1: Am J Ophthalmol. 2010 Mar 13; [Epub ahead of print] 

The Risk of Capsular Breakage from Phacoemulsification Needle Contact with the
Lens Capsule: A Laboratory Study.

Meyer JJ, Kuo AF, Olson RJ.

Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center,
University of Utah, Salt Lake City, Utah.

PURPOSE: To determine capsular breakage risk from contact by phacoemulsification
needles by machine and tip type. DESIGN: Experimental laboratory investigation.
METHODS: Infiniti (Alcon, Inc., Fort Worth, Texas, USA) with Intrepid cartridges
and Signature (Abbott Medical Optics, Inc., Santa Ana, California, USA)
phacoemulsification machines were tested using 19- and 20-gauge sharp and
rounded tips. Actual and unoccluded flow vacuum were determined at 550 mm Hg,
bottle height of 75 cm, and machine-indicated flow rate of 60 mL/minute.
Breakage from brief tip contact with a capsular surrogate and human cadaveric
lenses was calculated. RESULTS: Nineteen-gauge tips had more flow and less
unoccluded flow vacuum than 20-gauge tips for both machines, with highest
unoccluded flow vacuum in the Infiniti. The 19-gauge sharp tip was more likely
than the 20-gauge sharp tip to cause surrogate breakage for Signature with
micropulse and Ellips (Abbott Medical Optics, Inc.) ultrasound at 100% power.
For Infiniti using OZil (Alcon, Inc.) ultrasound, 20-gauge sharp tips were more
likely than 19-gauge sharp tips to break the membrane. For cadaveric lenses,
using rounded 20-gauge tips at 100% power, breakage rates were micropulse
(2.3%), Ellips (2.3%), OZil (5.3%). Breakage rates for sharp 20-gauge Ellips
tips were higher than for rounded tips. CONCLUSIONS: Factors influencing
capsular breakage may include active vacuum at the tip, flow rate, needle gauge,
and sharpness. Nineteen-gauge sharp tips were more likely than 20-gauge tips to
cause breakage in lower vacuum methods. For higher-vacuum methods, breakage is
more likely with 20-gauge than with 19-gauge tips. Rounded-edge tips are less
likely than sharp-edged tips to cause breakage. Copyright (c) 2010 Elsevier Inc.
All rights reserved.

PMID: 20231013  [PubMed - as supplied by publisher]

2: Am J Ophthalmol. 2010 Mar 13; [Epub ahead of print] 

Health-Related Quality of Life and Emotional Status of Anophthalmic Patients in
Korea.

Ahn JM, Lee SY, Yoon JS.

Institute of Vision Research, Department of Ophthalmology, Yonsei University
College of Medicine, Seoul, Korea; Siloam Eye Hospital, Seoul, Korea.

PURPOSE: To evaluate the health-related quality of life and emotional status of
anophthalmic patients. DESIGN: Prospective, cross-sectional study. METHODS: The
study included 134 monocular anophthalmic patients and 48 healthy volunteers who
visited the department of Ophthalmology at the Yonsei University College of
Medicine, Seoul, Korea, between July and December 2008. Surveys were
administered to participants to evaluate their sociodemographic characteristics
and disease-related factors. Data collected from the Short-Form 36-Item Health
Survey (SF-36) and the Hospital Anxiety and Depression Scale survey instruments
were analyzed to identify significant differences and correlations between
categories. RESULTS: Anophthalmic patients scored lower in all categories of
SF-36 compared with controls. Married females and participants with children
generally had lower scores on the SF-36, and some of the differences were
statistically significant. There were significant negative correlations between
all SF-36 scores and participant self-evaluations on whether they had negative
feelings regarding their social interpersonal relationships as a result of
wearing prostheses. Those who scored higher on the Hospital Anxiety and
Depression Scale anxiety and depression scales tended to evade social
interrelations significantly. CONCLUSIONS: Anophthalmic patients had lower
health-related quality-of-life scores than healthy individuals. This finding was
particularly evident in terms of the patients' own perceptions of their social
relationships, which were negatively affected by their use of prosthetic eyes.
Such perceptions reduced their quality of life and heightened their anxiety and
depression. Therefore, it is important to evaluate both the physical and
emotional well-being of anophthalmic patients to identify those patients who
will need additional physical and mental support. Copyright (c) 2010 Elsevier
Inc. All rights reserved.

PMID: 20231012  [PubMed - as supplied by publisher]

3: Am J Ophthalmol. 2010 Mar 13; [Epub ahead of print] 

Corneal Endothelial Cell Density and Associated Factors in a Population-Based
Study in Japan: The Kumejima Study.

Higa A, Sakai H, Sawaguchi S, Iwase A, Tomidokoro A, Amano S, Araie M.

Department of Ophthalmology, University of the Ryukyus Faculty of Medicine,
Okinawa, Japan.

PURPOSE: To examine the distribution of corneal endothelial cell density (ECD)
and relating factors in ophthalmologically normal Japanese in a population-based
setting. DESIGN: Cross-sectional, population-based study. METHODS: All residents
of Kumejima Island, Japan, located in southwestern Japan (eastern longitude 126
degrees 48' and northern latitude 26 degrees 20'), aged 40 years and older, were
asked to undergo a comprehensive questionnaire and ocular examination, including
noncontact specular microscopy of corneal endothelial cells. RESULTS: Of the
4632 residents, 3762 (81.2%) underwent the examination. The mean ECD among all
ophthalmologically normal participants (n = 2602), men (n = 1329), and women (n
= 1273) was 2943 +/- 387 cells/mm(2), 2927 +/- 385 cells/mm(2), and 2959 +/- 389
cells/mm(2), respectively, with a significant inter-sex difference after
adjusting for age (P = .001). Mean ECD was significantly lower in subgroups with
a history of outdoor work compared to corresponding subgroups after adjusting
for age and sex (P = .034). Linear regression analyses with an adjustment for
age and/or sex showed that age was significantly negatively correlated with ECD
with a slope of -7.43/mm(2)/year (P < .001), indicating a cell loss rate of
0.25% per year of age. Higher intraocular pressure was significantly correlated
with lower ECD, with a slope of -9.87/mm(2)/mm Hg (P < .001). CONCLUSIONS: Mean
ECD in ophthalmologically normal Japanese in Kumejima aged 40 years or older was
2943 cells/mm(2). Older age, male sex, higher intraocular pressure, and history
of outdoor work were also identified as factors correlating with lower ECD.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20231011  [PubMed - as supplied by publisher]

4: Am J Ophthalmol. 2010 Mar 13; [Epub ahead of print] 

Influence of the Extent of Myopia on the Progression of Normal-Tension Glaucoma.

