1: Am J Ophthalmol. 2012 Jan 25; [Epub ahead of print] 

Causes of Glaucoma After Descemet Membrane Endothelial Keratoplasty.

Naveiras M, Dirisamer M, Parker J, Ham L, van Dijk K, Dapena I, Melles GR.

Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands;
Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands.

PURPOSE: To describe the incidence and causes of glaucoma after Descemet
membrane endothelial keratoplasty (DMEK). DESIGN: Nonrandomized prospective
cohort study at a tertiary referral center. METHODS: The incidence of glaucoma
was evaluated in the first 275 consecutive eyes that underwent DMEK for Fuchs
endothelial dystrophy (260 eyes) or bullous keratopathy (15 eyes). Glaucoma was
defined as a postoperative intraocular pressure (IOP) elevation of >/=24 mm Hg,
or >/=10 mm Hg from the preoperative baseline. If possible, the cause of
glaucoma was identified, and best-corrected visual acuity (BCVA), endothelial
cell density (ECD), and postoperative course were documented, with a mean
follow-up of 22 (+/- 13) months. RESULTS: Overall, 18 eyes (6.5%) showed
postoperative glaucoma after DMEK. Seven eyes (2.5%) had an exacerbation of a
pre-existing glaucoma. Eleven eyes (4%) presented with a de novo IOP elevation,
associated with air bubble-induced mechanical angle closure (2%), steroid
response (0.7%), or peripheral anterior synechiae (0.4%), or without detectable
cause (0.7%). Two eyes (0.7%) required glaucoma surgery after DMEK. At 6 months,
all eyes had a BCVA of >/=20/40 (>/=0.5), and 81% reached >/=20/25 (>/=0.8) (n =
16); mean ECD was 1660 (+/- 554) cells/mm(2) (n = 15) (P > .1). CONCLUSION:
Glaucoma after DMEK may be a relatively frequent complication that could be
avoided by reducing the residual postoperative air bubble to 30% in phakic eyes,
applying a population-specific steroid regime, and avoiding decentration of the
Descemet graft. Eyes with a history of glaucoma may need close IOP monitoring in
the first postoperative months, especially in eyes with an angle-supported
phakic intraocular lens. Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22285014  [PubMed - as supplied by publisher]

2: Am J Ophthalmol. 2012 Jan 25; [Epub ahead of print] 

Changes in Health-Related Quality of Life 1 Year Following Strabismus Surgery.

Hatt SR, Leske DA, Liebermann L, Holmes JM.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

PURPOSE: To report changes in health-related quality of life (HRQOL) 1 year
following strabismus surgery. DESIGN: Retrospective cohort study. METHODS:
Seventy-three adults undergoing strabismus surgery in a single clinical practice
completed the Adult Strabismus-20 (AS-20) HRQOL questionnaire preoperatively and
at 6 weeks and 1 year postoperatively. All included adults were successfully
aligned at 6 weeks postoperatively. Success was defined based on clinical
criteria. Change in AS-20 psychosocial and function scores was evaluated as: 1)
difference in scores between 6 weeks and 1 year postoperatively and 2)
proportions exceeding previously published limits of agreement at 6 weeks and 1
year. RESULTS: For patients successfully aligned at both 6 weeks and 1 year (n =
51), further improvement in median scores was seen from 6 weeks to 1 year for
both the psychosocial scale (83.8 vs 93.8; P < .0001) and the function scale
(72.5 vs 77.5; P = .007). Also, a greater proportion exceeded limits of
agreement at 1 year than at 6 weeks (psychosocial: 48% vs 30%; P = .007,
function: 67% vs 51%; P = .01). For patients who became partial success (n = 18)
or failure (n = 4) at 1 year there was a numerical decrease in scores at 1 year.
CONCLUSIONS: Adult strabismus patients who remain successfully aligned show
continued improvement in both psychosocial and function scores from 6 weeks to 1
year postoperatively, indicating that improvement in HRQOL is long-lasting.
Evaluation of HRQOL should be considered when reporting strabismus surgery
outcomes in clinical trials, and may prove helpful in assessing outcomes in
clinical practice. Copyright (c) 2011 Elsevier Inc. All rights reserved.

PMID: 22285013  [PubMed - as supplied by publisher]

3: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Correlation Between Plasma Pentosidine Concentrations and Retinal Hemodynamics
in Patients With Type 2 Diabetes.

Sato E, Nagaoka T, Yokota H, Takahashi A, Yoshida A.

Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.

