Category: Peer-reviewed

Axial Biometry of the Entire Eye Using Ultra-Long Scan Depth Optical Coherence Tomography – Corrected Proof

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Purpose: To assess the repeatability of axial biometry of the entire eye using ultra-long scan depth optical coherence tomography (OCT) and to investigate the agreement with IOLMaster measurements (Carl Zeiss Meditec).Design: Prospective, observational case series.Methods: There were 37 adult subjects enrolled in group 1 and 12 adult subjects enrolled in group 2. Using ultra-long scan depth OCT, the left eyes of these groups were measured in 2 separate sessions. The images were processed by a manual method and custom-developed automatic software. A model eye was imaged for verification. The subjects in group 2 were imaged using ultra-long scan depth OCT and using the IOLMaster for axial length measurement comparison.Results: All measured parameters of the model eye matched the geometric parameters. In group 1, there were no significant differences in all measured parameters using automatic and manual segmentation methods (P > .05, paired t test). The percentage of coefficient of repeatability of segments ranged from 0.3% to 3.9%. The corresponding interclass correlation coefficients ranged from 0.946 to 0.999. The correlation between the results using automatic and manual segmentation methods appeared to be strong (R2 = 0.999; P < .05). In group 2, the axial length of the eye measured by the IOLMaster matched the results obtained by ultra-long scan depth OCT with the automatic method (R12 = 0.987; P < .05) and the manual method (R22 = 0.988; P < .05).Conclusions: Automatic axial biometry using ultra-long scan depth OCT successfully measured each segment of the entire eye with good repeatability. With further development of automatic segmentation, ultra-long scan depth OCT seems to be a promising tool in the axial biometry of the entire eye.

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CABP4 Mutations Do Not Cause Congenital Stationary Night Blindness – Corrected Proof

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I read with interest the analysis of Dutch patients diagnosed with congenital stationary night blindness (CSNB) by Bijveld et al, particularly what was written regarding patients with recessive mutations in calcium binding protein 4 (CABP4; Mendelian Inheritance in Man *608965). CABP4 encodes a protein that is specifically located in photoreceptor synaptic terminals, where it probably modulates photoreceptor calcium release. Only 3 of 101 patients diagnosed with CSNB in the authors’ series had CABP4 mutations, and all 3 patients (2 families) harbored the same homozygous mutation (c.646C>T; p.Arg216X). These 3 patients had nystagmus and low vision. Two were photophobic. All 3 had a normal fundus appearance and severe color deficiency. None complained of night blindness. All 3 were hyperopic. Such signs and symptoms, combined with their cone–rod dysfunction by electroretinography, should suggest a diagnosis of cone-rod disease rather than predominantly rod disease such as CSNB. However, because during scotopic flash stimulus there was an electronegative waveform, which is classically associated with CSNB, the 3 patients were labeled as CSNB2 (“incomplete CSNB,” with the “incomplete” referring to some rod function being present rather than completely absent). The authors recognized that these 3 patients had a distinct phenotype that was atypical for a diagnosis of CSNB2 and wondered whether studies of additional patients would confirm or refute their findings.

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Incidence of Visual Improvement in Uveitis Cases with Visual Impairment Caused by Macular Edema – Corrected Proof

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Purpose: Among cases of visually significant uveitic macular edema (ME), to estimate the incidence of visual improvement and identify predictive factors.Design: Retrospective cohort study.Participants: Eyes with uveitis, seen at 5 academic ocular inflammation centers in the United States, for which ME was documented to be currently present and the principal cause of reduced visual acuity (<20/40).Methods: Data were obtained by standardized chart review.Main Outcome Measures: Decrease of ≥0.2 base 10 logarithm of visual acuity decimal fraction-equivalent; risk factors for such visual improvement.Results: We identified 1510 eyes (of 1077 patients) with visual impairment to a level <20/40 attributed to ME. Most patients were female (67%) and white (76%), and had bilateral uveitis (82%). The estimated 6-month incidence of ≥2 lines of visual acuity improvement in affected eyes was 52% (95% confidence interval [CI], 49%–55%). Vision reduced by ME was more likely to improve by 2 lines in eyes initially with poor visual acuity (≤20/200; adjusted hazard ratio [HR] 1.5; 95% CI, 1.3–1.7), active uveitis (HR, 1.3; 95% CI, 1.1–1.5), and anterior uveitis as opposed to intermediate (HR, 1.2), posterior (HR, 1.3), or panuveitis (HR, 1.4; overall P = 0.02). During follow-up, reductions in anterior chamber or vitreous cellular activity or in vitreous haze each led to significant improvements in visual outcome (P < 0.001 for each). Conversely, snowbanking (HR, 0.7; 95% CI, 0.4–0.99), posterior synechiae (HR, 0.8; 95% CI, 0.6–0.9), and hypotony (HR, 0.2; 95% CI, 0.06–0.5) each were associated with lower incidence of visual improvement with respect to eyes lacking each of these attributes at a given visit.Conclusions: These results suggest that many, but not all, patients with ME causing low vision in a tertiary care setting will enjoy meaningful visual recovery in response to treatment. Evidence of significant ocular damage from inflammation (posterior synechiae and hypotony) portends a lower incidence of visual recovery. Better control of anterior chamber or vitreous activity is associated with a greater incidence of visual improvement, supporting an aggressive anti-inflammatory treatment approach for ME cases with active inflammation.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Androgen Receptor Identification in the Diagnosis of Eyelid Sebaceous Carcinomas – Accepted Manuscript