Sohn SW, Song JS, Kee C.

Department of Ophthalmology, Gangneung Asan Hospital, Ulsan University College
of Medicine, Gangneung, Korea.

PURPOSE: To evaluate the influence of the extent of myopia on the progression
rate of normal-tension glaucoma (NTG). DESIGN: Retrospective, observational case
series. METHODS: One hundred forty-three eyes of 143 patients with NTG who were
treated from 1994 through 2006 and followed up with standard automated perimetry
were evaluated in this study. The participants were divided into 4 groups: mild
myopia (-0.76 to -2.99 diopters [D]), moderate myopia (-3 to -5.99 D), severe
myopia (-6 D or less), and nonmyopia (emmetropia and hyperopia, -0.75 D or more)
groups. The change in mean deviation, corrected pattern standard deviation, mean
thresholds of 10 zones corresponding to the glaucoma hemifield test, and
thresholds of 52 points of the nonmyopia group were compared with those of the
other myopia groups. Additionally, we controlled each analysis for age and
posttherapeutic intraocular pressure to preclude the possibility of these
covariates influencing the analysis of the effect of myopia on the progression
of glaucoma. RESULTS: There was no statistically significant difference between
the nonmyopia group and each of the myopia groups in terms of mean deviation,
corrected pattern standard deviation, mean thresholds of 10 zones corresponding
to the glaucoma hemifield test, and the thresholds of 52 point changes against
refraction. Moreover, with the control of the other covariates (age and
posttherapeutic intraocular pressure), no statistically significant differences
were noted (multivariate analysis using mixed model, P > .1). CONCLUSIONS:
Although a high incidence of open-angle glaucoma among myopic patients has been
reported previously, myopia did not influence the progression rate of NTG after
treatment. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20231010  [PubMed - as supplied by publisher]

5: Am J Ophthalmol. 2010 Mar 12; [Epub ahead of print] 

Anterior Segment Complications After Diode Laser Photocoagulation for
Prethreshold Retinopathy of Prematurity.

Salgado CM, Celik Y, Vanderveen DK.

Children's Hospital Boston, Boston, Massachusetts; Pontificia Universidad
Catolica, Santiago, Chile; Gumussuyu Military Hospital, Department of
Ophthalmology, Istanbul, Turkey.

PURPOSE: To evaluate anterior segment complication rates in eyes treated for
prethreshold versus threshold retinopathy of prematurity (ROP) and look for
potential risk factors. DESIGN: Retrospective, observational case series study.
METHODS: All patients treated with diode laser for ROP between 1995 and 2007
were identified. A total of 259 eyes of 184 patients were studied, 120 eyes in
the pretheshold group and 139 eyes in the threshold group. We compare baseline
characteristics, treatment parameters, ocular complications, and structural
outcomes after treatment. The main outcome measured was anterior segment
complication rates in eyes treated for prethreshold versus threshold ROP and we
looked for potential risk factors. RESULTS: Thirteen of 120 eyes treated at
prethreshold had anterior segment complications versus 0 of 139 treated at
threshold (P < .01). All eyes developed post-laser hyphema, 3 with elevated
intraocular pressure. Three eyes developed cataract (2 requiring cataract
extraction); 1 required treatment for band keratopathy. The mean postmenstrual
age at treatment was significantly different between the prethreshold and
threshold groups (36.6 vs 37.9 weeks, P = .03); eyes with anterior segment
complications were treated at mean postmenstrual age of 35.7 weeks. No
difference was found based on gestationtal age at birth, birth weight, zone,
stage, or number of laser spots for eyes with anterior segment complications.
Most anterior segment complications (77%) resolved without long-term sequelae.
CONCLUSIONS: Younger postmenstrual age at laser treatment may be related to an
increased risk of anterior segment complications, which should be recognized and
managed appropriately. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20227677  [PubMed - as supplied by publisher]

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

A Novel Locus for Autosomal Recessive Retinitis Pigmentosa in a Consanguineous
Pakistani Family Maps to Chromosome 2p.

Naz S, Riazuddin SA, Li L, Shahid M, Kousar S, Sieving PA, Hejtmancik JF,
Riazuddin S.

National Centre of Excellence in Molecular Biology, University of the Punjab,
Lahore Pakistan.

OBJECTIVE: To identify a disease locus for autosomal recessive retinitis
pigmentosa in a consanguineous Pakistani family. DESIGN: Prospective linkage
study. METHODS: Blood samples were collected and genomic DNA was extracted. A
genome-wide scan was performed using 382 polymorphic microsatellite markers on
genomic DNA from 4 affected and 5 unaffected family members, and logarithm of
odds scores were calculated. RESULTS: A maximum 2-point logarithm of odds score
of 3.14 at theta = 0 was obtained for marker D2S165 during the genome-wide scan.
Fine mapping markers identified a 20.92-cM (19.98-Mb) interval flanked by D2S149
and D2S367 that cosegregates with the disease phenotype. Haplotype analyses
further refined the critical interval, distal to D2S220 in a 12.31-cM (13.35-Mb)
region that does not harbor any genes that previously have been associated with
retinitis pigmentosa. CONCLUSIONS: Linkage analysis identified a new locus for
autosomal recessive retinitis pigmentosa that maps to chromosome 2p22.3-p24.1 in
a consanguineous Pakistani family. Copyright (c) 2010 Elsevier Inc. All rights
reserved.

