally had higher amplitudes, velocity, and acceleration of pupil constriction than did the patients with glaucoma. These differences were significant when the test was performed with a spatial frequency of 6.25 cyc/deg.
CONCLUSIONS. Best stimulus conditions to elicit a pupil response to a pattern grating stimulus are 100% contrast and 55 cd/m2 mean luminance. The choice of the spatial frequency determines which component of the pupil reflex is more pronounced. Differences between patients with glaucoma and healthy control subjects are demonstrable.

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Pupillographic Measurements with Pattern Stimulation: The Pupil’s Response in Normal Subjects and First Measurements in Glaucoma Patients

Posted by mehdi khanlari at 12:51 PM | Comments (0)

Evaluation of arteriovenous crossing sheathotomy for decompression of branch retinal vein occlusion

Eye advance online publication 27 October 2006
... Pars plana vitrectomy and arteriovenous sheathotomy was performed on 11 patients with BRVO who had vision loss due to macular oedema. Ten patients with macular oedema due to BRVO and who have been treated with grid laser photocoagulation were included in the control group. The measurement of visual acuity with ETDRS chart was taken preoperatively and at 1, 3, 6, and 9 months follow-up in the study group and at 1, 3, 6, and 9 months after grid laser in the control group.....The mean preoperative logMAR visual acuity was 0.840.3 in the surgical group and 1.060.4 in the control group. The postoperative mean logMAR visual acuity was 0.410.2, 0.400.2, 0.400.3, and 0.360.3 at 1, 3, 6, and 9 months follow-up, respectively. In the control group the postlaser mean logMAR visual acuity was 0.920.3, 0.870.4, 0.850.3, and 0.820.3 at 1, 3, 6, and 9 months follow-up, respectively. The improvements of visual acuity in both groups were statistically significant when compared to pretreatment (P=0.003 and P=0.007 at 9 months in the study and control group, respectively).Conclusion Arteriovenous sheathotomy for decompression of BRVO in patients who have vision loss due to macular oedema was safe and effective for anatomical and functional improvement and resulted in significantly better visual outcomes than a matched control group of laser-treated eyes.

Posted by mehdi khanlari at 12:34 PM | Comments (0)

ombined Strabismus and Lens Surgery

Journal of American Association for Pediatric Ophthalmology and Strabismus Volume 10, Issue 5 , October 2006, Pages 430-434

Simultaneous eye muscle and lens surgery in patients with strabismus and lens abnormalities offers the advantage of avoiding staged surgery....Thirty-three combined strabismus and lens surgeries were performed on 30 patients who ranged in age from 22 months to 91 years. Fifteen of the strabismus procedures were performed for esotropia, 12 for exotropia, 4 for vertical deviations, and 2 for combined vertical-horizontal deviations. Surgical amounts often were reduced to lessen the risk of overcorrection, to minimize anesthetic requirements (when using topical rather than general anesthesia), or to avoiding additional surgery on the contralateral or ipsilateral eye. The intraocular surgeries included cataract extraction without or with posterior chamber intraocular lens, secondary intraocular lens implantation, and YAG laser posterior capsulotomy. In 28 cases, muscle and intraocular surgery was performed on the same eye, and in 5 cases the strabismus surgery was performed on the eye opposite the intraocular surgery...Results The average length of postoperative follow-up was 23.2 months (range, 1-94 months). Surgical, anesthetic, and postoperative complications, other than unsatisfactory ocular alignment, were limited to one retinal detachment in a patient with persistent fetal vasculature. Strabismic undercorrections (>12Δ of horizontal deviation or >5Δ of vertical deviation) occurred in 11 cases (37%). There were no overcorrections. A poor visual response (<20/50) to the intraocular surgery was encountered in 6 patients, all as the result of amblyopia or preexisting vitreoretinal pathology ConclusionsSimultaneous extraocular muscle and lens surgery is an option for patients with strabismus and lens abnormalities. Standard strabismus surgical amounts are recommended.

Posted by mehdi khanlari at 12:31 PM | Comments (0)

Ocular Axial Length Changes in Pseudophakic Children After Traumatic and Congenital Cataract Surgery

Journal of American Association for Pediatric Ophthalmology and Strabismus

Pseudophakic children tend to develop a large myopic shift. This may be in part due to accelerated growth in axial length. The purpose of this study was to evaluate and compare the postoperative change in axial length (ΔAL) in pseudophakic eyes, after extraction of traumatic or congenital cataract....ΔAL was greater for operated eyes than for fellow nonoperated eyes (traumatic cataract: p=0.06; unilateral congenital cataract, p=0.055). Axial elongation was significantly greater in children under 5 years old at operation than in those older than 5 (p=0.025). The difference in rate of ΔAL between operated and fellow nonoperated eyes, per 1 year of follow-up, was similar for traumatic and unilateral congenital cataract groups....ConclusionsThis study demonstrated a tendency toward greater axial lengthening in pseudophakic eyes of children, when compared with their nonoperated eyes. No significant difference was found in the tendency for increased axial lengthening between eyes operated on for traumatic cataracts and those operated on for congenital cataracts.

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Vitrectomy for non-ischaemic macular oedema in retinal vein occlusion

Acta Ophthalmologica Scandinavica

Hvarfner, et al. - To evaluate the effect of vitrectomy in eyes with non-ischaemic macular oedema secondary to hemi and central retinal vein occlusion...Conclusions: Vitrectomy in hemi and central retinal vein occlusion has the potential to reduce macular oedema and improve VA in the early postoperative phase but does not seem to improve the longterm outcome of the disease...

