Author: Am J Ophthalmol

Clinical Manifestations of Patients with Intraocular Inflammation and Positive QuantiFERON–TB Gold In-Tube Test in a Country Non-endemic for Tuberculosis – Accepted Manuscript

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Abstract: Purpose: To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON–TB test Gold In-Tube (quantiferon) in a country not endemic for tuberculosis.Design: Multicentre retrospective co…

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A Multicenter, Open-Label, 52-Week Study of 2% Rebamipide (OPC-12759) Ophthalmic Suspension in Patients with Dry Eye – Accepted Manuscript

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Abstract: Purpose: To investigate the efficacy and safety of 2% rebamipide ophthalmic suspension administered 4 times daily for 52 weeks in patients with dry eye.Design: Multicenter (17 sites), open-label single-arm study.Methods: A total of 154 patients with dry eye were enrolled in this study. After a 2-week screening period, patients received 2% rebamipide, instilled as 1 drop in each eye, 4 times daily for 52 weeks. The signs and symptoms measures were assessed at baseline, at weeks 2 and 4, and at every 4 weeks thereafter. The objective signs were fluorescein corneal staining score, lissamine green conjunctival staining score, and tear film break-up time, while subjective symptoms were dry eye-related ocular symptoms (foreign body sensation, dryness, photophobia, eye pain, and blurred vision). The safety variable was the occurrence of adverse events.Results: For all objective signs and subjective symptoms, the scores significantly improved at week 2 compared with at baseline (P < .001, paired t-test). Interestingly, further improvements of those scores were observed at every visit up to week 52. No deaths were reported, yet serious adverse events which were not thought to be drug-related were observed in 6 patients. Incidence of any of the adverse events did not markedly increase throughout the 52-week treatment period.Conclusion: The results of this study show that 2% rebamipide was effective in improving both the objective signs and subjective symptoms of dry eye patients for at least 52 weeks. In addition, 2% rebamipide treatment was generally well-tolerated.

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A Method to Estimate the Amount of Neuroretinal Rim Tissue in Glaucoma: Comparison with Current Methods for Measuring Rim Area – Accepted Manuscript

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Abstract: Purpose: To test whether the minimum rim area assessed by spectral domain optical coherence tomography (SD-OCT), based on the shortest distance from Bruch’s Membrane Opening (BMO) to the inner limiting membrane, corresponds more closely to retinal nerve fiber layer (RNFL) thickness and visual field mean deviation (MD) than current rim measures in early glaucoma.Design: Prospective cross-sectional study.Methods: 221 participants with non-endstage glaucoma or high-risk ocular hypertension performed standard automated perimetry, and received SD-OCT and confocal scanning laser ophthalmoscopy (CSLO) scans, on the same day. Rim area measured by CSLO was compared with three SD-OCT rim measures from radial B-scans: horizontal rim area between BMO and ILM within the BMO plane; mean minimum rim width (BMO-MRW); and minimum rim area (BMO-MRA) optimized within sectors and then summed. Correlations between these measures and either MD from perimetry or RNFL thickness from SD-OCT were compared using Steiger’s test.Results: RNFL thickness was better correlated with BMO-MRA (r=0.676) or BMO-MRW (r=0.680) than with either CSLO Rim Area (r=0.330, p<0.001) or Horizontal Rim Area (r=0.482, p<0.001).MD was better correlated with BMO-MRA (r=0.534) or BMO-MRW (r=0.546) than with either CSLO Rim Area (r=0.321, p<0.001) or Horizontal Rim Area (0.403, p<0.001). The correlation between MD and RNFL thickness was r=0.646.Conclusions: Minimum rim measurements from SD-OCT are significantly better correlated to both RNFL thickness and MD than rim measurements within the BMO plane, or based on the clinical disc margin. They provide new structural parameters for both diagnostic and research purposes in glaucoma.

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Imaging the Posterior Segment of the Eye using Swept-Source Optical Coherence Tomography in Myopic Glaucoma Eyes: Comparison with Enhanced-Depth Imaging – Accepted Manuscript

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Abstract: Purpose: To compare the detection rates of identifying the posterior border of the sclera and lamina cribrosa and measurement reproducibility of scleral and laminar thicknesses using enhanced depth imaging (EDI) of Heidelberg Spectralis optic…

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Randomized, Prospective, Comparative Trial of EX-PRESS Glaucoma Filtration Device versus Trabeculectomy (XVT Study) – Corrected Proof

