Ophthalmology Review

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May 31, 2007

Epiretinal prosthesis can help patients with retinitis pigmentosa perform simple visual tasks

AJO, May 2007
Three subjects with light perception or no light perception vision were enrolled at a single center. All subjects had retinitis pigmentosa (RP). A prototype retinal prosthesis was implanted in the eye with worse light sensitivity. The prosthesis had 4 × 4 array of platinum electrodes tacked to the epiretinal surface. The prosthesis was wirelessly controlled by a computer or by a head-worn video camera. Visual function testing was performed in single masked or double masked fashion. Scores from the visual task were compared to chance to determine statistical significance. The subjects performed significantly better than chance in 83% of the tests. Using the video camera, subjects scored as follows on simple visual tasks: locate and count objects (77% to 100%), differentiate three objects (63% to 73%), determine the orientation of a capital L (50% to 77%), and differentiate four directions of a moving object (40% to 90%). A subset of tests compared camera settings using multipixels vs single pixels. Using multipixel settings, subjects performed better (17%) or equivalent (83%) in accuracy and better (25%) or equivalent (75%) in reaction time.

Posted by kjalali at 08:52 PM | Comments (0)

Suturing clear corneal incisions may reduce risk of post-cataract surgery endophthalmitis

BJO, June 2007
This retrospective review of 815 consecutive surgeries identified five cases of infection in the un-sutured group and none in the sutured group. Patients who began antibiotic drops within 24 hours of surgery and those who received 5 percent povidone iodine drops after wound closure had a lower incidence of endophthalmitis.

Posted by kjalali at 08:51 PM | Comments (0)

Positive early results for VEGF trap for wet AMD

INDUSTRY NEWS
The VEGF Trap-Eye is a fully human, soluble VEGF receptor fusion protein that binds all forms of VEGF-A along with the related placental growth factor (PlGF). The VEGF Trap-Eye is a specific and highly potent blocker of these growth factors. Blockade of VEGF, which can prevent abnormal blood vessel formation and vascular leak, has proven beneficial in the treatment of wet AMD. Regeneron Pharmaceuticals, Inc. presented Phase 2 results evaluating the VEGF Trap-Eye at the 2007 Annual Meeting of the Association for Research in Vision and Ophthalmology. The VEGF Trap, a type of VEGF blocker, produced a statistically significant reduction in retinal thickness at 12 weeks.

Posted by kjalali at 08:47 PM | Comments (0)

May 29, 2007

A randomized clinical trial of two methods of fascia lata suspension in congenital ptosis.

: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):217-21 PURPOSE:: To compare the results of 2 methods of upper eyelid sling placement with autogenous fascia lata in the treatment of congenital ptosis. METHODS:: In a randomized clinical trial, patients with congenital upper eyelid ptosis and poor levator function (<4 mm) were randomly assigned to either of 2 methods of upper eyelid sling placement: group A, bitriangular fascia sling (modified Crawford method), and group B, monotriangular fascia sling (modified Fox method). RESULTS:: This study included 30 upper eyelids (15 eyelids in each surgical group) of 19 patients (8 unilateral and 11 bilateral cases) with congenital ptosis. Mean increase in eyelid fissure height was 2.7 +/- 2.3 mm in group A and 3.4 +/- 2.2 mm in group B. Change in eyelid fissure in both groups was significant (p < 0.001, paired t test) but the intergroup difference was not (p = 0.4, independent sample t test). Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the 2 groups. No patient experienced recurrent ptosis requiring reoperation in either group. CONCLUSIONS:: The monotriangular method of upper eyelid fascia sling placement can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation, and a shorter period of anesthesia

Posted by s.tavakolizadeh at 06:50 PM | Comments (0)

Snare Technique for Enucleation of Eyes With Advanced Retinoblastoma

Archives of Ophthalmology.May, 2007
Retrospective analysis of surgical outcomes for enucleation in pediatric retinoblastoma stage 5B using the snare wire loop (n = 55) and standard curved enucleation scissors (n = 22) revealed that a statistically significant longer mean optic nerve length was obtained with the snare (13.35 mm) compared with scissors (11.05 mm; P = .005). Four scissor cases had prolonged bleeding and required thrombin (18.2%), but no snare cases had difficulty with hemostasis (P = .005). More crush artifact was seen with the snare than with scissors (P<.001), but this did not affect the ability to determine tumor involvement at the surgical margin. The enucleation snare should be considered a valuable surgical instrument in the small pediatric orbit since obtaining the longest optic nerve segment has prognostic implications in retinoblastoma.

Posted by afarahi at 05:19 PM | Comments (0)

Rigid gas permeable contact lenses can be used to treat ectasia following LASIK

Clinical News from the 3rd Annual Regional Meeting of ISRS/AAO in Beijing. MAY 26, 2007

David Chao-Kai Chang, MD, presented his experience with two patients fitted with contact lenses to treat LASIK-induced ectasia. At one year, both patients experienced improved UCVA, BSCVA and improved topography. Dr. Chang described another case study that demonstrates the importance of taking contact lens history before performing refractive surgery due to the possibility of lens-induced warping. He described one patient who wore soft contact lenses for nine years and appeared to have keratoconus based on her topography and pachymetry. After eight weeks without lens wear, corneal maps were again performed, and there was no evidence of keratoconus.

Posted by afarahi at 05:14 PM | Comments (0)

Surface ablation, 20 years on: still a good treatment option

Clinical News Live from the 3rd Annual Regional Meeting of ISRS/AAOin Beijing. MAY 27, 2007

This 20-year-old procedure has been on the rise recently due to its excellent safety profile, improved clinical results and advances in pain control. It has been estimated that 225,000 surface ablation surgeries will occur in the United States this year.
Dr. McDonald cited some studies that show wave-front guided surface ablation actually achieves better visual acuity compared to LASIK. While visual recovery is still slightly slower than with LASIK, the gap is closing due to smoother ablations and better postoperative drug regimens. In her practice, 96 percent of her patients see 20/25 or better on day one. Her patients also report low pain on day one, two on a scale of one to 10.
Dr. McDonald has been conquering pain with her own strategy which includes a short-course of oral prednisone that tapers off rapidly over six days (80 mg a half hour before surgery and 80 mg the day after surgery; 40 mg on day two; 20 mg on day three; 10 mg on day four and 5 mg on day five) and 0.05 percent tetracaine allowed up to every hour while awake for the first three days. She also uses NSAIDs four times a day for three days, lots of chilled BSS during surgery and sterile BSS popsicle applied to closed eyes after surgery.
Physicians are tackling haze in myopic surface ablation with prophylactic mitomycin C (MMC), reported Ronald Krueger, MD. In his two-year study, patients treated with low-dose MMC (0.002 percent) after LASEK experienced less corneal haze compared with controls. His recommendation: in myopic patients with a refractive error of 6 D or less, and less than 75 microns of ablation, use 0.002 percent MMC for 30 seconds. In patients with a refractive error above 6 D and more than 75 microns of ablation, use 0.02 percent MMC for 30 seconds. Time of exposure seems to be less important than concentration.
Another study presented here today showed better outcomes with LASEK compared with LASIK for eyes with larger pupils. However, for patients with small pupils, LASEK and LASIK outcomes were comparable

Posted by afarahi at 05:02 PM | Comments (0)

Routine use of topical NSAIDs in cataract surgery may be justified clinically and economically

Clinical News Live from the 3rd Annual Regional Meeting of the ISRS/AAO in Beijing. MAY 27, 2007

Cataract surgeons are increasingly using topical non-steroidal anti-inflammatory drugs in combination with steroids in cataract patients at high-risk for postoperative inflammation. But Carlos Buznego, MD, today presented his study suggesting that it’s time to start using NSAIDs in all patients.
Two recent studies provide the clinical justification. One found that NSAIDs combined with prednisolone acetate was more effective than prednisolone alone in preventing macular edema in uncomplicated cataract surgery in low-risk eyes. Another study comparing different regimens of a preoperative NSAID to placebo found statistically significant improvements in intraoperative pupil size, shorter surgery time, quicker ultrasound time, less intraoperative discomfort, less postoperative discomfort and better visual outcomes. The economic benefit, said Dr. Buznego, is derived from fewer postoperative visits and increased referrals from happy patients who see better faster.

Posted by afarahi at 04:56 PM | Comments (0)

Topical anesthesia: Possible risk factor for endophthalmitis after cataract extraction

JCRS Pages 989-992 (June 2007)
To assess the relationship between the risk for acute endophthalmitis after cataract extraction and whether certain factors, such as surgeon qualification, numerical order, duration of surgery, operating theater, and type of anesthesia (topical or retrobulbar), could be modified to decrease the risk.
Two epidemiological studies were performed: a case-control study and a retrospective cohort study. The surgical records of all patients with clinically diagnosed endophthalmitis within 30 days after cataract surgery performed between February 2002 and September 2003 were reviewed. The endophthalmitis cases were compared with 108 randomly selected controls (4 controls per case). The global incidence of endophthalmitis and the incidence according to type of anesthesia were calculated.