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

November 10, 2006

Cataract Surgery and the 10-Year Incidence of Age-Related Maculopathy(The Blue Mountains Eye Study)

Ophthalmology Volume 113, Issue 11 , November 2006, Pages 2020-2025

In the Blue Mountains Eye Study (BMES) cohort, 2335 of 3654 baseline participants ≥49 years old (75% of survivors) were reexamined after 5 years and 1952 (76% of survivors) were reexamined after 10 years.
At the baseline examination, nonphakic (aphakic or pseudophakic) eyes were identified at slit-lamp examination and confirmed at lens photographic grading. Side-by-side grading of baseline and follow-up stereoretinal photographs was performed using the Wisconsin ARM grading system. Eye-specific data were analyzed using Kaplan–Meier estimates and generalized estimating equation models, adjusting for correlation between the 2 eyes.
After excluding eyes with either late ARM lesion at baseline or that had missing photographs at either examination, 4763 eyes were considered at risk of incident late ARM, including 132 eyes that had cataract surgery before the baseline examination. Late ARM developed in 10 of 132 nonphakic eyes (7.6%) compared to 96 of 4631 phakic eyes (2.1%). After adjusting for baseline age, gender, smoking, and presence of early ARM lesions, nonphakic (cataract surgical) eyes had a 3-fold risk of developing late-stage ARM (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.1–9.9) or neovascular ARM (OR, 3.4; 95% CI, 1.1–10.9) compared to phakic eyes.
Conclusions
Our findings support the hypothesis that the long-term risk of developing late ARM is higher in cataract surgical eyes, consistent with findings from the Beaver Dam Eye Study.

Posted by mmiraftab at 12:52 PM | Comments (0)

Retained Nuclear Fragments in the Anterior Chamber after Phacoemulsification with an Intact Posterior Capsule

Ophthalmology Volume 113, Issue 11 , November 2006, Pages 1949-1953

Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30.
Conclusions
Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.

Posted by mmiraftab at 12:47 PM | Comments (0)

Descemet’s Stripping with Endothelial Keratoplasty:Comparative Outcomes with Microkeratome-Dissected and Manually Dissected Donor Tissue

Ophthalmology Volume 113, Issue 11 , November 2006, Pages 1936-1942

Three hundred thirty consecutive transplants, 114 with manually dissected and 216 with microkeratome-dissected donor tissue.
Visual recovery was faster with microkeratome-dissected donor tissue, as evidenced by statistically better best spectacle-corrected visual acuity (VA) in that group 1 month after surgery (P = 0.015). Best spectacle-corrected VA was statistically comparable for the 2 groups preoperatively and 3 and 6 months postoperatively. Best spectacle-corrected VA was not correlated significantly with postoperative central corneal thickness (P = 0.25). Corneal thickness was significantly higher in the microkeratome group (690±77 μm, compared with 610±62 μm after hand dissection; P<0.0001). Mean refractive astigmatism was 1.5 diopters (D) preoperatively and 6 months postoperatively in both groups. Spherical equivalent refraction did not change in the microkeratome group (P = 0.64) but increased by 0.66 D in the hand dissection group (P = 0.0007). Methods designed to remove fluid from the donor/recipient graft interface ultimately reduced the detachment rate to <1% (1 in the last 140 cases). No donor perforations occurred in 216 microkeratome dissections, compared with 5 in 114 hand dissections (P = 0.002).
Conclusions
Microkeratome dissection reduced the risk of donor tissue perforation, provided faster visual recovery after DSEK, and did not alter the refractive outcome

Posted by mmiraftab at 12:45 PM | Comments (0)

Long-term Follow-up of Intacs for Post-LASIK Corneal Ectasia

Ophthalmology Volume 113, Issue 11 , November 2006, Pages 1909-1917

Eight eyes of 5 patients with post-LASIK corneal ectasia (3 men and 2 women) ages 31 to 54 years (mean age±standard deviation [SD], 41.60±9.24 years) who had completed 5 years of follow-up (mean follow-up ± SD, 60.1±4.9 months; range, 57–68 months).
Intervention
Two Intacs segments, inserted in the usual fashion, were used for low myopia correction (1 each nasally and temporally), with thickness based on the residual refraction of the patients.
Results
No intraoperative or late postoperative complications occurred in this series of patients. At 5 years, the SE error was statistically significantly reduced (pre-Intacs mean±SD, −5.47±2.66 diopters [D]; range, −11.50 to −3.00 D) to −2.56±3.44 D (range, −9.50 to 1.5 D; P = 0.01). At the end of the first postoperative year, refractive stability was obtained and remained stable during the follow-up period with no significant changes between the interval meantime (P>0.05). Pre-Intacs uncorrected visual acuity was 20/100 or worse in all eyes (range, counting fingers–20/100), whereas at the last follow-up examination, 6 (75%) of 8 eyes had uncorrected visual acuity of 20/40 or better (range, counting fingers–20/25). Two eyes (25%) maintained the pre-Intacs best spectacle-corrected visual acuity, whereas the rest of the eyes (6 eyes; 75%) experienced a gain of 1 or 2 lines. At the end of the first postoperative year, uncorrected and best-spectacle corrected visual acuity and topographic stability were obtained and were shown to have remained stable during the follow-up period with no significant changes between the interval meantime. Lamellar channel deposits were observed in confocal microscopy at or adjacent to the intrastromal ring segment.
Conclusions
Refractive stability was maintained for up to 5 years in the treatment of post-LASIK corneal ectasia after Intacs implantation. There was no evidence of progressive time-dependent corneal ectasia, late regression, or sight-threatening complications in this study.

