Objective: To measure iris volume and anterior segment parameters using a swept-source anterior segment optical coherence tomography (OCT) and investigate factors associated with iris volume and iris volume change after pupil dilation in eyes with open angles and angle closure.Design: Cross-sectional study.Participants: A total of 86 eyes, including 31 eyes from 21 patients with primary angle closure (PAC) or PAC suspect, 31 eyes from 20 patients with primary open-angle glaucoma (POAG), and 24 eyes from 15 normal subjects, were included.Methods: The anterior segment parameters and iris were imaged and measured by the Casia SS-1000 OCT (Tomey, Nagoya, Japan) in room light, dark, and after pharmacologic dilation. Linear mixed models were used to examine the association between iris volume and change in iris volume after dilation and each of the following: age, sex, anterior chamber volume (ACV), axial length, pupil diameter, and angle width.Main Outcome Measures: Iris volume.Results: The mean iris volume significantly decreased from light to dark and after pharmacologic dilation in angle closure (40.0±5.2, 38.8±5.4, and 32.5±4.5 mm3, respectively), POAG (40.2±5.3, 39.4±5.4, and 33.6±4.2 mm3, respectively), and normal eyes (40.1±4.2, 39.1±3.9, and 33.0±4.4 mm3, respectively). From room light to dark, the iris volume of 16.7% normal, 19.4% POAG, and 19.4% angle closure eyes increased iris volume (P = 0.960). After pharmacologic dilation, iris volume decreased in all eyes. Iris volume was negatively associated with ACV and positively associated with axial length (P < 0.001). The change in iris volume per millimeter change in pupil diameter was 2.11, 2.01, and 1.80 mm3/mm in the angle closure, POAG, and normal groups, respectively (P ≥ 0.414). A smaller ACV (P = 0.049) and older age (P = 0.036) were associated with a smaller change in iris volume per millimeter change in pupil diameter. A larger iris volume, smaller ACV, and greater pupil diameter were significant determinants of a smaller angle width (all P ≤ 0.003).Conclusions: The mean iris volume decreased after pupil dilation in open-angle and angle closure eyes, and the degree of reduction was less in eyes with a smaller ACV. Both iris volume and ACV were important determinants of the anterior chamber angle.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Author: Ophthalmology
Optical Coherence Tomography–Based Observation of the Natural History of Drusenoid Lesion in Eyes with Dry Age-Related Macular Degeneration – Corrected Proof
Purpose: To use spectral domain optical coherence tomography (SD-OCT) to investigate risk factors predictive for the development of atrophy of drusenoid lesions (DLs) (drusen and drusenoid pigment epithelium detachment) in eyes with non-neovascular age-related macular degeneration (NNVAMD).Design: Cohort study.Participants: Forty-one eyes from 29 patients with NNVAMD.Methods: Patients with NNVAMD who underwent registered SD-OCT imaging over a minimum period of 6 months were reviewed. Drusenoid lesions that were accompanied by new atrophy onset at 6 months or last follow-up (FUL) were further analyzed. Detailed lesion change was described throughout the study period. Odds ratios (ORs) and risk for new local atrophy onset were calculated.Main Outcome Measures: Drusenoid lesion features and longitudinal changes in features, including maximum lesion height, lesion diameter, lesion internal reflectivity, and presence and extent of overlying intraretinal hyperreflective foci (HRF). Subfoveal choroidal thickness (SFCT) and choroidal thickness (CT) were measured below each lesion.Results: A total of 543 individual DLs were identified at baseline, and 28 lesions developed during follow-up. The mean follow-up time was 21.3±8.6 months (range, 6–44 months). Some 3.2% of DLs (18/571) progressed to atrophy within 18.3±9.5 months (range, 5–28 months) of the initial visit. Drusenoid lesions with heterogeneous internal reflectivity were significantly associated with new atrophy onset at 6 months (OR, 5.614; 95% confidence interval [CI], 1.277–24.673) and new atrophy onset at FUL (OR, 7.005; 95% CI, 2.300–21.337). Lesions with the presence of HRF were significant predictors of new atrophy onset at 6 months (OR, 30.161; 95% CI, 4.766–190.860) and FUL (OR, 11.211; 95% CI, 2.513–50.019). Lesions with a baseline maximum height >80 μm or CT ≤135 μm showed a positive association with the new atrophy onset at FUL (OR, 7.886; 95% CI, 2.105–29.538 and OR, 3.796; 95% CI, 1.154–12.481, respectively).Conclusions: The presence of HRF overlying DLs, a heterogeneous internal reflectivity of these lesions, was found consistently to be predictive of local atrophy onset in the ensuing months. These findings provide further insight into the natural history of anatomic change occurring in patients with NNVAMD.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
A 4-Year Longitudinal Study of 555 Patients Treated with Ranibizumab for Neovascular Age-Related Macular Degeneration – Corrected Proof
