Purpose: To image the cortical vitreous, determine the prevalence of the bursa premacularis and space of Martegiani, and measure the dimensions of the bursa using the new 1050-nm swept-source deep range imaging optical coherence tomography (DRI OCT-1 Atlantis).Design: Retrospective cross-sectional study.Methods: One hundred and nineteen consecutive patients (5-100 years) underwent an OCT scan using 1050-nm swept-source deep range imaging optical coherence tomography. Prevalence of the bursa premacularis and space of Martegiani and the stage of posterior vitreous detachment (PVD) were determined. The horizontal (width) and anteroposterior (depth) dimensions of the bursa were recorded along with the patient’s age.Results: A bursa was detected in 57.1% (136/238) of eyes. The bursa and space of Martegiani coexisted in 97.8% of eyes. Prevalence of detected bursa was 84.5% in eyes with either no PVD or perifoveal PVD only; the prevalence fell with further increases in the extent of PVD. Prevalence of detected bursa was 75.4% in patient group aged 0-60 years and 38% in the group aged 60-100 years. Mean width was 7001 μm (range: 3354-10 316 μm, SD: 1412 μm). Mean depth was 416 μm (range: 31-1189 μm, SD: 187 μm). Width and depth of the bursa did not correlate with age (R2 width = 0.0316; R2 depth = 0.0108). Bilateral bursa tended to be symmetrical in width but less so in depth (R2 width = 0.63, P < .001; R2 depth = 0.33, P < .001).Conclusion: Swept-source OCT has allowed us to demonstrate the almost invariable coexistence of the bursa premacularis and space of Martegiani. Swept-source OCT can image both in patients from as early as the first to as late as the tenth decade of life.
Author: Am J Ophthalmol
In Vitro Susceptibility of Filamentous Fungal Isolates From a Corneal Ulcer Clinical Trial
Purpose: To describe the minimum inhibitory concentration (MIC) of fungal isolates to natamycin and voriconazole, and to compare these MICs to previous ocular susceptibility studies.Design: Experimental laboratory study using isolates from a randomized clinical trial.Methods: The Mycotic Ulcer Treatment Trial I was a randomized, double-masked, multicenter trial comparing topical natamycin and voriconazole for fungal keratitis treatment. Susceptibility testing to natamycin and voriconazole were performed according to Clinical and Laboratory Standards Institute methods. The relationship between organism and MIC was assessed. A literature review was performed to compare results to previous ocular susceptibility studies.Results: Of the 323 patients enrolled in the trial, MICs were available for 221 (68%). Fusarium (n = 126) and Aspergillus species (n = 52) were the most commonly isolated organisms. MICs to natamycin and voriconazole were significantly different across all genera (P < .001). The MIC median (MIC50) and 90th percentile (MIC90) for natamycin were equal to or higher than voriconazole for all organisms except Curvularia species. Compared to other organisms, Fusarium species isolates had the highest MICs to voriconazole and Aspergillus flavus isolates had the highest MICs to natamycin. Our results were similar to previous reports except that the voriconazole MIC90 against Aspergillus species was 2-fold higher and the natamycin MIC90 against Aspergillus fumigatus was 4-fold higher in our study.Conclusion: In this large susceptibility study, Fusarium isolates were least susceptible to voriconazole and A flavus isolates were least susceptible to natamycin when compared to other filamentous fungi. In the future, susceptibility testing may help guide therapy if performed in a timely manner.
Spinoza as an Optician
Baruch Spinoza (1632-1677), famous as a philosopher and pillar of the rational Enlightenment, for many years actually earned his living as a maker of telescopic lenses. He was knowledgeable about all the contemporary ideas about the physics of light an…
Spontaneous resolution of vitreomacular traction demonstrated by spectral-domain optical coherence tomography – Accepted Manuscript
Abstract: Purpose: To evaluate the natural course of idiopathic vitreomacular traction (VMT) with spectral-domain optical coherence tomography (SDOCT) from the vitreomacular adhesion (VMA) stage to the spontaneous resolution of VMT.Design: Prospective observational case series.Methods: We studied the natural course of idiopathic VMT in 46 eyes (46 patients) divided into those that proceeded to spontaneous VMT resolution (12 cases) and those that remained at the VMT stage (34 cases). All patients were examined with SDOCT at regular three-monthly intervals. We recorded the vitreomacular angle of VMA nasally and temporally, the horizontal diameter of VMA, macular thickness, visual acuity, photoreceptor layer, and external limiting membrane.Results: In the 12 eyes that proceeded to spontaneous resolution, the vitreous adhesion angle had a mean increase of 38° at VMT, compared to the angle at the VMA stage. In the 34 eyes that remained at the VMT stage, the mean angle of traction increased by only 1° throughout follow-up. In all 46 patients, the angle at the VMT stage was significantly associated with traction resolution (nasally P = 0.001, temporally P < 0.001). The likelihood of resolution was more than 99% lower for patients with a VMT diameter > 400 μm compared with that of eyes with a VMT diameter < 400 μm. Patients with broad-type VMT remained at the same stage, whereas patients with V-type VMT had 80% probability of resolution.Conclusions: Spontaneous VMT resolution is negatively associated with the horizontal adhesion diameter. The strength of the traction exerted by the vitreous on the fovea seems to be positively related to the size of the vitreomacular angle.
