Author: Ophthalmology

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We appreciate the interest of Galvis et al in our paper. Clinically observed incidence of endothelial immune rejection seems to be recognized as the final result of sustained immune rejection. Endothelial immune rejection response is a process from th…

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This Issue At A Glance

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Can ionizing radiation be used as an adjunctive treatment for neovascular age-related macular degeneration (AMD)? In the INTREPID study of low-voltage, external-beam, stereotactic radiotherapy (SRT), Jackson et al (p. 1893) found that SRT can signific…

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A Simple Vista en Este Número

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¿Puede utilizarse la radiación ionizante como tratamiento adyuvante para la degeneración macular relacionada con la edad (AMD)? En el estudio INTREPID de radioterapia estereotáctica (SRT) de haz externo de bajo voltaje, Jackson y otros (p. 1893) de…

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Erratum

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With apologies from the publisher, in the Report entitled, “Adaptive optics imaging of idiopathic epiretinal membranes” which printed in the July 2013 issue (Ophthalmology 2013;120:1508-9), the affiliation Fondazione G.B. Bietti IRCCS, Rome, Italy …

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期刊一览

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电离辐射可被用于新生血管性年龄相关性黄斑变性(AMD)的辅助治疗吗？在INTREPID研究中，Jackson (p. 1893) 等人采用低压、外照射放疗(SRT)，发现SRT能显著减少AMD患者重复进行玻璃体腔ranibizumab注射

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Quantitative Classification of Eyes with and without Intermediate Age-related Macular Degeneration Using Optical Coherence Tomography – Corrected Proof

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Objective: To define quantitative indicators for the presence of intermediate age-related macular degeneration (AMD) via spectral-domain optical coherence tomography (SD-OCT) imaging of older adults.Design: Evaluation of diagnostic test and technology.Participants and Controls: One eye from 115 elderly subjects without AMD and 269 subjects with intermediate AMD from the Age-Related Eye Disease Study 2 (AREDS2) Ancillary SD-OCT Study.Methods: We semiautomatically delineated the retinal pigment epithelium (RPE) and RPE drusen complex (RPEDC, the axial distance from the apex of the drusen and RPE layer to Bruch’s membrane) and total retina (TR, the axial distance between the inner limiting and Bruch’s membranes) boundaries. We registered and averaged the thickness maps from control subjects to generate a map of “normal” non-AMD thickness. We considered RPEDC thicknesses larger or smaller than 3 standard deviations from the mean as abnormal, indicating drusen or geographic atrophy (GA), respectively. We measured TR volumes, RPEDC volumes, and abnormal RPEDC thickening and thinning volumes for each subject. By using different combinations of these 4 disease indicators, we designed 5 automated classifiers for the presence of AMD on the basis of the generalized linear model regression framework. We trained and evaluated the performance of these classifiers using the leave-one-out method.Main Outcome Measures: The range and topographic distribution of the RPEDC and TR thicknesses in a 5-mm diameter cylinder centered at the fovea.Results: The most efficient method for separating AMD and control eyes required all 4 disease indicators. The area under the curve (AUC) of the receiver operating characteristic (ROC) for this classifier was >0.99. Overall neurosensory retinal thickening in eyes with AMD versus control eyes in our study contrasts with previous smaller studies.Conclusions: We identified and validated efficient biometrics to distinguish AMD from normal eyes by analyzing the topographic distribution of normal and abnormal RPEDC thicknesses across a large atlas of eyes. We created an online atlas to share the 38 400 SD-OCT images in this study, their corresponding segmentations, and quantitative measurements.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Neutrophil Collagenase, Gelatinase, and Myeloperoxidase in Tears of Patients with Stevens-Johnson Syndrome and Ocular Cicatricial Pemphigoid – Corrected Proof

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Objective: To investigate the levels of matrix metalloproteinases (MMPs), myeloperoxidase (MPO), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in tears of patients with Stevens-Johnson syndrome (SJS) and ocular cicatricial pemphigoid (OCP).Design: Prospective, noninterventional cohort study.Participants: Four SJS patients (7 eyes), 19 OCP patients (37 eyes), and 20 healthy controls who underwent phacoemulsification (40 eyes).Methods: Tear washes were collected from all patients and were analyzed for levels of MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, MPO, and TIMP-1 using multianalyte bead-based enzyme-linked immunosorbent assays. Total MMP activity was determined using a fluorometric assay. Correlation studies were performed between the various analytes within study groups.Main Outcome Measures: Levels of MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, MPO, and TIMP-1 (in nanograms per microgram of protein) and total MMP activity (in relative fluorescent units per minute per microgram of protein) in tears; MMP-8–to–TIMP-1 ratio; MMP-9–to–TIMP-1 ratio; and the correlations between MMP-8 and MMP-9 and both MMP and MPO.Results: MMP-8, MMP-9, and MPO levels were elevated significantly in SJS and OCP tears (SJS>OCP) when compared with controls. The MMP activity was highest in SJS patients, whereas OCP patients and controls showed lower and similar activities. The TIMP-1 levels were decreased in SJS and OCP patients when compared with those in controls, with levels in OCP patients reaching significance. The MMP-8–to–TIMP-1 and MMP-9–to–TIMP-1 ratios were markedly elevated in SJS and OCP tears (SJS>OCP) when compared with those of controls. Across all study groups, MMP-9 levels correlated strongly with MMP-8 and MPO levels, and MMP-8 correlated with MPO, but it did not reach significance in SJS patients. There was no relationship between MMP-7 and MPO.Conclusions: Because MMP-8 and MPO are produced by inflammatory cells, particularly neutrophils, the correlation data indicate that they may be the common source of elevated enzymes, including MMP-9, in SJS and OCP tears. Elevated MMP-to-TIMP ratios and MMP activity suggest an imbalance in tear MMP regulation that may explain the predisposition of these patients to demonstrate corneal melting and chronic complications associated with persistent inflammation. Myeloperoxidase in tears may be a sensitive and specific marker for the quantification of ocular inflammation.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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