Category: Peer-reviewed

Topical Rebamipide Treatment for Superior Limbic Keratoconjunctivitis in Patients with Thyroid Eye Disease – Accepted Manuscript

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Abstract: Purpose: To evaluate efficacy of topical rebamipide for superior limbic keratoconjunctivitis (SLK) in patients with thyroid eye disease (TED).Design: A retrospective, observational case series.Methods: Thirty-three eyes from 20 TED patients with SLK who received topical rebamipide [Mucosta® ophthalmic suspension unit dose 2%; chemical name, (2RS)-2-(4-chlorobenzoylamino)-3-(2-oxo-1, 2-dihydroquinolin-4-yl) propanoic acid] were included. The following items were evaluated before and 4 weeks after the start of treatments: presence or absence of SLK, rose bengal staining score, AD classification (A, area; D, density) of fluorescein staining, Schirmer’s test I (without topical anesthesia), tear break-up time (TBUT), Hertel exophthalmometry values, and margin reflex distances-1 and -2.Results: Twenty-eight eyes showed complete disappearance of SLK after treatment (84.8%; P < 0.001). The other 5 eyes (15.2%) demonstrated significant improvement but had residual punctate rose bengal staining and fluorescein staining, near the superior corneal limbus. All 5 eyes exhibited at least one of the following findings: proptosis > 17.7 mm and upper and/or lower eyelid retractions. Incidence of upper eyelid retraction was significantly higher in eyes with SLK than in those without SLK at the 4 week follow-up (P = 0.021). The severity of rose bengal staining, and fluorescein staining improved significantly after treatment (P < 0.001). Although the Schirmer’s test results remained constant before and after the treatment (P = 0.212), TBUT increased significantly in the post-therapeutic state (P = 0.009). No serious adverse events were reported.Conclusions: Topical rebamipide improved SLK in patients with TED, suggesting a first-line treatment in such patients.

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Endophthalmitis Caused by Streptococcal Species: Clinical Settings, Microbiology, Management, and Outcomes – Accepted Manuscript

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Abstract: Purpose: To report the clinical settings, antibiotic susceptibilities, and outcomes of endophthalmitis caused by Streptococcus species.Study Design: Retrospective, observational case series.Methods: Single-center study evaluating all patients with culture-positive endophthalmitis caused by Streptococcus species between January 1, 2000 and December 31, 2011.Results: Study criteria were met by 63 patients. The most common clinical settings were bleb-associated (17, 27%), post-intravitreal injection (16, 25%), and post-cataract surgery (13, 21%). The isolates were S. viridans (47, 71%), S. pneumoniae (13, 21%), and β-hemolytic Streptococci (5, 8%). Sixty (95%) of 63 isolates were susceptible to vancomycin, 47 (98%) of 48 to ceftriaxone (third generation cephalosporin), and 57 (93%) of 61 to levofloxacin (third generation fluoroquinolone). Between the first and second half of the study period, the minimal inhibitory concentration (MIC) of antibiotics required to inhibit 90% of isolates increased by 1.5-fold for ceftriaxone and 2-fold for levofloxacin, and remained the same for vancomycin. Initial treatment was vitreous tap (49, 78%) or pars plana vitrectomy (14, 22%); all received intravitreal antibiotics. Visual acuity outcomes were variable; best corrected visual acuity (BCVA) was ≥20/400 in 16 (25%) patients and <20/400 in 47 (75%) patients. Evisceration/enucleation was performed in 16 (25%) patients.Conclusion: Streptococcus isolates generally had high susceptibility rates to commonly used antibiotics. Higher antibiotic MICs were required to inhibit 90% of isolates in vitro in the second half of the study period compared to the first half. Despite prompt treatment, the majority of patients had poor outcomes.

