1: Am J Ophthalmol. 2010 Jul 17; [Epub ahead of print] 

Plus Disease in Retinopathy of Prematurity: Quantitative Analysis of Vascular
Change.

Thyparampil PJ, Park Y, Martinez-Perez ME, Lee TC, Weissgold DJ, Berrocal AM,
Chan RV, Flynn JT, Chiang MF.

Department of Ophthalmology, Columbia University College of Physicians and
Surgeons, New York, New York.

PURPOSE: To examine the relationship between rate of vascular change and plus
disease diagnosis. DESIGN: Retrospective observational case-control study.
METHODS: Wide-angle images were taken bilaterally from 37 infants at 31 to 33
weeks and 35 to 37 weeks postmenstrual age (PMA). The semi-automated Retinal
Image multiScale Analysis system was used to measure parameters for all arteries
and veins: integrated curvature, diameter, and tortuosity index. A reference
standard diagnosis (plus vs not plus) was defined for each eye by consensus of 5
experts at 35 to 37 weeks PMA. Weekly rate of change in parameters was compared
in eyes with plus vs not plus disease. Receiver operating characteristic area
under the curve (AUC) was calculated for plus disease detection based on 1)
weekly rates of parameter change between 31 to 33 weeks and 35 to 37 weeks PMA
and 2) parameter values at 35 to 37 weeks only. RESULTS: Weekly rates of change
in all venous parameters were significantly different in eyes with plus vs not
plus disease, particularly for tortuosity index (P < .0004) and diameter (P =
.018). Using weekly rate of change, AUC for plus disease detection was highest
for venous tortuosity index (0.819) and venous diameter (0.712). Using the 35 to
37-week PMA image only, AUC was highest for venous integrated curvature (0.952)
and diameter (0.789). CONCLUSION: Rate of change in venous, but not arterial,
parameters is correlated with plus disease development in this data set. This
did not appear to contribute information beyond analysis of an image at 35 to 37
weeks PMA only. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20643397  [PubMed - as supplied by publisher]

2: Am J Ophthalmol. 2010 Jul 17; [Epub ahead of print] 

Retinal Nerve Fiber Layer Thickness in Patients Receiving Chronic Anti-Vascular
Endothelial Growth Factor Therapy.

Horsley MB, Mandava N, Maycotte MA, Kahook MY.

Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of
Colorado Denver School of Medicine, Aurora, Colorado.

PURPOSE: To evaluate the effects of multiple intravitreal injections of
anti-vascular endothelial growth factor (VEGF) agents on the thickness of the
retinal nerve fiber layer (RNFL) in patients with wet age-related macular
degeneration (ARMD). DESIGN: Retrospective, observational, consecutive case
series of patients diagnosed with wet ARMD. METHODS: Forty-one eyes of 37
consecutive patients (25 female and 12 male; mean age 79.2 +/- 8.7 years) who
underwent treatment with pegaptanib, bevacizumab, and/or ranibizumab for ARMD
followed by sequential RNFL thickness measurement by optical coherence
tomography (OCT) were studied. Patients were included in the analyses if they
had greater than 10 total anti-VEGF injections, RNFL measurements prior to the
first injection, and at least 12 months of follow-up. Patients were divided into
3 groups depending on which anti-VEGF agent(s) they received. The OCT RNFL
measurements at the initial and final follow-up were used for analyses. RESULTS:
Average follow-up for all patients was 27.0 +/- 9.7 months and they received an
average of 16.0 +/- 5.5 intravitreal injections. The average RNFL thickness at
presentation was 92.4 +/- 15.2 mum and at last follow-up was 93.8 +/- 15.2 mum
(P = .68). There were no statistically significant differences in RNFL
measurements when comparing between individual anti-VEGF treatment groups.
CONCLUSION: Long-term treatment with anti-VEGF agents did not lead to
significant changes in RNFL thickness in a patient population with wet ARMD.
Despite the possibility of repeated intraocular pressure (IOP) fluctuations
after intravitreal injections and known neurotrophic properties of VEGF in the
eye, chronic therapy with intravitreal anti-VEGF agents does not appear to
adversely affect RNFL thickness. Further prospective studies with longer
follow-up are needed to corroborate the findings of this study. Copyright (c)
2010 Elsevier Inc. All rights reserved.

PMID: 20643396  [PubMed - as supplied by publisher]

3: Am J Ophthalmol. 2010 Jul 17; [Epub ahead of print] 

Incidence Rates and Risk Factors for Ocular Complications and Vision Loss in
HLA-B27-Associated Uveitis.

Loh AR, Acharya NR.

F.I. Proctor Foundation, University of California, San Francisco, San Francisco,
California.

PURPOSE: To calculate the incidence rates of ocular complications and vision
loss in HLA-B27-associated uveitis and to explore the effect of chronic
inflammation on clinical outcomes. DESIGN: Retrospective longitudinal cohort
study. METHODS: The clinical records of 99 patients (148 uveitis-affected eyes)
with HLA-B27-associated uveitis seen at a tertiary care center were included.
The main outcome measures were ocular complications (posterior iris synechiae,
band keratopathy, posterior subcapsular [PSC] cataracts, ocular hypertension,
hypotony, cystoid macular edema, and epiretinal membrane) and vision loss.
Anterior chamber inflammation was defined as >/=1+ grade inflammation. Chronic
uveitis was defined as persistent inflammation with relapse in <3 months after
discontinuing treatment or requiring medications to suppress inflammation for >3
months after reviewing the patient's entire clinical course. RESULTS: The
clinical course was most commonly acute/recurrent (75%) or chronic (20%). The
most common complications to develop during follow-up were ocular hypertension
(0.10/eye-year) and PSC cataracts (0.09/eye-year). In multivariate analysis, the
presence of posterior synechiae at presentation, inflammation,
corticosteroid-sparing therapy, corticosteroid injections, chronic disease, and
male gender were associated with a statistically significant increased risk of
developing vision loss (20/50 or worse). Chronic disease course was associated
with a 7-fold increased risk of visual impairment (hazard ratio [HR] = 6.8, P <
.0001). The presence of inflammation during follow-up was associated with an
increased risk of developing visual impairment (HR = 6.2, P < .0001). In
multivariate analysis, chronic disease course and topical corticosteroids were
associated with an increased risk of developing any incident ocular complication
(HR = 2.2, P = .04 and HR = 3.3, P = .01, respectively). CONCLUSIONS: Poorly
controlled inflammation was associated with the development of ocular
complications including vision loss. Patients with chronic inflammation were
also at greater risk of complications. Copyright (c) 2010 Elsevier Inc. All
rights reserved.

PMID: 20643395  [PubMed - as supplied by publisher]

4: Am J Ophthalmol. 2010 Jul 17; [Epub ahead of print] 

Prognosis of Upper Eyelid Epiblepharon Repair in Down Syndrome.

Lee KM, Choung HK, Kim NJ, Lee MJ, Lee KW, Khwarg SI.

