1: Arch Ophthalmol. 2010 Jul;128(7):945. 

A time and place for brand names.

Charles NC.

Publication Types:
    Comment
    Letter

PMID: 20625064  [PubMed - in process]

2: Arch Ophthalmol. 2010 Jul;128(7):944-5; author reply 945. 

Contact lens solutions revisited.

Warwar RE, Bullock JD.

Publication Types:
    Comment
    Letter

PMID: 20625063  [PubMed - in process]

3: Arch Ophthalmol. 2010 Jul;128(7):942-4. 

IgG4-positive dacryoadenitis and Kuttner submandibular sclerosing inflammatory
tumor.

Jakobiec FA, Stacy RC, Mehta M, Fay A.

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

PMID: 20625062  [PubMed - in process]

4: Arch Ophthalmol. 2010 Jul;128(7):941-2. 

Successful topical application of caspofungin in the treatment of fungal
keratitis refractory to voriconazole.

Hurtado-Sarrio M, Duch-Samper A, Cisneros-Lanuza A, Diaz-Llopis M, Peman-Garciia
J, Vazquez-Polo A.

Publication Types:
    Letter

PMID: 20625061  [PubMed - in process]

5: Arch Ophthalmol. 2010 Jul;128(7):937-40. 

Atypical acquired pediatric Horner syndrome.

Pollard ZF, Greenberg MF, Bordenca M, Lange J.

James Hall Eye Center, 5445 Meridian Mark Road, Atlanta, GA 30342, USA.
zanepollard@bellsouth.net

PMID: 20625060  [PubMed - in process]

6: Arch Ophthalmol. 2010 Jul;128(7):934-5. 

Genotypes need phenotypes.

Wiggs JL.

Publication Types:
    Editorial

PMID: 20625059  [PubMed - in process]

7: Arch Ophthalmol. 2010 Jul;128(7):931-3. 

Monocular infantile cataract: treatment is worth the effort.

Repka MX.

Publication Types:
    Comment
    Editorial

PMID: 20625058  [PubMed - in process]

8: Arch Ophthalmol. 2010 Jul;128(7):924-30. 

Lucien Howe, hereditary blindness, and the eugenics movement.

Ravin JG, Stern AM.

Division of Ophthalmology, University of Toledo College of Medicine, 3000
Regency Ct., Toledo, OH 43623, USA. jamesravin@bex.net

Ophthalmologists admire Lucien Howe, MD (1848-1928) (Figure 1), for his
leadership and philanthropy. During his presidency of the American
Ophthalmological Society (AOS), the organization established an award for
contributions to ophthalmology, now known as the Howe Medal (Figure 2), one of
the highest honors in the specialty. In addition, there are 2 other Howe Medals
and a Howe Award, each of which is given at irregular intervals. The American
Medical Association's Lucien Howe Prize Medal in Ophthalmology was first given
in 1926. The University of Buffalo (The State University of New York) and the
Buffalo Ophthalmological Society have given a Lucien Howe Medal in Ophthalmology
since 1928. The Medical Society of the State of New York's Lucien Howe Award was
established in 1906.

PMID: 20625057  [PubMed - in process]

9: Arch Ophthalmol. 2010 Jul;128(7):915-23. 

RP2 phenotype and pathogenetic correlations in X-linked retinitis pigmentosa.

Jayasundera T, Branham KE, Othman M, Rhoades WR, Karoukis AJ, Khanna H, Swaroop
A, Heckenlively JR.

Department of Ophthalmologyand Visual Sciences, Kellogg Eye Center, University
of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA.

OBJECTIVES: To assess the phenotype of patients with X-linked retinitis
pigmentosa (XLRP) with RP2 mutations and to correlate the findings with their
genotype. METHODS: Six hundred eleven patients with RP were screened for RP2
mutations. From this screen, 18 patients with RP2 mutations were evaluated
clinically with standardized electroretinography, Goldmann visual fields, and
ocular examinations. In addition, 7 well-documented cases from the literature
were used to augment genotype-phenotype correlations. RESULTS: Of 11 boys
younger than 12 years, 10 (91%) had macular involvement and 9 (82%) had
best-corrected visual acuity worse than 20/50. Two boys from different families
(aged 8 and 12 years) displayed a choroideremia-like fundus, and 9 boys (82%)
were myopic (mean error, -7.97 diopters [D]). Of 10 patients with
electroretinography data, 9 demonstrated severe rod-cone dysfunction. All 3
female carriers had macular atrophy in 1 or both eyes and were myopic (mean,
-6.23 D). All 9 nonsense and frameshift and 5 of 7 missense mutations (71%)
resulted in severe clinical presentations. CONCLUSIONS: Screening of the RP2
gene should be prioritized in patients younger than 16 years characterized by
X-linked inheritance, decreased best-corrected visual acuity (eg, >20/40), high
myopia, and early-onset macular atrophy. Patients exhibiting a
choroideremia-like fundus without choroideremia gene mutations should also be
screened for RP2 mutations. CLINICAL RELEVANCE: An identifiable phenotype for
RP2-XLRP aids in clinical diagnosis and targeted genetic screening.

