Showing papers in "Current Opinion in Ophthalmology in 2003"
TL;DR: As a group, patients with normal tension glaucoma benefit from lowering of IOP, and variable rate of deterioration, as well as lack of progression in a substantial number in 5 years, suggest that treatment should be individualized according to the stage of disease and rate of progression.
Abstract: Purpose of reviewBefore this study was done, there was a difference of opinion concerning whether intraocular pressure (IOP) was involved in producing optic nerve damage when there was glaucomatous damage to the optic nerve and characteristic visual field loss, even though the IOP was in the statist
279 citations
TL;DR: Orbital facial fracture management is germane to ophthalmologists, plastic surgeons, otolaryngologists, and others who treat patients to avoid difficult repair from immediate posttraumatic wound healing.
Abstract: Purpose of reviewOrbital facial fractures are a common result of facial trauma. Enophthalmos, diplopia resulting from extraocular muscle dysfunction, and infraorbital nerve hypesthesia may occur. The indications and timing for fracture repair are debated.Recent findingsThe timing and treatment indic
200 citations
TL;DR: Results from CIGTS do not support altering current treatment practices in the initial management of patients with primary open-angle glaucoma and most quality-of-life measurements were similar in the two treatment arms, except local eye symptoms, which were reported more frequently by the surgically treated patients.
Abstract: Purpose of reviewThis review summarizes the key findings from the Collaborative Initial Glaucoma Treatment Study (CIGTS), which was designed to evaluate whether medical therapy or trabeculectomy is the better initial treatment for patients with open-angle glaucoma (OAG). In addition to examining eff
142 citations
TL;DR: Epipolis laser in situ keratomileusis is an alternative modality of epithelial separation with the use of a device that features a blunt oscillating blade that does not require the useof alcohol for epithelial loosening.
Abstract: The reports of an increasing incidence of iatrogenic ectasia, the evolution of wavefront aberrometry, and the suggestion that the laser in situ keratomileusis flap could lead to unpredictable biomechanical corneal changes have renewed interest in surface ablation and have set the stage for the introduction of alternative photorefractive treatment modalities. The theoretical advantage of surface procedures, such as laser epithelial keratomileusis that preserve the epithelial button, stems from the repositioning of the epithelial flap over the laser-ablated corneal surface. This epithelial sheet is thought to act as a natural contact lens that decreases postoperative pain and haze formation. Epipolis laser in situ keratomileusis is an alternative modality of epithelial separation with the use of a device that features a blunt oscillating blade. This surgical approach does not require the use of alcohol for epithelial loosening.
119 citations
TL;DR: This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting “refractive surprises” postoperatively.
Abstract: As the number and types of keratorefractive procedures increase and as the baby boomer population moves into the "cataractous decades," the number of patients requiring cataract surgery following refractive surgery grows larger each year. While technological advances in surgical instrumentation and intraocular lens (IOL) design allow us to perform cleaner, faster, and more reliable cataract extractions, the ultimate postoperative refraction depends primarily on calculations performed before surgery. Third-generation IOL formulas ( Haigis, Hoffer Q, Holladay 2, or SRK/T) provide outstanding accuracy when used for eyes with physiologic, prolate corneas. In addition, most instruments used today for measuring corneal curvature and power were designed before the era of refractive surgery. These formulas and instruments make assumptions about the anatomy and refractive properties of the cornea that are no longer valid following most keratorefractive procedures. These breakdowns in IOL calculation often result in a "refractive surprise" after cataract surgery, which may require subsequent surgical correction. This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting "refractive surprises" postoperatively.
113 citations
TL;DR: For correction of refractive errors, a synthetic corneal onlay that allows stable overgrowth of epithelium appears to be promising and the development of biosynthetic matrices that permit host tissue regeneration.
