多中心葡萄膜炎激素治疗试验(MUST)的报告中，Friedman (p. 1571) 等人分析了2年随访中，患者眼压(IOP)升高及视神经损害的发病率，这些患者为非感染性中间葡萄膜炎、后葡萄膜炎或全葡萄膜炎患
Author: Ophthalmology
Faster Is Better
A pervasive advertisement on American television asserts that “faster is better” in the world of cellular telephones. With the assumption that cost and reliability are comparable and reasonable, few would disagree that speed is good. When it comes …
This Issue At A Glance
In a report from the Multicenter Uveitis Steroid Treatment (MUST) Trial, Friedman et al (p. 1571) analyzed the 2-year incidence of raised intraocular pressure (IOP) and optic nerve damage in patients who had noninfectious intermediate, posterior, or p…
Contents
A Simple Vista en Este Número
En un informe del Estudio Multicentro de Tratamiento de Uveítis con Esteroides (MUST), Friedman y otros (p. 1571) analizaron la incidencia a 2 años de aumento de la presión intraocular (IOP) y daño del nervio óptico en pacientes con uveítis poste…
MRI Brain Scans in Two Patients with the Argus II Retinal Prosthesis
The Argus II retinal prosthesis for improving the visual function of patients with end-stage retinitis pigmentosa (Second Sight Medical Products) received its Conformité Européenne marking in March 2011, and US Food and Drug Administration approval a…
Author reply
We thank Perry et al for their interest in our paper and for sharing their experience with the transcaruncular approach. We entirely agree that, in experienced hands, the approach can provide adequate exposure of the orbital apex in the majority of ca…
Treatment of CIN with Retinoic Acid and Topical Interferon Alfa-2b
I have read with interest the recent report from Krilis et al about topical treatment of conjunctiva-cornea intraepithelial neoplasia (CIN) using a combination of 1 million IU/ml topical interferon (INF)-α2b drops 4 times daily and 0.01% retinoic aci…
Dominant Optic Atrophy: Novel OPA1 Mutations and Revised Prevalence Estimates
Autosomal-dominant optic atrophy (DOA) is the most common inherited optic nerve disorder seen in clinical practice. So far, 2 causative genes have been identified in patients with DOA; OPA1, which accounts for 50%–60% of cases, and OPA3, which is rel…
Endoscope an Adjunct Rather than Alternative
We read with interest the article by Wu et al describing endoscopic transcaruncular repair of posterior medial orbital wall fractures. Although we agree that an endoscope introduced through an external incision may offer magnified visualization of the…
Appearance of Regressing Drusen on Optical Coherence Tomography in Age-related Macular Degeneration – Corrected Proof
Objective: To describe and interpret a multilaminar sub-retinal pigment epithelium (RPE) intense hyper-reflectivity observed in vivo in eyes clinically diagnosed with regressing drusen.Design: Observational case series.Participants: Twenty-three conse…
Dexamethasone Implant Anterior Chamber Migration: Risk Factors, Complications, and Management Strategies – Corrected Proof
Objective: To describe the risk factors, clinical course, and complications of migration of a dexamethasone (DEX) intravitreal implant (OZURDEX; Allergan, Inc., Irvine, CA) into the anterior chamber and subsequent management strategies.Design: Retrospe…
Validity of Self-Report in Type 1 Diabetic Subjects for Laser Treatment of Retinopathy – Corrected Proof
Purpose: This study sought to determine the validity of self-report of prior panretinal photocoagulation (PRP) and focal photocoagulation (FP) compared with fundus photography.Design: Prospective cohort study.Participants: One thousand three hundred sixty-three type 1 diabetic subjects from the Epidemiology of Diabetes Interventions and Complications (EDIC) study, a subset of the 1441 subjects originally enrolled in the multicenter Diabetes Control and Complications Trial.Methods: At each annual visit, subjects were asked by EDIC staff whether they had undergone PRP, FP, or both since the last completed annual clinic visit. Fundus photographs were collected from one quarter of the cohort each year and from the entire cohort at EDIC years 4 and 10. Photographs were graded for the presence and extent of PRP and FP. Seventeen years of subject reporting and photograph grading of PRP and FP were compared in EDIC subjects.Main Outcome Measures: The κ, sensitivity, specificity, and positive and negative predictive values were calculated for subject-reported PRP and FP. Factors influencing subject misreporting were investigated.Results: For subject reporting, 1244 (96%) of 1296 subjects with gradable photographs accurately reported whether they had a history of PRP in one or both eyes, and 1259 (97.5%) of 1291 with valid photographs correctly reported their history of FP. For PRP and FP, sensitivities were 90.4% and 74.0%, respectively; specificities were 96.0% and 98.8%, respectively; positive predictive values were 75.9% and 80.3%, respectively; negative predictive values were 98.9% and 98.4%, respectively; and κ values were 0.80 and 0.76, respectively. Risk factors associated with misreporting included prior laser for diabetic retinopathy and prior ocular surgery (each P<0.04).Conclusions: For subjects with type 1 diabetes, in the absence of a clinical examination or fundus photographs, subject self-report could be a reliable tool in a well-monitored study for assessing laser treatment type in diabetic retinopathy.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
No Face-Down Positioning and Broad Internal Limiting Membrane Peeling in the Surgical Repair of Idiopathic Macular Holes – Corrected Proof
Objective: To demonstrate the efficacy of broad internal limiting membrane (ILM) peeling and 20% sulfur hexafluoride (SF6) endotamponade with no face-down positioning in the surgical repair of idiopathic macular holes (MHs).Design: Retrospective study….