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

PMID: 20625056  [PubMed - in process]

10: Arch Ophthalmol. 2010 Jul;128(7):911-4. 

Chandelier retroillumination-assisted cataract extraction in eyes with vitreous
hemorrhage.

Jang SY, Choi KS, Lee SJ.

Department of Ophthalmology, College of Medicine, Soonchunhyang University, 657
Hannam-dong, Yongsan-gu, Seoul, Korea.

We describe the surgical technique of using an illuminated infusion chandelier
for cataract extraction in patients with absent red reflex due to vitreous
hemorrhage. A 23-gauge illuminated infusion chandelier was used for cataract
extraction in 6 consecutive patients (6 eyes) who underwent combined surgery:
phacoemulsification and 23-gauge sutureless vitrectomy. During surgery, the
light from the illuminated infusion chandelier was used to enhance the red
reflex and to better visualize the lens structure and capsule. Continuous
curvilinear capsulorhexis and phacoemulsification were successfully performed.
Capsular polishing was also performed safely and easily. The posterior capsule
remained intact and the intraocular lens was inserted into the bag in all cases.
Thus, the use of the 23-gauge illuminated infusion chandelier can improve
visualization of the lens structure and capsule, thereby facilitating successful
cataract extraction in select patients with vitreous hemorrhage.

PMID: 20625055  [PubMed - in process]

11: Arch Ophthalmol. 2010 Jul;128(7):906-10. 

Misrepresentation by ophthalmology residency applicants.

Wiggins MN.

Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W
Markham, Little Rock, AR 72205-7199, USA. wigginsmichael@uams.edu

OBJECTIVES: To determine the percentage of publication misrepresentation among
applicants to an ophthalmology residency, to compare that percentage with
published percentages from other specialties, and to compare the number of
US-trained applicants vs non-US-trained applicants found to misrepresent
published articles. METHODS: Published articles in peer-reviewed journals listed
on residency applications to the Jones Eye Institute from October 10, 2000, to
December 1, 2004, were searched, excluding applications that were unavailable or
were from current residents and faculty. The type of misrepresentation of
published articles and the country of medical school training were recorded.
Compared were US-trained applicants vs non-US-trained applicants to determine
which group was more likely to list published articles and which group was more
likely to have a misrepresented published article. RESULTS: Eight hundred
twenty-one of 852 applications (96.4%) were reviewed. Five hundred fifty
applicants (67.0%) were from US medical schools, and 271 applicants (33.0%) were
from non-US medical schools. Two hundred one applicants (24.5%) listed
peer-reviewed published articles. Misrepresentation of published articles was
found in 15 applicants (5 US trained and 10 non-US trained). The mean percentage
of applicants with misrepresentation per applicant pool was 1.9%, while the mean
percentage per applicants listing published articles was 8.1%. The most common
misrepresentation found was self-promotion on the author list (50.0%), followed
by omission of other authors (25.0%), nonexistent articles (12.5%), and
nonauthorship (12.5%). Foreign medical graduates were more likely to list
published articles (P = .008) and to have a misrepresented published article (P
= .01). CONCLUSIONS: Ophthalmology has one of the lowest reported percentages of
applicant publication misrepresentation in the literature. Foreign medical
graduates were more likely to list published articles and to misrepresent
published articles. Self-promotion on the author list was the most common type
of misrepresentation found. Residency program directors should request copies of
published articles from interviewing applicants.

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

PMID: 20625054  [PubMed - in process]

12: Arch Ophthalmol. 2010 Jul;128(7):900-5. 

Refractive error, axial dimensions, and primary open-angle glaucoma: the
Singapore Malay Eye Study.

Perera SA, Wong TY, Tay WT, Foster PJ, Saw SM, Aung T.

Glaucoma Service, Singapore National Eye Centre, 11 Third Hospital Ave.,
Singapore.

OBJECTIVE: To explore the relationship of refractive error and ocular biometry
with primary open-angle glaucoma (POAG) in the Malay population. METHODS: The
Singapore Malay Eye Study is a population-based cross-sectional survey that
examined 3280 persons (78.7% response) aged 40 to 80 years. Participants
underwent a standardized clinical examination including slitlamp biomicroscopy,
Goldmann applanation tonometry, refraction, dilated optic disc assessment, and
measurement of axial length (AL) and central corneal thickness (CCT). Glaucoma
was defined according to International Society for Geographical and
Epidemiological Ophthalmology criteria. RESULTS: After adjusting for possible
confounders, persons with moderate or high myopia (less than -4.0 diopters,
right eyes) were more likely to have POAG (odds ratio [OR], 2.87; 95% confidence
interval, 1.09-7.53); this association remained significant after controlling
for CCT (2.80; 1.07-7.37). Longer AL was associated with POAG (ORs, 2.49, 3.61,
and 2.88, comparing quartiles 2, 3, and 4, respectively, with quartile 1 of AL;
P = .03 for trend). If CCT was controlled for, persons with AL in quartile 4
were 3 times more likely to have POAG (OR, 3.00; 95% confidence interval,
1.09-8.24) than those in quartile 1. CONCLUSION: This population-based study in
Singapore shows an association of moderate myopia and increasing AL with POAG
independent of other factors, including CCT.

