Journal Contents

Acta Ophthalmol Scand
Am Jour Ophthalmol
Arch Ophthalmol
Br J Ophthalmol
Can J Ophthalmol
J Cat Ref Surg
Curr Eye Res
Eur J Ophthalmol
J Glaucoma
Graefes Ophthalmol
Indian J Ophthalmol
Int Ophthalmol Clin
Invest Ophth Vis Sci
Jpn J Ophthalmol
Korean J Ophthal
J Neuroophthalmol
Ophthalmic Epidemiol
Ophthalmic Genet
Ophthal Plast Rec Surg
Ophthalmic Res
Surv Ophthalmol
Ophthalmology Review Journal
Eye[JOUR] Established 1995
1. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.134. [Epub ahead of print]

Reply to Alexander et al (Subconjunctival anaesthesia for intravitreal

Lyall DA, Tey A, Foot B, Roxburgh ST, Virdi M, Robertson C, Macewen CJ.

Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.

PMID: 23807389   [PubMed - as supplied by publisher]

2. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.124. [Epub ahead of print]

Are generic topical prostanoids the way forward in the care of glaucoma patients?
- Yes.

Titcomb LC.

Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust,
Birmingham, UK.

PMID: 23807388   [PubMed - as supplied by publisher]

3. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.129. [Epub ahead of print]

Are generic topical prostanoids the way forward in the care of glaucoma patients?
- No.

Dubois VD.

Aintree University Hospital NHS Foundation Trust, Longmore Lane, Liverpool,
Merseyside, UK.

PMID: 23807387   [PubMed - as supplied by publisher]

4. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.132. [Epub ahead of print]

Subconjunctival anaesthesia for intravitreal injections.

Alexander P, Sahu D, Lotery AJ.

1] Faculty of Medicine, University of Southampton, Southampton, UK [2] Department
of Ophthalmology, University Hospital Southampton, Southampton, UK.

PMID: 23807386   [PubMed - as supplied by publisher]

5. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.135. [Epub ahead of print]

Intra-lesional 5 fluorouracil for the management of recurrent pterygium.

Said DG, Faraj LA, Elalfy MS, Yeung A, Miri A, Fares U, Otri AM, Rahman I,
Maharajan S, Dua HS.

1] Department of Ophthalmology, Nottingham University Hospitals, University of
Nottingham, Nottingham, UK [2] Cornea and Ocular Surface Unit, Research Institute
of Ophthalmology, Cairo, Egypt.

AimRecurrence is the most common complication arising from pterygium surgery. The
aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in
halting the recurrence of pterygium after surgical excision.MethodsA
retrospective review of patients treated for pterygium recurrence was carried
out. Patients with recurrent (secondary) pterygium were treated with multiple
weekly intra-lesional injections of 0.1-0.2 ml (2.5-5 mg) 5FU post-operatively
depending on the size of the recurrence. The treatment was started within 1 month
from the date of recurrence. The time from surgery to start of recurrence,
previous treatment modalities, and number of recurrences were documented. The
number of injections required to induce arrest of progression and/or regression
of vascularity and fleshiness of the pterygium and any complications related to
5FU treatment were examined.ResultsFifteen eyes from 14 patients with recurrent
pterygium treated with intra-lesional 5FU injections were analysed. Three of the 
15 eyes had undergone a secondary excision and 12 had undergone a primary
excision. In all, 93.3% of patients showed regression of the fibrovascular tissue
(thickness and vascularity) and arrest of progression following a dose of
0.1-0.2 ml (2.5-5 mg) 5FU. Twelve eyes required three injections or fewer,
whereas one patient required eight injections. This beneficial effect was
maintained over an average follow-up period of 17 months. No complications from
5FU were observed.ConclusionThe use of weekly intra-lesional 5FU injections for
the treatment of recurrent pterygium is safe and effective in limiting the
progression and inducing the regression of recurrent pterygium. The number of
injections can be tailored according to clinical need.Eye advance online
publication, 28 June 2013; doi:10.1038/eye.2013.135.

PMID: 23807385   [PubMed - as supplied by publisher]

6. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.130. [Epub ahead of print]


Wallang BS, Das S.

Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar,

Keratoglobus is a rare noninflammatory corneal thinning disorder characterised by
generalised thinning and globular protrusion of the cornea. It was first
described as a separate clinical entity by Verrey in 1947. Both congenital and
acquired forms have been shown to occur, and may be associated with various other
ocular and systemic syndromes including the connective tissue disorders.
Similarities have been found with other noninflammatory thinning disorders like
keratoconus that has given rise to hypotheses about the aetiopathogenesis.
However, the exact genetics and pathogenesis are still unclear. Clinical
presentation is characterised by progressive diminution resulting from irregular 
corneal topography with increased corneal fragility due to extreme thinning.
Conservative and surgical management for visual rehabilitation and improved
tectonic stability have been described, but remains challenging. In the absence
of a definitive standard procedure for management of this disorder, various
surgical procedures have been attempted in order to overcome the difficulties.
This article reviews the aetiological factors, differential diagnosis,
histopathology, and management options of keratoglobus.Eye advance online
publication, 28 June 2013; doi:10.1038/eye.2013.130.

