Purpose: To estimate the proportion of patients presenting with isolated third, fourth, or sixth cranial nerve palsy of presumed microvascular origin versus other causes.Design: Prospective, multicenter, observational case series.Participants: A total …
Author: Ophthalmology
Microbial Keratitis after Boston Type I Keratoprosthesis Implantation: Incidence, Organisms, Risk Factors, and Outcomes – Corrected Proof
Purpose: To identify the incidence of and risk factors for microbial keratitis after implantation of the Boston type I keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA).Design: Retrospective, single-surgeon consecutive case series.Part…
A Randomized Trial of Increasing Patching for Amblyopia – Corrected Proof
Objective: After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia.Design: Prospective, randomized, multicenter clinical trial.Participants: A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32–20/160) after 2 hours of daily patching for at least 12 weeks.Intervention: Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day.Main Outcome Measures: Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks.Results: Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50−2). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3–1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003).Conclusions: When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Outcome of ABCA4 Disease-Associated Alleles in Autosomal Recessive Retinal Dystrophies: Retrospective Analysis in 420 Spanish Families – Corrected Proof
Objective: To provide a comprehensive overview of all detected mutations in the ABCA4 gene in Spanish families with autosomal recessive retinal disorders, including Stargardt’s disease (arSTGD), cone-rod dystrophy (arCRD), and retinitis pigmentosa (arR…
Reproducibility of a Long-Range Swept-Source Optical Coherence Tomography Ocular Biometry System and Comparison with Clinical Biometers – Corrected Proof
Objective: To demonstrate a novel swept source optical coherence tomography (SS-OCT) imaging device using a vertical cavity surface-emitting laser (VCSEL) capable of imaging the full eye length and to introduce a method using this device for noncontact ocular biometry. To compare the measurements of intraocular distances using this SS-OCT instrument with commercially available optical and ultrasound biometers. To evaluate the intersession reproducibility of measurements of intraocular distances using SS-OCT.Design: Evaluation of technology.Participants: Twenty eyes of 10 healthy subjects imaged at the New England Eye Center at Tufts Medical Center and Massachusetts Institute of Technology between May and September 2012.Methods: Averaged central depth profiles were extracted from volumetric SS-OCT datasets. The intraocular distances, such as central corneal thickness (CCT), aqueous depth (AD), anterior chamber depth (ACD), crystalline lens thickness (LT), vitreous depth (VD), and axial length (AL), were measured and compared with a partial coherence interferometry device (IOLMaster; Carl Zeiss Meditec, Inc., Dublin, CA) and an immersion ultrasound (IUS) A-scan biometer (Axis-II PR; Quantel Medical, Inc., Cournon d’Auvergne Cedex, France).Main Outcome Measures: Reproducibility of the measurements of intraocular distances, correlation coefficients, and intraclass correlation coefficients.Results: The standard deviations of the repeated measurements of intraocular distances using SS-OCT were 6 μm (CCT), 16 μm (ACD), 14 μm (AD), 13 μm (LT), 14 μm (VD), and 16 μm (AL). Strong correlations among all 3 biometric instruments were found for AL (r > 0.98). The AL measurement using SS-OCT correlates better with the IOLMaster (r=0.998) than with IUS (r=0.984). The SS-OCT and IOLMaster measured higher AL values than ultrasound (175 and 139 μm, respectively). No statistically significant difference in ACD between the optical (SS-OCT or IOLMaster) and ultrasound methods was detected. High intersession reproducibility of SS-OCT measurements of all intraocular distances was observed with intraclass correlation coefficients >0.99.Conclusions: The SS-OCT using VCSEL technology enables full eye length imaging and high-precision, noncontact ocular biometry. The measurements with the prototype SS-OCT instrument correlate well with commercial biometers. The SS-OCT biometry has the potential to provide clinically useful comprehensive biometric parameters for pre- and postoperative eye evaluation.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Aqueous Flare and Choroidal Thickness in Patients with Chronic Hepatitis C Virus Infection: A Pilot Study – Corrected Proof
Purpose: To investigate the status of the blood–aqueous barrier and to evaluate the subfoveal choroidal thickness (SCT) in patients with asymptomatic untreated chronic hepatitis C virus (HCV) infection without any anterior or posterior ocular involvement and to search for possible correlations.Design: Observational case-control study.Participants and Controls: A total of 80 eyes of 20 HCV-positive patients (male-to-female ratio, 12:8; mean age, 46.9±7.23 years) and 20 healthy controls (male-to-female ratio, 10:10; mean age, 48.2±8.71 years) were examined.Methods: Participants underwent a complete ophthalmologic examination. Aqueous flare was quantified objectively by using the noninvasive laser flare cell meter FC-500 (Kowa Company Ltd, Tokyo, Japan), whereas SCT was evaluated by using enhanced depth imaging optical coherence tomography (Spectralis OCT; Heidelberg Engineering GmbH, Heidelberg, Germany). A Wilcoxon rank-sum test was performed to compare ocular findings between HCV patients and controls, and correlations were assessed by using the Spearman rank test.Main Outcome Measures: Retinal and choroidal thickness and anterior chamber inflammation of HCV patients and healthy controls.Results: Patients with HCV showed significantly higher aqueous flare values (8.37±2.25 photon counts/ms vs. 4.56±1.45 photon counts/ms; P<0.0001) and a significantly increased SCT (362.7±46.5 μm vs. 320.25±32.82 μm; P<0.0001) than healthy controls. Moreover, subjects with liver fibrosis had higher flare values than those with no significant hepatic fibrosis (9.62±1.99 photon counts/ms vs. 6.97±2.19 photon counts/ms; P = 0.0003) and thicker choroids (379.15±44.75 μm vs. 346.3±43.27 μm; P = 0.024). Statistical analysis revealed that there was a positive correlation between aqueous flare values and SCT in HCV patients (r = 0.69; P<0.0001) and between flare and the degree of liver fibrosis (r = 0.67; P = 0.0001).Conclusions: This study showed that impairment of the blood–aqueous barrier and thickened choroids are features of asymptomatic HCV patients, and that choroidal thickness increases as the degree of subclinical inflammation of the anterior chamber increases. Patients with significant liver fibrosis have the highest flare values and the thickest choroids.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topical Cyclosporine in the Treatment of Allergic Conjunctivitis: A Meta-analysis – Corrected Proof
