Showing papers in "Clinical Ophthalmology in 2011"
TL;DR: LSFG-NAVI showed favorable reproducibility in evaluation of retinal circulation of glaucoma patients, particularly in the optic disk and choroid, in a modified LSFG technique.
Abstract: Background:
Laser speckle flowgraphy (LSFG) enables noninvasive quantification of the retinal circulation in glaucoma patients. In this study, we tested the intrasession reproducibility of LSFG-NAVI, a modified LSFG technique.
146 citations
TL;DR: Multifocal intraocular lenses provide better uncorrected near visual acuity than monofocal IOLs, leading to less need for spectacles and higher spectacle independence rates compared with other multifocal I OLs.
Abstract: ®, 14 refractive, and two accommodative) patient cohorts. Multifocal and monofocal uncorrected distance visual acuity was 0.165 (0.090–0.240) and 0.093 (0.088–0.098), respectively. Compared with monofocal IOLs, multifocal IOLs produced better uncorrected near visual acuity (0.470 [0.322–0.618] versus 0.141 [0.131–0.152]; P , 0.0001), resulting in higher spectacle independence (incidence rate ratio [IRR] 3.62 [2.90–4.52]; P , 0.0001). Compared with refractive multifocal IOLs, diffractive multifocal IOLs produced a similar uncorrected distance visual acuity (0.105 [0.098–0.111] versus 0.085 [0.029–0.140]; P # 0.78, not significant) and better uncorrected near visual acuity (0.217 [0.118–0.317] ver sus 0.082 [0.067–0.098]; P , 0.0001) resulting in higher spectacle independence (IRR 1.75 [1.24–2.48]; P , 0.001). Compared with other multifocal IOLs, ReSTOR produced a better uncorrected distance visual acuity (0.067 [0.059–0.076] versus 0.093 [0.088–0.098]; P , 0.0001) and better uncorrected near visual acuity (0.064 [0.046–0.082] versus 0.141 [0.131–0.152]; P , 0.006), resulting in higher spectacle independence (IRR 2.06 [1.26–1.36]; P , 0.004). Halo incidence rates with different types of multifocal implants did not differ significantly. Conclusion: Multifocal IOLs provide better uncorrected near visual acuity than monofocal IOLs, leading to less need for spectacles. Multifocal IOL design might play a role in postsurgical outcome, because better results were obtained with diffractive lenses. ReSTOR showed better uncorrected near visual acuity, uncorrected distance visual acuity, and higher spectacle independence rates compared with other multifocal IOLs.
127 citations
TL;DR: The success rate of DCR for acquired NLDO in this group of patients was high overall with a low complication rate between the two types of surgery and endoscopic endonasal DCR surgery should be considered for primary treatment of nasolacrimal duct obstruction.
Abstract: Purpose To compare success rates of external dacryocystorhinostomy (DCR) and endoscopic endonasal DCR for acquired nasolacrimal duct obstruction (NLDO). Design Historical cohort study. Participants 100 patients who underwent external DCR and 105 patients who underwent endoscopic endonasal DCR. Methods A retrospective review of medical records of patients with acquired NLDO who underwent DCR from 2004-2010 was performed. Data regarding the lacrimal drainage system, eye examination, surgical outcomes, patient symptom control, and postoperative care were analyzed. Main outcome measures Surgical success was defined by patient's resolution of symptoms with patency on irrigation. Surgical failure was defined as no symptomatic reduction in epiphora and/or an inability to irrigate the lacrimal system postoperatively. Results A total of 205 patients underwent surgeries for acquired NLDO. The average age was 69 years, and 62.4% of subjects were female. Pooled results showed that both surgical approaches had similar success rates (endoscopic endonasal DCR 82.4% versus external DCR 81.6%; P = 0.895). Complication rates were low in both types of surgery. This included three patients with postoperative hemorrhage (two who had endonasal DCR surgery and one having external DCR surgery). This resolved with conservative treatment. Postoperative problems with lacrimal patency (including canalicular obstruction) occurred to 6.8% of endoscopic patients and 9% of those with the external DCR surgery. Of the 14 patients who had their silicone tubes fall out before the 2-month assessment, 10 were classified as failures (71%), in contrast to only a failure rate of 13.9% of those whose tubes were present for the recommended time. This difference was statistically significant (P Conclusion The success rate of DCR for acquired NLDO in our group of patients was high overall with a low complication rate between the two types of surgery. There was no statistically significant difference between endoscopic and external DCR. Endoscopic surgery may have a benefit of preserving the lacrimal pump system and leaving no surgical scar. Patient preference and availability of each service should direct management. Hence endoscopic endonasal DCR surgery should be considered for primary treatment of nasolacrimal duct obstruction.
107 citations
TL;DR: The unique properties of trehalose have prompted its investigation as a component in treatment for dry eye syndrome and this interesting and unique disaccharide appears to have properties which may be exploited in ophthalmology and other disease states.