PMID: 23807384   [PubMed - as supplied by publisher]

7. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.113. [Epub ahead of print]

Interactive binocular treatment (I-BiT) for amblyopia: results of a pilot study
of 3D shutter glasses system.

Herbison N, Cobb S, Gregson R, Ash I, Eastgate R, Purdy J, Hepburn T, Mackeith D,
Foss A.

Nottingham University Hospitals NHS Trust, Nottingham, UK.

PurposeA computer-based interactive binocular treatment system (I-BiT) for
amblyopia has been developed, which utilises commercially available 3D 'shutter
glasses'. The purpose of this pilot study was to report the effect of treatment
on visual acuity (VA) in children with amblyopia.MethodsThirty minutes of I-BiT
treatment was given once weekly for 6 weeks. Treatment sessions consisted of
playing a computer game and watching a DVD through the I-BiT system. VA was
assessed at baseline, mid-treatment, at the end of treatment, and at 4 weeks post
treatment. Standard summary statistics and an exploratory one-way analysis of
variance (ANOVA) were performed.ResultsTen patients were enrolled with
strabismic, anisometropic, or mixed amblyopia. The mean age was 5.4 years. Nine
patients (90%) completed the full course of I-BiT treatment with a mean
improvement of 0.18 (SD=0.143). Six out of nine patients (67%) who completed the 
treatment showed a clinically significant improvement of 0.125 LogMAR units or
more at follow-up. The exploratory one-way ANOVA showed an overall effect over
time (F=7.95, P=0.01). No adverse effects were reported.ConclusionThis small,
uncontrolled study has shown VA gains with 3 hours of I-BiT treatment. Although
it is recognised that this pilot study had significant limitations-it was
unblinded, uncontrolled, and too small to permit formal statistical
analysis-these results suggest that further investigation of I-BiT treatment is
worthwhile.Eye advance online publication, 28 June 2013;

PMID: 23807383   [PubMed - as supplied by publisher]

8. Eye (Lond). 2013 Jun 28. doi: 10.1038/eye.2013.140. [Epub ahead of print]

Posterior lens nucleus displacement following intravitreal injection.

Felcida V, Habal S, Tyagi AK.

Department of Vitreoretinal Surgery, Birmingham & Midland Eye Centre, Birmingham,

PMID: 23807382   [PubMed - as supplied by publisher]

9. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.133. [Epub ahead of print]

Mechanical testing of lid speculae and relationship to postoperative ptosis.

Crosby NJ, Shepherd D, Murray A.

Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK.

AimsPostoperative lid malpositions are known complications of routine intraocular
surgery and were previously attributed to the use of a bridle suture or the
myotoxic effect of retrobulbar or peribulbar anaesthetics. However, lid
malpositions are still seen under topical anaesthesia. Recent studies have
implicated the lid speculum as a factor. Patients with narrower vertical
palpebral apertures have been shown to develop postoperative ptosis more
frequently, but the reason is unknown. This is the first study to determine the
forces exerted by lid speculae over a range of palpebral
apertures.MethodsMechanical testing was undertaken using a Bose 3200 materials
testing machine. Tests were undertaken on four disposable and four reusable
speculae. The force used to compress each speculum was compared over a range of
displacements. A two-sample t-test was used to compare the stiffness of the two
types of speculum.ResultsThe stiffness of the reusable speculum was significantly
greater than the disposable speculum (P=0.002). The stiffness of each speculum
was greatest at the range of displacement corresponding to the narrower palpebral
apertures.ConclusionsDifferent speculae exert significantly different forces on
patients' eyelids during surgery. The patients who experience the greatest
compression from the speculae are those with the smallest palpebral apertures.
This may explain why these patients are more likely to develop postoperative lid 
malpositions.Eye advance online publication, 21 June 2013;

PMID: 23788211   [PubMed - as supplied by publisher]

10. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.121. [Epub ahead of print]

Imaging retinochoroidal anastomosis via spectral-domain optical coherence

Pilli S, O'Brien C, Lotery AJ.

Department of Ophthalmology, University Hospital Southampton NHS Foundation
Trust, Southampton, UK.

PMID: 23788210   [PubMed - as supplied by publisher]

11. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.138. [Epub ahead of print]

Congenital ptosis associated with combined superior rectus, lateral rectus, and
levator palpebrae synkinesis: the first reported case.

Chalvatzis NT, Tzamalis AK, Ziakas N, Kalantzis G, Dimitrakos SA, Harrad RA.

