1: Ophthalmology. 2008 May 8; [Epub ahead of print] 

Anterior Chamber Depth in Elderly Chinese The Liwan Eye Study.

He M, Huang W, Zheng Y, Alsbirk PH, Foster PJ.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen
University, Guangzhou, China; University College London Institute of
Ophthalmology, London, United Kingdom.

PURPOSE: To assess the anterior chamber depth (ACD) and its variation with age,
gender, and angle width in elderly Chinese in an urban area of southern China.
DESIGN: Cross-sectional study. PARTICIPANTS: Adults 50 and older were identified
using cluster random sampling in Liwan District, Guangzhou. METHODS: Gonioscopy
was performed before ACD measurements to estimate the geometric angle width
according to the Shaffer system. ACD was measured using optical pachymetry. True
ACD was calculated by subtracting central corneal thickness from the distance
between the anterior corneal epithelium and the anterior lens capsule. Data were
presented for the right phakic eyes. MAIN OUTCOME MEASURES: Anterior chamber
depth and gonioscopy. RESULTS: Among 1405 participants in the study, data from
1248 right eyes were available for analysis. The mean ACD values for men and
women were 2.59 mm (95% confidence interval [CI], 2.56-2.62; 25th-75th
percentile, 2.37-2.82) and 2.42 mm (95% CI, 2.39-2.44; 25th-75th percentile,
2.21-2.63). Mean ACD declined by 0.09 mm (95% CI, -0.011 to -0.008) per decade
(adjusted for gender) and was 0.18 mm (95% CI, -0.213 to -0.141) shallower in
women than men (adjusted for age). The ACD was found to be monotonically
associated with gonioscopic angle width, decreasing from 2.73 mm (standard
deviation [SD], 0.26) in Shaffer grade 4 to 1.94 mm (SD, 0.27) in Shaffer grade
0. There was also a relationship between ACD and refractive error; mean
spherical equivalent decreased by 0.030 mm ACD per diopter. CONCLUSIONS: This
study confirms an inverse association between ACD and age, female gender, and
spherical refractive error. Eyes with shallower ACDs had narrower angles.

PMID: 18471885 [PubMed - as supplied by publisher]

2: BMC Ophthalmol. 2008 May 6;8(1):8 [Epub ahead of print] 

Rotational stability of the AcrySof SA60TT toric intraocular lenses: a cohort
study.

Zuberbuhler B, Signer T, Gale R, Haefliger E.

ABSTRACT: BACKGROUND: To evaluate the rotational stability of the three types of
AcrySof SA60TT toric intraocular lenses (Alcon, Switzerland) in cataract surgery
after the first postoperative week. METHODS: A retrospective study of 44 eyes in
33 patients. All patients underwent similar uncomplicated phacoemulsification
cataract surgery. Seven eyes with corneal astigmatism of less than 1.5 D were
implanted with the AcrySof SA60T3 intraocular lens. Seventeen eyes with
astigmatism between 1.5 D and 2.25 D received the SA60T4 intraocular lens, and
20 eyes with more than 2.25 D of corneal astigmatism received the SA60T5
intraocular lens. Intraoperatively, the axis of the toric lens was aligned to
the steepest axis of the corneal astigmatism. Main outcome measure was the
postoperative position of the lens, assessed at 1 week and 3 months, using a
specially designed angle measuring eyepiece for the slit lamp. RESULTS: There
was no significant difference in the rotational stability of the three types of
toric intraocular lenses. Overall, the postoperative rotation was within 5
degrees in 95% and within 2 degrees in 68% of eyes. The mean absolute rotation
was 2.2 +/- 2.2 degrees. No lens showed more than 9 degrees of rotation, and no
lens required secondary repositioning. There was no trend for either clockwise
or anti-clockwise rotation. The surgical procedure did not change the corneal
astigmatism. CONCLUSIONS: Once placed to it\'s position, each of the three types
of the AcrySof SA60TT toric intraocular lenses demonstrate rotational stability
in the capsular bag.

