Ophthalmology Review: February 2007 Archives

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February 27, 2007

Effect of PCO on visual function

Eyeworld Feb 2007

A recent study found no significant difference in the effect of posterior capsular opacification (PCO) on visual function between patients with monofocal and multifocal intraocular lenses (IOLs).Published in Eye, the study compared the effect of clinically significant PCO on visual function in thirty-three consecutive patients with monofocal IOLs (24) and multifocal (nine) IOLs.
Co-authored by Mostafa A. Elgohary MRCOphth, Ophthalmology department, Essex County Hospital, Colchester, U.K., the study excluded patients with concurrent cause of visual loss or pupillary distortion. The study compared LogMAR high- and low-contrast (10%) distance visual acuity (VA), logMAR near VA, Pelli–Robson contrast sensitivity (CS), colour confusion index (CCI), and the presenting symptoms between the two groups, the researchers wrote.
There was no significant difference between the proportions of patients with different PCO grade in the two groups. Furthermore, at presentation, the multifocal group showed significantly greater high- and low-contrast distance VA (0.40 vs 0.20; P=0.04 and 0.34 vs0.98; P=0.006) than the monofocal group. The researchers found no significant differences in the near VA, CS, and CCI between the two groups. In addition, the researchers wrote that the visual functions above were not significantly different between the two groups after capsulotomy. Blurred distance and near vision were found to be the most frequent presenting symptoms (95.8% and 100%, respectively, in the monofocal group and 88.9% and 66.7% respectively, in the multifocal group). The researchers also reported that a greater proportion of patients in the monofocal group had blurred near vision (100% vs 66.7%). While the symptoms in the majority of patients in the monofocal group were moderate to severe, in the multifocal group the symptoms were mild to moderate.The study authors concluded that the effect of PCO on visual function in the two groups seemed comparable. However, patients in the multifocal group appeared to have an earlier loss of visual function

Posted by mehdi khanlari at 09:53 PM | Comments (0)

February 26, 2007

Second-generation multi-focal intraocular lenses versus Array SA40N intraocular lens

Eyeworld Feb 2007

A study published in the December issue of the Journal of Cataract and Refractive Surgery found three different multifocal intraocular lenses (IOLs) to perform differently under different lighting conditions.The prospective study, conducted by Werner W. Hьtz, M.D., Klinikum Bad Hersfeld, Bad Hersfeld, Germany, and colleagues, assessed the reading performance of the Array SA40N IOL (Advanced Medical Optics, AMO, Santa Ana, Calif.), Tecnis ZM001 IOL (AMO) and the AcrySof ReSTOR SA60D3 IOL (Alcon, Fort Worth, Tex.) under different lighting conditions based on reading acuity and reading speed tests.The randomized study included 120 eyes of 60 cataract patients (120 eyes) who were randomly assigned into three groups each receiving one of the three IOLs. The evaluation of pupil size and reading ability at near (visual acuity, reading speed) distances without correction, with best distance correction, and with best near correction was conducted six weeks post-op under low-light conditions (6 cd/m(2)) and bright-light conditions (100 cd/m(2)) using the Radner Reading Charts.In analyzing their results, researchers noted, “Six weeks postoperatively, there was no significant difference between the groups in pupil size measured under low-light (6 cd/m(2)) or bright-light (100 cd/m(2)) conditions.”Under low-light conditions, the group that was administered the Tecnis ZM001 IOL performed better in near visual acuity and reading speed with or without correction, than the other two groups the researchers wrote. The other two groups did not show any significant differences between one another.In addition, the both the Tecnis group and the AcrySof ReSTOR group performed significantly better than the SA40N group under bright-light conditions, and the Tecnis group performed better than the AcrySof ReSTOR group under these conditions.“Under bright-light conditions, second-generation multifocal IOLs provided better reading performance than the Array SA40N IOL,” the study authors concluded. “However, when tested under low-light conditions, patients with the Tecnis ZM001 IOL had the best reading acuity and reading speed.”

Posted by mehdi khanlari at 11:59 PM | Comments (0)

The IOL Counselor … a cataract surgeon’s new best friend?

Eyeworld Feb 2007

Patient education has always played a vital role in the success of cataract surgery, and the newly developed IOL Counselor (Patient Education Concepts Inc., in partnership with Eyeland Design Network, Germany) takes patient education of refractive cataract surgery and premium IOL implantation to the next level. The IOL Counselor is a cumulative set of educational tools designed to “elevate the communication skills of doctors and cataract counselors” who may not be comfortable with or lack experience in sales and closing skills. The Counselor is not an informed consent tool, per se, but it does include disclaimers and signed consent forms (acknowledging that simulations are not guarantees of post-surgical visual acuity), thereby providing the surgeon with some degree of protection. The IOL Counselor also includes financial software supplied by CareCredit, which calculates and presents payment options based on the patients’ Medicare status and provides a built-in forum to discuss the fiscal aspect of the surgery—often a difficult discussion between patient and surgical counselor.
The use of generic, non-scientific images has created a unique situation from a marketing perspective as both Alcon Laboratories, Inc. (Fort Worth, Texas, makers of ReSTOR) and Advanced Medical Optics, (Santa Ana, Calif., makers of ReZoom) have joined forces to aid in its initial launch.....

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

Prostaglandins such as latanoprost may decrease more than just IOP

Eyeworld Feb 2007

...A new study however, has found that latanoprost (0.005%), part of the family of prostaglandins, decreases anterior chamber depth (ACD) in patients with glaucoma or ocular hypertension after one month of treatment.Published in a recent issue of Investigative Ophthalmology & Visual Science, this study was a prospective, nonrandomized, auto-comparative trial comprising 40 eyes of 40 patients with glaucoma or ocular hypertension. Consuelo Gutiйrrez-Ortiz, M.D., Ph.D., Hospital Universitario Prнncipe de Asturias, Madrid, Spain, and colleagues measured ACD before and after one month of treatment with latanoprost using ultrasonography.They also measured ACD before and one hour after instillation of pilocarpine (2 %) both at baseline and one month after treatment with latanoprost. In addition, a control group comprising 20 eyes of 20 patients who did not receive latanoprost was analyzed to test the reproducibility of the ultrasonic measurements.
The mean IOP was lowered 34.7% after one month of treatment with latanoprost and did not affect visual acuity or lens thickness, the researchers reported.“We also found that the effect of topical pilocarpine on ACD after treatment with latanoprost is the same as before the therapy was started,” Dr. Gutiйrrez-Ortiz said in the study.The study authors reported consistent results with good reproducibility with the ultrasound device and also found the measurements of ACD and lens thickness on two repeated examinations in the same control eyes on separate days to be “virtually the same.”
“Based on these results, we believe that the differences found in the study group reflect real changes in the parameters analyzed,” Dr. Gutiйrrez-Ortiz said in the study.
The mechanics behind the alteration

The researchers postulated that latanoprost alters ACD by relaxing the ciliary zonules.“Some studies have shown that prostaglandins induce extracellular matrix remodeling by widening the intermuscular spaces along the longitudinal ciliary muscle bundles, fragmenting collagen types I and III, reducing the density and the branching of type IV collagen and laminin, and reducing the density of type III collagen,” Dr. Gutiйrrez-Ortiz wrote in the study.The study authors continued that collagen IV is also present in the human zonules while fibrillin-1 is a major component of the ciliary zonules and the zonular microfibrils are fragmented by the metalloproteinases.
“Thus, it makes sense that the structure and perhaps the dynamics of the ciliary zonules and the ciliary muscle could be modified by treatment with prostaglandin analogues,” Dr. Gutiйrrez-Ortiz wrote in the study.Because surgeons rely on zonules to hold intraocular lenses in place for 20 to 40 years, Dr. Robbins said it is important to understand these changes.“Are they resulting in just the relaxation of the zonules or is it a result of a weakening of the zonules so that [it] may be another risk factor for dislocated IOLs down the road or possibly increase the risk for vitreous loss at the time of surgery,” Dr. Robbins said.

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

Mixing and matching multifocal lenses: How popular is it

Eyeworld Feb 2007

Richard Hoffman M.D., "
When deciding to mix and match these IOLs, starting with a ReZoom IOL in the dominant eye would appear to be the best strategy. If postoperatively, the patient was satisfied with their range of vision, then a ReZoom could be placed in the second eye. If the near acuity was close to satisfactory in the first eye (J4 or J3), it is probable that a ReZoom lens in the second eye would give an overall binocular acuity of (J2 or J1) that would be satisfactory through the mechanism of binocular summation. If the near acuity in the first eye was poor and could not be attributed to a small pupil diameter (amenable to laser photomydriasis), then placement of a ReSTOR IOL in the second non-dominant eye would be more likely to give adequate near acuity while the ReZoom IOL in the dominant eye could cover any inadequacies in intermediate distance from the ReSTOR eye."
David F. Chang M.D.,
Younger cataract patients have higher refractive expectations. They spend much more time at the computer and are more active at night. Finally, having never experienced a cataract, refractive lens exchange patients are more likely to complain about optical aberrations, decreased visual quality, and limited accommodative range.In these younger patients with greater visual demands, I will often start with a ReSTOR in their non-dominant eye. They receive a second ReSTOR if they are perfectly happy, because suggesting a different IOL is a way of convincing them that their glass is “half empty” rather than “half full.” If they desire better intermediate function and are otherwise oblivious to haloes, ReZoom is a consideration for their second eye. However, if aberrations and optical quality are an issue, I might recommend a Crystalens in their second eye.

Posted by mehdi khanlari at 11:20 PM | Comments (0)

Today’s refractive surgery trends : Safety

Eyeworld Feb 2007

Surgeons are taking safety steps to avoid ectasia by measuring flap thickness intra-operatively, creating thinner flaps, and preferring a higher stromal thickness.
The ectasia concern remains despite 60% of respondents reporting having never seen a case of post-LASIK ectasia among their patients. Sixteen percent reported that they have had one case, and 12% have seen two.
“People are more concerned about ectasia and malpractice issues,” said Perry S. Binder, M.D., San Diego. “Therefore, we’re seeing more doctors say ‘I want my residual thickness to be greater than 250 microns.’” In fact, 18% of surgeons last year said they would prefer a residual stromal thickness of 275 microns; 17% would prefer 300 microns. The majority of respondents still feel comfortable with 250 microns, although that percentage has decreased as the higher numbers have increased.....The percentage of surgeons that measure flap thickness intra-operatively increased from 31% in 2004 to 35% in 2006, reflecting another safety trend. Still, Dr. Duffey was surprised that more growth has not occurred in that area. “To me it’s such a critical point…I keep expecting the numbers to be 50%, 75%, or even 90%, but it’s not,” he said.......Respondents also said they prefer thinner flaps, with 53% targeting 120 to 130 microns. In 2004 and 2005, a higher percentage preferred 150 to 160 microns.
The safety issue is also connected to the quest for better visual quality, Dr. MacRae believes......“With a thinner flap, there’s more room to do a larger optical zone,” he said.....The trend toward thinner flaps has pushed the growth of IntraLase (now AMO, Santa Ana, Calif.) technology, Dr. Duffey said. Furthermore, studies he has conducted have shown better predictability with thin flaps made by both IntraLase as well as mechanical microkeratomes. The bottom line: “The predictability gets better the thinner [the flaps] get,” Dr. Duffey said.....Forty-eight percent of surgeons prefer a central corneal pachymetry of 500 microns for LASIK. “Surgeons are afraid to operate on 500 microns or less, although there is no scientific evidence to say these increase or decrease the risk for ectasia,” Dr. Binder said

Posted by mehdi khanlari at 11:09 PM | Comments (0)

Today’s refractive surgery trends : Presbyopic choices

Eyeworld Feb 2007

Monovision is still the first choice for presbyopic patients; 42% of respondents said they prefer standard monovision while 20% choose modified monovision. Still, other choices are gaining ground.
“Now one third of surgeons are using modern presbyopic IOLs. Last year’s number was smaller, only 16%,” Dr. Duffey said. This year, 16% said their first choice for presbyopic patients is a ReSTOR IOL (Alcon, Fort Worth, Texas), 10% prefer ReZoom (Advanced Medical Optics, AMO, Santa Ana, Calif.), and 6% prefer Crystalens (eyeonics, Aliso Viejo, Calif.) Five percent would perform blended CK.
Despite the rapid growth of accommodating IOLs as shown in the survey, Dr. MacRae characterized their popularity by a slower increase. “I think there’s a creeping interest in them,” he said. “I think what’s inhibiting rapid growth is concern for visual quality. I think there are concerns that these lenses don’t give the best quality optics. This concern has slowed the proliferation of these lenses.”