1] Second Department of Ophthalmology, Aristotle University of Thessaloniki,
Thessaloniki, Greece [2] Bristol Eye Hospital, Bristol, UK.

PMID: 23788209   [PubMed - as supplied by publisher]

12. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.141. [Epub ahead of print]

Are Do-It-Yourself companies setting a good example? A systematic study of ocular
protection on the Internet.

Rufai SR, Alexander P, Lash SC.

Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.

PMID: 23788208   [PubMed - as supplied by publisher]

13. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.136. [Epub ahead of print]

Characteristics of rhegmatogenous retinal detachment and their relationship to
visual outcome.

Williamson TH, Shunmugam M, Rodrigues I, Dogramaci M, Lee E.

Department of Ophthalmology, St Thomas' Hospital, London, UK.

AimsTo examine pre-operative characteristics of rhegmatogenous retinal detachment
(RRD) and their relationship to visual acuity (VA) following
surgery.MethodsReview of prospectively completed electronic database. Baseline
characteristics, retinal drawings and outcomes were analysed.ResultsIn all, 847
eyes from 847 patients with a mean age of 62.2 years, 60% males, and 56% right
eyes were studied. Mean follow-up was 9.6 months. Preoperative VA correlated with
final VA (r(2)=0.21, P<0.0001). Median postoperative VA was 6/9 (Logmar 0.18,
quartiles=0.0-0.48) and was significantly related to anatomical success: 70.15%
achieved 0.18 or better with fully attached retina and primary success, whereas
only 8.33% achieved this when the retina was not fully attached at final
follow-up (failure) (P<0.0001). Univariate analysis found multiple variables
associated with achieving 0.18 postoperative vision, however, multivariate
analysis revealed only primary anatomical success with surgery; absence of
proliferative vitreo-retinopathy (PVR), better-presenting VA and fewer quadrants 
of detachment were associated with a better visual outcome (r(2)=0.26, P<0.0001).
Patients with a clinically attached fovea achieved better vision than patients
with a clinically detached fovea, independent of the visual loss duration. With
foveal detachment however, postoperative VA was better in patients with 1-3 days 
of visual loss compared with 4-6 days (P=0.013).ConclusionsFailure of primary
surgery, PVR, extensive RRD and poor-presenting VA are risk factors for poorer
visual outcome following surgery for RRD. Fovea off RRD at presentation achieved 
poorer postoperative VA than fovea attached and visual outcome was poorer when
there was a longer duration of visual symptoms.Eye advance online publication, 21
June 2013; doi:10.1038/eye.2013.136.

PMID: 23788207   [PubMed - as supplied by publisher]

14. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.131. [Epub ahead of print]

Dermal and conjunctival melanocytic proliferations in diffuse uveal melanocytic

Pulido JS, Flotte TJ, Raja H, Miles S, Winters JL, Niles R, Jaben EA, Markovic
SN, Davies J, Kalli KR, Vile RG, Garcia JJ, Salomao DR.

Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.

AimThe goal of this case report is to describe the dermatologic and conjunctival 
findings in a case of bilateral diffuse uveal melanocytic proliferation (BDUMP), 
a paraneoplastic syndrome usually associated with gynecologic cancers. There is
little information about other dermatologic melanocytic findings in these
patients.MethodsHistologic and fluorescent in situ hybridization (FISH) analysis 
of three separate skin biopsies, one of which was separated by 21 months from the
others, were performed in a 71-year-old patient with BDUMP to assess for
histologic and chromosomal abnormality. Conjunctival histologic evaluation was
also done.ResultsDermal melanocytic proliferation was seen in each specimen. The 
cells were spindle type with mitotic activity. FISH analysis showed a normal copy
of chromosomes. The conjunctival sample also showed normal FISH
analysis.ConclusionBDUMP is associated with multifocal dermal and conjunctival
melanocytic proliferation.Eye advance online publication, 21 June 2013;

PMID: 23788206   [PubMed - as supplied by publisher]

15. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.139. [Epub ahead of print]

Quality of bevacizumab compounded for intravitreal administration.

Palmer JM, Amoaku WM, Kamali F.

Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.

AimTo compare the quality and stability of unlicensed, repackaged bevacizumab
intended for intravitreal injection, as provided by five licensed compounding
pharmacies in the United Kingdom, with bevacizumab in its original glass
vial.MethodsRepackaged bevacizumab was obtained from five UK suppliers. Samples
were analyzed at two time points (day 1 and day 14). Microflow imaging was
performed to evaluate subvisible particle size, particle density, and particle
size distribution. Protein concentration, immunoglobulin G (IgG) content, and
molecular weight were also determined.ResultsA significant difference in
subvisible particle density was observed between bevacizumab batches from the
five suppliers on day 1 (P<0.001). An increase in subvisible particle density was
observed between day 1 and 14 for repackaged bevacizumab from all suppliers (all 
P<0.05), but not the reference compound. Protein concentration, IgG content, and 
molecular weight were comparable between batches from each supplier and the
reference bevacizumab.DiscussionThe study results indicate that the quality of
bevacizumab repackaged into prefilled plastic syringes is variable among the
different compounding pharmacies in the United Kingdom. Furthermore, particle
density may increase with storage in repackaged syringes. It is noteworthy that
particle size distribution in both the repackaged and reference bevacizumab fell 
outside of the range specified by the United States Pharmacopeia for injectable
ophthalmic solutions. These data highlight the need for further research into the
use of unlicensed, repackaged bevacizumab intended for intravitreal injection.Eye
advance online publication, 21 June 2013; doi:10.1038/eye.2013.139.