Results
Of 5011 cataract extractions performed, 27 cases of endophthalmitis occurred. The incidence was 5.39 per 1000 procedures. An independent statistically significant relationship was found between endophthalmitis and the use of topical anesthesia (odds ratio [OR], 11.8; 95% confidence interval [CI], 2.4-58.7) and surgery longer than 45 minutes (OR, 7.2; 95% CI, 1.7-29.7) but not between the other variables. The incidence of endophthalmitis was 1.8 per 1000 cataract extractions with retrobulbar anesthesia and 6.76 per 1000 with topical anesthesia (relative risk [RR], 3.76; 95% CI, 0.89-15.85). After the start of the study period was extended to May 2001, the incidence of endophthalmitis was 1.3 per 1000 cataract extractions with retrobulbar anesthesia and 8.7 per 1000 with topical anesthesia (RR, 6.72; 95% CI, 1.63-27.63).

Conclusion
Results suggest that there may be an association between topical anesthesia and endophthalmitis after cataract extraction.

Posted by alireza habibollahi at 03:32 PM | Comments (0)

Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factorsESCRS Endophthalmitis Study Group

JCRS Pages 978-988 (June 2007)

Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8).

Conclusions
Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.

Posted by alireza habibollahi at 03:18 PM | Comments (0)

One-year results of photorefractive keratectomy and laser in situ keratomileusis for myopia using a 213 nm wavelength solid-state laser

JCRS Pages 971-977 (June 2007)

20 patients (40 eyes) who had refractive surgery using the Pulzar Z1 laser system. Manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), safety, predictability, stability, and confocal microscopy images were evaluated.
Results
Ten patients (20 eyes) had PRK and 10 patients (20 eyes) had LASIK. The mean follow-up was 13.9 months and 14.6 months in the PRK group and LASIK group, respectively. No eye lost a line of Snellen BSCVA during the follow-up period; 2 eyes (10%) gained 2 Snellen lines. There was a statistically significant decrease in spherical equivalent manifest refraction postoperatively in both groups Refractive stability was obtained during the first postoperative month and remained stable during the follow-up period, with no significant changes between any interval in both groups .At the last follow-up, 95% of all eyes were within ±1.00 diopter of emmetropia. No late postoperative complications were observed.

Conclusion
Refractive surgery using the Pulzar Z1 213 nm wavelength solid-state laser was a safe, effective procedure in the treatment of low to moderate myopia.

Posted by alireza habibollahi at 03:13 PM | Comments (0)

Sequential Intacs and Verisyse phakic intraocular lens for refractive improvement in keratoconic eyes

JCRS Pages 966-970 (June 2007)
To evaluate the safety, efficacy, and stability of sequential Intacs (Addition Technology, Inc.) insertion and Verisyse phakic intraocular lens (pIOL) (AMO) implantation in selected cases of keratoconus.
8 eyes of 6 KCN with contact lens intolerance, clear corneas, a maximum K-value less than 60.0 D and minimum corneal thickness greater than 400 μm. Two 0.45 mm Intacs were inserted through a 1.8 mm radial incision created at 70% of the corneal depth opposite the cone apex. The 2 rings were pushed to meet and embrace the cone apex. Refraction 6 months after Intacs insertion showed residual myopia greater than 6.0 D and residual astigmatism not more than 2.0 D. Thus, a phakic Verisyse IOL was implanted horizontally in the anterior chamber through a 6.5 mm superior clear corneal incision, which was closed with 3, 10-0 nylon sutures after a peripheral iridectomy was created. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, and topographic profiles were taken 1 week and 1, 3, 6, 9, 12, 18, and 24 months after the second surgery.

Results
All eyes achieved UCVA of 20/40 or better. The final spherical error ranged from −1.75 to +1.00 D and the cylindrical error, from 1.25 to 2.50 D. No eye lost lines of preoperative BCVA. These results were relatively stable throughout the follow-up period.

Conclusions
Sequential Intacs and a Verisyse pIOL implantation was safe, stable, and effective in selected cases of keratoconus. It is a reversible surgery that is less invasive than penetrating keratoplasty (PKP). It can avoid or postpone the need for PKP, although it is not an alternative.

Posted by alireza habibollahi at 03:05 PM | Comments (0)

Surgical technique for suture fixation of a single-piece hydrophilic acrylic intraocular lens in the absence of capsule support

JCRS Pages 962-965 (June 2007)

We present a new intraocular lens (IOL) fixation technique that reduces the presence of intraocular knots and eliminates the need for scleral flaps while attaining excellent central positioning of the IOL. It also provides rapid visual rehabilitation from the insertion of a foldable IOL through a small corneal incision. This single-loop suture technique is an easy, convenient, and practical procedure, with minimum complications in the treatment of aphakia and the management of cataract surgery in eyes without capsular support

Posted by alireza habibollahi at 03:03 PM | Comments (0)

Automated vitrector-assisted optical iridectomy: Customized iridectomy

JCRS Pages 959-961 (June 2007)

An automated vitrector was used to create an optical iridectomy in 15 eyes of 15 patients with leucomatous corneal opacities. The optical iridectomy was performed successfully through a standard 1.2 mm incision in all eyes. No intraoperative complications were observed, and there was no case of iatrogenic cataract formation. The median best corrected visual acuity improved from 1/60 (range light perception to 6/60) preoperatively to 6/24 (range 6/60 to 6/12) at the last follow-up (mean 28 days). An automated vitrector can be successfully used to create an optical iridectomy in eyes with leucomatous corneal opacities. This technique was safe and could be performed through a small surgical incision

Posted by alireza habibollahi at 02:59 PM | Comments (0)

Sutureless single-port transconjunctival pars plana limited vitrectomy combined with phacoemulsification for management of phacomorphic glaucoma

JCRS Pages 951-954 (June 2007)

We describe a technique that uses a small-gauge, single-port, sutureless transconjunctival limited pars plana vitrectomy to facilitate phacoemulsification in eyes with a shallow anterior chamber and high intraocular pressure (phacomorphic glaucoma). These eyes have positive vitreous pressure, and anterior chamber formation with an ophthalmic viscosurgical device may not be possible. Surgery is difficult and prone to various intraoperative complications.

Posted by alireza habibollahi at 02:55 PM | Comments (0)

May 27, 2007

Diabetic retinopathy linked to ischemic stroke risk

Eyeworld May 2007

The Wisconsin Epidemiological Study of Diabetic Retinopathy found proliferative retinopathy was associated with incident stroke and stroke mortality in participants with Type 2 diabetes, Dr. Wong noted in the analysis. However, that study did not find an association of mild and moderate retinopathy with incident stroke, he added. Another study, the United Kingdom Prospective Diabetes Study, concluded retinopathy was not a significant risk factor for stroke, Dr. Wong noted.“Unlike ischemic strokes in nondiabetic individuals, the contribution of large vessel disease to diabetic ischemic stroke may be less important. Autopsy studies indicate that diabetic strokes are commonly related to cerebral microvascular disease,” the researchers said in the analysis. A separate study from the University of Kuopio in Finland found proliferative retinopathy was significantly associated with death, increasing the risks of all-cause, cardiovascular and coronary heart disease mortality by 3.05-, 3.32- and 2.54-fold, respectively. The risks for death were also elevated in women with background retinopathy as well, according to Markku Laakso, M.D., who reported the findings in Diabetes Care.Investigators followed 824 Finnish patients (425 men and 399 women) for 18 years; none had cardiovascular disease at baseline.
The associations the Finnish group found “were independent of current smoking, hypertension, total cholesterol, HDL cholesterol, glycemic control of diabetes, duration of diabetes, and proteinuria. This suggests the presence of common background pathways for diabetic microvascular and macrovascular disease other than those included in the conventional risk assessment of cardiovascular disease.”
What ophthalmologists can do
“Retinal specialists and ophthalmologists in general should be aware that patients with diabetes who have signs of retinopathy, even mild retinopathy, are at higher risk of ischemic stroke,” Dr. Wong said.
He also recommended ophthalmologists refer patients with retinopathy to their primary physician “for a careful stroke risk assessment and for the patients’ physicians to start risk reduction therapy in people with retinopathy.”

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

What French Impressionists really saw

Eyeworld May 2007

A report by Medical News Today said that Michael Marmor, M.D., ophthalmologist, Stanford University School of Medicine, has combined computer simulation with medical knowledge to recreate images of some of the masterpieces of Claude Monet and Edgar Degas, through their eyes. Though the French impressionists struggled with cataracts and retinal disease, they continued to work, the report said.
Marmor’s simulated versions of how the painters would most likely have seen their work showed Degas’ later paintings of nude bathers as so blurry that it was difficult to see any of the artist’s brush strokes, the report said.Similarly, when Marmor adjusted Monet’s later paintings of the lily pond and the Japanese bridge at Giverny to reflect the typical symptoms of cataracts, they appeared dark and muddied, according to the report. The artist’s signature vibrant colors were muted, replaced by browns and yellows.The report quoted Marmor as saying “These simulations may lead one to question whether the artists intended these late works to look exactly as they do.”“The fact is that these artists weren’t painting in this manner totally for artistic reasons.”The artistic styles of Degas and Monet were well formed before their eye disease affected their vision. But their paintings grew significantly more abstract in later life as, coincidentally, their eye problems increased, the report said.“Contemporaries of both have noted that their late works were strangely coarse or garish and seemed out of character to the finer works that these artists had produced over the years,” Marmor wrote in a paper titled “Ophthalmology and Art: Simulation of Monet’s Cataracts and Degas’ Retinal Disease” that was published in the December issue of the Archives of Ophthalmology.According to the report, Marmor chose to focus his simulations on the works of Degas and Monet because both artists suffered from eye disease that was well-documented in historical records, journals and medical histories. Degas had retinal eye disease that frustrated him for the last 50 years of his lengthy career, while Monet complained of cataracts interfering with his ability to see colors for 10 years before he finally underwent surgery to have them removed, the report said“We understand better from these simulations what Degas and Monet struggled with as vision failed,” Marmor said.