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

PMID: 20625053  [PubMed - in process]

13: Arch Ophthalmol. 2010 Jul;128(7):894-9. 

Use of visual acuity to screen for significant refractive errors in adolescents:
is it reliable?

Leone JF, Mitchell P, Morgan IG, Kifley A, Rose KA.

Discipline of Orthoptics, Faculty of Health Sciences, University of Sydney
Cumberland Campus, Lidcombe NSW 1825, Australia. jmaj7969@uni.sydney.edu.au

OBJECTIVE: To detect significant refractive error in a population-based random
cluster sample of 12-year-old schoolchildren by using sensitivity and
specificity of uncorrected visual acuity (VA). METHODS: The Sydney Myopia Study
randomly selected 21 secondary schools stratified by socioeconomic status. All
year 7 students (mean age, 12.7 years) were invited to participate. We tested VA
monocularly, unaided at 2.44 m, using a retroilluminated logMAR chart.
Cycloplegic autorefraction (induced with instillation of cyclopentolate
hydrochloride, 1%) was used to define clinically significant refractive error as
a spherical equivalent of -1.00 diopters (D) or less for myopia; at least +2.00
D for hyperopia; and -1.00 D or less cylinder power for astigmatism. RESULTS:
Data for both eyes were pooled for a total of 4497 observations. The sensitivity
and specificity for all clinically significant refractive errors at the best VA
cutoff level of 53 letters (6/6(-2)) were 72.2% and 93.3%, respectively. Myopia
had the highest sensitivity and specificity of any of the refractive errors for
detection using VA (97.8% and 97.1%, respectively, for a 45-letter VA cutoff
[6/9.5]). The best VA cutoffs for hyperopia and astigmatism were 57 (6/6(+2))
and 55 (6/6) letters, respectively, with sensitivities of 69.2% and 77.4%,
respectively, and specificities of 58.1% and 75.4%, respectively. CONCLUSIONS:
In this adolescent group, a VA cutoff of 6/9.5 or less detects myopic refractive
error reliably. However, there is no reliable VA cutoff for clinically
significant hyperopia or astigmatism. Improved VA screening methods are required
to improve detection of these conditions. Even so, with the methods described
herein, the prevalence of uncorrected VA may provide a reasonably accurate
estimate of the prevalence of myopia.

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

PMID: 20625052  [PubMed - in process]

14: Arch Ophthalmol. 2010 Jul;128(7):888-93. 

Attenuation of iodine 125 radiation with vitreous substitutes in the treatment
of uveal melanoma.

Oliver SC, Leu MY, DeMarco JJ, Chow PE, Lee SP, McCannel TA.

Department of Ophthalmology, Jules Stein Eye Institute, University of
California-Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA.

OBJECTIVE: To demonstrate attenuation of radiation from iodine 125 ((125)I) to
intraocular structures using liquid vitreous substitutes. METHODS: Four
candidate vitreous substitutes were tested for attenuation using empirical
measurement and theoretical calculation. In vitro and ex vivo cadaveric
dosimetry measurements were obtained with lithium fluoride thermoluminescent
dosimeters to demonstrate the attenuation effect of vitreous substitution during
(125)I simulated plaque brachytherapy. Theoretical dosimetry calculations were
based on Monte Carlo simulation. RESULTS: In a cylindrical phantom at a 17-mm
depth, liquid vitreous substitutes as compared with saline showed significant
reduction of radiation penetration (48% for 1000-centistoke [cSt] silicone oil
[polydimethyl-n-siloxane], 47% for 5000-cSt silicone oil
[polydimethyl-n-siloxane], 40% for heavy oil
[perfluorohexyloctane/polydimethyl-n-siloxane], and 35% for perfluorocarbon
liquid [perfluoro-n-octane]). Human cadaveric ex vivo measurements demonstrated
a 1000-cSt silicone oil to saline dose ratio of 35%, 52%, 55%, and 48% at arc
lengths of 7.6, 10.6, 22.3, and 28.6 mm from the plaque edge, respectively,
along the surface of the globe. Monte Carlo simulation of a human globe
projected attenuation as high as 57% using 1000-cSt silicone oil. CONCLUSIONS:
Intraocular vitreous substitutes including silicone oil, heavy oil, and
perfluorocarbon liquid attenuate the radiation dose from (125)I. Cadaveric ex
vivo measurements and Monte Carlo simulation both demonstrate radiation
attenuation using 1000-cSt silicone oil at distances corresponding to vital
ocular structures. Clinical Relevance Attenuation of radiation with silicone oil
endotamponade in the treatment of uveal melanoma may significantly reduce
radiation-induced injury to vital ocular structures.

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

PMID: 20625051  [PubMed - in process]

15: Arch Ophthalmol. 2010 Jul;128(7):884-7. 