Alcohol Use and Positive Screening Results for Depression and Anxiety Are Highly Prevalent among Chinese Children with Strabismus – Accepted Manuscript
Abstract: Purpose: To study associations between strabismus and alcohol use, anxiety and depression among 10-17-year-old children in Guangdong, southern China.Design: Cross-sectional, population-based studyMethods: Among 7537 children aged 6 to 17 years from 9 randomly-selected primary and middle schools, ocular alignment was assessed with the Hirschberg light reflex, cover-uncover testing, and alternate cover testing at distance (6 m) and near (40cm). Additionally, 4000 children (53.1%) aged 10+ years received self-administered questionnaires containing screening questions on alcohol use, anxiety and depression.Results: Examinations were completed on 7,464 of 7,537 subjects (99.0%), including 3,928 (52.6%) boys, with a mean age of 11.1±1.8 years. The prevalence of any strabismus, including exotropia (2.7%), esotropia (0.2%), and intermittent exotropia (3.9%), was 6.8%. Strabismus was more prevalent in urban students (7.3%) and females (7.4%) compared to rural students (6.0%) and males (6.2%) (all P < .05). In multivariate regression models, any strabismus was associated with older age and rural versus urban residence. Among 3903 (97.6%) children answering questionnaires, history of alcohol use (62.3% versus 36.3%) and positive screening responses for depression (26.0% versus 11.6%) and anxiety (10.3% versus 4.9%) were significantly (P < .01 for all) more common among children with strabismus.Conclusion: These Chinese children with strabismus had significantly higher prevalence of alcohol use and possible markers of emotional problems than children without strabismus. Further research should focus on the appropriateness of classifying surgical treatment for strabismus as "cosmetic" (ineligible for reimbursement) under China’s rural health insurance.
Multiple subretinal fluid blebs after successful retinal detachment surgery: Incidence, risk factors, and presumed pathophysiology – Accepted Manuscript
Abstract: Purpose: To investigate the incidence and the clinical factors associated with the occurrence of multiple subretinal fluid (SRF) blebs after successful rhegmatogenous retinal detachment (RD) repair.Design: Retrospective, observational case seriesMethods: We retrospectively investigated the medical records of 185 eyes of 184 patients who had undergone successful RD surgery either vitrectomy or scleral buckling. Each patient had undergone spectral domain optical coherence tomography (SD-OCT) combined with infrared reflectance (IR) imaging every 3 months postoperatively. We carefully examined postoperative SD-OCT and fundus IR images, in an effort to identify any SRF blebs present.Results: Multiple (≥3) SRF blebs were observed in 40 (21.6%) of 185 cases. SRF blebs were first detected 1.7 ± 1.8 months postoperatively. In 22 cases which could be fully followed up, SRF blebs were completely absorbed 13.1 ± 6.1 months postoperatively. Multiple logistic regression analysis showed that only young age (<30 years) was significantly associated with the occurrence of multiple SRF blebs (odds ratio, 5.1; 95% confidence interval, 1.5–17.6; p = 0.010). Serial measurements of SRF bleb size using SD-OCT showed that SRF bleb height was greatest at postoperative 2.9 ± 0.9 months, while SRF bleb width tended to decrease gradually over time. The SRF blebs typically spared large retinal vessels.Conclusions: Multiple SRF blebs are commonly found after successful RD surgery, especially in young patients. The serial morphological features evaluated in this study indicate that multiple SRF blebs may result from the active reattachment of retinal pigment epithelium and photoreceptors during the resolution of RD.