Abstract: Trehalose is a naturally occurring disaccharide comprised of two molecules of glucose. The sugar is widespread in many species of plants and animals, where its function appears to be to protect cells against desiccation, but is not found in mammals. Trehalose has the ability to protect cellular membranes and labile proteins against damage and denaturation as a result of desiccation and oxidative stress. Trehalose appears to be the most effective sugar for protection against desiccation. Although the exact mechanism by which trehalose protects labile macromolecules and lipid membranes is unknown, credible hypotheses do exist. As well as being used in large quantities in the food industry, trehalose is used in the biopharmaceutical preservation of labile protein drugs and in the cryopreservation of human cells. Trehalose is under investigation for a number of medical applications, including the treatment of Huntington's chorea and Alzheimer's disease. Recent studies have shown that trehalose can also prevent damage to mammalian eyes caused by desiccation and oxidative insult. These unique properties of trehalose have thus prompted its investigation as a component in treatment for dry eye syndrome. This interesting and unique disaccharide appears to have properties which may be exploited in ophthalmology and other disease states.
104 citations
TL;DR: Ex-PRESS is an effective device for long-term treatment of primary open-angle glaucoma, and patients required fewer intraocular pressure medications and fewer surgical interventions during the five-year study period.
Abstract: Background This study compared the efficacy of the EX-PRESS(®) glaucoma filtration device and trabeculectomy in primary open-angle glaucoma up to five years after surgery. Methods Patients from a previously reported randomized, open-label, parallel-arm clinical trial in which 78 patients received either the EX-PRESS glaucoma filtration device or underwent a trabeculectomy were followed for up to an additional four years (five total) beyond the original study (39 eyes per treatment group). Risk-benefit data were obtained for up to five years after glaucoma surgery. Outcome variables were intraocular pressures and intraocular pressure medications. Complete success was denoted by intraocular pressure values ≤ 18 mmHg without medication. Results The EX-PRESS glaucoma filtration device controlled intraocular pressure more effectively without medication for more patients from year 1 (86.8% versus 61.5%, P = 0.01) to year 3 (66.7% versus 41.0%, P = 0.02) than trabeculectomy. At year 1, only 12.8% of patients required intraocular pressure medication after EX-PRESS implantation, compared with 35.9% after trabeculectomy. The proportions became closer at year 5 (41% versus 53.9%). The responder rate was higher with EX-PRESS and time to failure was longer. In addition, surgical interventions for complications were fewer after EX-PRESS implantation. Conclusion This five-year analysis confirmed and extended the results reported after one year. Compared with trabeculectomy, EX-PRESS provided better intraocular pressure control in the first three years, and patients required fewer intraocular pressure medications and fewer surgical interventions during the five-year study period. For patients with primary open-angle glaucoma, the EX-PRESS glaucoma filtration device, implanted under a superficial scleral flap, produced significantly higher success rates than trabeculectomy. EX-PRESS is an effective device for long-term treatment of primary open-angle glaucoma.
104 citations
TL;DR: The clinical value of novel compounds for the treatment of glaucoma will depend ultimately on demonstrating favorable efficacy and benefit-to-risk ratios relative to currently approved prostaglandin analogs and β-blockers and/or having complementary modes of action.
Abstract: Introduction Glaucoma is a multifactorial disease characterized by progressive optic nerve injury and visual field defects. Elevated intraocular pressure (IOP) is the most widely recognized risk factor for the onset and progression of open-angle glaucoma, and IOP-lowering medications comprise the primary treatment strategy. IOP elevation in glaucoma is associated with diminished or obstructed aqueous humor outflow. Pharmacotherapy reduces IOP by suppressing aqueous inflow and/or increasing aqueous outflow. Purpose This review focuses on novel non-FDA approved ocular antihypertensive compounds being investigated for IOP reduction in ocular hypertensive and glaucoma patients in active clinical trials within approximately the past 2 years. Methods The mode of IOP reduction, pharmacology, efficacy, and safety of these new agents were assessed. Relevant drug efficacy and safety trials were identified from searches of various scientific literature databases and clinical trial registries. Compounds with no specified drug class, insufficient background information, reformulations, and fixed-combinations of marketed drugs were not considered. Results The investigational agents identified comprise those that act on the same targets of established drug classes approved by the FDA (ie, prostaglandin analogs and β-adrenergic blockers) as well as agents belonging to novel drug classes with unique mechanisms of action. Novel targets and compounds evaluated in clinical trials include an actin polymerization inhibitor (ie, latrunculin), Rho-associated protein kinase inhibitors, adenosine receptor analogs, an angiotensin II type 1 receptor antagonist, cannabinoid receptor agonists, and a serotonin receptor antagonist. Conclusion The clinical value of novel compounds for the treatment of glaucoma will depend ultimately on demonstrating favorable efficacy and benefit-to-risk ratios relative to currently approved prostaglandin analogs and β-blockers and/or having complementary modes of action.
96 citations
TL;DR: This review of orbital fractures has three goals: to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, to explain how to assess and examine a patient after periorBital trauma, and to understanding the medical and surgical management of orbital fracture management.
Abstract: This review of orbital fractures has three goals: 1) to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2) to explain how to assess and examine a patient after periorbital trauma, and 3) to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.