Posted by mehdi khanlari at 11:08 PM | Comments (0)

Today’s refractive surgery trends : Wavefront growth

Eyeworld Feb 2007

Wavefront technology continues to flourish, with 88% of respondents reporting that they use a wavefront analyzer. “About 90% of us are doing custom. It probably won’t get much higher than that,” Dr. Duffey believes. Use of the wavefront analyzer made meteoric leaps between 2003 and 2005, although the numbers stabilized in 2005.
Fifty-five percent of respondents use wavefront in 76% to 100% of their cases, a percentage that has increased in a step-ladder fashion in the past few years.This reflects a larger percentage of surgeons converting to wavefront in addition to the growing number of surgeons who use wavefront technology more frequently, Dr. Slade believes. The current emphasis on visual quality pushes wavefront’s popularity, Dr. MacRae said.

Posted by mehdi khanlari at 11:06 PM | Comments (0)

Today’s refractive surgery trends :Preferred surgeries

Eyeworld Feb 2007

Ninety-four percent of surgeons said that they perform LASIK and/or PRK,... “We don’t have many people saying they do only LASIK or only PRK,” Seventy-one percent said they perform limbal relaxing incisions (LRIs) with IOLs, and 57% said they perform refractive lens exchange (RLE); that same percentage of surgeons uses LRIs alone. A smaller number of surgeons perform conductive keratoplasty (CK), LASEK, Epi-LASIK, and insert phakic IOLs—each procedure being performed by 20% to 30% of respondents.
The trend toward less LASIK and increased phakic–IOL use was shown in hypothetical treatment scenarios for certain patients. For example, in a 30-year-old, –10 D or –12 D myope, most surgeons in the earlier years of the survey would have performed LASIK. However, in 2006, only 31% said they would perform LASIK. Thirty-five percent said they would use a phakic IOL, and 15% said they would wait and not perform any immediate surgery.
For a 45-year-old, +5 D hyperope, the percentage of surgeons who would have performed LASIK has declined from just over 30% in 1999 to only 8% in the last year. The number one choice was RLE, preferred by 61% of surgeons, followed by those who waited (23%).
Overall, surgeons said they will continue to perform LASIK and PRK in the future, although many plan to increase use of LRIs, RLEs, and phakic IOLs. Despite earlier predictions of increased laser thermokeratoplasty (LTK) from the 2000 survey, increased frequency of LTK’s has not occurred.In addition, a growing number of respondents—nearly one-third—reported that they have had refractive surgery performed on themselves.

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

Refractive Surgery Protocol for drug regimen

Eyeworld Feb 2007

• Vitamin C: 500 mg twice a day as soon as surgery is scheduled.
• Restasis (cyclosporine ophthalmic emulsion, Allergan, Irvine, Calif.): one drop in both eyes twice a day as soon as surgery is scheduled. Take Restasis for at least three months.
• Prednisone: 80 mg exactly one-half hour before surgery, 80 mg one day post surgery, 40 mg two days after surgery, 20 mg three days post surgery, 10 mg four days post surgery, and 5 mg five days post surgery.
• Zantac (ranitidine, GlaxoSmithKline, Research Triangle Park, N.C.): 150 mg twice a day for six days starting the day of surgery.
• Pred Forte (prednisone, Allergan): one drop in both eyes four times a day for seven days starting the day of surgery.
• Zymar (gatifloxacin ophthalmic solution, Allergan): one drop in both eyes four times a day for seven days starting the day of surgery (for gastritis from prednisone).
• Acular LS (ketorolac tromethamine ophthalmic solution, Allergan): one drop in both eyes four times a day for three days starting the day of surgery.
• Comfort drops (1:20 of 1% tetracaine): one drop in both eyes every hour as needed for pain for the first three days starting the day of surgery.
• Preservative-free artificial tears: every two hours while awake.
• Refresh Celluvisc lubricant eye drops (Allergan): one drop in both eyes at night until bandage contact is removed (approximately six or seven days).
• Refresh PM Ointment (Allergan): every night after bandage contact lens is removed until one month after surgery.
• Tylenol Extra Strength (McNeil Consumer Healthcare, Fort Washington, Pa.): one tablet every four to six hours as needed for pain.
• Mepergan Fortis (promethazine with meperidine, Wyeth-Ayerst Laboratories, Collegeville, Pa.): one tablet every four to six hours
(escape medicine for severe pain).
• Ice packs: as needed at home.

Posted by mehdi khanlari at 10:47 PM | Comments (0)

Statin use associated with myasthenia gravis

Medicine (Baltimore)
A recent report described four patients who developed a myasthenic-like syndrome after starting a statin drug. Ophthalmologist should be inquired about statin use in patients with new-onset ptosis or diplopia of unknown cause. If statin use was recent, obtain anti-acetylcholine receptor antibodies and discuss other treatment options with the patient’s prescribing physician.

Posted by kjalali at 06:35 AM | Comments (0)

Good preliminary results for myopic macular degeneration treatment

INDUSTRY NEWS
OXiGENE reports that all participants in its Phase II Combretastatin A4 Phosphate trial maintained visual acuity; defined as less than a three line loss in visual acuity at three months. No serious drug-related adverse events were reported.

Posted by kjalali at 06:22 AM | Comments (0)

February 25, 2007

Progression of Geographic Atrophy and Impact of Fundus Autofluorescence Patterns in Age-related Macular Degeneration

Am J Ophthalmol., Vol. 143, March 2007
Methods
Standardized digital FAF images were obtained from 195 eyes of 129 patients with GA using confocal scanning laser ophthalmoscopy (excitation 488 nm, emission >500 nm). Areas of GA were quantified and patterns of abnormal FAF in the junctional zone were classified. Repeated FAF images were obtained over a median follow-up period of 1.80 years (interquartile range [IQR], 1.28 to 3.34).

Results
Areas of GA (median, 7.04 mm2 at baseline; IQR, 3.12 to 10.0) showed a median enlargement of 1.52 mm2/year (IQR, 0.81 to 2.33). Progression rates in eyes with the banded (median 1.81 mm2/year) and the diffuse FAF pattern (1.77 mm2/year) were significantly higher compared to eyes without FAF abnormalities (0.38 mm2/year) and focal FAF patterns (0.81 mm2/year, P < .0001). Within the group of the diffuse pattern, eyes with a diffuse trickling pattern could be identified that exhibited an even higher spread rate (median 3.02 mm2/year) compared to the other diffuse types (1.67 mm2/year, P = .001).

Conclusions
The results indicate that distinct phenotypic FAF patterns have an impact on disease progression in eyes with atrophic AMD and may therefore serve as prognostic determinants. The findings underscore the relevance of FAF imaging and the pathogenetic role of excessive retinal pigment epithelium (RPE) lipofuscin (LF) accumulation in GA. Natural history data and identification of high-risk characteristics will be helpful to design interventional studies aiming at slowing the spread of atrophy.

Posted by mriazi at 08:02 PM | Comments (0)

Reproducibility of and Effect of Magnification on Optical Coherence Tomography Measurements in Children

AM J Ophthalmol, Vol. 143, March 2007
Methods
The Sydney Childhood Eye Study examined 2,353 year 7 students (75.3% response) from a random cluster sample of 21 secondary schools across Sydney. A consecutive subsample of 120 children had OCT (StratusOCT, Carl Zeiss, Dublin, California, USA) performed by a single operator, which was repeated with a brief rest between the two sessions. Scans of the NFL, macula, and optic disk were performed.

Results
Intersubject variability of measurements of macular thickness, NFL thickness, and optic disk parameters assessed using intraclass correlation coefficients accounted for >85%, >62%, and >38% of total variability of measurements, respectively. Corresponding coefficients of variability were <5%, <8%, and <13%. Magnification effects attributable to axial length and refractive error on the measurement of these parameters were statistically not significant.

Conclusion
The StratusOCT demonstrated reproducible measurements of macular and NFL thickness. Measurement of most optic disk parameters were also reproducible. Magnification attributable to axial length and refractive error had minimal impact on measurements of macular and NFL thickness

Posted by mriazi at 07:50 PM | Comments (0)

Long-term Follow-up of High Myopic Foveoschisis: Natural Course and Surgical Outcome

AM J Ophthalm, vol. 143, March 2007
Methods
Twenty-nine operated and nonoperated cases of MF (29 eyes of 23 patients) were studied. All eyes underwent repeated examinations, including optical coherence tomographic (OCT) recordings, during a mean follow-up of 31.2 months. Special attention was paid to the evolution of visual acuity (VA) and to the thickness of foveoschisis.

Results
Mean refraction was −14.4 diopters, and mean axial length was 29.1 mm. OCT scans revealed that the foveoschisis was associated with macular anomalies: a premacular structure in 13 (44.8%) of 29 eyes, a foveal detachment in 10 (34.5%) of 29 eyes, and a lamellar macular hole in six (20.7%) of 29 eyes. Isolated foveoschisis was found in four eyes (13.8%). During follow-up, foveoschisis and VA worsened in 20 eyes and remained stable in nine. Ten of the 20 eyes that worsened had a premacular structure. A macular hole occurred in nine eyes, six of which had previously exhibited foveal detachment. Eleven eyes with foveoschisis underwent surgery, which improved VA significantly (P = .04, Wilcoxon test), but three eyes developed a macular hole.

Conclusions
MF may remain stable for many years without affecting VA. However, when it is combined with the presence of a premacular structure, the risk of a decrease in VA increases. When it is combined with foveal detachment, a macular hole seems to develop frequently, whether or not surgery is performed.

Posted by mriazi at 07:29 PM | Comments (0)

February 19, 2007

Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approachfor rectus muscle recession and plication.

Br J Ophthalmol. 2007 Jan;91(1)
AIM: To present a novel, minimally invasive strabismus surgery (MISS) technique for rectus muscle operations. METHODS: In this prospective study with a non-concurrent, retrospective comparison group, the first 20 consecutive patients treated with MISS were matched by age, diagnosis and muscles operated on, with 20 patients with a limbal opening operated on by the same surgeon at Kantonsspital, St Gallen, Switzerland. A total of 39 muscles were operated on. MISS is performed by applying two small radial cuts along the superior and inferior muscle margin. After muscle separation from surrounding tissue, a recession or plication is performed through the resulting tunnel. Alignment, binocular single vision, variations in vision, refraction, and number and types of complications during the first 6 postoperative months were registered. RESULTS: Visual acuity decreased at postoperative day 1 in both groups. The decrease was less pronounced in the group operated on with MISS (difference of decrease 0.14 logMAR, p<0.001). An abnormal lid swelling at day 1 was more frequent in the control group (21%, 95% confidence interval (CI) 9% to 41%, 5/24 v 0%, 95% CI 0 to 13%, 0/25, p<0.05). No significant difference was found for final alignment, binocular single vision, other visual acuities, refractive changes or complications (allergic reactions, dellen formation, abnormal conjuctival findings). A conversion to a limbal opening was necessary in 5% (95% CI 2% to 17%, 2/39) of muscles. CONCLUSIONS: This study shows that this new, small-incision, minimal dissection technique is feasible. The MISS technique seems to be superior in the direct postoperative period as better visual acuities and less lid swelling were observed. Long-term results did not differ in the two groups.