Department of Ophthalmology, Seoul National University College of Medicine,
Seoul National University Hospital, Seoul, Korea.

OBJECTIVE: To evaluate the recurrence rate after upper eyelid epiblepharon
repair in patients with Down syndrome. DESIGN: Retrospective, observational
study. METHODS: Total of 578 Korean children (21 with Down syndrome patients,
557 with non-Down syndrome patients), who had undergone epiblepharon repair and
were followed up for more than 2 months, were included in this study. The
recurrence rate was compared between two groups at 2, 6 months after surgery.
Recurrence was defined as the re-appearance of cilia touching to cornea. The
recurrence rate was also analyzed according to whether patients had undergone
concomitant z-medial epicanthoplasty or not. RESULTS: Lower eyelid epiblepharon
repair was performed on 22 eyelids of Down syndrome patients, and 1072 eyelids
of non-Down syndrome patients. At 3 months after surgery, the recurrence rate
was not significantly different between two groups (P = 1.00). Upper eyelid
epiblepharon was repaired on 40 eyelids of Down syndrome patients, and 204
eyelids in non-Down syndrome patients. At 2 and 6 months after surgery, the
recurrence rate was significantly higher in Down syndrome patients (27.5% and
29.4%) than non-Down syndrome patients (3.4% and 4.6%) (P = 0.000, P = 0.004,
respectively). The recurrence rate of upper eyelid epiblepharon repair was not
affected in both groups whether Z-epicanthoplasty was combined or not (P = 1.00
in both groups). CONCLUSIONS: In Down syndrome patients, the recurrence rate
after upper eyelid epiblepharon repair was higher than non-Down syndrome
patients. The effect of combined Z-medial epicanthoplasty was limited in both
groups. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20643394  [PubMed - as supplied by publisher]

5: Am J Ophthalmol. 2010 Jul 17; [Epub ahead of print] 

Outer Foveolar Defect After Surgery for Idiopathic Macular Hole.

Kang SW, Lim JW, Chung SE, Yi CH.

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea.

PURPOSE: To describe the clinical implications of outer foveolar defects on
optical coherence tomography (OCT) in eyes treated surgically for macular hole
(MH). DESIGN: Retrospective observational case series. METHODS: Ninety-six eyes
of 93 subjects who had undergone surgery for the treatment of idiopathic MH were
included. Clinical data, including OCT prior to and at follow-up visits ranging
from 3 to 32 months after surgery, were analyzed. Incidence, risk factors, and
clinical outcomes of outer foveolar defect were evaluated. RESULTS: Outer
foveolar defects were noted on postoperative OCT in 44 of the 96 eyes (45.8%).
The mean preoperative diameter of MH in the eyes (333.5 +/- 126.3 mum)
evidencing outer foveolar defects was significantly smaller than those that did
not (504.2 +/- 155.6 mum) (P < .0001). The mean disappearance time of the defect
was estimated to be 182 days after surgery. The mean postoperative visual acuity
(logMAR) improved to 0.40 +/- 0.26 from 0.58 +/- 0.23 after the disappearance of
outer foveolar defects. CONCLUSIONS: Outer foveolar defects were detected
predominantly after surgery for small MHs. The defect decreases gradually in
size and eventually disappears completely approximately 6 months after surgery.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20643393  [PubMed - as supplied by publisher]

6: Am J Ophthalmol. 2010 Jul 12; [Epub ahead of print] 

Evaluating Exaggerated, Prolonged, or Delayed Postoperative Intraocular
Inflammation.

Doshi RR, Arevalo JF, Flynn HW Jr, Cunningham ET Jr.

Department of Ophthalmology, California Pacific Medical Center, San Francisco,
California.

PURPOSE: To provide a diagnostic approach for the evaluation of patients with
exaggerated, prolonged, or delayed postoperative intraocular inflammation.
DESIGN: Perspective. METHODS: Selected articles on normal and abnormal
postoperative intraocular inflammation were reviewed and interpreted in the
context of the authors' clinical and research experience. RESULTS: In addition
to infectious endophthalmitis, a number of noninfectious conditions
characterized by exaggerated, prolonged, or delayed postoperative inflammation
have been described. Heuristically, increased postsurgical inflammation may be
categorized by time from surgery to first recognition using the following
general guidelines: as immediate and occurring within 2 days after surgery; as
early and occurring after 2 days, but within the first 2 weeks, after surgery;
and as delayed and occurring more than 2 weeks after surgery. CONCLUSIONS:
Although infectious endophthalmitis always must be excluded as a cause of
increased postoperative intraocular inflammation, potential noninfectious causes
also exist. We review both infectious and noninfectious causes of increased
postoperative inflammation and provide a diagnostic framework for evaluating
such patients. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20630493  [PubMed - as supplied by publisher]

7: Am J Ophthalmol. 2010 Jul 12; [Epub ahead of print] 

Cardiovascular Risk Factors, Inflammation, and Corneal Arcus: The Singapore
Malay Eye Study.

Wu R, Wang JJ, Tai ES, Yin Wong T.

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
(R.W., T.Y.W.); the Centre for Eye Research Australia, University of Melbourne,
Australia (J.J.W.); the Centre for Vision Research, University of Sydney,
Australia (J.J.W.); and the Departments of Medicine (E.S.T.) and Ophthalmology
(T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore,
Singapore.

PURPOSE: To examine the relationship of corneal arcus with cardiovascular risk
factors and inflammation in Malay adults living in Singapore. DESIGN:
Population-based cross-sectional study. METHODS: A total of 3280 Malays aged
40-80 years (out of 4168 eligible participants; 78.7% response rate) had a
standardized interview, systemic and ocular examinations, and laboratory
investigations, including measurement of C-reactive protein (CRP), chronic
kidney disease, and peripheral artery disease. Corneal arcus was defined from
anterior segment images taken with a slit-lamp camera. RESULTS: Corneal arcus
was seen in 2345 out of 3260 participants who had anterior segment images
(73.2%). After adjustment for age, gender, total cholesterol, serum glucose, and
current smoking, many cardiovascular risk factors significantly associated with
corneal arcus, including male gender (odds ratio [OR] 1.65, 95% confidence
interval [CI] 1.27-2.03), older age (per 10 years, OR 4.49, 95% CI 3.91-5.15),
higher body mass index (per kg/m(2), OR 1.02, 95% CI 1.00-1.04), higher levels
of CRP (per 10 mg/L, OR 1.36, 95% CI 1.13-1.64), total cholesterol (per mmol/L,
OR 1.21, 95% CI 1.11-1.32), low-density lipoprotein cholesterol (per mmol/L, OR
1.94, 95% CI 1.38-2.74), presence of peripheral artery disease (OR 3.85, 95% CI
1.29-11.5), chronic kidney disease (OR 1.14, 95% CI 1.03-1.38), and current
smoking (OR 1.29, 95% CI 1.02-1.69). CONCLUSIONS: This study confirms known
associations of traditional cardiovascular risk factors with corneal arcus in an
Asian population. Additionally, corneal arcus may be associated with systemic
inflammatory markers, peripheral artery disease, and chronic kidney disease.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20630492  [PubMed - as supplied by publisher]

8: Am J Ophthalmol. 2010 Jul 7; [Epub ahead of print] 

Association of Dyslipidemia in Moderate to Severe Meibomian Gland Dysfunction.