Abstract: Bioengineered corneas are substitutes for human donor tissue that are designed to replace part or the full thickness of damaged or diseased corneas. They range from prosthetic devices that solely address replacement of the cornea's function to tissue-engineered hydrogels that allow some regeneration of the host tissue. In addition, there are also bioengineered lenticules that may be implanted into the cornea to improve vision by altering the refractive properties of the eye, an alternative procedure to refractive surgery. In recent years, there have been significant developments in many areas of bioengineered corneas, such as the clinical trials of an artificial cornea designed as a prosthesis, the development of completely natural corneal replacements, and the development of biosynthetic matrices that permit host tissue regeneration. For correction of refractive errors, a synthetic corneal onlay that allows stable overgrowth of epithelium appears to be promising.
106 citations
TL;DR: Progress in the matter of reducing the prevalence of blindness secondary to this disease will require the increasing willingness of the world's ophthalmologists to refer patients with JIA-associated uveitis much earlier in the course of his or her disease for consideration of immunomodulatory therapy, and will require legislation mandating visual acuity testing in children attending day care centers.
Abstract: Purpose of review This review surveys publications from peer-reviewed literature published since 2001on the matter of uveitis associated with juvenile idiopathic arthritis. Recent findings Uveitis associated with juvenile idiopathic arthritis (JIA) continues to blind substantial numbers of children every year, even in the most developed of societies. This is so because of delayed diagnosis (as a consequence of the silent, asymptomatic nature of ocular inflammation in some patients), and because of delayed referral by general ophthalmologists of children with JIA-associated uveitis to ocular immunologists prepared to move on to systemic immunomodulatory therapy in those instances where the child's uveitis is chronic or continues to recur with each attempt at tapering corticosteroid. The evidence for this is vast. Summary Progress in the matter of reducing the prevalence of blindness secondary to this disease will require the increasing willingness of the world's ophthalmologists to refer patients with JIA-associated uveitis much earlier in the course of his or her disease for consideration of immunomodulatory therapy, and will require legislation mandating visual acuity testing in children attending day care centers.
81 citations
TL;DR: In this article, the authors used photodynamic therapy, laser photocoagulation, and transpupillary thermotherapy for primary management of choroidal hemangioma.
Abstract: Circumscribed choroidal hemangioma is an uncommon, benign vascular tumor manifesting as an orange-red mass in the posterior pole of the eye. Serous retinal detachment accounts for decreased vision in most patients. Diagnosis of this tumor is challenging with many patients initially misdiagnosed with choroidal melanoma or metastasis. Several ancillary tests such as ultrasonography, fluorescein angiography, indocyanine green angiography, and magnetic resonance imaging help differentiate this tumor from other simulating lesions. Asymptomatic lesions should be observed, but visually threatening or visually impairing lesions require treatment. Photodynamic therapy, laser photocoagulation, and transpupillary thermotherapy may be used for primary management of this tumor. Patients who fail to respond to previous treatment or those with extensive serous retinal detachment can be treated using radiotherapeutic modalities. Long interval between onset of symptoms and treatment, poor visual acuity at presentation, and presence of chronic retinal or retinal pigment epithelial changes are associated with poor long-term vision.
80 citations
TL;DR: A review of the medical literature was performed for all articles published in English between August 1, 2001 and July 31, 2002 on the topic of cystoid macular edema after cataract surgery to select nine articles that were most relevant to the practicing ophthalmologist for inclusion in this review.
Abstract: Cystoid macular edema (CME) is a common problem after cataract extraction. It can occur after uncomplicated surgery in patients with otherwise healthy eyes, after complicated surgery, or after surgery in patients with ocular diseases such as uveitis or diabetic retinopathy. Usually vision loss from cystoid macular edema is temporary and responds to treatment with topical anti-inflammatory medications. However, some cases respond poorly to conservative treatment and may develop permanent visual loss. A review of the medical literature was performed for all articles published in English between August 1, 2001 and July 31, 2002 on the topic of cystoid macular edema after cataract surgery. The authors selected nine articles that were most relevant to the practicing ophthalmologist for inclusion in this review. Topics of interest included vitreous loss, retained lens fragments, diabetes, uveitis, retinitis pigmentosa, ocular hypotensive lipids, internal limiting membrane peeling, and intravitreal triamcinolone injection.
74 citations
TL;DR: The idea of a model of zero tolerance to intraocular inflammation to minimize the incidence of irreversible damage to ocular structures essential to good vision is reemphasized.