87 citations
TL;DR: In this paper, the complication profile and safety evaluation of supraselective intra-arterial melphalan chemotherapy in children undergoing treatment with advanced retinoblastoma was reported.
Abstract: Purpose:
The purpose of this study is to report the complication profile and safety evaluation of supraselective intra-arterial melphalan chemotherapy in children undergoing treatment with advanced retinoblastoma.
85 citations
TL;DR: In this paper, the right eye of 20 rabbits was injected intravitreally with 1.25 mg/0.05 mL bevacizumab and the half-life was 6.61 days in this rabbit model.
Abstract: ®) in rabbits. Methods: The right eye of 20 rabbits was injected intravitreally with 1.25 mg/0.05 mL bevacizumab. Both eyes of four rabbits each time were enucleated at days 1, 3, 8, 15, and 29. Bevacizumab concentrations were measured in serum, aqueous humor, and vitreous. Results: Maximum vitreous (406.25 µg/mL) and aqueous humor (5.83 µg/mL) concentrations of bevacizumab in the right eye were measured at day 1. Serum bevacizumab concentration peaked at day 8 (0.413 µg/mL) and declined to 0.032 µg/mL at 4 weeks. Half-life values in right vitreous, right aqueous humor, and serum were 6.61, 6.51, and 5.87 days, respectively. Concentration of bevacizumab in the vitreous of the noninjected eye peaked at day 8 (0.335 ng/mL) and declined to 0.218 ng/mL at 4 weeks. In the aqueous humor of the noninjected eye, maximum concentration of bevacizumab was achieved at day 8 (1.6125 ng/mL) and declined (to 0.11 ng/mL) at 4 weeks. Conclusion: The vitreous half-life of 1.25 mg/0.05 mL intravitreal bevacizumab was 6.61 days in this rabbit model. Maximum concentrations of bevacizumab were reached at day 1 in both vitreous and aqueous humor of the right eye and at day 8 in the serum. Very low concentrations of bevacizumab were measured in the fellow noninjected eye.
84 citations
TL;DR: Systane Balance is a novel formulation that contains both polymer and lipid components designed to protect the ocular surface and replenish tear film lipids simultaneously, a factor that is of particular relevance to patients who have dry eye associated with meibomian gland dysfunction.
Abstract: The understanding of dry eye disease has advanced recently through increasing recognition that the etiology of the condition involves both tear evaporation and insufficient tear production, and that tear film instability and inflammation play roles in the various stages of the disease. Of significance, it has been recognized that lipid layer thickness correlates with tear film stability. The management of dry eye involves various strategies and therapeutic approaches that address one or more etiopathological components of the disease. The purpose of this review is to outline the characteristics and clinical utility of the Systane® ocular lubricants that contain hydroxypropyl-guar and one or both of the demulcents, ie, polyethylene glycol 400 and propylene glycol. Clinically, these products are safe and are indicated for the temporary relief of burning and irritation due to dryness of the eye. In particular, this review describes the formulations, mechanisms of action, and clinical utility of the newest additions to this topical ocular lubricant family, Systane Ultra® and Systane Balance®. Both of these ocular products are formulated with an intelligent delivery system and both provide symptomatic relief to patients with dry eye. However, Systane Balance is a novel formulation that contains both polymer and lipid components designed to protect the ocular surface and replenish tear film lipids simultaneously, a factor that is of particular relevance to patients who have dry eye associated with meibomian gland dysfunction.
78 citations
TL;DR: Ocular iontophoresis of EGP-437 demonstrated statistically and clinically significant improvements in signs and symptoms of dry eye syndrome within a CAE model.
Abstract: Purpose:
To assess safety and efficacy of EGP-437 (dexamethasone phosphate 40 mg/mL [DP]) in dry eye patients.
TL;DR: There is a causal relationship between the thinner RNFLT that led to the MD and reduction in the microcirculation in the optic nerve head in glaucoma patients with myopic optic disks.
Abstract: Background Eyes with glaucoma are characterized by optic neuropathy with visual field defects in the areas corresponding to the optic disk damage. The exact cause for the glaucomatous optic neuropathy has not been determined. Myopia has been shown to be a risk factor for glaucoma. The purpose of this study was to determine whether a significant correlation existed between the microcirculation of the optic disk and the visual field defects and the retinal nerve fiber layer thickness (RNFLT) in glaucoma patients with myopic optic disks. Methods Sixty eyes of 60 patients with myopic disks were studied; 36 eyes with glaucoma (men:women = 19:17) and 24 eyes with no ocular diseases (men:women = 14:10). The mean deviation (MD) determined by the Humphrey field analyzer, and the peripapillary RNFLT determined by the Stratus-OCT were compared between the two groups. The ocular circulation was determined by laser speckle flowgraphy (LSFG), and the mean blur rate (MBR) was compared between the two groups. The correlations between the RNFLT and MBR of the corresponding areas of the optic disk and between MD and MBR of the optic disk in the glaucoma group were determined by simple regression analyses. Results The average MBR for the entire optic disk was significantly lower in the glaucoma group than that in the control group. The differences of the MBR for the tissue in the superior, inferior, and temporal quadrants of the optic disk between the two groups were significant. The MBR for the entire optic disk was significantly correlated with the MD (r = 0.58, P = 0.0002) and the average RNFLT (r = 0.53, P = 0.0008). The tissue MBR of the optic disk was significantly correlated with the RNFLT in the superior, inferior, and temporal quadrants. Conclusions Our study suggests that there is a causal relationship between the thinner RNFLT that led to the MD and reduction in the microcirculation in the optic nerve head.