Intravitreous bevacizumab injection: an experimental study in New Zealand white
rabbits.

Cortez RT, Ramirez G, Collet L, Thakuria P, Giuliari GP.

Centro de Cirugia Oftalmologica, Universidad Central de Venezuela, Caracas,
Venezuela.

OBJECTIVES: To determine the effects of intraocular pressure (IOP) and needle
diameter on the amount of reflux after intravitreous bevacizumab injection.
METHODS: Prospective randomized interventional study. Twelve New Zealand white
rabbits weighing approximately 2.5 to 3.5 kg each were randomized 1:1 to group 1
or group 2. Bevacizumab stained with trypan blue was used for intravitreous
injection. To lower the IOP, eyes in group 2 underwent anterior chamber
paracentesis before intravitreous injection. Two eyes in each group were
injected using 27-, 30-, or 32-gauge needles. If a subconjunctival bleb formed
after intravitreous injection, its diameter was measured using a caliper.
RESULTS: The median IOP in group 1 was 17.5 mm Hg. Eyes injected using 27-gauge
and 30-gauge needles showed stained subconjunctival blebs with median sizes of 3
mm and 1.7 mm, respectively; eyes injected using 32-gauge needles showed no
subconjunctival bleb formation. The median IOP in group 2 was 10.3 mm Hg. Eyes
injected using 27-gauge needles showed stained subconjunctival blebs with a
median size of 0.7 mm, and eyes injected using 30-gauge and 32-gauge needles
showed no subconjunctival bleb formation. CONCLUSION: Decreasing the IOP before
intravitreous injection and using a smaller-gauge needle reduce the risk of drug
reflux after intravitreous bevacizumab injection. CLINICAL RELEVANCE:
Intravitreous injection is an increasingly common route of drug delivery to
treat ocular diseases. Techniques that maximize bioavailability are examined in
this study.

PMID: 20625050  [PubMed - in process]

16: Arch Ophthalmol. 2010 Jul;128(7):876-83. 

Induction of rapid and highly efficient expression of the human ND4 complex I
subunit in the mouse visual system by self-complementary adeno-associated virus.

Koilkonda RD, Chou TH, Porciatti V, Hauswirth WW, Guy J.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638
NW 10th Ave., Miami, FL 33136, USA.

OBJECTIVE: To demonstrate the high efficiency and rapidity of allotopic
expression of a normal human ND4 subunit of complex I in the vertebrate retina
using a self-complementary adeno-associated virus (scAAV) vector for ocular gene
delivery to treat acute visual loss in Leber hereditary optic neuropathy (LHON).
METHODS: The nuclear-encoded human ND4 subunit fused to the P1 isoform of
subunit C of adenosine triphosphate synthase (ATPc) mitochondrial targeting
sequence and FLAG epitope was packaged in scAAV2 capsids or single-stranded (ss)
AAV2 capsids. These constructs were injected into the vitreous cavities of mice.
The contralateral eyes were injected with scAAV-green fluorescent protein (GFP).
One week later, pattern electroretinograms and gene expression of the human ND4
subunit and GFP were evaluated. Quantitative analysis of ND4FLAG-injected eyes
was assessed relative to Thy1.2-labeled retinal ganglion cells (RGCs). RESULTS:
Pattern electroretinogram amplitudes remained normal in eyes inoculated with
scAAV-ND4FLAG, ssAAV-ND4FLAG, and GFP. Confocal microscopy revealed the typical
perinuclear mitochondrial expression of scAAV-ND4FLAG in almost the entire
retinal flat mount. In contrast, scAAV-GFP expression was cytoplasmic and
nuclear. Relative to Thy1.2-positive RGCs, quantification of
scAAV-ND4FLAG-positive RGCs was 91% and that of ssAAV-ND4FLAG-positive RGCs was
51%. CONCLUSION: Treatment of acute visual loss due to LHON may be possible with
a normal human ND4 subunit gene of complex I, mutated in most cases of LHON,
when delivered by an scAAV vector. Clinical Relevance Unlike most retinal
degenerations that result in slowly progressive loss of vision over many years,
LHON due to mutated mitochondrial DNA results in apoplectic, bilateral severe
and usually irreversible visual loss. For rescue of acute visual loss in LHON, a
highly efficient and rapid gene expression system is required.

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

PMID: 20625049  [PubMed - in process]

17: Arch Ophthalmol. 2010 Jul;128(7):871-5. 

Survival in patients with presymptomatic diagnosis of metastatic uveal melanoma.

Kim IK, Lane AM, Gragoudas ES.