Dao AH, Spindle JD, Harp BA, Jacob A, Chuang AZ, Yee RW.

University of Texas Medical School at Houston, Department of Ophthalmology and
Visual Sciences, Houston, Texas.

PURPOSE: To determine whether meibomian gland disease, a major contributor to
dry eye syndrome, is associated with dyslipidemia. DESIGN: Retrospective
case-control study. METHODS: setting: Clinical practice. patient or study
population: Sixty-six patients from January 2008 to July 2009 with moderate to
severe meibomian gland disease whose serum lipid levels were obtained. We
excluded patients who were already taking lipid-altering substances and patients
with rheumatologic disease. We analyzed several parameters in prevalence of
dyslipidemia (total cholesterol > 200 mg/dL, low-density lipoprotein [LDL] > 130
mg/dL, high-density lipoprotein [HDL] < 40 mg/dL, and triglycerides >150 mg/dL)
in MGD patients and compared these patients to the general population as
reported by data from the National Health and Nutrition Examination Survey
(NHANES). main outcome measure: The prevalence of dyslipidemia (elevated total
cholesterol, elevated LDL, decreased HDL, or elevated triglycerides) in patients
with moderate to severe MGD. RESULTS: Patients with moderate to severe MGD had a
higher incidence of dyslipidemia with respect to elevated total cholesterol
(>200 mg/dL), 67.4% to 45.1% (P = .0012) when compared to population controls.
There was a smaller number of MGD patients with low HDL (HDL < 40 mg/dL), 6.5%,
when compared to controls, 15.7% (P = .045). The incidence of increased LDL was
not statistically significant (P = .184). There was a statistically smaller
number of MGD patients with high triglycerides (TG > 150 mg/dL), 15.2%, when
compared to controls, 33.1% (P = .0049). CONCLUSIONS: Patients with moderate to
severe MGD have a higher incidence of dyslipidemia with respect to elevated
total cholesterol than the general population. Surprisingly, the component of
total cholesterol that contributed most to this increase in total cholesterol
came from elevated serum HDL levels. To our knowledge, elevated HDL has not been
associated with any pathologic state. Patients with MGD had a statistically
significant lower incidence of hypoalphalipoproteinemia (low HDL) than the
general population. Patients with MGD also had a lower incidence of
hypertriglyceridemia than the general population. Copyright (c) 2010 Elsevier
Inc. All rights reserved.

PMID: 20619393  [PubMed - as supplied by publisher]

9: Am J Ophthalmol. 2010 Jul 7; [Epub ahead of print] 

Ophthalmic Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal
Necrolysis and Relation to SCORTEN.

Morales ME, Purdue GF, Verity SM, Arnoldo BD, Blomquist PH.

Departments of Ophthalmology (M.E.M., S.M.V., P.H.B.) and Surgery (G.F.P.,
B.D.A.), University of Texas Southwestern Medical Center, Dallas, Texas.

PURPOSE: To evaluate the severity of ocular involvement of patients with
Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN
overlap, and to investigate the relationship of the SCORTEN (a
severity-of-illness score for SJS and TEN based on a minimal set of well-defined
variables calculated within 24 hours of admission) with eye disease in this
patient population. DESIGN: Retrospective observational case series. METHODS:
Charts of all patients admitted to the Parkland Memorial Hospital Burn Center
with a preliminary diagnosis of SJS, SJS/TEN overlap, or TEN between 1998 and
2008 were reviewed. Patients were included for study if they met clinical
criteria, had positive diagnostic skin biopsy, and had dermatologic and
ophthalmologic consultations. Eighty-two patients with a diagnosis of SJS,
SJS/TEN overlap, or TEN met inclusion criteria. Ocular manifestations were
classified as mild, moderate, or severe. Admission data were used to calculate
the SCORTEN. Main outcome measure was the severity of ocular involvement with
respect to diagnosis and SCORTEN. RESULTS: Overall, 84% of patients had ocular
involvement (71% SJS, 90% TEN, 100% SJS/TEN overlap). There was no difference in
the severity of acute ocular complications among groups. While the SCORTEN value
did correlate well with mortality rate (correlation coefficient 0.97, P = .005),
there was no correlation between the SCORTEN value and severity of eye
involvement in the acute setting. There was also no association of any
individual diagnosis of SJS/overlap/TEN with the severity of eye involvement,
although eye findings are more common in TEN (P = .03). CONCLUSIONS: Ocular
damage in the acute setting was more frequent in patients with epidermal
detachment >10% of the total body surface area. The SCORTEN value did not
correlate with the severity of eye involvement in the acute setting. Copyright
(c) 2010 Elsevier Inc. All rights reserved.

PMID: 20619392  [PubMed - as supplied by publisher]

10: Am J Ophthalmol. 2010 Jul 7; [Epub ahead of print] 

Nosocomial Acute-Onset Postoperative Endophthalmitis at a University Teaching
Hospital (2002-2009).

Wykoff CC, Parrott MB, Flynn HW Jr, Shi W, Miller D, Alfonso EC.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami
School of Medicine, Miami, Florida.

PURPOSE: To evaluate acute-onset postoperative endophthalmitis occurring at an
academic medical center and to compare rates over the last 25 years at a single
institution. DESIGN: Retrospective, consecutive case series. METHODS: Medical
records were reviewed for all patients diagnosed with acute-onset postoperative
nosocomial endophthalmitis from 2002 through 2009 associated with surgery at
Bascom Palmer Eye Institute. RESULTS: The 8-year frequency of acute-onset
postoperative endophthalmitis was 0.025% (14 of 56 672 intraocular surgeries).
The rate was 0.028% (8/28 568) for cataract surgery and 0.011% (2/18 492) for
pars plana vitrectomy (PPV). Both PPV endophthalmitis cases followed 20-gauge
surgery and no cases followed small-gauge, transconjunctival PPV (n = 2262).
Three cases occurred following penetrating keratoplasty (3/2788, 0.108%). The
most common bacterial isolate was Staphylococcus (n = 7, 50%). Initial treatment
involved ocular paracentesis (n = 8, 57%) or vitrectomy (n = 5, 36%), in
combination with injection of intraocular antibiotics (n = 14, 100%). Vancomycin
and ceftazidime were used in 13 eyes (93%) and intraocular steroids were given
initially to 9 eyes (64%). Final visual acuity was >/=20/200 in 9 eyes (64%) and
2 eyes (14%) were no light perception. At this institution since 1984, there has
been a statistically significant trend for a decreasing rate of acute-onset
postoperative endophthalmitis (1984-1994: 0.09%; 1995-2001: 0.05%; 2002-2009:
0.025%; P < .001). CONCLUSION: At a university teaching hospital involving
resident, fellow, and faculty surgeons, the frequency of acute-onset
postoperative nosocomial endophthalmitis is low, has not increased in the era of
sutureless clear corneal cataract surgery, and has steadily decreased when
compared to prior time periods from the same institution. Copyright (c) 2010
Elsevier Inc. All rights reserved.