TL;DR: This review will highlight the current methods available for corticosteroid delivery to the eye with a particular emphasis on the DEX intravitreal implant and the evidence currently available for its use in noninfectious uveitis.
Abstract: Uveitis can be a sight-threatening eye disease with significant morbidity. Corticosteroids remain the mainstay of treatment of uveitis and provide an effective treatment against ocular inflammation. However, the various modes available for corticosteroid drug delivery can carry significant ocular and systemic side effects which can limit their use in the treatment of uveitis. In an effort to avoid the damage to ocular structures that can ensue with recurrent episodes of ocular inflammation, the side effects associated with systemic steroids, and the need for repeated administration of both topical and locally injected corticosteroids, sustained-release intraocular corticosteroid implants have been developed. The dexamethasone (DEX) drug delivery system (Ozurdex(®); Allergan Inc, Irvine, CA), is a biodegradable intravitreal implant. This implant has been shown to be effective in the treatment of macular edema and noninfectious posterior uveitis and has been approved by the FDA for these entities. This review will highlight the current methods available for corticosteroid delivery to the eye with a particular emphasis on the DEX intravitreal implant and the evidence currently available for its use in noninfectious uveitis.
TL;DR: Clinical studies indicate that this dexamethasone implant is a promising new treatment option for patients with persistent macular edema resulting from retinal vein occlusion, diabetic retinopathy, and uveitis or Irvine-Gass syndrome.
Abstract: Macular edema is one of the leading causes of vision loss among patients with retinal vein occlusion, diabetic retinopathy, and posterior chamber inflammatory disease. However, the treatment of macular edema is considerably limited by the difficulty in delivering effective doses of therapeutic agents into the vitreous cavity. In recent years, the development of a sustained-release dexamethasone intravitreal implant (Ozurdex(®)) has enabled more controlled drug release at a stable rate over a long period of time, with a potentially lower rate of adverse events. Clinical studies indicate that this dexamethasone implant is a promising new treatment option for patients with persistent macular edema resulting from retinal vein occlusion, diabetic retinopathy, and uveitis or Irvine-Gass syndrome.
TL;DR: TNF-α levels are elevated in aqueous in patients with POAG compared to normal subjects based on highly sensitive Luminex® bead immunoassay and may be a reliable biomarker in the progression of glaucoma.
Abstract: PURPOSE Tumor necrosis factor alpha (TNF-α), a macrophage/monocyte derived pluripotent cytokine is associated with tissue ischemia, neuronal damage and remodeling. The physiological level of TNF-α in aqueous humor of normal and glaucomatous eyes is unknown. In this study, we evaluated the TNF-α levels in aqueous in patients with primary open angle glaucoma (POAG) and compared them to controls. METHODS 50-100 μL of undiluted aqueous humor samples were obtained from eyes of 32 POAG patients who underwent cataract extraction, trabeculectomy or aqueous shunt implantation. Controls were obtained from 32 normal subjects who underwent routine cataract surgery. TNF-α levels were quantified using singleplex bead immunoassay analysis. RESULTS The average TNF-α level in POAG samples was 2.72 ± 1.5 pg/mL (mean ± SD). The average TNF-α level in normal samples was 1.59 ± 0.46 pg/mL (mean ± SD). Significant increase of TNF-α levels in POAG samples was noted in comparison to normal samples (P < 0.001). CONCLUSION TNF-α levels are elevated in aqueous in patients with POAG compared to normal subjects based on highly sensitive Luminex(®) bead immunoassay and may be a reliable biomarker in the progression of glaucoma.
TL;DR: Surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed GlaucomA Valve implantation were similar, with similar results in postoperative visual acuity and intraocular pressure.
Abstract: Purpose:
To compare surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed Glaucoma Valve implantation.
TL;DR: This article aims to review the available evidence regarding the use of pharmacologic agents in the treatment of VMA-related pathology and discusses vitreous molecular organization and principles of physiologic posterior Vitreous detachment to allow for a consideration of vitreolytic agent mode of action and molecular targets.
