Purpose: To characterize the development of retinal detachment (RD) after open globe trauma.Design: Case-control study.Participants: A total of 892 patients comprising 893 open globe injuries (OGIs), of whom 255 were ultimately diagnosed with RD, with the remaining eyes serving as controls.Methods: Retrospective chart review of patients with OGIs presenting to the Massachusetts Eye and Ear Infirmary between 1999 and 2011. Kaplan–Meier analysis was used to estimate the time to detachment, and multivariable logistic regression was used to define the clinical factors associated with RD after OGI.Main Outcome Measures: Demographic and clinical characteristics at the time of presentation after OGI, date of RD diagnosis, and last date of follow-up.Results: Primary repair of the open globe was typically undertaken within hours of presentation. A total of 255 eyes were ultimately diagnosed with RD after open globe trauma, yielding an incidence of 29% (95% confidence interval, 26–32). For eyes that developed RD, 27% (69/255) detached within 24 hours of primary open globe repair, 47% (119/255) detached within 1 week, and 72% (183/255) detached within 1 month. Multivariable regression analysis revealed the presence of vitreous hemorrhage (odds ratio [OR], 7.29; P < 0.001), higher zone of injury (OR, 2.51 per integer increase in zone number; OR, 1.00–6.30; P < 0.001), and poorer logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of presentation after OGI (OR, 2.41 per integer increase in logMAR visual acuity; OR, 1.00–81.30; P < 0.001) to be associated with RD. A screening tool was created: the Retinal Detachment after Open Globe Injury score.Conclusions: Retinal detachment is common after open globe trauma, although often not appearing until days to weeks after the initial traumatic event. Several clinical variables at the time of initial presentation can predict the future risk of detachment.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Category: Peer-reviewed
Development and Validation of an Associative Model for the Detection of Glaucoma Using Pupillography – Corrected Proof
Purpose: To develop and validate an associative model using pupillography that best discriminates those with and without glaucoma.Design: A prospective case-control study.Methods: We enrolled 148 patients with glaucoma (mean age 67 ± 11) and 71 controls (mean age 60 ± 10) in a clinical setting. This prototype pupillometer is designed to record and analyze pupillary responses at multiple, controlled stimulus intensities while using varied stimulus patterns and colors. We evaluated three approaches: (1) comparing the responses between the two eyes; (2) comparing responses to stimuli between the superonasal and inferonasal fields within each eye; and (3) calculating the absolute pupil response of each individual eye. Associative models were developed using stepwise regression or forward selection with Akaike information criterion and validated by fivefold cross-validation. We assessed the associative model using sensitivity, specificity and the area-under-the-receiver operating characteristic curve.Results: Persons with glaucoma had more asymmetric pupil responses in the two eyes (P < 0.001); between superonasal and inferonasal visual field within the same eye (P = 0.014); and smaller amplitudes, slower velocities and longer latencies of pupil responses compared to controls (all P < 0.001). A model including age and these three components resulted in an area-under-the-receiver operating characteristic curve of 0.87 (95% CI 0.83 to 0.92) with 80% sensitivity and specificity in detecting glaucoma. This result remained robust after cross-validation.Conclusions: Using pupillography, we were able to discriminate among persons with glaucoma and those with normal eye examinations. With refinement, pupil testing may provide a simple approach for glaucoma screening.
