Author: Am J Ophthalmol

Accomodative Tone in Children Under General Anesthesia – Corrected Proof

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Purpose: To determine the effect of general anesthesia on the accommodative tone in children.Design: Cohort study in an academic practice.Methods: In children under 12 years of age who were undergoing general anesthesia, cycloplegic refraction was measured using streak retinoscopy during an office visit. Within 6 months, streak retinoscopy without cycloplegia was performed under general anesthesia. The main outcome measure was the difference between retinoscopy under anesthesia and cycloplegic retinoscopy in children.Results: In 41 children with an average age of 3.7 years (range, 0.8 to 11 years) retinoscopy under anesthesia yielded significantly more myopic measurements than cycloplegic retinoscopy for the sphere and spherical equivalent (P < 0.0001 for both) but was in good agreement with cycloplegic retinoscopy for cylinder power and axis. The average difference between retinoscopy under anesthesia and cycloplegic retinoscopy was −0.98 diopters (D) (95% limit of agreement, −3.08 D to +1.10 D) for the sphere, 0.08 D (95% limit of agreement, −0.67 D to +0.82 D) for the cylinder, and −0.94 D (95% limit of agreement, −3.01 D to +1.13 D) for the spherical equivalent. Retinoscopy under anesthesia was within 1 D of cycloplegic retinoscopy in 25 subjects (61%) for the sphere, in all subjects for the cylinder, and in 28 subjects (68.3%) for the spherical equivalent.Conclusions: Although general anesthesia reduced the accommodative tone in most children, it was still significant in some as compared to the tone found in cycloplegic retinoscopy. If an accurate measurement is essential, cycloplegia is recommended when measuring refraction in children under general anesthesia.

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Optical Coherence Tomography Morphologic Grading of Macular Commotio Retinae and its Association With Anatomic and Visual Outcomes – Corrected Proof

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Purpose: To investigate the morphologic characteristics of macular commotio retinae using spectral-domain optical coherence tomography (SDOCT) and develop a grading system for traumatic photoreceptor damage.Design: Retrospective, observational case series.Methods: setting: Seoul National University Bundang Hospital. patients: Forty-nine patients with macular commotio retinae, examined by SDOCT within 7 days of the initial traumatic event. observations: A 4-step grading system was based on the morphology revealed by SDOCT. Best-corrected visual acuity (BCVA) and structural integrity of the 3 photoreceptor layers (cone outer segment tips [COST], inner/outer segment [IS-OS] junction, external limiting membrane [ELM]) were evaluated at baseline, at 1 month, and at the final visit. Visual and anatomic outcomes at 1 month and at the final visit were compared among subgroups. main outcome measures: The severity of photoreceptor damage as revealed by SDOCT and BCVA.Results: The following 4 distinct photoreceptor morphologic features were observed: increase in IS-OS junction reflectivity with the disappearance of the thin hyporeflective optical space (n = 8, grade 1), COST defect only (n = 5, grade 2), COST and IS-OS junction defects (n = 16, grade 3), and COST, IS-OS junction, and ELM defects (n = 20, grade 4). Eyes with higher grades at baseline had significantly worse visual (final BCVA, P = .002) and anatomic outcomes (complete photoreceptor recovery, P < .001).Conclusions: The number of disrupted photoreceptor layers, as determined using SDOCT images, can be used to grade macular commotio retinae. This system may be useful in documenting the baseline severity of photoreceptor damage and in predicting visual and anatomic outcomes.

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Mechanism of Retinal Pigment Epithelium Tear Formation Following Intravitreal Anti–Vascular Endothelial Growth Factor Therapy Revealed by Spectral-Domain Optical Coherence Tomography – Corrected Proof

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Purpose: To demonstrate the mechanism by which retinal pigment epithelium (RPE) tears occur in eyes with neovascular age-related macular degeneration (AMD) treated with intravitreal anti–vascular endothelial growth factor (VEGF) agents using spectral…

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Risk Factors, Microbiological Profile, and Treatment Outcomes of Pediatric Microbial Keratitis in a Tertiary Care Hospital in Hong Kong – Corrected Proof

