Category: Peer-reviewed

Suprachoroidal Hemorrhage in Pars Plana Vitrectomy: Risk Factors and Outcomes Over 10 Years – Corrected Proof

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Purpose: To investigate the rate and risk factors of developing suprachoroidal hemorrhage (SCH) after pars plana vitrectomy (PPV) and the outcomes as a result.Design: Retrospective, comparative consecutive series.Participants: A total of 5459 patients who underwent pars plana vitrectomies over 10 years in 3 surgical centers.Methods: All patient demographic, medical, and ophthalmic data and operative information from 3 vitreoretinal centers were entered prospectively into an electronic medical record. Univariate analysis was undertaken, comparing risk factors between cases (SCH) and controls. Multivariable logistic regression was performed to test for independence between the risk factors (P < 0.2 in univariate analysis) and SCH.Main Outcome Measures: Risk factors for developing SCH. Visual outcome and development of complications.Results: A total of 5459 PPVs were undertaken for a wide range of indications. Fifty-six cases of PPV were complicated by SCH (1.03%). Multivariable logistic regression showed that significant risk factors for developing this included advancing age, (mean age, 69 years in cases and 60 years in controls; odds ratio [OR], 1.04; P = 0.001), male sex (76.8% of cases and 58.7% of controls; OR, 2.38; P = 0.008), presence of rhegmatogenous retinal detachment (RRD) (80.3% of cases and 52.5% of controls; OR, 5.92; P < 0.0001), presence of a dropped lens fragment (10.7% of cases and 4.5% of controls; OR, 6.94; P = 0.002), and the use of antiplatelet or anticoagulant drugs (33.9% of cases and 17.7% of controls; OR, 2.29; P = 0.007). Suprachoroidal hemorrhage was more common with increasing quadrants of RRD. The significant operative risk factor was application of an explant (25% of cases and 4.07% of controls; OR, 5.63; P < 0.0001). Phthisis (7.1% of cases and 0.9% of controls; P = 0.002, Fisher exact test) and glaucoma (14.3% of cases and 7.2% of controls; P = 0.044, chi-square test) were more common in cases than in controls.Conclusions: The risk factors for developing intraoperative SCH during PPV are male sex, advancing age, RRD, a scleral explant, a dropped lens fragment, and the use of aspirin or warfarin. Patients with this complication have a greater risk of developing ocular hypertension requiring treatment and phthisis.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Myopic Maculopathy Imaged by Optical Coherence Tomography: The Beijing Eye Study – Corrected Proof

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Purpose: To examine the features of myopia-related optical coherence tomography (OCT) findings in a population-based setting.Design: Population-based study.Participants: The Beijing Eye Study 2011 included 3468 subjects with an age of 50 years or more.Methods: The participants underwent a detailed ophthalmic examination including OCT with enhanced depth imaging of the macula.Main Outcome Measures: Optical coherence tomography features of the macula in highly myopic eyes defined by a refractive error of −6 diopters or less or an axial length of 26.5 mm or more.Results: Readable OCT images were available for 6530 eyes (94.5%) of 3278 participants. The most common change in the macula was maculoschisis (0.8±0.1%), followed by incomplete posterior vitreous detachment (0.7±0.1%), disruption of the photoreceptor inner segment/outer segment interface (0.6±0.1%), epiretinal membranes (0.6±0.1%), macular defects in Bruch’s membrane (0.3±0.1%), clumping of the retinal pigment epithelium (0.2±0.1%), vitreofoveal adhesion (0.2±0.1%), and macular holes in 2 eyes (0.1±0.1%). Prevalence of any myopic maculopathy per eye was 112 of 6530, or 1.71±0.16% (95% confidence interval [CI], 1.40–2.03). After adjustment for longer axial length (P<0.001; odds ratio [OR], 2.68; 95% CI, 1.97–3.64) and myopic refractive error (P<0.001; OR, 0.63; 95% CI, 0.55–0.73), presence of any myopic maculopathy was not significantly associated with any systemic variables (all P≥0.05), including biochemical blood examination and ocular parameters. Best-corrected visual acuity was associated significantly with the absence of a disruption of the photoreceptor inner segment/outer segment interface (P<0.001), epiretinal membranes (P<0.001), and macular holes (P<0.001) after adjustment for age and cylindrical refractive error.Conclusions: Based on OCT examination, the most common macular change in highly myopic eyes was maculoschisis, followed by incomplete posterior vitreous detachment, disruption of the photoreceptor inner segment/outer segment interface, epiretinal membranes, macular defects in Bruch’s membrane, clumping of the retinal pigment epithelium, vitreofoveal adhesion, and macular holes. The most important macular changes with a negative effect on best-corrected visual acuity were a disruption of the photoreceptor inner segment/outer segment interface and epiretinal membranes.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Global Prevalence of Vision Impairment and Blindness: Magnitude and Temporal Trends, 1990–2010 – Corrected Proof

