Posterior Iris-claw Aphakic Intraocular Lens Implantation in Children is an interesting article. The authors have rightly pointed out that many complications of anterior iris claw aphakic intraocular lenses (IOL) are avoided. However, potentially the m…
Author: Am J Ophthalmol
Long-term Outcomes in Ranibizumab-Treated Patients With Retinal Vein Occlusion; The Role of Progression of Retinal Nonperfusion
Purpose: To determine the percentage of ranibizumab-treated patients with retinal vein occlusion (RVO) who had resolution of edema for at least 6 months after the last injection, along with factors and outcomes that correlate with resolution.Design: Post hoc analysis of open-label clinical trial.Methods: Twenty patients with branch RVO (BRVO) and 20 with central RVO (CRVO) received ranibizumab monthly for 3 months and as needed for recurrent/persistent macular edema, no more frequently than every 2 months. Patients still requiring injections after month 40 received scatter and grid laser photocoagulation to try to reduce the need for injections. Main outcome measures included the percentage of patients who had resolution of edema, change in best-corrected visual acuity (BCVA) from baseline, and change in area of retinal nonperfusion in central subfields.Results: Nine patients with BRVO (45%) had edema resolution from injections alone after a mean of 20.2 months, 4 resolved after addition of laser, 4 were unresolved through 72 months, and 3 exited prior to resolution. Five patients with CRVO (25%) resolved from injections alone after a mean of 14.0 months, 8 remained unresolved through 72 months despite addition of laser, and 7 exited prior to resolution. For BRVO or CRVO, there was a negative correlation between posterior retinal nonperfusion area and BCVA at months 18, 24, and 36 (P < .05).Conclusions: In patients with RVO, infrequent ranibizumab injections to control edema may not be sufficient to prevent progression of retinal nonperfusion, which may contribute to loss of visual gains.
Reporting Visual Acuities
The AJO encourages authors to report the visual acuity in the manuscript using the same nomenclature that was used in gathering the data provided they were recorded in one of the methods listed here. This table of equivalent visual acuities is provided…
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We appreciate the thoughtful comments of Rath and associates and agree with their assessment of the limitations of our study. We intended to examine the diagnostic yield and therapeutic benefit of nonquantitative polymerase chain reaction (PCR) in the …
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We appreciate the comments of García-González and Teus on our article. In the study cohort, less than 17% of the patients were dissatisfied with the outcome. It is to be noticed that the Parinaud (p) scale is a measurement at 33 cm (not at 35 cm as…
Uncorrected Binocular Performance after Biaspheric Ablation Profile (PresbyMAX) for Presbyopic Corneal Treatment
Surgical correction of presbyopia continues to be one of the biggest challenges for refractive surgeons. We have read with great interest the article by Baudu and associates about the postoperative binocular visual results of LASIK using PresbyMAX, a c…
The Diagnostic Utility of Anterior Chamber Paracentesis for Polymerase Chain Reaction in Anterior Uveitis
We read with interest the article by Anwar and associates on diagnostic utility of polymerase chain reaction (PCR) in anterior uveitis. The study addresses an important diagnostic challenge in the management of infectious anterior uveitis. However, it …
Leprosy and the Germ Theory
The germ theory of disease, one of the great accomplishments of science, was not established for two centuries after Anton van Leeuenhoek in 1674 saw microscopic, motile “animalcules” in stagnant pond water. These were relatively large single-celle…
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Thank you very much, Dr. Khawaja Khalid Shoaib, for your interest in our article, Posterior Iris-claw Aphakic Intraocular Lens Implantation in Children. We agree with Dr. Shoaib regarding the rather short 31-month average follow-up in our study. The…
Relationship between Systemic Cytokines and Complement Factor H Y402H Polymorphism in Patients With Dry Age-Related Macular Degeneration – Corrected Proof
Purpose: To investigate the relationship between systemic cytokines, the complement factor H (CFH) Y402H polymorphism, drusen load, and subfoveal choroidal thickness in patients with dry age-related macular degeneration (AMD).Design: Cross-sectional study.Methods: Forty-four dry AMD patients under care of the Retina Service at the University of British Columbia were enrolled. Drusen load was measured with an automated software algorithm in spectral-domain optical coherence tomography; subfoveal choroidal thickness was measured manually using enhanced depth imaging. Bio-Plex suspension assays (Bio-Rad Laboratories) were used to analyze cytokines in plasma and CFH Y402H was genotyped. Statistical analyses included analysis of covariance and Pearson correlation, corrected for multiple comparisons.Results: The levels of 3 of 4 studied cytokines were significantly different among patients with CC, CT, or TT variants of the CFH Y402H polymorphism (P < .01). Patients with the at-risk CC variant had higher systemic levels of interleukin-6, interleukin-18, and tumor necrosis factor α than those with the CT variants, the TT variant, or both (P < .01). Interleukin-1β did not reach significance (P = .02), but did demonstrate a consistent trend. No correlation was found between plasma cytokines and drusen load or choroidal thickness (all P > .15).Conclusions: The elevated systemic levels of selected proinflammatory cytokines, including those representing products of inflammasome activation, were associated with the CC at-risk variant of the Y402H polymorphism and suggest that genetic factors regulate the inflammatory status in dry AMD patients. Our data support the central role of inflammation in the pathogenesis of AMD and provide further evidence of a systemic involvement in AMD etiology.