Retina Service, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston,
MA 02114, USA. ivana_kim@meei.harvard.edu

OBJECTIVE: To determine if patients diagnosed as having metastatic uveal
melanoma before the onset of symptoms experience more favorable survival
outcomes than patients diagnosed after the onset of symptoms. METHODS: A
retrospective cohort study was performed among 90 patients who were diagnosed as
having metastatic uveal melanoma after proton beam irradiation by routine
surveillance testing (asymptomatic group) compared with 259 patients who were
diagnosed as having metastatic uveal melanoma after development of symptoms
(symptomatic group). The median survival times and cumulative rates of
melanoma-related death after diagnosis of metastasis were compared between the 2
groups. RESULTS: No differences were noted between groups in known prognostic
factors for melanoma-related death, including age and tumor size. Cumulative
rates of melanoma-related death were higher for patients in the symptomatic
group vs the asymptomatic group (P < .001, log-rank test) owing to differences
in mortality observed in the first year after diagnosis of metastasis (87.8% vs
68.5%). By the second year after diagnosis of metastasis, cumulative rates had
reached 90% or higher in both groups. The median time to melanoma-related death
after primary tumor diagnosis was 40.6 months in the asymptomatic group vs 45.1
months in the symptomatic group (P = .61). CONCLUSION: Presymptomatic detection
of metastatic uveal melanoma by routine surveillance testing seems to confer a
survival advantage only in the first year after diagnosis of metastasis, which
is likely because of lead-time bias.

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

PMID: 20625048  [PubMed - in process]

18: Arch Ophthalmol. 2010 Jul;128(7):865-70. 

Review of 676 second primary tumors in patients with retinoblastoma: association
between age at onset and tumor type.

Woo KI, Harbour JW.

Ocular Oncology Service, Department of Ophthalmology & Visual
Sciences,Washington University School of Medicine, 660 S Euclid Ave., St Louis,
MO 63110, USA.

OBJECTIVE: To obtain a more accurate understanding of second primary tumors
(SPTs) by analyzing a large number of SPTs from the published literature.
METHODS: A literature search was performed to identify published cases of SPTs
in patients with retinoblastoma. Patient age, radiation field, tumor location,
and tumor type were analyzed for statistical association. RESULTS: The study
included 676 SPTs in 602 patients. Median age at diagnosis of SPT was 13.0 years
(range, 0.3-60.4 years) for all SPTs, 2.7 years for midline intracranial
primitive neuroectodermal tumors, 13.0 years for sarcomas, 27.0 years for
melanomas, and 29.0 years for carcinomas. The median age at which SPTs occurred
inside the radiation field was younger than that for SPTs occurring outside the
radiation field or in patients who did not undergo irradiation (P < .001).
Sarcomas occurred more commonly inside the radiation field (P < .001).
Melanomas, lipomas, leukemias, and lymphomas occurred more commonly outside the
radiation field or in patients who did not undergo irradiation (P < .001).
CONCLUSIONS: Retinoblastoma patients pass through multiple windows of
susceptibility to specific SPTs. This information will aid health care providers
in monitoring this high-risk group, and it provides new insights for studying
the underlying genetic predisposition to SPTs.

PMID: 20625047  [PubMed - in process]

19: Arch Ophthalmol. 2010 Jul;128(7):859-64. 

Halo nevus of the choroid in 150 patients: the 2010 Henry van Dyke Lecture.

Shields CL, Maktabi AM, Jahnle E, Mashayekhi A, Lally SE, Shields JA.

Ocular Oncology Service, Wills Eye Institute, 840 Walnut Street, Philadelphia,
PA 19107, USA. carol.shields@shieldsoncology.com

OBJECTIVE: To evaluate choroidal halo nevus. METHODS: We performed a
retrospective medical record review on all patients with a clinical diagnosis of
choroidal halo nevus treated at the Ocular Oncology Service at Wills Eye
Institute from April 1, 1974, through June 30, 2008. Their clinical
characteristics and natural history were studied. RESULTS: The choroidal halo
nevus showed 2 components, including a distinct central pigmented region
surrounded by a yellow halo. Of the 150 patients, 107 (71.3%) were women and 43
(28.7%) were men; and 149 (99.3%) were white, with a median age at presentation
of 54 years. Autoimmune disorders were found in 4 patients (2.7%), a rate
similar to the prevalence in the US population (2.7% vs 3.1%, P = .74).
Preexistent cutaneous melanoma was found in 5 patients (3.3%), which was
significantly more prevalent than the rate for the US population (3.3% vs 0.3%,
P < .001). The halo was peripheral in 139 patients (92.7%) and slightly internal
in 11 (7.3%). Two patients (1.3%) had multifocal halo nevi. The nevus location
was superior in 31 patients (20.7%), temporal in 43 (28.7%), inferior in 29
(19.3%), nasal in 27 (18.0%), and macular in 20 (13.3%). Related features
included drusen in 85 patients (56.7%), subretinal fluid in 21 (14.0%), orange
pigment in 13 (8.7%), and retinal pigment epithelial atrophy in 15 (10.0%).
There were no intraocular inflammatory findings. Of the 110 patients with nevi
with follow-up, growth into melanoma occurred in 4 patients (3.6%) at a median
interval of 41 months. CONCLUSIONS: Halo nevus is a variant of choroidal nevus
that has a brown center and yellow halo. No relationship was found with
autoimmune disorders, but a relationship with previous cutaneous melanoma is
possible.

