1: Ophthalmology. 2010 Jul 23; [Epub ahead of print] 

Foveal Cystoid Spaces Are Associated with Enlarged Foveal Avascular Zone and
Microaneurysms in Diabetic Macular Edema.

Murakami T, Nishijima K, Sakamoto A, Ota M, Horii T, Yoshimura N.

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate
School of Medicine, Sakyo, Japan.

OBJECTIVE: To study the association between pathomorphology at the foveal center
delineated by spectral domain optical coherence tomography (SD-OCT) and vascular
changes around the fovea in fluorescein angiography (FA) in patients with
diabetic macular edema (DME). DESIGN: Retrospective, observational,
cross-sectional study. PARTICIPANTS: Consecutive series of 86 eyes from 72
patients with clinically significant macular edema (CSME) on which SD-OCT and FA
were performed on the same day. METHODS: Fluorescein angiography using HRA2
(Heidelberg Engineering, Heidelberg, Germany) and SD-OCT images using Spectralis
OCT (Heidelberg Engineering) were obtained for all patients. Microaneurysms
(MAs) in the perifoveal capillary network (PCN) and foveal avascular zone (FAZ)
in the FA images were quantified. The pathomorphology at the foveal center was
evaluated in OCT images. We then investigated the association between pathologic
perifoveal capillaries in FA and the neuroglial morphology in OCT. MAIN OUTCOME
MEASURES: The relationship between pathologic changes in perifoveal capillaries
in FA and foveal pathomorphology in OCT. RESULTS: According to the foveal
morphology in OCT images, 44 eyes presented foveal cystoid spaces (cystoid
macular edema [CME]), 25 eyes had serous retinal detachment (SRD) at the foveal
center, and 17 eyes had foveal thickening without cystoid spaces or retinal
detachment (retinal swelling). After 3 eyes with ischemic maculopathy were
excluded, the relationship was evaluated. The number of MAs in the PCN was
significantly greater in eyes with CME (3.20+/-1.76) than in eyes with SRD
(0.40+/-1.04; P < 0.01) or retinal swelling (0.47+/-0.72; P< 0.01). In addition,
the FAZ in the eyes with CME (0.553+/-0.323 mm(2)) was significantly larger than
that of the eyes with SRD (0.302+/-0.245 mm(2); P < 0.01) or retinal swelling
(0.268+/-0.142 mm(2); P < 0.01). These associations were found in eyes with
thickened posterior hyaloid membranes. CONCLUSIONS: The eyes with cystoid spaces
at the foveal center delineated by OCT had more MAs in the PCN and larger FAZ in
FA images. FINANCIAL DISCLOSURE(S): The authors have no proprietary or
commercial interest in any materials discussed in this article. Copyright (c)
2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.

PMID: 20656355  [PubMed - as supplied by publisher]

2: Ophthalmology. 2010 Jul 23; [Epub ahead of print] 

Developmental Anatomy of the Nasolacrimal Duct: Implications for Congenital
Obstruction.

Moscato EE, Kelly JP, Weiss A.

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

OBJECTIVE: To measure the height, anteroposterior, and transverse diameters of
the nasolacrimal duct (NLD) in normal children between 2 weeks and 34 months of
age and to compare the development of the NLD with the maxilla. DESIGN:
Retrospective case series. PARTICIPANTS: Thirty-eight children with no history
of NLD abnormalities who underwent prior axial computed tomography (CT) facial
scans of 0.50 to 0.625 mm resolution. METHODS: Consecutive cases of CT facial
series over a 16-month period at a single institution were studied. MAIN OUTCOME
MEASURES: Height, anteroposterior and transverse diameters, and volume of the
NLD; height of the maxillary sinus. RESULTS: The height of the bony NLD
increases 1.8-fold, the average diameter increases 1.4-fold, and the volume
increases 4.6-fold between 2 weeks and 34 months of age. The dimensional
increases of the NLD are nonlinear, with most of the increase occurring in the
first 6 months of life. The increase in height of the NLD is highly correlated
with postnatal growth of the maxilla. CONCLUSIONS: Spontaneous resolution of NLD
obstruction in normal infants is coincident with elongation, limited radial
extension, and the resulting volume expansion of the NLD. We propose that
increases in hydrostatic pressure within the fluid column of the NLD combined
with central cavitation of the epithelial core can account for the patency of
the NLD in normal infants. FINANCIAL DISCLOSURE(S): The author(s) have no
proprietary or commercial interest in any materials discussed in this article.
Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 20656354  [PubMed - as supplied by publisher]

3: Ophthalmology. 2010 Jul 23; [Epub ahead of print] 

Contrast Sensitivity and Optical Quality of the Eye after Instillation of
Timolol Maleate Gel-Forming Solution and Brinzolamide Ophthalmic Suspension.