PMID: 18460196 [PubMed - as supplied by publisher]

3: Ophthalmology. 2008 May 2; [Epub ahead of print] 

Telemedical Diagnosis of Retinopathy of Prematurity Intraphysician Agreement
between Ophthalmoscopic Examination and Image-Based Interpretation.

Scott KE, Kim DY, Wang L, Kane SA, Coki O, Starren J, Flynn JT, Chiang MF.

Division of Neonatology, Columbia University College of Physicians and Surgeons,
New York, New York.

OBJECTIVE: To evaluate the intraphysician agreement between ophthalmoscopic
examination and image-based telemedical interpretation for retinopathy of
prematurity (ROP) diagnosis, when performed by the same expert physician grader.
DESIGN: Prospective, nonrandomized, comparative study. PARTICIPANTS: Sixty-seven
consecutive premature infants who underwent ROP examination at a major
university medical center whose parents consented for participation. METHODS:
Infants underwent standard dilated ophthalmoscopy by one of two pediatric
ophthalmologists, followed by retinal imaging with a commercially available
wide-angle fundus camera by a trained neonatal nurse. Study examinations were
performed at 31 to 33 weeks postmenstrual age (PMA) and/or 35 to 37 weeks PMA.
Images were uploaded to a Web-based telemedicine system developed by the
authors. After a 4- to 12-month period, telemedical interpretations were
performed in which each physician graded images from infants upon whom he had
initially performed ophthalmoscopic examinations. Diagnoses were classified
using an ordinal scale: no ROP, mild ROP, type 2 prethreshold ROP, and
treatment-requiring ROP. MAIN OUTCOME MEASURES: Absolute intraphysician
agreement and kappa statistic between ophthalmoscopic examination and
telemedical interpretation were calculated by eye. All intraphysician
discrepancies were reviewed, and underlying causes were classified by eye as no
ROP identified by ophthalmoscopic examination, no ROP identified by telemedical
interpretation, discrepancy about presence of zone 1 ROP, discrepancy about
presence of plus disease, or other discrepancy in classification of ROP stage.
RESULTS: Absolute intraphysician agreement between ophthalmoscopic examination
and telemedical interpretation was 86.3%. The kappa statistic for intraphysician
agreement between examinations ranged from 0.657 (substantial agreement) for
diagnosis of treatment-requiring ROP to 0.854 (near-perfect agreement) for
diagnosis of mild or worse ROP. Among 206 eye examinations (103 infant
examinations), there were 28 (13.6%) intraphysician discrepancies in diagnosis,
8 of which resulted from uncertainty about presence of zone 1 disease and 4 from
uncertainty about presence of plus disease. CONCLUSIONS: Intraphysician
agreement between ophthalmoscopic examination and telemedical interpretation for
ROP was very high. Neither examination modality appeared to have a systematic
tendency to overdiagnose or underdiagnose ROP. Diagnosis of zone 1 disease and
plus disease were major sources of clinically significant discrepancies.

PMID: 18456337 [PubMed - as supplied by publisher]

4: Ophthalmology. 2008 May 1; [Epub ahead of print] 

Merkel Cell Carcinoma.

Holak N, Holak H.

Salzgitter, Germany.

Publication Types:
    LETTER

PMID: 18455238 [PubMed - as supplied by publisher]

5: Ophthalmology. 2008 May 1; [Epub ahead of print] 

Outcome Measures.

Essex R.

Canberra, Australia.

Publication Types:
    LETTER

PMID: 18455237 [PubMed - as supplied by publisher]

6: Ophthalmology. 2008 May;115(5):922-3. 

Comment on:
    Ophthalmology. 2007 Aug;114(8):1425-6.

Tulane after katrina.

Ayyala R, Sacks JG.

Publication Types:
    Comment
    Letter

PMID: 18452775 [PubMed - indexed for MEDLINE]

7: Ophthalmology. 2008 May;115(5):921-2; author reply 922. 

Comment on:
    Ophthalmology. 2007 May;114(5):860-5.

Intraocular telescope.

Beden U, Sonmez B, Erkan D.

Publication Types:
    Comment
    Letter

PMID: 18452773 [PubMed - indexed for MEDLINE]

8: Ophthalmology. 2008 May;115(5):920-1; author reply 921. 