Posted by mmiraftab at 12:41 PM | Comments (0)

Evidence for Superior Efficacy and Safety of LASIK over Photorefractive Keratectomy for Correction of Myopia

Ophthalmology Volume 113, Issue 11 , November 2006, Pages 1897-1908

Meta-analysis/systematic review.Patient data from previously reported prospective randomized controlled trials (PRCTs) and a systematic review of prospective case series in the Food and Drug Administration (FDA) clinical trials database.
Methods
A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify PRCTs comparing LASIK and PRK for correction of myopia. A meta-analysis was performed on the results of PRCTs. In parallel, a systematic review of prospective data from FDA case series of LASIK and PRK for correction of myopia was undertaken.
Main Outcome Measures
Key efficacy outcomes (uncorrected visual acuity [UCVA] ≥ 20/20, ±0.50 diopters [D] of the target mean refractive spherical equivalent) and safety outcomes (loss of ≥2 lines of best spectacle-corrected visual acuity [BSCVA], final BSCVA ≥ 20/40, and final BSCVA < 20/25 where preoperative BSCVA was ≥20/20).
Results
Seven PRCTs were identified comparing PRK (683 eyes) and LASIK (403 eyes) for correction of myopia. More LASIK patients achieved UCVA ≥ 20/20 at 6 months (odds ratio, random effects model [95% confidence interval], 1.72 [1.14–2.58]; P = 0.009) and 12 months (1.78 [1.15–2.75], P = 0.01). Loss of ≥2 lines of BSCVA at 6 months was less frequent with LASIK (2.69 [1.01–7.18], P = 0.05). Data from 14 LASIK (7810 eyes) and 10 PRK (4414 eyes) FDA laser approval case series showed that more LASIK patients achieved UCVA of 20/20 or better at 12 months (1.15 [1.03–1.29], P = 0.01), significantly more LASIK patients were within ±0.50 D of target refraction at 6 months (1.38 [1.26–1.50], P<0.00001) and 12 months (1.21 [1.08–1.36], P = 0.0009) after treatment, and loss of ≥2 lines of BSCVA at 6 months was less frequent with LASIK (2.91 [2.22–3.83], P<0.00001).
Conclusions
LASIK appears to have efficacy and safety superior to those of PRK. However, the data examined are from studies conducted ≥5 years ago. It is therefore unclear how our findings relate to present-day methods and outcomes. Further trials comparing contemporary equipment and techniques are needed to reevaluate the relative merits of these procedures.

Posted by mmiraftab at 12:32 PM | Comments (0)

November 07, 2006

Bimanual microphaco advantages in posterior polar cataract

Eyeworld Nov 2006

....I. Howard Fine, M.D., clinical professor, Casey Eye Institute, Oregon Health & Science University, Portland, who has performed bimanual phacoemulsification for five years, said that the technique described for posterior polar cataracts was a very good idea.
“The real advantages are not the small incision size—that will become an advantage when we have lenses that go through that incision...The real advantages of the technique, he said, are fluidics....Dr. Fine said that the procedure was particularly beneficial for posterior polar cataract surgery because 35% of patients with posterior polar cataracts have an open capsule....He said it is important not to put too much pressure into the eye to the extent that the force will open the capsule where the discontinuity is and deposit the nucleus into the vitreous,...Dr. Fine also said that it is important not to shallow the chamber because if the lens comes forward, it may lift out of the opening in the capsule....Therefore because the bimanual microphacoemulsification procedure described in the study separates irrigation from aspiration and phacoemulsification, the ophthalmic viscosurgical device (OVD) can be instilled while the irrigator is in the eye, keeping the location of the lens perfect, Dr. Fine said.
Another advantage of the procedure, Dr. Fine said, is the ability to switch hands, which is not an option with coaxial phacoemulsification....“You take your phaco hand piece out, leave the irrigator in, add more viscoelastic, take your irrigator out, put the phaco [hand piece] in the left side where the irrigator was and the irrigating chopper through the right, and then continue the operation,” he said.