Cost-Effectiveness of Osteo-Odonto Keratoprosthesis in Singapore – Corrected Proof
Purpose: To determine the long-term cost-effectiveness of osteo-odonto keratoprosthesis (OOKP) relative to no treatment among patients with end-stage corneal and ocular surface diseases in Singapore.Design: Cost-effectiveness analysis based on data fro…
The Effect of Enoxaparin-Containing Irrigation Fluid Used During Cataract Surgery on Postoperative Inflammation in Patients With Diabetes – Corrected Proof
Purpose: To investigate effects of enoxaparin on postoperative inflammation in patients with moderate nonproliferative diabetic retinopathy (NPDR) and nuclear cataract.Design: Prospective masked controlled trial.Methods: setting: Institutional practice. study population: The study included 51 eyes of 51 diabetes mellitus (DM) patients with moderate NPDR and grade 2-3 nuclear cataracts. Group 1 included randomly selected patients who received enoxaparin in balanced salt solution (BSS) during cataract surgery, while standard BSS was used in Group 2. observation procedure: Patients were followed up 1 day, 1 week, and 1 and 2 months after the surgery. main outcome measures: Anterior chamber cell and flare.Results: Postoperatively, 20 patients from Group 1 and 4 patients in Group 2 had less than a mean of 10 cells at day 1 (P = .012). At the first week, 20 patients from Group 1 and 10 patients from Group 2 had less than a mean of 10 cells (P = .004). When compared for flare, 20 patients from Group 1 and 8 patients from Group 2 had a flare between 0 and +1 at postoperative day 1 (P < .001). By the end of postoperative first week, 24 patients from Group 1and 18 patients from Group 2 had a flare between 0 and +1 (P = .012). There was no difference between groups in terms of postoperative inflammation at the first and second months after the surgery.Conclusion: The results of the study suggest that enoxaparin added into the infusion fluid may reduce postoperative inflammation in patients with DM, and this result supports the anti-inflammatory effect of enoxaparin.
Retinal Asymmetry in Children Measured With Optical Coherence Tomography – Corrected Proof
Purpose: To determinate the physiological asymmetry of retinal measurements in the pediatric population with Fourier-domain optical coherence tomography (Cirrus HD-OCT).Design: Prospective cross-sectional study.Methods: Three hundred and fifty-seven he…
Expanding the Cone Location and Magnitude Index to Include Corneal Thickness and Posterior Surface Information for the Detection of Keratoconus – Corrected Proof
Purpose: To extend the capabilities of the Cone Location and Magnitude Index algorithm to include a combination of topographic information from the anterior and posterior corneal surfaces and corneal thickness measurements to further improve our abilit…
Evaluating the Accuracy of the Visual Field Index for the Humphrey Visual Field Analyzer in Patients with Mild to Moderate Glaucoma – Corrected Proof
Purpose: To evaluate the accuracy of the visual field index (VFI) for the Humphrey Visual Field Analyzer in a population of patients with mild to moderate glaucoma.Design: Retrospective cohort study.Methods: The study included 42 patients (61 eyes) with at least 11 years of follow-up, and annual automated visual fields (VFs). Patients with mean deviations ≤−20 dB were excluded. All unreliable fields were omitted (fixation losses ≥20%, false-positive ≥15%, false-negative ≥33%). The VFs were divided into two 5-year series and the data were analyzed by the new Humphrey Visual Field Analyzer software. Projected VFIs from the first 5 years were compared with observed values obtained from the last 5 years. Unreliable fields initially excluded were reintroduced into the series (22 eyes) to create a comparison.Results: Predicted VFIs were accurate with a mean overestimation of VF deterioration of 1.37% (95% CI: −0.22%, 2.96%). Of the predicted values, 95% were between −4.5% and 5.2% of the observed values when the predicted VFI was ≥90%; and between −13.8% and 20.5% when the predicted VFI was <90%. No statistical difference was found between the reliable and unreliable series (mean difference of 0.09% [95% CI: −0.41%, 0.59%]).Conclusion: The new software for the Humphrey Visual Field Analyzer projects an accurate value for patients when the predicted VFI is ≥90%. Clinicians should consider the limitations of the software, especially for those patients with greater initial VF loss.