Effects of Choroidal Vascular Hyperpermeability on Anti–Vascular Endothelial Growth Factor Treatment for Polypoidal Choroidal Vasculopathy – Corrected Proof
Purpose: To evaluate the effect of choroidal vascular hyperpermeability, as determined using indocyanine green angiography (ICGA), on the outcome of anti–vascular endothelial growth factor (VEGF) treatment for polypoidal choroidal vasculopathy (PCV).Design: Retrospective comparative series.Methods: Based on the presence of choroidal vascular hyperpermeability on ICGA, 103 eyes (101 patients) with PCV were categorized into 2 subgroups: choroidal vascular hyperpermeability (+) group (41 eyes) and choroidal vascular hyperpermeability (−) group (62 eyes). All subjects were treatment naïve and treated by anti-VEGF with initial 3 loading injections per month, followed by an as-needed reinjection. Best-corrected visual acuity (BCVA) and central macular thickness after treatment were compared between the 2 groups at baseline and at 3, 6, 9, and 12 months.Results: At 12 months after treatment, mean BCVA was significantly improved from 0.68 logarithm of the minimal angle of resolution (logMAR) (20/95 Snellen equivalent) to 0.50 logMAR (20/63 Snellen equivalent) in the choroidal vascular hyperpermeability (−) group (P = .01); however, there was no significant improvement, from 0.79 logMAR (20/123 Snellen equivalent) to 0.74 logMAR (20/109 Snellen equivalent), in the choroidal vascular hyperpermeability (+) group. In paired comparisons of BCVA between baseline and each follow-up visit, the choroidal vascular hyperpermeability (−) group showed significant improvement of BCVA at every follow-up visit (P < .05); however, the choroidal vascular hyperpermeability (+) group did not show significant visual improvement after 9 months (P > .05).Conclusions: The therapeutic response to anti-VEGF treatment for PCV in patients with choroidal vascular hyperpermeability decreased over time. Choroidal vascular hyperpermeability was associated with an inferior visual outcome after intravitreal anti-VEGF treatment for PCV.
Predictability of Intraocular Lens Power Calculation Formulae in Infantile Eyes With Unilateral Congenital Cataract: Results from the Infant Aphakia Treatment Study – Corrected Proof
Purpose: To compare accuracy of intraocular lens (IOL) power calculation formulae in infantile eyes with primary IOL implantation.Design: Comparative case series.Methods: The Hoffer Q, Holladay 1, Holladay 2, Sanders-Retzlaff-Kraff (SRK) II, and Sanders-Retzlaff-Kraff theoretic (SRK/T) formulae were used to calculate predicted postoperative refraction for eyes that received primary IOL implantation in the Infant Aphakia Treatment Study. The protocol targeted postoperative hyperopia of +6.0 or +8.0 diopters (D). Eyes were excluded for invalid biometry, lack of refractive data at the specified postoperative visit, diagnosis of glaucoma or suspected glaucoma, or sulcus IOL placement. Actual refraction 1 month after surgery was converted to spherical equivalent and prediction error (predicted refraction − actual refraction) was calculated. Baseline characteristics were analyzed for effect on prediction error for each formula. The main outcome measure was absolute prediction error.Results: Forty-three eyes were studied; mean axial length was 18.1 ± 1.1 mm (in 23 eyes, it was <18.0 mm). Average age at surgery was 2.5 ± 1.5 months. Holladay 1 showed the lowest median absolute prediction error (1.2 D); a paired comparison of medians showed clinically similar results using the Holladay 1 and SRK/T formulae (median difference, 0.3 D). Comparison of the mean absolute prediction error showed the lowest values using the SRK/T formula (1.4 ± 1.1 D), followed by the Holladay 1 formula (1.7 ± 1.3 D). Calculations with an optimized constant showed the lowest values and no significant difference between the Holladay 1 and SRK/T formulae (median difference, 0.3 D). Eyes with globe AL of less than 18 mm had the largest mean and median prediction error and absolute prediction error, regardless of the formula used.Conclusions: The Holladay 1 and SRK/T formulae gave equally good results and had the best predictive value for infant eyes.