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

Practical ways of reducing endophthalmitis

Eyeworld Nov 2006

From the study, Dr. Kamalarajah concluded that strong risk factors for the occurrence of PIE included inpatient cataract surgery (P = 0.001), surgery performed in dedicated eye theatres (P < 0.001), consultant grade of surgeon (P = 0.003), and posterior capsule tear during cataract surgery (P < 0.001)....The use of face masks by surgeons and scrub nurses (P < 0.001) and the use of subconjunctival antibiotics at the end of cataract surgery (P < 0.001) were protective against the development of infection. Gentamicin (various manufactures) and cefuroxime were the most commonly used subconjunctival antibiotics.....Multivariate logistic regression modeling identified the following statistically significant risk factors for PIE following cataract surgery: inpatient cataract surgery, surgery in dedicated eye theatres, consultant grade surgeon (compared to registrar), and posterior capsule tears during cataract surgery......“The administration of subconjunctival antibiotics at the end of cataract surgery and the use of face masks by the surgeon and scrub nurse in theatre were protective against infection,” the researchers said....From their research, the investigators note that potentially important risk factors that were not significantly associated with PIE included a history of diabetes, silicone IOLs and multiuse phaco needles, and phaco tubing....For this study, a surprisingly high percentage of cases receiving intra-op antibiotics (75%) showed bacterial growth from the ocular samples taken at the time of treatment for endophthalmitis, the investigators said.
“Unfortunately, we were unable to speculate on the effectiveness of the intra-op antibiotics, as the antibiotic sensitivity data on the organisms cultured were not retrieved,” they said.....for PIE to be associated with in patient cataract surgery, surgery in dedicated eye theatres, lack of face mask use in theatre, consultant grade surgeon, posterior capsule tear during cataract surgery, and the nonadministration of subconjunctival antibiotics at the end of cataract surgery, the study said.....Consultants performing cataract surgery were associated with a significantly higher risk of post-op PIE than registrar grade surgeons, but this probably was a result of the fact that consultants are usually the most experienced ophthalmic surgeons and will perform more of the technically difficult cataract procedures compared to registrars. These difficult procedures may be associated with a higher risk of intra-op and thus post-op complications....The study also identified face masks as a factor. “In a critical review of the evidence for and against the use of face masks in the operating theatre, [other studies have] concluded that there was little convincing evidence to support discontinuing the wearing of surgical face masks,” Dr. Kamalarajah said....The administration of subconjunctival antibiotics at the end of surgery had a protective effect against the development of PIE.
Subconjunctival cefuroxime achieves therapeutic levels in the anterior chamber within 12 to 24 minutes of administration and maintains clinically significant levels for up to 12 hours.
In conclusion, the researchers determined that “the routine use of face masks during cataract surgery and subconjunctival antibiotics at the end of surgery are easily modifiable changes in clinical practice and should be strongly encouraged in light of our results.”
Additional antibiotic prophylaxis to prevent infectious endophthalmitis also should be considered in patients who have posterior capsule rupture during cataract surgery.

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

Studying statins: Protective effect shown against nuclear cataracts

Eyeworld Nov 2006

Statins have become part of the American lexicon, known for their lipid lowering effect in patients with high cholesterol. Now new study results, published in the June 21 issue of the Journal of the American Medical Association (JAMA), indicate that statins may also have the unexpected benefit of keeping nuclear cataracts at bay...
Dr. Klein has a couple of theories as to what may be taking place. There is some evidence suggesting that nuclear cataract is the result of oxidant stress or oxidizing of the proteins in the lens of the eye and that the statins, which are thought to be antioxidants, are having an effect,....Another possibility is that it may be inflammation, as marked by increased levels of tumor necrosis factor that is playing a pivotal role here. People with higher levels of tumor necrosis factor in their blood also appear to have an increased risk of nuclear cataract, she said. And because statins are thought to have anti-inflammatory properties, this is another possibility.
Not all statins may be created equal, however. It was patients on simvastatin (Zocor, Merck, Whitehouse Station, N.J.) who appeared to have the lowest risk for nuclear cataracts. Just 6% of simvastatin users developed nuclear cataracts compared with 16% of atorvastatin (Lipitor, Pfizer, New York) users and 14% of users of all other statins combined.“Atorvastatin still appeared to have a protective effect, but it wasn’t statistically significant and it was quite a bit less of a reduction than we found with simvastatin,” Dr. Klein said. This might be a function of the fact that simvastatin has been around longer than the other statins or might be some dose-related effect......However, it is unlikely that statins will be prescribed solely to prevent cataracts since there are many potential side effects.

Posted by mehdi khanlari at 10:33 PM | Comments (0)

Central Corneal Epitheliopathy in a Long-Term, Overnight Orthokeratology Lens Wearer: A Case Report.

Optometry & Vision Science. 83(10):709-714, October 2006.

... The purpose of this study is to report an unusual case of central corneal epitheliopathy (CCE) in a long-term orthokeratology lens wearer.... A single observational case report of a 12-year-old Chinese female myope with 31/2 years' experience in wearing orthokeratology lenses overnight was diagnosed with a CCE lesion during her regular orthokeratology aftercare consultation. The patient was asymptomatic. Trace or almost negative fluorescein staining was observed over the particular lesion area and, according to the clinical features of the corneal lesion, was thought to be a partially formed "dellen." The lesion healed after the use of the orthokeratology lenses was suspended for 4 months and reappeared when the patient resumed wearing the lenses. Close monitoring of the corneal condition was needed on this patient, and permanent discontinuation of the orthokeratology procedures will be considered if the signs and symptoms of the lesion worsen Conclusion. A central corneal "dellen" may be associated with long-term, overnight use of orthokeratology lenses.

Posted by mehdi khanlari at 10:08 PM | Comments (0)

November 05, 2006

Secondary diffractive bifocal piggyback intraocular lens implantation

JCRS Pages 1938-1943 (November 2006)
Six pseudophakic emmetropic patients who had a monofocal IOL implanted in the capsular bag. All eyes had secondary piggyback Acri.Twin bifocal diffractive IOL (Acri.Tec) implantation in the ciliary sulcus to provide pseudoaccommodation. Contralateral implantation of 1 Acri.Twin near-weighted 733D IOL in the nondominant eye and 1 Acri.Twin distance-weighted 737D IOL in the dominant eye was performed. Monocular and binocular best distance-corrected visual acuity and distance-corrected near visual acuity were evaluated 6 months after surgery.

Results
The mean binocular best distance-corrected visual acuity and distance-corrected near visual acuity were −0.080 logMAR and −0.016 logMAR, respectively. There were no statistically significant differences in binocular best distance-corrected acuity after the piggyback IOL implantation (P>.01). The differences between monocular and binocular visual acuity were the result of the distance- and near-weighted light distribution of the Acri.Twin IOLs. All IOLs were well centered with no tilt. Two eyes had pupillary capture of the optic.