PMID: 20227676  [PubMed - as supplied by publisher]

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

Corneal Aberrations and Visual Acuity After Laser In Situ Keratomileusis:
Femtosecond Laser Versus Mechanical Microkeratome.

Calvo R, McLaren JW, Hodge DO, Bourne WM, Patel SV.

Departments of Ophthalmology, Rochester, Minnesota.

PURPOSE: To compare corneal high-order aberrations and visual acuity after laser
in situ keratomileusis (LASIK) with the flap created by a femtosecond laser
(bladeless) to LASIK with the flap created by a mechanical microkeratome.
DESIGN: Prospective, randomized, paired-eye study. METHODS: Fellow eyes of 21
patients with myopia or myopic astigmatism were randomized by ocular dominance.
Corneal topography and visual acuity were measured before and at 1, 3, 6, 12,
and 36 months after LASIK. Wavefront errors from the anterior corneal surface
were calculated from the topography data over 4- and 6-mm-diameter pupils and
decomposed into Zernike polynomials to the 6th order. RESULTS: There were no
differences in corneal total high-order aberrations, spherical aberration, coma,
or trefoil between methods of flap creation at any examination over 4- and
6-mm-diameter pupils. Over a 6-mm pupil, total high-order aberrations increased
by 1 month after LASIK with both treatments (P PMID: 20227675  [PubMed - as supplied by publisher]

8: Am J Ophthalmol. 2010 Mar 3; [Epub ahead of print] 

Thermal Comparison of Infiniti OZil and Signature Ellips Phacoemulsification
Systems.

Schmutz JS, Olson RJ.

Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center,
University of Utah, Salt Lake City, Utah (J.S.S., R.J.O.).

PURPOSE: To determine thermal characteristics of Signature Ellips (Abbott
Medical Optics, Santa Ana, California, USA) and Infiniti OZil (Alcon, Inc, Fort
Worth, Texas, USA) transverse ultrasound and compare both with longitudinal
ultrasound in clinically relevant scenarios. DESIGN: Laboratory investigation.
METHODS: Temperature increase over baseline after 60 seconds was measured in
water at positions in 90-degree increments around the sleeve near the proximal
needle shaft in an artificial chamber for Ellips and OZil on continuous
ultrasound with aspiration blocked and unblocked. This was also done with
Signature using longitudinal ultrasound, with and without micropulse (6 ms on,
12 ms off), with aspiration blocked and unblocked, and at the OZil sleeve tip on
continuous transverse mode with aspiration unblocked. RESULTS: OZil (8.1 +/- 0.3
C) had greater temperature increase than Ellips (5.2 +/- 0.3 C; P < .0001) with
aspiration unblocked and blocked (29.3 +/- 1.0 C vs 12.2 +/- 0.7 C; P < .0001).
OZil had uneven distribution of heat around the shaft (30.1 +/- 0.5 C vs 28.5
+/- 0.6 C; P < .0001), whereas Ellips did not (P = .57). OZil was cooler at the
tip (6.6 +/- 0.2 C; P < .0001). Friction in a cadaver eye incision only
increased these numbers by 10% (OZil, irrigation blocked). CONCLUSIONS: Metal
stress probably creates heat at the proximal needle junction for both transverse
methods. Heat generation differences between OZil and Ellips result from the
manner in which they create needle motion. Incision burns may occur, especially
for OZil, under nonpulsed settings during fragment removal with occlusion when
reaching across the anterior chamber such that the proximal needle shaft came
near the wound. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20202619  [PubMed - as supplied by publisher]

9: Am J Ophthalmol. 2010 Mar 3; [Epub ahead of print] 

Structure-Function Correlations using Scanning Laser Polarimetry in Primary
Angle-Closure Glaucoma and Primary Open-Angle Glaucoma.

Lee PJ, Liu CJ, Wojciechowski R, Bailey-Wilson JE, Cheng CY.

Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.

PURPOSE: To assess the correlations between retinal nerve fiber layer (RNFL)
thickness measured with scanning laser polarimetry and visual field (VF)
sensitivity in primary open-angle glaucoma (POAG) and primary angle-closure
glaucoma (PACG). DESIGN: Prospective, comparative, observational cases series.
METHODS: Fifty patients with POAG and 56 patients with PACG were examined using
scanning laser polarimetry with variable corneal compensation (GDx VCC; Laser
Diagnostic Technologies, Inc, San Diego, California, USA) and Humphrey VF
analyzer (Carl Zeiss Meditec, Inc, Dublin, California, USA) between August 2005
and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL
thickness and VF sensitivity, expressed as mean sensitivity in both decibel and
1/Lambert scales, were estimated by the Spearman rank correlation coefficient
(r(s)) and multivariate median regression models (pseudo R(2)). The correlations
were determined globally and for 6 RNFL sectors and their corresponding VF
regions. RESULTS: The correlation between RNFL thickness and mean sensitivity
(in decibels) was weaker in the PACG group (r(s) = 0.38; P = .004; pseudo R(2) =
0.17) than in the POAG group (r(s) = 0.51; P < .001; pseudo R(2) = .31), but the
difference in the magnitude of correlation was not significant (P = .42). With
Bonferroni correction, the structure-function correlation was significant in the
superotemporal (r(s) = 0.62), superonasal (r(s) = 0.56), inferonasal (r(s) =
0.53), and inferotemporal (r(s) = 0.50) sectors in the POAG group (all P <
.001), whereas it was significant only in the superotemporal (r(s) = 0.53) and
inferotemporal (r(s) = 0.48) sectors in the PACG group (both P < .001). The
results were similar when mean sensitivity was expressed as 1/Lambert scale.
CONCLUSIONS: Both POAG and PACG eyes had moderate structure-function
correlations using scanning laser polarimetry. Compared with eyes with POAG,
fewer RNFL sectors have significant structure-function correlations in eyes with
PACG. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20202618  [PubMed - as supplied by publisher]

10: Am J Ophthalmol. 2010 Feb 25; [Epub ahead of print] 

Anterior Segment Optical Coherence Tomography Evaluation of the Integrity of
Clear Corneal Incisions: A Comparison between 2.2-mm and 2.65-mm Main Incisions.