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Purpose: To compare the clinical outcomes of the EX-PRESS glaucoma filtration device placed under a partial-thickness scleral flap with trabeculectomy.Design: Randomized, prospective, multicenter trial.Methods: A total of 120 eyes in 120 subjects were analyzed, including 59 eyes treated with EX-PRESS and 61 eyes treated with trabeculectomy. Both the EX-PRESS and the trabeculectomy groups were treated intraoperatively with mitomycin C and followed postoperatively for 2 years. Surgical success was defined as 5 mm Hg ≤ intraocular pressure ≤ 18 mm Hg, with or without medications, without further glaucoma surgery.Results: Mean intraocular pressure was significantly reduced compared with baseline in both groups (P < 0.001). Average intraocular pressure and number of medications were similar in both groups during follow-up, with mean intraocular pressure at 2 years after surgery of 14.7 ± 4.6 mm Hg and 14.6 ± 7.1 mm Hg in the EX-PRESS and trabeculectomy groups, respectively (P = 0.927). At 2 years after surgery, the success rate was 83% and 79% in the EX-PRESS and trabeculectomy groups, respectively (P = 0.563). Although visual acuity (logMAR) was significantly decreased on day 1 in both groups, the vision was not significantly different compared with baseline at 1 month after EX-PRESS implant (P = 0.285) and 3 months after trabeculectomy (P = 0.255). The variance of early postoperative intraocular pressure values was similar between groups on the first postoperative day but higher after trabeculectomy compared with EX-PRESS implant on day 7 (P = 0.003). The total number of postoperative complications was higher after trabeculectomy than after EX-PRESS implantation (P = 0.013).Conclusions: Mean intraocular pressures, medication use, and surgical success were similar at 2 years after treatment with the EX-PRESS device and trabeculectomy. Vision recovery between groups was also similar throughout the study, although return to baseline vision was more rapid in the EX-PRESS group. Intraocular pressure variation was lower during the early postoperative period, and postoperative complications were less common after EX-PRESS implantation compared with trabeculectomy.

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Impact of Crystalline Lens Opacification on Effective Phacoemulsification Time in Femtosecond Laser-Assisted Cataract Surgery – Corrected Proof

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Purpose: To compare effective phacoemulsification time in cataract surgery performed by manual phacoemulsification vs femtosecond laser-assisted lens fragmentation.Design: Retrospective, consecutive, nonrandomized, comparative case series.Methods: The setting was the Department of Ophthalmology, Goethe-University, Frankfurt, Germany. The study population included 150 eyes of 86 patients with senile cataract. In the intervention, 88 eyes (group 1) underwent femtosecond laser-assisted surgery (corneal incisions, capsulotomy, lens fragmentation) using the LenSx platform (Alcon) and residual lens work-up with pulsed ultrasound energy (Infiniti Vision System; Alcon). In 62 eyes (group 2), complete cataract removal was performed with phacoemulsification only, using pulsed ultrasound energy with the same device (Infiniti). Nucleus staging (Pentacam nucleus staging; PNS) was evaluated using Pentacam HR (Oculus); endothelial cell density was measured using specular microscopy (NonCon Robo). The main outcome measures were as follows. Mean preoperative PNS staging was assessed using an automatic ordinal scaling (PNS-O, grades 0–5) and a manually defined density grid derived from Scheimpflug imaging (PNS-P [%]). Effective phacoemulsification time and endothelial cell loss were evaluated in both groups.Results: Preoperative PNS-O and PNS-P showed no significant difference between groups (P = 0.267). Overall mean effective phacoemulsification time was significantly lower in group 1 (1.58 ± 1.02 seconds) compared to 4.17 ± 2.06 seconds in group 2 (P = 0.001). Effective phacoemulsification time was significantly lower in group 1 for all PNS-O stages (P < 0.001). With increasing preoperative PNS-P, effective phacoemulsification time increased in both groups; however, this gain was noticeably, but not significantly, lower in group 2. Endothelial cell loss was significantly lower in group 1 (P = 0.02).Conclusions: Femtosecond laser-assisted cataract surgery allows a significant reduction in effective phacoemulsification time, which correlates positively with the preoperative lens opacity.