Hiraoka T, Daito M, Okamoto F, Kiuchi T, Oshika T.

PURPOSE: To investigate the influence of timolol maleate 0.5% gel-forming
solution and brinzolamide 1% ophthalmic suspension on contrast sensitivity,
ocular higher-order aberration (HOA), and corneal surface light scattering.
DESIGN: Prospective, comparative study. PARTICIPANTS: Forty normal volunteers
were enrolled in this study. METHODS: We evaluated contrast sensitivity, ocular
HOA, and corneal light scattering before and 2, 5, 10, and 15 minutes after
instillation of antiglaucoma eyedrops. Contrast sensitivity function was
assessed with the CSV-1000RN chart (Vector Vision Co., Greenville, OH).
Higher-order aberration was measured for a 4-mm pupil using the Hartmann-Shack
aberrometer (KR-9000PW; Topcon, Tokyo, Japan). Corneal surface light scattering
was quantitatively evaluated by using the Scheimpflug camera (EAS-1000, Nidek,
Aichi, Japan). MAIN OUTCOME MEASURES: Time course of changes in contrast
sensitivity, ocular HOAs, and corneal light scattering. RESULTS: Both timolol
gel-forming solution and brinzolamide significantly decreased contrast
sensitivity for at least 5 minutes after instillation (P<0.01). There were no
significant differences in contrast sensitivity between the drugs at any time
points. Higher-order aberration, such as third- and fourth-order aberrations and
total HOAs, significantly increased after instillation of each drug (P<0.001).
Timolol gel-forming solution significantly increased HOA up to 5 minutes after
instillation (P<0.05), whereas brinzolamide significantly increased HOA for at
least 2 minutes after instillation (P<0.001). Corneal surface scattering
significantly increased for 5 minutes after instillation of brinzolamide
(P<0.01), but not after instillation of timolol gel-forming solution.
CONCLUSIONS: Both drugs temporarily deteriorate contrast sensitivity function
and optical quality of the eye. However, the mechanism underlying contrast
sensitivity reduction seems to be different between the drugs. The reduction may
be mainly attributed to increased HOA after instillation of timolol gel and
increased light scattering after instillation of brinzolamide. FINANCIAL
DISCLOSURE(S): The authors have no proprietary or commercial interest in any
materials discussed in this article. Copyright (c) 2010 American Academy of
Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 20656353  [PubMed - as supplied by publisher]

4: Ophthalmology. 2010 Jul 23; [Epub ahead of print] 

Laminar and Prelaminar Tissue Displacement During Intraocular Pressure Elevation
in Glaucoma Patients and Healthy Controls.

Agoumi Y, Sharpe GP, Hutchison DM, Nicolela MT, Artes PH, Chauhan BC.

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax,
Canada.

OBJECTIVE: To determine the response of the anterior lamina cribrosa and
prelaminar tissue to acute elevation of intraocular pressure (IOP) in glaucoma
patients and healthy subjects. DESIGN: Prospective case-control series.
PARTICIPANTS AND CONTROLS: Patients with open-angle glaucoma (n = 12; mean
age+/-standard deviation [SD], 66.8+/-6.0 years), age-matched healthy controls
(n = 12; mean age+/-SD, 67.1+/-6.2 years), and young controls (n = 12; mean
age+/-SD, 36.1+/-11.7 years). METHODS: One eye was imaged with spectral-domain
optical coherence tomography to obtain 12 high-resolution radial scans centered
on the optic disc. Imaging was repeated at precisely the same locations with an
ophthalmodynamometer held perpendicular to the globe via the inferior lid to
raise the IOP. A line joining Bruch's membrane opening in 4 radial scans was
used as reference in the baseline and elevated IOP images. The vertical distance
from the reference line to the anterior prelaminar tissue surface and anterior
laminar surface was measured at equidistant points along the reference line in
the 2 sets of images. The difference between the 2 sets of corresponding
measurements were used to determine laminar displacement (LD) and prelaminar
tissue displacement (PTD). MAIN OUTCOME MEASURES: Laminar displacement and PTD.
RESULTS: Intraocular pressure elevation among patients, age-matched controls,
and young controls was similar (mean+/-SD, 12.4+/-3.2 mmHg). The mean+/-SD LD
and PTD were 0.5+/-3.3 mum and 15.7+/-15.5 mum, respectively. The LD was not
statistically different from 0 (P = 0.366), but PTD was (P<0.001). The mean+/-SD
LD was similar among the groups (-0.5+/-3.7 mum, 0.2+/-2.0 mum, and 2.0+/-3.6
mum, respectively; P = 0.366), whereas the mean+/-SD PTD was different
(6.8+/-13.7 mum, 20.8+/-17.5 mum, and 19.6+/-11.8 mum, respectively; P = 0.045).
In all subjects, the PTD was greater than LD. In multivariate regression
analyses, LD was negatively associated with optic disc size (P = 0.007), whereas
PTD was positively associated with the degree of IOP elevation (P = 0.013).
CONCLUSIONS: In glaucoma patients and controls, the anterior laminar surface is
noncompliant to acute IOP elevation. Acute optic disc surface changes represent
compression of prelaminar tissue and not laminar displacement. FINANCIAL
DISCLOSURE(S): Proprietary or commercial disclosure may be found after the
references. Copyright (c) 2010 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 20656352  [PubMed - as supplied by publisher]