Chee SP, Ti SE, Lim LI, Chan AS, Jap A.

Singapore National Eye Centre, Singapore, Republic of Singapore; Department of
Ophthalmology, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Republic of Singapore; Singapore Eye Research Institute,
Singapore, Republic of Singapore.

PURPOSE: To compare wound characteristics and integrity of the 2.2-mm and
2.65-mm clear corneal incisions. DESIGN: Prospective, randomized clinical trial.
METHODS: Patients undergoing phacoemulsification with lens implant were
randomized to receive a 2.2-mm or 2.65-mm temporal clear corneal incision. The
incisions were evaluated at 2, 24, and 96 hours for gape and wound architecture
using anterior segment optical coherence tomography and for integrity using the
Seidel test. Squareness of an incision was calculated (ratio of the incision
length to the width). RESULTS: There were 30 patients in each group. Both
incision sizes were watertight, although a mild internal main wound gape was
detected on anterior segment optical coherence tomography in 35 eyes (58.3%) at
2 hours. The smaller wound was more square (0.81; standard deviation [SD], 0.11)
than the larger wound (0.62; SD, 0.08; P < .001, t test). The mean squareness of
eyes without wound gape at 2 hours (0.66; SD, 0.11) was lower than those with a
wound gape (0.75; SD, 0.14; P = .008). A squareness factor of 0.72 or more had a
positive predictive value for presence of wound gape at 2 hours of 79.3% and a
negative predictive value of 61.3%. One side port incision with squareness of
1.39 had a mild leak at 2 and 24 hours, but no gape was seen on anterior segment
optical coherence tomography. CONCLUSIONS: Both the 2.2-mm and 2.65-mm clear
corneal incisions clinically were competent, but the side port incision may
leak. A truly square wound has a greater likelihood of being associated with
internal wound gape at 2 hours after surgery, especially if the squareness
factor is 0.72 or more. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20189160  [PubMed - as supplied by publisher]

11: Am J Ophthalmol. 2010 Feb 25; [Epub ahead of print] 

Topical Mecamylamine for Diabetic Macular Edema.

Campochiaro PA, Shah SM, Hafiz G, Heier JS, Lit ES, Zimmer-Galler I, Channa R,
Nguyen QD, Syed B, DO DV, Lu LI, Monk J, Cooke JP, Kengatharan MK, Hsu HH.

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore,
Maryland.

PURPOSE: Stimulation of nicotinic acetylcholine (nACh) receptors on vascular
endothelial cells promotes angiogenesis and vascular permeability in animal
models. The safety and bioactivity of topical mecamylamine, an antagonist of
nACh receptors, was tested in patients with diabetic macular edema. DESIGN: A
multicenter phase I/II clinical trial. METHODS: Twenty-three patients with
chronic diabetic macular edema received 1% mecamylamine topically twice daily
for 12 weeks, the primary end point. Patients underwent safety assessments,
measurement of best-corrected visual acuity (BCVA), and measurement of foveal
thickness using optical coherence tomography at baseline, 1, 4, 8, 12, and 16
weeks. RESULTS: Mecamylamine drops were well tolerated and there were no
drug-related safety problems. Mean improvement in BCVA at 1, 4, 8, 12, and 16
weeks was 2.8, 1.9, 2.4, 0.8, and 3.1 letters, respectively. There was little
change in mean excess foveal thickness. There was substantial heterogeneity in
response, because 8 patients showed convincing improvement in BCVA, foveal
thickness, or both, 9 patients showed equivocal or no substantial changes, and 4
patients showed worsening. Five patients showed a substantial improvement in
BCVA, foveal thickness, or both between their last visit while receiving
mecamylamine and 1 month after stopping mecamylamine. CONCLUSIONS: This study
suggested that administration of topical mecamylamine, a nonspecific nACh
receptor blocker, may have heterogeneous effects in patients with diabetic
macular edema. Variable expression of nACh receptor subtypes on endothelial
cells that have different effects on permeability would provide an explanation
for these results and should be investigated, because more specific nACh
receptor blockers may dissociate antipermeability and propermeability effects.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20189159  [PubMed - as supplied by publisher]

12: Am J Ophthalmol. 2010 Feb 25; [Epub ahead of print] 

Combined Fluocinolone Acetonide Intravitreal Insertion and Glaucoma Drainage
Device Placement for Chronic Uveitis and Glaucoma.

Malone PE, Herndon LW, Muir KW, Jaffe GJ.

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

PURPOSE: To determine whether a fluocinolone acetonide sustained-release
intravitreal drug delivery system can be implanted safely at the same time that
a glaucoma drainage device is placed for eyes with uveitis and elevated
intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy.
DESIGN: Retrospective, observational case series. METHODS: Subjects had chronic
noninfectious intermediate or posterior uveitis and elevated IOP while receiving
maximum tolerated medical therapy. Fluocinolone acetonide implantation and
glaucoma tube shunt placement were performed in a single surgical session. The
main outcome measures were inflammatory recurrences, visual acuity (VA), use of
adjunctive anti-inflammatory therapy, IOP, and adverse events. RESULTS: Seven
eyes of 5 patients were studied. The average number of recurrences 12 months
before implantation was 3 episodes per eye; of the 3 eyes followed up for more
than 30 months, none had an inflammatory recurrence within 30 months after
implantation. The mean Snellen visual acuity 12 months after the combined
surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use
decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12
months after the combined surgery (P = .019). CONCLUSIONS: The favorable results
observed in all eyes suggest that fluocinolone acetonide implantation can be
safely combined with glaucoma tube shunt placement in a single surgical session
in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering
therapy. Uveitis recurrences decreased, visual acuity improved, and IOP
decreased. There were no adverse events during insertion of the fluocinolone
acetonide implant and placement of the glaucoma tube shunt. Copyright (c) 2010
Elsevier Inc. All rights reserved.

PMID: 20189158  [PubMed - as supplied by publisher]

13: Am J Ophthalmol. 2010 Feb 23; [Epub ahead of print] 

Four-Year Incidence and Progression of Lens Opacities: The Los Angeles Latino
Eye Study.