Conclusions
The Acri.Twin bifocal diffractive IOL implanted in the ciliary sulcus using the piggyback technique provided pseudoaccommodation in emmetropic pseudophakic eyes. Binocular implantation of these IOLs should be performed considering the differences in light distribution of the distance-weighted IOL and the near-weighted IOL models.

Posted by alireza habibollahi at 02:54 PM | Comments (0)

Postoperative surface deposits on intraocular lenses in children

JCRS Pages 1932-1937 (November 2006)

To report the clinicopathologic features of 4 intraocular lenses (IOLs) composed of 3 different hydrophilic biomaterials explanted from children who had postoperative opacification of the IOL optic.

The IOLs were explanted 20, 11, 22, and 25 months postoperatively from children aged 10, 3, 36, and 20 months old, respectively, at IOL implantation. Clinical data were obtained to correlate the findings with possible associated risk factors. The explanted IOLs were examined by gross and light microscopy. They were further analyzed with a stain for calcium, alizarin red 1%. Scanning electron microscopy and energy dispersive X-ray spectroscopy (EDS) were also performed.

Results
The primary reason for cataract surgery in Case 1 and Case 2 was persistent hyperplastic primary vitreous (PHPV); 1 patient received a B-Lens IOL (Hanita) and the other a Centerflex IOL (Rayner). The primary reason in Case 3 was familial bilateral congenital cataract and in Case 4, rubella cataract; both patients received a Hydroview IOL (Bausch & Lomb). All 4 IOLs had surface deposits on the optic, but the morphology of the deposits on the B-Lens and Centerflex IOLs was different than that in previously reported cases. The deposits in all four cases stained positive with alizarin red and consisted of calcium and phosphorus when imaged with EDS.

Conclusions
Calcified deposits on 2 Hydroview IOLs explanted from children were similar to those seen in adults with the same IOL. The deposits on the B-Lens and Centerflex IOLs were probably secondary to a breakdown of the blood–aqueous barrier caused by preexisting PHPV.

Posted by alireza habibollahi at 02:49 PM | Comments (0)

Inhibition of intraocular fibrin formation after infusion of low-molecular-weight heparin during combined phacoemulsification–trabeculectomy surgery

JCRS Pages 1921-1925 (November 2006)
43 of 54

Reza Zarei, MD, Reza Azimi, MD, Sasan Moghimi, MD, Ali Abdollahi, MD, Heidar Amini, MD, Yadollah Eslami, MD, Ghasem Fakhraii, MD
Farabi Eye Hospital, Tehran, Iran.
To evaluate the effect of intraocular infusion of dalteparin, a low-molecular-weight heparin (LMWH) administered in the infusion fluid to prevent early postoperative fibrin formation in combined phacoemulsification–trabeculectomy surgery (phacotrabeculectomy).

Setting

Methods
Standard combined phacotrabeculectomy was performed prospectively in a masked fashion in 60 eyes; 35 eyes received 5 IU/mL LMWH in the infusate and 25 eyes served as controls. Masked postoperative examinations assessed visual acuity, intraocular pressure (IOP), anterior chamber cell and flare, and fibrin formation with slitlamp examinations 1, 3, 7, 30, and 90 days after surgery.

Results
The rate of intraocular fibrin/membrane formation was significantly lower in the LMWH group than in the control group at each follow-up.The amount of IOP was lower in LMWH group at each follow up . Final visual acuity was better in LMWH group.The frequency of synechia formation was lower in the LMWH group on day 90.
Conclusions
Infusion of dalteparin, a LMWH, may be an effective inhibitor of postoperative fibrin formation in phacotrabeculectomy surgery. It may reduce the frequency of synechia formation and improve visual acuity. It may not be associated with increased risk for intraoperative or postoperative complications at the tested dose. This drug may be a useful adjunct in combined surgery.

Posted by alireza habibollahi at 02:43 PM | Comments (0)

Microincision bimanual phacotrabeculectomy in eyes with coexisting glaucoma and cataract

JCRS Pages 1917-1920 (November 2006)
China,MICS with a sleeveless phaco needle and irrigating chopper was performed in combination with trabeculectomy. Phacoemulsification was performed through 2 small clear corneal wounds, sparing the trabeculectomy site from trauma. IOL was then implanted through the trabeculectomy site, so no corneal wound larger than 1.5 mm was required for IOL implantation.

Results
The first 10 consecutive eyes of 10 patients who had combined phacotrabeculectomy by a microincision bimanual technique had significantly reduced intraocular pressure. There was a 10.5% reduction in the mean corneal endothelial cell count. There were no other complications up to 6 months after surgery.

Conclusion
Microincision bimanual phacotrabeculectomy appeared to be an effective and safe option in patients with glaucoma and coexisting cataract.