Reticular Pattern Dystrophy of the Retina: A Spectral-Domain Optical Coherence Tomography Analysis – Corrected Proof
Purpose: To analyze the outer retinal and retinal pigment epithelium (RPE) features of reticular pattern dystrophy of the retina using spectral-domain optical coherence tomography (SDOCT).Design: Retrospective observational case series.Methods: Consecu…
Macular Ganglion Cell/Inner Plexiform Layer Measurements by Spectral Domain Optical Coherence Tomography for Detection of Early Glaucoma and Comparison to Retinal Nerve Fiber Layer Measurements – Corrected Proof
Purpose: To evaluate the performance of ganglion cell layer/inner plexiform layer (GCL/IPL) measurements with spectral-domain optical coherence tomography (Cirrus HD-OCT) for detection of early glaucoma and to compare results to retinal nerve fiber layer (RNFL) measurements.Design: Cross-sectional prospective diagnostic study.Methods: We enrolled 99 subjects, including 59 eyes with glaucoma (47 subjects) (mean deviation >−6.0 dB) and 91 normal eyes (52 subjects). Patients underwent biometry and peripapillary and macular OCT imaging. Performance of the GCL/IPL and RNFL algorithms was evaluated with area under receiver operating characteristic curves (AUC), likelihood ratios, and sensitivities/specificities adjusting for covariates. Combination of best parameters was explored.Results: Average (SD) mean deviation in the glaucoma group was −2.5 (1.9) dB. On multivariate analyses, age (P < 0.001) and axial length (P = 0.03) predicted GC/IPL measurements in normal subjects. No significant correlation was found between average or regional GC/IPL thickness and respective outer retina (OR) thickness measurements (P > 0.05). Average RNFL thickness performed better than average GCL/IPL measurements for detection of glaucoma (AUC = 0.964 vs 0.937; P = 0.04). The best regional measures from each algorithm (inferior quadrant RNFL vs minimum GCL/IPL) had comparable performances (P = 0.78). Entering the GC/IPL to OR ratio into prediction models did not enhance the performance of the GCL/IPL measures. Combining the best parameters from each algorithm improved detection of glaucoma (P = 0.04).Conclusions: Regional GCL/IPL measures derived from Cirrus HD-OCT performed as well as regional RNFL outcomes for detection of early glaucoma. Using the GC/IPL to OR ratio did not enhance the performance of GCL/IPL parameters. Combining the best measures from the 2 algorithms improved detection of glaucoma.
The Association between Cataract Surgery and Atypical Antipsychotic Use: A Nested Case-Control Study – Corrected Proof
Purpose: To investigate cataract risk associated with the use of atypical antipsychotics.Design: Retrospective, nested case-control study.Methods: A large health claims database (The British Columbia Ministry of Health Databases) from British Columbia,…
Prognostic Factors of Eyes With Naïve Subfoveal Myopic Choroidal Neovascularization After Intravitreal Bevacizumab – Corrected Proof
Purpose: To determine the efficacy of 1 intravitreal bevacizumab injection followed by pro re nata (1 + PRN) injection in cases of subfoveal myopic choroidal neovascularization (CNV) and to identify CNV-recurrence–related prognostic factors.Design: Retrospective observational case series.Methods: In total, 103 eyes of 89 consecutive naive patients who had subfoveal myopic CNV and had been followed-up for at least 2 years were included. Of those eyes, 24 had recurrences. The remaining eyes were stable after the initial treatment.Results: The average patient age was 51.1 ± 15.2 years. The average follow-up duration was 44.1 ± 12.7 months. At baseline and at the 1-year, 2-year, and final visits, the average best corrected visual acuities (BCVAs) were 0.57 ± 0.45, 0.38 ± 0.51, 0.40 ± 0.52, and 0.41 ± 0.41 logMAR, respectively. The recurrence rate during follow-up was 23.3%. The BCVA improved by 0.2 logMAR after 2.7 injections in the eyes without recurrence but by only 0.08 logMAR after 6.9 injections in the eyes with recurrence. In univariate analysis, recurrence was associated with older age, more myopic refraction, thinner choroid, larger CNV lesions, and subfoveal hemorrhage at baseline. In multivariate analysis, only baseline CNV lesion size associated significantly with CNV recurrence (P = 0.002). Recurrence, baseline BCVA, choroidal thickness, and CNV size associated significantly with final BCVA (P = 0.026, <0.0001, 0.007, and 0.002, respectively). Baseline choroidal thickness, CNV size, age, and presence of lacquer cracks associated significantly with injection number (P < 0.0001, <0.0001, 0.026, and 0.035, respectively).Conclusions: 1 + PRN intravitreal bevacizumab monotherapy effectively stabilized subfoveal myopic CNV. The CNV size, the baseline BCVA, and the choroidal thickness were the main prognostic factors of subfoveal myopic CNV after 1 + PRN injection of bevacizumab.