Abstract: With the dissemination of optical coherence tomography over the past two decades, the role of persistent vitreomacular adhesion (VMA) in the development of numerous macular pathologies – including idiopathic macular hole, vitreomacular traction syndrome, cystoid and diabetic macular edema, neovascularization in diabetic retinopathy and retinal vein occlusion, exudative age-related macular degeneration, and myopic traction maculopathy – has been established. While invasive vitreoretinal procedures have long been utilized to address complications related to these disorders, such an approach is hampered by incomplete vitreoretinal separation and vitreous removal, surgical complications, and high costs. In light of such limitations, investigators have increasingly looked to nonsurgical means for the treatment of persistent pathologic VMA. Chief among these alternative measures is the intravitreal application of pharmacologic agents for the induction of vitreous liquefaction and/or vitreoretinal separation, an approach termed pharmacologic vitreolysis. This article aims to review the available evidence regarding the use of pharmacologic agents in the treatment of VMA-related pathology. In addition, a discussion of vitreous molecular organization and principles of physiologic posterior vitreous detachment is provided to allow for a consideration of vitreolytic agent mode of action and molecular targets.
TL;DR: The iStent is a safe and effective treatment option in patients with secondary open-angle glaucoma, and reduces the topical treatment burden in one hypotensive medication.
Abstract: ®glaucoma device in patients with secondary open-angle glaucoma. Patients and methods: A prospective, nonrandomized, interventional case series involving 10 patients with secondary open-angle glaucoma (traumatic, steroid, pseudoexfoliative, and pigmentary glaucoma) of recent onset who underwent ab interno implantation iStent. Patients were assessed following the procedure on days 1, 7, and 15 and months 1, 3, 6, and 12, and examinations included visual acuity, intraocular pressure (IOP) measurement using Goldmann tonometry, number of glaucoma medications, and complications. Wilcoxon rank-test for data with abnormal distribution was used for the analysis of IOP and glaucoma medications at baseline versus 3, 6, and 12 months following the procedure. Results: The mean baseline IOP was 26.5 ± 7.9 (range 18–40) mmHg, and significantly decreased in 10.4 ± 9.2 mmHg at three months (P , 0.05), in 7.4 ± 4.9 mmHg at six months (P , 0.05), and in 6.6 ± 5.4 mmHg at 12 months (P , 0.05) following iStent implantation. The mean number of hypotensive medications at baseline was 2.9 ± 0.7 (range 2–4). Statistically significant reductions in the number of medications of 1.1 ± 1.1 were observed at three months (P , 0.05), 1.0 ± 0.7 at six months (P , 0.05), and 1.1 ± 0.6 at 12 months (P , 0.05). No significant changes in visual acuity were noted. The most common complications comprised mild hyphema in seven eyes and transient IOP $30 mmHg in three eyes on postoperative day 1. Obstruction of the lumen of the stent with a blood clot was seen in three eyes, and all instances resolved spontaneously. Conclusion: The iStent is a safe and effective treatment option in patients with secondary openangle glaucoma, and reduces the topical treatment burden in one hypotensive medication.
TL;DR: The nighttime melatonin level is altered in patients with diabetes and PDR but not in diabetic patients without PDR, although patients with PDR may have various dysfunctions that affect melatonin secretion more severely.
Abstract: BACKGROUND The purpose of this study was to evaluate the dynamics of plasma melatonin secretion in patients with type 2 diabetes mellitus and diabetic retinopathy. METHODS Plasma melatonin levels were measured by high-performance liquid chromatography in 56 patients. Patients were divided into a diabetic group (30 patients) and a nondiabetic group (26 patients). The diabetic group was divided further into a proliferative diabetic retinopathy (PDR) group (n = 14) and a nonproliferative diabetic retinopathy (NPDR) group (n = 16). Plasma melatonin levels obtained at midnight and 3 am were compared between the groups. RESULTS Nighttime melatonin levels were significantly lower in the diabetic group than in the nondiabetic group (P < 0.03) and lower in the PDR group than in the nondiabetic and NPDR groups (P < 0.01 and P < 0.03, respectively), but no significant difference was found between the nondiabetic and NPDR groups. The daytime melatonin level did not significantly differ between the nondiabetic and diabetic groups or between the nondiabetic, NPDR, and PDR groups. CONCLUSION The nighttime melatonin level is altered in patients with diabetes and PDR but not in diabetic patients without PDR. Although patients with PDR may have various dysfunctions that affect melatonin secretion more severely, advanced dysfunction of retinal light perception may cause altered melatonin secretion. Alteration of melatonin secretion may accelerate further occurrence of complications in diabetic patients.
TL;DR: The formulation of a causative model of CSCR enables to understand how the therapeutic approach cannot be based on a generalized therapy but should be individualized for each patient, and that sometimes a combined strategy of treatment is required.