Posted by s.tavakolizadeh at 04:09 PM | Comments (0)

February 18, 2007

Current approaches to the management of acute primary angle closure

Current Opinion in Ophthalmology, 02/15/

Lam, Dennis SC., et al. ? Recent advances in the management of acute primary angle closure include argon laser peripheral iridoplasty, immediate anterior chamber paracentesis, and cataract or lens extraction by phacoemulsification...This technique has the potential to prevent recurrence of the condition and progression to chronic angle closure glaucoma. With existing and upcoming new data on managing acute primary angle closure, it is hopeful that a more optimal treatment algorithm will be established soon...
07

Posted by mehdi khanlari at 11:40 PM | Comments (0)

Pain Associated With Local Anesthetic Injection in Eyelid Procedures: Comparison of Microprocessor-Controlled Versus Traditional Syringe Techniques

Ophthalmic Plastic and Reconstructive Surgery, 02/15/07

Lee, Edward W. MD., et al. ? To evaluate the pain associated with local infiltration of the eyelid, using a microprocessor-controlled delivery system (CompuMed, using the Wand), as compared with traditional manual syringe infiltration technique...Conclusions: The Wand was effective at significantly reducing the pain associated with local anesthetic infiltration in minor eyelid surgical procedures. Patients appear to feel pain from the initial needle stick but not during the actual injection...

Posted by mehdi khanlari at 11:37 PM | Comments (0)

A Better Way to Evaluate CK Candidates

Review of Ophthalmolog/16/07y, 02

David Geffen, OD., et al. ? A standard recommendation for patients interested in surgical correction of presbyopia is a trial of monovision. Typically, this has involved placing a spherical contact lens on the nondominant eye as a means of demonstrating the trade-off in distance vision...In our practice, we have found a better way by using the multifocal contact lens in the non-dominant eye and slightly over-plussing the patient. It provides them with a vision that is much closer to the results we see with NearVision CK. As important, the results obtained with the multifocal lens very closely match post-CK vision, right down to the higher-order aberrations...

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

Visually significant persistent outer retinal fluid following closure of a macular hole

Acta Ophthalmologica Scandinavica, 02/16/07

Sears, Katharine S., et al. ? Twenty-eight consecutive patients who underwent macular hole surgery performed by a single surgeon were examined pre- and postoperatively using slit-lamp biomicroscopy and optical coherence tomography (OCT)...Conclusions: Large pockets of persistent outer retinal fluid defects as shown on OCT may reduce final visual acuity in patients following macular hole surgery...

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

Endothelial Cell Loss After Toric Iris-fixated Phakic Intraocular Lens Implantation: Three-year Follow-up

Journal of Refractive Surgery, 02/14/07

Mana Tehrani, MD., et al. - Conclusions: Annual cumulative cell loss was -1.9% for the myopic group and -1.6% for the hyperopic group, which is two to three times greater than physiological annual cell loss in normal eyes without surgery. An annual endothelial cell count analysis is highly recommended in every patient after iris-claw lens implantation to detect potential progressive cell loss

Posted by mehdi khanlari at 10:48 PM | Comments (0)

Cataract Surgery Is Associated with a Higher Rate of Photodynamic Therapy for Age-Related Macular Degeneration

Ophthalmology Volume 114, Issue 2 , February 2007, Pages 278-282

Fifty (0.85%) cataract patients and 94 control cases (0.32%) underwent PDT after cataract surgery (P<0.0001, chi-square test). A significant rise in PDT rate was noticed in cataract patients compared to controls during the first 6 months after surgery (P = 0.004, chi-square test). Between 6 and 12 months postoperatively, the PDT rates were similar in both groups. However, a more significant rise in PDT rates occurred between 1 and 1.5 years after surgery (P<0.0001, chi-square test). The Kaplan–Meier PDT-free survival curve of cataract patients was significantly worse than that of the controls (P<0.0001, chi-square test; P = 33.7, log-rank test). The hazard ratio for cataract patients compared to controls to undergo PDT after surgery was 2.7 (confidence interval = 2.4–5.7). The most significant factors to reduce the time to PDT were advanced age followed by having had cataract surgery, place of birth, socioeconomic status, and hyperlipidemia (Cox proportional hazards survival regression).
Conclusions
We identified an increased rate of PDT, presumably for subfoveal AMD, 1 to 1.5 years after cataract surgery.

Posted by mmiraftab at 11:25 AM | Comments (0)

Fluctuation of Intraocular Pressure and Glaucoma Progression in the Early Manifest Glaucoma Trial

Ophthalmology Volume 114, Issue 2 , February 2007, Pages 205-209

Two hundred fifty-five glaucoma patients from the Early Manifest Glaucoma Trial (EMGT; 129 treated and 126 control patients).
Study visits, conducted every 3 months, included ophthalmologic examinations, IOP measurements, and standard automated perimetry, with fundus photography every 6 months. Intraocular pressure values were included only until the time of progression in those eyes that showed such progression. Individual mean follow-up IOP and IOP fluctuation, calculated as the standard deviation of IOP at applicable visits, were the variables of main interest. Cox regression with time-dependent variables was used to evaluate the association between IOP fluctuation and time to progression, both with and without IOP mean in the models. These analyses also controlled for other significant variables.
Main Outcome Measures
Glaucoma progression, as defined by a predetermined visual field criterion, worsening of the disk, assessed by an independent disc reading center, or both.
Results
Median follow-up time was 8 years (range, 0.1–11.1 years). Sixty-eight percent of the patients progressed. When considering mean follow-up IOP and IOP fluctuation in the same time-dependent model, mean IOP was a significant risk factor for progression. The hazard ratio (HR) was 1.11 (95% confidence interval [CI], 1.06–1.17; P<0.0001). Intraocular pressure fluctuation was not related to progression, with an HR of 1.00 (95% CI, 0.81–1.24; P = 0.999).
Conclusions
These results confirm our earlier finding that elevated IOP is a strong factor for glaucoma progression, with the HR increasing by 11% for every 1 mmHg of higher IOP. Intraocular pressure fluctuation was not an independent factor in our analyses, a finding that conflicts with some earlier reports. One explanation for the discrepancy is that our analyses did not include postprogression IOP values, which would be biased toward larger fluctuations because of more intensive treatment. In contrast, in this EMGT report, no changes in patient management occurred during the period analyzed.

Posted by mmiraftab at 11:21 AM | Comments (0)

The Risk of Glaucoma in Pseudoexfoliation Syndrome

Journal of Glaucoma. 16(1):117-121, January 2007

Retrospective community-based study of newly diagnosed cases of PEX syndrome in all residents of Olmsted County, Minnesota between 1976 and 1991. The end point was considered the initiation of therapy, which included patients with glaucoma (optic disc damage or visual field defects), or with elevated intraocular pressure (IOP) >21 mm Hg in the presence of risk factors; the subsequent development of damage in the latter group was also determined.
Results: Two hundred fifty-five patients (318 eyes) had newly diagnosed PEX over the 15-year interval. Mean age was 73+/-10 years; 78% (199/255) were female. Of all PEX patients, 16% were placed on therapy at the time of initial diagnosis of PEX. In the remaining PEX patients, the probability of being placed on therapy was 44% at 15 years. Bilateral PEX was present in 25% at initial diagnosis and developed in another 29% by 15 years. Of those not placed on therapy, 16% (23/142) had IOP increase 5+ mm Hg during follow-up, with 11% (16/142) reaching 22 mm Hg or more. The strongest risk factors for converting to therapy were IOP at initial diagnosis of PEX and bilateral involvement.
Conclusions: In a geographically defined population of PEX patients, 16% required treatment upon presentation. Of the remaining PEX patients, 44% received therapy over the next 15 years.

Posted by mmiraftab at 11:14 AM | Comments (0)

Comparison of Silicone and Polypropylene Ahmed Glaucoma Valve Implants

Journal of Glaucoma. 16(1):36-41, January 2007

A retrospective chart review of 180 eyes of 166 patients who underwent AGV implantation with a minimum follow-up period of 3 months was performed. All patients who underwent implantation of either the AGV model S-2 (polypropylene) or model FP-7 (silicone) were included, unless previous laser cyclophotocoagulation had been performed. The primary outcome measures were the change in intraocular pressure (IOP) and visual acuity after surgery and the rate of postoperative complications.
Results: No significant differences were seen in the baseline characteristics of patients in each group. Baseline IOP was statistically equivalent in the 2 groups (silicone =33.8+/-11.9 mm Hg, polypropylene=33.0+/-10.3 mm Hg, P=0.6). A significant reduction in IOP from baseline was achieved after both silicone and polypropylene AGV implantation (silicone =-17.7+/-11.8 mm Hg, polypropylene =-17.7+/-11.3 mm Hg, both P<0.00005). However, there was no statistically significant difference in IOP decrease between the 2 groups at any follow-up visit (all P>0.09). The mean number of postoperative antiglaucoma medications was also similar in the silicone and the polypropylene AGV groups at each time point (all P>0.2). The rate of complications and the change in visual acuity did not differ between the 2 groups (P>0.6 and P>0.3, respectively).
Conclusions: Silicone and polypropylene AGVs have similar results with respect to both safety and efficacy in the treatment of patients with refractory glaucoma.

Posted by mmiraftab at 11:11 AM | Comments (0)

Comparison of Trabeculectomy With Ex-PRESS Miniature Glaucoma Device Implanted Under Scleral Flap

Journal of Glaucoma. 16(1):14-19, January 2007

In this retrospective comparative series of 100 eyes, we compared 50 eyes in 49 patients treated with the Ex-PRESS miniature glaucoma implant under a scleral flap with 50 matched control eyes in 47 patients treated with trabeculectomy. Success was defined as intraocular pressure (IOP) >=5 mm Hg and <=21 mm Hg, with or without glaucoma medications, without further glaucoma surgery or removal of implant. Early postoperative hypotony was defined as IOP <5 mm Hg during the first postoperative week.
Results: The average follow-up was 10.8 months (range 3.5 to 18) for the Ex-PRESS group and 11.2 months (range 3 to 15) for the trabeculectomy group. Although the mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group, the reduction of IOP was similar in both groups after 3 months. The number of postoperative glaucoma medications in both groups was not significantly different. Kaplan-Meier survival curve analysis showed no significant difference in success between the 2 groups (P=0.594). Early postoperative hypotony and choroidal effusion were significantly more frequent after trabeculectomy compared with Ex-PRESS implant under scleral flap (P<0.001).
Conclusions: The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.