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

Reproducibility of Endothelial Assessment during Corneal Organ Culture: Comparison of a Computer-Assisted Analyzer with Manual Methods

Investigative Ophthalmology and Visual Science, 05/15/07

Nilanjana Deb Joardar, et al. - Conclusions: Manual counting shows systematic underestimation of ECD with high interobserver variability. The analyzer in automated mode overestimates ECD and is absolutely unreliable. Detection of cell contours by the specific algorithm, combined with manual correction by a skilled technician, appears to be the most reliable method of ECD and morphometry determination [more...]

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

Treatment of Progressive Keratoconus by Riboflavin-UVA-Induced Cross-Linking of Corneal Collagen: Ultrastructural Analysis by Heidelberg Retinal Tomograph II In Vivo Confocal Microscopy in Humans

Cornea, 05/15/07

Mazzotta Cosimo PhD., et al. - To assess ultrastructural stromal modifications after riboflavin-UVA-induced cross-linking of corneal collagen in patients with progressive keratoconus...Conclusions: Reduction in anterior and intermediate stromal keratocytes followed by gradual repopulation has been confirmed directly in vivo in humans by HRT II-RCM confocal microscopy after riboflavin-UVA-induced corneal collagen cross-linking [more...]

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

Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens Prospective randomized masked clinical trial

Journal of Cataract & Refractive Surgery, 05/09/07

Deepak Pandita MS., et al. - To evaluate contrast sensitivity and glare disability after implantation of an AcrySof IQ Natural SN60WF aspherical intraocular lens (IOL) (Alcon Laboratories)...Conclusion: Eyes with the AcrySof IQ SN60WF IOL had significantly higher contrast sensitivity than eyes with an AcrySof SA60AT or AcrySof Natural SN60AT IOL at all spatial frequencies during mesopic testing (with and without glare) with 4.0 and 6.0 mm artificial pupil [more...]
Journal of Cataract & Refractive Surgery, 05/09/07

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

Bag-in-the-lens intraocular lens implantation in the pediatric eye

Journal of Cataract & Refractive Surgery, 05/09/07

Marie Jose Tassignon MD PhD FEBO., et al. - Conclusions: The bag-in-the-lens implantation technique in children and babies was safe and kept the visual axis clear after cataract surgery. In the near future, 4.0 or 4.5 mm IOLs will be available that may improve the success rate of IOL implantation in the small eyes of babies [more...]

Posted by mehdi khanlari at 11:26 PM | Comments (0)

Ophthalmology April 2007Comparison of the Effects of LASIK Retreatment Techniques on Epithelial Ingrowth Rates

Ophthalmology April 2007

To compare the incidence of postoperative epithelial ingrowth using 3 different surgical LASIK retreatment techniques...Thirty consecutive eyes that underwent LASIK retreatments by a single surgeon....The first 10 eyes underwent LASIK retreatment using the surgeon’s routine surgical technique (forceps lift group), the next 10 retreated eyes had a bandage contact lens placed after surgery and removed the following day (contact lens group), and the next 10 patients had retreatment performed using a Pinelli spatula to cleave the circumference of the flap edge before lifting the flap and no contact lens placed after surgery (spatula cleaving group). The retreatment technique did not vary apart from these modifications.....Results....The incidence of epithelial ingrowth was 40% in the contact lens group, 20% in the forceps lift group, and 10% in the spatula cleaving group. There was a trend toward a significant difference between the contact lens and spatula cleaving groups (P = 0.12). The patients with epithelial ingrowth showed a trend toward being older, with a mean age of 53±8.5 years compared with a mean age of 44±13 years for the patients without epithelial ingrowth (P = 0.07). Incidence of ingrowth was not related to the preoperative spherical equivalent.....Conclusions.....There was an increased incidence of epithelial ingrowth with use of an overnight bandage contact lens in our series. The Pinelli spatula may reduce trauma to the epithelium at the flap edge. The incidence of epithelial ingrowth was not related to the preoperative spherical equivalent. Increasing age may be a risk factor for epithelial ingrowth, but further study is warranted.

Posted by mehdi khanlari at 11:26 PM | Comments (0)

Descemet Stripping With Endothelial Keratoplasty for Treatment of Iridocorneal Endothelial Syndrome.

Cornea. 26(4):493-497, May 2007.

To describe use of Descemet stripping with endothelial keratoplasty (DSEK) to treat corneal edema associated with iridocorneal endothelial (ICE) syndrome....In this retrospective, consecutive, interventional case series, the corneal endothelium was selectively replaced by the DSEK technique in eyes with ICE syndrome. Three eyes were treated at 1 center between June 2005 and July 2006. Descemet membrane and endothelium were stripped from the recipient and an 8- or 8.5-mm-diameter donor button consisting of posterior stroma and healthy endothelium was folded and implanted through a 5-mm incision. An air bubble was used to press the donor tissue against the recipient cornea, allowing it to attach without sutures. In 1 case with extensive peripheral anterior synechiae (PAS), after the PAS were broken, the anterior chamber was shallow, so a temporary anchor suture was placed in the peripheral edge of the donor tissue to help ensure that it would unfold in the correct orientation.Results: DSEK successfully resolved corneal edema in 3 male patients with unilateral ICE syndrome who were 47 to 67 years of age. Follow-up ranged from 1 to 14 months. Best spectacle-corrected visual acuity at the most recent visit was 20/20 to 20/30, with a mean refractive cylinder of 1.2 D.Conclusions: Selective replacement of dysfunctional endothelium with DSEK can successfully treat corneal edema and associated visual loss and pain caused by ICE syndrome. Visual recovery is rapid and refractive changes are minimal compared with replacement of the full corneal thickness with a traditional penetrating keratoplasty.

Posted by mehdi khanlari at 11:23 PM | Comments (0)

Anterior Segment Optical Coherence Tomography for Imaging the Anterior Chamber After Laser Peripheral Iridotomy

Ajo May 2007

Farnaz Memarzadeha, Yan Lia, Vikas Chopraa, Rohit Varmaa, Brian A. Francisa and David Huang, a,

To evaluate changes in anterior segment morphology by anterior segment optical coherence tomography (OCT) and gonioscopy before and after laser peripheral iridotomy (LPI).ConclusionsChanges in the anterior chamber angle morphology post-LPI can be imaged and objectively quantified by anterior segment OCT.

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

May 26, 2007

Artificial corneas much improved

Eyeworld May 2007

Call it a keratoprosthesis, call it an artificial cornea. Whichever term is preferred, the devices available in the United States play a substantial role in combating corneal blindness in patients who are no longer candidates for penetrating keratoplasty (PK).The Boston K-Pro (also called the Dohlman-Doane, developed at Massachusetts Eye and Ear Infirmary, MEEI, Boston) has been in development since the 1960s, and was approved for use in the United States in 1992. Another artificial cornea, the AlphaCor (developed by Argus Biomedical, Australia) has been available in the United States since 2002......The Boston K-Pro is made of clear plastic with excellent tissue tolerance and optical properties, MEEI notes on its Web site. It consists of two parts, but when fully assembled in the eye looks more like a collar button. The device is inserted into a corneal graft, which is then sutured into the patient’s cloudy cornea in a surgical procedure similar to a standard transplant.

Posted by mehdi khanlari at 11:04 PM | Comments (0)

May 25, 2007

Treatment of eye floaters with laser

EYE FLOATER TREATMENT CENTER
Eye floaters are a result of changes in the Vitreous Body, the colloidal gel that occupies most of the hollow sphere of the eye. Aside from maintaining good nutrition, taking anti-oxident vitamins, and following a healthy lifestyle, Ophthalmologists have no specific answer on how to prevent them. But there is a proven treatment. Laser has helped thousands of people. It is a reasonable alternative to vitrectomy, an operation that is available if laser can't help.

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

Experimental study shows subconjunctival insulin injections may treat diabetic retinopathy

INDUSTRY NEWS
A study presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology finds that insulin can reduce the degenerative and inflammatory responses in diabetic rat retinas, without altering blood glucose levels.

Posted by kjalali at 09:46 PM | Comments (0)

Avastin may prevent corneal neovascularisation

BJO, June 2007
Researchers induced chemical injury in rats and then treated them with topical Avastin. Neovascularisation covered, on average, 38.2 percent of the corneal surface in the Avastin-treated group, compared with 63.5 percent in the control group.