Varma R, Richter GM, Torres M, Foong AW, Choudhury F, Azen SP; Los Angeles
Latino Eye Study Group.

Doheny Eye Institute and Department of Ophthalmology,Keck School of Medicine,
University of Southern California, Los Angeles, California; Department of
Preventive MedicineKeck School of Medicine, University of Southern California,
Los Angeles, California.

PURPOSE: To estimate the 4-year incidence and progression of lens opacities.
DESIGN: Population-based longitudinal study. METHODS: A total of 4658 adult
Latinos from Los Angeles County were examined at baseline and 4-year follow-up.
Examination included assessment of lens opacities using the Lens Opacities
Classification System II (LOCS II). Incidences of cortical, nuclear, and
posterior subcapsular opacities (with LOCS II scores >/=2) were defined as
opacity development in persons without that opacity at baseline. Single and
mixed opacities were defined in persons without any opacity at baseline.
Incidence of all lens changes included development of at least 1 opacity or
cataract surgery among those without any opacity at baseline. Four-year
progressions were defined as increase of >/=2 in LOCS II score. RESULTS: The
4-year incidence of all lens opacities was 14.2%. Four-year incidence of
cataract surgery was 1.48%. The incidences were 4.1% for cortical-only, 5.8% for
nuclear-only, 0.5% for PSC-only, and 2.5% for mixed. The incidences for any
opacities were 7.5% for cortical, 10.2% for nuclear, and 2.5% for PSC. Incidence
increased with age (P < .0001 for all). The progressions were 8.5% for cortical,
3.7% for nuclear, and 2.9% for PSC opacities. CONCLUSIONS: Our Latino population
had a higher incidence of nuclear than cortical opacities, but a greater
progression of cortical than nuclear opacities. Incidence and progression of PSC
was low. Additional understanding of the natural history and progression of
various lens opacities will give us a better understanding of the pathogenesis
and management of lens opacities. Copyright (c) 2010 Elsevier Inc. All rights
reserved.

PMID: 20181327  [PubMed - as supplied by publisher]

14: Am J Ophthalmol. 2010 Mar;149(3):531. 

Re: Spontaneous corneal clearance despite graft detachment in Descemet membrane
endothelial keratoplasty.

Choo SY, Zahidin AZ, Then KY.

Publication Types:
    Comment
    Letter

PMID: 20172087  [PubMed - indexed for MEDLINE]

15: Am J Ophthalmol. 2010 Mar;149(3):529-30; author reply 530-1. 

Re: Angle-closure glaucoma--simpler answers to complex mechanisms.

Gosala S.

Publication Types:
    Comment
    Letter

PMID: 20172085  [PubMed - indexed for MEDLINE]

16: Am J Ophthalmol. 2010 Mar;149(3):528-9; author reply 529. 

Stratus OCT signal strength and reliability of retinal nerve fiber layer
measurements.

Liu Y, Samarawickrama C, Pai A, Tariq Y, Mitchell P.

Publication Types:
    Comment
    Letter

PMID: 20172083  [PubMed - indexed for MEDLINE]

17: Am J Ophthalmol. 2010 Mar;149(3):527; author reply 527-8. 

Increased likelihood of glaucoma at the same intraocular pressure in subjects
with pseudoexfoliation.

Teus MA.

Publication Types:
    Comment
    Letter

PMID: 20172081  [PubMed - indexed for MEDLINE]

18: Am J Ophthalmol. 2010 Mar;149(3):525-6; author reply 526-7. 

Re: Outcome of raised intraocular pressure in uveitic eyes with and without a
corticosteroid-induced hypertensive response.

Nazm N, Dubey S, Gandhi M, Pegu J.

Publication Types:
    Comment
    Letter

PMID: 20172078  [PubMed - indexed for MEDLINE]

19: Am J Ophthalmol. 2010 Mar;149(3):524-5; author reply 525. 

Recovery of corneal hysteresis after reduction of intraocular pressure in
chronic primary angle-closure glaucoma.

Poostchi A, Nicholas S, Wells AP.

Publication Types:
    Comment
    Letter

PMID: 20172077  [PubMed - indexed for MEDLINE]

20: Am J Ophthalmol. 2010 Mar;149(3):523; author reply 523-4. 

Testability of vision and refraction in preschoolers.

Pai A, Samarawickrama C, Burlutsky G, Leone J, Mitchell P.

Publication Types:
    Comment
    Letter

PMID: 20172075  [PubMed - indexed for MEDLINE]

21: Am J Ophthalmol. 2010 Mar;149(3):503-7. 

The development of myopia among children with intermittent exotropia.

Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG.

Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester,
Minnesota 55905, USA.

PURPOSE: To describe the long-term refractive error changes in children
diagnosed with intermittent exotropia (IXT) in a defined population. DESIGN:
Retrospective, population-based observational study. METHODS: Using the
resources of the Rochester Epidemiology Project, the medical records of all
children (<19 years) diagnosed with IXT as residents of Olmsted County,
Minnesota, from January 1, 1975 through December 31, 1994 were retrospectively
reviewed for any change in refractive error over time. RESULTS: One hundred
eighty-four children were diagnosed with IXT during the 20-year study period;
135 (73.4%) had 2 or more refractions separated by a mean of 10 years (range,
1-27 years). The Kaplan-Meier rate of developing myopia in this population was
7.4% by 5 years of age, 46.5% by 10 years, and 91.1% by 20 years. There were 106
patients with 2 or more refractions separated by at least 1 year through 21
years of age, of which 43 underwent surgery and 63 were observed. The annual
overall progression was -0.26 diopters (SD +/- 0.24) without a statistically
significant difference between the observed and surgical groups (P = .59).
CONCLUSION: In this population-based study of children with intermittent
exotropia, myopia was calculated to occur in more than 90% of patients by 20
years of age. Observation versus surgical correction did not alter the
refractive outcome. (c) 2010 Elsevier Inc. All rights reserved.

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

PMID: 20172074  [PubMed - indexed for MEDLINE]

22: Am J Ophthalmol. 2010 Mar;149(3):488-95. 