PMID: 20619391  [PubMed - as supplied by publisher]

11: Am J Ophthalmol. 2010 Jul 7; [Epub ahead of print] 

Alcohol Consumption and the Long-Term Incidence of Cataract and Cataract
Surgery: The Blue Mountains Eye Study.

Kanthan GL, Mitchell P, Burlutsky G, Wang JJ.

Centre for Vision Research, Department of Ophthalmology and Westmead Millennium
Institute, University of Sydney, Sydney, Australia.

PURPOSE: To assess whether alcohol consumption is associated with the long-term
incidence of cataract or cataract surgery. DESIGN: Population-based prospective
cohort study. METHODS: A total of 3654 persons aged 49+ years were examined at
baseline and 2564 were re-examined after 5 and/or 10 years. Lens photographs
were taken at each visit and assessed using the Wisconsin Cataract Grading
System by masked graders. An interviewer-administered questionnaire was used to
collect information on alcohol consumption. RESULTS: No significant associations
were observed between alcohol consumption and long-term risk of nuclear,
cortical, and posterior subcapsular cataract. However, after adjusting for age,
gender, smoking, diabetes, myopia, socioeconomic status, and steroid use, total
alcohol consumption of over 2 standard drinks per day was associated with a
significantly increased likelihood of cataract surgery, when compared to total
daily alcohol consumption of 1 to 2 standard drinks (adjusted odds ratio [OR]
2.10, 95% confidence interval [CI] 1.16-3.81). Abstinence from alcohol was also
associated with increased likelihood of cataract surgery when compared to a
total alcohol consumption of 1 to 2 standard drinks per day (adjusted OR 2.36,
95% CI 1.25-4.46). CONCLUSION: A U-shaped association of alcohol consumption
with the long-term risk of cataract surgery was found in this older cohort:
moderate consumption was associated with 50% lower cataract surgery incidence,
compared either to abstinence or heavy alcohol consumption. Copyright (c) 2010
Elsevier Inc. All rights reserved.

PMID: 20619390  [PubMed - as supplied by publisher]

12: Am J Ophthalmol. 2010 Jul 6; [Epub ahead of print] 

Macular Hole Surgery and Cataract Extraction: Combined vs Consecutive Surgery.

Muselier A, Dugas B, Burelle X, Passemard M, Hubert I, Mathieu B, Berrod JP,
Bron AM, Creuzot-Garcher C.

Department of Ophthalmology University Hospital, Dijon, France.

PURPOSE: To compare the functional and the anatomic outcomes of a combined
surgery and consecutive surgery for macular hole and cataract extraction.
DESIGN: Multicenter, retrospective, comparative case series. PATIENTS: One
hundred twenty patients (120 eyes) with an idiopathic macular hole and cataract
were operated on in 1 or 2 sessions in 2 academic centers, Dijon University
Hospital and Nancy University Hospital. Combined surgery (n = 64) and
consecutive surgery (n = 56) were performed between 2006 and 2007. All patients
underwent pars plana vitrectomy with internal limiting membrane peeling and gas
tamponade. Cataract extraction was performed with phacoemulsification followed
by a posterior chamber intraocular lens implantation. The main outcome measures
were near and far visual acuity at 6 and 12 months, and the rate of closure of
macular hole evaluated with optical coherence tomography. RESULTS: After a
12-month follow-up, the postoperative best-corrected visual acuities
significantly improved in both the combined and the consecutive surgery groups
(near and far vision in both groups, P < .0001). However the improvement of far
visual acuity was not significant in the consecutive surgery group at 6 months
(P = .06) while such an improvement was observed in the combined surgery group
(P < .0001). The rates of closure, 100% and 96% in the combined and the
consecutive groups respectively, and the complications did not differ
significantly between groups. CONCLUSION: Both combined and consecutive
surgeries are safe and effective methods to treat macular hole and cataract with
equivalent functional and anatomic results in both procedures. However, combined
surgery shortened the delay for visual recovery. Copyright (c) 2010 Elsevier
Inc. All rights reserved.

PMID: 20615492  [PubMed - as supplied by publisher]

13: Am J Ophthalmol. 2010 Jul;150(1):130-1; author reply 131. 

Complications and clinical outcomes of descemet stripping automated endothelial
keratoplasty with intraocular lens exchange.

Chiang CC, Tsai YY.

Publication Types:
    Comment
    Letter

PMID: 20609714  [PubMed - indexed for MEDLINE]

14: Am J Ophthalmol. 2010 Jul;150(1):129; author reply 129-30. 

Pegaptanib for branch retinal vein occlusion.

Wong I, Koo S, Chan C.

Publication Types:
    Comment
    Letter

PMID: 20609713  [PubMed - indexed for MEDLINE]

15: Am J Ophthalmol. 2010 Jul;150(1):128; author reply 128-9. 

Sub-tenon triamcinolone acetonide injection in the treatment of scleritis.

Park YH.

Publication Types:
    Comment
    Letter

PMID: 20609711  [PubMed - indexed for MEDLINE]

16: Am J Ophthalmol. 2010 Jul;150(1):82-87.e1. 

Pars plana anterior vitrectomy, hyaloido-zonulectomy, and iridectomy for aqueous
humor misdirection.

Bitrian E, Caprioli J.

Jules Stein Eye Institute, University of California Los Angeles, USA.

PURPOSE: To report a surgical technique for aqueous misdirection refractory to
medical treatment consisting of combined pars plana vitrectomy,
hyaloido-zonulectomy, and peripheral iridectomy. DESIGN: Noncomparative case
series. METHODS: The charts of 5 pseudophakic patients who sought treatment for
aqueous humor misdirection refractory to medical treatment from May 2008 trough
February 2009 were reviewed. All 5 patients underwent anterior vitrectomy,
hyaloido-zonulectomy, and peripheral iridectomy with an anterior vitrector
through a pars plana incision. Main outcome measures were preoperative and
postoperative visual acuity, intraocular pressure, medications, slit-lamp
examination results, and fundus findings. RESULTS: Five female patients (age
range, 23 to 89 years) had increased intraocular pressure and shallowing of the
anterior chamber after cataract extraction or trabeculectomy, and none responded
to conventional medical therapy. After surgery, prompt resolution of the aqueous
misdirection was achieved in all cases. The follow-up was 7.6 months (range, 1
to 13 months). CONCLUSIONS: Aqueous misdirection refractory to medical treatment
can be treated successfully with surgery consisting of partial pars plana
vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. 2010 Elsevier Inc.
All rights reserved.

Publication Types:
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 20609709  [PubMed - indexed for MEDLINE]

17: Am J Ophthalmol. 2010 Jul;150(1):55-62.e2. 