Posted by kjalali at 09:41 PM | Comments (0)

May 22, 2007

Study finds similar PCO rates at 2 years for one- and three-piece IOLs

OSN SuperSite Top Story 4/24/2007

Patients implanted with either a one-piece or a three-piece sharp-edge hydrophobic acrylic IOL had similarly low rates of posterior capsular opacification at 2 years follow-up, a prospective study found. However, the one-piece IOL was associated with a higher incidence of capsular folds, the study authors said.Reda Zemaitiene, MD, PhD, and colleagues in Kaunas, Lithuania, compared rates of anterior and posterior capsule opacification (PCO) between patients randomly assigned to receive one of two AcrySof IOLs (Alcon). The study included 37 patients implanted with the three-piece MA30BA and 37 patients implanted with the one-piece SA30AL.Both lenses feature a biconvex, square-edged, 5.5-mm hydrophobic acrylic optic and a 12.5 mm overall diameter. The three-piece lens has PMMA haptics angled at 5°; while the one-piece lens has no haptic angulation, according to the study.The researchers found that patients who received the one-piece IOL had more capsulorrhexis rim area fibrosis in the anterior chamber at 6 months and 1 year, although the difference was not statistically significant. This patient group experienced a significantly higher incidence of capsular folds at all follow-up points.Capsular folds were seen in 27.03% of the three-piece IOL group and 43.24% of the one-piece IOL group at 1 day postop, which decreased to 6.06% of the three-piece group and 19.35% of the one-piece group at 2 years, according to the study.Patients implanted with the three-piece IOL had significantly more PCO up to 1 year postop, particularly around the entire IOL optic and in the central 3-mm optic zone."However, 2 years after surgery, PCO values in both groups were no longer different," the authors said.Both groups had similar visual acuities throughout the follow-up period and no patients required Nd:YAG laser capsulotomies, they noted.The study is published in the May issue of the British Journal of Ophthalmology

Posted by mehdi khanlari at 10:46 PM | Comments (0)

AMO launches new phacoemulsification system at ASCRS

OSN SuperSite Breaking News 4/27/2007

Advanced Medical Optics announced the launch of its WhiteStar Signature phacoemulsification system at the American Society of Cataract and Refractive Surgery meeting in San Diego. The new system combines AMO's WhiteStar technology with its Fusion dual pump fluidic system to improve chamber stability and reduce post-occlusion surge, according to a press release from the company.The system also features a streamlined user interface and a one step, one hand cassette, intuitive touch screen and intelligent help feature, according to the release.David Chang, MD, clinical professor of ophthalmology at the University of California, San Francisco, said the dual pump marks a step forward in phaco fluidics."The dual pump represents the next generation in phaco fluidics, and the new user interface is a significant improvement for surgeons and staff," he said in the press release

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

Comparison of Ultrasonic Energy Expenditures and Corneal Endothelial Cell Density Reductions During Modulated and Non-Modulated Phacoemulsification

OPHTHALMIC SURGERY, LASERS & IMAGING 2007; 38(3):209

To compare the Legacy 20000 Advantec continuous and Infiniti hyperpulse modes (Alcon Laboratories, Fort Worth, TX) with respect to average power, machine-measured phacoemulsification time, total stopwatch real time spent within the phacoemulsification process, balanced salt solution (BSS) volume, and corneal endothelial cell density losses
CONCLUSIONS
The Legacy and Infiniti performed similarly in continuous mode. With the Infiniti hyperpulse mode, a total ultrasonic energy reduction of 66% was noted. The machines required the same amount of total stopwatch measured time to accomplish phacoemulsification and produced the same 5% corneal endothelial cell loss. Therefore, clinically, these two machines behave in a comparable manner relative to safety and effectiveness

Posted by mehdi khanlari at 10:39 PM | Comments (0)

Kelman lecturer: Key to prevention of PCO lies in capsular bend, accommodative IOLs

OSN SuperSite Breaking News 5/2/2007

SAN DIEGO — In the future, the cataract surgeon's ability to protect against posterior capsular opacification will hinge upon innovative new designs and placement of intraocular lenses, according to the surgeon who delivered the Charles D. Kelman Innovator's Lecture here.Okihiro Nishi, MD, described his theory behind avoiding posterior capsular opacification (PCO) and introduced his latest idea for an accomodative lens design at the American Society of Cataract and Refractive Surgery meeting."The capsular bend induces contact inhibition of migrating lens epithelial cells regardless of materials of an IOL," Dr. Nishi explained, showing images and diagrams of both round- and square-edged IOLs. He said that without this bending effect, the cells can migrate to the posterior chamber and cause PCO. He explained that bending is best caused by square-edged IOLs, but is not guaranteed. Next, Dr. Nishi introduced his novel design combining one posterior and one anterior square-edged IOL and filling the space between with gel. The anteriorally-placed IOL is designed with a hole through which the gel can be inserted. The hole rotates to lie under the iris and prevent leakage, he said.In theory and in a rabbit model, the accommodation occurs with the forward movement of the anterior IOL. Dr. Nishi said the next step is to test the theory in a primate."In conclusion, the procedure using the novel accommodative IOL securely prevented leakage," he said. "The procedure is simple, safe and highly reproducible. ... It can be a breakthrough

Posted by mehdi khanlari at 10:31 PM | Comments (0)

Centerflex IOL associated with low capsulotomy rate at 3 years postop

OSN may 2007

SAN DIEGO — The Centerflex foldable hydrophilic acrylic IOL was associated with a 5.2% rate of symptomatic posterior capsular opacification requiring Nd:YAG capsulotomy after 3 years in vivo, a retrospective study found.Rebecca L. Ford, MD, and colleagues at Whipps Cross Hospital, London, and Harold Wood Hospital in Romford, England, reviewed the rate of Nd:YAG capsulotomies performed from 2000 to 2003 in patients implanted with the Centerflex single-piece IOL (Rayner). Dr. Ford presented their results here at the American Society of Cataract and Refractive Surgery meeting.Four senior surgeons at the two hospitals performed 3,325 routine cataract surgeries with Centerflex implantation. Of these, 172 required laser capsulotomies (5.2%) within the 3-year period, Dr. Ford said."It seems that the peak time was within 16 months of surgery," she said.
The lens, which features a squared optic and haptic edge design, has been used in England for the last 10 years. The U.S. Food and Drug Administration is currently reviewing the application for U.S. marketing of the lens, she said.

Posted by mehdi khanlari at 09:45 PM | Comments (0)

[Management of hyperopia in children

Cont Lens Anterior Eye. 2007 May;30(2):76-PURPOSE: To study the prevalence of hyperopia in school-aged children and to analyze the factors that increase the risk of squint or amblyopia in a retrospective study. METHODS: Three hundred eyes of 150 children with hyperopia who did not have anisometropia > or =1.5 D were selected.Children with hyperopia of +3.5 D or greater have an increased risk of amblyopia and squint that threatens their visual function. Hyperopic correction should be prescribed even if no strabismus or amblyopia is detected in order to prevent this risk. Screening programs should also be promoted to detect these children at an early age.

Posted by s.tavakolizadeh at 06:13 PM | Comments (0)

An investigation into the mechanisms causing antipodean strabismus

J AAPOS. 2007 Mar 12;
BACKGROUND: Antipodean strabismus is a rare clinical entity in which a patient manifests an esotropia when fixating with one eye and an exotropia when fixating with the other eye. It has been described in the settings of marked uncorrected anisometropia, dissociated strabismus or combinations of paresis, and mechanical restriction of eye movement. METHODS: A retrospective review of four patients with antipodean strabismus. RESULTS: All patients demonstrated a unique and uncommon pattern in which there was esotropia with one eye fixating and exotropia with the other eye fixating. None of the patients demonstrated anisometropia or signs of dissociated horizontal deviation. One patient developed antipodean strabismus after prior surgery to correct a traumatic sixth nerve palsy. Another patient had an associated pseudotumor cerebri. The other two patients had no pertinent medical history and, on clinical examination, demonstrated markedly asymmetric accommodative convergence/accommodation (AC/A) ratios. CONCLUSIONS: Antipodean strabismus is an atypical heterotropia, which can be associated with a variety of clinical findings. This article demonstrates the uniqueness of this clinical entity and illustrates the first association of this pattern with a markedly asymmetric AC/A ratio.

Posted by s.tavakolizadeh at 06:13 PM | Comments (0)

May 20, 2007

Long-term Results of Scleral Fixation of Posterior Chamber Intraocular Lenses in Children

Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran PURPOSE: To evaluate the long-term results of transsclerally fixated posterior chamber intraocular lenses (SF-PCIOLs) in children without adequate capsular support. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Twenty-five eyes of 23 children who underwent primary (6 eyes) or secondary (19 eyes) implantation of SF-PCIOLs. The primary cases included those undergoing surgery for lens subluxation due to Marfan's syndrome, and secondary cases included those after surgery for congenital cataract (3 eyes) or traumatic cataract (16 eyes). All eyes lacked adequate capsular support and, in secondary cases, manifested contact lens intolerance. INTERVENTION: Ab externo transscleral fixation of PCIOLs. MAIN OUTCOME MEASURES: Visual acuity (VA), IOL position, and postoperative complications. RESULTS: The mean age of patients at the time of SF-PCIOL implantation was 79+/-20.2 months (range, 33-120). The mean duration of follow-up after surgery was 81.1+/-46.2 months (range, 12-144). Best-corrected VA improved postoperatively in 12 eyes (48%) by >1 Snellen line. The main cause of reduced vision was corneal and retinal pathologies and amblyopia. Complications included transient intraocular hemorrhage in 13 eyes (52%), transient choroidal effusion in 2 eyes (8%), late endophthalmitis in 1 eye (4%), retinal detachment in 1 eye (4%), and late IOL dislocation due to breakage of polypropylene sutures after 7 to 10 years in 6 eyes (24%). CONCLUSION: Scleral fixation of PCIOLs can be visually rewarding in selected cases, but there is a high rate of complications during a long-term follow-up;

Posted by s.tavakolizadeh at 02:19 PM | Comments (0)

[Iris hooks and modified capsular tension ring for subluxation lens in patients with Marfan's syndrome.]