PURPOSE: To investigate whether plasma pentosidine, a well-defined advanced
glycation end product, is associated with retinal hemodynamic abnormalities in
patients with type 2 diabetes. DESIGN: Prospective cross-sectional study.
METHODS: Forty-two eyes with type 2 diabetes mellitus were evaluated. The type 2
diabetic eyes were divided into 2 groups: 22 eyes (22 patients; mean age, 61
years) with nondiabetic retinopathy (NDR) and 20 eyes (20 patients; mean age, 61
years) with mild nonproliferative diabetic retinopathy (NPDR). We used a retinal
laser Doppler system to measure the arterial diameter, velocity, and blood flow
in the major temporal retinal arteries. The pulsatility ratio, a resistive index
expressed as the peak systolic to the end diastolic velocity ratio, was
calculated from the blood velocity traces. Plasma pentosidine was measured in 42
patients with diabetes using a commercially available competitive enzyme-linked
immunosorbent assay. RESULTS: The pulsatility ratio significantly increased in
patients with NPDR (4.8 +/- 1.5) compared with patients with NDR (3.7 +/- 0.8)
(P = .0061). No differences in velocity, diameter, or blood flow were seen
between the 2 groups. Plasma pentosidine levels also increased significantly (P
= .0085) in patients with NPDR (0.057 +/- 0.015) compared to patients with NDR
(0.047 +/- 0.012). The pulsatility ratio was correlated positively with the
plasma pentosidine levels in patients with NPDR (Pearson correlation, r = 0.45,
P = .044). Multiple regression analysis showed that the plasma pentosidine level
was significantly associated with the pulsatility ratio (standardized
coefficient, 0.62; P = .009). CONCLUSIONS: The vascular rigidity of the retinal
arteries may increase with increasing plasma pentosidine in patients with type 2
diabetes with retinopathy. Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265156  [PubMed - as supplied by publisher]

4: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Multimodal Fundus Imaging in Choroidal Osteoma.

Navajas EV, Costa RA, Calucci D, Hammoudi DS, Simpson ER, Altomare F.

Department of Ophthalmology and Vision Sciences, Princess Margaret Hospital,
University of Toronto, Toronto, Ontario, Canada.

PURPOSE: To describe the morphologic features of calcified and decalcified
choroidal osteomas using multimodal imaging and correlate these findings with a
previous histopathologic study. DESIGN: Retrospective observational case series.
METHODS: Three patients with choroidal osteoma underwent complete ophthalmologic
examination, fundus photography, and multimodal fundus imaging, including
Fourier-domain optical coherence tomography (FD-OCT) and blue-light fundus
autofluorescence (bAF). RESULTS: FD-OCT imaging of calcified tumors revealed a
distinctive latticework pattern of reflectivity resembling the spongy bone
structure seen histopathologically. On bAF the fluorescence was relatively well
preserved overlying calcified tumors. In decalcified areas 2 patterns of
reflectivity were identified: the first consisted of areas of relative
hyperreflectivity with a lamellar appearance while the second was characterized
by heterogeneous, hyperreflective, mound-like irregular areas associated with
some posterior optical shadowing. Decalcified tumor areas had reduced overall
fluorescence on bAF. CONCLUSION: FD-OCT demonstrated different reflectivity
patterns in both calcified and decalcified portions of the choroidal osteoma,
which may correspond to different stages of tumor evolution. A distinctive
latticework pattern of reflectivity similar to spongy bone was seen in calcified
tumors. These observations improve our knowledge of the in vivo structure of
choroidal osteomas and may have implications for the diagnosis and management of
this tumor. Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265155  [PubMed - as supplied by publisher]

5: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Surgical and Visual Outcomes of the Type I Boston Keratoprosthesis for the
Management of Aniridic Fibrosis Syndrome in Congenital Aniridia.

Bakhtiari P, Chan C, Welder JD, de la Cruz J, Holland EJ, Djalilian AR.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago,
Illinois.

PURPOSE: To report the clinical features and surgical management of aniridic
fibrosis syndrome using the type I Boston Keratoprosthesis (KPro). DESIGN:
Interventional case series. METHODS: Retrospective chart review of 9 eyes in 9
patients with congenital aniridia that developed aniridic fibrosis syndrome.
RESULTS: All patients had clinical diagnosis of congenital aniridia. Previously,
all patients had undergone cataract surgery with posterior chamber intraocular
lens (IOL) implantation and 7 patients had existing tube shunts. In all cases,
fibrosis presented as progressive retrocorneal and retrolenticular membrane
formation causing displacement of the IOL and secondary corneal decompensation.
Two eyes had tractional folds in the retina with posterior extension of the
membrane. The management included IOL explantation in 7 of 9 cases, removal of
fibrosis with pars plana vitrectomy in all 9 patients, and implantation of a
type I Boston KPro in all eyes. At a mean final follow-up of 26.1 months (range
6 to 48 months), vision remained improved in all patients. No patient had
recurrence of the fibrotic membrane after KPro implantation. CONCLUSION: This
study represents another case series describing aniridic fibrosis syndrome and
the largest study to report utilization of the type I Boston KPro in such
patients. As the fibrosis can cause IOL dislocation, corneal decompensation,
hypotony, and retinal detachment, monitoring for aniridic fibrosis syndrome in
congenital aniridia with early surgical intervention is recommended. Type I
Boston KPro may be considered in the surgical treatment of this condition.
Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265154  [PubMed - as supplied by publisher]

6: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Clinical Outcomes of Repeat Autologous Cultivated Limbal Epithelial
Transplantation for Ocular Surface Burns.