Identification of Three ABCA4 Sequence Variations Exclusive to African American Patients in a Cohort of Patients With Stargardt Disease – Corrected Proof
Purpose: To describe the clinical and molecular findings in ten unrelated African American patients with Stargardt disease.Design: Retrospective, observational case series.Methods: We reviewed the clinical histories, examinations, and genotypes of 85 patients with molecular diagnoses of Stargardt disease. Three ABCA4 sequence variations identified exclusively in African Americans were evaluated in 300 African American controls and by in silico analysis.Results: ABCA4 sequence changes were identified in 85 patients from 80 families, of which 11 patients identified themselves as African American. Of these 11 patients, 10 unrelated patients shared 1 of 3 ABCA4 sequence variations: c.3602T>G (p.L1201R); c.3899G>A (p.R1300Q); or c.6320G>A (p.R2107H). The minor allele frequencies in the African American control population for each variation were 7.5%, 6.3%, and 2%, respectively. This is comparable to the allele frequency in African Americans in the Exome Variant Server. In contrast, the allele frequency of all three of these variations was less than or equal to 0.05% in European Americans. Although both c.3602T>G and c.3899G>A have been reported as likely disease-causing variations, one of our control patients was homozygous for each variant, suggesting that these are nonpathogenic. In contrast, the absence of c.6320G>A in the control population in the homozygous state, combined with the results of bioinformatics analysis, support its pathogenicity.Conclusions: Three ABCA4 sequence variations were identified exclusively in 10 unrelated African American patients: p.L1201R and p.R1300Q likely represent nonpathogenic sequence variants, whereas the p.R2107H substitution appears to be pathogenic. Characterization of population-specific disease alleles may have important implications for the development of genetic screening algorithms.
Effect of Cornea Donor Graft Thickness on the Outcome of Descemet Stripping Automated Endothelial Keratoplasty Surgery – Corrected Proof
Purpose: To determine whether Descemet stripping automated endothelial keratoplasty (DSAEK) donor cornea graft thickness impacts measurements of best spectacle-corrected visual acuity (BSCVA), refractive error and intraocular pressure (IOP).Design: Retrospective chart review in a tertiary care center at Duke University Eye Center.Methods: We studied 460 eyes that had undergone DSAEK surgery. They were segregated into three groups based on the thickness of the donor graft: <100 μm (n = 67 eyes); 100–150 μm (n = 316 eyes); and >150 μm (n = 77 eyes). The three graft-thickness groups were assessed at about 6 months postoperatively for measurement of BSCVA, spherical equivalent, and IOP.Results: Baseline demographics were similar in the three groups. All groups experienced significant improvement in BSCVA (mean ± SD = −0.34 ± 0.50 logMAR); mild hyperopic shift (mean ± SD = 0.48 ± 1.7 D); and stability in IOP measurements (mean ± SD = 0.19 ± 4.8 mm Hg). There were no significant differences in groups according to donor graft thicknesses with respect to change in BSCVA (P = 0.8); hyperopic shift (P = 0.76); or IOP measurement (P = 0.56).Conclusions: DSAEK significantly improves BSCVA. DSAEK graft thickness may not play an important role in the final BSCVA, refractive error, or accuracy of IOP measurement. The ideal DSAEK graft thickness to minimize graft-related complications remains to be determined.
Peripapillary Choroidal Thickness in Both Eyes of Glaucoma Patients With Unilateral Visual Field Loss – Corrected Proof
Purpose: To investigate whether peripapillary choroidal thickness in perimetrically affected eyes of primary open-angle glaucoma (POAG) patients differs from that in perimetrically unaffected fellow eyes and eyes of healthy controls.Design: Retrospective, comparative, cross-sectional study.Methods: Thirty-one POAG patients with unilateral visual field loss and 31 healthy controls were included. Eyes were divided into 3 groups: 31 eyes in group A (eyes with visual field loss), 31 eyes in group B (perimetrically unaffected fellow eyes), and 31 eyes in group C (age- and sex-matched controls). A 360-degree 3.4-mm diameter peripapillary circle scan was performed for retinal nerve fiber layer (RNFL) assessment using enhanced depth imaging optical coherence tomography. The observer used the manual segmentation function to delineate the posterior edge of the retinal pigment epithelium and the sclerochoroidal interface. The RNFL thickness algorithm function was used to generate the choroidal thickness automatically in corresponding sectors. Statistical analysis was conducted to compare mean choroidal thickness and RNFL thickness among 3 groups and to correlate choroidal thickness with age, RNFL thickness, and visual field mean deviation.Results: The global mean RNFL and choroidal thickness measurements were 62.3 ± 16.7 μm and 154.3 ± 69.7 μm in group A, 90.4 ± 12.2 μm and 154.7 ± 68.9 μm in group B, and 106.6 ± 9.2 μm and 154.2 ± 60.9 μm in group C. The RNFL thickness was significantly thinner in group A than in groups B and C globally and at all peripapillary locations (all P = .000). The RNFL thickness also was significantly thinner in group B than in group C (P = .000 to .021). However, choroidal thickness measurements did not differ among 3 groups globally or at any peripapillary location (P = .273 to .934, P = .757 to .994, and P = .808 to .975, respectively). Age was the only significant factor associated with peripapillary choroidal thickness in each group (r = −0.418 to −0.641, r = −0.569 to −0.690, and r = −0.689 to −0.827, respectively; all P < .05).Conclusions: There was no significant difference in peripapillary choroidal thickness of POAG eyes with visual field loss compared with that of perimetrically unaffected fellow eyes and eyes of healthy controls, which does not support using peripapillary choroidal thickness as a clinical parameter in POAG diagnosis or management.