Screening and characterization of Staphylococcus aureus from ophthalmology clinic surfaces: a proposed surveillance tool – Accepted Manuscript
Abstract: Purpose: To screen environmental surfaces of an outpatient ophthalmic clinic for methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MSSA and MRSA); to identify the most commonly contaminated surfaces; and to phenotype an…
The Sensitivity of the Bielschowsky Head Tilt Test in Diagnosing Acquired Bilateral Superior Oblique Paresis – Accepted Manuscript
Abstract: Purpose: To determine the sensitivity of the Bielschowsky head-tilt test and other commonly used criteria in identifying patients with true bilateral superior oblique paresis.Design: A retrospective chart review was performed to identify pati…
Autologous Transplantation of the Internal Limiting Membrane for Refractory Macular Holes – Accepted Manuscript
Abstract: Purpose: To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes.Design: Prospective, interventional case series.Patient and Methods: Ten eyes of 10 consecutive patient…
Topical Rebamipide Treatment for Superior Limbic Keratoconjunctivitis in Patients with Thyroid Eye Disease – Accepted Manuscript
Abstract: Purpose: To evaluate efficacy of topical rebamipide for superior limbic keratoconjunctivitis (SLK) in patients with thyroid eye disease (TED).Design: A retrospective, observational case series.Methods: Thirty-three eyes from 20 TED patients with SLK who received topical rebamipide [Mucosta® ophthalmic suspension unit dose 2%; chemical name, (2RS)-2-(4-chlorobenzoylamino)-3-(2-oxo-1, 2-dihydroquinolin-4-yl) propanoic acid] were included. The following items were evaluated before and 4 weeks after the start of treatments: presence or absence of SLK, rose bengal staining score, AD classification (A, area; D, density) of fluorescein staining, Schirmer’s test I (without topical anesthesia), tear break-up time (TBUT), Hertel exophthalmometry values, and margin reflex distances-1 and -2.Results: Twenty-eight eyes showed complete disappearance of SLK after treatment (84.8%; P < 0.001). The other 5 eyes (15.2%) demonstrated significant improvement but had residual punctate rose bengal staining and fluorescein staining, near the superior corneal limbus. All 5 eyes exhibited at least one of the following findings: proptosis > 17.7 mm and upper and/or lower eyelid retractions. Incidence of upper eyelid retraction was significantly higher in eyes with SLK than in those without SLK at the 4 week follow-up (P = 0.021). The severity of rose bengal staining, and fluorescein staining improved significantly after treatment (P < 0.001). Although the Schirmer’s test results remained constant before and after the treatment (P = 0.212), TBUT increased significantly in the post-therapeutic state (P = 0.009). No serious adverse events were reported.Conclusions: Topical rebamipide improved SLK in patients with TED, suggesting a first-line treatment in such patients.
Endophthalmitis Caused by Streptococcal Species: Clinical Settings, Microbiology, Management, and Outcomes – Accepted Manuscript
Abstract: Purpose: To report the clinical settings, antibiotic susceptibilities, and outcomes of endophthalmitis caused by Streptococcus species.Study Design: Retrospective, observational case series.Methods: Single-center study evaluating all patients with culture-positive endophthalmitis caused by Streptococcus species between January 1, 2000 and December 31, 2011.Results: Study criteria were met by 63 patients. The most common clinical settings were bleb-associated (17, 27%), post-intravitreal injection (16, 25%), and post-cataract surgery (13, 21%). The isolates were S. viridans (47, 71%), S. pneumoniae (13, 21%), and β-hemolytic Streptococci (5, 8%). Sixty (95%) of 63 isolates were susceptible to vancomycin, 47 (98%) of 48 to ceftriaxone (third generation cephalosporin), and 57 (93%) of 61 to levofloxacin (third generation fluoroquinolone). Between the first and second half of the study period, the minimal inhibitory concentration (MIC) of antibiotics required to inhibit 90% of isolates increased by 1.5-fold for ceftriaxone and 2-fold for levofloxacin, and remained the same for vancomycin. Initial treatment was vitreous tap (49, 78%) or pars plana vitrectomy (14, 22%); all received intravitreal antibiotics. Visual acuity outcomes were variable; best corrected visual acuity (BCVA) was ≥20/400 in 16 (25%) patients and <20/400 in 47 (75%) patients. Evisceration/enucleation was performed in 16 (25%) patients.Conclusion: Streptococcus isolates generally had high susceptibility rates to commonly used antibiotics. Higher antibiotic MICs were required to inhibit 90% of isolates in vitro in the second half of the study period compared to the first half. Despite prompt treatment, the majority of patients had poor outcomes.