Zhonghua Yan Ke Za Zhi. 2007 Feb;43(2):108- OBJECTIVE: To evaluate clinical efficiency and safety of the iris hooks and modified capsular tension ring (MCTR) for the treatment of subluxation lens in patients with Marfan's syndrome. METHODS: This study comprised 5 patients (7 eyes) with Marfan's syndrome and subluxation lens. After 3.2 mm clear cornea incision and continuous curvilinear capsulorhexis (CCC), 2 - 4 disposable nylon iris hooks were inserted through the stab incisions and placed in the capsulorhexis to support the capsule and enlarged the CCC. Following irrigation/aspiration, a MCTR with suture in its eyelet was placed in the capsule bag. After tightening and tying the suture of MCTR, the capsular bag was centered and fixed. A foldable AcrySof one-piece intraocular lens (IOL) was then placed in the capsule bag. RESULTS: Twelve months after the operation, the best corrected visual acuity was >/= 0.8 in six eyes and 0.7 in one eye. The scheimpflug images obtained from the Pentacam demonstrated that the IOL were well centered. UBM showed that all the MCTR and the haptics of the IOL were in the capsule bag, the eyelet of the MCTR was rested stably between the capsulorhexis margin and the iris. The retroillumination photograph indicated that only one eye had obvious posterior capsular opacification. No intraoperative and postoperative complications such as prolapse of vitreous and retina detachment was occured. CONCLUSIONS: The iris hooks can provide excellent intraoperative capsule-lens stability and facilitate the manipulation during operation. MCTR allows additional suture fixation to the eye wall without damaging the capsular bag and maintains the long-term stability of the intraocular lens. Furthermore, MCTR is helpful for avoiding dislocation of the IOL due to progressive weakening of the zonular fibers in some patients and provides long-term safety.

Posted by s.tavakolizadeh at 02:19 PM | Comments (0)

May 16, 2007

Cornea, 05/14/07

Grieser Eric J MD., et al. - To report the benign seven year follow-up on a free-floating anterior chamber epithelial inclusion cyst that did not require treatment...Conclusions: The long clinical course of our patient shows that epithelial inclusion cysts may be managed without treatment for many years with careful and frequent follow-up [more...]

Posted by mehdi khanlari at 07:08 AM | Comments (0)

Anterior Segment Optical Coherence Tomography for Imaging the Anterior Chamber After Laser Peripheral Iridotomy

American Journal of Ophthalmology, 05/14/07

Farnaz Memarzadeh, et al. - To evaluate changes in anterior segment morphology by anterior segment optical coherence tomography (OCT) and gonioscopy before and after laser peripheral iridotomy (LPI)...Conclusions: Changes in the anterior chamber angle morphology post-LPI can be imaged and objectively quantified by anterior segment OCT [more...]

Posted by mehdi khanlari at 07:05 AM | Comments (0)

Vertical Corneal Striae in Families with Autosomal Dominant Hearing Loss: DFNA9/COCH

American Journal of Ophthalmology, 05/15/07

Anne M L C Bischoff, et al. - Conclusions: Data analysis demonstrated a significant association between vertical corneal striae and the Pro51Ser and Gly88Glu mutations in the COCH gene in DFNA9 families 1, 2, and 3 with cochleovestibular dysfunction. Our findings suggest that the vertical corneal striae and cochleovestibular dysfunction may be caused by the same COCH mutations [more...]

Posted by mehdi khanlari at 07:03 AM | Comments (0)

Demonstration of ?Owl?s Eye? Morphology by Confocal Microscopy in a Patient With Presumed Cytomegalovirus Corneal Endotheliitis

American Journal of Ophthalmology, 05/15/07

Atsushi Shiraishi, et al. - To report confocal microscopic observations of characteristic corneal endothelial lesions in a patient with presumed cytomegalovirus (CMV) corneal endotheliitis...Conclusions: Confocal microscopy can detect the owl?s eye morphology in the corneal endothelium of patients with presumed CMV corneal endotheliitis [more...]

Posted by mehdi khanlari at 06:59 AM | Comments (0)

Treatment of Progressive Keratoconus by Riboflavin-UVA-Induced Cross-Linking of Corneal Collagen: Ultrastructural Analysis by Heidelberg Retinal Tomograph II In Vivo Confocal Microscopy in Humans

Cornea, 05/15/07
Mazzotta Cosimo PhD., et al. - To assess ultrastructural stromal modifications after riboflavin-UVA-induced cross-linking of corneal collagen in patients with progressive keratoconus...Conclusions: Reduction in anterior and intermediate stromal keratocytes followed by gradual repopulation has been confirmed directly in vivo in humans by HRT II-RCM confocal microscopy after riboflavin-UVA-induced corneal collagen cross-linking [more...]

Posted by mehdi khanlari at 06:56 AM | Comments (0)

Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty

Journal of Cataract & Refractive Surgery, 05/15/07
Louis Hoffart MD, et al. - To report the results of correction of post-keratoplasty astigmatism by arcuate keratotomy performed with the Hanna arcitome (Moria)...Conclusions: Arcuate keratotomy performed with the Hanna arcitome was effective in reducing post-keratoplasty astigmatism. The device enabled safer, easier arcuate incisions than with manual techniques. However, predictability and efficacy could be improved by a more accurate nomogram [more...]

Posted by mehdi khanlari at 06:55 AM | Comments (0)

Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens Prospective randomized masked clinical trial

Journal of Cataract & Refractive Surgery, 05/09/07
Deepak Pandita MS., et al. - To evaluate contrast sensitivity and glare disability after implantation of an AcrySof IQ Natural SN60WF aspherical intraocular lens (IOL) (Alcon Laboratories)...Conclusion: Eyes with the AcrySof IQ SN60WF IOL had significantly higher contrast sensitivity than eyes with an AcrySof SA60AT or AcrySof Natural SN60AT IOL at all spatial frequencies during mesopic testing (with and without glare) with 4.0 and 6.0 mm artificial pupil [more...]

Posted by mehdi khanlari at 06:53 AM | Comments (0)

Endophthalmitis after Uncomplicated Cataract Surgery with the Use of Fourth-Generation Fluoroquinolones A Retrospective Observational Case Series

Ophthalmology, 05/10/07
Majid Moshirfar MD, FACS., et al. - Conclusions: The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%. This rate was within the range of previously reported rates of endophthalmitis in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant [more...]

Posted by mehdi khanlari at 06:49 AM | Comments (0)

May 15, 2007

Complications of Primary Placement of Motility Post in Porous Polyethylene Implants During Enucleation

AJO,May,2007
The records of all patients who had undergone primary enucleation and spherical porous polyethylene (PP) implant with motility coupling post (MCP) insertion, and who were followed for at least six months were reviewed. The MCP was screwed to a wrapped implant to protrude 3 mm to 4 mm anteriorly. After placing the implant into the orbit, the extraocular muscles were sutured to the implant, and the Tenon capsule and conjunctiva were closed onto the MCP. When the MCP was not exposed spontaneously within two months after surgery, it was externalized with a conjunctival cut-down procedure.
The complications in the early postoperative period included prominent MCP decentration associated with implant motility restriction (6%), preseptal cellulitis (4%), and conjunctival prolapsus (8%). Complications during the late period included: excessive discharge (15%), MCP decentration (4%), implant exposure (6%), implant infection (2%), pyogenic granuloma (8%), conjunctival overgrowth over the MCP (2%), conjunctival discoloration (4%), and lax eyelid syndrome (2%).
Conclusions:Although MCP placement in the spherical PP implant during enucleation is a useful technique, it may be associated with complications such as MCP decentration, excessive discharge, exposure, and infection of the implant.

Posted by afarahi at 05:30 PM | Comments (0)

Hyperopic Keratoconus

Journal of Refractive Surgery Vol. 23 No. 5 May 2007

To report three patients (four eyes) with hyperopic keratoconus.Patients were evaluated with corneal curvature topography, ultrasonic pachymetry, and rotating Scheimpflug camera.One patient, without other risk factors, developed unilateral ectasia after LASIK following primary hyperopic ablation in an eye suspicious for keratoconus. Two additional hyperopic patients (three eyes) had curvature and elevation findings compatible with keratoconus.Although rare, keratoconus could present in hyperopia. If keratoconus is suspected, we suggest avoidance of LASIK and its potential for development of corneal ectasia.