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Purpose: To report the risk factors and microbiological profile of pediatric microbial keratitis cases in a tertiary care hospital in Hong Kong.Design: Retrospective study.Methods: Case records of patients <18 years old with microbial keratitis were reviewed over a period of 10 years, between January 2001 and December 2010. Risk factors, microbiological profile, and treatment outcomes were analyzed.Results: Overall, 18 patients (13 female, 5 male) with unilateral microbial keratitis were included. The mean age was 12.4 years (range: 3-17 years). The most commonly associated risk factor was contact lens wear (15, 83.3%). Seven cases (38.8%) were associated with orthokeratology lenses. Two cases (11.1%) were related to intrinsic keratopathy and 1 case (5.5%) was infected secondary to trauma. Microbiological culture was positive in 16 cases (88.8%). Overall, Pseudomonas sp. was the most commonly isolated organism (10/16, 62.5%), followed by coagulase-negative Staphylococcus (5/16, 31.2%) and Corynebacterium sp. (2/16, 12.5%). All cases responded to intensive medical management with topical antibiotics. One case with posttraumatic keratitis required stepped surgeries with initial tectonic penetrating keratoplasty followed by lens aspiration and retinal detachment repair. At the last follow-up, 13 out of 17 eyes (76.5%) had best-corrected visual acuity ≥20/40.Conclusions: Contact lens wear was the most commonly encountered risk factor for the occurrence of microbial keratitis in the pediatric age group in our setting. Orthokeratology remains one of the leading causes of contact lens–related infections. The majority of the cases responded to medical management.)

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Morphologic Characterization of Dome-Shaped Macula in Myopic Eyes With Serous Macular Detachment – Corrected Proof

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Purpose: To analyze dome-shaped maculas topographic features and related serous retinal detachment (SRD) in eyes with myopic staphyloma.Design: Retrospective, observational case series.Methods: We reviewed the records of 48 eyes in 33 patients with dome-shaped maculas who were referred because of decreased vision. Ophthalmologic examination included axial length measurement, spectral domain optical coherence tomography (OCT), and fluorescein and indocyanine green angiography. The height of the macular bulge was measured, and the choroidal thickness was mapped.Results: Patient mean age was 55.0 ± 13.6 years. Mean axial length was 27.49 ± 2.53 mm. Mean best-corrected visual acuity (BCVA) was 0.50 ± 0.33 logMAR. Three dome-shaped macula patterns were observed: round dome in 10/48 (20.8%) eyes; horizontal oval-shaped dome in 30/48 (62.5%) eyes; and vertical oval-shaped dome in 8/48 (16.7%) eyes. The mean macular bulge height was 407.7 ± 215.1 μm (120–1130) and was significantly greater in vertical oval-shaped domes. The mean central choroidal thickness (CCT) was 146.5 ± 56.0 μm, significantly greater than at 3 mm nasal and temporal to the fovea (P < 0.0001). The CCT was positively correlated to macular bulge height but not to BCVA. Foveal SRD was present in 25/48 eyes and significantly increased for macular bulge height greater than 350 μm (P = 0.0047). BCVA was significantly lower when SRD was present (P = 0.043).Conclusions: Most dome-shaped maculas did not display a round but a horizontal or vertical oval-shaped dome and could be missed on a single OCT scan. Chronic foveal SRD was associated with decreased vision and was more common when the macular bulge was highly elevated.

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A Comparison of Treatment Approaches for Bilateral Congenital Nasolacrimal Duct Obstruction – Corrected Proof