Basu S, Ali H, Sangwan VS.

Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad,
India; Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, L V Prasad Eye
Institute, Hyderabad, India.

PURPOSE: To report the clinical outcomes of repeat autologous cultivated limbal
epithelial transplantation in patients with recurrence of limbal stem cell
deficiency after a failed primary procedure. DESIGN: Retrospective case series.
METHODS: This study included 50 patients, above 8 years of age, with clinically
diagnosed unilateral limbal stem cell deficiency following ocular surface burns,
treated between 2001 and 2010. Following failure of primary surgery all patients
underwent a repeat limbal biopsy from the unaffected eye. The limbal cells were
expanded ex vivo on a human amniotic membrane substrate for 10 to 14 days using
a completely xeno-free explant culture technique. The resulting cultured
epithelial monolayer and amniotic membrane were transplanted onto the patient's
affected eye. All patients underwent a comprehensive ophthalmic examination of
both eyes at every follow-up visit. Postoperative corneal surface stability,
change in visual acuity, and complications were objectively analyzed. RESULTS:
At a mean follow-up of 2.3 +/- 1.4 (median: 1.96, range: 1 to 7.5) years, 33 of
the 50 recipient eyes (66%) maintained a completely epithelialized, avascular,
and clinically stable corneal surface. A 2-line improvement in visual acuity was
seen in 38 of the 50 recipient eyes (76%). None of the donor eyes developed any
clinical features of ocular surface disease, conjunctival overgrowth of the
donor site, or decrease in vision throughout the follow-up period. CONCLUSIONS:
Repeat autologous cultivated limbal epithelial transplantation successfully
restores corneal epithelial stability and improves vision in eyes with
recurrence of limbal stem cell deficiency, following failed primary surgery for
ocular burns, without adversely affecting donor eyes. Copyright (c) 2012
Elsevier Inc. All rights reserved.

PMID: 22265153  [PubMed - as supplied by publisher]

7: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

The Effect of Alpha Antagonists on Pupil Dynamics: Implications for the
Diagnosis of Intraoperative Floppy Iris Syndrome.

Theodossiadis PG, Achtsidis V, Theodoropoulou S, Tentolouris N, Komninos C,
Fountas KN.

2nd Department of Ophthalmology, "Attikon" University Hospital, University of
Athens, Athens, Greece.

PURPOSE: To assess pupil dynamics quantitatively in relation to the use of
alpha(1)-adrenoceptor antagonists, which contribute to the features of
intraoperative floppy iris syndrome, using a new, hand-held, digital
pupillometer. DESIGN: Prospective case-control study. METHODS: We studied 15 and
25 patients administered tamsulosin and alfuzosin, respectively, as well as 25
control patients. Resting pupil diameter and subsequent contraction, latency,
constriction velocity, and dilation velocity were recorded using an electronic
pupillometer. All pupil measurements were performed before and after
pharmacologic dilation. RESULTS: In predilation pupillary measurements, we
detected a significant decrease in maximum pupillary diameter by 0.50 +/- 0.19
mm (P = .011) and in the mean percentage of diameter reduction after stimulation
(5.23 +/- 2.42%, P = .035) in the tamsulosin group. Alfuzosin also induced a
significant decrease in maximum pupillary diameter (0.49 +/- 0.17 mm, P = .005).
Constriction velocity was significantly reduced by 0.70 +/- 0.20 m/s (P = .001)
in the tamsulosin group and by 0.54 +/- 0.18 m/s (P = .004) in the alfuzosin
group. In terms of postdilation measurements, maximum and minimum pupil
diameters were reduced significantly only in the tamsulosin group (by 1.09 +/-
0.31 mm [P = .001] and by 0.89 +/- 0.36 mm [P = .016], respectively).
CONCLUSIONS: We describe a reliable, accurate, and rapid method to acquire
quantitative pupil measurements and identify the tendency for intraoperative
floppy iris syndrome before cataract surgery after the use of alfuzosin and
tamsulosin. This investigation also analyzed the similarities and differences
induced by the 2 drugs in predilation and postdilation pupil dynamics,
demonstrating that tamsulosin is more potent than alfuzosin in inducing
intraoperative floppy iris syndrome. Copyright (c) 2012 Elsevier Inc. All rights
reserved.

PMID: 22265152  [PubMed - as supplied by publisher]

8: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Use of Topiramate and Risk of Glaucoma: A Case-Control Study.

Etminan M, Maberley D, Mikelberg FS.

Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, Canada; Department of Medicine, Faculty of
Medicine, University of British Columbia, Vancouver, Canada.