Posted by mmiraftab at 04:37 PM | Comments (0)

Description, Etiology, and Prevention of an Outbreak of Diffuse Lamellar Keratitis After LASIK

Journal of Refractive Surgery Vol. 23 No. 5 May 2007

To describe an outbreak of diffuse lamellar keratitis (DLK) and provide a hypothesis about the etiology.
METHODS
A retrospective analysis was carried out on 328 eyes of 220 patients who underwent LASIK over 9 months. The occurrence of DLK using two different methods of cleaning and sterilizing surgical instruments and an autoclave reservoir were analyzed. Microbial analyses were carried out by two laboratories on samples obtained from the original autoclave reservoir and tubing. A chi-square test was used to compare qualitative values. The Student t test was used to compare numerical values.
RESULTS
Forty-six (24.5%) of 188 cases of DLK were diagnosed. Sphingomona paucimobilis and Burkholderia pickettii were isolated in the reservoir of the steam sterilizer. Electron microscopy revealed gram-negative microbes on the tubing walls. After changing the reservoir of the steam sterilizer and implementing a new cleaning and sterilization protocol based on air-drying the instruments and draining and drying the reservoir of the sterilizer, the occurrence of DLK stopped. No statistically significant correlation was noted between the occurrence of DLK and gender, age, or volume of tissue removed.
CONCLUSIONS
Data obtained during this DLK outbreak support the theory that a bacterial endotoxin, which can survive short-cycle steam sterilization, could be responsible for an outbreak of DLK. We recommend cleaning and sterilization protocols based on air-drying surgical instruments and leaving the reservoirs completely dry at the end of each surgical day.

Posted by mmiraftab at 04:34 PM | Comments (0)

Customized LASIK Treatment for Myopia Based on Preoperative Manifest Refraction and Higher Order Aberrometry: The Rochester Nomogram

Journal of Refractive Surgery Vol. 23 No. 5 May 2007

To develop and test the efficacy of myopic treatment, based on preoperative manifest refraction and higher order aberrations, in enhancing the postoperative refractive error following customized LASIK treatment and compare results with the manufacturer-recommended sphere offset Zyoptix treatment nomogram, which does not account for the preoperative higher order aberrations.
METHODS
One hundred seventy-five myopic eyes (89 patients) were treated based on the Rochester nomogram, which specified the amount of myopia to be treated based on preoperative manifest refraction and higher order aberrations, including third order aberrations and spherical aberration. Postoperative refractive error was measured at 1 month and compared to that theoretically estimated with the Zyoptix nomogram.
RESULTS
The mean preoperative sphere and cylinder were –4.5±22.05 diopters (D) and –0.81±0.70 D, respectively. The mean postoperative spheres were +0.04±0.33 D and +0.31±0.54 D, using the Rochester and Zyoptix nomograms, respectively. The mean postoperative spherical equivalent refractions were –0.11±0.34 D and +0.15±0.53 D using the Rochester and Zyoptix nomograms, respectively. The Rochester nomogram reduced the range of postoperative spherical equivalent to ±1.00 D, which was significantly better than that using the Zyoptix nomogram (t=5.46, P<.0001), which would have resulted in 8% of eyes with a postoperative spherical equivalent refraction >±1.00 D. Using the Rochester nomogram, 93.1% of eyes attained a postoperative UCVA >20/20. The percentage of postoperative hyperopic overcorrection decreased to 2.8% in the Rochester nomogram group from 22.3% using the Zyoptix nomogram, which only adjusts spherical values based on preoperative sphere and does not account for preoperative aberrations.
CONCLUSIONS
The Rochester nomogram compensates for the effect of preoperative higher order aberrations on sphere and provided reduced range of postoperative spherical equivalent refraction.

Posted by mmiraftab at 04:25 PM | Comments (0)

Corneal Manifestations of Ocular Demodex Infestation

AJO.May,2007
Ahmad Kheirkhah, Victoria Casas, Wei Li, Vadrevu K. Raju, Scheffer C.G. Tseng
This retrospective review included six patients with Demodex blepharitis who also exhibited corneal abnormalities, which led to suspicion of limbal stem cell deficiency in three cases. All patients received weekly lid scrubs with 50% tea tree oil and a daily lid scrubs with tea tree shampoo for a minimum of six weeks. Improvement of symptoms and corneal and conjunctival signs were evaluated.
Their corneal manifestation included superficial corneal vascularization (six eyes of five cases), marginal corneal infiltration (two eyes of two cases), phlyctenule-like lesion (one eye of one case), superficial corneal opacity (two eyes of two cases), and nodular corneal scar (two eyes of two cases).
Conclusions:A variety of corneal pathologic features together with conjunctival inflammation, commonly noted in rosacea, can be found in patients with Demodex infestation of the eyelids. When conventional treatments for rosacea fail, one may consider lid scrub with tea tree oil to eradicate mites as a new treatment.

Posted by afarahi at 02:57 PM | Comments (0)

Test

Posted by behroozko at 12:01 PM | Comments (0)

May 14, 2007

Magnetic resonance imaging evidence for widespread orbital dysinnervation in dominant Duane's retraction syndrome linked to the DURS2 locus.

Invest Ophthalmol Vis Sci. 2007 Jan;48(1):194-202 PURPOSE: High-resolution, multipositional magnetic resonance imaging (MRI) was used to demonstrate extraocular muscles (EOMs) and associated motor nerves in Duane retraction syndrome (DRS) linked to the DURS2 locus on chromosome 2. METHODS: Five male and three female affected members of two autosomal dominant DURS2 pedigrees were enrolled in the study. Coronal T(1)-weighted MRI of the orbits was obtained in multiple gaze positions, as well as with heavy T(2) weighting in the plane of the cranial nerves. MRI findings were correlated with motility. RESULTS: All subjects had unilateral or bilateral limitation of abduction, or of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Orbital motor nerves were typically small, with the abducens nerve (cranial nerve [CN]6) often nondetectable. Lateral rectus (LR) muscles were structurally abnormal in seven subjects, with structural and motility evidence of oculomotor nerve (CN3) innervation from vertical rectus EOMs leading to A or V patterns of strabismus in three cases. Four cases had superior oblique, two cases superior rectus, and one case levator EOM hypoplasia. Only the medial and inferior rectus and inferior oblique EOMs were spared. Two cases had small CN3s. CONCLUSIONS: DRS linked to the DURS2 locus is associated with bilateral abnormalities of many orbital motor nerves, and structural abnormalities of all EOMs except those innervated by the inferior division of CN3. The LR may be coinnervated by CN3 branches normally destined for any other rectus EOMs. Therefore, DURS2-linked DRS is a diffuse congenital cranial dysinnervation disorder involving but not limited to CN6

Posted by s.tavakolizadeh at 05:35 PM | Comments (0)

Trypan blue-assisted posterior tenectomy of the superior oblique.

J Pediatr Ophthalmol Strabismus. 2007 Jan-Feb;44(1):45-6 Posterior tenectomy of the superior oblique tendon can be difficult, particularly for inexperienced surgeons, due to problems in visualization and anatomic peculiarities. Trypan blue can be used to stain the superior oblique tendon for easy identification and delineation of it at its insertion, making the current surgical technique less difficult.

Posted by s.tavakolizadeh at 05:35 PM | Comments (0)

May 12, 2007

[The clinical features and surgical treatment of masked bilateral superior oblique palsy]

Zhonghua Yan Ke Za Zhi. 2007 Jan;43(1):27-31 OBJECTIVE: To investigate the clinical features, diagnosis and the management of masked bilateral superior oblique palsy (MBSOP). METHODS: Retrospectively analyzed the records of all 7 patients that met the clinical criteria for MBSOP in Zhongshan Ophthalmic Center between 1999 and 2003. The head tilt, vertical deviation in primary position and the action of obliquus pre- and postoperatively were collected in detail. RESULTS: All 7 patients were diagnosed as unilateral SOP in the first time. The average hypertropia in primary position preoperatively was 19.7(Delta) (range 6(Delta) to 30(Delta)). All patients had a head tilt, obvious unilateral inferior oblique overaction (+2 to +4) and mild superior oblique underaction (-1 to -2), and normal action in contralateral superior and inferior obliquus. Initial surgery consisted of ispilateral inferior oblique weakening with (5 patients) or without (2 patients) ispilateral superior rectus recession. In 1 week to 4 years, all of the previously masked eye presented the inferior oblique overaction (+2 to +3) and superior oblique underaction (0 to -1). All patients underwent a second surgery in 4 months to 4 years after the initial surgery. The average hypertropia in primary position was 2.3(Delta) (range 0(Delta) to 7(Delta)) after the second operation. Postoperative alignment was excellent in all patients. CONCLUSIONS: Masked bilateral superior oblique palsy is quite difficult to detect before surgical correction of the initial manifest palsy. The possibility of an occult contralateral palsy should be considered in all undergoing surgery for unilateral SOP. The superior rectus recession and the inferior oblique weakening procedure should be performed at different stages. When the masked palsy becomes evident, a successful surgical outcome can usually be expected.

Posted by s.tavakolizadeh at 07:20 PM | Comments (0)

Reexploration and inferior oblique myectomy temporal to the inferior rectus to treat persistent inferior oblique overaction.

J AAPOS. 2007 Feb;11(1):48-51 PURPOSE: Persistent symptomatic inferior oblique (IO) muscle overaction (IOOA) after IO muscle weakening surgery is a common problem. We describe the results of reexploration and myectomy of the IO muscle using a standard inferotemporal approach to treat this clinical entity. METHODS: A retrospective noncomparative consecutive series of patients referred for treatment of persistent IOOA. The following preoperative and postoperative measurements were recorded in each case: (1) the ductions and versions of the overacting IO muscle and its antagonist superior oblique (SO) muscle; and (2) alternate prism cover test, using loose prisms at 6 m, in primary position and right- and leftgaze. RESULTS: Eight patients were identified. Three had previously undergone a standard IO myectomy, and five had undergone a standard IO muscle recession. The median period of postoperative follow-up was 12 months (range, 7 months to 2 years). The IOOA was eliminated in three patients and a reduction of IOOA of at least 1 unit was achieved in all patients. Seven patients showed improvement of their SO muscle underaction on versions, postoperatively. All patients achieved a marked improvement in their alignment across the three standard horizontal positions of gaze.CONCLUSIONS: Reexploration and myectomy of the IO muscle near to the temporal border of the inferior rectus muscle is a reliable and effective way of treating persistent IOOA

Posted by s.tavakolizadeh at 06:23 PM | Comments (0)

Anterior and nasal transposition of the inferior oblique muscles in patients with missing superior oblique tendons.

