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.
Author: Am J Ophthalmol
Correlation Between Corneal and Scleral Pneumatonometry: An Alternative Method for Intraocular Pressure Measurement – Corrected Proof
Purpose: To evaluate scleral pneumatonometry as an alternative method for measuring intraocular pressure (IOP).Design: Prospective cross-sectional study.Methods: Adult subjects with healthy eyes were recruited from the Comprehensive Eye Service at the University of Illinois Eye and Ear Infirmary from August 2008 through February 2009. Study measurements included corneal pneumatonometry (IOPk), scleral pneumatonometry (IOPs), axial length (AL), spherical equivalent (SE), and central corneal thickness (CCT). Main outcome measures were scleral IOP and corneal IOP.Results: Analysis included a monocular data set from single eyes of 97 subjects (age: 18-82 years). IOPs was consistently higher than IOPk, and correlated positively with IOPk (r = 0.57, P < .0001), age (r = 0.51, P < .0001), and SE (r = 0.32, P = .0002). The difference between scleral and corneal IOP (IOPs − IOPk) correlated positively with IOPs (r = 0.89, P < .0001), age (r = 0.57, P < .0001), and SE (r = 0.34, P < 0.0001). Bland-Altman analysis for agreement between scleral and corneal pneumatonometry measurements showed a mean difference of 8.08 mm Hg, with the 95% limit of agreement between -3.47 and 19.64 mm Hg. Regression analysis yielded the following equation: IOPk = 11.9 + 0.32(IOPs) − 0.05(Age).Conclusions: Scleral pneumatonometry correlates positively with corneal pneumatonometry and is more accurate at lower values and in younger patients. When adjusted for age, scleral pneumatonometry may be an adequate alternative in situations where corneal measurements are impractical.
Anterior Segment Optical Coherence Tomography of Long-Term Phakic Angle-Supported Intraocular Lenses – Corrected Proof
Purpose: To evaluate the long-term age-related anterior chamber changes by anterior segment optical coherence tomography (OCT) and the impact of such changes on the stability and behavior of angle-supported phakic intraocular lenses (IOLs).Design: A re…
Long-term Stability of Vascular Endothelial Growth Factor Suppression Time Under Ranibizumab Treatment in Age-Related Macular Degeneration – Corrected Proof
Purpose: To determine intra-individual long-term stability of vascular endothelial growth factor (VEGF) suppression time in eyes with neovascular age-related macular degeneration (AMD) treated with ranibizumab.Design: Nonrandomized, prospective clinica…
Selective Laser Trabeculoplasty Following Failed Combined Phacoemulsification Cataract Extraction and Ab Interno Trabeculectomy – Corrected Proof
Purpose: To assess the effect of selective laser trabeculoplasty (SLT) following failed phacoemulsification cataract extraction combined with ab interno trabeculectomy (AIT) using the Trabectome (phaco-trabectome).Design: Randomized, interventional case series.Methods: Retrospectively, the medical records of patients who underwent SLT between March 2010 and July 2012 by 1 surgeon at a single center after a failed phaco-AIT were evaluated. Inclusion criteria were age ≥18 years with no upper limit and prior failed phaco-AIT attributable to glaucoma progression. Exclusion criterion was performance of any additional glaucoma procedure with influence on intraocular pressure (IOP) during follow-up and a follow-up after surgery of <3 months. Success was defined by reduction of IOP of >3 mm Hg and 20% and number of antiglaucoma medications equal to or less than baseline. Main outcome measures were IOP, antiglaucoma medications, time to failure, and Kaplan-Meier survival curve.Results: Fourteen eyes of 13 subjects were included. Mean follow-up after SLT was 12.9 ± 8.7 months. Total laser energy was 59.5 ± 8.7 mJ. Baseline IOP was 17.9 ± 3.3 mm Hg and number of antiglaucoma medications at baseline was 2.0 ± 1.0. All SLT procedures failed. Median time to failure after SLT was 3.6 ± 0.8 (range 2.1-5.1) months. Number of antiglaucoma medications did not change.Conclusions: In eyes in which the IOP was no longer controlled following phaco-trabectome, SLT had a limited duration of significant IOP-lowering effect. Other alternatives, such as incisional filtration surgery, should be considered following failed phaco-trabectome.