Posted by mmiraftab at 11:09 AM | Comments (0)

February 17, 2007

AMO Acquires IntraLase and WaveFront Sciences

Review of ophthalmology Feb 2007

Advanced Medical Optics and IntraLase last month entered into a definitive agreement for AMO to acquire IntraLase for approximately $808 million in cash.AMO expects the transaction to be completed early in the second quarter of 2007. The transaction is subject to IntraLase stockholder approval as well as regulatory approvals and other customary closing conditions. “This acquisition offers significant strategic value by further establishing AMO as the global refractive technology leader, positioning us with a broad range of technologies and expertise to serve the needs of comprehensive refractive practices,”

Posted by mehdi khanlari at 11:25 PM | Comments (0)

February 16, 2007

Reducing the risk for endophthalmitis after cataract surgery: Population-based nested case-control study: Endophthalmitis Population Study of Western Australia sixth report

JCRS Pages 269-280 (February 2007)
To characterize operative and nonoperative risks for the potentially blinding complication of endophthalmitis after cataract surgery.

Setting
Ophthalmology services for the whole state of Western Australia.

Methods
This retrospective population-based nested case-control study in Western Australia covered the period between 1980 and 2000.
Wound location, suturing the wound, and type of cataract operation did not affect the risk for postoperative endophthalmitis. Antibiotic prophylaxis reduced the risk, but only if given as a subconjunctival injection . The risk for endophthalmitis was greater with same-day surgery than with admission the day before surgery. A concurrent eyelid procedure was a substantial risk. Surgeons within 2 years of obtaining specialist qualifications were more likely to have a case of endophthalmitis, although this was partly the result of more posterior capsule breaches. Posterior capsule breach increased the risk when it occurred in private hospitals,but not in public hospitals.

Conclusions
Nonoperative as well as operative factors are important in the prevention of endophthalmitis. Subconjunctival injection of antibiotics appears to be beneficial for endophthalmitis prophylaxis. The model showed that active risk management strategies designed to optimize hospitalization and chemoprophylaxis may reduce the incidence of endophthalmitis by up to 81%.

Posted by alireza habibollahi at 11:27 PM | Comments (0)

Postcataract endophthalmitis: Incidence and microbial isolates in a United Kingdom region from 1996 through 2004

JCRS Pages 265-268 (February 2007)
To investigate the incidence of endophthalmitis after cataract surgery, analyze the microbiologic spectrum of infecting organisms, and assess the diagnostic utility of an anterior chamber paracentesis and vitreous biopsy.

A retrospective noncomparative consecutive series comprised 105 postcataract endophthalmitis cases.

Results
The annual mean incidence of endophthalmitis over the study period was 0.099% (10/101 920), and there was no significant increase in the incidence during the study. The culture-positive rate was 58.1% (61/105). Gram-positive microbes were isolated in 93.4% of cases (57/61), with coagulase-negative staphylococci accounting for 62.3% (38/61). Anterior chamber taps yielded positive cultures in 25.7% of cases, and vitreous biopsy was positive in 53.4%.

Conclusions
The incidence of endophthalmitis in this region of the United Kingdom remained stable, with gram-positive microbes accounting for 93.4% of the isolates. A combination of anterior chamber tap and vitreous biopsy should be performed in suspected cases of endophthalmitis

Posted by alireza habibollahi at 11:21 PM | Comments (0)

Longitudinal study of intraocular lens exchange

JCRS Pages 254-257 (February 2007)
To analyze the indications for intraocular lens (IOL) exchange, interval between the first IOL implantation and the exchange, type and mix of IOLs used, effect on vision, and frequency of complications.
This retrospective study comprised 49 eyes of 49 adult patients who had IOL exchange between 1986 and 2002 performed by the same surgeon. The mean age was 70 years old, and 55% were women. The mean interval between surgeries was 53.8 months and the mean follow-up, 35.6 months. The patients were divided into 2 groups according to the type of IOL originally implanted: anterior chamber (AC) or posterior chamber (PC).

Results
There were 15 eyes with an AC IOL and 34 eyes with a PC IOL. The difference in mean age and follow-up were not statistically significant between groups. The mean interval between the primary surgery and IOL explantation was 82.3 months in the AC IOL group and 37.9 months in the PC IOL group. The main reason for IOL exchange was inflammation (53.34%) and dislocation/decentration (85.30%), respectively. The preoperative best corrected visual acuity was similar in both groups, and visual acuity was maintained or improved in 80%. Vitreous prolapse was the main intraoperative complication.
Conclusions
The primary indication for IOL exchange was intraocular inflammation in patients with an AC IOL and IOL malposition in patients with a PC IOL. The results confirm the safety and positive visual outcome in this complex group of patients.

Posted by alireza habibollahi at 11:14 PM | Comments (0)

Cystoid macular edema following photorefractive keratectomy complicated by presumptive infectious keratitis

JCRS Pages 348-349 (February 2007)
A 71-year-old man developed cystoid macular edema (CME) following PRK. He had a history of CME following cataract surgery in both eyes, which had responded well to topical steroid and nonsteroidal antiinflammatory drops. The cataract surgery in the left eye had resulted in a hyperopic surprise, with secondary anisometropia and visual discomfort. For this reason, the patient elected to have PRK. Three weeks after the procedure, he returned, complaining of visual loss. Optical coherence tomography and fluorescein angiography confirmed the presence of CME. This responded well to topical and sub-Tenon's corticosteroids and nonsteroidal antiinflammatory drops.

Posted by alireza habibollahi at 11:02 PM | Comments (0)

Opacification of Array SA40N silicone multifocal intraocular lens

JCRS Pages 342-347 (February 2007)

We report opacification of 2 multifocal intraocular lenses (IOLs). Patients with these IOLs may be more likely to require IOL explantation than those with monofocal IOLs.

Posted by alireza habibollahi at 10:59 PM | Comments (0)

Iris damage by inadvertent cannula injection

JCRS Pages 339-341 (February 2007)

Iris damage occurred in 2 patients due to the inadvertent forceful injection of a cannula. Despite luer lock syringes, the J-shaped cannula was injected during cortical removal in one eye and during hydration of the incision at the end of the procedure in the second eye. Iris damage should be added to the growing list of injuries that can result from cannula-related complications.

Posted by alireza habibollahi at 10:52 PM | Comments (0)

Bilateral methicillin-resistant Staphylococcus aureus keratitis after photorefractive keratectomy

JCRS Pages 316-319 (February 2007)

A 52-year-old woman with a history of liver transplantation developed bilateral corneal infiltrates 1 week after uneventful photorefractive keratectomy (PRK). Cultures grew methicillin-resistant Staphylococcus aureus (MRSA), resistant to fluoroquinolone antibiotics. The infections responded to topical vancomycin and resolved bilaterally over 3 weeks. Three months postoperatively, the uncorrected visual acuity (UCVA) was 20/20 in the right eye and 20/25 in the left eye; the BSCVA was 20/20 in both eyes. During the course of treatment, the patient reported chronic intermittent prophylactic use of oral ciprofloxacin. While fluoroquinolones typically provide excellent postoperative coverage, Staphylococcus organisms have a growing antibiotic resistance to fluoroquinolones, and MRSA may become a more prevalent organism in corneal infections. Chronic subtherapeutic fluoroquinolone use can increase the mutational resistance of Staphylococcus to fluoroquinolone and methicillin. The patient's frequent hospital visits placed her at high risk for MRSA colonization.

Posted by alireza habibollahi at 10:48 PM | Comments (0)

External Dacryocystorhinostomy: Double-Flap Anastomosis or Excision of the Posterior Flaps?

Ophthalmic Plastic & Reconstructive Surgery.January/February 2007.

This randomized, clinical trial included 63 consecutive patients undergoing DCR. Patients were alternately assigned to two groups on the basis of the pattern of flap anastomosis. An H-shaped incision was created in the lacrimal sac and the nasal mucosa in all patients. In group A, posterior and anterior flaps were separately approximated; in group B, only the anterior flaps were sutured after resection of both posterior flaps. Our study suggests that DCR with double-flap anastomosis has no advantage over DCR with only anterior flaps. Anastomosis by suturing only anterior flaps and excision of the posterior flaps is easier to perform and does not appear to adversely affect the outcome of DCR surgery.

Posted by afarahi at 06:09 PM | Comments (0)

Use of a Novel Topical Hemostatic Sealant in Lacrimal Surgery: A Prospective, Comparative Study

Ophthalmic Plastic & Reconstructive Surgery. January/February 2007.

FloSeal Matrix is a new, two-component (collagen granules and thrombin), topical hemostatic sealant. FloSeal was used during surgery in 10 consecutive patients undergoing DCR. A further 10 consecutive patients (comparative group) had DCR without FloSeal; nasal packing was performed to control postoperative bleeding. The severity of postoperative bleeding and patient comfort were compared between the two groups at three time points (immediately after surgery, 12 hours after surgery, and 24 hours after surgery).
All patients in the comparative group had some degree of postoperative bleeding (minimal to severe), whereas the nine patients in the FloSeal group had none or minimal bleeding. The difference was statistically significant at all three measured time points (p = 0.047, 0.006, 0.05). The FloSeal group also had less postoperative discomfort (p = 0.0001).
Conclusions: FloSeal Matrix is an effective hemostasis adjunct in patients undergoing lacrimal surgery. It has the added benefits of high patient satisfaction and ease of use.

Posted by afarahi at 06:02 PM | Comments (0)

Evisceration Techniques and Implant Extrusion Rates: A Retrospective Review of Two Series and a Survey of ASOPRS Surgeons.

Ophthalmic Plastic & Reconstructive Surgery. January/February 2007.

The implant extrusion rate was zero in the author's series of 53 patients, compared with 27.1% (54 of 192 implants) in series treated by other surgeons. Statistically significant differences were found between the two series in surgical technique, wound care, and duration of antibiotic administration. The author routinely performed posterior sclerotomy, whereas the other surgeons did not. Average implant size was 18.8 mm in the author's series, compared with 13.7 mm in the other series. Antibiotic therapy was administered for 10 to 18 days in the author's series, compared with 28 to 46 days in patients treated by other surgeons. The response rate to the survey was 65% (223 of 343 surveys). Among the surgeons surveyed, immediate and secondary implant techniques were used in nearly equal frequency. Delayed implant technique is used least frequently. Reported implant extrusion rates varied greatly among surgeons, ranging from 0% to 20%. Only 3.9% of surgeons expressed a concern over sympathetic ophthalmia.
Conclusions: Injudicious antibiotic use and smaller implants do not decrease the risk of implant extrusion. The survey revealed that immediate and secondary implant techniques are used with equal frequency. The theoretical risk of sympathetic ophthalmia does not appear to be a concern to most surgeons.

Posted by afarahi at 05:56 PM | Comments (0)

Long-term Follow-up of Porous Polyethylene Spherical Implants After Enucleation and Evisceration

Ophthalmic Plastic & Reconstructive Surgery.January/February 2007.

In 106 cases of retrospective, interventional, noncomparative case series eighty patients (75.5%) underwent enucleation (group A) and 26 (24.5%) underwent evisceration (group B). Patient demographics were similar in both groups. Mean implant size in group A was 20.5 mm and 17.2 mm in group B. Mean follow-up in group A was 40 months (range, 12 to 80 months). Mean follow-up in group B was 63 months (range, 12 to 72 months). Six cases (7.5%) in group A had complications (excluding implant exposure), whereas one case (3.8%) in group B had a complication (excluding implant exposure). Five patients (6.3%) in group A had implant exposure; 14 cases (53.8%) of implant exposure occurred in group B.
Conclusions: Our case series revealed a significantly higher incidence of implant exposure after evisceration than after enucleation. Our data suggest that enucleation should be the procedure of choice when removing an eye to minimize the risk of subsequent complications, particularly orbital implant exposure

Posted by afarahi at 05:34 PM | Comments (0)

Porous Implant Exposure: Incidence, Management, and Morbidity.