J AAPOS. 2007 Feb;11(1):29-33. Epub 2006 Sep 18 INTRODUCTION: Patients with missing superior oblique (SO) tendons present with overelevation/underdepression in adduction. Unilateral cases often exhibit abnormal head postures, whereas in bilateral cases, there may be a marked V-pattern with upgaze exotropia. These patients may have craniosynostosis. METHODS: Nine children with unilateral (n = 2) or bilateral (n = 7) absent SO tendons underwent anterior and nasal transposition of the inferior oblique (IO) muscles, some in combination with horizontal rectus recession for horizontal strabismus. They were evaluated 6 to 46 months postoperatively for alignment and oculomotor examination. RESULTS: Postoperatively, all patients improved. Both unilateral cases were orthotropic with no abnormal head posture. In the bilateral cases, vertical deviation in adduction and exotropia in upgaze had largely cleared, although some symptoms remained, most notably vertical deviation in side gaze (3 patients) and V-pattern esotropia in downgaze (2 patients). A patient missing both SO tendons as well as the left superior rectus muscle, who had the anterior and nasal transposition on the right side only, remained with 25(Delta) left hypotropia. CONCLUSIONS: Anterior and nasal transposition of the IO muscle reduces overelevation in adduction and helps eliminate or reduce divergence of the eyes in upgaze, but esodeviation may persist in downgaze. This procedure was most effective in unilateral absence of the SO tendon. It is likely to benefit patients with severe congenital fourth nerve palsy in which standard IO muscle weakening procedures have been ineffective

Posted by s.tavakolizadeh at 06:23 PM | Comments (0)

Inferior oblique muscle fixation to the orbital wall: a profound weakening procedure

J AAPOS. 2007 Feb;11(1):17-22. Epub 2006 Sep 7.INTRODUCTION: Recurrent or persistent inferior oblique overaction may occur after inferior oblique (IO) recession or anterior transposition. IO nasal and temporal myectomy and anterior-nasal transposition may result in undesirable IO palsy, exotropia, incyclotorsion, or limitation of elevation. We describe a reversible profound weakening surgical procedure of the IO muscle. METHODS: A total of 10 consecutive subjects with V-pattern strabismus and/or IO overaction underwent IO orbital fixation procedure by attaching its insertion to the periosteum of the lateral orbital wall. Five subjects with persistent IO overaction after IO anterior transposition underwent bilateral IO orbital wall fixation. Four subjects with no previous IO surgery underwent unilateral IO orbital wall fixation; 3 of these 4 subjects had superior oblique palsy with a large vertical deviation in primary position and 1 had a V pattern with asymmetric IO overaction. RESULTS: V pattern significantly improved from 22(Delta) preoperatively to 7(Delta) postoperatively (p = 0.002). IO overaction improved from 2.5 (range, + 1.5 to + 4) to 0.1 (range, -2 to +3) postoperatively (p < 0.001). Six of 9 subjects had no residual overelevation in adduction postoperatively. Unilateral IO orbital fixation corrected 7(Delta) of vertical deviation in the primary position and 23(Delta) in adduction. Mean postoperative follow-up was 5 months. CONCLUSIONS: IO orbital fixation has a profound weakening effect on the IO muscle. Advantages of this procedure include reversibility and that it can be converted into another form of weakening procedure, if required.

Posted by s.tavakolizadeh at 06:23 PM | Comments (0)

May 11, 2007

ISNT rule and HRT results

Review of ophthalmology Vol. No: 14:5Issue: 5/1/2007

Data from a foundation-supported study conducted at the New Jersey Medical School (with one author employed by Heidelberg Engineering) challenge the idea that the rank order of optic nerve rim area follows the ISNT rule (inferior, superior, nasal, temporal). Researchers analyzed a subset of the Caucasian normative database used by the Heidelberg Retina Tomograph 3 to see whether their HRT results supported this rule. The sub-group consisted of 280 subjects judged normal after a comprehensive biomicroscopic examination, with IOP less than 22 mmHg and normal automated visual field results.Researchers analyzed the neuroretinal rim areas of each quadrant of the right eye, and noted the percentages of eyes showing different patterns of rim area quadrant orders. The data showed that the average rim area, in descending order was inferior, nasal, superior and temporal (INST). By frequency, the percentage of eyes following the various rules were: NIST , 33 percent; INST, 21 percent; ISNT, 18 percent; NSIT, 10 percent; SINT, 6 percent; and SNIT, 3 percent. The study authors note that vascular structures in the nasal quadrant likely contributed to these results.Although the rank order of HRT 3 rim area data doesn’t follow the ISNT rule (the NIST and INST rules were more common), the authors believe that the order of rim area may be helpful for determining optic nerve health, as in the finding that the temporal rim area was smallest in 92 percent of these normal eyes.3314

Posted by mehdi khanlari at 10:20 PM | Comments (0)

Comparisons between Pascal dynamic contour tonometry, the TonoPen, and Goldmann applanation tonometry in patients with glaucoma

Acta Ophthalmologica Scandinavica, 05/04/07

Salvetat Maria L., et al. - To compare intraocular pressure (IOP) measurements taken with Pascal dynamic contour tonometry (DCT), the TonoPen and the Goldmann applanation tonometry (GAT)...Conclusions: Agreement with GAT measurements was higher for Pascal DCT than for TonoPen readings; however, Pascal DCT significantly overestimated IOP values compared with GAT. Measurements of IOP obtained with both Pascal DCT and the TonoPen appeared to be influenced by CCT, and this influence appeared to be greater for the latter [more...]

Posted by mehdi khanlari at 09:27 PM | Comments (0)

Prevalence of glaucoma in patients with obstructive sleep apnoea?a cross-sectional case-series

Eye, 05/07/07
R E Bendel., et al. - Conclusion: The prevalence of glaucoma in patients with obstructive sleep apnoea is an estimated 27%. Sex, age, body mass index or apnoea plus hypopnoea index are not factors influencing the presence of glaucoma in this population of patients [more...]

Posted by mehdi khanlari at 09:22 PM | Comments (0)

The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up

Acta Ophthalmologica Scandinavica, 05/08/07

Sisto Dario., et al. - To compare the intermediate-term efficacy of 5-fluorouracil (5-FU) and Mitomycin C (MMC) as adjunctive antimetabolites in neovascular glaucoma (NVG) filtration surgery...Conclusions: The percentage of patients who achieved postoperative IOP<21mmHg was similar in both groups, although a larger proportion of patients treated with MMC-augmented trabeculectomy required topical treatment in comparison with the 5-FU group [more...]

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

May 09, 2007

Topical treatment for early cataracts shows potential against intraocular calcification

OSN SuperSite Breaking News 5/4/2007

SAN DIEGO — A topical drug being investigated for treating early cataracts may also be effective for treating band keratopathy, intraocular calcification and asteroid hyalosis, according to a surgeon speaking here.Randall J. Olson, MD, discussed the results of a recent early-stage clinical trial of the drug at the American Society of Cataract and Refractive Surgery meeting. "I think that it will be clinically important for intraocular calcification issues — the role in clinical treatment of cataracts," he said.Arresting cataract formation involves the creation and removal of multilamellar bodies, which are an integral part of early cataract growth, Dr. Olson said."There is clear evidence that this material can remove multilamellar bodies," he said, noting that removing the multilamellar bodies would affect the rate at which cataracts form.

Posted by mehdi khanlari at 11:56 PM | Comments (0)

Study: ReSTOR lens offers excellent near, distance vision

OSN SuperSite Breaking News 5/7/2007

SAN DIEGO — The AcrySof ReSTOR multifocal IOL provides "excellent" near and distance vision and is associated with good overall patient satisfaction, despite some issues with glare and halos, according to a surgeon speaking here.Josh Fullmer, MD, and a colleague reviewed the charts of 50 patients bilaterally implanted with the AcrySof ReSTOR IOL (Alcon). They also performed a telephone survey of 48 of these 50 patients, which evaluated spectacle independence and satisfaction with the lens. Respondents were also asked about any glare or halo problems and whether such visual disturbances affected their performance of daily activities.Dr. Fullmer presented the results at the American Society of Cataract and Refractive Surgery meeting.At 1 month follow-up, 90% of patients had achieved J1 uncorrected best distance visual acuity, 88% had 20/20 uncorrected distance vision and all patients were at least 20/30, according to the study.The survey found that 76% of patients required no spectacle correction. Of those who did use spectacles, 83% only occasionally used reading glasses, Dr. Fullmer said. Also, only about 29% of respondents reported blurriness at intermediate distances, he added.Overall, 46 of the 48 survey respondents reported being satisfied with the lens. Only one patient indicated dissatisfaction with the lens and stated that he or she would not have the lens implanted again. However, this patient would recommend the lens to friends, Dr. Fullmer said."The ReSTOR lens provides excellent near and distance acuity, and adequate spectacle freedom; the lens has significant glare, but overall, patient satisfaction was very good," he said.