Assessment of choroidal topographic changes by swept source optical coherence tomography after photodynamic therapy for central serous chorioretinopathy – Accepted Manuscript
Abstract: Purpose: To investigate the relationship between choroidal thickness and angiographic abnormalities in central serous chorioretinopathy (CSC) eyes by swept-source optical coherence tomography (Swept-OCT), before and after half-fluence photody…
Dry Eye Exacerbation in Patients Exposed to Desiccating Stress under Controlled Environmental Conditions – Accepted Manuscript
Abstract: Purpose: To determine if controlled environmental conditions can induce acute exacerbations of signs and symptoms in dry eye and asymptomatic subjects.Design: Prospective cross-sectional study.Methods: Nineteen patients with dry eye and 20 asymptomatic controls were exposed to controlled low humidity (5% relative humidity, desiccating environment) for 2 hours in our Controlled Environmental Research Laboratory at the University of Valladolid. The patients completed the Single-Item Score Dry Eye Questionnaire and the following diagnostic tests were performed before and after exposure: tear osmolarity, phenol red thread test, conjunctival hyperemia, fluorescein tear-break-up time (T-BUT), Schirmer test, and ocular surface vital staining. Sixteen molecules in the tears samples were analyzed by multiplex bead analysis.Results: After exposure, the patients and controls had a significant (P≤0.003) increase in corneal staining (from 0.68±0.15 to 1.16±0.14 and 0.50±0.15 to 1.30±0.19, respectively), significantly decreased (P≤0.01) fluorescein T-BUT values (from 2.78±0.56 to 1.94±0.24 seconds and 2.81±0.24 to 2.13±0.19 seconds, respectively), and significantly increased (P≤0.03) matrix metallopeptidase-9 tear levels (from 10,054.4±7,326.6 to 25,744.5±13,212.4 and 10,620.5±4,494.3 to 16,398.7±5,538.3 pg/ml, respectively). In the control group, the epidermal growth factor tear levels decreased significantly (P=0.007) (from 1,872.1±340.7 to 1,107.1±173.6 pg/ml), and the interleukin-6 levels significantly (P<0.001) increased (from 29.6±5.8 to 54.3±8.3 pg/ml) after exposure.Conclusion: Adult patients with mild-to-moderate dry eye and asymptomatic subjects of similar ages can develop acute exacerbation in an environmental chamber that resembles the sudden worsening that patients with dry eye experience daily.
Recurrence Rates of Ocular Toxoplasmosis During Pregnancy – Accepted Manuscript
Abstract: Purpose: To investigate whether recurrence rates of ocular toxoplasmosis are higher during pregnancy among women of childbearing age.Design: Retrospective longitudinal cohort study.Methods: We reviewed medical records of all women seen at a u…
Measurement of Scleral Thickness using Swept-Source Optical Coherence Tomography in Open-Angle Glaucoma Patients with Myopia – Accepted Manuscript
Abstract: Purpose: To use swept-source optical coherence tomography (OCT) to image the posterior sclera at the posterior pole and around the optic nerve head (ONH), and measure the subfoveal scleral thickness and laminar thickness to evaluate the relationship between the measured thicknesses and ocular parameters.Design: Prospective, cross-sectional design.Methods: One hundred and twelve glaucoma patients and 46 controls with axial length more than 26 mm were enrolled. Swept-source OCT images were obtained to capture the subfoveal and ONH region. Subfoveal scleral thickness and laminar thickness were measured from obtained B-scan images. To verify the reproducibility of the measurement, intraclass correlation coefficients were calculated from selected B-scans. Scleral and laminar thickness in patients with normal tension glaucoma (NTG) was compared with that in patients with primary open angle glaucoma (POAG). Pearson’s correlation was calculated to assess the relationships of scleral and laminar thicknesses with ocular parameters.Results: Posterior scleral thickness could be measured in 68.4% and laminar thickness could be measured in 88.6% using swept-source OCT. Interobserver and intraobserver measurement reproducibility was moderate to excellent. The subfoveal scleral thickness was 670.84 ± 160.60 μm in the POAG group and 496.55 ± 115.20 μm in the NTG group, which was significantly different between groups. Subfoveal scleral thickness (r = -0.677, P < 0.001) was negatively correlated with axial length only in NTG patients, not POAG patients.Conclusions: Swept-source OCT detected differences in the thickness of the posterior sclera between NTG and POAG eyes. Subfoveal scleral thickness was negatively correlated with axial length only in NTG eyes.