PURPOSE: To examine the possible link of acute-onset glaucoma with topiramate.
DESIGN: Case-control study. METHODS: A case-control study was conducted among a
cohort of subjects who had visited an ophthalmologist in the Province of British
Columbia, Canada from 2000 to 2007. Cases were identified as those newly
diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and
matched to the cases by age and calendar time using density-based sampling.
Crude and adjusted rate ratios (RRs) for current and past use of topiramate were
computed. As a sensitivity analysis, the risk of glaucoma with a positive
control drug (an oral steroid) and a negative control drug (inhaled albuterol)
was also assessed. RESULTS: From the initial cohort of 989 591 subjects, 178 264
cases of glaucoma and 891 320 controls were identified. There was a slight
increase in the risk of glaucoma among current users of topiramate (RR = 1.23
[95% confidence interval (CI), 1.09-1.40]). This risk was further elevated among
new users of the drug (RR = 1.54 [95% CI, 1.09-2.17]). No increase in the risk
of glaucoma requiring drug therapy was observed among current topiramate users
(RR = 1.09 [95% CI, 0.80-1.61]). CONCLUSION: We found an increase in the risk of
glaucoma with first-time users of topiramate. Future studies are needed to
confirm these findings. Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265151  [PubMed - as supplied by publisher]

9: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Surgical Rehabilitation of the Open Globe Injury Patient.

Andreoli MT, Andreoli CM.

Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston,
Massachusetts.

PURPOSE: To describe the long-term surgical course of patients with open globe
injury. DESIGN: Retrospective case series. METHODS: Patients with open globe
injuries (848 in total) treated surgically at the Massachusetts Eye and Ear
Infirmary between 2000 and 2009 were retrospectively reviewed. Data from
presentation, initial repair, and follow-up surgery were analyzed. RESULTS:
Among 848 injuries, 1415 surgical procedures were performed. The mean follow-up
time was 19.7 months, including 6017 visits. On average, patients required 1.7
surgeries and 7.1 follow-up visits. Factors predicting follow-up surgery
included more severe ocular trauma score, worse prerepair visual acuity, retinal
hemorrhage, anterior vitrectomy at primary repair, pars plana vitrectomy at
primary repair, and lensectomy at primary repair. Patients with zone II injury,
hemorrhagic choroidal detachment, and a history of previous ocular surgery
tended to require follow-up surgery less frequently. Patients requiring a second
surgery tended to have worse visual acuity at presentation and postrepair.
Postoperative visual outcomes were worse for patients who underwent
vitreoretinal follow-up surgery, likely because of mechanism of injury.
Variables associated with inferior visual outcome were worse prerepair visual
acuity, postoperative afferent pupillary defect (APD), old age, scleral
laceration, and retinal detachment. CONCLUSION: Open globe injuries require
significant surgical follow-up. Patients requiring multiple operations tended to
have worse postoperative visual acuity. Patients who underwent vitreoretinal
surgery had overall worse visual outcomes. While the first year of surveillance
appears to be pivotal in the course of an open globe injury, these patients can
expect long-term care from comprehensive and subspecialty ophthalmologists.
Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265150  [PubMed - as supplied by publisher]

10: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Efficacy and Potential Complications of Difluprednate Use for Pediatric Uveitis.

Slabaugh MA, Herlihy E, Ongchin S, van Gelder RN.

Department of Ophthalmology, University of Washington School of Medicine,
Seattle, Washington.

PURPOSE: To evaluate the clinical effect of topical difluprednate in pediatric
patients for treatment of noninfectious uveitis. DESIGN: Retrospective,
observational case series. METHODS: Twenty-six eyes of 14 pediatric patients
with noninfectious uveitis who were treated with topical difluprednate were
evaluated. Anterior and posterior cell grade, visual acuity, intraocular
pressure (IOP), and cystoid macular edema (CME) were recorded at each visit.
Main outcome measures were changes in anterior segment cell, CME, visual acuity,
and IOP and development of a visually significant cataract. RESULTS: A
significant (>/= 2-grade decrease or decrease to 0 in anterior segment cell)
reduction in anterior segment inflammation was observed during treatment with
topical difluprednate in 88% of eyes (22/25) when used as an adjuvant to
systemic immunomodulatory therapy. In addition, improvement in CME associated
with uveitis was seen in response to topical therapy with difluprednate in 78%
of eyes with CME (7/9). A significant IOP response (IOP increase of >/= 10 mm Hg
from baseline and IOP >/= 24 mm Hg) was seen in 50% of eyes (13/26) and in 50%
of patients (7/14); 3 eyes of 2 patients required glaucoma surgery. Cataract
formation or progression was observed in 39% of eyes (10/26) and in 43% of
patients (6/14); 5 eyes of 3 patients required cataract surgery. CONCLUSIONS:
Difluprednate is an effective agent for both control of anterior segment
inflammation and reduction of CME in pediatric patients with uveitis when used
as an adjuvant to systemic immunomodulatory therapy. A high rate of
steroid-induced IOP elevation and cataract formation is seen in this population.
Close monitoring of pediatric patients receiving difluprednate is recommended.
Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265149  [PubMed - as supplied by publisher]

11: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Clinical Features of Newly Diagnosed Cytomegalovirus Retinitis in Northern
Thailand.