Ophthalmic Plastic & Reconstructive Surgery. January/February 2007.
To identify what factors may predispose patients to exposure of porous anophthalmic implants and to determine the outcome of exposed porous implants.Porous implants were inserted in 80% (3012 of 3777) of the cases identified from 49 publications. The difference in exposure rate between coralline hydroxyapatite (4.9%) and porous polyethylene (8.1%) implants is primarily related to a higher reported complication rate of uncovered porous polyethylene implants, particularly in retinoblastoma patients. Other techniques associated with increased exposures include wrapping implants with bovine pericardium or polyglactin mesh. Evisceration and secondary procedures did not have statistically different complication rates compared with enucleation. There are more late exposures of porous polyethylene than coralline hydroxyapatite implants. Spontaneous healing of exposures occurred in 13% (19 of 145) of cases. Covering exposures with patch grafts underneath vascularized conjunctival flaps was the most successful method of surgical repair. Implant removal was necessary after 29% (42 of 145) of exposures.

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

A New Formula for Cataract Success

Review of Ophthalmology Feb 2007

A surgeon from Moorfields Eye Hospital in London, however, says he has developed BESSt, a formula that can estimate a post-refractive patient’s corneal power accurately without any pre-refractive surgery corneal data. Here’s how the formula works.The surgeon who developed the formula, Edmondo Borasio, did so while working as a fellow with Moorfields’ Dr. Julian Stevens. Their names, along with Moorfields colleague Guy T. Smith, make up the BESSt acronym: Borasio Edmondo Smith and Stevens.The BESSt formula is a modified version of a Gaussian optics formula, and was developed after studying 150 refractive surgery eyes.
In order to perform corneal power calculations using the BESSt Power Calculator, the surgeon must know the cornea’s anterior and posterior radii of curvature, as well as the central thickness. Dr. Borasio takes these values from the Oculus Pentacam, but he says that, theoretically, they could be acquired with an Orbscan and an ultrasonic pachymeter, though the accuracy of the formula wasn’t tested with the Orbscan. For IOL power calculations, he recommends getting the axial length measurement with an IOL Master (Carl Zeiss Meditec), because he says A-Scan ultrasound is less accurate. The surgeon also must have the target postop refraction and the IOL’s A-Constant.The BESSt Corneal Power Calculator is available for free at besstformula.com. This version provides corneal power only. A full-featured version costs about 90 pounds

Posted by mehdi khanlari at 08:20 AM | Comments (0)

External Dacryocystorhinostomy: Double-Flap Anastomosis or Excision of the Posterior Flaps?

Ophthalmic Plastic and Reconstructive Surgery, 02/12/07

Serin, Didem MD., et al. ? Conclusions: Our study suggests that DCR with double-flap anastomosis has no advantage over DCR with only anterior flaps. Anastomosis by suturing only anterior flaps and excision of the posterior flaps is easier to perform and does not appear to adversely affect the outcome of DCR surgery...

Posted by mehdi khanlari at 08:20 AM | Comments (0)

A New Formula for Cataract Success

Posted by mehdi khanlari at 08:20 AM | Comments (0)

Intravitreal Bevacizumab for Filtering Surgery

Ophthalmic Research, 02/05/07

Jost B. Jonas., et al. ? It was the aim of this study to report on the intravitreal use of bevacizumab as antiproliferative agent in combination with filtering surgery...Conclusions: Intravitreal bevacizumab may potentially be helpful as addition to antiglaucomatous filtering surgery, particularly in neovascular glaucoma...

Posted by mehdi khanlari at 08:11 AM | Comments (0)

Transscleral red-laser cyclophotocoagulation combined with limited anterior retinal cryocoagulation in neovascular glaucoma

Acta Ophthalmologica Scandinavica, 02/08/07
Raivio, Virpi E., et al. ? To evaluate transscleral contact red-laser cyclophotocoagulation (CPC), using a visible red 647-nm krypton or 670-nm diode laser and limited transscleral anterior retinal cryocoagulation in neovascular glaucoma...Conclusions: A combination of transscleral contact red-laser CPC with limited anterior retinal cryocoagulation is efficient in lowering IOP in neovascular glaucoma and is well tolerated. During follow-up, a decrease in VA occurs in a significant proportion of patients...

Posted by mehdi khanlari at 07:54 AM | Comments (0)

Using Computers to Monitor Patient Flow

Review of Ophthalmology Feb 2007

Being able to identify where the patients in your practice are at any given time has a host of advantages, both in terms of monitoring what’s happening in real time, and in terms of being able to analyze the information afterwards to identify bottlenecks (practical or human). ..... The system uses a reprogrammable, electronic chart insert whose presence is detected by radiofrequency transmitters located throughout the practice—including in the chart rack found outside every exam lane. The transmitters track each patient from the moment he arrives until he leaves the office. The information about the current location of each chart is forwarded to a central computer system; that information can be called up on any computer in the practice. (See sample screen, below.) The system also tracks the time spent at each location—including how long each patient waits after check-in, how long it takes for the tech to work up the patient, how long the patient waits for dilation, and how much time the doctor spends with him.In addition to exposing bottlenecks in patient flow, Brevium also reveals which patients routinely go through the system faster or more slowly. This information, combined with information about diagnosis, gender and language spoken, makes it possible to predict future scheduling needs with remarkable accuracy. Dr. Jarstad says this has allowed him to “smart schedule” up to 30 percent more patients per day, eliminating doctor downtime and patient wait time..............

sample Brevium patient flow monitoring screen. A map of the clinic appears on the right; room colors indicate use (tech, doctor, special equipment or waiting room). Patients are listed at the left as they arrive. A colored timeline shows: when they were scheduled to arrive (red dot); when they’re waiting (light hatched pattern); when they’re dilating (horizontal lines); and whether they are with a tech or doctor (color code for type of staff member). A white horizontal bar highlights patients who are not yet being seen. Clicking on a patient’s bar lights up current room and staff member with the patient. (Here, Consuelo B, with technician Mary in Room 3, has been selected.) The system also times each part of every patient encounter for later analysis.

Posted by mehdi khanlari at 07:44 AM | Comments (0)

ophthalmology notes -1

The fibrin glue (Tisseel, Baxter) is comprised of two components—a sealant protein made of human plasminogen, fibrinogen and fibrinonectin, and factor XIII reconstituted in a bovine aprotinin, and a sealing component made of thrombin reconstituted in calcium chloride. The components are combined and applied to the desired area,

Posted by mehdi khanlari at 06:51 AM | Comments (0)

February 14, 2007

Endothelial Cell Loss After Toric Iris-fixated Phakic Intraocular Lens Implantation: Three-year Follow-up

Journal of Refractive Surgery, 02/14/07

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

Experience with the Polymer-Coated Hydroxyapatite Implant after Enucleation in 126 Patients

Ophthalmology, 02/14/07

Carol L. Shields MD., et al. ? Conclusions: The polymer-coated hydroxyapatite implant is smoothly placed into the orbit after enucleation without the need for additional tissue wrap. With proper placement, this implant provides satisfactory functional motility and shows favorable tissue tolerance with no clinical evidence of allergic reaction or extrusion...

Posted by mehdi khanlari at 12:02 AM | Comments (0)

Clinical trial under way for topical AMD therapy

Ophthalmology Times Jan 15, 2007

San Diego—TargeGen has begun a phase I trial of a topical drug to treat age-related macular degeneration (AMD).The single-site, 45-patient study will test its small-molecule, multitargeted kinase inhibitor TG100801 as a therapy for AMD and other eye diseases. The eye drop suppresses disease-related edema, angiogenesis, and inflammation. TargeGen expects to complete the phase I study by the end of the first quarter of 2007, with plans to start a phase II trial by mid-year.

Posted by mehdi khanlari at 12:00 AM | Comments (0)

Eye drop could prevent blood vessel growth

Ophthalmology Times Jan 15, 2007

Roanoke, VA—OcuCure Therapeutics Inc. has received $1.5 million in seed financing to develop a topical eye drop for wet age-related macular degeneration (AMD) and dry AMD prophylaxis.The company's therapeutic compounds are selective tubulin inhibitors that prevent new blood vessels from sprouting and directly target the elimination of newly formed blood vessels. The company believes the dual mechanism will lead to better long-term visual outcomes. The compound possibly could be used alone or in AMD combination therapy, according to Sunder Malkani, president and chief executive officer of OcuCure.
The company was established in 2005 based on drug discovery research supported by the Carilion Biomedical Institute here.

Posted by mehdi khanlari at 12:00 AM | Comments (0)

February 13, 2007

Novel AMD drug being tested on 15 patients

Ophthalmology Times Jan 15, 2007

Redwood City, CA—The first of 15 patients has received CGC-11047, a novel poly-amine analog that targets choroidal neovascularization associated with age-related macular degeneration.
The drug, in a phase I dose-escalation study, is designed to halt cell growth and induce apoptosis by displacing certain cell components from their natural binding sites and preventing cell replication. The drug has demonstrated an ability to suppress the growth of vascular lesions under the retina and to cause a regression in neovascular swelling and leakage. A total of 15 patients will be treated subconjunctivally, avoiding the need to inject into the eye, in cohorts of escalating doses. The study's primary investigator is Peter Campochiaro, MD, professor of ophthalmology, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.CGC-11047 also is being studied as a treatment for certain cancers using a different dose formulation

Posted by mehdi khanlari at 10:56 PM | Comments (0)

Change in corneal aberrations after cataract surgery with 2 types of aspherical intraocular lenses

JCRS Pages 217-226 (February 2007)
To study the effect of cataract surgery through 3.2 mm superior incisions on corneal aberrations with 2 types of monofocal intraocular lenses (IOLs) with an aspherical design.

Corneal topography of 43 eyes was obtained before and after small corneal incision cataract surgery. Twenty-two eyes had implantation of a Tecnis Z9000 silicone IOL (Advanced Medical Optics) and 21 had implantation of an AcrySof IQ SN60WF acrylic IOL (Alcon Research Labs) using the recommended injector for each IOL type. The intended incision size (3.2 mm) was similar in the 2 groups. Corneal aberrations were estimated using custom-developed algorithms (based on ray tracing) for 10.0 mm and 5.0 mm pupils. Comparisons between preoperative and postoperative measurements and across the groups were made for individual Zernike terms and root-mean-square (RMS) wavefront error.

Results
The RMS (excluding tilt and defocus) did not change in the AcrySof IQ group and increased significantly in the Tecnis group with the 10.0 mm and 5.0 mm pupil diameters. Spherical aberration and coma-like terms did not change significantly; however, vertical astigmatism, vertical trefoil, and vertical tetrafoil changed significantly with surgery with the 10.0 mm and 5.0 mm pupil diameters (P<.0005). The induced wave aberration pattern for 3rd- and higher-order aberrations consistently showed a superior lobe, resulting from a combination of positive vertical trefoil (Z3−3) and negative tetrafoil (Z44). The mean vertical astigmatism increased by 2.47 μm ± 1.49 (SD) and 1.74 ± 1.44 μm, vertical trefoil increased by 1.81 ± 1.19 μm and 1.20 ± 1.34 μm, and tetrafoil increased by −1.10 ± 0.78 μm and −0.89 ± 0.68 μm in the Tecnis group and AcrySof IQ group, respectively. There were no significant differences between the corneal aberrations in the 2 postoperative groups, although there was a tendency toward more terms or orders changing statistically significantly in the Tecnis group, which had slightly higher amounts of induced aberrations.

Conclusions
Cataract surgery with a small superior incision induced consistent and significant changes in several corneal Zernike terms (vertical astigmatism, trefoil, and tetrafoil), resulting in a significantly increased overall corneal RMS wavefront error. These results can be used to improve predictions of optical performance with new IOL designs using computer eye models and identify the potentially different impact of incision strategies on cataract surgery.