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

PMID: 20625046  [PubMed - in process]

20: Arch Ophthalmol. 2010 Jul;128(7):853-8. 

Clinical features of tuberculous serpiginouslike choroiditis in contrast to
classic serpiginous choroiditis.

Vasconcelos-Santos DV, Rao PK, Davies JB, Sohn EH, Rao NA.

Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA 90033, USA.

OBJECTIVE: To compare distinctive clinical features of presumed tuberculous
serpiginouslike choroiditis (Tb-SLC) with classic serpiginous choroiditis (SC)
in patients living in a region that is nonendemic for tuberculosis. METHODS:
Retrospective comparative analysis of clinical features of 5 patients with
recurrent Tb-SLC and 5 with SC. RESULTS: All patients with recurrent Tb-SLC
primarily emigrated from areas highly endemic for tuberculosis and had been
unsuccessfully treated with steroids/immunosuppressive agents. Results of
uveitis investigations were negative except for positive tuberculin skin test
results. These patients received oral tuberculostatic drugs, without recurrences
(follow-up, 6-91 months). The ocular involvement in Tb-SLC was mostly
unilateral, with multiple irregular serpiginoid lesions involving the posterior
pole and periphery but usually sparing the juxtapapillary area. All 5 cases had
inflammatory cells in the vitreous. Patients with SC were from areas nonendemic
for tuberculosis, had negative uveitis workup findings (including tuberculin
skin test results), and were successfully managed with
steroids/immunosuppressive agents (follow-up, 6-72 months) with no recurrence.
Ocular involvement in SC was usually bilateral, rarely multifocal, and primarily
involved the posterior pole, especially around the optic disc and extending
contiguously to the macula. No patient with SC presented with vitritis.
CONCLUSION: In areas nonendemic for tuberculosis, SC can be clinically
differentiated from Tb-SLC. Patients with Tb-SLC come from highly endemic
regions, show significant vitritis, and often present with multifocal lesions in
the posterior pole and periphery. Cases of SC, in contrast, reveal minimal or no
vitritis and frequently show bilateral involvement with larger solitary lesions
extending primarily from the juxtapapillary area and sparing the periphery.

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

PMID: 20625045  [PubMed - in process]

21: Arch Ophthalmol. 2010 Jul;128(7):847-52. 

Computer-assisted measurement of retinal vascular width and tortuosity in
retinopathy of prematurity.

Kiely AE, Wallace DK, Freedman SF, Zhao Z.

School of Medicine, Department of Ophthalmology, Duke University Medical Center,
Durham, NC 27710, USA.

OBJECTIVES: To validate the accuracy of ROPtool software in measuring retinal
vascular width and tortuosity in a large image set compared with expert
diagnoses. METHODS: Tortuosity and dilation indexes generated by ROPtool were
compared with 3 expert consensus grades of normal, pre-plus, or plus disease for
368 quadrants in 92 RetCam (Clarity Medical Systems, Pleasanton, California)
fundus images. Sensitivity and specificity of ROPtool software in diagnosing
tortuosity and dilation sufficient for plus and pre-plus disease were
calculated. These measures were compared with individual accuracies of 3
experienced pediatric ophthalmologists. RESULTS: The mean tortuosity indexes for
expert-diagnosed categories of normal, pre-plus, and plus disease were 7.04,
18.73, and 34.62, respectively (P < .001), and the mean dilation indexes were
9.63, 12.05, and 13.61, respectively (P < .001). When optimal tortuosity and
dilation index thresholds (from receiver operating characteristic curves) were
applied, resultant sensitivity and specificity were 0.913 and 0.863,
respectively, for plus tortuosity and 0.782 and 0.840, respectively, for plus
dilation. These values were comparable to the performance of examiners judged
against the same expert panel. CONCLUSION: ROPtool version 2.1.5 accurately
measures tortuosity and dilation of posterior pole blood vessels in RetCam
images, corresponding well with expert diagnostic categories of normal,
pre-plus, and plus disease and performing comparably to experienced examiners.

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

PMID: 20625044  [PubMed - in process]

22: Arch Ophthalmol. 2010 Jul;128(7):843-6. 

Refractive outcomes of lens-sparing vitrectomy for retinopathy of prematurity.

Carvounis PE, Poll J, Weikert MP, Wilhelmus K, Lakhanpal RR, Holz ER.

Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77025, USA.