Ausayakhun S, Keenan JD, Ausayakhun S, Jirawison C, Khouri CM, Skalet AH, Heiden
D, Holland GN, Margolis TP.

Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang
Mai, Thailand.

PURPOSE: To characterize the clinical manifestations of cytomegalovirus (CMV)
retinitis in northern Thailand. DESIGN: Prospective, observational,
cross-sectional study. METHODS: We recorded characteristics of 52 consecutive
patients newly diagnosed with CMV retinitis at a tertiary university-based
medical center in northern Thailand. Indirect ophthalmoscopy by experienced
ophthalmologists was supplemented with fundus photography to determine the
proportion of eyes with various clinical features of CMV retinitis. RESULTS: Of
the 52 patients with CMV retinitis, 55.8% were female. All were HIV-positive.
The vast majority (90.4%) had started antiretroviral therapy. CMV retinitis was
bilateral in 46.2% of patients. Bilateral visual acuity worse than 20/60 was
observed in 23.1% of patients. Of 76 eyes with CMV retinitis, 61.8% had zone I
disease and 21.6% had lesions involving the fovea. Lesions larger than 25% of
the retinal area were observed in 57.5% of affected eyes. CMV retinitis lesions
commonly had marked or severe border opacity (47.4% of eyes). Vitreous haze
often was present (46.1% of eyes). Visual impairment was more common in eyes
with larger retinitis lesions. Retinitis lesion size, used as a proxy for
duration of disease, was associated with fulminant appearance (odds ratio, 1.24;
95% confidence interval, 1.01 to 1.51) and marked or severe border opacity (odds
ratio, 1.36; 95% confidence interval, 1.11 to 1.67). Based on lesion size,
retinitis preceded antiretroviral treatment in each patient. CONCLUSIONS:
Patients seeking treatment at a tertiary medical center in northern Thailand had
advanced CMV retinitis, possibly because of delayed diagnosis. Earlier screening
and treatment of CMV retinitis may limit progression of disease and may prevent
visual impairment in this population. Copyright (c) 2012 Elsevier Inc. All
rights reserved.

PMID: 22265148  [PubMed - as supplied by publisher]

12: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Diagnostic Capability of Spectral-Domain Optical Coherence Tomography for
Glaucoma.

Wu H, de Boer JF, Chen TC.

Glaucoma Service, Massachusetts Eye and Ear Infirmary, Department of
Ophthalmology, Harvard Medical School, Boston, Massachusetts.

PURPOSE: To determine the diagnostic capability of spectral-domain optical
coherence tomography in glaucoma patients with visual field defects. DESIGN:
Prospective, cross-sectional study. METHODS: Settings: Participants were
recruited from a university hospital clinic. Study population: One eye of 85
normal subjects and 61 glaucoma patients with average visual field mean
deviation of -9.61 +/- 8.76 dB was selected randomly for the study. A subgroup
of the glaucoma patients with early visual field defects was calculated
separately. Observation Procedures: Spectralis optical coherence tomography
(Heidelberg Engineering, Inc) circular scans were performed to obtain
peripapillary retinal nerve fiber layer (RNFL) thicknesses. The RNFL diagnostic
parameters based on the normative database were used alone or in combination for
identifying glaucomatous RNFL thinning. Main Outcome Measures: To evaluate
diagnostic performance, calculations included areas under the receiver operating
characteristic curve, sensitivity, specificity, positive predictive value,
negative predictive value, positive likelihood ratio, and negative likelihood
ratio. RESULTS: Overall RNFL thickness had the highest area under the receiver
operating characteristic curve values: 0.952 for all patients and 0.895 for the
early glaucoma subgroup. For all patients, the highest sensitivity (98.4%; 95%
confidence interval, 96.3% to 100%) was achieved by using 2 criteria: >/= 1 RNFL
sectors being abnormal at the < 5% level and overall classification of
borderline or outside normal limits, with specificities of 88.9% (95% confidence
interval, 84.0% to 94.0%) and 87.1% (95% confidence interval, 81.6% to 92.5%),
respectively, for these 2 criteria. CONCLUSIONS: Statistical parameters for
evaluating the diagnostic performance of the Spectralis spectral-domain optical
coherence tomography were good for early perimetric glaucoma and were excellent
for moderately advanced perimetric glaucoma. Copyright (c) 2012 Elsevier Inc.
All rights reserved.