Abstract: Cataract surgery in a patient with uveitis is more complex than senile cataract extraction, because it involves multiple considerations related to the cause of uveitis, prospects of visual rehabilitation, appropriate surgical timing and technique, and the type and material of the intraocular lens used. Establishing the diagnosis, thorough eye examination, careful patient selection and meticulous control of perioperative inflammation are key elements to a successful visual outcome. Our aims in this article are to review the literature on this subject over the past year and highlight the behavior of intraocular lenses of various biomaterials in the uveitic eye. In addition, we also reemphasize the idea of a model of zero tolerance to intraocular inflammation to minimize the incidence of irreversible damage to ocular structures essential to good vision.
71 citations
TL;DR: The optimal treatment for bleb-related infections is evolving, but consensus is that a high degree of vigilance and aggressive treatment are key to minimizing the potentially blinding nature of this complication.
Abstract: Purpose of review To present a review of the current literature regarding the management of glaucoma-filtering bleb infections. Recent findings With the increased use of intraoperative antifibrotic (eg, mitomycin and fluorouracil) as an adjunct to standard trabeculectomy, an increased incidence is seen of late-onset filtering bleb-related infections. These infections range from infections localized to the bleb (blebitis) to endophthalmitis. Risk factors for bleb-related infections include an inferior or nasally located bleb; presence of a high bleb or blepharitis; development of a late-onset bleb leak; use of antifibrotic agents; chronic antibiotic use; and performance of a trabeculectomy alone versus a combined procedure. Summary The optimal treatment for bleb-related infections is evolving, but consensus is that a high degree of vigilance and aggressive treatment are key to minimizing the potentially blinding nature of this complication. It is important to note that those glaucoma procedures that provide the lowest intraocular pressure are often those that predispose to bleb-related infections.
TL;DR: Recent papers related to intraocular medications, preservatives, and devices, including antibiotics, anesthetics, viscoelastics, and enzymatic sterilization detergents, that have potentially toxic effects on the corneal endothelium are reviewed.
Abstract: The purpose of this review is to discuss the recently published literature related to corneal endothelial toxicity and safety. We discuss postoperative complications, such as toxic endothelial cell destruction syndrome and toxic anterior segment syndrome, that cause significant injury to the patient and anxiety to the physician. Additionally, we review recent papers related to intraocular medications, preservatives, and devices, including antibiotics, anesthetics, viscoelastics, and enzymatic sterilization detergents, that have potentially toxic effects on the corneal endothelium.
TL;DR: Advances in microtechnology have allowed for the development of sophisticated, high-density integrated circuit devices that may be implanted either in the subretinal or epiretinal space, and special emphasis is given to retinal implants.
Abstract: Visual prostheses are based on neuronal electrical stimulation at different locations along the visual pathway (ie, cortical, optic nerve, epiretinal, subretinal). In terms of retinal prostheses, advances in microtechnology have allowed for the development of sophisticated, high-density integrated circuit devices that may be implanted either in the subretinal or epiretinal space. Analogous to the cochlear implants for some forms of deafness, these devices could restore useful vision by converting visual information into patterns of electrical stimulation that would excite the remaining spared inner retinal neurons in patients with diseases such as retinitis pigmentosa and age-related macular degeneration. The different types of implants and recent results are discussed, but special emphasis is given to retinal implants.
TL;DR: Retinal arterial occlusion remains a difficult clinical entity to manage and most reports remain anecdotal due to its low incidence (0.85/100,000/y).
Abstract: Retinal arterial occlusion remains a difficult clinical entity to manage. Treatment can best be categorized as conservative (ocular massage, pharmacologic, anterior chamber paracentesis) and invasive (catheterization of the proximal ophthalmic artery through the femoral artery with the infusion of thrombolytic agents). Most reports remain anecdotal due to its low incidence (0.85/100,000/y).
TL;DR: The spectrum of ocular disease related to HTLV-1 continues to expand and the recognition of corneal pathology in Brazilian and Caribbean patients with HT LV-1 that have not been described in Japanese patients is recognition.