Lifetime Risk of Blindness in Open-Angle Glaucoma – Corrected Proof
Purpose: To determine the lifetime risk and duration of blindness in patients with manifest open-angle glaucoma (OAG).Design: Retrospective chart review.Methods: We studied glaucoma patients who died between January 2006 and June 2010. Most glaucoma patients living in the catchment area (city of Malmö; n = 305 000) are managed at the Department of Ophthalmology at Skåne University Hospital in Malmö. From the patient records we extracted visual field status, visual acuity, and low vision or blindness as defined by the World Health Organization (WHO) criteria and caused by glaucoma at the time of diagnosis and during follow-up. We also noted age at diagnosis and death and when low vision or blindness occurred.Results: Five hundred and ninety-two patients were included. At the time of the last visit 250 patients (42.2%) had at least 1 blind eye because of glaucoma, while 97 patients (16.4%) were bilaterally blind, and 12 patients (0.5%) had low vision. Median time with a glaucoma diagnosis was 12 years (<1-29), median age when developing bilateral blindness was 86 years, and median duration of bilateral blindness was 2 years (<1-13). The cumulative incidences of blindness in at least 1 eye and bilateral blindness from glaucoma were 26.5% and 5.5%, respectively, after 10 years, and 38.1% and 13.5% at 20 years.Conclusions: Approximately 1 out of 6 glaucoma patients was bilaterally blind from glaucoma at the last visit. Median duration of bilateral blindness was 2 years.
Novel Technique for the Preparation of Corneal Grafts for Descemet Membrane Endothelial Keratoplasty – Corrected Proof
Purpose: To report a simple novel technique to facilitate preparation of Descemet membrane grafts for Descemet membrane endothelial keratoplasty (DMEK).Design: Laboratory investigation and retrospective, single-center, consecutive case series.Methods: Preparation of the endothelial graft is performed on an artificial anterior chamber, endothelial side up. After an incomplete circular superficial trephination, we describe a simple technique using a 27 gauge cannula to detach the Descemet membrane (DM). Endothelial cell density (ECD) was measured before dissection on 12 human corneas for research and 3 days after storage in organ culture. Histologic and electron microscopy analysis were performed. A DMEK was performed in 50 patients with Fuchs dystrophy. Visual acuity and ECD were evaluated 2 and 6 months after surgery.Results: ECD was 2765 ± 256 cells/mm2 on corneas for research before dissection and 2651 ± 305 cells/mm2 after 3 days in organ culture (P < .01). Histologic and electronic sections confirm that the cleavage was between DM and posterior stroma. Clinically, preparation of 2 corneas from a single donor was unsuccessful; 48 corneas were clear at 2 months and 47 at 6 months. At 2 months 77% of the patients had recovered a visual acuity of at least 20/30. At 6 months, 91.5% of the patients had a visual acuity of at least 20/30. ECD was 2656 ± 28 cells/mm2 (range: 2450-3100 cells/mm2) preoperatively, 1797 ± 41 cells/mm2 (range: 1100-2700 cells/mm2) at 2 months, and 1658 ± 43 cells/mm2 (range: 900-2600 cells/mm2) at 6 months.Conclusion: We report here a reliable and efficient technique for the preparation of pure Descemet membrane grafts.