Abstract: Despite numerous studies describing predominantly its demography and clinical course, many aspects of central serous chorioretinopathy (CSCR) remain unclear. Perhaps the major impediment to finding an effective therapy is the difficulty of performing studies with large enough cohorts, which has meant that clinicians have focused more on therapy than on a deeper understanding of the pathogenesis of the disease. Hypotheses on the pathogenesis of CSCR have ranged from a basic alteration in the choroid to an involvement of the retinal pigment epithelium (RPE). Starting from evidence that affected subjects often present a personality prone to stress with altered pituitary–hypothalamic axis response (HPA) and that they have higher levels of serum and urinary cortisol and catecholamines than healthy subjects, we hypothesize a cascade of events that may lead to CSCR through hypercoagulability and augmented platelet aggregation. In particular we investigated the role of tissue plasminogen activator, increasing plasminogen activator inhibitor 1 (PAI-1), and plasmin-α2- plasmin inhibitor complexes. We reviewed the different therapeutic approaches, including adrenergic antagonists, carbonic anhydrase inhibitors, mifepristone, ketoconazole, laser photocoagulation, intravitreal injection of bevacizumab, and photodynamic therapy with verteporfin (PDT) and our model of pathogenesis seems to be in agreement with the clinical effects obtained from these treatments. In accord with our thesis, we began to treat a group of patients affected by CSCR with low-dose aspirin (75–100 mg), because of its effectiveness in other vascular diseases and its low ocular and general toxicity with prolonged use. The formulation of a causative model of CSCR enables us to understand how the therapeutic approach cannot be based on a generalized therapy but should be individualized for each patient, and that sometimes a combined strategy of treatment is required. Moreover a complete knowledge of the disease will help to identify patients prone to the most persistent forms of CSCR, and thus help to find a treatment.
TL;DR: Corneal collagen crosslinking is a promising new technique for the management of infective keratitis not responding to antimicrobial therapy and further elucidation of its safety and role in management of infectious ker atitis is needed.
Abstract: PURPOSE To report the use of corneal collagen crosslinking in the treatment of infective keratitis not responding to antimicrobial therapy. METHODS Two retrospective case reports of infective keratitis treated with corneal collagen crosslinking. RESULTS In both cases, corneal collagen crosslinking caused a rapid resolution of the infective keratitis, leaving residual stromal scarring. Due to the density of scarring, one case required subsequent penetrating keratoplasty for visual rehabilitation. CONCLUSION Corneal collagen crosslinking is a promising new technique for the management of infective keratitis not responding to antimicrobial therapy. Further elucidation of its safety and role in management of infectious keratitis is needed by way of future studies.
TL;DR: Adalimumab is a valuable option in the treatment of uveitis associated with active juvenile idiopathic arthritis.
Abstract: Background: The purpose of this study was to investigate the long-term effects of adalimumab, a tumor necrosis factor alpha antagonist, in the treatment of uveitis associated with juvenile idiopathic arthritis. Methods: Adalimumab was initiated in 94 patients with juvenile idiopathic arthritis to treat active arthritis and/or active associated uveitis. In 18 patients, therapy was discontinued after a short period because of inefficacy or side effects. The activity of uveitis (using Standardized Uveitis Nomenclature [SUN] criteria and clinical examination) and arthritis (number of swollen or active joints) was evaluated at the start and at end of the study. Results: At the end of the study, uveitis was under good clinical control in two thirds of 54 patients (31% did not need any local treatment and 35% used only 1–2 corticosteroid drops a day), and one third had active uveitis (at least three corticosteroid drops a day). According to SUN criteria, adalimumab treatment for uveitis showed improved activity (a two-fold decrease in uveitis activity) in 28% of patients, with a moderate response in 16 patients, no change in a further 16 patients, and worsening activity (a two-fold increase in uveitis activity) in 13% of patients. The overall proportion of patients with active arthritis decreased. At the beginning of the study, 69% of patients with uveitis had more than two active joints, and at the end of the study only 27% had active joint disease. In 27 patients with juvenile idiopathic arthritis without uveitis on adalimumab, the number of active joints decreased from 93% to 59%. Systemic corticosteroid treatment could be stopped in 22% of patients with uveitis and in 11% of those without uveitis. Most of the patients had received methotrexate, other immunosuppressive therapy, or other biological drugs before initiating adalimumab. Conclusion: Adalimumab is a valuable option in the treatment of uveitis associated with active juvenile idiopathic arthritis.
TL;DR: The purpose of this review is to critically evaluate the clinical utility of Ozurdex® in the current treatment strategy of macular edema related to retinal vein occlusion.
Abstract: Macular edema is a common cause of visual loss in patients with retinal vein occlusions. Ozurdex®, a dexamethasone intravitreal implant, has been shown in randomized controlled trials to reduce macular edema and improve visual acuity in patients with either branch retinal vein occlusions or central retinal vein occlusions. It was approved in the United States in 2009. Since then, new therapeutic agents and clinical data have emerged. The purpose of this review is to critically evaluate the clinical utility of Ozurdex® in the current treatment strategy of macular edema related to retinal vein occlusion.
TL;DR: High baseline IOP, age and amount of laser energy used are identified as predictive factors of success after selective laser trabeculoplasty (SLT) treatment in glaucoma patients.