Ultrasound biomicroscopy in chronic pseudophakic ocular inflammation associated with misplaced intraocular lens haptics – Accepted Manuscript
Abstract: Purpose: To evaluate the usefulness of ultrasound biomicroscopy in confirming intraocular lens haptic-induced ocular irritation and in the management of these patients.Design: A retrospective review of patient data.Methods: Twenty pseudophaki…
Trimethoprim-sulfamethoxazole versus placebo to reduce the risk of recurrences of toxoplasma gondii retinochoroiditis: randomized controlled clinical trial – Accepted Manuscript
Abstract: Purpose: To compare the effects of trimethoprim-sulfamethoxazole versus placebo in reducing the risk of recurrences of toxoplasma gondii retinochoroiditis.Design: Single-center, prospective randomized, double-masked, clinical trial.Methods: A…
Dry Eye in the Beaver Dam Offspring Study: Prevalence, Risk Factors, and Health-Related Quality of Life – Accepted Manuscript
Abstract: Purpose: To estimate dry eye prevalence in the Beaver Dam Offspring Study (BOSS), including a young adult population, and investigate associated risk factors and impact on health-related quality of life.Design: Cohort study.Methods: The BOSS (2005-2008) is a study of aging in the adult offspring of the population-based Epidemiology of Hearing Loss Study cohort. Questionnaire data on health history, medication use, risk factors, and quality of life were available for 3275 participants. Dry eye was determined by self-report of frequency of symptoms and the intensity of those symptoms. Associations between dry eye and risk factors were analyzed using logistic regression.Results: The prevalence of dry eye in the BOSS was 14.5%, 17.9% of women and 10.5% of men. In a multivariate model, statistically significant associations were found with female sex (Odds Ratio (OR), 1.68; 95% Confidence Interval (CI), 1.33-2.11), current contact lens use (OR, 2.01; 95%CI, 1.53-2.64), allergies (OR, 1.59; 95%CI 1.22-2.08), arthritis (OR, 1.44; 95%CI, 1.12-1.85), thyroid disease (OR, 1.43; 95%CI, 1.02-1.99), antihistamine use (OR, 1.54; 95%CI, 1.18-2.02), and steroid use (OR, 1.54; 95%CI, 1.16-2.06). Dry eye was also associated with lower scores on the Medical Outcomes Short Form-36 (β=-3.9, p<0.0001) as well as on the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) (β=-3.4, p<0.0001) when controlling for age, sex, and comorbid conditions.Conclusions: The prevalence of dry eye and its associated risk factors in the BOSS were similar to previous studies. In this study, DES was associated with lower quality of life on a health-related quality of life instrument and the vision-specific NEI-VFQ-25.
Corneal biomechanics as a function of intraocular pressure and pachymetry by Dynamic Infrared Signal and Scheimpflug Imaging Analysis in normal eyes – Accepted Manuscript
Abstract: Purpose: To evaluate corneal biomechanical deformation response using Ocular Response Analyzer (ORA) and Corvis ST data.Design: Prospective Observational case control studyMethods: 1262 eyes of 795 patients were enrolled. 3 groups were established, according to the corneal compensated intraocular pressure (IOPcc), group I (10-13mmHg), group II (14-17mmHg), and group III (18-21mmHg). Each group included 3 subgroups, based on central corneal thickness (CCT), subgroup 1 (465-510㎛), 2 (510-555㎛), and 3 (555-600㎛). In addition, similar groups of CCT were divided into subgroups of IOPcc. Corneal hysteresis (CH) and corneal resistance factor (CRF) were derived from ORA. The parameters of highest concavity with the parameters of first and second applanation were recorded from Corvis ST.Results: CH and CRF, applanation time1, and radius of curvature at highest concavity showed significant differences between CCT subgroups for each IOPcc group (p < 0.0001). CH, applanation time 1, 2, and applanation velocity 2, as well as deformation amplitude (DA) showed significant differences by IOP subgroups for all CCT groups. IOPcc is correlated negatively with CH (r = -0.38, p < 0.0001). There are positive correlations of IOPcc with applanation time 1, applanation velocity 2, radius, and negative correlation with applanation time 2 (r = – 0.54, p < 0.0001), applanation velocity 1(r = -0.118, p < 0.0001) and deformation amplitude (r = – 0.362, p < 0.0001).Conclusion: ORA and Corvis ST parameters are informative in the evaluation of corneal biomechanics. IOP is important in deformation response evaluation and must be taken into consideration.
Vitreoretinal Management and Surgical Outcomes in Proliferative Sickle Retinopathy: A Case Series – Accepted Manuscript
Abstract: Purpose: To report the outcomes of current vitreoretinal surgical management of proliferative sickle retinopathy and to compare current methods to previous studies.Design: A retrospective, interventional case series.Methods: Fifteen eyes of 1…