The prevalence of macular telangiectasia type 2 in the Beaver Dam eye study.

Klein R, Blodi BA, Meuer SM, Myers CE, Chew EY, Klein BE.

University of Wisconsin-Madison School of Medicine and Public Health, Department
of Ophthalmology and Visual Sciences, 53726, USA. kleinr@epi.ophth.wisc.edu

PURPOSE: To examine the prevalence of macular telangiectasia type 2 and lesions
characterizing it. DESIGN: Population-based cohort study. METHODS: setting: City
and township of Beaver Dam, 1988-1990. study population: A total of 4790 people
43-86 years of age. observation procedure(s): Grading from stereoscopic fundus
photographs to measure macular telangiectasia type 2. main outcome measure:
Prevalent macular telangiectasia type 2. RESULTS: Macular telangiectasia type 2
was present at baseline in 0.1% of the population (95% confidence interval [CI]
0.09, 0.1). The frequencies of loss of retinal transparency, crystals in the
inner retinal layers, blunted retinal vessels, localized intraretinal pigment
migration in the juxtafoveolar region, and presence of yellow deposits and
lamellar holes in the foveal area in those without macular telangiectasia type 2
varied from 0.06% for retinal telangiectatic vessels to 1.2% for lamellar holes.
Smoking was associated with pigment clumping (odds ratio [OR] per pack year
1.02; 95% CI 1.00, 1.03; P = .02), retinal pigment epithelial (RPE)
depigmentation (OR 1.02 per pack year; 95%CI 1.00, 1.04; P = .02), loss of
transparency (OR 1.02 per pack year; 95% CI 1.00, 1.03; P = .008), and the
presence of a yellow spot in the fovea (OR 2.24 current vs past or never smoker;
95% CI 1.29, 3.89; P = .004), but not with presence of macular telangiectasia
type 2 (OR 2.72; 95% CI 0.45, 16.28; P = .27). CONCLUSIONS: The prevalence of
macular telangiectasia type 2 (0.1%) is higher than previously thought. These
data are useful in estimating the burden of this condition in the population.
The role of smoking in the development of macular telangiectasia type 2 requires
further study. 2010 Elsevier Inc. All rights reserved.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 20609708  [PubMed - indexed for MEDLINE]

18: Am J Ophthalmol. 2010 Jul;150(1):48-54.e1. 

Efficacy of intravitreal bevacizumab combined with photodynamic therapy for
polypoidal choroidal vasculopathy.

Gomi F, Sawa M, Wakabayashi T, Sasamoto Y, Suzuki M, Tsujikawa M.

Department of Ophthalmology, Osaka University Medical School, Japan.
fgomi@ophthal.med.osaka-u.ac.jp 

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) with or without
intravitreal bevacizumab injection for polypoidal choroidal vasculopathy.
DESIGN: Retrospective, comparative, interventional case series. METHODS: We
included 146 eyes of 146 patients with treatment-naive polypoidal choroidal
vasculopathy including the subfoveal region treated with PDT monotherapy or
combined with intravitreal bevacizumab injection. Treatments were chosen
according to the time period. For eyes that received combination therapy,
bevacizumab (1.25 mg) was administrated 1 day before PDT. All eyes were followed
up for at least 12 months. Ophthalmic evaluations, including measurement of the
best-corrected visual acuity and optical coherence tomography, were performed at
every visit. Indocyanine green angiography and fluorescein angiography were
performed every 3 months. RESULTS: Sixty-one eyes were treated with PDT combined
with bevacizumab and 85 eyes were treated with PDT monotherapy. The mean
best-corrected visual acuity was significantly better in the combined treatment
group than in the monotherapy group at 3 months (P = .0016), 6 months (P =
.028), 9 months (P = .038), and 12 months (P = .048). However, lesions resolved
in 78.7% of eyes in the combined group and in 75.3% in the monotherapy group;
the recurrence rates were 43.8% and 40.6%, respectively, and did not differ
significantly. The rate of development of subretinal hemorrhage within 1 month
from the initial treatment was significantly lower in the combined group than in
the PDT monotherapy group (4.5% vs 17.7%; P = .023). CONCLUSIONS: Photodynamic
therapy combined with bevacizumab injection offers significantly better early
visual outcomes than PDT alone. Combined treatment did not affect the resolution
and recurrence of lesions; however, it decreased the rate of development of
PDT-related hemorrhages. 2010 Elsevier Inc. All rights reserved.

Publication Types:
    Comparative Study

PMID: 20609707  [PubMed - indexed for MEDLINE]

19: Am J Ophthalmol. 2010 Jul;150(1):33-39.e2. 

RNAi-based treatment for neovascular age-related macular degeneration by
Sirna-027.

Kaiser PK, Symons RC, Shah SM, Quinlan EJ, Tabandeh H, Do DV, Reisen G,
Lockridge JA, Short B, Guerciolini R, Nguyen QD; Sirna-027 Study Investigators.

Cole Eye Institute, Cleveland Clinic, Ohio, USA.

PURPOSE: To assess the safety, tolerability, pharmacokinetics, and dose-limiting
toxicity of single intravitreal injection of Sirna-027, a small interfering RNA
targeting vascular endothelial growth factor receptor-1, in patients with
choroidal neovascularization (CNV) resulting from neovascular age-related
macular degeneration (AMD). Secondary objectives included assessment of anatomic
changes in retinal thickness, size of CNV, and changes in visual acuity. DESIGN:
Prospective, open-label, single-dose, dose-escalation phase 1 study. METHODS:
Twenty-six eyes of 26 patients with a median age of 82 years and CNV resulting
from AMD who had previous treatments with other therapies were treated at 2
academic retinal practices. Patients received a single dose of Sirna-027 (100,
200, 400, 800, 1200, or 1600 microg/eye). Blood was sampled for pharmacokinetic
analysis at 1, 4, and 24 hours after injection and on day 7. Patients underwent
ophthalmic examinations including visual acuity, fluorescein angiography, and
optical coherence tomography at screening and days 7, 14, 28, and 84. The main
outcome measures were adverse reactions and dose-limiting toxicities. RESULTS:
Intravitreal injection of a single dose of Sirna-027 from 100 to 1600 microg was
well tolerated in patients with AMD, with no dose-limiting toxicity found.
Adverse events were mild to moderate in severity. Adjusted mean foveal thickness
decreased within 2 weeks after study treatment. The decrease was most pronounced
in the 100- and 200-microg doses. CONCLUSIONS: A single intravitreal dose of
Sirna-027 up to 1600 microg/eye was well tolerated in patients with CNV
resulting from neovascular AMD that had been refractory to other therapies.
Stabilization or improvement in visual acuity and foveal thickness was observed.
No dose-response or dose-limiting effects were noted. 2010 Elsevier Inc. All
rights reserved.

Publication Types:
    Clinical Trial, Phase I
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 20609706  [PubMed - indexed for MEDLINE]

20: Am J Ophthalmol. 2010 Jul;150(1):27-32.e1. 