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A multivariate analysis and statistical model for predicting visual acuity and keratometry one year after crosslinking for keratoconus – Accepted Manuscript

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Abstract: Purpose: To investigate putative prognostic factors for predicting visual acuity and keratometry one year following corneal cross-linking (CXL) for treating keratoconus.Design: Prospective cohort study.Methods: This study included all consecutively treated keratoconus patients (102 eyes) in one academic treatment centre, with minimal one-year follow-up following CXL. Primary treatment outcomes were corrected distance visual acuity (logMAR CDVA) and maximum keratometry (Kmax). Univariable analyses were performed to determine correlations between baseline parameters and follow-up measurements. Correlating factors (P≤0.20) were then entered into a multivariable linear regression analysis, and a model for predicting CDVA and Kmax was created.Results: Atopic constitution, positive family history and smoking were not independent factors affecting CXL outcomes. Multivariable analysis identified cone eccentricity as a major factor for predicting Kmax outcome (ß-coefficient 0.709, P 0.02), whereas age, gender and baseline keratometry were not independent contributors. Post-treatment visual acuity could be predicted based on pre-treatment visual acuity (ß-coefficient -0.621, P <0.01, R2 0.45). Specifically, a low visual acuity predicts visual improvement. A prediction model for Kmax did not accurately estimate treatment outcomes (R2 0.15).Conclusions: Our results confirm the role of cone eccentricity with respect to the improvement of corneal curvature following CXL. Visual acuity outcome can be predicted accurately based on pre-treatment VA. Age, gender and Kmax are debated as independent factors for predicting the outcome of treating keratoconus with CXL.

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Optic disc planimetry, corneal hysteresis, central corneal thickness and intraocular pressure as risk factors for glaucoma – Accepted Manuscript

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Abstract: Purpose: To determine whether corneal hysteresis and central corneal thickness are independent risk factors for glaucoma.Design: This was a cross-sectional population based cohort study.Methods: Associations were tested between corneal hysteresis, measured in 1754 population-based subjects from the TwinsUK cohort, and glaucoma-related endophenotypes, including intraocular pressure (IOP), vertical cup to disc ratio, optic disc area and optic disc cup area. Corneal hysteresis, IOP and Central Corneal Thickness (CCT) were measured using the Ocular Response Analyser (ORA-Reichert® Buffalo, NY). Optic disc photographs were analysed using the Stereo DX program. Multivariable linear regression analysis was performed using STATA software.Results: Data was available on 1645 individuals. Multiple regression analysis showed corneal hysteresis to be significantly negatively associated with age (beta coefficient = -0.03, p <0.00005) and IOP (beta coefficient = -0.06, p< 0.00005). Corneal hysteresis was also found to be associated with CCT (beta coefficient =0.02, p<0.0005). There was no significant association between corneal hysteresis and optic disc area (p=0.6), cup area (p=0.77), vertical cup to disc ratio (p=0.51), or spherical equivalent (p=0.08). CCT was also found to be significantly associated with IOP (beta coefficient =3.3, p<0.0005) and corneal hysteresis (beta coefficient = 9.4, p<0.0005), but not with age (p=0.59 or spherical equivalent (p=0.16).Conclusion: In this large cohort of healthy British twins, we found no relationship between corneal hysteresis or CCT and quantitative measures of optic disc cupping, suggesting that corneal hysteresis and CCT are not independent risk factors for glaucoma.

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Corneal changes in Xeroderma Pigmentosum: a clinicopathological Report – Accepted Manuscript

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Abstract: Purpose: To report the clinicopathological features of corneal involvement in patients with Xeroderma pigmentosum.Design: Retrospective review of corneal histopathology.Methods: Thirteen corneal specimens of 11 patients with Xeroderma pigmentosum who underwent keratoplasty (lamellar/full- thickness) for corneal involvement were studied. Five microns thick sections were made from all the samples and stained using Hematoxylin & Eosin (H & E) and Periodic Acid Schiff (PAS) stains. A light microscopic examination was performed to study the histopathological changes.Results: The corneal findings on clinical examination were haze, scarring, vascularization, stromal edema, pigment clumps on endothelial surface and corneal thinning. The histopathological evaluation revealed changes in all layers of cornea. Epithelial changes seen were intraepithelial edema, fibrosis, epithelial downgrowths and pannus formation. Bowman’s membrane was fragmented or absent. Stroma was characterized by alteration in the lamellar pattern, scarring, edema, loss of keratocytic nuclei and calcification. Descemet membrane was thickened to variable extent in most specimens and there was marked loss of endothelial cells in all.Conclusion: Most histological features are consistent with the previous few reports. The remarkable finding in all corneal specimens was moderate to severe degree of loss of the endothelial cells. This noteworthy finding supports the Ultraviolet (UV) radiation induced endothelial cell damage in these patients. This has an important clinical implication when planning for anterior lamellar keratoplasty, as endothelial cell density may be subnormal in these patients.

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