Posted by alireza habibollahi at 02:32 PM | Comments (0)

Wavefront Analysis and Contrast Sensitivity of Aspheric and Spherical Intraocular Lenses: A Randomized Prospective Study

Volume 142, Issue 5,(November 2006)

Sixty patients were randomized to receive three IOL types: Alcon AcrySofIQ (40 eyes), AcrySofNatural (40 eyes), and advanced medical optic (AMO)Sensar (40 eyes). Complete ophthalmologic examination including uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography, and wavefront analysis were performed preoperatively, 30 days, and 90 days postoperatively. Pelli-Robson chart test and functional acuity contrast testing (FACT-Optec6500) were performed approximately 50 days after surgery. Statistical analyses were performed using analysis χ2, analysis of variance (ANOVA), and multiple comparisons Tukey test.
Results
After 90 days, all eyes had postoperative BSCVA ≥20/32. The AcrySofIQ IOL showed statistically significant less induction of spherical aberration (P < .001) when compared with the AMOSensar and the AcrySofNatural IOLs. The AMOSensar presented significantly less spherical aberration then the AcrySofNatural (P < .05). The AcrySofIQ also had lower values of total and high-order aberration (HOA) (P < .05) when compared with the AMOSensar and the AcrySofNatural. The mean values of trefoil 9, coma, and HOA root mean square (RMS) decreased between one and three months (P < .001, P < .001, P = .023, P < .001, respectively) in all groups. Mean Pelli-Robson contrast sensitivity values in photopic condition were similar between the groups. The AcrySofIQ showed better results in 3cpd spatial frequency in mesopic condition using FACT-Optec 6500 (P = .008), although there were no statistical differences in photopic and mesopic with glare conditions.

Posted by mmiraftab at 10:48 AM | Comments (0)

Acute Endophthalmitis in Eyes Treated Prophylactically with Gatifloxacin and Moxifloxacin

Volume 142, Issue 5, (November 2006)

Forty-two eyes of 42 patients with acute endophthalmitis occurring within six weeks after cataract surgery were identified. All patients were seen in a referral vitreoretinal practice over a two-year time interval. The number of patients using prophylactic gatifloxacin or moxifloxacin and results of bacterial culture and sensitivity to all fluoroquinolone antibiotics were recorded.
Results
Thirty-one of 42 eyes (74%) were treated with perioperative gatifloxacin or moxifloxacin and 24 eyes (57%) were continuously taking one of these antibiotics at the time of diagnosis. Nineteen eyes (45%) had a positive bacterial culture. The most frequent organism isolated was coagulase-negative Staphylococcus. Sensitivities were performed for 14 gram-positive organisms, and sensitivities to ciprofloxacin (50%), ofloxacin (44%), levofloxacin (46%), gatifloxacin (38%), and moxifloxacin (38%) were noted. Five organisms were resistant to gatifloxacin and moxifloxacin with a minimum inhibitory concentration of 8 μg/ml. All gram-positive organisms were sensitive to vancomycin. Median visual acuity improved from hand motions to 20/40 at last follow-up.
Conclusion
Acute endophthalmitis can develop after cataract surgery despite the prophylactic use of fourth-generation fluoroquinolone antibiotics. Gram-positive organisms causing acute endophthalmitis are frequently resistant to all fluoroquinolones, including a significant number of cases resistant to gatifloxacin and moxifloxacin.

Posted by mmiraftab at 10:42 AM | Comments (0)

November 04, 2006

Cataractous Changes due to Posterior Chamber Flattening with a Posterior Chamber Phakic Intraocular Lens Secondary to the Administration of Pilocarpine

ophthalmology August 2006

To present the first reported case of cataract formation as a consequence of instillation of pilocarpine in an eye with a posterior chamber phakic intraocular lens (IOL)....A 46-year-old man received a hyperopic implantable collamer lens (ICL) bilaterally....Both eyes underwent uneventful ICL implantation for the correction of a manifest spherical equivalent of +7 diopters (D) in the right eye and +7.1 D in the left eye. The left eye was followed for 2 years without developing complications. The right eye, however, showed on the first postoperative day a fleckenlike opacification on the anterior pole of the crystalline lens after instillation on the operative day of 2% pilocarpine in an attempt to accelerate recovery from unwanted pupil dilation causing patient complaints of glare disability after surgery. Optical coherence tomography demonstrated complete contact of the ICL with the natural lens 24 hours postoperatively. Serial IOP measurements were always within the normal limits. The instillation of 1% cyclopentolate resulted in an increase in the ICL vault that measured 132 μm 24 hours later. Three days after the completion of a 3-day course of topical 1% cyclopentolate, the opacification was less dense and demarcated, and a 124-μm vault was measured. Three months postoperatively, the cataract was associated with a 3-line loss of BCVA and considerable degradation of the contrast sensitivity, especially at higher spatial frequencies and with a glare source, and corneal endothelial cell changes were within normal limits. One year after ICL implantation, the right eye had to undergo phacoemulsification and IOL implantation, which were uneventful.ConclusionsPosterior chamber flattening with resulting crystalline lens opacification can occur immediately after the instillation of pilocarpine in an eye with a hyperopic ICL. Therefore, caution should be taken with the administration of cholinergic agonists such as pilocarpine in patients with phakic IOLs, at least if they are hyperopic ICLs.

Posted by mehdi khanlari at 11:50 PM | Comments (0)

Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis

Eye

The aim of this study was to describe the pathological findings in lens capsules and intraocular lens (IOL) studied by scanning and/or transmission electron microscopy (SEM and TEM, respectively) in a series of four eyes with chronic pseudophakic endophthalmitis (CPE)....Patients and methods We performed a retrospective study of four patients presenting CPE in whom surgical treatment with pars plana vitrectomy, capsulectomy with extraction of the IOL, and intravitreous antibiotic therapy was thereafter performed. The extracted IOL and the capsular remains were studied by SEM and/or TEM and microbiologic analysis of aqueous humour and vitreous aspirate was also carried out in all the cases.Conclusions Microorganisms were found in the IOL or the capsular material in the four cases studied, thereby explaining the refractoriness and severity of infection. The possible presence of polymicrobial infections, especially in the cases with filamentous bacteria, also explains the recurrence of infection.