Objective: To investigate the visual outcome, pattern of discontinuation, ocular complications, and mortality of patients treated with a variable ranibizumab dosing regimen for neovascular age-related macular degeneration (AMD) for 4 years.Design: Retrospective chart review supplemented with clinical examination.Participants: Six hundred eyes of 555 patients initiated intravitreal treatment with vascular endothelial growth factor inhibition for neovascular AMD in 2007 in a community-based hospital.Methods: Patient data from a database were retrieved from 2007 through 2011. Descriptive evaluation of the main outcome measures was carried out for the cohort of patients. A group of patients who had been discontinued because of apparent disease inactivity was reexamined.Main Outcome Measures: Best-corrected visual acuity (BCVA; Snellen), number of intravitreal injections, causes of discontinuations, ocular complications, and standardized mortality rate.Results: One hundred ninety-two eyes (32%) were still receiving active treatment after 4 years. The mean BCVA in the 192 eyes was unchanged from the start (baseline, 0.30; 4-year follow-up, 0.32; P>0.3). Visual acuity after the third loading dose was associated significantly with the outcome (P < 0.0001) and was a better predictor than baseline acuity. The mean number of injections was 5.5 per year. For 408 eyes (68%), discontinuation of treatment was motivated by the following 4 reasons: lack of apparent treatment response (28%), failure to appear at follow-up (11%), death (9%), and disease inactivity (20%, 120 eyes). Treatment was resumed later in 18% of patients discontinued because of inactivity. Sixty-seven eyes were reexamined in 2012 from the group of patients with disease inactivity. The final visual acuity by then had decreased significantly from the time of discontinuation, from 0.38 to 0.15 (P = 0.001). Endophthalmitis occurred in 2 eyes of 7584 injections. A total of 125 patients had died, corresponding to 75% of the mean mortality in the community.Conclusions: One third of the eyes were still receiving active treatment after 4 years and had stable visual acuity. One third of fellow eyes (eyes at risk) started treatment during the 4 years. One fifth of discontinued eyes resumed treatment, indicating that close follow-up should be maintained for patients discontinued because of disease inactivity. The ocular complication rate was 0.2%, and the mortality rate was below expected.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Fibrin Glue for Closure of Conjunctival Incision in Strabismus Surgery: A Report by the American Academy of Ophthalmology – Corrected Proof
Objective: To evaluate the severity of postoperative inflammation, degree of patient discomfort, adequacy of wound closure, and length of operating time when using fibrin glue compared with sutures to close limbal conjunctival incisions after strabismu…
Reduced Cerebrovascular Reactivity in Posterior Cerebral Arteries in Patients with Primary Open-Angle Glaucoma – Corrected Proof
Purpose: To evaluate the hemodynamics and vasoreactivity in the posterior cerebral artery (PCA) in patients with primary open-angle glaucoma (POAG).Design: Case-control study.Participants: Thirteen POAG patients (age range, 40–60 years) with marked visual field loss (mean deviation [MD], <−6 dB); a preserved, mostly normal, central visual field of at least 5°; and best-corrected visual acuity of at least 20/40 formed the study group. Exclusion criterion was presence or history of any systemic disorder including cardiovascular diseases. The control group consisted of 12 healthy subjects matched for age and sex with the study group.Methods: Applying transcranial Doppler sonography, we measured hemodynamic parameters in both PCAs at baseline, under monocular reversing checkerboard stimulation, and under hyperventilation. The eye with more marked visual field loss was selected in glaucoma patients, whereas in controls, the tested eye was chosen randomly. Ipsilateral and contralateral PCA were defined according to the tested eye.Main Outcome Measures: Peak systolic velocity (PSV), end-diastolic velocity, mean velocity (MV), MV change percentage (MV%), resistivity index (RI), pulsatility index (PI).Results: At baseline, RI (0.55±0.04 vs. 0.52±0.03; P = 0.04) and PI (0.88±0.11 vs. 0.80±0.07; P = 0.04) in the ipsilateral PCA were significantly higher in glaucoma patients than in controls. During checkerboard stimulation, MV% in both PCAs were significantly smaller in the glaucoma group than in controls (19.7±7.2% and 19.0±8.3% vs. 30.7±7.9% and 27.5±9.0%, respectively; P = 0.001 and 0.02, respectively). During hyperventilation, glaucoma patients showed significantly lower MV% in the contralateral PCA than control subjects (−39.8±9.6% versus −47.4±7.0%; P = 0.03). Perimetric pattern standard deviation (PSD) in the tested eye was correlated significantly with RI and PI of the ipsilateral PCA during checkerboard stimulation (P = 0.003, r = −0.76; and P = 0.002, r = −0.76). The MV% of contralateral PCA was correlated inversely with PSD in the fellow eye (P = 0.02, r = −0.64). The difference in MV% between both PCAs was correlated positively with the difference in MD between 2 eyes (P = 0.003, r = 0.75). Under hyperventilation, PSV in the contralateral PCA was correlated negatively with the PSD in the fellow eye (P = 0.03, r = −0.60).Conclusions: Vascular insufficiency in the PCAs may be associated with POAG. Changes in the vasoreactivity of PCAs to central visual stimulation may precede marked central visual field loss.