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The 5-Year Incidence of Bleb-Related Infection and Its Risk Factors after Filtering Surgeries with Adjunctive Mitomycin C: Collaborative Bleb-Related Infection Incidence and Treatment Study 2 – Corrected Proof

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Purpose: To report the 5-year incidence of bleb-related infection after mitomycin C–augmented glaucoma filtering surgery and to investigate the risk factors for infections.Design: Prospective, observational cohort study.Participants: A total of 1098 …

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Clinical Measurement of the Angle of Ocular Movements in the Nine Cardinal Positions of Gaze – Corrected Proof

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Purpose: To measure the maximum angle of ocular versions using photographs of the 9 cardinal positions and a modified limbus test.Design: An evaluation of diagnostic technology; a prospective observational study.Participants: We enrolled 104 healthy subjects, 20 to 40 years of age.Methods: Photographs were obtained in the 9 cardinal positions of gaze and the images were processed using Photoshop. The images were analyzed using the Image J program to measure the angle of version. The maximum angle of the 9 cardinal positions was quantified using a modified limbus test.Main Outcome Measures: We measured the maximum angle of ocular versions in the 9 cardinal positions of gaze. We also compared the results for males and females.Results: The mean angles of maximum version were adduction 47.4°, abduction 46.4°, elevation 31.8°, depression 47.8°, elevation in adduction 39.7°, elevation in abduction 40.7°, depression in adduction 52.7°, and depression in abduction 49.2°. The mean angle of maximum elevation was significantly smaller than that of depression (P < 0.001). There were no correlations between the angle of maximum version and age, spherical equivalents, or axial length. The angle of maximum version for males was significantly greater than that for females, except for inferior gaze.Conclusions: A modified limbus test using photographs of the 9 cardinal positions is an objective and reproducible tool for quantifying ocular movement. Considering its simplicity, ease of use, and low cost, it has clear applications in clinical practice.

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Gonioscopy-Assisted Transluminal Trabeculotomy, A Novel Ab Interno Trabeculotomy: Technique Report and Preliminary Results – Corrected Proof

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Purpose: To introduce a novel, minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results.Design: Retrospective, noncomparative cases series.Participants: Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data.Methods: Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas.Main Outcome Measures: Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications.Results: Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0% [SD, 22.7%]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8% [SD, 16.0%]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7% [SD, 15.8%]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8% [SD, 17.4%]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9% (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in 30% of patients at the 1-week visit.Conclusions: The preliminary results and safety profile for GATT, a novel, minimally invasive circumferential trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabeculotomy.

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Assessment of choroidal topographic changes by swept source optical coherence tomography after photodynamic therapy for central serous chorioretinopathy – Accepted Manuscript

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Abstract: Purpose: To investigate the relationship between choroidal thickness and angiographic abnormalities in central serous chorioretinopathy (CSC) eyes by swept-source optical coherence tomography (Swept-OCT), before and after half-fluence photody…

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Measurement of Scleral Thickness using Swept-Source Optical Coherence Tomography in Open-Angle Glaucoma Patients with Myopia – Accepted Manuscript

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Abstract: Purpose: To use swept-source optical coherence tomography (OCT) to image the posterior sclera at the posterior pole and around the optic nerve head (ONH), and measure the subfoveal scleral thickness and laminar thickness to evaluate the relationship between the measured thicknesses and ocular parameters.Design: Prospective, cross-sectional design.Methods: One hundred and twelve glaucoma patients and 46 controls with axial length more than 26 mm were enrolled. Swept-source OCT images were obtained to capture the subfoveal and ONH region. Subfoveal scleral thickness and laminar thickness were measured from obtained B-scan images. To verify the reproducibility of the measurement, intraclass correlation coefficients were calculated from selected B-scans. Scleral and laminar thickness in patients with normal tension glaucoma (NTG) was compared with that in patients with primary open angle glaucoma (POAG). Pearson’s correlation was calculated to assess the relationships of scleral and laminar thicknesses with ocular parameters.Results: Posterior scleral thickness could be measured in 68.4% and laminar thickness could be measured in 88.6% using swept-source OCT. Interobserver and intraobserver measurement reproducibility was moderate to excellent. The subfoveal scleral thickness was 670.84 ± 160.60 μm in the POAG group and 496.55 ± 115.20 μm in the NTG group, which was significantly different between groups. Subfoveal scleral thickness (r = -0.677, P < 0.001) was negatively correlated with axial length only in NTG patients, not POAG patients.Conclusions: Swept-source OCT detected differences in the thickness of the posterior sclera between NTG and POAG eyes. Subfoveal scleral thickness was negatively correlated with axial length only in NTG eyes.