The Effects of Glasses for Anisometropia on Stereopsis – Corrected Proof
Purpose: To assess the effects of glasses for anisometropia on stereopsis and to determine the factors that affect the level of stereopsis.Design: Retrospective observational case series.Methods: One hundred six nonamblyopic patients who were wearing glasses for anisometropia and 56 who were wearing glasses for isoametropia were enrolled. The levels of stereopsis in the anisometropic patients were divided into normal (≤40 seconds of arc), equivocal (40 < – ≤ 100), and subnormal (100 < – ≤ 400) and compared with those in the isoametropic patients. It was evaluated whether the amount of interocular difference in the lens power of the glasses, the type of anisometropia, a history of amblyopia, and the age at the time of the prescription of the first glasses were related to the stereopsis.Results: In the anisometropia, the mean stereopsis (seconds of arc) was 77.52 (40-200) in the Titmus-fly test and 52.78 (40-100) in the Randot stereotest. The rate of normal and equivocal stereopsis was 87.7% in the Titmus-fly test and 96.9% in the Randot stereotest. The isoametropic patients demonstrated better stereopsis (52.86 and 39.20 in either test) than did the anisometropic patients (P < .05). The stereopsis was worse in the spherical hyperopic type of anisometropia than in the spherical myopic type (P < .05). The level of stereopsis was not related to the other factors that were investigated.Conclusions: The level of stereopsis with the wearing of anisometropic glasses was clinically near normal and the glasses did not seriously affect the binocular vision regardless of the severity of the anisometropia.
Glued Trans-scleral Intraocular Lens Exchange for Anterior Chamber Lenses in Complicated Eyes: Analysis of Indications and Results – Corrected Proof
Purpose: To determine the clinical outcomes after glued trans-scleral posterior chamber intraocular lens (IOL) exchange for anterior chamber (AC) IOL.Design: Retrospective case series.Methods: Eyes with AC IOL explantation with glued IOL implantation i…
Age-related Prevalence and Met Need for Correctable and Uncorrectable Near Vision Impairment in a Multi-country Study – Corrected Proof
Purpose: To estimate the prevalence, potential determinants, and proportion of met need for near vision impairment (NVI) correctable with refraction approximately 2 years after initial examination of a multi-country cohort.Design: Population-based, prospective cohort study.Participants: People aged ≥35 years examined at baseline in semi-rural (Shunyi) and urban (Guangzhou) sites in China; rural sites in Nepal (Kaski), India (Madurai), and Niger (Dosso); a semi-urban site (Durban) in South Africa; and an urban site (Los Angeles) in the United States.Methods: Near visual acuity (NVA) with and without current near correction was measured at 40 cm using a logarithm of the minimum angle of resolution near vision tumbling E chart. Participants with uncorrected binocular NVA ≤20/40 were tested with plus sphere lenses to obtain best-corrected binocular NVA.Main Outcome Measures: Prevalence of total NVI (defined as uncorrected NVA ≤20/40) and NVI correctable and uncorrectable to >20/40, and current spectacle wearing among those with bilateral NVA ≤20/63 improving to >20/40 with near correction (met need).Results: Among 13 671 baseline participants, 10 533 (77.2%) attended the follow-up examination. The prevalence of correctable NVI increased with age from 35 to 50–60 years and then decreased at all sites. Multiple logistic regression modeling suggested that correctable NVI was not associated with gender at any site, whereas more educated persons aged >54 years were associated with a higher prevalence of correctable NVI in Nepal and India. Although near vision spectacles were provided free at baseline, wear among those who could benefit was <40% at all but 2 centers (Guangzhou and Los Angeles).Conclusions: Prevalence of correctable NVI is greatest among persons of working age, and rates of correction are low in many settings, suggesting that strategies targeting the workplace may be needed.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
The Relationship between Better-Eye and Integrated Visual Field Mean Deviation and Visual Disability – Corrected Proof