Posted by mehdi khanlari at 11:52 PM | Comments (0)

Eye geometry compensates for horizontal coma, spherical aberration

OSN SuperSite Breaking News 5/8/2007

FORT LAUDERDALE, Fla. — Internal optics compensate for off-axis horizontal corneal coma in IOL-implanted eyes, according to study data presented here at the Association for Research in Vision and Ophthalmology meeting.Susana Marcos, PhD, and colleagues investigated whether compensation for coma occurs in pseudophakic eyes with spherical aberration-correcting IOLs. They also sought to identify the eye geometry causing compensation."It is well known that in young eyes positive spherical aberration of the cornea is partially compensated by internal [spherical aberration]," the authors said in the study abstract. "Aspheric [IOLs] have been introduced to mimic this effect in pseudophakic eyes. Compensation of horizontal coma has also been shown to occur in young eyes and the active/passive nature of this effect has been debated."The patient group included 38 eyes of 21 patients implanted with two types of aspheric IOLs with negative spherical aberration. Researchers used a laser ray tracing system to measure total aberrations and videokeratoscopy to identify corneal aberrations. They also measured IOL tilt and decentration using a custom Purkinje imaging system. They referred tilt to the pupillary axis and decentration to the pupillary center, according to the study.Data showed that spherical aberration was reduced with respect to corneal values in all eyes. Total horizontal coma was also markedly reduced in all eyes, according to the study.

Posted by mehdi khanlari at 11:49 PM | Comments (0)

Topical chelation therapy shown to be potential treatment for diabetic cataracts

OSN May 2007

FORT LAUDERDALE, Fla. — A topical chelation therapy was effective in reducing excess intraocular metals that are known to contribute to the formation of diabetic cataracts, according to a poster presentation at the Association for Research in Vision and Ophthalmology meeting here.\Naseem H. Ansari, PhD, and colleagues at University of Texas Medical Branch described measures to reduce excess metals and treat or prevent diabetic cataract in a rat model.Research has determined that transition metal ions play a role in generating reactive oxygen species, which increase oxidative stress and cause pathologies such as diabetic cataract, the study authors said."Elevated levels of chelatable pool of redox-active metal ions have indeed been shown to be present at increased concentrations in aged and cataractous lenses," they said. "However, metal chelation attempts to prevent cataractogenesis have been limited due to the permeability barrier of the cell membrane to the metal chelators."To study the efficacy of chelation in preventing cataract, investigators used EDTA, a topical chelator, combined with methylsulfonylmethane (MSM), a permeability enhancer.In a rat study, investigators applied topical EDTA combined with MSM. They applied various concentrations of EDTA and MSM to assess the effectiveness of the combination in preventing or diminishing diabetic cataract.The first leg of the study showed that EDTA and MSM enters the aqueous humor and lens. The second leg showed a "significant amelioration" of cataract formation, the authors said."Oxidative markers, which were increased in the diabetic rat lens, significantly normalized in the lenses of the diabetic rat that were treated with EDTA+MSM," they said."EDTA in the presence of MSM can enter into the lens when topically applied onto the eye," they said. "Furthermore, it appears that 'excess metals' in diabetes trigger the oxidative stress and contribute to cataractogenesis. Chelation therapy using EDTA+MSM can be a promising clinical therapy for protecting against diabetic cataracts

Posted by mehdi khanlari at 11:45 PM | Comments (0)

May 08, 2007

Comparison of two pupillometers in determining pupil size for refractive surgery

Acta Ophthalmologica Scandinavica, May, 2007
To compare a handheld and a digital pupillometer in determining pupil size in a population of refractive surgery candidates (group 1) and after implantation of an Artisan phakic intraocular lens (PIOL) for correction of myopia (group 2).Pupil size was measured with the Colvard and Procyon pupillometers in 121 eyes in group 1 and 83 eyes in group 2. Pupil sizes measured with the Colvard device were compared with the scotopic, mesopic-low and mesopic-high measurements taken with the Procyon pupillometer in both groups. Conclusions:  Measurements of pupil diameter with the Colvard pupillometer correlated best with measurements taken by the Procyon pupillometer under standardized mesopic-low light conditions. We believe that digital binocular infrared pupillometry is advantageous for obtaining standardized measurements of pupil size

Posted by afarahi at 07:21 PM | Comments (0)

May 04, 2007

First clinical trial of gene therapy for childhood blindness

INDUSTRY NEWS
Researchers announced that the first operation occurred this week. Some indications of the results may be available within several months. Twelve patients have been enrolled in the study.

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

First human recombinant hyaluronidase product is now available

INDUSTRY NEWS
Baxter Healthcare Corporation expects Hylenex to provide an advanced and more sustainable supply of hyaluronidase, circumventing the quality and supply problems associated with the animal-derived product.

Posted by kjalali at 07:39 PM | Comments (0)

Prophylaxis of Acute Posttraumatic Bacterial Endophthalmitis

Archives of Ophthalmology, April 2007
This large, multi-center, randomized trial finds the infection rate was almost nine times higher among controls, compared to the treated group. However, among eyes without a retained foreign body, the infection rate was similar between the groups. Intravitreal injection was associated with a lower infection rate, compared to intracameral injection.

Posted by kjalali at 07:32 PM | Comments (0)

May 01, 2007

Endophthalmitis after Cataract Surgery: A Nationwide Prospective Study Evaluating Incidence in Relation to Incision Type and Location

Ophthalmology,May,2007
Through a standard reporting form sent to the Swedish National Cataract Register (NCR), patient and operation technique data were recorded. In addition, postoperative endophthalmitis (PE )cases with a traceable number to the main register were collected. Various parameters with a possible impact on endophthalmitis development were evaluated. The overall rate of PE was 0.048% (109 cases in 225 471 CEs). Incidences of PE were 0.053% with clear corneal incisions and 0.036% with sclerocorneal incisions (P = 0.14, logistic regression analysis). The corresponding results were 0.040% for superior incisions and 0.055% for temporal incisions (P = 0.14). Communication between the anterior segment and vitreous was found to be a highly significant independent risk factor for PE (P<0.001), as were patient age ≥ 85 years (P<0.001) and the nonuse of intracameral cefuroxime (P<0.001).
Conclusions:The overall rate of PE after cataract surgery is low in Sweden, which may be a consequence of the widespread use of prophylactic intracameral cefuroxime. Only a trend for an increased risk of PE was detected for clear corneal and temporal wounds. The present data indicate that the use of clear corneal and/or temporal approaches will result in 1 additional PE case in approximately 5500 procedures on top of the PE rate after sclerocorneal or superior incisions, which was approximately 1 case in 2400 operations.

Posted by afarahi at 04:24 PM | Comments (0)

Low-Dose Cyclophosphamide and Interferon Alfa 2a for the Treatment of Capillary Hemangioma of the Orbit

Ophthalmology,May,2007
Five patients with a median age of 9 weeks presented with a rapidly enlarging orbital mass. Two patients also had involvement of the upper eyelid obstructing the visual axis. Patients underwent biopsy to confirm the diagnosis before starting combination therapy with low-dose oral cyclophosphamide (10 mg/kg per day for 3 days repeated every 2 weeks) and subcutaneous IFNα2a (3 million units/m2 per day once daily) for a maximum treatment time of 4 to 6 months.
Four of 5 patients had marked regression of the hemangioma by 40% to 60% with subsequent reduction in proptosis, corneal exposure, and obstruction of the visual axis. None of the 4 patients developed amblyopia. Side effects included mild neutropenia and uncomplicated infections. There was no neurologic toxicity after a median follow-up of 10 months. One patient failed to respond to treatment and required further treatment with intralesional steroid injections.
Conclusions:Combination of low-dose cyclophosphamide with IFNα2a for a short period of time induced early and lasting regression of orbital juvenile capillary hemangiomas with minimal side effects. This regimen may be a suitable alternative that avoids the toxicity of long-term administration of interferon only. However, the experience reported here does not show if cyclophosphamide alone may be sufficient and allow complete avoidance of interferon and its potential serious side effects, and longer follow-up is needed to determine if cyclophosphamide causes any long-term harm.

Posted by afarahi at 04:13 PM | Comments (0)

Cataract associated with type-1 diabetes mellitus in the pediatric population

Journal of AAPOS,April,2007
Retrospective review of the medical records of 14 patients from seven institutions. All patients under the age of 18 years who met the inclusion criteria of type-1 diabetes mellitus and cataract were included.Mean age at the time of diabetes diagnosis was 9.8 years (range, 0.5-14 years), and mean age at cataract diagnosis was 11.7 years (range, 5-16 years). Two patients presented with cataracts one month before the diagnosis of diabetes; seven after the diagnosis of diabetes; and in five patients the cataract was found at the time the diabetes was diagnosed by the pediatrician. Nineteen out of 23 operated eyes had a best corrected post operative visual acuity of 20/40 or better. Two patients (4 eyes) developed diabetic retinopathy postoperatively.
Conclusions:Although cataract formation in type-1 diabetes is rare, it is treatable and potentially sight-saving in young children and adolescents.

Posted by afarahi at 03:19 PM | Comments (0)