Abstract: Purpose of reviewHuman T-cell lymphotropic virus type 1 (HTLV-1) infection is endemic in Japan, the Caribbean islands, and parts of Central Africa and South America. Known ophthalmic manifestations of HTLV-1 include malignant infiltrates in patients with adult T-cell leukemia/lymphoma, retinal degen
TL;DR: The field of cataract and implant surgery has emerged as a true and recognized form of refractive surgery as mentioned in this paper, and an increasingly important goal is to obtain the most desirable refractive outcome for our patients, and to decrease their dependence upon spectacle correction.
Abstract: An increasingly important goal of modern cataract and implant surgery is to obtain the most desirable refractive outcome for our patients, and in so doing, decrease their dependence upon spectacle correction. Refined spherical outcomes are now achieved by directing close attention to biometry technique, through the use of third generation intraocular lens (IOL) power formulae, and refinements in technology such as partial coherence interferometry. Similarly, improvements in astigmatic outcomes are now possible by focusing upon and obtaining more accurate preoperative cylinder measurements, careful surgical planning particularly in regard to incision(s) design, use of toric IOLs, and employing advanced postoperative enhancement techniques. Because of these refinements in technique and technology, the field of cataract and implant surgery has emerged as a true and recognized form of refractive surgery.
TL;DR: Prostaglandin analogs are a novel class of intraocular-lowering medications used primarily for the treatment of glaucoma that reduce intraocular pressure primarily by enhancing uveoscleral outflow.
Abstract: Prostaglandin analogs are a novel class of intraocular-lowering medications used primarily for the treatment of glaucoma. These topical medications reduce intraocular pressure primarily by enhancing uveoscleral outflow. The recent literature has enhanced our understanding of the mechanism of action, efficacy, and safety of these agents and has allowed us to better understand the differences between the three commonly used once-daily medications.
TL;DR: This review addresses new epidemiologic data, specifically the occurrence of ocular disease in postnatal infections, and puts the changed views on the frequency and pathogenesis of toxoplasmic ocular manifestations into historical perspective.
Abstract: Purpose of reviewThe concepts of toxoplasmosis and its ocular manifestations in humans have thoroughly changed in the past 3 years. This review addresses new epidemiologic data, specifically the occurrence of ocular disease in postnatal infections, and puts the changed views on the frequency and pat
TL;DR: Because glaucoma and its treatment can affect global quality of life as well as vision-related functioning, the assessment of both general and visual system health status is relevant.
Abstract: Purpose of reviewThis report briefly reviews recent instruments designed to test the visual function and quality of life of patients with glaucoma.Recent findingsSeveral investigators have examined the functional status and vision-related quality of life among patients with glaucoma. These studies h
TL;DR: Several studies have reported that phacoemulsification with intraocular lens implantation after PPV is a relatively safe procedure that can improve visual acuity and quality of life.
Abstract: Continuous refinements in vitreoretinal surgical techniques and an increasing number of posterior segment disorders are being successfully managed with pars plana vitrectomy (PPV). This has resulted in an increase in the number of vitrectomized eyes seen by cataract surgeons. Cataract surgery in previously vitrectomized eyes has been reported to be more challenging than in eyes without previous vitrectomy. Special considerations and precautions are often required before, during, and after the surgery to successfully address these challenges. Several studies have reported that phacoemulsification with intraocular lens implantation after PPV is a relatively safe procedure that can improve visual acuity and quality of life. The extent of visual improvement may be limited only by retinal comorbidity.
TL;DR: A number of novel treatments for AC and angle closure have recently been proposed, including cataract extraction, paracentesis, and argon laser iridoplasty, but the efficacy of these treatments remains to be demonstrated with prospective studies, ideally organized in a controlled, randomized fashion.