Objective: To determine the extent of difference between better-eye visual field (VF) mean deviation (MD) and integrated VF (IVF) MD among Salisbury Eye Evaluation (SEE) subjects and a larger group of glaucoma clinic subjects and to assess how those me…
Impact of Age-related Change of Retinal Nerve Fiber Layer and Macular Thicknesses on Evaluation of Glaucoma Progression – Corrected Proof
Objective: To investigate the impact of age-related change of macular and circumpapillary retinal nerve fiber layer (RNFL) measurements on evaluation of glaucoma progression.Design: Prospective, longitudinal study.Participants: A total of 150 eyes of 9…
Authors May Select Immediate Open Access to Their Articles
We all receive tabloids, mailings, and unsolicited or spam e-mails that intend to provide free information to either a large or sometimes a selective registered audience; some of this content has an advertising objective, but some content clearly has a…
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We appreciate the interest of Galvis and associates in our study. We additionally applaud them for doing a surveillance of the local bacterial pathogens encountered in their geographic area. The authors point out the results of the ESCRS endophthalmiti…
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We had proposed the short-term external buckling with pneumatic retinopexy as a novel and effective treatment for rhegmatogenous retinal detachment (RRD) with inferior retinal breaks, with a comparable success rate to other treatment methods.
The Effect of Prior Trabeculectomy on Refractive Outcomes of Cataract Surgery
We read with interest the recent article concerning the refractive outcomes after cataract surgery in patients who had a filtering bleb. We highlight that there is significant uncertainty in regard to refractive outcomes; despite intense research, we…
Clinical and Microbiological Profile of Post-Penetrating Keratoplasty Infectious Keratitis in Failed and Clear Grafts
In their recent article, Constantinou and associates reported clinical outcomes in patients who experienced infectious keratitis after penetrating keratoplasty. Their principal conclusion was that “prolonged use of corticosteroid eye drops is a major…
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We appreciate the interest of Sukhija and associates in our manuscript. They note that intraocular pressure (IOP) has been reported to be lower in infants than adults and for this reason they propose that IOP should be considered to be raised at a lower threshold than >21 mm Hg in children. Although it is probably true that IOP is lower during early infancy, it rises to adult levels during childhood. For this reason, the international standard for pediatric glaucoma studies for a raised IOP continues to be >21 mm Hg. As stated in the Methods section, topical corticosteroids were generally used for 4 weeks after cataract surgery. This steroid regimen adequately controlled postoperative inflammation in these eyes. The only additional intraocular surgeries performed in these eyes were glaucoma surgeries and secondary IOL implantation. Gonioscopy was performed on all of these eyes but was not reported because of space limitations. None of the patients had significant angle-closure issues or a family history of childhood-onset glaucoma. An IOP trend analysis was not performed because of the many uncontrolled variables that can influence IOP in a retrospective study.
Short-Term External Buckling With Pneumatic Retinopexy for Retinal Detachment With Inferior Retinal Breaks
The study by Cheng and associates one short-term external buckling with pneumatic retinopexy treating retinal detachment with inferior retinal breaks gives us new insight. Rhegmatogenous retinal detachment (RRD) with inferior breaks usually is a contr…
Clinical and Molecular Analysis of Stargardt Disease With Preserved Foveal Structure and Function
Purpose: To describe a cohort of patients with Stargardt disease who show a foveal-sparing phenotype.Design: Retrospective case series.Methods: The foveal-sparing phenotype was defined as foveal preservation on autofluorescence imaging, despite a retin…