The significance of external limiting membrane status for visual acuity in
age-related macular degeneration.

Oishi A, Hata M, Shimozono M, Mandai M, Nishida A, Kurimoto Y.

Department of Ophthalmology, Kobe City Medical Center General Hospital, Japan.
aquio@kuhp.kyoto-u.ac.jp

PURPOSE: To evaluate status of the external limiting membrane (ELM) as a
contributor of visual acuity (VA) in age-related macular degeneration (AMD).
DESIGN: Hospital-based, cross-sectional study. METHODS: We retrospectively
reviewed spectral-domain optical coherence tomography images of 158 patients
with AMD who had undergone photodynamic therapy and classified them based on the
status of the ELM: absent, discontinuous, or complete. We simultaneously
assessed foveal thickness, presence or absence of subretinal fluid/mass,
presence or absence of subretinal pigment epithelium fluid/mass, status of the
inner segment/outer segment (IS/OS) junction, and status of the intermediate
line between the IS/OS junction and retinal pigment epithelium. Correlation
coefficients between each parameter and VA were analyzed. RESULTS: There was a
strong correlation between ELM status and VA (r = -0.75, P < .001), and that was
higher than that of the IS/OS (r = -0.69, P < .001). Multivariate analysis
showed that ELM status is the most important factor for VA. Other parameters
that correlated with VA included age, status of the intermediate line, and
presence of subretinal or subretinal pigment epithelium fibrosis. Foveal
thickness showed V-shaped correlation, with the dividing line around 200 mum.
CONCLUSION: ELM status may be more useful than is IS/OS status in evaluation of
retinal morphology and function in patients with AMD. 2010 Elsevier Inc. All
rights reserved.

PMID: 20609705  [PubMed - indexed for MEDLINE]

21: Am J Ophthalmol. 2010 Jul;150(1):10-15.e1. 

Risk factors for recurrent fibrovascular proliferation in aggressive posterior
retinopathy of prematurity after early vitreous surgery.

Yokoi T, Yokoi T, Kobayashi Y, Nishina S, Azuma N.

Department of Ophthalmology, National Center for Child Health and Development,
Tokyo, Japan.

PURPOSE: To analyze risk factors for postoperative recurrence of fibrovascular
tissue in eyes with aggressive posterior retinopathy of prematurity (AP ROP)
treated with early vitreous surgery. DESIGN: Retrospective, consecutive,
observational case series. METHODS: Thirty-one patients (50 eyes) with AP ROP
who underwent early vitreous surgery between March 2005 and April 2008
participated. Eyes with stage 4A or 4B disease in which fibrovascular tissue was
not attached to the vitreous base were included; those in which fibrovascular
tissue was attached extensively to vitreous base or those without dense
photocoagulation to the nonvascularized retina were excluded. Eligible eyes were
divided into 2 groups based on postoperative recurrence or no recurrence of
fibrovascular tissue. Data on gender, gestational age, birth weight, Apgar
score, intubation duration, severe systemic complications, preoperative ROP
stage, zone, fibrovascular tissue and vitreous base adhesion, clock hours of
fibrovascular tissue, postmenstrual age at the initial application of dense
photocoagulation, dense photocoagulation to both vascularized and
nonvascularized retina, postmenstrual age at vitrectomy, and intraoperative
hemorrhage were collected and analyzed. RESULTS: Fifty eyes of 31 patients
underwent early vitrectomy. Seven (14%) eyes were excluded and 43 eyes (86%)
were included. Eight (18%) of 43 eyes had a recurrence of fibrovascular tissue.
Both univariate and multivariate analysis indicated application of dense
photocoagulation to both the vascularized and nonvascularized retina was a
significant factor in the decreased recurrence of fibrovascular tissue (P = .002
and P = .008, respectively). CONCLUSIONS: Application of preoperative dense
photocoagulation to vascularized and nonvascularized retina may be important for
lowering the recurrence of fibrovascular tissue in eyes with AP ROP. 2010
Elsevier Inc. All rights reserved.

PMID: 20609704  [PubMed - indexed for MEDLINE]

22: Am J Ophthalmol. 2010 Jul;150(1):3-5. 

Cohort studies: design and pitfalls.

Soh SE, Saw SM.

Department of Epidemiology and Public Health, National University of Singapore,
Republic of Singapore.

PMID: 20609703  [PubMed - indexed for MEDLINE]

23: Am J Ophthalmol. 2010 Jul;150(1):1-2. 

The use and interpretation of linear regression analysis in ophthalmology
research.

Boscardin WJ.

Department of Medicine and Epidemiology, University of California, San
Francisco, USA. john.boscardin@ucsf.edu

PMID: 20609702  [PubMed - indexed for MEDLINE]

24: Am J Ophthalmol. 2010 Jul 2; [Epub ahead of print] 

Unifocal and Multifocal Reactive Lymphoid Hyperplasia vs Follicular Lymphoma of
the Ocular Adnexa.

Stacy RC, Jakobiec FA, Schoenfield L, Singh AD.

David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston,
Massachusetts (R.C.S., F.A.J.); and the Departments of Anatomic Pathology (L.S.)
and Ophthalmic Oncology (A.D.S.), Cole Eye Institute, Cleveland Clinic
Foundation, Cleveland, Ohio.

PURPOSE: To characterize the differentiating histopathologic and
immunophenotypic features of reactive lymphoid hyperplasia (RLH) and follicular
lymphoma of the ocular adnexa. DESIGN: Retrospective case study with clinical
follow-up and review of the literature. METHODS: Clinical records of 9 cases of
RLH and 6 cases of follicular lymphoma from 2 institutions were reviewed. Light
microscopic evaluation and immunohistochemical stains including CD20, CD3, CD5,
CD21, CD23, BCL-2, BCL-6, CD10, kappa, lambda, and Ki67 were used to distinguish
the 2 categories. RESULTS: RLH preferentially involved the conjunctiva, whereas
follicular lymphoma had a propensity to involve the lacrimal gland. Microscopic
analysis with immunohistochemical staining distinguished RLH from follicular
lymphoma. BCL-2 was positive in follicular centers of follicular lymphoma but
not in RLH. CD10 identified follicular center cells and Ki67 quantified cells in
S-phase. CD21 and CD23 detected dendritic cell scaffoldings of indistinct
germinal centers. None of the patients with RLH developed lymphoma during their
clinical courses (up to 18 years). However, 3 patients with orbital, but not
conjunctival, RLH developed immunohistochemically proven multifocal
nonophthalmic supradiaphragmatic adnexal RLH (sites included lung, parotid,
axillary nodes, and uvea). All 6 patients with follicular lymphoma had
disseminated disease. CONCLUSIONS: A correct diagnosis of RLH vs follicular
lymphoma can be reliably established employing immunohistochemical methods. A
heretofore undescribed "multifocal RLH" syndrome must be distinguished from
follicular lymphoma. Conjunctival RLH can usually be managed surgically without
radiotherapy, but "multifocal RLH" required systemic treatment in 2 of 3
patients. Follicular lymphoma requires systemic chemotherapy if discovered
beyond stage 1E. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20599186  [PubMed - as supplied by publisher]

25: Am J Ophthalmol. 2010 Jul 1; [Epub ahead of print] 

Randomized, Double-Masked, Sham-Controlled Trial of Ranibizumab for Neovascular
Age-Related Macular Degeneration: PIER Study Year 2.