PMID: 23788205   [PubMed - as supplied by publisher]

16. Eye (Lond). 2013 Jun 21. doi: 10.1038/eye.2013.127. [Epub ahead of print]

The biometric study in different stages of primary angle-closure glaucoma.

Chen YY, Chen YY, Sheu SJ, Chou P.

1] Department of Public Health and Institute of Public Health, National Yang-Ming
University, Taipei, Taiwan [2] Department of Ophthalmology, Madou Sin-Lau
Hospital, Tainan County, Taiwan.

PurposeThis study compared the general and ocular biometric characteristics of
normal, primary angle closure (PAC), and primary angle-closure glaucoma (PACG)
patients to better understand the possible relationship between differences in
ocular parameters that might predict risk for PACG in PAC patients.MethodsOne
hundred normal, 90 PAC, and 90 PACG eyes were retrospectively reviewed. General
characteristics such as age, gender, body height, body weight, blood pressure,
pulse, systemic diseases, and education level were recorded. Ocular findings
included visual acuity, intraocular pressure, refraction, cup to disc ratio, and 
ocular biometry. Ocular biometry was obtained by A-scan ultrasonography (Digital 
A/B scan 5500; Sonomed Inc., Lake Success, NY, USA). The parameters recorded were
anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens/axial
length factor (LAF), and relative lens position (RLP).ResultsAlthough the
controls, PAC group, and PACG group were found to be significantly different in
age (62.7±9.8; 65.3±7.5; and 66.0±7.4, respectively), there were no gender
differences. With regard to ocular parameters, the ACD tended to decrease and the
LT and LAF tended to increase from normal to PAC to PACG. The eyes of the PACG
group had significantly shallower ACD (P<0.001) and thicker lens (P<0.001) than
those of the PAC group. While PAC had similar lens position to the control group,
PACG had more anteriorly positioned lens than the PAC group (P<0.001). Logistic
regression analysis found a significant association between a decrease in ACD and
increased risk of PACG (odds ratio (OR)=3.59 for 0.2 mm decrease in ACD) as well 
as a significant association between an increase in LT and increased risk of PACG
(OR=1.30).ConclusionsIn addition to LT, a shallower ACD owing to a change in RLP 
may have a role in the progression from PAC to PACG. Owing to the differences of 
certain biometric characteristics between PAC and PACG, A-scan ultrasonography
might potentially be used for the early detection of PACG in PAC eyes.Eye advance
online publication, 21 June 2013; doi:10.1038/eye.2013.127.

PMID: 23788204   [PubMed - as supplied by publisher]

17. Eye (Lond). 2013 Jun 14. doi: 10.1038/eye.2013.128. [Epub ahead of print]

Alternative methods for the screening of retinopathy of prematurity: binocular
indirect ophthalmoscopy vs wide-field digital retinal imaging.

Sekeroglu MA, Hekimoglu E, Sekeroglu HT, Arslan U.

ROP Screening, Treatment and Training Center, Department of Ophthalmology, Etlik 
Zubeyde Hanim Maternity and Women's Health Research Hospital, Ankara, Turkey.

PurposeTo compare the diagnostic efficacy of wide-field digital retinal imaging
(WFDRI) with binocular indirect ophthalmoscopy (BIO) for retinopathy of
prematurity (ROP) screening.MethodsPremature infants admitted for ROP screening
were included in this prospective, randomized and double-blind comparative study.
They were examined by using BIO and WFDRI.ResultsA total of 58 infants were
enrolled in the study. The sensitivities of WFDRI in detecting any stage of ROP, 
treatment-requiring ROP and plus disease were 58.6, 100, and 100% respectively,
with a specificity of 100% for all. The proportional agreement between WFDRI and 
BIO was 0.903 for detection of any stage of ROP, 1.0 for treatment-requiring ROP,
and 1.0 for plus disease.ConclusionThe sensitivity and specificity of WFDRI was
excellent for the diagnosis of severe and treatment-requiring ROP. However, BIO
was superior in mild ROP particularly for the ones in retinal periphery.Eye
advance online publication, 14 June 2013; doi:10.1038/eye.2013.128.