Pattern electroretinogram and psychophysical tests of visual function for
discriminating between healthy and glaucoma eyes.

Tafreshi A, Racette L, Weinreb RN, Sample PA, Zangwill LM, Medeiros FA, Bowd C.

Hamilton Glaucoma Center and Department of Ophthalmology, University of
California at San Diego, La Jolla, California 92093-0946, USA.

PURPOSE: To compare the diagnostic accuracy of the pattern electroretinogram
(pattern ERG) to that of standard automated perimetry (SAP), short-wavelength
automated perimetry (SWAP), and frequency-doubling technology (FDT) perimetry
for discriminating between healthy and glaucomatous eyes. DESIGN:
Cross-sectional study. METHODS: Eighty-three eyes of 42 healthy recruits and 92
eyes of 54 glaucoma patients (based on optic disc appearance) from the
University of California, San Diego, Diagnostic Innovations in Glaucoma Study
were tested with pattern ERG for glaucoma detection (PERGLA; Lace Elettronica,
Pisa, Italy), SAP, SWAP, and FDT within 9 months. Receiver operating
characteristic (ROC) curves were generated and compared for pattern ERG
amplitude and SAP, SWAP, and FDT mean deviation and pattern standard deviation
(PSD). Sensitivities and specificities were compared and agreement among tests
was described. RESULTS: The area under the ROC curve for pattern ERG amplitude
was 0.744 (95% confidence interval = 0.670, 0.818). The ROC curve area was 0.786
(0.720, 0.853) for SAP PSD, 0.732 (0.659, 0.806) for SWAP PSD, and 0.818 (0.758,
0.879) for FDT PSD. At 95% specificity, sensitivities of SAP and FDT PSD were
significantly higher than that of pattern ERG amplitude; at 80% specificity,
similar sensitivities were observed among tests. Agreement among tests was
slight to moderate. CONCLUSION: The diagnostic accuracy of the pattern ERG
amplitude was similar to that of SAP and SWAP, but somewhat worse than that of
FDT. Nevertheless, the pattern ERG may hold some advantage over psychophysical
testing because of its largely objective nature. (c) 2010 Elsevier Inc. All
rights reserved.

Publication Types:
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 20172073  [PubMed - indexed for MEDLINE]

23: Am J Ophthalmol. 2010 Mar;149(3):458-64.e1. 

Choroidal neovascularization in pathologic myopia: intravitreal ranibizumab
versus bevacizumab--a randomized controlled trial.

Gharbiya M, Giustolisi R, Allievi F, Fantozzi N, Mazzeo L, Scavella V, Gabrieli
CB.

Department of Ophthalmology, University of Rome La Sapienza, Rome, Italy.
magda.gharbiya@tiscali.it

PURPOSE: To compare the short-term efficacy and safety of intravitreal
ranibizumab versus bevacizumab in treating myopic choroidal neovascularization
(CNV). DESIGN: Prospective, comparative, randomized, interventional study.
METHODS: Thirty-two eyes from 32 patients with myopic CNV were consecutively
enrolled and randomly treated, in a 1:1 ratio, with intravitreal ranibizumab
(0.5 mg) or bevacizumab (1.25 mg) as needed, after the first injection. ETDRS
best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical
coherence tomography (OCT), and fluorescein angiographic findings were examined
before and after treatment. Patients were followed up for 6 months. RESULTS: No
statistically significant difference in the BCVA improvement, as well as in the
FCT reduction, was found between groups during follow-up (P value at 1, 3, 6
months > .05). Complete resolution of fluorescein leakage was observed in all 16
bevacizumab-treated eyes and in 15 out of 16 (93.7%) ranibizumab-treated eyes.
No ocular or systemic adverse effects from treatment were encountered.
CONCLUSION: This randomized clinical study cannot determine a statistically
significant difference in anti-VEGF treatment effect between ranibizumab and
bevacizumab for the treatment of CNV secondary to pathologic myopia. A larger
study is required to determine the relative efficacy and duration of action of
these drugs. (c) 2010 Elsevier Inc. All rights reserved.

Publication Types:
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 20172072  [PubMed - indexed for MEDLINE]

24: Am J Ophthalmol. 2010 Mar;149(3):447-52. 

Primary retinectomy in proliferative vitreoretinopathy.

Tan HS, Mura M, Oberstein SY, de Smet MD.

Department of Ophthalmology, Academic Medical Center, University of Amsterdam,
Amsterdam, The Netherlands. h.tan@amc.uva.nl

PURPOSE: To describe the functional and anatomic results of retinectomy without
scleral buckling for anterior proliferative vitreoretinopathy in eyes that did
not undergo previous buckling surgery. DESIGN: Retrospective, nonrandomized,
interventional case series. METHODS: We reviewed the results of 123 consecutive
cases of retinectomy for rhegmatogenous retinal detachment complicated by
anterior proliferative vitreoretinopathy. The primary outcome measure was
anatomic success, defined as complete retinal reattachment. Secondary outcome
measures were final anatomic success, final visual acuity outcome, number of
operations required for retinal reattachment, baseline extent of proliferative
vitreoretinopathy, ocular pressure at final follow-up, extent of retinectomy,
and occurrence of complications. RESULTS: The anatomic success rate was 77.2%.
Final attachment rate was 95.9%, reached after 1 rhegmatogenous retinal
detachment reoperation in 21 cases and after 2 rhegmatogenous retinal detachment
reoperations in 4 cases. We had a low rate of postoperative hypotony (4.1%).
Visual acuity was significantly improved from 2.10 to 1.44 logarithm of the
minimal angle of resolution units (P < .001). Improvement was related
significantly to retinectomy extent and primary anatomic success. CONCLUSIONS:
Our results show that primary retinectomy without scleral buckling has good
anatomic and functional results. (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20172071  [PubMed - indexed for MEDLINE]

25: Am J Ophthalmol. 2010 Mar;149(3):441-6.e1-2. 

Association between the efficacy of photodynamic therapy and indocyanine green
angiography findings for central serous chorioretinopathy.