Purpose: To assess the efficacy and safety of topical cyclosporine versus placebo in the treatment of allergic conjunctivitis.Design: Systematic review and meta-analysis.Participants: Seven qualified studies incorporating 306 eyes of 153 patients were analyzed.Methods: Searches of randomized controlled trials were conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform.Main Outcome Measures: We assessed the methodologic quality of individual included trials and performed meta-analyses using the random effects model if P<0.1 in the test for heterogeneity, or otherwise used the fixed effect model. We assessed scores of composite signs and symptoms, reduction in steroid eye drop use in steroid-dependent patients, and safety outcomes (i.e., stinging or burning sensation).Results: At 2 weeks of follow-up or longer, evidence suggests a statistically significant improvement in the composite signs (standardized mean difference [SMD], −1.21; 95% confidence interval [CI], −1.80 to −0.62; I2 = 71%) and symptoms (SMD, −0.84; 95% CI, −1.51 to −0.16; I2 = 80%) after topical cyclosporine treatment for allergic conjunctivitis regardless of the dosage of treatment. There was a significant reduction (mean difference, −61.16; 95% CI, −101.61 to −20.72; I2 = 58%) in the use of steroid eye drops in patients with steroid-dependent allergic conjunctivitis. Stinging or burning sensation (odds ratio, 2.56; 95% CI, 0.19–35.06; I2 = 73%) was common in both the cyclosporine and placebo groups.Conclusions: This systematic review and meta-analysis suggests topical cyclosporine could be an effective and safe treatment method for allergic conjunctivitis. Further randomized controlled trials with larger sample sizes and standardized outcome measurements, follow-up periods, and cyclosporine concentrations are warranted to determine the short- and long-term efficacy and safety and the minimal effective dosage of topical cyclosporine for allergic conjunctivitis.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ethical Authorship and the Ingelfinger Rule in the Digital Age
Ophthalmology’s Guide for Authors includes a policy regarding prior and repetitive publication that states: “The Journal will not consider manuscripts that have appeared, in part or in total, in other publications, except in special circumstances app…
Author reply
We thank Sabour and Ghassemi for their interest in our paper and their comments about the interpretation of the statistical analysis. The predictive value of the temporal–superior and temporal–inferior positions of the Moorfields Regression Analysi…
Author reply
We thank Yoon et al for their interest in our article and their comments on their cited publication and personal experience. As noted in their letter, the incidence of brow ptosis after temporal artery biopsy (TAB) had not been reported previously. We …
Author reply
We thank Dr. Killer for his interest in our study. We fully agree with him that (1) the assumption of a narrow orbital cerebrospinal fluid (CSF) space indicating a low intracranial CSF pressure is valid only if there is a free communication between the…
Brow Ptosis After Temporal Artery Biopsy
Recently we described 4 patients referred over a period of 5 years after suffering facial nerve injury from superficial temporal artery biopsy. A literature search uncovered 3 more cases, bringing the total number of reported cases to 7. From this low …
Cataract Extraction and the Iris Configuration
Mansberger et al recently described a 16.5% reduction in intraocular pressure (IOP) after cataract extraction. We agree that “the exact mechanism of IOP lowering after cataract surgery is unknown.”
Macular Hole and Choroidal Thickness
We read with great interest and attention the recent article from Zeng et al regarding the choroidal thickness in both eyes of patients with unilateral idiopathic macular hole. They concluded that choroidal thickness was thinner in eyes affected with i…
Oral Acyclovir for Herpes Simplex Blepharoconjunctivitis in Children
We read the article by Liu et al on the clinical characteristics, treatment, and outcomes of pediatric herpes simplex virus (HSV) infections of the anterior segment with great interest. The researchers found that of the 53 patients (57 eyes), 18 eyes h…
Predictive Value of Confocal Scanning Laser for the Onset of Visual Field Loss
We were interested to read the paper by Larrosa et al published in the August 2012 issue of Ophthalmology. The authors report the ability of Moorfields regression analysis (MRA) to predict the onset of glaucoma in a population of patients with suspecte…
MRI in Retinoblastoma with Orbital Cellulitis
Retinoblastoma-associated orbital cellulitis is a well-recognized clinical entity. Inflammation of orbital soft tissues can clinically mimic extraocular tumor invasion, potentially affecting patient management decisions. Magnetic resonance imaging (MRI…
Second Reflective Band Intensity in Age-related Macular Degeneration
Further characterization of the anatomic changes present in early age-related macular degeneration (AMD) will lead to improved markers of disease severity and progression. Currently, spectral-domain optical coherence tomography (SD-OCT) allows the deli…
Intraocular Pressure in Patients with Muscular Dystrophies
Myotonic (DM1) and facioscapulohumeral muscular dystrophy (FSHD) are among the most common muscle disease with ocular involvement. Myotonic muscular dystrophy affects about 1:8000 Caucasian individuals and is inherited in an autosomal dominant mode. Be…
An Unusual Case of Epidermal Iris Cyst
We report an unusual case of an iris cyst with a white mass in the anterior chamber (AC). The diagnosis of epidermal cyst was confirmed histopathologically. A 24-year-old man visited us for a white mass in the AC of his right eye. The cornea had been…