PMID: 23764991   [PubMed - as supplied by publisher]

18. Eye (Lond). 2013 Jun 14. doi: 10.1038/eye.2013.112. [Epub ahead of print]

Microperimetric sensitivity in patients on hydroxychloroquine (Plaquenil)

Jivrajka RV, Genead MA, McAnany JJ, Chow CC, Mieler WF.

Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, 
Chicago, IL, USA.

PurposeThe purpose of this study was to measure macular sensitivity using
microperimetry in patients on Plaquenil therapy without evidence of retinopathy
as assessed by recommended screening standards.MethodsSixteen patients from a
clinical practice treated with 200 or 400 mg/day of Plaquenil for more than 5
years, without visual complaints (visual acuity 20/25 or better), and without a
history of diabetes or macular disease were included. Participants underwent a
complete ophthalmic examination with spectral-domain optical coherence tomography
(SD-OCT), 10-2 Humphrey visual field (HVF), fundus autofluoresecene (FAF),
multifocal electroretinography (mfERG), and microperimetry that covered the
central 12° of the visual field. Ten age-similar, visually normal subjects served
as controls.ResultsThe average age of the study cohort was of 54.5 years, with an
average daily Plaquenil dose of 4.00 mg/kg/day (range, 1.77-6.67 mg/kg/day) and
an average cumulative dose of 1485 g (range, 256-3650 g). All patients had normal
ocular exams, and no evidence of retinopathy based on 10-2 HVF, FAF, mfERG, and
SD-OCT. The mean retinal sensitivity by microperimetry was 15.0 dB (OD) and
14.6 dB (OS). The overall mean microperimetry sensitivity of the patients
(14.7±1.9 dB) was significantly lower (P<0.001) than that of the controls
(16.5±2.1 dB).ConclusionsPatients on Plaquenil without clinical evidence of
retinal toxicity can have reduced retinal sensitivity, as assessed by
microperimetry. The mean sensitivity difference between the patients and controls
suggests that microperimetry can provide important information regarding visual
function in patients on Plaquenil therapy.Eye advance online publication, 14 June
2013; doi:10.1038/eye.2013.112.

PMID: 23764990   [PubMed - as supplied by publisher]

19. Eye (Lond). 2013 Jun 14. doi: 10.1038/eye.2013.95. [Epub ahead of print]

Late in-the-bag intraocular lens dislocation requiring explantation: risk factors
and outcomes.

Fernández-Buenaga R, Alio JL, Pérez-Ardoy AL, Larrosa-Quesada A, Pinilla-Cortés
L, Barraquer R, Alio JL 2nd, Muñoz-Negrete FJ.

Vissum Corporation, Alicante, Spain.

PurposeTo study the predisposing factors for late in-the-bag intraocular lens
(IOL) dislocation and to analyze the outcomes after explantation
surgery.MethodsIn this retrospective multicentre study, 61 eyes were enrolled.
The main inclusion criterion was in-the-bag spontaneous IOL dislocation after
uneventful phacoemulsification cataract extraction. Only eyes with serious
dislocation that required IOL explantation were eligible. Follow-up after
explantation surgery of at least 3 months was required. Exclusion criteria were
complicated cataract surgery, out-of-the-bag IOL dislocation, and dislocations
that occurred in the first year after the cataract surgery. The main outcome
measures were predisposing factors for dislocation, interval between cataract
surgery and dislocation, surgical treatment at the time of explantation,
preoperative and postoperative corrected distance visual acuity (CDVA), and
postoperative complications.ResultsHigh myopia was detected in 12 cases (19.7%)
and it was the main predisposing factor. Mean time interval from cataract surgery
to dislocation was 7.5 (SD 5.2) years. The dislocated in-the-bag IOL was replaced
with a scleral fixated IOL (36.1%), angle-supported anterior chamber IOL (31.1%),
sulcus repositioning (18%), or posterior chamber iris sutured IOL (4.9%).
Finally, 9.8% of the patients were left aphakic. Mean CDVA improved significantly
after surgery (P=0.005). Final CDVA of 20/40 or better was achieved in 29 cases
(47.5%).ConclusionsHigh myopia was the main risk factor for late in-the-bag IOL
dislocation. Surgical treatment significantly improved the CDVA in our sample and
was associated with a low complication rate.Eye advance online publication, 14
June 2013; doi:10.1038/eye.2013.95.

PMID: 23764989   [PubMed - as supplied by publisher]

20. Eye (Lond). 2013 Jun 14. doi: 10.1038/eye.2013.106. [Epub ahead of print]

Ocular perfusion pressure and choroidal thickness in eyes with polypoidal
choroidal vasculopathy, wet-age-related macular degeneration, and normals.

Rishi P, Rishi E, Mathur G, Raval V.

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India.

