Purpose: To determine the clinical profile, causes, and outcomes of “spontaneous” vitreous hemorrhage in children (<18 years).Design: Retrospective computer-assisted chart review.Methods: Charts of 124 eyes of 76 children who presented with nontraumatic, nonsurgical vitreous hemorrhage between 2002 and 2012 were reviewed. All children underwent an appropriate ocular and systemic examination. Data collected included demographics, visual acuity, cause of “spontaneous” vitreous hemorrhage, ocular and systemic findings at presentation and at last follow-up, investigations, management details, and visual outcomes.Results: The median age was 153.45 ± 56.19 months. There were 39 female and 37 male patients. Forty-eight patients had bilateral vitreous hemorrhage. The most common presenting complaints were diminished vision (96.45%) and behavioral changes (87.24%). The mean baseline BCVA in logMAR was 2.25 ± 1.11. The most common causes included vasculitis (34.6%) and hematologic disorders (27.4%). Patients were given medical therapy (topical and/or systemic) or underwent laser photocoagulation (29%) and/or surgery (55.6%). Twenty-nine eyes (23.3%) did not require any intervention. The mean number of surgeries was 1.89 ± 1.45 (range 1-4 surgeries). The mean final visual acuity was 0.76 ± 0.58 logMAR and was significantly better than the baseline (P < .001). The best anatomic and visual outcomes were seen in vasculitis, whereas congenital disorders such as retinoschisis had the worst.Conclusions: Spontaneous pediatric vitreous hemorrhage has a diverse etiology, vasculitis being the most common cause in our series. A comprehensive evaluation (systemic and ocular) is required to ensure that vision- and life-threatening conditions are not missed.
Category: Peer-reviewed
Evaluation of Corneal Microstructure in Keratoconus: A Confocal Microscopy Study – Corrected Proof
Purpose: To compare the corneal microstructure in patients with manifest keratoconus (KCN), subclinical KCN, and topographically normal relatives of patients with KCN and in healthy controls.Design: Prospective and cross-sectional study.Methods: We enrolled 145 subjects in the study. The participants were divided into 4 groups, based on clinical and topographical evaluation: the manifest KCN group (n = 30), the subclinical KCN group (n = 32), the KCN relatives group (n = 53), and the control group (n = 30). Corneal microstructure was assessed by corneal in vivo confocal microscopy in all of the individuals. Mean outcome measures were basal epithelial cell density, endothelial cell density, anterior keratocyte density, posterior keratocyte density, sub-basal nerve density, sub-basal nerve diameter, and stromal nerve diameter.Results: The mean basal epithelial cell density, endothelial cell density, and sub-basal nerve diameter were not significantly different among the 4 groups (P = 0.057, P = 0.592, and P = 0.393, respectively). The mean anterior and posterior stromal keratocyte densities were significantly lower in the manifest group, in the subclinical group, and in the relatives group when compared with the control group (for both parameters; P < 0.001, P < 0.001, and P< 0.001, respectively). The mean stromal nerve diameter in the manifest group, subclinical group, and relatives group was significantly higher than in the control group (P = 0.001, P = 0.049, and P = 0.004, respectively).Conclusion: The anterior and posterior stromal keratocyte densities were statistically lower and stromal nerve diameter was statistically higher in patients with manifest KCN, subclinical KCN, and topographically normal KCN relatives compared with controls. Confocal microscopy may be useful for the determination of early corneal microstructural changes before manifestation of typical or subtle topographic signs.