Suprachoroidal Hemorrhage in Pars Plana Vitrectomy: Risk Factors and Outcomes Over 10 Years – Corrected Proof
Purpose: To investigate the rate and risk factors of developing suprachoroidal hemorrhage (SCH) after pars plana vitrectomy (PPV) and the outcomes as a result.Design: Retrospective, comparative consecutive series.Participants: A total of 5459 patients who underwent pars plana vitrectomies over 10 years in 3 surgical centers.Methods: All patient demographic, medical, and ophthalmic data and operative information from 3 vitreoretinal centers were entered prospectively into an electronic medical record. Univariate analysis was undertaken, comparing risk factors between cases (SCH) and controls. Multivariable logistic regression was performed to test for independence between the risk factors (P < 0.2 in univariate analysis) and SCH.Main Outcome Measures: Risk factors for developing SCH. Visual outcome and development of complications.Results: A total of 5459 PPVs were undertaken for a wide range of indications. Fifty-six cases of PPV were complicated by SCH (1.03%). Multivariable logistic regression showed that significant risk factors for developing this included advancing age, (mean age, 69 years in cases and 60 years in controls; odds ratio [OR], 1.04; P = 0.001), male sex (76.8% of cases and 58.7% of controls; OR, 2.38; P = 0.008), presence of rhegmatogenous retinal detachment (RRD) (80.3% of cases and 52.5% of controls; OR, 5.92; P < 0.0001), presence of a dropped lens fragment (10.7% of cases and 4.5% of controls; OR, 6.94; P = 0.002), and the use of antiplatelet or anticoagulant drugs (33.9% of cases and 17.7% of controls; OR, 2.29; P = 0.007). Suprachoroidal hemorrhage was more common with increasing quadrants of RRD. The significant operative risk factor was application of an explant (25% of cases and 4.07% of controls; OR, 5.63; P < 0.0001). Phthisis (7.1% of cases and 0.9% of controls; P = 0.002, Fisher exact test) and glaucoma (14.3% of cases and 7.2% of controls; P = 0.044, chi-square test) were more common in cases than in controls.Conclusions: The risk factors for developing intraoperative SCH during PPV are male sex, advancing age, RRD, a scleral explant, a dropped lens fragment, and the use of aspirin or warfarin. Patients with this complication have a greater risk of developing ocular hypertension requiring treatment and phthisis.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ten-Year Results of a Randomized Controlled Trial Comparing 0.02% Mitomycin C and Limbal Conjunctival Autograft in Pterygium Surgery – Corrected Proof
Objective: To compare the long-term outcome of pterygium surgery and the long-term effect on endothelial counts after mitomycin C (MMC) or limbal conjunctival autograft (LCAU) in pterygium surgery.Design: We performed a 10-year follow-up study of a ran…
Reproducibility of Graft Preparations in Descemet’s Membrane Endothelial Keratoplasty – Corrected Proof
Purpose: To assess the reproducibility of manual graft preparation and evaluate the incidence rate and nature of structural anomalies of Descemet’s membrane (DM) preventing successful graft preparation in DM endothelial keratoplasty (DMEK).Design: Pros…
Influence of the Vitreomacular Interface on Outcomes of Ranibizumab Therapy in Neovascular Age-related Macular Degeneration – Corrected Proof
Purpose: To investigate the influence of the vitreomacular interface (VMI) on the functional and anatomic efficacy of ranibizumab therapy in patients with neovascular age-related macular degeneration (AMD).Design: Subanalysis of a prospective, 12-month…
Myopic Maculopathy Imaged by Optical Coherence Tomography: The Beijing Eye Study – Corrected Proof
Purpose: To examine the features of myopia-related optical coherence tomography (OCT) findings in a population-based setting.Design: Population-based study.Participants: The Beijing Eye Study 2011 included 3468 subjects with an age of 50 years or more.Methods: The participants underwent a detailed ophthalmic examination including OCT with enhanced depth imaging of the macula.Main Outcome Measures: Optical coherence tomography features of the macula in highly myopic eyes defined by a refractive error of −6 diopters or less or an axial length of 26.5 mm or more.Results: Readable OCT images were available for 6530 eyes (94.5%) of 3278 participants. The most common change in the macula was maculoschisis (0.8±0.1%), followed by incomplete posterior vitreous detachment (0.7±0.1%), disruption