PurposeTo measure the choroidal thickness and ocular perfusion pressure in eyes
with polypoidal choroidal vasculopathy (PCV), wet-age-related macular
degeneration (AMD), and age-matched normal subjects, and look for a possible
association between the two.MethodsThis was a prospective study including 22 eyes
with PCV, 33 eyes with wet-AMD, and 35 age-matched normal eyes. Choroidal
thickness was measured using enhanced depth imaging (EDI) with spectral-domain
optical coherence tomography (SD OCT). Mean ocular perfusion pressure (MOPP) was 
calculated using the mathematical formula 2/3[DBP+1/3{SBP × DBP}]-IOP
(DBP-diastolic blood pressure, SBP-systolic blood pressure, IOP-intraocular
pressure). Analyses were carried out using SPSS 14 software and comparisons of
mean made using't' tests.ResultsEyes with PCV showed increased (285.9 μm;
subfoveal) choroidal thickness, whereas eyes with wet-AMD (119.4 μm; subfoveal)
showed reduced choroidal thickness in comparison with normal eyes (186.77 μm;
subfoveal). MOPP in the PCV group was 57.85 mm Hg (P value 0.00), in the wet-AMD 
group was 52.1 mm Hg (P-value 0.12), and in the normal group was
49.79 mm Hg.ConclusionIt is postulated that higher MOPP in eyes with PCV could
have an etiologic implication in disease manifestation and progression. Larger
studies with longer follow-up may help validate these findings.Eye advance online
publication, 14 June 2013; doi:10.1038/eye.2013.106.

PMID: 23764988   [PubMed - as supplied by publisher]

21. Eye (Lond). 2013 Jun;27(6):786. doi: 10.1038/eye.2013.84.

Ranibizumab for the treatment of choroidal neovascularisation secondary to
pathological myopia: interim analysis of the REPAIR study.

Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George
S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C,
Osborne A.

PMCID: PMC3682371
PMID: 23759680   [PubMed - in process]

22. Eye (Lond). 2013 Jun;27(6):685-7. doi: 10.1038/eye.2013.65.

The NHS Act of 1951; Is it time to re-act?

Ratnarajan G, Wormald R, Astbury N.

1] Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin
University, Cambridge, UK [2] UCL Institute of Ophthalmology, London, UK.

PMCID: PMC3682370 [Available on 2014/6/1]
PMID: 23759679   [PubMed - in process]

23. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.93. [Epub ahead of print]

Is it necessary to use three mandatory loading doses when commencing therapy for 
neovascular age-related macular degeneration using bevacizumab? (BeMOc Trial).

Menon G, Chandran M, Sivaprasad S, Chavan R, Narendran N, Yang Y.

Frimley Park NHS Foundation Trust, Frimley, UK.

PurposeTo determine whether a Pro Re Nata (PRN) regimen with three initial
mandatory loading doses results in better functional and anatomical outcome
compared with a PRN regimen without initial loading when using intravitreal
bevacizumab in patients with minimal classic or occult choroidal
neovascularisation secondary to age-related macular degeneration.MethodsPatients 
were randomised (1 : 1) to Loading (LD group) or No Loading (NLD group) and
treated with open label intravitreal bevacizumab. In the LD group, patients
received two mandatory doses after the baseline dose before entering the PRN
phase and in the NLD group, patients did not receive mandatory doses after the
baseline dose. Six-weekly evaluations were performed up to week 54 and
retreatment was done based on OCT criteria. Visual stability and reduction in
central retinal thickness were compared between groups.Results49 patients were in
the NLD group and 50 patients were in the LD group. At the 12-month end point,
84% of the patients in the LD group achieved visual stability (<15 letter loss)
compared with 67% of the patients in the NLD group (P<0.05). The mean reduction
in central macular thickness was 105.35 μm in the LD group and 81.45 μm in the
NLD group (P>0.05). There was no significant difference in scores of VFQ-25
questionnaire testing between the two groups and no serious ocular or systemic
side effects were observed.ConclusionThe results supported our hypothesis that a 
loading dose leads to slightly better visual stability in terms of proportions of
patients experiencing moderate visual loss, but did not support the hypothesised 
difference in anatomical outcome.Eye advance online publication, 7 June 2013;

PMID: 23743535   [PubMed - as supplied by publisher]

24. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.110. [Epub ahead of print]

Kyrieleis plaques in herpes zoster virus-associated acute retinal necrosis: a
case report.

Empeslidis T, Konidaris V, Brent A, Vardarinos A, Deane J.

Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester,

PMID: 23743534   [PubMed - as supplied by publisher]

25. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.116. [Epub ahead of print]

Changes in choroidal thickness, axial length, and ocular perfusion pressure
accompanying successful glaucoma filtration surgery.

Kara N, Baz O, Altan C, Satana B, Kurt T, Demirok A.

Department of Ophthalmology, Sehitkamil State Hospital, Gaziantep, Turkey.