Spontaneous Vitreous Hemorrhage in Children – Corrected Proof
Purpose: To determine the clinical profile, causes, and outcomes of “spontaneous” vitreous hemorrhage in children (<18 years).Design: Retrospective computer-assisted chart review.Methods: Charts of 124 eyes of 76 children who presented with nontraumatic, nonsurgical vitreous hemorrhage between 2002 and 2012 were reviewed. All children underwent an appropriate ocular and systemic examination. Data collected included demographics, visual acuity, cause of “spontaneous” vitreous hemorrhage, ocular and systemic findings at presentation and at last follow-up, investigations, management details, and visual outcomes.Results: The median age was 153.45 ± 56.19 months. There were 39 female and 37 male patients. Forty-eight patients had bilateral vitreous hemorrhage. The most common presenting complaints were diminished vision (96.45%) and behavioral changes (87.24%). The mean baseline BCVA in logMAR was 2.25 ± 1.11. The most common causes included vasculitis (34.6%) and hematologic disorders (27.4%). Patients were given medical therapy (topical and/or systemic) or underwent laser photocoagulation (29%) and/or surgery (55.6%). Twenty-nine eyes (23.3%) did not require any intervention. The mean number of surgeries was 1.89 ± 1.45 (range 1-4 surgeries). The mean final visual acuity was 0.76 ± 0.58 logMAR and was significantly better than the baseline (P < .001). The best anatomic and visual outcomes were seen in vasculitis, whereas congenital disorders such as retinoschisis had the worst.Conclusions: Spontaneous pediatric vitreous hemorrhage has a diverse etiology, vasculitis being the most common cause in our series. A comprehensive evaluation (systemic and ocular) is required to ensure that vision- and life-threatening conditions are not missed.
Evaluation of Corneal Microstructure in Keratoconus: A Confocal Microscopy Study – Corrected Proof
Purpose: To compare the corneal microstructure in patients with manifest keratoconus (KCN), subclinical KCN, and topographically normal relatives of patients with KCN and in healthy controls.Design: Prospective and cross-sectional study.Methods: We enrolled 145 subjects in the study. The participants were divided into 4 groups, based on clinical and topographical evaluation: the manifest KCN group (n = 30), the subclinical KCN group (n = 32), the KCN relatives group (n = 53), and the control group (n = 30). Corneal microstructure was assessed by corneal in vivo confocal microscopy in all of the individuals. Mean outcome measures were basal epithelial cell density, endothelial cell density, anterior keratocyte density, posterior keratocyte density, sub-basal nerve density, sub-basal nerve diameter, and stromal nerve diameter.Results: The mean basal epithelial cell density, endothelial cell density, and sub-basal nerve diameter were not significantly different among the 4 groups (P = 0.057, P = 0.592, and P = 0.393, respectively). The mean anterior and posterior stromal keratocyte densities were significantly lower in the manifest group, in the subclinical group, and in the relatives group when compared with the control group (for both parameters; P < 0.001, P < 0.001, and P< 0.001, respectively). The mean stromal nerve diameter in the manifest group, subclinical group, and relatives group was significantly higher than in the control group (P = 0.001, P = 0.049, and P = 0.004, respectively).Conclusion: The anterior and posterior stromal keratocyte densities were statistically lower and stromal nerve diameter was statistically higher in patients with manifest KCN, subclinical KCN, and topographically normal KCN relatives compared with controls. Confocal microscopy may be useful for the determination of early corneal microstructural changes before manifestation of typical or subtle topographic signs.
Role of Liquid Culture Media in the Laboratory Diagnosis of Microbial Keratitis – Corrected Proof
Purpose: To determine whether liquid culture media are helpful in the diagnosis of infectious keratitis.Design: Retrospective noncomparative case series.Subjects and Methods: This is a retrospective review of microbiology records of 114 corneal scraping samples from infectious keratitis patients. Samples were processed by corneal smear microscopy (potassium hydroxide with calcofluor white and Gram stains) and culture examination (5% sheep blood agar, sheep blood chocolate agar, Sabouraud dextrose agar, brain heart infusion, thioglycolate broth, and Robertson’s cooked meat broth. Cases where at least 1 liquid medium was taken were included in the study and all cases were required to have significant growth in culture as per the institutional criteria. Results of smear examination and culture growth were analyzed.Results: Out of 114 cases, 44 (38.59%) were bacterial, 62 (54.38%) fungal, and 8 (7.01%) were mixed (bacteria + fungus) infection. Thirty-eight out of 44 cases of bacterial keratitis (86.36%) were diagnosed by solid media alone (criterion 1) and 6 of 44 (13.63%) required liquid media for diagnosis (P < .001). In fungal keratitis, 61 of 62 cases (98.38%) were diagnosed using solid media alone (criterion 1) while 1 case required liquid media for diagnosis. In mixed infection, none of the cases required liquid media for diagnosis of fungal component; however, all 8 cases required liquid media for establishing bacterial component.Conclusions: Liquid culture media increase the chance of isolation of bacteria in pure bacterial and/or mixed infection; however, their role in isolating fungus is limited. Owing to overlap in clinical diagnosis of bacterial and fungal keratitis, we recommend inclusion of both solid and liquid culture media in the laboratory diagnosis of nonviral keratitis.