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

Comparison of Polypropylene and Silicone Ahmed Glaucoma Valves

Ophthalmology August 2006, Pages 1320-1326

..To evaluate and compare the clinical outcomes after implantation of the silicone plate and the polypropylene plate Ahmed Glaucoma Valves...A total of 132 patients with uncontrolled glaucoma were treated with either the silicone or polypropylene Ahmed Glaucoma Valve implant....Success was defined according to 2 criteria: (1) intraocular pressure (IOP) of 6 mmHg or more or 21 mmHg or less, and (2) IOP reduction of at least 30% relative to preoperative values. Eyes requiring further glaucoma surgery, including cyclophotocoagulation, or showing loss of light perception were classified as failures.Conclusion The silicone Ahmed Glaucoma Valve (model FP7) showed improved IOP reduction compared with the polypropylene (model S2) implant. Differences observed in mean IOP, success rate, and complications suggest that plate material may influence clinical outcome.

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

Evidence for oxidative stress in lens epithelial cells in pseudoexfoliation syndrome

EYE

.. To investigate the oxidative status in lens epithelial cells of patients with pseudoexfoliation (PEX) syndrome..... Lens capsule samples obtained during cataract surgery of patients with PEX syndrome and normal age-matched control subjects were examined for changes in the levels of glutathione (GSH), glutathione disulphide (GSSG), protein concentration, and lipid peroxidation. Concentrations of GSH, GSSG, lipid peroxidation, and protein concentration were determined by specific fluorescent assays....Conclusion The increased MDA and decreased GSH levels indicate high oxidative stress. On the other hand, GSSG usually increases in cases of high-oxidative stress, but this is not always the case, as it may not always accumulate in cells. Our findings suggest a role for oxidative stress in the pathogenesis and the progression of PEX syndrome.

Posted by mehdi khanlari at 11:27 PM | Comments (0)

Comparison of Conventional and Silicone Hydrogel Contact Lenses for Bullous Keratoplasty.

Eye & Contact Lens: Science & Clinical Practice. September 2006.

... To compare the efficacy and safety of conventional lenses and silicone hydrogel lenses in the treatment of bullous keratopathy. The silicone hydrogel bandage contact lenses used were Focus NIGHT & DAY and PureVision. The conventional lens used was Sauflon 85%....This was a prospective, comparative study of 22 patients with painful bullous keratopathy in one eye. Patients visited a specialty contact lens department and were fitted with all three different lens types in their affected eye for 1 month each, for a total duration of 3 months. The main outcome measures were comfort and pain relief, which patients scored on a scale that ranged from 1 to 5, with 1 being very poor and 5 being excellent. Doctors assessed the fit of the lens, its movement, and any deposit buildup...... The median comfort score was 3.9 for PureVision, 3.8 for Focus NIGHT & DAY, and 2.8 for Sauflon 85%; there was a statistical significance among the three groups (P=0.031). Silicone hydrogel lenses performed better than conventional lenses for comfort. The Mann-Whitney test showed that there was no statistically significant difference for comfort scores of Focus NIGHT & DAY versus PureVision (P<0.782) or of Focus NIGHT & DAY versus Sauflon 85% (P<0.073). However, there was a statistically significant difference for comfort scores of PureVision versus Sauflon 85% (P<0.0136). The median pain relief score was 3.8 for PureVision, 3.7 for Focus NIGHT & DAY, and 3.2 for Sauflon 85%. There was no significant difference among the three lenses for pain relief score. All three lens types were similarly good with regard to contact lens fit, movement, and deposit buildup.Conclusions. The use of silicone hydrogel lenses are a safe and effective alternative to conventional contact lenses for the treatment of bullous keratopathy.

Posted by mehdi khanlari at 11:03 PM | Comments (0)

November 03, 2006

Intravenous dexamethasone improved visual function in idiopathic optic neuritis

OSN SuperSite
The efficacy of dexamethasone in 40 patients with acute optic neuritis has been evaluated. All patients received a daily 100 mg dose of intravenous dexamethasone for 3 days. The researchers found that distance visual acuity significantly improved at 24 hours after the first dose (P < .001) and near vision significantly improved at 24 hours after the second dose (P = .006). Patients experienced significant improvements in color vision (P < .001) and contrast sensitivity (P = .013) 24 hours after the third dose. By 1 month, the researchers also saw significant improvements in relative afferent pupillary defect and visual fields (P = .005). Only four eyes of four patients experienced a recurrence of neuritis. At 2 years' follow-up, 23 of 28 eyes available for examination (82.14%) had achieved visual acuity better than 20/40.

Posted by kjalali at 06:52 PM | Comments (0)

NIH funding research to develop light-sensitive photoswitches for restoring vision

OSN SuperSite
The National Institutes of Health has awarded a $6 million, 5-year grant to a newly created research center in California to investigate photoswitches for restoring light sensitivity in patients with degenerative blindness. The research will focus on using an ultraviolet green light to alter an azobenzene compound — an ion channel found in nerve cells — that changes its shape when illuminated by different light wavelengths. Researchers hope to use the light to turn cells "on" or "off". The grant will help the research group to develop virus vectors for carrying the photoswitches into certain cells. It will also fund research into new types of photoswitches based on other chemical structures and strategies for achieving the desired control of cell processes.