PurposeTo investigate the changes in choroidal thickness (CT), axial length (AL),
and ocular perfusion pressure (OPP) accompanying intraocular pressure (IOP)
reduction after trabeculectomy.MethodsThirty-nine eyes of 39 patients with
primary open-angle glaucoma uncontrolled by medical therapy were included in this
prospective and interventional study. All patients underwent a fornix-based
trabeculectomy. The CT was measured by enhanced depth imaging-optical coherence
tomography. IOP, AL, and systolic/diastolic blood pressure were also measured,
and OPP was calculated. All measurements were performed at baseline and 1 month
after surgery.ResultsThe mean IOP was 25.0±5.8 mm Hg at baseline and
11.7±2.6 mm Hg after trabeculectomy (P<0.001), and the mean subfoveal CT was
295±84 mm Hg at baseline and 331±82 mm Hg after trabeculectomy (P<0.001). The
mean AL was 23.64±0.98 mm at baseline and 23.54±0.96 mm after trabeculectomy
(P<0.001), whereas the mean OPP was 38.8±6.2 mm Hg preoperatively, and
51.1±7.3 mm Hg postoperatively (P<0.001). The change in CT negatively correlated 
with the change in IOP (r=-0.785, P<0.001) and AL (r=-0.693, P<0.001), whereas it
positively correlated with the change in OPP (r=0.418, P=0.008).ConclusionThese
results suggest that the large IOP decrease following trabeculectomy causes
choroidal thickening. In addition, CT changes are associated with IOP and AL
reduction as well as OPP increase.Eye advance online publication, 7 June 2013;

PMID: 23743533   [PubMed - as supplied by publisher]

26. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.114. [Epub ahead of print]

Two-year results of intravitreal ranibizumab for polypoidal choroidal
vasculopathy with recurrent or residual exudation.

Saito M, Iida T, Kano M, Itagaki K.

Department of Ophthalmology, Fukushima Medical University School of Medicine,
Fukushima, Japan.

AimTo clarify the 2-year efficacy of ranibizumab for patients with polypoidal
choroidal vasculopathy (PCV) with recurrent or residual exudation from branching 
vascular networks after previous photodynamic therapy (PDT).MethodsWe
retrospectively reviewed 26 eyes of 26 Japanese patients (22 men, 4 women) in
this pilot study. All eyes had PCV with complete regression of polypoidal lesions
resulting from PDT detected by indocyanine green angiography (ICGA), but
recurrent or residual leakage from branching vascular networks on fluorescein
angiography and evidence of persistent fluid on optical coherence tomography
(OCT). Three consecutive intravitreal injections of ranibizumab (0.5 mg/0.05 ml) 
were administered to all eyes.ResultsThe mean logarithm of the minimum angle of
resolution best-corrected visual acuity (BCVA) improved significantly from 0.55
at baseline to 0.35 at 12 months (P<0.0001) and 0.43 at 24 months (P=0.0012). The
mean increases in the BCVA 12 and 24 months after baseline were 1.95 and 1.23
lines, respectively. The mean central retinal thickness significantly decreased
from 295 μm at baseline to 189 μm at 12 months (P<0.0038) and 163 μm at 24 months
(P<0.001). The mean numbers of intravitreal ranibizumab (IVR) injections at
months 12 and 24, including the initial treatments, were 5.8 and 8.8,
respectively. Five (19.2%) eyes had recurrent polypoidal lesions on ICGA at a
mean of 15.7 months after baseline. At month 24, OCT showed no exudation in 17
(65.4%) of the 26 eyes. No adverse events developed.ConclusionsIVR injections
maintained or improved the VA and retinal thickness at 24 months in eyes with PCV
with recurrent or residual exudation from branching vascular networks after
previous PDT.Eye advance online publication, 7 June 2013;

PMID: 23743532   [PubMed - as supplied by publisher]

27. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.117. [Epub ahead of print]

Partial posterior hyaloidectomy for macular disorders.

Kim JH, Kang SW, Kim YT, Kim SJ, Chung SE.

Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research
Institute, Konyang University College of Medicine, Seoul, Korea.

PurposeTo evaluate the effect of partial posterior hyaloidectomy (PPH) in
preventing iatrogenic retinal breaks related to the induction of a posterior
vitreous detachment (IPVD)MethodsFifty-nine patients who necessitated IPVD for an
epiretinal membrane or macular hole were included in this prospective,
interventional case series. Extensive removal of vitreous gel, close to the
retina, was conducted before IPVD under 23 G (gauge)-vitrectomy system. The PPH
involved the limited extent of IPVD and limited removal of the outermost vitreous
cortex to an area slightly beyond the margin of the temporal major vascular
arcade. The incidence of retinal breaks related to the surgery was compared with 
57 eyes that had undergone conventional 23-G total vitrectomy accompanied by
extensive IPVD using χ(2)-test.ResultsPatients were followed-up for a mean of
14.3 months (6-30 months) after the surgery. The incidence of peripheral retinal 
breaks after the PPH was 3.4% (2/59 eyes), which was significantly lower than
that in the eyes that underwent conventional 23 G vitrectomy (15.8%, 9/57 eyes,
P=0.023) for the same disorders that required an IPVD. No patient complained of
postoperative floaters, postoperatively.ConclusionsPPH would be an efficient
procedure to prevent iatrogenic peripheral retinal breaks related to an IPVD.Eye 
advance online publication, 7 June 2013; doi:10.1038/eye.2013.117.