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Dry Eye Exacerbation in Patients Exposed to Desiccating Stress under Controlled Environmental Conditions – Accepted Manuscript

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Abstract: Purpose: To determine if controlled environmental conditions can induce acute exacerbations of signs and symptoms in dry eye and asymptomatic subjects.Design: Prospective cross-sectional study.Methods: Nineteen patients with dry eye and 20 asymptomatic controls were exposed to controlled low humidity (5% relative humidity, desiccating environment) for 2 hours in our Controlled Environmental Research Laboratory at the University of Valladolid. The patients completed the Single-Item Score Dry Eye Questionnaire and the following diagnostic tests were performed before and after exposure: tear osmolarity, phenol red thread test, conjunctival hyperemia, fluorescein tear-break-up time (T-BUT), Schirmer test, and ocular surface vital staining. Sixteen molecules in the tears samples were analyzed by multiplex bead analysis.Results: After exposure, the patients and controls had a significant (P≤0.003) increase in corneal staining (from 0.68±0.15 to 1.16±0.14 and 0.50±0.15 to 1.30±0.19, respectively), significantly decreased (P≤0.01) fluorescein T-BUT values (from 2.78±0.56 to 1.94±0.24 seconds and 2.81±0.24 to 2.13±0.19 seconds, respectively), and significantly increased (P≤0.03) matrix metallopeptidase-9 tear levels (from 10,054.4±7,326.6 to 25,744.5±13,212.4 and 10,620.5±4,494.3 to 16,398.7±5,538.3 pg/ml, respectively). In the control group, the epidermal growth factor tear levels decreased significantly (P=0.007) (from 1,872.1±340.7 to 1,107.1±173.6 pg/ml), and the interleukin-6 levels significantly (P<0.001) increased (from 29.6±5.8 to 54.3±8.3 pg/ml) after exposure.Conclusion: Adult patients with mild-to-moderate dry eye and asymptomatic subjects of similar ages can develop acute exacerbation in an environmental chamber that resembles the sudden worsening that patients with dry eye experience daily.

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Is neutralizing vitreal growth factors a viable strategy to prevent proliferative vitreoretinopathy?

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Publication date: Available online 9 January 2014
Source:Progress in Retinal and Eye Research
Author(s): Steven Pennock , Luis J. Haddock , Dean Eliott , Shizuo Mukai , Andrius Kazlauskas
Proliferative vitreoretinopathy (PVR) is a blinding disorder that occurs in eyes with rhegmatogenous retinal detachment and in eyes that have recently undergone retinal detachment surgery. There are presently no treatment strategies to reduce the risk of developing PVR in eyes with retinal detachment, and surgical intervention is the only option for eyes with retinal detachment and established PVR. Given the poor visual outcome associated with the surgical treatment of PVR, considerable work has been done to identify pharmacologic agents that could antagonize the PVR process. Intensive efforts to identify molecular determinants of PVR implicate vitreal growth factors. A surprise that emerged in the course of testing the ‘growth factor hypothesis’ of PVR was the existence of a functional relationship amongst growth factors that engage platelet-derived growth factor (PDGF) receptor α (PDGFRα), a receptor tyrosine kinase that is key to pathogenesis of experimental PVR. Vascular endothelial cell growth factor A (VEGF), which is best known for its ability to activate VEGF receptors (VEGFRs) and induce permeability and/or angiogenesis, enables activation of PDGFRα by a wide spectrum of vitreal growth factors outside of the PDGF family (non-PDGFs) in a way that triggers signaling events that potently enhance the viability of cells displaced into vitreous. Targeting these growth factors or signaling events effectively neutralizes the bioactivity of PVR vitreous and prevents PVR in a number of preclinical models. In this review, we discuss recent conceptual advances in understanding the role of growth factors in PVR, and consider the tangible treatment strategies for clinical application.

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