PMID: 22265147  [PubMed - as supplied by publisher]

13: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Reduced-Fluence Photodynamic Therapy Combined With Intravitreal Bevacizumab for
Polypoidal Choroidal Vasculopathy.

Sagong M, Lim S, Chang W.

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu,
Korea.

PURPOSE: To evaluate the efficacy and safety of reduced-fluence photodynamic
therapy (PDT) combined with bevacizumab for polypoidal choroidal vasculopathy
(PCV). DESIGN: Prospective, noncomparative, interventional case series. METHODS:
Sixteen treatment-naive patients with polypoidal choroidal vasculopathy were
treated with reduced-fluence PDT combined with bevacizumab. All patients were
followed up monthly for 12 months with measurements of best-corrected visual
acuity (BCVA) and central foveal thickness by optical coherence tomography.
Indocyanine green angiography and fluorescein angiography were performed every 3
months. Patients were re-treated with reduced-fluence PDT combined with
bevacizumab or with sole injection of bevacizumab when indicated. RESULTS: The
mean logMAR BCVA showed significant improvement from 0.76 at baseline to 0.46 at
12 months (P = .002). At 12 months, the BCVA improved in 9 eyes (56.3%) by 3
lines or more, was stable in 6 eyes (37.5%), and decreased in 1 eye (6.3%)
because of recurrence of polyps. During the study period, 3 patients (18.8%) had
recurrence of polyps and 2 patients (12.5%) had persistent polyps. Mean episodes
of reduced-fluence PDT and mean injections of intravitreal bevacizumab over 12
months were 1.44 and 2.44, respectively. Although 3 patients had mild choroidal
nonperfusion-1 eye after 1 session of PDT and 2 eyes after 2 sessions-no severe
complications, including endophthalmitis, uveitis, or subretinal hemorrhage,
developed. CONCLUSION: Reduced-fluence PDT combined with bevacizumab for PCV
seemed to be effective for improving vision and reducing complications. Further
study to optimize the light dose of PDT in combination therapy is needed in
order to achieve better treatment outcomes for PCV. Copyright (c) 2012 Elsevier
Inc. All rights reserved.

PMID: 22265146  [PubMed - as supplied by publisher]

14: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Succinate Increases in the Vitreous Fluid of Patients With Active Proliferative
Diabetic Retinopathy.

Matsumoto M, Suzuma K, Maki T, Kinoshita H, Tsuiki E, Fujikawa A, Kitaoka T.

Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical
Sciences, Nagasaki University, Nagasaki, Japan.

PURPOSE: To examine vitreous succinate levels from proliferative diabetic
retinopathy (PDR) patients and ascertain their association with PDR activity.
DESIGN: Comparative case series. METHODS: A total of 81 eyes of 72 PDR patients
were divided into active PDR (22 eyes), quiescent PDR (21 eyes), and active PDR
with intravitreal bevacizumab injection (38 eyes). Twenty epiretinal membrane
(ERM) patients (21 eyes) served as controls. RESULTS: Mean vitreous succinate
levels were 1.27 muM in ERM and 2.20 muM in PDR, with the differences
statistically significant (P = .03). When comparing mean vitreous succinate
levels (active PDR: 3.32 muM; quiescent PDR: 1.02 muM; active PDR with
intravitreal bevacizumab injection: 1.20 muM), significant differences were
found between active and quiescent PDR (P < .01) and between active PDR and
active PDR with intravitreal bevacizumab injection (P < .01). Even though
succinate levels were low, retinopathy activities were very high in patients
with active PDR with intravitreal bevacizumab injection. Mean vitreous vascular
endothelial growth factor (VEGF) levels (active PDR: 1696 pg/mL; quiescent PDR:
110 pg/mL; active PDR with intravitreal bevacizumab injection: n.d.) were
similar to previous reports. Mean vitreous erythropoietin levels (active PDR:
703 mIU/mL; quiescent PDR: 305 mIU/mL; active PDR with intravitreal bevacizumab
injection: 1562 mIU/mL) suggested very high retinopathy activities in patients
with active PDR with intravitreal bevacizumab injection. CONCLUSIONS: Succinate,
like VEGF, may be an angiogenic factor that is induced by ischemia in PDR.
Although succinate is reported to promote VEGF expression, VEGF inhibition
decreases succinate. Thus, VEGF, via a positive feedback mechanism, may regulate
succinate. Copyright (c) 2011 Elsevier Inc. All rights reserved.

PMID: 22265145  [PubMed - as supplied by publisher]

15: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Clinical Outcomes in Patients With Cytomegalovirus Retinitis Treated With
Ganciclovir Implant.

Oktavec KC, Nolan K, Brown DM, Dunn JP, Livingston AG, Thorne JE.

Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins
University Bloomberg School of Public Health, Baltimore, Maryland.