Abraham P, Yue H, Wilson L.

Black Hills Regional Eye Institute, Rapid City, South Dakota.

PURPOSE: To evaluate efficacy and safety of quarterly (and then monthly)
ranibizumab during the 2-year Phase IIIb, multicenter, randomized,
double-masked, sham injection-controlled study of the efficacy and safety of
ranibizumab in subjects with subfoveal CNV with or without classic CNV secondary
to AMD (PIER) study. DESIGN: Phase IIIb, multicenter, randomized, double-masked,
sham injection-controlled trial in patients with choroidal neovascularization
(CNV) secondary to age-related macular degeneration (AMD). METHODS: Patients
were randomized 1:1:1 to sham injection (n = 63) or 0.3 mg (n = 60) or 0.5 mg (n
= 61) intravitreal ranibizumab monthly for 3 months and then quarterly. During
study year 2, eligible sham-group patients crossed over to 0.5 mg ranibizumab
quarterly. Later in year 2, all eligible randomized patients rolled over to 0.5
mg ranibizumab monthly. Key efficacy and safety outcomes of the 2-year trial are
reported. RESULTS: At month 24, visual acuity (VA) had decreased an average of
21.4, 2.2, and 2.3 letters from baseline in the sham, 0.3 mg, and 0.5 mg groups
(P < .0001 for each ranibizumab group vs sham). VA of sham patients who crossed
over (and subsequently rolled over) to ranibizumab decreased across time, with
an average loss of 3.5 letters 10 months after crossover. VA of 0.3 mg and 0.5
mg group patients who rolled over to monthly ranibizumab increased for an
average gain of 2.2 and 4.1 letters, respectively, 4 months after rollover. The
ocular safety profile of ranibizumab was favorable and consistent with previous
reports. CONCLUSIONS: Ranibizumab provided significant VA benefit in patients
with AMD-related CNV compared with sham injection. Ranibizumab appeared to
provide additional VA benefit to treated patients who rolled over to monthly
dosing, but not to patients who began receiving ranibizumab after >14 months of
sham injections. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20598667  [PubMed - as supplied by publisher]

26: Am J Ophthalmol. 2010 Jun 28; [Epub ahead of print] 

Efficacy of Ranibizumab in Patients With Macular Edema Secondary to Central
Retinal Vein Occlusion: Results From the Sham-Controlled ROCC Study.

Kinge B, Stordahl PB, Forsaa V, Fossen K, Haugstad M, Helgesen OH, Seland J,
Stene-Johansen I.

Retinaklinikken Aleris, Oslo, Norway.

PURPOSE: The ROCC study (randomized study comparing ranibizumab to sham in
patients with macular edema secondary to central Retinal vein OCClusion [CRVO])
evaluated the short-term effect of intravitreal ranibizumab injections on
best-corrected visual acuity (BCVA) and macular edema. DESIGN: Prospective,
multicenter, randomized, double-masked, placebo-controlled trial. METHODS: In
this 6-month trial, 32 patients with macular edema secondary to CRVO were
randomized to receive monthly intravitreal ranibizumab (0.5 mg/0.05 mL) or sham
injections for 3 consecutive months. If macular edema persisted, patients
received further monthly injections. Primary outcome measures were BCVA and
central macular thickness (CMT) at 6 months. RESULTS: Twenty-nine patients
completed the study. After 3 months, BCVA improved by a mean +/- standard
deviation (SD) of 16 +/- 14 Early Treatment Diabetic Retinopathy Study (ETDRS)
letters in the ranibizumab group (n = 15), compared with a mean loss of 5 +/- 15
ETDRS letters in the sham group (n = 14; P = .001). The mean +/- SD change in
CMT was -411 +/- 200 mum in the ranibizumab group and -86 +/- 165 mum with sham
(P < .001). At 6 months, the mean +/- SD change in BCVA was 12 +/- 20 ETDRS
letters in the ranibizumab group compared with -1 +/- 17 ETDRS letters in the
sham group (P = .067). The mean +/- SD change in CMT was -304 +/- 194 mum with
ranibizumab and -151 +/- 205 mum with sham (P = .05). Twelve patients (80%) in
the ranibizumab group required more than 3 initial injections; mean +/- SD
number of injections was 4.3 +/- 0.9 during the study. CONCLUSION: Monthly
ranibizumab significantly increased BCVA and decreased macular edema, compared
with sham, in patients with CRVO. Repeated consecutive injections are necessary
to maintain initial positive results. Copyright (c) 2010 Elsevier Inc. All
rights reserved.

PMID: 20591399  [PubMed - as supplied by publisher]

27: Am J Ophthalmol. 2010 Jun 28; [Epub ahead of print] 

One-Year Outcomes After Retinal Detachment Surgery Among Medicare Beneficiaries.

Day S, Grossman DS, Mruthyunjaya P, Sloan FA, Lee PP.

Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.

PURPOSE: To determine longitudinal rates of second retinal detachment operation
and postoperative adverse outcomes after retinal detachment surgery in a
nationally representative sample of older Americans. DESIGN: Retrospective,
longitudinal cohort analysis. METHODS: A total of 9216 Medicare beneficiaries
were identified from the Medicare 5% sample who were diagnosed with
rhegmatogenous retinal detachment and underwent primary pars plana vitrectomy
(PPV), scleral buckle, pneumatic retinopexy, or laser photocoagulation or
cryotherapy alone. Rhegmatogenous retinal detachment, PPV, scleral buckle,
pneumatic retinopexy, or laser photocoagulation/cryotherapy was ascertained from
International Classification of Diseases and Current Procedural Terminology
procedure codes. Rates of second retinal detachment operation and postoperative
adverse outcomes were analyzed by cumulative incidence and logistic regression
to control for prior adverse outcome measures and demographic factors. RESULTS:
At 1-year follow-up, the rate of receipt of a second retinal detachment
operation for beneficiaries who had undergone primary pneumatic retinopexy was
much higher (40.6%, P < .0001) relative to the scleral buckle (19.2%) group.
After controlling for demographic variables and ocular comorbidities, pneumatic
retinopexy individuals were nearly 3 times more likely to receive a second
retinal detachment surgery than scleral buckle individuals. No significant
differences exist in risk of second retinal detachment surgery for the PPV
compared to the scleral buckle group. Individuals receiving PPV were 2 times
more likely to suffer adverse outcomes than were those undergoing scleral
buckle. Results were robust in sensitivity analysis. CONCLUSIONS: Rates of
second operation were much higher after pneumatic retinopexy than PPV or scleral
buckle, and rates of adverse outcomes were higher in PPV, even after controlling
for risk factors and demographic variables. Copyright (c) 2010 Elsevier Inc. All
rights reserved.