Comment on:
    Ophthalmology. 2008 Apr;115(4):718-722.e1.

X-linked retinoschisis.

Byeon SH, Kwon OW, Lee SC.

Publication Types:
    Comment
    Letter

PMID: 18452772 [PubMed - indexed for MEDLINE]

9: Ophthalmology. 2008 May;115(5):919; author reply 919-20. 

Comment on:
    Ophthalmology. 2008 Apr;115(4):686-92.

Myopia risk factors.

Kabai P, Bakk J.

Publication Types:
    Comment
    Letter

PMID: 18452771 [PubMed - indexed for MEDLINE]

10: Ophthalmology. 2008 May;115(5):917-8; author reply 918-9. 

Comment on:
    Ophthalmology. 2007 Sep;114(9):1795-6.

Body mass index and vein occlusion.

Kawasaki R, Wong TY, Wang JJ, Kayama T, Yamashita H.

Publication Types:
    Comment
    Letter

PMID: 18452768 [PubMed - indexed for MEDLINE]

11: Ophthalmology. 2008 May;115(5):917-917.e2. 

Intravitreal triamcinolone and blood glucose.

Feldman-Billard S, Chibani A, Heron E.

Publication Types:
    Letter

PMID: 18452767 [PubMed - indexed for MEDLINE]

12: Ophthalmology. 2008 May;115(5):916-916.e1. 

Age-related macular degeneration genetics.

Recalde S, Fernandez-Robredo P, Altarriba M, Salinas-Alaman A, Garcia-Layana A.

Publication Types:
    Letter

PMID: 18452766 [PubMed - indexed for MEDLINE]

13: Ophthalmology. 2008 May;115(5):911-5. 

Noncontact infrared meibography to document age-related changes of the meibomian
glands in a normal population.

Arita R, Itoh K, Inoue K, Amano S.

Itoh Clinic, Saitama, Japan. ritoh@za2.so-net.ne.jp

PURPOSE: To examine the morphologic changes in meibomian glands associated with
aging and gender using a novel meibography system and to assess their relation
with slit-lamp findings regarding eyelid and tear film function in a normal
population. DESIGN: Cross-sectional observation case series. PARTICIPANTS: Two
hundred thirty-six healthy volunteers (114 men, 122 women; mean age+/-standard
deviation, 41.2+/-23.1 years; range, 4-98 years). METHODS: The upper and lower
eyelids were turned over and the meibomian glands were observed using the
noncontact meibography system, which consisted of a slit lamp equipped with an
infrared charge-coupled device video camera and an infrared transmitting filter.
A transilluminating light probe was not necessary. Partial or complete loss of
the meibomian glands was scored for each eyelid from grade 0 (no loss of
meibomian glands) through grade 3 (the lost area was more than two thirds of the
total meibomian gland area). The tear film break-up time (BUT) was measured and
tear film production was evaluated by Schirmer test. MAIN OUTCOME MEASURES:
Score of meibomian gland changes (meiboscore), tear film BUT, and Schirmer test
value. RESULTS: Using the meibography system, clear images of the meibomian
glands were obtained in all subjects, including children. There were significant
positive correlations between age and meiboscore in the entire subject
population (R = 0.428; P<0.0001), as well as in males (R = 0.462; P<0.0001) and
females (R = 0.418; P<0.0001). There were significant negative correlations
between age and tear film BUT (R = -0.153; P = 0.019) and the Schirmer test
value (R = -0.289; P<0.0001). The meiboscore was significantly positively
correlated with the lid margin abnormality score (R = 0.359; P<0.0001).
CONCLUSIONS: The noncontact meibography system is a useful, quick, and
patient-friendly method for obtaining information on the meibomian gland
structure. Using this method, the authors found that changes in meibomian glands
increase with age.

PMID: 18452765 [PubMed - indexed for MEDLINE]

14: Ophthalmology. 2008 May;115(5):866-9. 

Rapidly progressive cataract and iris atrophy during treatment of Acanthamoeba
keratitis.

Herz NL, Matoba AY, Wilhelmus KR.

Sid W. Richardson Ocular Microbiology Laboratory, Cullen Eye Institute,
Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.