5: Ophthalmology. 2010 Jul 23; [Epub ahead of print] 

Antibiotic Resistance of Conjunctiva and Nasopharynx Evaluation Study: A
Prospective Study of Patients Undergoing Intravitreal Injections.

Kim SJ, Toma HS, Midha NK, Cherney EF, Recchia FM, Doherty TJ.

Department of Ophthalmology, Vanderbilt University School of Medicine,
Nashville, Tennessee.

PURPOSE: To determine the baseline antibiotic susceptibility patterns of
conjunctival and nasopharyngeal flora isolated from patients undergoing
intravitreal (IVT) injections for choroidal neovascularization (CNV). DESIGN:
Prospective, observational study. PARTICIPANTS: Forty-eight eyes of 24 patients
undergoing unilateral IVT injections for CNV. METHODS: Bilateral conjunctival
and unilateral nasopharyngeal cultures on the treatment side were taken before
application of any topical medications. MAIN OUTCOME MEASURES: Bacterial
isolates were identified and tested for antibiotic susceptibility to 16
different antibiotics using the Kirby-Bauer disc diffusion technique. RESULTS: A
total of 57 bacterial isolates were obtained from the conjunctiva of 48 eyes.
Coagulase-negative staphylococci (CNS) accounted for 37 of the 57 isolates
(65%). The most common CNS organisms were Staphylococcus epidermidis and
Staphylococcus lugdunensis accounting for 73% and 11% of CNS isolates,
respectively. More than half of S. epidermidis isolates demonstrated some level
of resistance to ofloxacin and levofloxacin, and 33% and 37% of isolates showed
some level of resistance against gatifloxacin and moxifloxacin, respectively.
Some 60% and 30% of CNS isolates were resistant to >/=3 and >/=5 antibiotics,
respectively. Among the 24 nasopharyngeal cultures, 8 (33%) grew Staphylococcus
aureus, and 1 of the 8 isolates (13%) was resistant to all penicillin,
cephalosporin, macrolide, and fluoroquinolone antibiotics tested. CONCLUSIONS:
Our results demonstrate subtantial levels of resistance to third- and
fourth-generation fluoroquinolones and multiresistance among ocular CNS isolated
from patients undergoing IVT injections for CNV. FINANCIAL DISCLOSURE(S): The
authors have no proprietary or commercial interest in any materials discussed in
this article. Copyright (c) 2010 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 20656351  [PubMed - as supplied by publisher]

6: Ophthalmology. 2010 Jul 23; [Epub ahead of print] 

Nine-year Results of a Volunteer Lay Network Photoscreening Program of 147 809
Children Using the MTI PhotoScreener in Iowa.

Longmuir SQ, Pfeifer W, Leon A, Olson RJ, Short L, Scott WE.

Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals
and Clinics, Iowa City, Iowa.