Inoue R, Sawa M, Tsujikawa M, Gomi F.

Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

PURPOSE: To determine the efficacy of photodynamic therapy (PDT) and indocyanine
green angiography (ICGA) findings for treating chronic central serous
chorioretinopathy (CSC). DESIGN: Observational case series. METHODS: Thirty-two
eyes of 27 patients with chronic CSC and symptoms for at least 6 months were
recruited. The minimum follow-up was 1 year. The total PDT energy was reduced to
about 36 to 42 mJ/cm(2). The baseline middle-phase ICGA findings were classified
as intense, intermediate, or no hyperfluorescence depending on the degree of
hyperfluorescence. The resolution of the subretinal fluid and recurrence rates
were assessed in relation to each ICGA finding at baseline. RESULTS: ICGA before
PDT showed intense hyperfluorescence in 23 eyes (72%), intermediate
hyperfluorescence in 6 eyes (19%), and no hyperfluorescence in 3 eyes (9%). The
subretinal fluid resolved completely 3 months after 1 application of PDT in 23
eyes (100%) with intense hyperfluorescence, 6 eyes (100%) with intermediate
hyperfluorescence, and no eyes (0%) with no hyperfluorescence. In the last
group, the subretinal fluid did not resolve throughout the follow-up period
despite additional applications of PDT. The subretinal fluid recurred in 7 of 29
eyes (24%) in which the subretinal fluid resolved at 3 months; recurrence was
frequent in eyes with intermediate hyperfluorescence (5 eyes; 83%). CONCLUSION:
The PDT success rate in eyes with chronic CSC depends on the degree of
hyperpermeability on ICGA. PDT is not effective or the recurrence rate is
predicted to be high in eyes without intense hyperfluorescence. (c) 2010
Elsevier Inc. All rights reserved.

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

PMID: 20172070  [PubMed - indexed for MEDLINE]

26: Am J Ophthalmol. 2010 Mar;149(3):433-40.e1. 

Viral retinitis after intravitreal triamcinolone injection in patients with
predisposing medical comorbidities.

Shah AM, Oster SF, Freeman WR.

Jacobs Retina Center, Department of Ophthalmology, University of California, San
Diego, La Jolla, California 92093, USA.

PURPOSE: To review the cases of viral retinitis after intravitreal steroid
administration at a single center, to estimate the incidence, and to propose
risk factors for its occurrence. DESIGN: Retrospective, observational case
series. METHODS: Seven hundred thirty-six intravitreal triamcinolone (IVTA)
injections were administered in the clinic and operating room by 3 retina
specialists at a single academic medical center between September 2002 and
November 2008. Inclusion criteria were simply a history of 1 or more IVTA
injections during the period. The overall incidence of viral retinitis after
IVTA injection was calculated. Subsequently, a chart audit was performed to
estimate the number of patients with immune-altering conditions who had received
IVTA during the period, and the incidence within this subgroup was calculated.
RESULTS: Viral retinitis developed after IVTA injection in 3 patients, yielding
an overall incidence of 3 in 736 or 0.41%. An estimated 334 injections were
administered to patients with an immune-altering condition, including diabetes.
All 3 of the patients in whom viral retinitis developed after IVTA injection
possessed abnormal immune systems, yielding an incidence rate of 3 in 334 or
0.90% within this subgroup. CONCLUSIONS: Our high reported incidence for this
potentially devastating complication can be attributed to multiple factors,
including coexisting medical immunocompromising comorbidities, a higher dose
with a longer duration of local immunosuppression in the vitreous, multiple
injections, as well as previous viral retinitis. Caution with a high index of
clinical suspicion and frequent follow-up is advised in patients receiving IVTA
injection with potentially immune-altering conditions, even after apparent
immune recovery. (c) 2010 Elsevier Inc. All rights reserved.

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

PMID: 20172069  [PubMed - indexed for MEDLINE]

27: Am J Ophthalmol. 2010 Mar;149(3):416-22.e1-2. 

Quality of life in keratoconus patients after penetrating keratoplasty.

Yildiz EH, Cohen EJ, Virdi AS, Hammersmith KM, Laibson PR, Rapuano CJ.

Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson
University, Philadelphia, Pennsylvania 19107, USA.

PURPOSE: To determine vision-related quality of life (QoL) measured with the
National Eye Institute Visual Function Questionnaire (NEI-VFQ) in keratoconus
(KCN) patients who have undergone penetrating keratoplasty (PK) in 1 or both
eyes and to compare the results of our study to those of historical controls.
DESIGN: Clinical-based, cross-sectional study. METHODS: SETTING: Wills Eye
Institute, Cornea Service, Thomas Jefferson University, Philadelphia,
Pennsylvania. STUDY POPULATION: This study included 149 consecutive patients who
had undergone PK for KCN. INTERVENTION: Between June 1, 2008 and December 31,
2008, the NEI-VFQ was administered to 149 patients. The relationship between
demographic and clinical factors and NEI-VFQ subscale scores was evaluated. MAIN
OUTCOME MEASURE: Vision-related quality of life. RESULTS: Eighty-three of 149
patients (55.7%) were male. Approximately half of the patients (76/149; 51.0%)
had PK in both eyes. Visual acuity with current correction in the better eye was
better than 20/40 in 80% of patients (119/149). Our sample had significantly
lower (worse) NEI-VFQ scores compared to Collaborative Longitudinal Evaluation
of Keratoconus (CLEK) historical control group for the subscales of role
difficulties, dependency, driving, and peripheral vision. In general, scores of
our sample were between scores of patients with age-related macular degeneration
(AMD) category 3 and 4. Patients with visual acuity better than 20/40 (in the
better eye) showed significantly higher scores in all subscales except color
vision. There was a significant relationship between minimum time since the
graft of 5 years or greater and NEI-VFQ overall score better than AMD category 3
(P = .004). CONCLUSION: Despite satisfactory results on visual outcome measures
obtained after PK, vision-related QoL in KCN patients remains impaired. (c) 2010
Elsevier Inc. All rights reserved.

PMID: 20172068  [PubMed - indexed for MEDLINE]

28: Am J Ophthalmol. 2010 Mar;149(3):398-404.e1-2. 