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Purpose: To compare the clinical outcomes of two treatment approaches for bilateral nasolacrimal duct obstruction (NLDO) in infancy.Design: Multicenter, randomized clinical trial.Methods: We studied 57 infants between the ages of 6 and <10 months who had bilateral NLDO. Participants were randomized to receive either (1) immediate office-based probing within two weeks (n = 31) or (2) 6 months of observation and nonsurgical management followed by surgical facility-based probing for unresolved cases (n = 26). Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) in both eyes on masked examination at 18 months of age.Results: In the observation and deferred facility probing group, resolution without surgery occurred by 6 months after randomization in both eyes for 14 participants (56%), in one eye for 5 (20%), and in neither eye for 6 (24%). Eight participants in the observation and deferred facility probing group underwent facility probing (one of whom later had a second facility probing). Four participants in the immediate office probing group later underwent an additional procedure in a surgical facility. In the immediate office probing group, treatment success at 18 months of age occurred in both eyes for 19 of 29 (66%) participants and in one eye for 3 (10%); in the observation and deferred facility probing group, treatment success occurred in both eyes for 19 of 25 (76%) participants and in one eye for 3 (12%) (difference in success = −10%; 95% CI = −35% to 14%).Conclusions: Both the immediate office probing approach and the observation and deferred facility probing approach are successful and reasonable treatment options for infants with bilateral NLDO.

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Clinical Results of Ab Interno Trabeculotomy Using the Trabectome for Open-Angle Glaucoma: The Mayo Clinic Series – Corrected Proof

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Purpose: To determine outcomes of ab interno trabeculotomy for treatment of open-angle glaucoma (OAG).Design: Retrospective interventional single-surgeon, single-center case series.Methods: Data were collected from 246 patients undergoing ab interno trabeculotomy between September 1, 2006, and December 1, 2010, with 3 months’ follow-up or longer. Kaplan-Meier analysis was performed using Criteria A (postoperative intraocular pressure [IOP] ≤21 mm Hg or ≥20% reduction from preoperative IOP) and Criteria B (IOP ≤18 mm Hg and ≥20% reduction in IOP). Failure included increased glaucoma medications or subsequent surgery. Failure risk factors were identified using Cox proportional hazards ratio (HR).Results: Of 88 cases of ab interno trabeculotomy-only and 158 cases of ab interno trabeculotomy with cataract extraction, the retention rate was 70% for 1 year and 62% for 2 years. Preoperative mean IOP was 21.6 ± 8.6 mm Hg; the number of glaucoma medications was 3.1 ± 1.1. At 24 months postoperatively, mean IOP was reduced 29% to 15.3 ± 4.6 mm Hg (P < 0.001) and the number of glaucoma medications was reduced 38% to 1.9 ± 1.3 (P < 0.001) with a success rate of 62% (95% CI, 56%–68%) using Criteria A and 22% (95% CI, 16%–29%) using Criteria B. Failure risk factors using Criteria A included primary OAG (HR 3.14, P < 0.01, 95% CI, 1.91–5.17) and past argon laser trabeculoplasty (HR 1.81, P < 0.01, 95% CI, 1.18–2.77). Using Criteria B, the HR for pseudoexfoliative glaucoma was 0.43 (P < 0.01, 95% CI 0.27–0.67). Of the cases, 66 (26.8%) required subsequent surgery on an average of 10 months (2 days to 3.2 years) after ab interno trabeculotomy.Conclusions: For criteria involving IOP ≤18 mm Hg, the 24-month survival of ab interno trabeculotomy is low. This surgery is appropriate for patients requiring a target IOP of 21 mm Hg or above.

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Postoperative Optical Coherence Tomographic Appearance and Relation to Visual Acuity After Vitrectomy for Myopic Foveoschisis – Corrected Proof

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Purpose: To investigate the appearance of postoperative spectral-domain optical coherence tomography (SD-OCT) and the relationship of the findings to visual acuity in myopic foveoschisis.Design: Retrospective observational case series.Methods: We studied 17 eyes (17 women; mean age, 66.4 years) with myopic foveoschisis. SD-OCT was performed preoperatively and 1, 3, 6, and 12 months after vitrectomy. The average central foveal thickness and choroidal thickness and the integrity of the foveal photoreceptor inner segment/outer segment junction as well as the external limiting membrane were correlated with the postoperative best-corrected visual acuity (BCVA).Results: The mean refractive error was −11.9 diopters, axial length 29.7 mm, choroidal thickness 29.9 μm, and logarithm of the maximum angle of resolution (logMAR) visual acuity 0.52 at baseline. The mean preoperative central foveal thickness was 470.8 μm, which was not associated with age, refractive error, symptom duration, or BCVA. The mean postoperative retinal thicknesses at 1, 3, 6, and 12 months were 310.4, 251.8, 218.2, and 218.7 μm, respectively (P < 0.01 at all time points). The final BCVA improved significantly (P < 0.001). The preoperative BCVA (P < 0.0001) difference in central foveal thickness between 3 and 12 months postoperatively (P < 0.05), the final integrity of the inner segment/outer segment junction (P < 0.05), and the ELM (P < 0.05) were significantly associated with the final BCVA. The preoperative choroidal thickness was negatively associated with axial length (P < 0.05) but not with postoperative central foveal thickness or BCVA.Conclusions: The final BCVA in myopic foveoschisis is associated with the retinal thickness changes postoperatively and recovery of the photoreceptor cells as seen in OCT images.