PURPOSE: To present the largest cohort of preschool children screened by the MTI
PhotoScreener over a 9-year period from a single, statewide vision screening
effort. DESIGN: Cross-sectional study. PARTICIPANTS: We included 147 809
children screened between May 1, 2000, and April 30, 2009 by a photoscreening
program. METHODS: Retrospective review of results from the Iowa photoscreening
program using the MTI PhotoScreener. The photographs were taken by volunteers
from local Lions clubs and sent to the University of Iowa for interpretation.
Children who failed the photoscreening were referred to local eye care
professionals, who preformed a comprehensive eye evaluation and forwarded the
results to the Iowa KidSight program. MAIN OUTCOME MEASURES: Number of
screenings, referral rate, positive predictive value (PPV), follow-up rate, and
associated costs per year are described. RESULTS: Over the 9 years of the
continuously operating program, 147 809 children underwent photoscreens to
detect amblyopic risk factors at 9746 sites. Because of abnormal photoscreen
results, 6247 children (4.2%) were referred. Of the children, 24.3% were
evaluated by local ophthalmologists and 76.7% were seen by local optometrists.
Between 2000 and 2009, the follow-up rate ranged from a low of 36.1% to a high
of 89.5%, with an overall program follow-up rate after the addition of the
follow-up coordinator of 81.3%. The overall PPV of the MTI PhotoScreener was
94.2%. Taking into account overall operating budget including salaries and
associated costs, the cost of screening 1 child has been reduced to $US9 per
child. CONCLUSIONS: The addition of a part-time follow-up coordinator to the
photoscreening program produced 89.5% follow-up rate when screening 147 809
children for amblyopia risk factors over a 9-year period. FINANCIAL
DISCLOSURE(S): The authors have no proprietary or commercial interest in any of
the materials discussed in this article. Copyright (c) 2010 American Academy of
Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 20656350  [PubMed - as supplied by publisher]

7: Ophthalmology. 2010 Jul 13; [Epub ahead of print] 

Predicting the Onset of Glaucoma The Confocal Scanning Laser Ophthalmoscopy
Ancillary Study to the Ocular Hypertension Treatment Study.

Weinreb RN, Zangwill LM, Jain S, Becerra LM, Dirkes K, Piltz-Seymour JR, Cioffi
GA, Trick GL, Coleman AL, Brandt JD, Liebmann JM, Gordon MO, Kass MA; OHTS CSLO
Ancillary Study Group.

Department of Ophthalmology, University of California-San Diego, Hamilton
Glaucoma Center, La Jolla, California.

OBJECTIVE: To evaluate the predictive ability of baseline confocal scanning
laser ophthalmoscopy (CSLO) Glaucoma Probability Score (GPS) for the development
of primary open-angle glaucoma (POAG) and to compare it with the Moorfields
regression analysis (MRA) classification, other topographic optic disc
parameters, and stereophotograph-based cup-to-disc ratio. DESIGN: Longitudinal,
randomized clinical trial. PARTICIPANTS: We included 857 eyes of 438
participants in the CSLO Ancillary Study to the Ocular Hypertension Treatment
Study (OHTS) with good quality baseline CSLO images. METHODS: The ability of
baseline GPS, MRA, and optic disc parameters to predict the development of POAG
was evaluated in univariate and multivariable proportional hazard ratio
analyses. Likelihood ratios and positive and negative predictive values were
compared. MAIN OUTCOME MEASURES: The POAG end point as determined by repeatable
changes in the visual field or optic disc. RESULTS: Sixty-four eyes of 50 CSLO
Ancillary Study participants developed POAG. Median time to reach a POAG end
point was 72.3 months. The 93 eyes of 388 participants not reaching endpoint
were followed for a median of 124.9 months. Baseline GPS identified many more
eyes as outside normal limits than the MRA. In multivariable analyses, all
regional and global baseline GPS indices were significantly associated with the
development of POAG; hazard ratios (95% confidence interval) ranged from 2.92 to
3.74 for an outside normal limits result. The MRA indices were also
significantly associated with the development of POAG in multivariable analyses.
In addition, the predictive ability of baseline GPS, MRA and stereometric
parameters were similar to the predictive ability of models using
photograph-based horizontal cup-to-disc ratio. CONCLUSIONS: These results
suggest that baseline GPS, MRA, and stereoparameters alone or when combined with
baseline clinical and demographic factors can be used to predict the development
of POAG end points in OHTS participants and are as effective as
stereophotographs for estimating the risk of developing POAG in ocular
hypertensive subjects. FINANCIAL DISCLOSURE(S): Proprietary or commercial
disclosure may be found after the references. Copyright (c) 2010 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 20633931  [PubMed - as supplied by publisher]

8: Ophthalmology. 2010 Jul 12; [Epub ahead of print] 

Interferon Alfa-associated Anterior Ischemic Optic Neuropathy.

Fraunfelder FW, Fraunfelder FT.

Department of Ophthalmology (Casey Eye Institute), Oregon Health & Science
University, Portland, Oregon.