PURPOSE: To describe the clinical outcomes of patients with cytomegalovirus
(CMV) retinitis and AIDS treated with ganciclovir implant. DESIGN: Retrospective
cohort study. METHODS: The charts of 115 patients (166 affected eyes) with CMV
retinitis treated with ganciclovir implant in the Division of Ocular Immunology,
Wilmer Eye Institute from April 1996 through November 2009 were reviewed.
Ophthalmologic data collected included visual acuity, ocular complications,
treatment, and presence of immune recovery. Kaplan-Meier analyses and Cox
regression models were used to investigate relationships between potential risk
factors and ocular outcomes. RESULTS: At implantation, 55% of patients were
prescribed highly active antiretroviral therapy (HAART), 21% were formerly on
HAART, and 24% were HAART-naive. One hundred sixty-six eyes received 257
ganciclovir implants. Fifty-seven of the implanted eyes were diagnosed with a
total of 126 ocular complications after implant surgery (rate = 0.19/eye-year
[EY]), the 3 most common being cataract, vitreous hemorrhage, and retinal
detachment. Despite these ocular complications, the development of severe vision
loss (>/=6 lines lost) was low (0.005/EY). Patients with immune recovery during
follow-up were less likely to have ocular complications after implant surgery;
however, only the risk reduction for retinal detachment achieved statistical
significance (hazard ratio = 0.29, 95% CI: 0.08, 0.98). CONCLUSIONS: Our data
suggest that ocular complications after implant surgery, including cataract,
vitreous hemorrhage, and retinal detachment, were relatively common after
ganciclovir implantation but severe vision loss after surgery was low. Presence
of immune recovery may lessen the risk of postoperative ocular complications.
Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265144  [PubMed - as supplied by publisher]

16: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Sequential Topical Riboflavin With or Without Ultraviolet A Radiation With
Delayed Intracorneal Ring Segment Insertion for Keratoconus.

Renesto AD, Melo LA Jr, Sartori MD, Campos M.

Vision Institute, Department of Ophthalmology, Federal University of Sao Paulo,
Sao Paulo, Brazil.

PURPOSE: To report refractive, topographic, pachymetric, tonometric, and corneal
biomechanical outcomes 24 months after corneal cross-linking (CXL), followed by
insertion of intrastromal corneal ring segments (ICRS) in keratoconic eyes.
DESIGN: Prospective randomized clinical trial. METHODS: settings: Institutional.
Study population: Thirty-nine eyes of 31 patients, allocated into 2 groups.
Intervention: Patients in the CXL group underwent corneal CXL with riboflavin
and ultraviolet A (UVA) light. Patients in the riboflavin eyedrops group
received riboflavin 0.1% (w/v) eyedrops - 20% dextran solution for 1 month.
After 3 months, all patients underwent insertion of ICRS. Main outcome measures:
Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity
(BSCVA), and topography were evaluated at baseline, at 1 month and 3 months
after CXL or riboflavin eyedrops, and again at 1-, 3-, 6-, 12-, and 24-month
intervals after ICRS insertion. RESULTS: Mean (standard deviation [SD]) baseline
UCVA and BSCVA in the CXL group and the riboflavin eyedrops group were 1.12
(0.59) and 0.84 (0.49), and 0.68 (0.43) and 0.45 (0.23), respectively; 24-month
mean (SD) UCVA and BSCVA in the CXL group and the riboflavin eyedrops group were
0.79 (0.50) and 0.62 (0.28), and 0.52 (0.45) and 0.32 (0.21), respectively, with
no statistically significant difference between groups (P = .70 and P =
.78).There were no statistical differences between groups postoperatively at 24
months for all 3 topographic parameters, flattest-K1 (P = .81), steepest-K2 (P =
.68), and average keratometry (mean power; P = .52). CONCLUSIONS: ICRS
insertion, with or without prior CXL, showed no difference between groups in
terms of refractive, topographic, pachymetric, tonometric, and corneal
biomechanical results at 24 months. Copyright (c) 2012 Elsevier Inc. All rights
reserved.

PMID: 22265143  [PubMed - as supplied by publisher]

17: Am J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Graft Rejection Following Descemet Stripping Automated Endothelial Keratoplasty:
Features, Risk Factors, and Outcomes.

Wu EI, Ritterband DC, Yu G, Shields RA, Seedor JA.

Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New
York; and New York Medical College, Valhalla, New York.