Non-syndromic supernumerary caruncles causing ocular irritation after cataract
surgery: a critical review of caruncular dysgeneses.

Jakobiec FA, Lam H, Bhat P, Pineda R.

Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard
Medical School, Boston, Massachusetts 02114, USA. Fred_Jakobiec@meei.harvard.edu

PURPOSE: To describe a patient with 2 ipsilateral supernumerary caruncles and to
determine if they are predictive of associated abnormalities. DESIGN:
Retrospective and interventional clinicopathologic study with a critical review
of the literature over the past 100 years. METHODS: Assessment of clinical
features and histopathologic findings in paraffin-embedded tissue sections
stained with hematoxylin and eosin, Masson trichrome, periodic acid-Schiff (PAS)
reaction with and without diastase, and Ziehl-Neelsen method. RESULTS: Two
placoid lesions causing ocular irritation after routine phacoemulsification were
discovered in the inferomedial palpebral conjunctiva. They were totally separate
from a normal caruncle. Their surface was studded with yellowish micronodules
with projecting white vellus hairs. There were no associated local ophthalmic or
systemic abnormalities. Microscopically, they were covered by a goblet
cell-rich, nonkeratinizing squamous epithelium with subadjacent pilosebaceous
units, the hairs of which were highlighted by the Masson trichrome and
Ziehl-Neelsen stains, and small lobules of lacrimal gland tissue. The ocular
irritation has not returned after surgery. CONCLUSIONS: A literature review
confirms that supernumerary (extra) caruncles coexisting with a normal caruncle
are always unilateral and unassociated with any other ocular anomalies, as in
the current case. They may, however, cause ocular irritation. They must be
distinguished from ectopic (topographically displaced) or dysplastic caruncles
that are generally bilateral and often associated with ocular adnexal
abnormalities or Goldenhar syndrome. Ectopic or dysplastic caruncles, but not
supernumerary ones, are characteristically accompanied by plical abnormalities
or its absence. Well-documented supernumerary and ectopic caruncles have always
been located in the inferior palpebral conjunctiva. (c) 2010 Elsevier Inc. All
rights reserved.

Publication Types:
    Case Reports
    Review

PMID: 20172067  [PubMed - indexed for MEDLINE]

29: Am J Ophthalmol. 2010 Mar;149(3):390-7.e1. 

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

Shah AK, Terry MA, Shamie N, Chen ES, Phillips PM, Hoar KL, Friend DJ,
Davis-Boozer D.

Devers Eye Institute, Portland, Oregon 97210, USA. akshah2004@yahoo.com

PURPOSE: To evaluate complications and clinical outcomes of Descemet stripping
automated endothelial keratoplasty (DSAEK) with intraocular lens (IOL) exchange
compared with DSAEK alone. DESIGN: Retrospective, interventional case series.
METHODS: DSAEK was performed in 19 eyes in which the anterior chamber IOL was
exchanged for a posterior chamber IOL (study group) and in 188 eyes in which the
posterior chamber IOL was left in place (comparison group). The complications of
graft dislocations, primary graft failure episodes, and pupillary block were
recorded for all eyes. Six-month best spectacle-corrected visual acuity and mean
central endothelial cell density were measured prospectively and then compared
with preoperative values for all eyes. RESULTS: Dislocations occurred in 0 (0%)
of 19 eyes in the study group and in 5 (3%) of 188 eyes in the comparison group
(P = .47), with 0 primary graft failures and 0 pupillary block episodes in
either group. Preoperative mean best spectacle-corrected visual acuity for those
eyes without any underlying ocular comorbidities was 20/205 and 20/100 in the
study and comparison groups, respectively (P = .18). Mean best
spectacle-corrected visual acuity at 6 months improved to 20/48 in the study
group and to 20/34 in the comparison group, a statistically significant
difference (P = .01). Mean donor cell loss at 6 months was 33% in the study
group and 26% in the comparison group (P = .18). CONCLUSIONS: Concurrent IOL
exchange with DSAEK surgery does not increase the dislocation, primary graft
failure, or pupillary block rates in the immediate postoperative period. Donor
endothelial cell loss in DSAEK was not increased significantly by IOL exchange.
Visual acuity was slightly worse after combined surgery than after DSAEK alone.
(c) 2010 Elsevier Inc. All rights reserved.

PMID: 20172066  [PubMed - indexed for MEDLINE]

30: Am J Ophthalmol. 2010 Mar;149(3):371-82.e1. 

Posterior vitreous detachment: evolution and complications of its early stages.

Johnson MW.

Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center,
University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
markwj@umich.edu

PURPOSE: To summarize emerging concepts regarding the onset and progression,
traction effects, and complications of the early stages of age-related posterior
vitreous detachment (PVD). DESIGN: Interpretive essay. METHODS: Review and
synthesis of selected literature, with clinical illustrations, interpretation,
and perspective. RESULTS: Imaging of the vitreoretinal interface with optical
coherence tomography has shown that PVD begins in the perifoveal macula. Recent
longitudinal studies have demonstrated conclusively that early PVD stages
persist chronically and progress slowly over months to years. Vitreous traction
forces resulting from perifoveal PVD with a small vitreofoveolar adhesion (500
microm or less) may cause localized cystoid foveal thickening or one of several
macular hole conditions. Traction associated with larger adhesion zones may
cause or exacerbate a separate group of macular disorders. Ultrastructural
studies suggest that epiretinal membrane develops from cortical vitreous
remnants left on the retinal surface after PVD and plays an important role in
traction vitreomaculopathies. CONCLUSIONS: Age-related PVD is an insidious,
chronic event that begins in the perifoveal macula and evolves over a prolonged
period before vitreopapillary separation. Although asymptomatic in most
individuals, its early stages may be complicated by a variety of macular and
optic disc pathologic features, determined in part by the size and strength of
the residual vitreoretinal adhesion. (c) 2010 Elsevier Inc. All rights reserved.

Publication Types:
    Review

PMID: 20172065  [PubMed - indexed for MEDLINE]