PMID: 23743531   [PubMed - as supplied by publisher]

28. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.118. [Epub ahead of print]

23- vs 20-gauge pars plana vitrectomy in combination with bimanual
microincisional cataract surgery (b-MICS) for the treatment of macular hole and
cataract as a one-step procedure.

Schönfeld CL.

Augenklinik Herzog Carl Theodor, München, Germany.

Background/aims23-gauge pars plana vitrectomy (ppv) is a new method for
vitreo-retinal surgery. It may reduce operation time, the risk of complications, 
and patient discomfort, especially in combination with simultaneous bimanual
microincisional cataract surgery (b-MICS).MethodsSeventy-five consecutive
patients who underwent combined cataract surgery and ppv at our center between 1 
January 2008 and 31 December 2010 were included. The first 36 patients were
treated with 20-gauge ppv, the following 39 patients with 23-gauge ppv. Study end
points 8 weeks after surgery were duration of the procedure, improvement of
visual acuity, and occurrence of complications.ResultsDuration of surgery was
reduced in 23- vs 20-gauge ppv (54.0±11.6 vs 61.0±19.0 min, P=0.08). Visual
acuity improved significantly in both the groups (20-gauge: logMAR 0.750±0.304
before and 0.369±0.273 after surgery; 23-gauge: logMAR 0.663±0.340 before and
0.339±0.273 after surgery). There were no appreciable group differences in
baseline or post-treatment visual acuity.Conclusions23-gauge ppv in combination
with b-MICS is a suitable, safe, and effective method for the treatment of
combined cataract and vitreo-retinal diseases. The procedure is somewhat shorter 
and patient discomfort during and after surgery is improved. In terms of efficacy
and safety, 23-gauge ppv is equivalent with conventional 20-gauge ppv.Eye advance
online publication, 7 June 2013; doi:10.1038/eye.2013.118.

PMID: 23743530   [PubMed - as supplied by publisher]

29. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.125. [Epub ahead of print]

What makes a good operation great? Factors determining patient satisfaction with 
local anaesthesia in cataract surgery.

Kim MJ, Jain S.

Deparment of Ophthalmology, Barnet and Chase Farm Hospitals, Hertfordshire, UK.

PMID: 23743529   [PubMed - as supplied by publisher]

30. Eye (Lond). 2013 Jun 7. doi: 10.1038/eye.2013.115. [Epub ahead of print]

Post-brachytherapy tumor endoresection for treatment of toxic maculopathy in
choroidal melanoma.

McCannel TA.

Department of Ophthalmology, The Jules Stein Eye Institute, University of
California, Los Angeles, Los Angeles, CA, USA.

PurposeToxic tumor syndrome may occur when the irradiated choroidal melanoma
releases cytokines, by exudation from irradiated ischemic tissue. We report our
experience and outcomes in a series of post-brachytherapy tumor endoresection to 
mediate radiation complications.MethodsPatients who underwent endoresection of a 
choroidal melanoma treated with iodine-125 plaque brachytherapy were evaluated.
Baseline patient and tumor parameters were tabulated.ResultsFive patients
underwent post-brachytherapy tumor endoresection with intraocular gas or silicone
oil tamponade. Three of the five patients underwent concomitant
phacoemulsification with intraocular lens placement. Initial tumor height ranged 
from 2.03-8.91 mm (mean 5.81 mm). Time between brachytherapy and endoresection
ranged from 13-62 months (mean 26.8 months), and total follow-up time from
brachytherapy ranged from 2.5-9.75 years (mean 5.2 years). Vision
post-brachytherapy and pre-endoresection ranged from 20/30 to 20/400. Final
visual acuity ranged from 20/70 to no light perception. One patient developed
neovascular glaucoma. Radiation maculopathy increased in all patients. One
patient developed metastasis at last follow-up. No patient developed exudative
retinal detachment, none had local treatment failure, and none required
enucleation.ConclusionAlthough tumor endoresection post-brachytherapy is a
technically feasible procedure, all patients in our series experienced
progressive radiation maculopathy with gradual visual decline.Eye advance online 
publication, 7 June 2013; doi:10.1038/eye.2013.115.

PMID: 23743528   [PubMed - as supplied by publisher]