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

Quality of vision after cataract surgery after Tecnis Z9000 intraocular lens implantation: Effect of contrast sensitivity and wavefront aberration improvements on the quality of daily vision

JCRS Pages 210-216 (February 2007)
To compare ocular performance and quality of vision in pseudophakic eyes with an aspherical intraocular lens (IOL) or a conventional spherical IOL.

Twenty patients (40 eyes) were randomly divided in 2 equal groups to bilaterally receive the aspherical Tecnis Z9000 IOL (AMO) or the spherical CeeOn Edge 911 IOL (AMO). Contrast sensitivity was measured and ocular wavefront analysis performed before surgery and 6 months after. Patients completed the Activities of Daily Vision Scale (ADVS) to evaluate patient-centered visual outcomes. Other examinations included refraction before and after mydriasis and pupil diameter.

Results
The mean postoperative best corrected visual acuity (logMAR) was 0.03 in the Tecnis group and 0.01 in the CeeOn Edge group .Refractive evaluation with mydriasis showed a mean myopic shift as low as −0.02 D in the Tecnis group and −0.51 D in the CeeOn Edge group . Mesopic contrast sensitivity at high spatial frequencies was significantly better in the Tecnis group .while contrast sensitivity under photopic and glare conditions was not different between the 2 groups. Spherical aberration was significantly lower in the Tecnis group, which had a mean Z40 of 0.01μm, than in the CeeOn Edge group, which had a mean Z40 of 0.16μm . The global score on the ADVS was not statistically different between groups; however, quality of distance vision was better in the Tecnis group than in the CeeOn Edge group (mean 99.0 versus 89.2.

Conclusion
Implantation of an aspherical IOL with a negative spherical aberration resulted in reduced ocular spherical aberration and improved mesopic contrast sensitivity and led to better subjective quality of vision.

Posted by alireza habibollahi at 10:36 PM | Comments (0)

Spherical aberration and coma with an aspherical and a spherical intraocular lens in normal age-matched eyes

JCRS Pages 203-209 (February 2007)

To study optical aberrations in eyes having uneventful cataract surgery and in-the-bag implantation of an aspherical Tecnis Z9000 IOL)AMO or a spherical CeeOn Edge 911 IOL (Pharmacia) and compare the results with those in a group of phakic age-matched eyes.
Materials
Three groups, each with 30 patients (30 eyes), were examined with the Topcon KR-9000PW topographer/aberrometer. Spherical aberration and coma were analyzed in detail for 4.0 mm optical zone. Internal values were obtained by subtracting corneal aberrations from ocular aberrations. Point spread function and modulation transfer function (MTF) were considered for optical quality.

Results
The mean internal spherical aberration Z40 was −0.048 μm ± 0.017 (SD) in the Tecnis group, +0.033 ± 0.026 μm in the 911 Edge group (P<.001), and −0.013 ± 0.056 μm in the phakic group (P = .149). The mean internal vertical coma Z3−1 was 0.087 ± 0.056 μm, 0.054 ± 0.043 μm (P = .005), and 0.044 ± 0.044 μm (P<.001), respectively. The internal horizontal coma Z3+1 showed a similar pattern; however, total resulting coma was similar in the 3 groups. The mean Strehl ratio was 0.284 ± 0.166 in the Tecnis group, 0.145 ± 0.077 in the 911 Edge group (P<.01), and 0.164 ± 0.097 in the phakic group (P<.01). The MTF curve was better in the Tecnis group (P<.001).

Conclusions
After uneventful implantation, the aspherical IOL yielded better ocular aberration and optical quality results than the spherical IOL. Induced coma was somewhat higher in the Tecnis group; however, the overall results were not affected. Physiologic IOL decentration after correct in-the-bag implantation did not negate the advantages of asphericity.

Posted by alireza habibollahi at 10:29 PM | Comments (0)

Quality of vision with the Acri.Twin asymmetric diffractive bifocal intraocular lens system

JCRS Pages 197-202 (February 2007)

Spain, To assess the quality of vision in patients who had implantation of asymmetric Acri.Twin bifocal diffractive intraocular lenses (IOLs) by evaluating distance and near visual acuities and photopic and mesopic contrast sensitivity under monocular and binocular conditions.

The study comprised 343 consecutive patients who had bilateral implantation of the Acri.Twin system: a distance-weighted 737D IOL and a near-weighted 733D IOL. Monocular and binocular best corrected distance visual acuities, best distance corrected near visual acuity, and distance contrast sensitivity under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined.

Results
Eyes with the 737D IOL had better best corrected distance acuity than eyes with the 733D IOL (mean 0.036 ± 0.061 logMAR versus 0.141 ± 0.131 logMAR) (P<.0001). Eyes with the 733D IOL had better best distance corrected near acuity than eyes with the 737D IOL (mean 0.015 ± 0.115 logMAR versus 0.059 ± 0.091 logMAR) (P = .0027). Binocularly, the Acri.Twin system allowed good distance and near vision; the means were 0.031 ± 0.059 logMAR and 0.005 ± 0.024 logMAR, respectively. Contrast sensitivity with the Acri.Twin system was within normal limits under photopic and mesopic conditions. Contrast sensitivity was statistically significantly better with the Acri.Twin system, followed by the 737D IOL and the 733D IOL under both illumination levels.
Conclusions
Asymmetric bilateral implantation of the Acri.Twin IOL gave good simultaneous distance and near vision with improved contrast sensitivity under photopic and mesopic conditions. Differences between monocular and binocular visual acuity and contrast sensitivity were obtained because of the distance-/near-weighted light distribution of Acri.Twin IOLs.

Posted by alireza habibollahi at 10:22 PM | Comments (0)

Optimum target refraction for highly and moderately myopic patients after monofocal intraocular lens implantation

Journal of Cataract & Refractive Surgery Volume 33, Issue 2 , February 2007, Pages 240-246

Sixty-nine eyes of 69 patients scheduled for phacoemulsification and monofocal intraocular lens (IOL) implantation were studied. The following age groups were recruited: 50s, 60s, and 70s. With addition of a spherical lens of 1.0, 1.5, 2.0, 2.5, or 3.0 diopters (D) after best distance correction (simulation of various degrees of myopia), visual acuity at various distances was measured using the all-distance vision tester. With the assumption that visual acuity of 20/30 is necessary for near and intermediate vision, the distances at which the mean visual acuity reached 20/30 were determined.
Results
Six patients did not have all examinations; thus, 24 patients in the 50s group, 23 in the 60s group, and 22 in the 70s group were included in the analysis. With simulation of −1.0 or −1.5 D of myopia, sufficient near visual acuity at 0.3 m was not obtained. With −2.0 D of myopia, visual acuity better than 20/30 was obtained at 0.7 m, 0.5 m, and 0.3 m. However, with −2.5 D of myopia, visual acuity reached 20/30 at 0.5 m and 0.3 m; with −3.0 D of myopia, it reached only 20/30 at 0.3 m. There were no significant differences between the age groups in mean visual acuity from far to near distances except for intermediate visual acuity with −1.0 D and −1.5 D of myopia and for near visual acuity with −2.5 D of myopia.
Conclusions
Eyes with a monofocal IOL that simulates −2.0 D of myopia achieved sufficient visual acuity for both near and intermediate distances in 3 age groups. This indicates that −2.0 D is the optimum target refraction in myopic eyes.

Posted by mmiraftab at 07:57 PM | Comments (0)

Eleven-year follow-up of laser in situ keratomileusis

Journal of Cataract & Refractive Surgery Volume 33, Issue 2 , February 2007, Pages 191-196

Seven patients (4 with bilateral treatment and 3 with unilateral treatment) who had myopic LASIK and completed 11 years of follow-up were included in the study.
Results
The mean age of the 2 men and 5 women was 41.7 years ± 6.5 (SD) (range 34 to 50 years). The mean follow-up was 140.18 ± 6.70 months (range 132 to 150 months). At 11 years, the spherical equivalent error was statistically significantly reduced, from a mean of −12.96 ± 3.17 diopters (D) (range −19.00 to −10.00 D) before LASIK to a mean of −1.14 ± 1.67 D (range −4.25 to 1.00 D) after (P<.001). Predictability of postoperative refraction 6 months and 11 years after LASIK showed that 6 eyes (55%) were within ±1.00 D of intended correction. No late postoperative complications occurred. Five patients (8 eyes, 73%) were satisfied with the final outcome.
Conclusions
Laser in situ keratomileusis was moderately predictable in the correction of high degrees of myopia. After the sixth postoperative month, refractive and topographic stability were obtained. No long-term sight-threatening complications occurred during the follow-up period.

Posted by mmiraftab at 07:56 PM | Comments (0)

Corneal Haze Following PRK With Mitomycin C as a Retreatment Versus Prophylactic Use in the Contralateral Eye

Journal of Refractive Surgery Vol. 23 No. 1 January 2007

A 40-year-old woman underwent PRK with MMC to treat previous corneal haze (secondary to previous PRK without MMC) for residual refractive error of +0.50 +0.25 x 165 in the left eye and PRK with MMC to prevent corneal haze in the right eye.Postoperative slit-lamp examination revealed no haze in the right eye, but continued mild haze in the left eye.Treatment with PRK and MMC for previous corneal haze is not as effective as primary PRK with MMC in preventing postoperative corneal haze formation.

Posted by mmiraftab at 07:50 PM | Comments (0)

Reduced Best Spectacle-corrected Visual Acuity from Inserting a Thicker Intacs Above and Thinner Intacs Below in Keratoconus

Journal of Refractive Surgery Vol. 23 No. 1 January 2007

A 33-year-old woman with keratoconus and contact lens intolerance underwent Intacs surgery in the left eye at another institution. Two segments were used—a thinner one (0.25 mm) below the cone and a thicker one (0.35 mm) above the cone.Two months postoperatively, the patient presented to our practice with BSCVA reduced from 20/20 to 20/30. The superior Intacs segment was explanted, the inferior segment was exchanged for a thicker one (0.35 mm), and collagen cross-linking with riboflavin treatment was performed. This resulted in visual, topographic, and refractive improvement with BSCVA returning to 20/20.Single inferior segment Intacs may be more appropriate for paracentral and peripheral cones. Collagen cross-linking may help cause further flattening. Using asymmetrical segments, with the thicker segment above the cone, may increase distortions and result in loss of BSCVA.

Posted by mmiraftab at 07:48 PM | Comments (0)

Surface Wave Elastometry of the Cornea in Porcine and Human Donor Eyes

Journal of Refractive Surgery Vol. 23 No. 1 January 2007

To introduce a nondestructive technique for characterization of corneal stiffness, determine measurement precision, and investigate comparative stiffness values along central, radial, and circumferential vectors in porcine corneas. The effects of epithelial debridement, relaxing incisions, and crosslink-mediated stiffening on surface wave velocity are also studied.
METHODS
A handheld prototype system was used to measure ultrasound surface wave propagation time between two fixed-distance transducers along a ten-position map. Repeatability was assessed with replicate measurements in 6 porcine corneas. In 12 porcine globes with controlled intraocular pressure (IOP), serial measurements were performed before and after epithelial removal, then after 250- and 750-µm-deep relaxing incisions. In human globes with constant intravitreal pressure, central wave velocity and transcorneal IOP measurements were compared before and after collagen cross-linking.
RESULTS
Measurement repeatability across all regions was between 2.2% and 8.1%. Epithelial removal resulted in increases in measured stiffness in 67% of eyes, but statistical power was insufficient to detect a systematic change. Wave velocity across a central incision decreased significantly after 250-µm keratotomy (P<.001), but did not undergo a significant further decrease with deeper keratotomy. Meridional stiffness changes consistent with coupling effects were detected after keratotomy. Surface wave velocity and transcorneal IOP measurements increased markedly after collagen cross-linking despite maintenance of a constant IOP.
CONCLUSIONS
Handheld corneal elastometry provides a repeatable measure of regional stiffness changes after relaxing incisions and collagen cross-linking in in vitro experiments. Surface wave elastometry allows focal assessment of corneal biomechanical properties that are relevant in refractive surgery, ectatic disease, and glaucoma.