PMID: 20591398  [PubMed - as supplied by publisher]

28: Am J Ophthalmol. 2010 Jun 28; [Epub ahead of print] 

Inhibition of Corneal Neovascularization by Topical Bevacizumab (Anti-VEGF) and
Sunitinib (Anti-VEGF and Anti-PDGF) in an Animal Model.

Perez-Santonja JJ, Campos-Mollo E, Lledo-Riquelme M, Javaloy J, Alio JL.

Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology/Vissum,
Miguel Hernandez University School of Medicine, Alicante, Spain; Department of
Ophthalmology, Virgen de los Lirios Hospital, Alcoy, Alicante, Spain.

PURPOSE: To evaluate the effects of topically applied bevacizumab and sunitinib
on experimentally induced corneal neovascularization. DESIGN: Experimental
animal study. METHODS: Thirty-six New Zealand rabbits were involved. One eye per
rabbit was used. Corneal neovascularization was induced by placing 5 silk
sutures in the upper cornea. Rabbits were randomized to 1 of 3 groups (12
rabbits each): Group 1 received saline 0.9%, Group 2 bevacizumab 5 mg/mL, and
Group 3 sunitinib 0.5 mg/mL. All treatments were administered 3 times daily for
14 days. Photographs were taken on a slit lamp on days 7 and 14, and
angiographic photographs were taken on day 14. The area of neovascularization
was measured in mm(2), percentage of the total corneal area, and percentage of
the corneal surface covered by sutures. RESULTS: On day 14, corneal
neovascularization area in Group 1 (25.92 +/- 5.08 mm(2), 18.78% +/- 3.5% of
corneal surface, 105.59% +/- 18.9% of corneal surface with sutures) was larger
than in Groups 2 (18.52 +/- 7.94 mm(2), 13.67% +/- 5.8%, 76.35% +/- 33.2%)
(1-way analysis of variance, P = .041) and 3 (4.57 +/- 2.32 mm(2), 3.40% +/-
1.7%, 18.94% +/- 9.2%)(P < .001). Neovascularization in Group 2 was larger than
in Group 3 (P < .001). Compared to saline, corneal neovascularization was
inhibited 28.5% by bevacizumab and 82.3% by sunitinib. Sunitinib settled on the
iris. CONCLUSIONS: Topical administration of both bevacizumab and sunitinib
inhibits corneal neovascularization in rabbits. But vascular endothelial growth
factor (VEGF) pathway blockade by bevacizumab was not sufficient for a profound
inhibition. Blocking both VEGF and platelet-derived growth factor pathways using
sunitinib was 3-fold more effective. Copyright (c) 2010 Elsevier Inc. All rights
reserved.

PMID: 20591397  [PubMed - as supplied by publisher]

29: Am J Ophthalmol. 2010 Jun 28; [Epub ahead of print] 

Use of Intraoperative Fourier-Domain Anterior Segment Optical Coherence
Tomography During Descemet Stripping Endothelial Keratoplasty.

Knecht PB, Kaufmann C, Menke MN, Watson SL, Bosch MM.

University Hospital Zurich, Department of Ophthalmology, Zurich, Switzerland.

PURPOSE: To evaluate the intraoperative use of handheld Fourier-domain optical
coherence tomography (OCT) during Descemet stripping automated endothelial
keratoplasty (DSAEK) to assess the donor-host interface. DESIGN: Prospective,
observational case series. METHODS: Six patients undergoing DSAEK surgery were
included. OCT scans of the cornea were performed intraoperatively after
insertion of the donor disc, after instillation of air in the anterior chamber
beneath the disc, after vent incisions in the host cornea in each quadrant,
following air-fluid exchange at the end of operation, and on day 1 after
surgery. The central 3 mm of each cornea was scanned. The broadest gap between
donor and host cornea (interface space) was measured. RESULTS: Adequate readings
could be obtained from all patients without any complications. In 2 patients
there was a decrease in the width of the interface space after each surgical
step documented by the OCT scans. At the end of their operation, no interface
space was detectable. In 2 patients, interface space disappeared after the vent
incisions and did not reappear during the further course of the surgery. In
further 2 patients the separation between the host and donor was still
detectable at the end of the operation. All patients had no detectable interface
gap on day 1. CONCLUSIONS: Handheld anterior segment OCT can be used to assess
the host-donor interface in lamellar corneal transplantation surgery. Donor
adherence can occur in spite of residual interface space at the end of surgery.
Further studies should be conducted to answer the question of which surgical
steps are useful in assisting with donor adhesion. Copyright (c) 2010 Elsevier
Inc. All rights reserved.

PMID: 20591396  [PubMed - as supplied by publisher]

30: Am J Ophthalmol. 2010 Jun 28; [Epub ahead of print] 

Choroidal Thickness in Normal Eyes Measured Using Cirrus HD Optical Coherence
Tomography.

Manjunath V, Taha M, Fujimoto JG, Duker JS.

New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

PURPOSE: To examine choroidal thickness and area in healthy eyes using
spectral-domain optical coherence tomography (SD-OCT). DESIGN: Retrospective,
observational case series. METHODS: Thirty-four eyes (34 subjects), with no
retinal or choroidal disease, underwent high-definition raster scanning using
SD-OCT with frame enhancement software. Choroidal thickness was measured from
the posterior edge of the retinal pigment epithelium to the choroid/sclera
junction at 500-mum intervals up to 2500 mum temporal and nasal to the fovea.
The central 1-mm area of the choroid was also measured, along with foveal
thickness of the retina. All measurements were performed by 2 independent
observers. Statistical analysis was used to correlate inter-observer findings,
choroidal thickness and area measurements with age, and choroidal thickness with
retinal foveal thickness. RESULTS: The 34 subjects had a mean age of 51.1 years.
Reliable measurements of choroidal thickness were obtainable in 74% of eyes
examined. Choroidal thickness and area measurements had strong inter-observer
correlation (r = 0.92, P < .0001 and r = 0.93, P < .0001 respectively). Area had
a moderate negative correlation with age (r = -0.62, P < .0001) that was
comparable to the correlation between mean subfoveal choroidal thickness and age
(r = -0.61, P < .0001). Retinal and choroidal thickness were found to be poorly
correlated (r = -0.23, P = .18). Mean choroidal thickness showed a pattern of
thinnest choroid nasally, thickening in the subfoveal region, and then thinning
again temporally. Mean subfoveal choroidal thickness was found to be 272 mum
(SD, +/- 81 mum). CONCLUSIONS: Choroidal thickness can be measured using SD-OCT
high-definition raster scans in the majority of eyes. Choroidal thickness across
the macula demonstrates a thin choroid nasally, thickest subfoveally, and again
thinner temporally, and a trend toward decreasing choroidal thickness with age.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20591395  [PubMed - as supplied by publisher]