Subgrouping of Primary Angle-Closure Suspects Based on Anterior Segment Optical Coherence Tomography Parameters – Corrected Proof
Purpose: To identify subgroups of primary angle-closure suspects (PACS) based on anterior segment optical coherence tomography (AS-OCT) and biometric parameters.Design: Cross-sectional study.Participants: We evaluated 243 PACS subjects in the primary g…
Ciliary Body and Choroidal Pseudomelanoma from Ultrasonographic Imaging of Hypermature Cataract in 20 Cases – Corrected Proof
Purpose: To describe a series of 20 patients with opaque media, referred with uveal melanoma, but subsequently found to have pseudomelanoma from oblique imaging of hypermature cataract on ultrasonography.Design: Case series.Participants: Twenty patient…
Bupivacaine Injection Remodels Extraocular Muscles and Corrects Comitant Strabismus – Corrected Proof
Purpose: To evaluate the clinical effectiveness and anatomic changes resulting from bupivacaine injection into extraocular muscles to treat comitant horizontal strabismus.Design: Prospective, observational clinical series.Participants: Thirty-one comit…
Resident Compliance with the American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Primary Open-Angle Glaucoma – Corrected Proof
Purpose: To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients.Design: Retrospective chart review.Participants: One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center.Methods: Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines.Main Outcome Measures: Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency.Results: The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P > 0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts.Conclusions: Residents’ compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ranibizumab versus Bevacizumab for Neovascular Age-related Macular Degeneration: Results from the GEFAL Noninferiority Randomized Trial – Corrected Proof
Objective: To evaluate the relative efficacy and safety profile of bevacizumab versus ranibizumab intravitreal injections for the treatment of neovascular age-related macular degeneration (AMD).Design: Multicenter, prospective, noninferiority, double-masked, randomized clinical trial performed in 38 French ophthalmology centers. The noninferiority limit was 5 letters.Participants: Patients aged ≥50 years were eligible if they presented with subfoveal neovascular AMD, with best-corrected visual acuity (BVCA) in the study eye of between 20/32 and 20/320 measured on the Early Treatment of Diabetic Retinopathy Study chart and a lesion area of less than 12 optic disc areas (DA).Methods: Patients were randomly assigned to intravitreal administration of bevacizumab (1.25 mg) or ranibizumab (0.50 mg). Hospital pharmacies were responsible for preparing, blinding, and dispensing treatments. Patients were followed for 1 year, with a loading dose of 3 monthly intravitreal injections, followed by an as-needed regimen (1 injection in case of active disease) for the remaining 9 months with monthly follow-up.Main Outcome Measures: Mean change in visual acuity at 1 year.Results: Between June 2009 and November 2011, 501 patients were randomized. In the per protocol analysis, bevacizumab was noninferior to ranibizumab (bevacizumab minus ranibizumab +1.89 letters; 95% confidence interval [CI], −1.16 to +4.93, P < 0.0001). The intention-to-treat analysis was concordant. The mean number of injections was 6.8 in the bevacizumab group and 6.5 in the ranibizumab group (P = 0.39). Both drugs reduced the central subfield macular thickness, with a mean decrease of 95 μm for bevacizumab and 107 μm for ranibizumab (P = 0.27). There were no significant differences in the presence of subretinal or intraretinal fluid at final evaluation, dye leakage on angiogram, or change in choroidal neovascular area. The proportion of patients with serious adverse events was 12.6% in the bevacizumab group and 12.1% in the ranibizumab group (P = 0.88). The proportion of patients with serious systemic or ocular adverse events was similar in both groups.Conclusions: Bevacizumab was noninferior to ranibizumab for visual acuity at 1 year with similar safety profiles. Ranibizumab tended to have a better anatomic outcome. The results are similar to those of previous head-to-head studies.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Role of Liquid Culture Media in the Laboratory Diagnosis of Microbial Keratitis – Corrected Proof
Purpose: To determine whether liquid culture media are helpful in the diagnosis of infectious keratitis.Design: Retrospective noncomparative case series.Subjects and Methods: This is a retrospective review of microbiology records of 114 corneal scraping samples from infectious keratitis patients. Samples were processed by corneal smear microscopy (potassium hydroxide with calcofluor white and Gram stains) and culture examination (5% sheep blood agar, sheep blood chocolate agar, Sabouraud dextrose agar, brain heart infusion, thioglycolate broth, and Robertson’s cooked meat broth. Cases where at least 1 liquid medium was taken were included in the study and all cases were required to have significant growth in culture as per the institutional criteria. Results of smear examination and culture growth were analyzed.Results: Out of 114 cases, 44 (38.59%) were bacterial, 62 (54.38%) fungal, and 8 (7.01%) were mixed (bacteria + fungus) infection. Thirty-eight out of 44 cases of bacterial keratitis (86.36%) were diagnosed by solid media alone (criterion 1) and 6 of 44 (13.63%) required liquid media for diagnosis (P < .001). In fungal keratitis, 61 of 62 cases (98.38%) were diagnosed using solid media alone (criterion 1) while 1 case required liquid media for diagnosis. In mixed infection, none of the cases required liquid media for diagnosis of fungal component; however, all 8 cases required liquid media for establishing bacterial component.Conclusions: Liquid culture media increase the chance of isolation of bacteria in pure bacterial and/or mixed infection; however, their role in isolating fungus is limited. Owing to overlap in clinical diagnosis of bacterial and fungal keratitis, we recommend inclusion of both solid and liquid culture media in the laboratory diagnosis of nonviral keratitis.
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…
Author reply
We thank Dr Huevra for his interest and thoughtful comments on our paper and largely agree with his views on managing this problematic condition. We did not set out to compare topical with subconjunctival delivery of interferon—this was beyond the sc…
Subclinical Keratoconus: The Need for an Objective Classification System
Arbelaez et al reported the use of a support vector machine for the detection of keratoconus and subclinical keratoconus by topographic and tomographic data. The authors defined subclinical keratoconus as corneas presenting topographic and tomographic…
Editorial Board
Author reply
We thank Saad and Gatinel for their interesting observation. We agree that a quantitative definition might have been useful for both suspect keratoconus and forme fruste keratoconus (FFKC). Unfortunately, these definitions, such as those by Rabinowitz …
期刊一览
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
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…
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 …
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…
Contents
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…
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…