Posted by mmiraftab at 07:46 PM | Comments (0)

Wavefront-guided LASIK for Myopia Using the LADAR CustomCornea and the VISX CustomVue

Journal of Refractive Surgery Vol. 23 No. 1 January 2007

Preoperatively, the CustomCornea group had a mean manifest sphere of –3.58±1.61 diopters (D) (range: –0.50 to –7.25 D), cylinder of +0.64±0.45 D (range: 0 to +1.75 D), and manifest refractive spherical equivalent (MRSE) of –3.26±1.56 D. The CustomVue group had a manifest sphere of –4.00±1.69 D (range: –1.50 to –7.50 D), cylinder of +0.60±0.52 D (range: 0 to +2.00 D), and MRSE of –3.70±1.64 D. At 3 months, 94% of CustomCornea eyes and 84% of CustomVue eyes had UCVA >20/20 (P=.20). Twenty-four percent of CustomVue eyes and 22% of CustomCornea eyes gained 1 line of BSCVA. In both groups, 96% of eyes were within 0.50 D of emmetropia. Mean CustomCornea glare contrast sensitivity improved (P=.04) whereas more eyes improved than worsened in both groups. Spherical aberration and total higher order aberrations increased, and trefoil decreased in both groups. A decrease in coma was noted in 70% of CustomCornea eyes.
CONCLUSIONS
Wavefront-guided LASIK with both platforms is safe, effective, and delivers excellent visual results. CustomCornea improves contrast sensitivity under glare conditions.

Posted by mmiraftab at 07:42 PM | Comments (0)

Bupivacaine injection of eye muscles to treat strabismus

British Journal of Ophthalmology 2007;91:146-148
Background: Bupivacaine injected into animal muscles induces a cycle of myotoxicity, degeneration, regeneration and hypertrophy of muscle fibres, without adverse effects on other tissues. This induced hypertrophy can be harnessed to treat strabismus.
Methods: Bupivacaine, 4.5 ml of a 0.75% solution, was injected into the right lateral rectus (RLR) muscle of a patient who had diplopia and who showed 14-prism-dioptres oesotropia.
Results: RLR paresis persisted for 7 days. Then, the RLR regained its abducting ability, and progressive improvement of alignment to 4-prism-dioptres oesophoria occurred over the next 33 days, with the elimination of diplopia. Alignment remained the same at 54 days after injection. Magnetic resonance imaging showed a focal increase in the size of the injected RLR of 58% in the posterior area, with reduced change in anterior portions of the RLR.
Conclusion: Injection of bupivacaine to induce hypertrophy of the injected muscle and thus alter eye alignment was effective in our patient. This approach can be a useful addition to the treatment of strabismus.

Posted by mmiraftab at 07:40 PM | Comments (0)

February 11, 2007

Switch from Antibiotic Eye Drops to Instillation of Mother's Milk Drops as a Treatment of Infant Epiphora

Journal of Tropical Pediatrics, January, 2007

In a paediatric practice, the management of patients with signs and symptoms of congenital nasolacrimal duct obstruction (CNLO) was switched from topical antibiotic to topical mother's milk (MM) -based regimens. The conservative management of this condition includes frequent cleansing of the lids, digital lacrimal sac massage, and application of topical antibiotic drops when there is a mucopurulent discharge. The method for managing CNLO has evolved in our office of paediatrics during the past 7 years. This change was initiated by some mothers who have applied traditional therapy: MM eye drops. This evolution has been accompanied by a number of articles from the mid 1990s into the 2000s on safety of MM eye drops in case of neonatal conjunctivitis, and on the anti-inflammatory characteristics and antibacterial activity of topical MM.

Posted by afarahi at 07:50 PM | Comments (0)

February 09, 2007

Survey of Iranian Eye M.D.s

EyeNet,January,2007
S-Farzad Mohammadi, MD, of the Farabi Eye Hospital in Tehran surveyed Iranian members of the Academy. He found that the five membership benefits that were most used were Opthalmology journal (97 percent), discounts on educational materials and programs (62 percent), free Annual Meeting registration (48 percent), EyeNet Magazine (45 percent) and Academy Express (34 percent). Most of the respondents were interested in e-services (90 percent) and had visited the Academy's Web site (85 percent). The survey was backed by the Academy and Iran's national society.

Posted by afarahi at 12:38 PM | Comments (0)

Long-term results of topical mitomycin-C for conjunctival melanocytic lesions

Specialty News and Views: Oculoplastics/Orbit - January 2007
In regard to"OSN SuperSite Breaking News 1/30/2007"(posted by Dr Khanlari)

In 2005, Kurli and Finger published the long-term results from their study of 16 patients with biopsy-proven primary acquired melanosis (PAM) with atypia (8 patients) or conjunctival malignant melanoma (MM) (8 patients) treated with topical mitomycin-C (MMC).All 16 patients in this case series demonstrated a clinical response to topical MMC, defined as regression of the areas of pigmentation. With long-term follow up, however, 5 of the 10 patients in the primary treatment group developed tumor recurrence
Based on the studies published to date, caution is warranted when treating a patient with an invasive conjunctival melanoma with any topical modality. Nodular nests of subepithelial melanoma appear to be resistant to topical MMC, although some patients with microscopic invasion on histopathology may do well with topical MMC. The beneficial effect of adjuvant MMC for conjunctival melanomas after surgical excision is also questionable.
The literature is rich with small case series and case reports on the effect of MMC on ocular surface neoplasia, and the results of topical treatment are variable. Chalasani et al, in a recent meta-analysis of 21 patients with PAM with atypia treated between 1980 and 2006, found that 43% had a complete response to primary topical treatment, but 14% had recurrences after a follow up of an average of 40 months. The recurrence rate was higher in patients with primary conjunctival melanoma (43% out of 7 patients in an average follow up of 22 months). With this limited follow up, such high recurrence rates do not favor topical mitomycin-C as a primary treatment for PAM with atypia and for malignant melanoma.
In their recent study, Tunc and Erbilen suggest that combined topical MMC and cyclosporin-A might have better efficacy in preventing recurrence of squamous cell carcinoma because of different therapeutic mechanisms. This conclusion was based on only 2 treated patients and should be further supported, although it is doubtful if even this will be sufficient in all cases. The success rate of such a combined treatment would be related to the concentration, application frequency, and number of residual tumor cells.

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

February 04, 2007

Early zigzag-pattern PK results favorable

OSN SuperSite Breaking News 1/15/2007

KOLOA, Hawaii ? Early results of zigzag-pattern penetrating keratoplasty performed with a femtosecond laser show the procedure to improve postoperative outcomes, according to a presenter here.The zigzag configuration, which can only be made with a femtosecond laser, "is biomechanically stable and secure and surgically straightforward," said Roger F. Steinert, MD, here at the Subspecialty Saturday meeting of Hawaiian Eye 2007. "The advantage of the zigzag PK is that the watertight seal gives a smooth transition," Dr. Steinert performed the zigzag PK procedure on 16 eyes with up to 9 months' follow-up with the IntraLase femtosecond laser (Intralase Corp.). He performed a 0.5-mm lamellar ring cut at a depth of 320 ?m, with 45? angle and 24?bite 10-0 nylon running suture closure.Topography showed that at 3 months, six out of eight eyes were at or under the 3.5 D SimK mean. Four out of five eyes showed a best corrected visual acuity of 20/40 to 20/80. Dr. Steinert noted that typically with conventional PK it takes 6 months to regain functional vision and with Descemet-stripping lamellar endokeratoplasty it normally takes 3 months.Postoperative evaluation with the Visante OCT (Carl Zeiss Meditec) "shows strong healing, and it shows that at 3 months there is a greater signal at the wound, which may correlate with wound healingHe said he is working with Carl Zeiss Meditec, maker of the Visante OCT, to digitize the image to verify if this is quantifiably indicative of wound healing....the OCT image indicated the procedure is an improvement over conventional methods."You can see in the image the suture is absolutely perfectly aligned, telling us biomechanically we're doing something right here... the next step is a randomized prospective comparison of femtosecond PK with conventional PK

Posted by mehdi khanlari at 11:15 PM | Comments (0)

ArGentis licenses transdermal progesterone therapy for dry eye syndrome

OSN SuperSite Breaking News 1/23/2007

MEMPHIS, Tenn. — ArGentis, a specialty biopharmaceutical company, has licensed a topical cream that delivers progesterone transdermally as a potential treatment for dry eye syndrome, the company announced in a press release. The treatment was developed by researchers at the Southern College of Optometry here.The progesterone cream is applied to the upper and lower eyelids to delivery the drug to affected glands. The drug is believed to activate the secretion of corticosteroids that suppress inflammation and restore tear production, according to a researcher at the college.ArGentis previously licensed a testosterone-containing transdermal treatment from the college, which is intended to treat dry eye syndrome in postmenopausal women. The company plans to file investigational new drug applications for both products early next year, according to the release.

Posted by mehdi khanlari at 11:00 PM | Comments (0)

LX211, a calcineurin inhibitor for treating noninfectious posterior, intermediate and panuveitis, and LX201, a cyclosporine-A-eluting silicone matrix ocular implant

OSN SuperSite Breaking News 1/23/2007

JERSEY CITY, N.J. — Two investigational products developed by Lux Biosciences have been granted orphan drug status by the Food and Drug Administration, according a press release from the company.The products include LX211, a calcineurin inhibitor for treating noninfectious posterior, intermediate and panuveitis, and LX201, a cyclosporine-A-eluting silicone matrix ocular implant being developed for preventing rejection of corneal transplants.The release from Lux Biosciences said the company plans to begin enrolling patients in three controlled, double-masked trials of LX211 this month. Trials of LX201 are expected to begin during the first quarter of this year, the release said.

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

Diode laser effective for trichiasis in study

OSN SuperSite Breaking News 1/30/2007

Treatment with an 810-nm diode laser significantly reduced the number of trichiatic eyelashes at 3 months' follow-up in a prospective study.
Randal T. H. Pham, MD, MS, FACS, and colleagues evaluated the use of the laser in 153 eyelids of 87 patients with darkly pigmented trichiatic eyelashes. Their results were published in the November/December issue of Ophthalmic Plastic & Reconstructive Surgery.The researchers found that immediately after treatment the average number of trichiatic eyelashes per patient was reduced from 3.5 to 0.4. Among 41 patients followed for a average of 3 months after treatment, the mean number of trichiatic eyelashes per patient was reduced from 3.58 to 0.73, The differences were statistically significant regardless of gender, age or location of the eyelashes, the authors said.