OBJECTIVE: To evaluate the refractive outcomes of 3-port lens-sparing vitrectomy
(LSV) for subtotal retinal detachments owing to retinopathy of prematurity.
METHODS: The study included 9 infants who had undergone complete ablative laser
treatment for threshold retinopathy of prematurity in both eyes, subsequently
developed stage 4A retinal detachment in 1 eye for which they underwent LSV, and
maintained complete retinal attachment bilaterally. Eyes that underwent LSV were
compared with fellow eyes. Cycloplegic refraction was performed, and corneal
curvature, axial length, lens thickness, lens position, and anterior chamber
depth were measured. RESULTS: Significantly less myopia was present in eyes that
had undergone LSV compared with control eyes (mean spherical equivalent, -6.78
vs -10.33 diopter [D]; P < .001). The reduced myopia in LSV eyes was
predominantly owing to increased anterior chamber depth (mean, 3.81 vs 2.96 mm;
P < .001) and a more posterior position of the lens (mean, 5.58 vs 4.63 mm; P <
.001). There was a minor contribution from reduced corneal power in LSV eyes
(mean, 43.90 vs 44.20 D; P = .02). There was no significant difference in axial
length, lens thickness, or lens power between LSV and control eyes. CONCLUSIONS:
Infant eyes undergoing 3-port LSV for stage 4A retinopathy of prematurity
develop less myopia than fellow eyes treated with ablative laser alone. The
difference is owing to posterior displacement of the lens, with a smaller
contribution from reduced corneal power. The reduction in myopia may explain the
excellent functional outcomes following 3-port LSV for stage 4A retinopathy of
prematurity.

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

PMID: 20625043  [PubMed - in process]

23: Arch Ophthalmol. 2010 Jul;128(7):834-40. 

Economic evaluation of toric intraocular lens: a short- and long-term decision
analytic model.

Pineda R, Denevich S, Lee WC, Waycaster C, Pashos CL.

Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

OBJECTIVE: To assess the economic value of improved uncorrected visual acuity
among patients with cataract and preexisting astigmatism treated with toric
intraocular lenses (IOLs) compared with conventional monofocal IOLs. METHODS: We
developed a decision analytic model of hypothetical patients with preexisting
astigmatism. We examined costs and outcomes among patients 65 years and older
with cataract and preexisting astigmatism (1.5-3.0 diopters) who were receiving
either toric or conventional IOLs with and without intraoperative refractive
correction (IRC). Data were obtained from the literature and from a survey of 60
US ophthalmologists. Total medical costs of bilateral treatment were calculated
for the first posttreatment year and remaining lifetime. Cost-effectiveness and
cost-utility outcomes were computed. Future costs and utilities were discounted
by 3%. RESULTS: A larger proportion of patients receiving toric IOLs achieved
distance vision spectacle independence (67%) and uncorrected visual acuity of
20/25 or better OU (53%) compared with conventional IOLs with (63% and 48%,
respectively) or without IRC (53% and 44%, respectively), resulting in fewer
future vision corrections. Toric IOLs provided an additional 10.20
quality-adjusted life years (QALYs) compared with conventional IOLs with (10.14
QALYs) and without IRC (10.10 QALYs). Higher first-year costs of the toric IOL
($5739) compared with the conventional IOL with ($5635) or without ($4687) IRC
were offset by lifetime cost savings of $34 per patient, $393 per patient
achieving uncorrected visual acuity of 20/25 or better, and $349 per QALY
compared with the conventional IOL without IRC. CONCLUSIONS: Toric IOLs reduce
lifetime economic costs by reducing the need for glasses or contact lenses
following cataract removal. These results can inform physicians and patients
regarding the value of toric IOLs in the treatment of cataract and preexisting
astigmatism.

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

PMID: 20625042  [PubMed - in process]

24: Arch Ophthalmol. 2010 Jul;128(7):825-33. 

Meta-analysis of the efficacy and safety of alpha2-adrenergic agonists,
beta-adrenergic antagonists, and topical carbonic anhydrase inhibitors with
prostaglandin analogs.

Tanna AP, Rademaker AW, Stewart WC, Feldman RM.

Department of Ophthalmology, Northwestern University Feinberg School of
Medicine, 645 N Michigan Ave., Chicago, IL 60611, USA. atanna@northwestern.edu

OBJECTIVE: To perform a meta-analysis to estimate the intraocular pressure
(IOP)-lowering efficacy and safety of alpha(2)-adrenergic agonists (AAs),
beta-adrenergic antagonists (BBs), and topical carbonic anhydrase inhibitors
(TCAIs) when used in combination with a prostaglandin analog (PGA). METHODS:
MEDLINE, Embase, and the Cochrane Controlled Trials Register were systematically
searched for relevant articles in April 2009. Ten observer-masked randomized
clinical trials that reported baseline IOP while receiving PGA monotherapy and
follow-up IOP while receiving combination therapy were identified. The pooled
IOP-lowering efficacy achieved with each class of adjunctive agent was
calculated using random-effects models. The frequencies of adverse events were
pooled across studies and compared using Fisher exact test. RESULTS: Mean
diurnal IOP reduction achieved in all 3 groups was statistically similar (P =
.22). At trough, IOP reduction was greater in the TCAI (P < .001) and BB (P <
.001) groups than in the AA group. Peak IOP reduction was similar in the 3
groups (P = .66). Eye or eyelid pain or burning and xerostomia were
significantly more common in the AA group. Fatigue, weakness, or dizziness was
more common in the AA and BB groups compared with the TCAI group. Taste
disturbance was significantly more common in the TCAI group. CONCLUSIONS: All 3
classes are similarly effective in lowering mean diurnal IOP when used in
combination with PGAs. The AA class is statistically significantly less
effective in reducing IOP at trough compared with BBs and TCAIs. The types of
adverse events that were identified varied among the different classes of
adjunctive therapies.