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Abstract: Purpose: To assess the role of androgen receptor detection in diagnosing eyelid sebaceous carcinomas and compare it with that of adipophilin.Design: Retrospective clinicopathologic study.Methods: Ten sebaceous carcinomas (eight invasive, two intraepithelial only) were immunohistochemically stained for androgen receptors and compared with adipophilin staining. Receptor staining was also performed on benign sebaceous tumors (a sebaceoma and an adenoma), and as controls on eyelid basal cell carcinomas, eyelid squamous cell carcinomas, conjunctival squamous dysplasias and conjunctival melanomas.Results: All eight patients with an invasive component of sebaceous carcinoma had a biopsy in which the tumor cells were diffusely androgen receptor positive (>20% of cells and usually >40%) and adipophilin positive. Eight cases displaying an intraepithelial (“pagetoid”) component of spread were also diffusely androgen receptor- and adipophilin-positive in at least one of multiple biopsies from each patient. However, in eight of 21 separate conjunctival biopsy specimens with intraepithelial cytologic atypia, adipophilin was negative. A sebaceoma and a sebaceous adenoma were also positive for both of these biomarkers. Among the controls, squamous carcinomas and melanomas were androgen receptor- and adipophilin-negative. Basal cell carcinomas displayed focal receptor positivity in fewer than 5% of cells and were adipophilin-negative.Conclusions: Androgen receptors and adipophilin can immunohistochemically separate sebaceous tumors from squamous carcinomas and melanomas, which were negative for both, and from basal cell carcinomas, which were receptor-positive in a distant minority of cells. Regarding intraepithelial (“pagetoid”) spread, androgen receptor detection was more sensitive and reliable than adipophilin in highlighting this component of the disease.

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RADIANCE: A Randomized Controlled Study of Ranibizumab in Patients with Choroidal Neovascularization Secondary to Pathologic Myopia – Corrected Proof

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Objective: To compare the efficacy and safety of ranibizumab 0.5 mg, guided by visual acuity (VA) stabilization or disease activity criteria, versus verteporfin photodynamic therapy (vPDT) in patients with visual impairment due to myopic choroidal neovascularization (CNV).Design: Phase III, 12-month, randomized, double-masked, multicenter, active-controlled study.Participants: Patients (N = 277) with visual impairment due to myopic CNV.Methods: Patients were randomized to receive ranibizumab on day 1, month 1, and thereafter as needed guided by VA stabilization criteria (group I, n = 106); ranibizumab on day 1 and thereafter as needed guided by disease activity criteria (group II, n = 116); or vPDT on day 1 and disease activity treated with ranibizumab or vPDT at investigators’ discretion from month 3 (group III, n = 55).Main Outcome Measures: Mean average best-corrected visual acuity (BCVA) change from baseline to month 1 through months 3 (primary) and 6, mean BCVA change and safety over 12 months.Results: Ranibizumab treatment in groups I and II was superior to vPDT based on mean average BCVA change from baseline to month 1 through month 3 (group I: +10.5, group II: +10.6 vs. group III: +2.2 Early Treatment Diabetic Retinopathy Study [ETDRS] letters; both P < 0.0001). Ranibizumab treatment guided by disease activity was noninferior to VA stabilization-guided retreatment based on mean average BCVA change from baseline to month 1 through month 6 (group II: +11.7 vs. group I: +11.9 ETDRS letters; P < 0.00001). Mean BCVA change from baseline to month 12 was +13.8 (group I), +14.4 (group II), and +9.3 ETDRS letters (group III). At month 12, 63.8% to 65.7% of patients showed resolution of myopic CNV leakage. Patients received a median of 4.0 (group I) and 2.0 (groups II and III) ranibizumab injections over 12 months. No deaths or cases of endophthalmitis and myocardial infarction occurred.Conclusions: Ranibizumab treatment, irrespective of retreatment criteria, provided superior BCVA gains versus vPDT up to month 3. Ranibizumab treatment guided by disease activity criteria was noninferior to VA stabilization criteria up to month 6. Over 12 months, individualized ranibizumab treatment was effective in improving and sustaining BCVA and was generally well tolerated in patients with myopic CNV.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus – Corrected Proof

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Objective: To describe the incidence and types of adult-onset strabismus in a geographically defined population.Design: Retrospectively reviewed population-based cohort.Participants: All adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with new-onset adult strabismus from January 1, 1985, through December 31, 2004.Methods: The medical records of all potential cases identified by the resources of the Rochester Epidemiology Project were reviewed.Main Outcome Measures: Incidence rates for adult-onset strabismus and its types.Results: Seven hundred fifty-three cases of new-onset adult strabismus were identified during the 20-year period, yielding an annual age- and gender-adjusted incidence rate of 54.1 cases (95% confidence interval, 50.2–58.0) per 100 000 individuals 19 years of age and older. The 4 most common types of new-onset strabismus were paralytic (44.2% of cases), convergence insufficiency (15.7%), small-angle hypertropia (13.3%), and divergence insufficiency (10.6%). The incidence of adult-onset strabismus overall and its 4 most common forms significantly increased with age (P < 0.001 for all), with a peak incidence in the eighth decade of life. The lifetime risk of being diagnosed with adult-onset strabismus was 4.0% in women and 3.9% in men.Conclusions: Paralytic strabismus was the most common subtype of new-onset adult strabismus in this population-based cohort. All of the most common forms of adult-onset strabismus increased with age, especially after the sixth decade of life. Further characterization of strabismus types found in this study is warranted to better define this disorder.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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