Posted by mehdi khanlari at 10:56 PM | Comments (0)

OSN SuperSite Breaking News 1/30/2007

OSN SuperSite Breaking News 1/30/2007

Most conjunctival tumors treated with MMC remained in remission at 2 years, study foundAfter treatment with topical mitomycin-C, most conjunctival tumors disappeared and did not recur for a mean period of 2 years, a small prospective study foundAltan A. Ozcan, MD, and colleagues at Çukurova University in Adana, Turkey, evaluated use of the antimetabolite in nine eyes of nine patients with conjunctival tumors. In all cases, mitomycin-C (MMC) was applied in a 0.04% concentration four times daily for 1 week followed by 1 week without treatment; patients received one to six treatment courses.At 24.6 months mean follow-up, tumors had completely disappeared without recurrence in seven patients. One patient did not experience tumor regression, and another had to cease treatment because of an adverse effect from the MMC.Larger studies with longer follow-up are needed to determine the duration of tumor control, the authors noted. The study is published in the January issue of Ophthalmologica.

Posted by mehdi khanlari at 10:53 PM | Comments (0)

Allergan introduces dual-action artificial tear

OSN SuperSite Breaking News 2/1/2007

IRVINE, Calif. — Allergan launched an over-the-counter lubricant eye drop for treating dry eye syndrome, the company announced in a press release.Optive (carboxymethylcellulose sodium 0.5%, glycerin 0.9%) is available in a multi-use bottle preserved with Purite, a dissolvable preservative with no known cytotoxic, allergenic or irritating effects. The drops are formulated to provide both lubrication to the tear film and penetration below the surface of the eye for osmoprotection against hypertonic stress, a company official said in the release.Dry eye patients who used Optive in a 3-month trial demonstrated statistically significant improvement in six common signs and symptoms of dry eye with little blurring of vision, according to the release.

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

PRK, LASIK found stable at 10 years in large series

OSN February 2007

PRK and LASIK outcomes were predictable, safe and stable in a large series of patients followed for 10 years, according to a speaker here.At the European Society of Cataract and Refractive Surgeons meeting, Jorge L. Ali󬠍D, PhD, presented 10-year results of PRK and LASIK in 800 eyes treated for myopia or myopic astigmatism at his clinic in Alicante, SpainDr. Ali󒳠study, funded by the Spanish government, included 500 eyes treated with PRK for a mean spherical equivalent of ?6.5 D and 300 eyes treated with LASIK for a mean spherical equivalent of ?11.8 D. All procedures were performed with the Visx Twenty/Twenty excimer laser, manufactured by Visx before that company?s acquisition by Advanced Medical Optics. No re-treatments were performed beyond 6 months postoperatively, and the patients were followed up at 3 months and 1, 2, 5 and 10 years, he said. Overall results showed that after 10 years, PRK had a safety index of 1 and an efficacy index of 1.7. LASIK had a safety index of 1.17 and an efficacy index of 0.83, he said.No statistically significant difference was found between both procedures ? in the predictability, safety, efficacy and corneal stability Complications after PRK included 10 central islands, four cases of corneal leukoma and two corneal ulcers. Complications after LASIK included 13 corneas with epithelial problems, eight cases of moderate corneal melting, six cases with symptomatic ocular surface syndrome, four cases of severe corneal striae and two cases of corneal scarring at the interface.Three cases of corneal ectasia were seen in the LASIK group, but Dr. Ali󠥸plained that these occurred before current standards and indications for LASIK had been developed.
Low myopia outcomes
For the data analysis, the investigators divided the eyes into three groups according to their severity of myopia.The low myopia group included 228 eyes treated with PRK and 21 eyes treated with LASIK, Dr. Ali󠳡id. Low myopia was defined as spherical equivalent of less than 6 D.In the low myopia group, PRK had a 4% retreatment rate and LASIK had a 14% retreatment rate.The predictability outcomes for low myopia showed that in the PRK group, 68% of eyes were within ?0.5 D of emmetropia and 83% were within ?1 D of emmetropia. In the LASIK group, 48% of eyes were within ?0.5 D of emmetropia and 76% were within ?1 D of emmetropia. The efficacy index was 0.89 for LASIK and 0.82 for PRK, and the safety index was 1.06 for LASIK and 1.03 for PRK, Dr. Ali󠳡id, noting that these numbers reflected the full 10-year evolution of the study.Keratometry for both groups showed good corneal stability throughout the entire 10-year follow-up.
Intermediate myopia
The intermediate myopia group included 195 eyes treated with PRK and 80 treated with LASIK. Intermediate myopia was defined as spherical equivalent between 10 D and 6 D.The rates of retreatment (which was only performed once) were 29% for PRK and 25% for LASIK.Predictability for the PRK group showed 51% of eyes were within ?0.5 D of emmetropia and 69% were within ?1 D. In the LASIK group, 66% were within ?0.5 D of emmetropia and 67% were within ?1 D of emmetropia. The efficacy indexes were 0.89 for LASIK and 0.78 for PRK, and the safety indexes were 1.11 for LASIK and 1.02 for PRK.Corneal keratometry showed that both groups had good corneal stability through the duration of the study
High myopia outcomes
Eyes with high myopia, defined as more than ?10 D, included 71 PRK eyes and 196 LASIK eyes,According to the results, the re-treatment rate was 51% for PRK eyes and 27% for LASIK eyes.Predictability data for the PRK group showed that 53% of eyes were within 0.5 D of emmetropia and 59% were within 1 D of emmetropia. In the LASIK group, 35% of eyes were within 0.5 D of emmetropia and 49% of eyes were within 1 D of emmetropia.The efficacy index was 0.79 for the LASIK group and 0.76 for the PRK group. The safety index was 1.21 in the LASIK group and 1.12 in the PRK group
Conclusions reflect earliest refractive surgery
In the end, both procedures demonstrated high predictability in low myopia, , although PRK showed a trend toward better predictability than LASIK.LASIK showed better predictability and safety in intermediate and high myopia, More refractive procedures show good stability and good results 10 years after the surgery Putting the results into context, Dr. Ali󠥸plained to Ocular Surgery News during a telephone interview that with the latest advances in refractive surgery such as transition zones, tissue saving algorithms and energy saving lasers taking hold, results from LASIK and PRK are only going to improve.
Limited complications
Though the primary purpose of the study was to assess refractive outcomes and stability, that the results reflected a good profile for complications such as dry eye or ocular surface syndrome.
We were operating with myopia up to 20 D with this technique, something that would be impossible now,? he told Ocular Surgery News. ....According to Dr. Ali󠴨ere was a trend toward an increased myopia of 0.75 D at 10 years in the intermediate and high myopia groups, but this was a result of the natural course of myopia....In the biomechanical study we p

Ophthalmology Review

Daily Notes in Ophthalmology

February 27, 2007

Effect of PCO on visual function

February 26, 2007

Second-generation multi-focal intraocular lenses versus Array SA40N intraocular lens

The IOL Counselor … a cataract surgeon’s new best friend?

Prostaglandins such as latanoprost may decrease more than just IOP

Mixing and matching multifocal lenses: How popular is it

Today’s refractive surgery trends : Safety

Today’s refractive surgery trends : Presbyopic choices

Today’s refractive surgery trends : Wavefront growth

Today’s refractive surgery trends :Preferred surgeries

Refractive Surgery Protocol for drug regimen

Statin use associated with myasthenia gravis

Good preliminary results for myopic macular degeneration treatment

February 25, 2007

Progression of Geographic Atrophy and Impact of Fundus Autofluorescence Patterns in Age-related Macular Degeneration

Reproducibility of and Effect of Magnification on Optical Coherence Tomography Measurements in Children

Long-term Follow-up of High Myopic Foveoschisis: Natural Course and Surgical Outcome

February 19, 2007

Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approachfor rectus muscle recession and plication.

February 18, 2007

Current approaches to the management of acute primary angle closure

Pain Associated With Local Anesthetic Injection in Eyelid Procedures: Comparison of Microprocessor-Controlled Versus Traditional Syringe Techniques

A Better Way to Evaluate CK Candidates

Visually significant persistent outer retinal fluid following closure of a macular hole

Endothelial Cell Loss After Toric Iris-fixated Phakic Intraocular Lens Implantation: Three-year Follow-up

Cataract Surgery Is Associated with a Higher Rate of Photodynamic Therapy for Age-Related Macular Degeneration

Fluctuation of Intraocular Pressure and Glaucoma Progression in the Early Manifest Glaucoma Trial

The Risk of Glaucoma in Pseudoexfoliation Syndrome

Comparison of Silicone and Polypropylene Ahmed Glaucoma Valve Implants

Comparison of Trabeculectomy With Ex-PRESS Miniature Glaucoma Device Implanted Under Scleral Flap

February 17, 2007

AMO Acquires IntraLase and WaveFront Sciences

February 16, 2007

Reducing the risk for endophthalmitis after cataract surgery: Population-based nested case-control study: Endophthalmitis Population Study of Western Australia sixth report

Postcataract endophthalmitis: Incidence and microbial isolates in a United Kingdom region from 1996 through 2004

Longitudinal study of intraocular lens exchange

Cystoid macular edema following photorefractive keratectomy complicated by presumptive infectious keratitis

Opacification of Array SA40N silicone multifocal intraocular lens

Iris damage by inadvertent cannula injection

Bilateral methicillin-resistant Staphylococcus aureus keratitis after photorefractive keratectomy

External Dacryocystorhinostomy: Double-Flap Anastomosis or Excision of the Posterior Flaps?

Use of a Novel Topical Hemostatic Sealant in Lacrimal Surgery: A Prospective, Comparative Study

Evisceration Techniques and Implant Extrusion Rates: A Retrospective Review of Two Series and a Survey of ASOPRS Surgeons.

Long-term Follow-up of Porous Polyethylene Spherical Implants After Enucleation and Evisceration

Porous Implant Exposure: Incidence, Management, and Morbidity.

A New Formula for Cataract Success

External Dacryocystorhinostomy: Double-Flap Anastomosis or Excision of the Posterior Flaps?

A New Formula for Cataract Success

Intravitreal Bevacizumab for Filtering Surgery

Transscleral red-laser cyclophotocoagulation combined with limited anterior retinal cryocoagulation in neovascular glaucoma

Using Computers to Monitor Patient Flow

ophthalmology notes -1

February 14, 2007

Endothelial Cell Loss After Toric Iris-fixated Phakic Intraocular Lens Implantation: Three-year Follow-up

Experience with the Polymer-Coated Hydroxyapatite Implant after Enucleation in 126 Patients

Clinical trial under way for topical AMD therapy

Eye drop could prevent blood vessel growth

February 13, 2007

Novel AMD drug being tested on 15 patients

Change in corneal aberrations after cataract surgery with 2 types of aspherical intraocular lenses

Quality of vision after cataract surgery after Tecnis Z9000 intraocular lens implantation: Effect of contrast sensitivity and wavefront aberration improvements on the quality of daily vision

Spherical aberration and coma with an aspherical and a spherical intraocular lens in normal age-matched eyes

Quality of vision with the Acri.Twin asymmetric diffractive bifocal intraocular lens system

Optimum target refraction for highly and moderately myopic patients after monofocal intraocular lens implantation

Eleven-year follow-up of laser in situ keratomileusis

Corneal Haze Following PRK With Mitomycin C as a Retreatment Versus Prophylactic Use in the Contralateral Eye

Reduced Best Spectacle-corrected Visual Acuity from Inserting a Thicker Intacs Above and Thinner Intacs Below in Keratoconus

Surface Wave Elastometry of the Cornea in Porcine and Human Donor Eyes

Wavefront-guided LASIK for Myopia Using the LADAR CustomCornea and the VISX CustomVue

Bupivacaine injection of eye muscles to treat strabismus

February 11, 2007

Switch from Antibiotic Eye Drops to Instillation of Mother's Milk Drops as a Treatment of Infant Epiphora

February 09, 2007

Survey of Iranian Eye M.D.s

Long-term results of topical mitomycin-C for conjunctival melanocytic lesions

February 04, 2007

Early zigzag-pattern PK results favorable