Abstract: Purpose Glaucoma is a progressive optic neuropathy that may lead to blindness. Reducing intraocular pressure (IOP) is the only known treatment to slow progression in glaucoma. IOP can be reduced by pharmaceutical treatment, laser and surgery. The aim of the present study was to assess predictive factors of success after selective laser trabeculoplasty (SLT) treatment. Methods We used a retrospective chart review of eyes that underwent SLT between January 1, 2005 and December 31, 2005. The dependent variable was time to failure after SLT treatment. Failure after SLT was defined as any changes in the medical treatment, and/or a new SLT treatment was performed and/or the patient was sent for surgery. All patients were treated with 90° SLT. A multivariate regression analysis was performed to assess correlation between time to failure after SLT and age, gender, IOP before treatment, number of medications used, SLT number, amount of spots, laser energy used, grade of angle, pigmentation and diagnosis. Results 120 eyes of 120 patients were identified. The average time to failure after SLT was 18 months. The predictive factors identified were: age, IOP before SLT and dose. Conclusion Predictive factors identified in our study were high baseline IOP, age and amount of laser energy used. Our study confirms previous results about baseline IOP as a predictive factor.
TL;DR: FD-OCT does not seem to be decisive for early detection of structural damage in patients with no functional impairment, suggesting that there is a need for analysis software to be further refined to enhance glaucoma diagnostic capability.
Abstract: Aims To evaluate the capability of Fourier-domain optical coherence tomography (FD-OCT) to detect structural damage in patients with preperimetric glaucoma. Methods A total of 178 Caucasian subjects were enrolled in this cohort study: 116 preperimetric glaucoma patients and 52 healthy subjects. Using three-dimensional FD-OCT, the participants underwent imaging of the ganglion cell complex (GCC) and the optic nerve head. Sensitivity, specificity, likelihood ratios, and predictive values were calculated for all parameters at the first and fifth percentiles. Areas under the curves (AUCs) were generated for all parameters and were compared (Delong test). For both the GCC and the optic nerve head protocols, the OR logical disjunction (Boolean logic operator) was calculated. Results The AUCs didn't significantly differ. Macular global loss volume had the largest AUC (0.81). Specificities were high at both the fifth and first percentiles (up to 97%), but sensitivities were low, especially at the first percentile (55%-27%). Conclusion Macular and papillary diagnostic accuracies did not differ significantly based on the 95% confidence interval. The computation of the Boolean OR operator has been found to boost diagnostic accuracy. Using the software-provided classification, sensitivity and diagnostic accuracy were low for both the retinal nerve fiber layer and the GCC scans. FD-OCT does not seem to be decisive for early detection of structural damage in patients with no functional impairment. This suggests that there is a need for analysis software to be further refined to enhance glaucoma diagnostic capability.
TL;DR: In Upper Egypt, socioeconomic and sociocultural status, family negligence, and lack of supervision are important factors in pediatric eye injuries, as 92% of children were without adult supervision when the ocular trauma occurred.
Abstract: PURPOSE: To analyze the patterns, causes, and outcome of pediatric ocular trauma at Assiut University Hospital in Upper Egypt (South of Egypt). METHODS: All ocular trauma patients aged 16 years or younger admitted to the emergency unit of Ophthalmology Department of Assiut University between July 2009 and July 2010 were included in the study. The demographic data of all patients and characteristics of the injury events were determined. The initial visual acuity and final visual acuity after 3 months follow-up were recorded. RESULTS: One hundred and fifty patients were included. The majority of injuries occurred in children aged 2-7 years (50.7%). There were 106 (70.7%) boys and 44 (29.3%) girls. The highest proportion of injuries occurred in the street (54.7%) followed by the home (32.7%). Open globe injuries accounted for 67.3% of injuries, closed globe for 30.7%, and chemical injuries for 2%. The most common causes were wood, stones, missiles, and glass. LogMar best corrected visual acuity at 3 months follow-up was: 0-1 in 13.3%; Language: en
TL;DR: Innovation and quality improvement were demonstrated in both optometry to ophthalmology referrals and in primary optometric care by use of telemedicine with spectral domain optical coherence tomography images.
Abstract: Purpose To describe a quality improvement for referral of National Health Service patients with macular disorders from a community optometry setting in an urban area. Methods Service evaluation of teleophthalmology consultation based on spectral domain optical coherence tomography images acquired by the community optometrist and transmitted to hospital eye services. Results Fifty patients with suspected macular conditions were managed via telemedicine consultation over 1 year. Responses were provided by hospital eye service-based ophthalmologists to the community optometrist or patient within the next day in 48 cases (96%) and in 34 (68%) patients on the same day. In the consensus opinion of the optometrist and ophthalmologist, 33 (66%) patients required further "face-to-face" medical examination and were triaged on clinical urgency. Seventeen cases (34%) were managed in the community and are a potential cost improvement. Specialty trainees were supervised in telemedicine consultations. Conclusion Innovation and quality improvement were demonstrated in both optometry to ophthalmology referrals and in primary optometric care by use of telemedicine with spectral domain optical coherence tomography images. E-referral of spectral domain optical coherence tomography images assists triage of macular patients and swifter care of urgent cases. Teleophthalmology is also, in the authors' opinion, a tool to improve interdisciplinary professional working with community optometrists. Implications for progress are discussed.
TL;DR: 23 gauge transconjunctival vitrectomy surgery was associated with a lower rate of retinal break formation than 20 gauge vit rectomy for proliferative diabetic retinopathy.