of the photoreceptor inner segment/outer segment interface (0.6±0.1%), epiretinal membranes (0.6±0.1%), macular defects in Bruch’s membrane (0.3±0.1%), clumping of the retinal pigment epithelium (0.2±0.1%), vitreofoveal adhesion (0.2±0.1%), and macular holes in 2 eyes (0.1±0.1%). Prevalence of any myopic maculopathy per eye was 112 of 6530, or 1.71±0.16% (95% confidence interval [CI], 1.40–2.03). After adjustment for longer axial length (P<0.001; odds ratio [OR], 2.68; 95% CI, 1.97–3.64) and myopic refractive error (P<0.001; OR, 0.63; 95% CI, 0.55–0.73), presence of any myopic maculopathy was not significantly associated with any systemic variables (all P≥0.05), including biochemical blood examination and ocular parameters. Best-corrected visual acuity was associated significantly with the absence of a disruption of the photoreceptor inner segment/outer segment interface (P<0.001), epiretinal membranes (P<0.001), and macular holes (P<0.001) after adjustment for age and cylindrical refractive error.Conclusions: Based on OCT examination, the most common macular change in highly myopic eyes was maculoschisis, followed by incomplete posterior vitreous detachment, disruption of the photoreceptor inner segment/outer segment interface, epiretinal membranes, macular defects in Bruch’s membrane, clumping of the retinal pigment epithelium, vitreofoveal adhesion, and macular holes. The most important macular changes with a negative effect on best-corrected visual acuity were a disruption of the photoreceptor inner segment/outer segment interface and epiretinal membranes.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Global Prevalence of Vision Impairment and Blindness: Magnitude and Temporal Trends, 1990–2010 – Corrected Proof
Purpose: Vision impairment is a leading and largely preventable cause of disability worldwide. However, no study of global and regional trends in the prevalence of vision impairment has been carried out. We estimated the prevalence of vision impairment and its changes worldwide for the past 20 years.Design: Systematic review.Participants: A systematic review of published and unpublished population-based data on vision impairment and blindness from 1980 through 2012.Methods: Hierarchical models were fitted fitted to estimate the prevalence of moderate and severe vision impairment (MSVI; defined as presenting visual acuity <6/18 but ≥3/60) and the prevalence of blindness (presenting visual acuity <3/60) by age, country, and year.Main Outcome Measures: Trends in the prevalence of MSVI and blindness for the period 1990 through 2010.Results: Globally, 32.4 million people (95% confidence interval [CI], 29.4–36.5 million people; 60% women) were blind in 2010, and 191 million people (95% CI, 174–230 million people; 57% women) had MSVI. The age-standardized prevalence of blindness in older adults (≥50 years) was more than 4% in Western Sub-Saharan Africa (6.0%; 95% CI, 4.6%–7.1%), Eastern Sub-Saharan Africa (5.7%; 95% CI, 4.4%–6.9%), South Asia (4.4%; 95% CI, 3.5%–5.1%), and North Africa and the Middle East (4.6%; 95% CI, 3.5%–5.8%), in contrast to high-income regions with blindness prevalences of ≤0.4% or less. The MSVI prevalence in older adults was highest in South Asia (23.6%; 95% CI, 19.4%–29.4%), Oceania (18.9%; 95% CI, 11.8%–23.7%), and Eastern and Western Sub-Saharan Africa and North Africa and the Middle East (95% CI, 15.9%–16.8%). The MSVI prevalence was less than 5% in all 4 high-income regions. The global age-standardized prevalence of blindness and MSVI for older adults decreased from 3.0% (95% CI, 2.7%–3.4%) worldwide in 1990 to 1.9% (95% CI, 1.7%–2.2%) in 2010 and from 14.3% (95% CI, 12.1%–16.2%) worldwide to 10.4% (95% CI, 9.5%–12.3%), respectively. When controlling for age, women’s prevalence of blindness was greater than men’s in all world regions. Because the global population has increased and aged between 1990 and 2010, the number of blind has increased by 0.6 million people (95% CI, −5.2 to 5.3 million people). The number with MSVI may have increased by 19 million people (95% CI, −8 to 72 million people) from 172 million people (95% CI, 142–198 million people) in 1990.Conclusions: The age-standardized prevalence of blindness and MSVI has decreased in the past 20 years. However, because of population growth and the relative increase in older adults, the blind population has been stable and the population with MSVI may have increased.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.