PURPOSE: To identify characteristics associated with cataract occurring during
the course of Acanthamoeba keratitis. DESIGN: Retrospective observational case
series. PARTICIPANTS: Eighty-one laboratory-confirmed patients with Acanthamoeba
keratitis. METHODS: Review of clinical records. MAIN OUTCOME MEASURES:
Development of cataract during management of Acanthamoeba keratitis. RESULTS:
Rapidly progressive crystalline lens opacification occurred in 9 eyes within 4
to 15 weeks after diagnosis of Acanthamoeba keratitis. Three were associated
with inflammatory complications, including anterior scleritis (2 eyes) and
iridocyclitis (1 eye). Six others had the abrupt onset of a dense cataract,
including 5 with iris atrophy, that occurred during the initial 6 months of
therapy with chlorhexidine, a diamidine, and adjunctive corticosteroid.
Extracapsular cataract extraction was performed with or after penetrating
keratoplasty. Secondary glaucoma developed in 6 of 9 eyes subsequent to iris
atrophy (4 eyes) or a cyclitic membrane (2 eyes), and 3 eyes underwent
trabeculectomy. CONCLUSIONS: Cataract may occur and progress during the
management of Acanthamoeba keratitis in association with anterior segment
inflammation, iris atrophy, and secondary glaucoma.

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

PMID: 18452764 [PubMed - indexed for MEDLINE]

15: Ophthalmology. 2008 May;115(5):790-795.e4. 

Mechanism of action of bimatoprost, latanoprost, and travoprost in healthy
subjects. A crossover study.

Lim KS, Nau CB, O\'Byrne MM, Hodge DO, Toris CB, McLaren JW, Johnson DH.

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

PURPOSE: To study the effects of 3 prostaglandin analogs, bimatoprost,
latanoprost, and travoprost, on aqueous dynamics in the same subjects and to
compare techniques of assessing outflow facility. DESIGN: Experimental study
(double-masked, placebo-controlled, randomized paired comparison, 4-period
crossover). PARTICIPANTS: Thirty healthy adult subjects. METHODS: Bimatoprost,
latanoprost, travoprost, or a placebo was administered to the left eye once a
day in the evening for 7 days, after a minimum 4-week washout period between
each session. Tonographic outflow facility was measured by Schiotz tonography
and pneumatonography on day 7. On day 8, the aqueous humor flow rate and
fluorophotometric outflow facility were measured by fluorophotometry.
Uveoscleral outflow was calculated from the aqueous humor flow rate and outflow
facility using the Goldmann equation. MAIN OUTCOME MEASURES: Facility of
outflow, aqueous humor flow rate, intraocular pressure (IOP), and calculation of
uveoscleral outflow. RESULTS: All medications lowered IOP relative to a placebo.
None of the drugs affected aqueous humor production. All medications increased
outflow facility compared with placebo when measured by Schiotz and 2-minute
pneumatonography (P< or =0.02); the apparent increase of outflow facility
measured with fluorophotometry and 4-minute pneumatonography did not reach
statistical significance. In contrast, uveoscleral outflow was significantly
increased by all medications when calculated from 4-minute pneumatonography
data, and fluorophotometry and Schiotz data at higher episcleral venous
pressures. The apparent increase found with 2-minute pneumatonography did not
reach statistical significance. These differing results in the same patients
indicate that differences in measurement techniques, and not differences in
mechanism of action, explain previous conflicting published reports on the
mechanism of action of the prostaglandins. CONCLUSIONS: Bimatoprost,
latanoprost, and travoprost have similar mechanisms of action. All 3 drugs
reduce IOP without significantly affecting the aqueous production rate. All
drugs increase aqueous humor outflow, either by enhancing the pressure-sensitive
(presumed trabecular) outflow pathway or by increasing the pressure-insensitive
(uveoscleral) outflow, but the assessment of the amount of flow through each
pathway depends upon the measurement technique.

Publication Types:
    Comparative Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov\'t

PMID: 18452763 [PubMed - indexed for MEDLINE]

16: Ophthalmology. 2008 May;115(5):763-8. 

Comment in:
    Ophthalmology. 2008 May;115(5):761-2.

Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma.

Berdahl JP, Allingham RR, Johnson DH.

Duke University Eye Center, Durham, North Carolina 27710, USA.
johnberdahl@gmail.com

PURPOSE: To compare cerebrospinal fluid (CSF) pressure in patients with primary
open-angle glaucoma (POAG) with that in nonglaucomatous patients. DESIGN:
Case-control study. PARTICIPANTS: Thirty-one thousand, seven hundred and
eighty-six subjects underwent lumbar puncture (LP) between 1996 and 2007 at the
Mayo Clinic, Rochester, Minnesota. Of these, 28 patients who had POAG and 49
patients who did not have POAG were analyzed. METHODS: Retrospective review of
medical records. Comparison of the 2 groups and factors associated with CSF
pressure were analyzed by univariate and multivariate analyses. MAIN OUTCOME
MEASURES: Demographics (age and gender), medical history, medication use,
indication for LP, intraocular pressure (IOP), optic disc cup-to-disc ratio,
visual field assessment, and CSF pressure. RESULTS: The mean CSF pressure +/-
standard deviation was 13.0+/-4.2 mmHg in nonglaucoma patients and 9.2+/-2.9
mmHg in POAG patients (P<0.00005). The CSF pressure was lower in POAG patients
regardless of indication for LP or age. Linear regression analysis showed that
cup-to-disc ratio correlated independently with IOP (P<0.0001), CSF pressure
(P<0.0001), and the translaminar pressure difference (P<0.0001). Multivariate
analysis demonstrated that larger cup-to-disc ratio (P<0.0001) was associated
with lower CSF pressure. CONCLUSIONS: Cerebrospinal fluid pressure is
significantly lower in POAG patients compared with that in nonglaucomatous
controls. These data support the notion that CSF pressure may play an important
contributory role in the pathogenesis of POAG.

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

PMID: 18452762 [PubMed - indexed for MEDLINE]

17: Ophthalmology. 2008 May;115(5):761-2. 

Comment on:
    Ophthalmology. 2008 May;115(5):763-8.

Low intracranial pressure: a tipping point in our understanding of primary
open-angle glaucoma?

Pasquale LR.

Publication Types:
    Comment
    Editorial

PMID: 18452761 [PubMed - indexed for MEDLINE]

18: BMC Ophthalmol. 2008 Apr 29;8(1):7 [Epub ahead of print] 

Specific detection of fungal pathogens by 18S rRNA gene PCR in microbial
keratitis.

Embong Z, Wan Hitam WH, Yean Yean C, Abdul Rashid NH, Kamarudin B, Zainal Abidin
SK, Osman S, Zainuddin ZF, Ravichandran M.

ABSTRACT: BACKGROUND: The sensitivity and specificity of 18S rRNA polymerase
chain reaction (PCR) in the detection of fungal aetiology of microbial keratitis
was determined in thirty patients with clinical diagnosis of microbial
keratitis. Methods. Corneal scrapings from patients were used for Gram stain,
culture and PCR analysis. PCR was performed with primer pairs targeted to the
18S rRNA gene. The result of the PCR was compared with conventional culture and
Gram staining method. The PCR positive samples were identified by DNA sequencing
of the internal transcribed spacer (ITS) region of the rRNA gene. Main outcome
measures were sensitivity and specificity of PCR in the detection of fungus in
corneal keratitis. Results. Combination of microscopy and culture gave a
positive result in 11 of 30 samples of microbial keratitis. PCR detected 10 of
11 samples that were positive by conventional method. One of the 19 samples that
was negative by conventional method was positive by PCR. Statistical analysis
revealed that the PCR to have a sensitivity of 90.9% and specificity of 94.7% in
the detection of a fungal aetiology in microbial keratitis. Conclusion. PCR is a
rapid, sensitive and useful method to detect fungal aetiology in microbial
keratitis.

PMID: 18445283 [PubMed - as supplied by publisher]

19: Ophthalmology. 2008 Apr 26; [Epub ahead of print] 

Intravitreal Bevacizumab to Treat Iris Neovascularization and Neovascular
Glaucoma Secondary to Ischemic Retinal Diseases in 41 Consecutive Cases.