Abstract: Background: To assess the rate and type of retinal break formation in patients undergoing 23 gauge transconjunctival vitrectomy surgery for complications of proliferative diabetic retinopathy compared with 20 gauge vitrectomy surgery. Methods: Retrospective case notes review of two consecutive series of patients who had primary pars plana vitrectomy for complications of proliferative diabetic retinopathy by a single surgeon. The control group had standard 20 gauge vitrectomy surgery whilst the second group had 23 gauge transconjunctival vitrectomy surgery. Results: Eighty-five eyes were included in the 20 gauge group and 85 eyes in the 23 gauge group. The groups were well matched for surgical complexity and indications for surgery, as well as a variety of other preoperative variables. There was a significant reduction in the incidence of peripheral sclerotomy-related retinal breaks and lesions suspicious for breaks (4/85 [5%] 23 gauge versus 14/85 [16%] 20 gauge, P = 0.02) and posterior retinal breaks (3/85 [4%] 23 gauge versus 12/85 [14%] 20 gauge, P = 0.03). Six eyes (7%) in total had definite new retinal breaks of any type detected in the 23 gauge group compared with 16 (18.8%) in the 20 gauge group (P = 0.04). One patient in each group experienced a retinal detachment postoperatively related in both cases to a posterior retinal break associated with recurrent traction. Conclusion: In this series of patients, 23 gauge transconjunctival vitrectomy surgery was associated with a lower rate of retinal break formation than 20 gauge vitrectomy for proliferative diabetic retinopathy.
TL;DR: Treatment with alcaftadine 0.25% ophthalmic solution resulted in mean differences of >1 unit (ocular itching) and approximately 1 unit (conjunctival redness), which was significant (P < 0.001) compared with placebo treatment.
Abstract: Purpose: To evaluate the effectiveness of alcaftadine 005%, 01%, and 025% ophthalmic solutions in treating the signs and symptoms of allergic conjunctivitis when compared with olopatadine hydrochloride 01% and placebo using the conjunctival allergen challenge (CAC) model Methods: One hundred and seventy subjects were randomized and 164 subjects completed all visits CAC was performed to determine and confirm subjects’ eligibility at visits 1 and 2, respectively The CAC was repeated at visit 3 (day 0 ± 3), 16 hours after study medication instillation, and at visit 4 (day 14 ± 3), 15 minutes after instillation Ocular itching and conjunctival redness were evaluated after an allergen challenge, along with several secondary endpoints Results: Alcaftadine 025% and olopatadine 01% treatments exhibited significantly lower mean scores compared with placebo for ocular itching and conjunctival redness at visits 3 and 4 Most adverse events were self-limiting and mild in severity No serious treatment-related adverse events occurred Conclusion: Treatment with alcaftadine 025% ophthalmic solution resulted in mean differences of 1 unit (ocular itching) and approximately 1 unit (conjunctival redness), which was significant (P , 0001) compared with placebo treatment All doses of alcaftadine were safe and well tolerated in the population studied
TL;DR: The clinical use of hemoglobin in red blood cells (RBCs) as an intrinsic motion-contrast agent in the generation of detailed noninvasive capillary-perfusion maps (nCPMs) is described, which were highly reproducible in repeated measurements and often better than that revealed by the very best fluorescein angiography.
Abstract: PURPOSE: Assessment of capillary abnormalities facilitates early diagnosis, treatment, and follow-up of common retinal pathologies. Injected contrast agents like fluorescein are widely used to image retinal capillaries, but this highly effective procedure has a few disadvantages, such as untoward side effects, inconvenience of injection, and brevity of the time window for clear visualization. The retinal function imager (RFI) is a tool for monitoring retinal functions, such as blood velocity and oximetry, based on intrinsic signals. Here we describe the clinical use of hemoglobin in red blood cells (RBCs) as an intrinsic motion-contrast agent in the generation of detailed noninvasive capillary-perfusion maps (nCPMs). PATIENTS AND METHODS: Multiple series of nCPM images were acquired from 130 patients with diabetic retinopathy, vein occlusion, central serous retinopathy, age-related macular degeneration, or metabolic syndrome, as well as from 37 healthy subjects. After registration, pixel value distribution parameters were analyzed to locate RBC motion. RESULTS: The RFI yielded nCPMs demonstrating microvascular morphology including capillaries in exquisite detail. Maps from the same subject were highly reproducible in repeated measurements, in as much detail and often better than that revealed by the very best fluorescein angiography. In patients, neovascularization and capillary nonperfusion areas were clearly observed. Foveal avascular zones (FAZ) were sharply delineated and were larger in patients with diabetic retinopathy than in controls (FAZ diameter: 641.5 ± 82.3 versus 463.7 ± 105 μm; P < 0.001). Also visible were abnormal vascular patterns, such as shunts and vascular loops. CONCLUSION: Optical imaging of retinal capillaries in human patients based on motion contrast is noninvasive, comfortable, safe, and can be repeated as often as required for early diagnosis, treatment guidance, and follow up of retinal disease progression.