Abstract: Purpose of review Recent studies underscore the importance of angle-closure glaucoma (ACG) as a cause of world blindness. A major contribution in assessing the true impact of this disease has been an article estimating the number of persons with occludable angles, angle closure, and blindness from ACG in China as 28.2 million, 9.1 million, and 1.7 million, respectively. Although these numbers are based on data from Singapore and Mongolia, which may be applied to China only with caution, they emphasize the blinding potential of ACG, which is three times as likely to be associated with blindness as open-angle glaucoma (OAG). Recent findings Recent reports in the Chinese literature on ACG prevalence suffer from definitional problems that would appear to lead to systematic overestimates of ACG prevalence and underestimates of OAG prevalence. Nonetheless, data from studies by Chinese investigators further emphasize the strong association between ACG and blindness, with fully 16% of subjects with ACG blind in one report-a far higher proportion than for OAG in China and elsewhere. The importance of topiramate as a cause of secondary angle closure has recently been understood, in part, because of a series of 19 such cases reported by investigators at the Food and Drug Administration. Summary Angle closure in this setting appears to be caused by uveal effusion and anterior rotation of the ciliary body with resultant closure of the angle. The condition is not always responsive to laser iridectomy, and elimination of the causative agent appears to be critical. Ultrasonic biomicroscopy is a potential new diagnostic modality for ACG, allowing the measurement of novel parameters, such as the angle opening distance (AOD) at 500 microm (AOD 500). The efficacy of such parameters in improving screening for ACG can only be established by prospective studies of potentially at-risk eyes. A number of novel treatments for AC and angle closure have recently been proposed, including cataract extraction, paracentesis, and argon laser iridoplasty. As with proposed new diagnostic modalities, the efficacy of these treatments remains to be demonstrated with prospective studies, ideally organized in a controlled, randomized fashion.
TL;DR: The next several years promise to yield exciting new advances in understanding of the genetic epidemiology and treatment of HLA-B27–associated uveitis, especially with regard to the genetic underpinning of these diseases.
Abstract: PURPOSE OF REVIEW: To review current knowledge about the pathogenesis, clinical presentation, and treatment of HLA-B27-associated uveitis, which is the most commonly identified cause of uveitis in community-based practice and an important cause of ocular morbidity. RECENT FINDINGS: Significant advances have been made in understanding the pathogenesis of HLA-B27-associated ocular and systemic disease, especially with regard to the genetic underpinning of these diseases. Increasing attention has also been focused on the use of alternative therapies in the treatment of HLA-B27-associated uveitis, with special attention to sulfa class antibiotics, historically have been used to treat the articular manifestations of the spondyloarthritides, and newer drugs that inhibit tumor necrosis factor-alpha. SUMMARY: The next several years promise to yield exciting new advances in understanding of the genetic epidemiology and treatment of HLA-B27-associated uveitis.
TL;DR: Evidence has emerged to support the initial observation that depolarizing bipolar cells are the likely retinal target in melanoma-associated retinopathy, and further research into the functional role of recoverin in cancer cells may advance the understanding in cancer immunology.
Abstract: Purpose of reviewThe recent literature was reviewed to analyze the developments in the diagnosis, pathogenesis, and immunology of this group of paraneoplastic syndromes. Clinical features and pathologic findings are summarized.Recent findingsThe mechanism of cell death in cancer-associated retinopat
TL;DR: Although corticosteroids remain the primary initial treatment for patients with Uveitis, use of noncorticosteroid immunosuppressive agents in selected patients with uveitis allows for improved control and decreased risk of corticosterone-induced side effects.
Abstract: Purpose of review This review summarizes current patterns in the use of immunosuppressive agents in patients with uveitis. Recent findings A number of immunosuppressive agents are currently available for the treatment of uveitis. Reports of safety and efficacy, although numerous, have been largely nonrandomized and performed without controls, limiting, to some extent, the strength and generalizability of their conclusions. Nonetheless, the volume of case reports and case series provides compelling evidence that immunosuppressive agents are effective at providing long-term control in patients with moderate to severe chronic or recurrent uveitis. The choice of immunosuppressive agent is complex, and depends on the cause and severity of the patient's underlying inflammation, the presence or absence of associated systemic inflammation, and the patient's prior response to immunosuppressive treatments. Summary Although corticosteroids remain the primary initial treatment for patients with uveitis, use of noncorticosteroid immunosuppressive agents in selected patients with uveitis allows for improved control and decreased risk of corticosteroid-induced side effects.
TL;DR: This review discusses the latest studies on various mechanisms of neuroprotection in the treatment of glaucomatous optic neuropathy as a means of preserving retinal ganglion cells and their axonal projections.