PURPOSE: To investigate the clinical features, risk factors, and treatment
outcomes following immunologic graft rejection in eyes that have undergone
Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN:
Retrospective case review. METHODS: The charts for 353 DSAEK procedures
performed at a single clinical practice at the New York Eye and Ear Infirmary
from August 2006 to November 2010 were reviewed. Cases with at least 3 months
follow-up were included. Outcome measures included rates of graft rejection,
clinical findings, treatment outcomes, and risk factor analysis. RESULTS: Thirty
of 353 DSAEKs developed graft rejection (8.5%). Kaplan-Meier rate of rejection
was 6.0% at 1 year (n = 175), 14.0% at 2 years (n = 79), and 22.0% at 3 years (n
= 39). Rejection episodes occurred between 0.8 and 34 months. Clinical findings
included anterior chamber cells, keratic precipitates, endothelial rejection
line, and host-donor interface vascularization. Risk factors for development of
graft rejection were cessation of postoperative steroid (hazard ratio 5.49, P <
.0001) and black race (hazard ratio 2.71, P = .02). Recipient age, sex, surgical
indication, glaucoma, postoperative steroid response, corneal neovascularization
or peripheral anterior synechiae, graft size, prior keratoplasty in fellow eye,
and concurrent or subsequent procedures were not associated with graft
rejection. Twenty-two out of 30 rejection episodes (73.3%) resolved with steroid
treatment. CONCLUSIONS: Graft rejection is an important complication following
DSAEK. In contrast to penetrating keratoplasty, rejection following DSAEK is
almost exclusively endothelial. Among risk factors traditionally associated with
graft rejection, cessation of topical steroids was most significant. Prompt
recognition and treatment of DSAEK rejection can lead to favorable outcomes.
Copyright (c) 2012 Elsevier Inc. All rights reserved.

PMID: 22265142  [PubMed - as supplied by publisher]

18: Am J Ophthalmol. 2012 Feb;153(2):389-90. 

Reply.

Querques G, Querques L, Souied EH.

Creteil, France.

Publication Types:
    Letter

PMID: 22264961  [PubMed - in process]

19: Am J Ophthalmol. 2012 Feb;153(2):389. 

Natural course of adult-onset foveomacular vitelliform dystrophy: a
spectral-domain optical coherence tomography analysis.

Dolz-Marco R, Gallego-Pinazo R, Diaz-Llopis M.

Valencia, Spain.

Publication Types:
    Letter

PMID: 22264960  [PubMed - in process]

20: Am J Ophthalmol. 2012 Feb;153(2):388. 

Reply.

Sohn HJ, Oh IK, Han DH, Kim KH, Lee DY, Nam DH, Kim IT.

Seoul, Korea.

Publication Types:
    Letter

PMID: 22264959  [PubMed - in process]

21: Am J Ophthalmol. 2012 Feb;153(2):387-8. 

Possible Short-term Changes of Aqueous Inflammatory Cytokines After Intravitreal
Bevacizumab for Diabetic Macular Edema.

Lee WJ, Cho HY.

Gyeonggi-do, South Korea.

Publication Types:
    Letter

PMID: 22264958  [PubMed - in process]

22: Am J Ophthalmol. 2012 Feb;153(2):386. 

Oral mucosal graft to correct lid margin pathologic features in cicatricial
ocular surface diseases.

Kamal S, Kumar S.

New Delhi, India.

Publication Types:
    Letter

PMID: 22264957  [PubMed - in process]

23: Am J Ophthalmol. 2012 Feb;153(2):386-7. 

Reply.

Tseng SC.

Miami, Florida.

Publication Types:
    Letter

PMID: 22264956  [PubMed - in process]

24: Am J Ophthalmol. 2012 Feb;153(2):384. 

Use of infliximab in the treatment of peripheral ulcerative keratitis in crohn
disease.

Singh A, Sangwan VS.

Hyderabad, India.

Publication Types:
    Letter

PMID: 22264955  [PubMed - in process]

25: Am J Ophthalmol. 2012 Feb;153(2):384-5. 

Reply.

Tu EY, Pham M, Chow CC, Badawi D.

Chicago, Illinois.

Publication Types:
    Letter

PMID: 22264954  [PubMed - in process]

26: Am J Ophthalmol. 2012 Feb;153(2):383. 

Corneal thickness change in eyes undergoing corneal cross-linking.

Zhang ZY.

Shanghai, China.

Publication Types:
    Letter

PMID: 22264953  [PubMed - in process]

27: Am J Ophthalmol. 2012 Feb;153(2):383-4. 

Reply.

Holopainen JM, Krootila K.

Helsinki, Finland.

Publication Types:
    Letter

PMID: 22264952  [PubMed - in process]

28: Am J Ophthalmol. 2012 Feb;153(2):382. 

Blindness and Long-term Progression of Visual Field Defects in Chinese Patients
With Primary Angle-Closure Glaucoma.

Rao A.

Orissa, India.

Publication Types:
    Letter

PMID: 22264951  [PubMed - in process]

29: Am J Ophthalmol. 2012 Feb;153(2):382-3. 

Reply.

Quek DT, Perera SA, Aung T.

Singapore, Republic of Singapore.

Publication Types:
    Letter

PMID: 22264950  [PubMed - in process]

30: Am J Ophthalmol. 2012 Feb;153(2):381. 

Reply.

Ponto KA, Kahaly GJ.

Mainz, Germany.

Publication Types:
    Letter

PMID: 22264949  [PubMed - in process]