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Prevalence and Characteristics of Age-Related Macular Degeneration in the Japanese Population: The Nagahama Study – Corrected Proof

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Purpose: To estimate the age- and sex-specific prevalence of early age-related macular degeneration (AMD; drusen and retinal pigment abnormalities) and late AMD (exudative AMD and geographic atrophy) in the Japanese population.Design: Community-based, cross-sectional study.Methods: The study was held in Nagahama, Japan, and included 6065 Japanese individuals (aged ≥50 years) recruited in 2008-2010. We graded fundus photographs of both eyes for the AMD phenotype based on drusen size, the presence of retinal pigment abnormalities, and late AMD. The associations between smoking and AMD phenotypes were also evaluated.Results: We assessed 5595 subjects (women, 65%) with a gradable macular condition. Early and late AMD prevalence increased from 16.1% and 0.27% at 50-59 years to 31.2% and 0.98%, respectively, at 70-74 years and was predominant in male subjects in each age group. Smoking was associated with both early and late AMD stages and retinal pigment abnormalities (P < .0001), but not with drusen (P = .305). The prevalence of retinal pigment abnormalities was significantly higher in men (P < .0001), which was associated with high rates of cigarette smoking. We found no sex difference for the prevalence of large drusen (P = .264).Conclusions: The prevalence of early AMD among adult Japanese persons was similar to the rates in white populations. The prevalence of late AMD in Japanese people aged <70 years was similar to that observed in white populations, whereas that in Japanese people aged ≥70 years was relatively lower.

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Associations of Candidate Genes to Age-Related Macular Degeneration Among Racial/Ethnic Groups in the Multi-Ethnic Study of Atherosclerosis – Corrected Proof

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Purpose: To describe the relationships of selected candidate genes to the prevalence of early age-related macular degeneration (AMD) in a cohort of whites, blacks, Hispanics, and Chinese Americans.Design: Cross-sectional study.Methods: setting: Multicenter study. study population: A total of 2456 persons aged 45-84 years with genotype information and fundus photographs. procedures: Twelve of 2862 single nucleotide polymorphisms (SNPs) from 11 of 233 candidate genes for cardiovascular disease were selected for analysis based on screening with marginal unadjusted P value <.001 within 1 or more racial/ethnic groups. Logistic regression models tested for association in case-control samples. main outcome measure: Prevalence of early AMD.Results: Early AMD was present in 4.0% of the cohort and varied from 2.4% in blacks to 6.0% in whites. The odds ratio increased from 2.3 for 1 to 10.0 for 4 risk alleles in a joint effect analysis of Age-Related Maculopathy Susceptibility 2 rs10490924 and Complement Factor H Y402H (P for trend = 4.2×10−7). Frequencies of each SNP varied among the racial/ethnic groups. Adjusting for age and other factors, few statistically significant associations of the 12 SNPs with AMD were consistent across all groups. In a multivariate model, most candidate genes did not attenuate the comparatively higher odds of AMD in whites. The higher frequency of risk alleles for several SNPs in Chinese Americans may partially explain their AMD frequency’s approaching that of whites.Conclusions: The relationships of 11 candidate genes to early AMD varied among 4 racial/ethnic groups, and partially explained the observed variations in early AMD prevalence among them.

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