Posted by kjalali at 06:48 PM | Comments (0)

Regular exercise may cut wet AMD risk up to 70%

OSN SuperSite
The relationship between physical activity and the 15-year cumulative incidence of AMD in 3,874 participants in the Beaver Dam study has been studied. Patients who engaged in regular physical activity three or more times a week at baseline were 70% less likely to develop exudative AMD than patients without an active lifestyle. Additionally, those who walked regularly were 30% less likely to develop the disease. Physical activity, however, was not related to the incidence of early AMD or pure geographic atrophy. The results were controlled for age, gender, arthritis history, systolic blood pressure, body mass index, smoking history and education.

Posted by kjalali at 06:42 PM | Comments (0)

Ophthalmology Review

Daily Notes in Ophthalmology

November 30, 2006

Rates of bacterial endophthalmitis are similar for residents and experienced surgeons

The new challenge for Physicians

Smoking and Body Mass Index important factors for progression to advanced AMD

Smoking and Body Mass Index important factors for progression to advanced AMD

New sleeve design aims to reduce cataract surgery complications

Controversies about Endophthalmitis risk reduced with intracameral cefuroxime

Airbag dislocates crystalline lens

November 29, 2006

A Double-Masked Study of Nepafenac 0.1% and Ketorolac 0.4% for Pain and Epithelial Healing Following PRK

November 27, 2006

NSAID reduces CME, improves vision after cataract surgery

November 26, 2006

Valsalva-like Retinopathy Following Hyperopic Laser In Situ Keratomileusis

Visual Loss Following Dacryocystectomy

Optical Coherence Tomography Findings in Central Retinal Artery Occlusion

A Surgical Technique to Protect the Macular Hole in Indocyanine Green-Assisted Vitrectomy

Monoscopic Versus Stereoscopic Photography in Screening for Clinically Significant Macular Edema

ZB5M Anterior Chamber and Fyodorov’s Posterior Chamber Phakic Intraocular Lenses: Long-term Follow-up

Probability Model of the Inaccuracy of Residual Stromal Thickness Prediction to Reduce the Risk of Ectasia After LASIK Part II: Quantifying Population Risk

Have You Seen the 10-year Long-term Safety Data on LASIK?

November 25, 2006

Smooth moves for surface ablation

Eyes on Epi-LASIK

Collagen crosslinking treats causes of ectasia

November 23, 2006

More evidence supporting possible association between cataract surgery and an increased risk of developing late ARM

November 18, 2006

Factors Predicting Unsuccessful Big Bubble Deep Lamellar Anterior Keratoplasty

Take a New Shot at Shingles

Trabeculectomy with Mitomycin C for Treatment of Neovascular Glaucoma in Diabetic Patients

Axial Length, Myopia, and the Severity of Lens Opacity at the Time of Cataract Surgery

Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser

November 17, 2006

Determining when to hop off the custom-wavefront bandwagon

November 11, 2006

The Additive Effect of Topical Dorzolamide and Systemic Acetazolamide in Pediatric Glaucoma

Pupillographic Measurements with Pattern Stimulation: The Pupil’s Response in Normal Subjects and First Measurements in Glaucoma Patients

Pupillographic Measurements with Pattern Stimulation: The Pupil’s Response in Normal Subjects and First Measurements in Glaucoma Patients

Evaluation of arteriovenous crossing sheathotomy for decompression of branch retinal vein occlusion

ombined Strabismus and Lens Surgery

Ocular Axial Length Changes in Pseudophakic Children After Traumatic and Congenital Cataract Surgery

Vitrectomy for non-ischaemic macular oedema in retinal vein occlusion

November 10, 2006

Cataract Surgery and the 10-Year Incidence of Age-Related Maculopathy(The Blue Mountains Eye Study)

Retained Nuclear Fragments in the Anterior Chamber after Phacoemulsification with an Intact Posterior Capsule

Descemet’s Stripping with Endothelial Keratoplasty:Comparative Outcomes with Microkeratome-Dissected and Manually Dissected Donor Tissue

Long-term Follow-up of Intacs for Post-LASIK Corneal Ectasia

Evidence for Superior Efficacy and Safety of LASIK over Photorefractive Keratectomy for Correction of Myopia

November 07, 2006

Bimanual microphaco advantages in posterior polar cataract

Practical ways of reducing endophthalmitis

Studying statins: Protective effect shown against nuclear cataracts

Central Corneal Epitheliopathy in a Long-Term, Overnight Orthokeratology Lens Wearer: A Case Report.

November 05, 2006

Secondary diffractive bifocal piggyback intraocular lens implantation

Postoperative surface deposits on intraocular lenses in children

Inhibition of intraocular fibrin formation after infusion of low-molecular-weight heparin during combined phacoemulsification–trabeculectomy surgery

Microincision bimanual phacotrabeculectomy in eyes with coexisting glaucoma and cataract

Wavefront Analysis and Contrast Sensitivity of Aspheric and Spherical Intraocular Lenses: A Randomized Prospective Study

Acute Endophthalmitis in Eyes Treated Prophylactically with Gatifloxacin and Moxifloxacin

November 04, 2006

Cataractous Changes due to Posterior Chamber Flattening with a Posterior Chamber Phakic Intraocular Lens Secondary to the Administration of Pilocarpine

Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis

Comparison of Polypropylene and Silicone Ahmed Glaucoma Valves

Evidence for oxidative stress in lens epithelial cells in pseudoexfoliation syndrome

Comparison of Conventional and Silicone Hydrogel Contact Lenses for Bullous Keratoplasty.

November 03, 2006

Intravenous dexamethasone improved visual function in idiopathic optic neuritis

NIH funding research to develop light-sensitive photoswitches for restoring vision

Regular exercise may cut wet AMD risk up to 70%