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Clinical Outcomes of Intraocular Lens Scaffold Surgery: A One-Year Study – Corrected Proof
Purpose: To evaluate the safety and 1-year outcome of the intraocular lens (IOL) scaffold technique in eyes with soft to moderate nuclear remnants after intraoperative posterior capsule rupture (PCR).Design: Single-center, retrospective, interventional…
Ciliary Body Lymphangiogenesis
With interest we read the recent article by Khan et al investigating the ciliary body for the presence of peritumoral lymphatic vessels in uveal melanoma with and without extraocular extension. This study confirms previous findings by Birke et al on th…
Author reply
We appreciate the interest shown by Carifi et al regarding our article. The volume of intracameral phenylephrine (IPH) injected (0.6 ml), means we can be sure that enough amount of drug is administered, because part of the drug will be released through…
Molecular Analysis of Uveal Melanoma
Onken et al report a prospective evaluation of a gene expression profiling (GEP)-based assay, designed around 15 genes, that assigns uveal melanoma (UM) to 2 prognostic subgroups: Classes 1 and 2, which respectively are associated with low and high ris…
Author reply
We appreciate the interest of Heindl et al in our recent article in which we report the presence of ciliary body lymphatics in all melanoma eye cases studied. Our group was the first to identify lymphatics in the ciliary body of the normal human eye. T…
Risk of Lens Opacity in Patients with Diabetes Mellitus
I read the paper entitled “Risk factors for incident cortical, nuclear, posterior subcapsular, and mixed lens opacities: the Los Angeles Latino Eye Study” with interest. The same authors also reported a population-based, cross-sectional study targe…
August 2012 Cover Photo Is Not Coats’ Disease
We were interested to see the cover photo on the August 2012 edition of Ophthalmology showing a fluorescein angiogram with findings attributed to macular telangiectasia type 1 (Coats’ disease). The wide field fluorescein angiogram very nicely demonstra…
This Issue At A Glance
Long-term results from a study by Richoz et al (p. 1354) show that corneal collagen cross-linking (CXL) effectively halts the progression of ectasia that has occurred after LASIK or photorefractive keratectomy (PRK). The procedure improves the correcte…
A Simple Vista en Este Número
Los resultados a largo plazo de un estudio realizado por Richoz y otros (p. 1354) muestran que el enlace cruzado de colágeno corneal (CXL) detiene efectivamente la progresión de la ectasia producida después de LASIK o de queratectomía fotorrefracti…
Adenoid Cystic Carcinoma of the Lacrimal Gland: Rare … Lethal … Cured?
There are few more difficult conversations in ophthalmology than that between a surgeon and a patient with newly diagnosed adenoid cystic carcinoma of the lacrimal gland. The results of conventional treatment, most commonly orbital exenteration followe…
期刊一览
Richoz 等人 (p. 1354) 的一项长期随访研究发现角膜胶原交联术 (CXL) 可以有效阻止 LASIK 或准分子激光角膜切削术 (PRK) 术后角膜扩张的进展. 这一方法改善了患者最佳矫正远视力 (CDVA) 及最大K值 (Km…
Streptococcal Endophthalmitis in Pediatric Keratoprosthesis
The first Boston type I keratoprosthesis used in a child was reported in 2006. Since then, others have advocated for early and primary keratoprosthesis implantation in young patients.
Vitreous Detachments after Phacoemulsification Surgery
I enjoyed reading the informative paper by Hikichi and have a single simple question regarding this important information. The data: Retinal tears occurred in 6.4% of eyes after development of a posterior vitreous detachment. These tears were signifi…
A Novel Homozygous BEST1 Mutation Correlates with Complex Ocular Phenotypes
The BEST1 gene has been implicated in distinguishable ocular diseases ranging from macular degeneration to nanophthalmos. Homozygous BEST1 mutations were previously associated with several diseases including autosomal-recessive bestrophinopathy (ARB), …
Phacoemulsification versus Trabeculectomy in Medically Uncontrolled Chronic Angle-Closure Glaucoma without Cataract
We read with interest the article by Tham et al on phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract. We appreciate their discussion on the specific benefits and drawbacks of both phacoe…