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Purpose: Vision impairment is a leading and largely preventable cause of disability worldwide. However, no study of global and regional trends in the prevalence of vision impairment has been carried out. We estimated the prevalence of vision impairment and its changes worldwide for the past 20 years.Design: Systematic review.Participants: A systematic review of published and unpublished population-based data on vision impairment and blindness from 1980 through 2012.Methods: Hierarchical models were fitted fitted to estimate the prevalence of moderate and severe vision impairment (MSVI; defined as presenting visual acuity <6/18 but ≥3/60) and the prevalence of blindness (presenting visual acuity <3/60) by age, country, and year.Main Outcome Measures: Trends in the prevalence of MSVI and blindness for the period 1990 through 2010.Results: Globally, 32.4 million people (95% confidence interval [CI], 29.4–36.5 million people; 60% women) were blind in 2010, and 191 million people (95% CI, 174–230 million people; 57% women) had MSVI. The age-standardized prevalence of blindness in older adults (≥50 years) was more than 4% in Western Sub-Saharan Africa (6.0%; 95% CI, 4.6%–7.1%), Eastern Sub-Saharan Africa (5.7%; 95% CI, 4.4%–6.9%), South Asia (4.4%; 95% CI, 3.5%–5.1%), and North Africa and the Middle East (4.6%; 95% CI, 3.5%–5.8%), in contrast to high-income regions with blindness prevalences of ≤0.4% or less. The MSVI prevalence in older adults was highest in South Asia (23.6%; 95% CI, 19.4%–29.4%), Oceania (18.9%; 95% CI, 11.8%–23.7%), and Eastern and Western Sub-Saharan Africa and North Africa and the Middle East (95% CI, 15.9%–16.8%). The MSVI prevalence was less than 5% in all 4 high-income regions. The global age-standardized prevalence of blindness and MSVI for older adults decreased from 3.0% (95% CI, 2.7%–3.4%) worldwide in 1990 to 1.9% (95% CI, 1.7%–2.2%) in 2010 and from 14.3% (95% CI, 12.1%–16.2%) worldwide to 10.4% (95% CI, 9.5%–12.3%), respectively. When controlling for age, women’s prevalence of blindness was greater than men’s in all world regions. Because the global population has increased and aged between 1990 and 2010, the number of blind has increased by 0.6 million people (95% CI, −5.2 to 5.3 million people). The number with MSVI may have increased by 19 million people (95% CI, −8 to 72 million people) from 172 million people (95% CI, 142–198 million people) in 1990.Conclusions: The age-standardized prevalence of blindness and MSVI has decreased in the past 20 years. However, because of population growth and the relative increase in older adults, the blind population has been stable and the population with MSVI may have increased.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Imaging the Iris with Swept-Source Optical Coherence Tomography: Relationship between Iris Volume and Primary Angle Closure – Corrected Proof

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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.

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Optical Coherence Tomography–Based Observation of the Natural History of Drusenoid Lesion in Eyes with Dry Age-Related Macular Degeneration – Corrected Proof

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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.

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A 4-Year Longitudinal Study of 555 Patients Treated with Ranibizumab for Neovascular Age-Related Macular Degeneration – Corrected Proof

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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.

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Arginase in Retinopathy

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Publication date: Available online 3 July 2013 Source:Progress in Retinal and Eye Research Author(s): S. Priya Narayanan , Modesto Rojas , Jutamas Suwanpradid , Haroldo A. Toque , R. William Caldwell , Ruth B. Caldwell Ischemic r…

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