Wakabayashi T, Oshima Y, Sakaguchi H, Ikuno Y, Miki A, Gomi F, Otori Y, Kamei M,
Kusaka S, Tano Y.

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

PURPOSE: To evaluate the biologic efficacy of intravitreal bevacizumab (IVB) for
iris neovascularization (INV) or neovascular glaucoma (NVG) in patients with
ischemic retinal disorders. DESIGN: Retrospective, consecutive, interventional
case series. PARTICIPANTS: Thirty patients (41 eyes) with INV or NVG secondary
to ischemic retinal disorders. METHODS: Patients received IVB (1 mg) as the
initial treatment for INV or NVG and were followed up for at least 6 months.
Ophthalmic evaluations included measurement of visual acuity and intraocular
pressure (IOP), a complete ophthalmic examination, and fluorescein angiography.
Patients were divided into 3 subgroups: INV without elevated IOP (INV group),
NVG with an open angle (O-NVG group), and NVG with angle closure (C-NVG group)
for outcomes analysis. MAIN OUTCOME MEASURES: The controllability of IOP by IVB,
incidence of recurrence, and requirement for surgery to treat NVG. RESULTS: No
significant ocular or systemic adverse events developed during follow-up (range,
6-22 months; mean, 13.3 months). The mean IOP levels were 14.7, 31.2, and 44.9
mmHg at baseline in the INV, O-NVG, and C-NVG groups, respectively. In the INV
group (9 eyes), the INV regressed or resolved after 1 injection. Iris
neovascularization recurred in 4 eyes by 6 months and stabilized after repeated
injections without IOP elevation. In the O-NVG group (17 eyes), rapid
neovascular regression with successful IOP normalization (/=2 mm as grade 2. MAIN OUTCOME MEASURE: Fornix fat prolapse. RESULTS: There
were 43 males and 37 females, with a mean age of 77.70 years (range, 57-93
years) (standard deviation, 7.79). There were 47 patients with right-sided and
33 with left-sided entropion. The range of horizontal lid laxity was between 7.5
and 11 mm. The amount of vertical laxity assessed by lower lid excursion between
extreme up- and downgaze ranged from 2 to 5 mm. Comparison between the affected
and nonaffected sides failed to show a statistical difference in horizontal or
vertical laxity (0.19/=15%) of poor structural outcomes without treatment. Children underwent
cycloplegic retinoscopy at examinations between 6 months postterm and 3 years\'
postnatal age. INTERVENTION: Eyes were randomized to receive treatment at
high-risk prethreshold ROP (early treated [ET]) or conventional management (CM),
with treatment only if threshold ROP developed. MAIN OUTCOME MEASURES: Myopia
(spherical equivalent >/= 0.25 diopters [D]) or high myopia (>/=5.00 D) at each
visit. RESULTS: Prevalences of myopia were similar in treated eyes in the ET and
CM groups, increasing from approximately 58% to 68% between 6 and 9 months, with
little change thereafter. Both ET and CM eyes showed an increasing prevalence of
high myopia, approximately 19% at 6 months and increasing 4% to 8% at successive
examinations. Zone of ROP and presence or absence of plus disease had little
effect on prevalence of myopia or high myopia between ages 6 months and 3 years.
However, eyes with ROP residua (straightened temporal vessels or macular
heterotopia) showed a higher prevalence of myopia and high myopia than eyes
without residua. CONCLUSIONS: Approximately 70% of high-risk prethreshold ROP
eyes were myopic in early childhood, and the proportion with high myopia
increased steadily between ages 6 months and 3 years. Timing of treatment of
high-risk prethreshold ROP did not influence refractive error development. There
was little difference in prevalence of myopia or high myopia between eyes with
zone I and eyes with zone II ROP, nor between eyes with plus disease and eyes
with no plus disease. However, prevalence of myopia and high myopia was higher
in eyes with retinal residua of ROP than in eyes with normal-appearing posterior
poles, highlighting the importance of follow-up eye examinations of infants who
had prethreshold ROP.

PMID: 18423871 [PubMed - as supplied by publisher]