Abstract: PURPOSE OF REVIEW Efforts to discover modalities and pathophysiologies that might afford successful neurorescue, neurorestoration, and neuroprotection of cells of the central nervous system have focused on processes that affect the central nervous system proper, that is, the brain. Often overlooked in the search for neural protection is the fact that the mammalian optic nerve behaves in many ways as an integral part of the central nervous system. As such, the eye--the optic nerve and retina--affords an ideal clinical model for neuroprotection and neuroprotective agents. Glaucomatous optic neuropathy is the most prevalent of all adult optic neuropathies, and offers an ideal primate and lower mammalian animal model for investigations of neuroprotection. RECENT FINDINGS This is especially compelling because while recent studies in glaucoma have shown reduction of intraocular pressure (IOP) to be an effective modality in the treatment of glaucomatous optic neuropathy, not all patients respond to or can achieve meaningful IOP reductions. Therefore much attention has now been focused on neuroprotection as a strategy in therapies for glaucomatous optic neuropathy as a means of preserving retinal ganglion cells and their axonal projections. SUMMARY This review discusses the latest studies on various mechanisms of neuroprotection in the treatment of glaucomatous optic neuropathy.
TL;DR: Ocular hypertensive subjects who received topical glaucoma medication experienced conversion to glau coma at less than half the rate of subjects who were monitored without treatment.
Abstract: Purpose of reviewTo summarize the major findings of the Ocular Hypertension Treatment Study (OHTS).Recent findingsOcular hypertensive subjects who received topical glaucoma medication experienced conversion to glaucoma at less than half the rate of subjects who were monitored without treatment. Risk
TL;DR: Understanding of these clinical entities of the posterior segment is important in minimizing the potentially sight-threatening complications from bone marrow and solid organ transplantation.
Abstract: Purpose of reviewA review is presented of the current literature on retinal complications of bone marrow and solid organ transplantation.Recent findingsRetinal complications of bone marrow and solid organ transplantation include microvascular retinopathy, infection, and hemorrhagic findings. Other c
TL;DR: Side effects of multifocal technology including unwanted photic phenomena and deterioration in contrast sensitivity are being further defined and evaluated to better assess the effects of these intraocular lenses on functional vision and patient satisfaction.
Abstract: Refractive lens exchange with a multifocal intraocular lens is becoming a more popular method of refractive surgery in the presbyopic patient. The limitations of keratorefractive surgery have led to a resurgence of lens exchange surgery for patients with prescriptions outside the limits of corneal refractive procedures, in addition to patients with routine refractive errors requesting a surgical procedure to achieve emmetropia and also address presbyopia. Side effects of multifocal technology including unwanted photic phenomena and deterioration in contrast sensitivity are being further defined and evaluated to better assess the effects of these intraocular lenses on functional vision and patient satisfaction. Attention to detail in regards to proper patient selection, preoperative measurements, intraoperative technique, and postoperative management will ultimately result in excellent outcomes and improved patient acceptance of this effective technique.
TL;DR: The physician has an important role in understanding which treatment options are appropriate for mild, moderate, and severe photoaging, and in educating patients on the risks and benefits of each.
Abstract: Purpose of reviewIn recent years, many new products and techniques have arisen that are useful in the rejuvenation of facial skin. Most of the therapies are directed at improving the results of photoaging. These cutaneous changes occur from chronic exposure to ultraviolet B light (290 to 320 nm) ass
TL;DR: ROP is a challenging and involving area of pediatric ophthalmology and basic science and clinical research on retinopathy of prematurity is highlighted, as are studies investigating anti-angiogenic agents for treatment.
Abstract: PURPOSE OF REVIEW This review highlights recent advances in basic science and clinical research on retinopathy of prematurity (ROP). RECENT FINDINGS The modern concept of ROP pathophysiology is discussed, as are studies investigating anti-angiogenic agents for treatment. Results of the largest clinical trials are summarized. Current screening criteria, potential modifications to them, and telephotoscreening are discussed. SUMMARY ROP is a challenging and involving area of pediatric ophthalmology.