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

PMID: 20625041  [PubMed - in process]

25: Arch Ophthalmol. 2010 Jul;128(7):819-24. 

Evidence of corneal lymphangiogenesis in dry eye disease: a potential link to
adaptive immunity?

Goyal S, Chauhan SK, El Annan J, Nallasamy N, Zhang Q, Dana R.

Schepens Eye Research Institute, 20 Staniford St., Boston, MA 02114, USA.

OBJECTIVE: To determine the effect of desiccating stress on corneal angiogenic
responses in dry eye disease (DED) using a murine model. METHODS: Dry eye was
induced in murine eyes using high-flow desiccated air. Corneas were double
stained with CD31 (panendothelial marker) and LYVE-1 (lymphatic endothelial
marker). Real-time polymerase chain reaction was performed to quantify
expression of vascular endothelial growth factors (VEGF-A, VEGF-C, and VEGF-D)
and their receptors (VEGFR-2 and VEGFR-3) in the cornea on days 6, 10, and 14.
Enumeration of CD11b(+)/LYVE-1(+) monocytic cells was performed in corneas with
DED on day 14. Flow cytometric evaluation of the draining lymph nodes in normal
mice and mice with DED was performed to determine whether DED is associated with
homing of mature (major histocompatibility complex class II(hi))
antigen-presenting cells to the lymphoid compartment. RESULTS: Lymphatic vessels
unaccompanied by blood vessels were seen growing toward the center of corneas
with DED. Significant increases in lymphatic area (P < .001) and lymphatic
caliber (P < .02) were seen on day 14 of disease. Lymphangiogenic-specific
VEGF-D and VEGFR-3 levels increased earliest on day 6 followed by increased
VEGF-C, VEGF-A, and VEGFR-2 levels. Increased recruitment of CD11b(+)/LYVE-1(+)
monocytic cells to the cornea and homing of mature CD11b(+) antigen-presenting
cells to the draining lymph nodes were also associated with DED. CONCLUSION:
Low-grade inflammation associated with DED is an inducer of lymphangiogenesis
without accompanying hemangiogenesis.

PMID: 20625040  [PubMed - in process]

26: Arch Ophthalmol. 2010 Jul 12; [Epub ahead of print] 

Glycemic and Blood Pressure Control in an Asian Malay Population With Diabetes
and Diabetic Retinopathy.

Huang OS, Lamoureux EL, Tay WT, Tai ES, Wang JJ, Wong TY.

University of New South Wales, Kensington, Australia (Ms Huang); Singapore Eye
Research Institute, Singapore National Eye Centre, Singapore (Drs Lamoureux and
Wong and Mss Huang and Tay); Centre for Eye Research Australia, the Royal
Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
(Drs Lamoureux, Wang, and Wong); Department of Medicine, National University
Health System, Singapore (Dr Tai); Centre for Vision Research, Westmead
Millennium Institute, University of Sydney, Sydney, Australia (Dr Wang);
Department of Ophthalmology, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore (Dr Wong).

OBJECTIVE: To examine the prevalence of and factors associated with suboptimal
glycemic and blood pressure (BP) control in a Malay population with diabetes
mellitus in Singapore. METHODS: The Singapore Malay Eye Study was a
population-based survey of 3280 Malay individuals (78.7% response rate) aged 40
to 80 years. Diabetes was defined as a nonfasting glucose level of 200 mg/dL or
greater, use of diabetic medication, or physician diagnosis. Diabetic
retinopathy (DR) was graded from retinal photographs using the modified Airlie
House classification. Optimal control was defined as a hemoglobin A(1c) level of
less than 7% and BP of 130/80 mm Hg or lower. RESULTS: In participants with
diabetes (n = 768), only 26.9% had optimal glycemic and 13.4% optimal BP
control, respectively. In those with DR (n = 272), rates of optimal glycemic and
BP control were even lower (17.4% and 10.3%, respectively). After adjusting for
age, sex, socioeconomic status, and other factors, compared with participants
with optimal glycemic control, those with suboptimal control were younger (P =
.005), more likely to be unaware of their diabetes status (P < .001), and taking
medication for diabetes (P < .001) and had higher levels of total cholesterol (P
= .009) and DR (P < .001). After adjusting for similar risk factors, compared
with participants with optimal BP control, those with suboptimal BP control were
older (P = .006) and more likely to have higher total cholesterol levels (P =
.002), BMIs (P = .04), and DR (P = .02). CONCLUSIONS: In this Asian Malay
population with diabetes, more than three-quarters had poor glycemic and BP
control. Strategies to improve awareness and implement evidence-based guidelines
are needed to reduce the effect and burden of diabetic complications in
Asia.Published online July 12, 2010 (doi:10.1001/archophthalmol.2010.168).

PMID: 20625039  [PubMed - as supplied by publisher]