The Medicare Glaucoma Screening Benefit: A Critical Program That Misses its Target
In January 2002, United States (US) eye doctors celebrated what was perceived as a huge victory: Medicare’s first-time coverage of a screening benefit for an ocular disease, glaucoma. The benefit covers an annual dilated eye examination with an intraoc…
Impact of the Revised American Academy of Ophthalmology Guidelines Regarding Hydroxychloroquine Screening on Actual Practice
This letter refers to the article “Impact of the Revised American Academy of Ophthalmology Guidelines Regarding Hydroxychloroquine Screening in Actual Practice,” by Browning, and to the accompanying editorial by Marmor. The problem of defining cost…
Refractive Error after Cataract Surgery Combined with Descemet Stripping Automated Endothelial Keratoplasty
Purpose: To assess refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty using adjusted keratometric (K) readings to calculate intraocular lens (IOL) power.Design: Prospective, interventional case s…
Learning Strabismus Surgery: A Case-Based Approach
Media Type: Textbook Synopsis: Invaluable in its educational content, Learning Strabismus Surgery: A case-based approach provides general ophthalmology residents, fellows and practicing clinicians a view into the thought process of expert strabismus …
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We thank Galvis and associates for their interest in our article and their thoughtful comments. They suggested that the amount of change in corneal higher-order aberrations with age is less than that in total ocular higher-order aberrations, and cornea…
Effect of Timolol on Refractive Outcomes in Eyes With Myopic Regression After Laser In Situ Keratomileusis: A Prospective Randomized Clinical Trial
We perused with great interest the randomized controlled trial by Shojaei and associates, which studied the effect of timolol eye drops in refractive outcomes in eyes with myopic regression after laser in situ keratomileusis (LASIK). In this trial, the authors compared the outcomes of treating patients presenting with myopic regression following LASIK with timolol eye drops instilled twice a day to treatment by instilling artificial tear drops in an identical regime as placebo. The spherical equivalent was significantly better in the timolol (treatment) arm 6 months after treatment, and also 6 months after discontinuation of treatment (P < .001 for both comparisons). Based on these results, the authors concluded that instillation of timolol eye drops is effective for the treatment of myopic regression after LASIK and its effect seems to last for at least 6 months after discontinuation. The study design and statistical analysis were appropriate, but we do have the following observations to make.
Initiation of Anti-TNF Therapy and the Risk of Optic Neuritis: From the Safety Assessment of Biologic ThERapy (SABER) Study
I read with interest the article “Initiation of anti-TNF therapy and the risk of optic neuritis: from the safety assessment of biologic ThERapy (SABER) Study”; however, I have some hesitation about drawing major conclusions from this experience.
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We would like to thank Dr Sharma and his associates for their interest in our paper. We also appreciate them for noticing the typographical errors in our paper. They noted that the logMAR values reported in Table 5 should have been written as positive…
Ocular Torsion among Patients with Intermittent Exotropia: Relationships with Disease Severity Factors
We read the article “Ocular Torsion among Patients with Intermittent Exotropia: Relationships with Disease Severity Factors,” by Shin and associates, with interest. We would like to congratulate the authors on this excellent study. It is a laudable…