PURPOSE: To report a possible association between interferon alfa therapy and
anterior ischemic optic neuropathy (AION). DESIGN: Database study and review of
the literature. PARTICIPANTS: Thirty-six case reports from spontaneous reporting
systems and the literature. METHODS: Case reports from a review of the
literature were combined with spontaneous reports from the National Registry of
Drug-Induced Ocular Side Effects, the World Health Organization, and the Food
and Drug Administration looking for reports on interferon therapy associated
with optic neuropathy. MAIN OUTCOME MEASURES: Data from the spontaneous reports
include the type of interferon, age, gender, adverse drug reaction (ADR),
dosage, duration of therapy until onset of ADR, concomitant drugs, systemic
disease, and dechallenge and rechallenge data. RESULTS: Thirty-six case reports
of AION are described in association with interferon alfa therapy. The average
age of subjects was 54.5 years; 26 were male and 10 were female. The median
duration of therapy to onset of AION was 4.5 months, with 50% of subjects having
some form of permanent vision loss. Anterior ischemic optic neuropathy was
bilateral in 67% of subjects. There are 3 positive rechallenge case reports.
CONCLUSIONS: Interferon alfa's association with AION can be classified as
"possible" using the World Health Organization classification system. If optic
neuropathy is suspected, rapid cessation of interferon therapy may portend a
better prognosis because multiple case reports indicate visual defects may be
permanent if this possible ADR remains unrecognized. FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 20630599  [PubMed - as supplied by publisher]

9: Ophthalmology. 2010 Jul 12; [Epub ahead of print] 

Heritability of Spherical Equivalent A Population-Based Twin Study among 63- to
76-Year-Old Female Twins.

Parssinen O, Jauhonen HM, Kauppinen M, Kaprio J, Koskenvuo M, Rantanen T.

Department of Ophthalmology, Central Hospital of Central Finland, Jyvaskyla,
Finland.

PURPOSE: To examine the heritability of spherical equivalent (SE) in older
women. DESIGN: Population-based twin study. PARTICIPANTS: Ninety monozygotic
(MZ) and 86 dizygotic (DZ) female twin pairs aged 63 to 76 years who were born
from 1924 through 1937. METHODS: Ocular refraction was measured using an
autorefractor and controlled by the subjective method. The contributions of
genetic and environmental factors to individual differences in SE were estimated
by applying an independent pathway model to twin data. MAIN OUTCOME MEASURES:
Contribution of genetic and environmental effects to the variation in SE.
RESULTS: Mean SE of the study population was 1.68 (standard deviation, +/-1.82)
with no differences observed either between the MZ and the DZ individuals or
between the left and the right eyes. The pairwise correlations were higher in
the MZ sisters (intraclass correlation coefficient [ICC], 0.803 right eye and
0.807 left eye) than DZ sisters (ICC, 0.406 right eye and 0.435 left eye).
Quantitative genetic modeling showed that 83% (95% confidence interval, 77%-87%)
of the variance in SE could be explained by heritable factors. CONCLUSIONS:
Additive genetic influences explained most of the individual differences in SE
among older Finnish women. FINANCIAL DISCLOSURE(S): The author(s) have no
proprietary or commercial interest in any materials discussed in this article.
Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 20630598  [PubMed - as supplied by publisher]

10: Ophthalmology. 2010 Jul 12; [Epub ahead of print] 

The Impact of Fish and Shellfish Consumption on Age-Related Macular
Degeneration.

Swenor BK, Bressler S, Caulfield L, West SK.

Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.

PURPOSE: To determine the relationship between fish and shellfish consumption
and age-related macular degeneration (AMD) status in the Salisbury Eye
Evaluation (SEE) Study participants. DESIGN: A cross-sectional study of dietary
and ophthalmologic data. PARTICIPANTS: A random sample of 2520 Salisbury,
Maryland, residents aged 65 to 84 years. METHODS: A food frequency questionnaire
was used to estimate weekly fish/shellfish consumption for each participant.
Age-related macular degeneration status was determined from fundus photographs
obtained at baseline and graded by 2 masked readers for drusen size, retinal
pigment epithelium abnormalities, geographic atrophy (GA), and choroidal
neovascularization (CNV). The association between weekly fish/shellfish intake
and risk of AMD was investigated using logistic regression while adjusting for
risk factors and correlation between eyes. MAIN OUTCOME MEASURES: Status of AMD.
RESULTS: The distribution of weekly fish/shellfish consumption was not different
between specific AMD categories compared with controls (P = 0.6, 0.7, and 0.7
for large drusen, pigment abnormalities, and advanced AMD compared with
controls, respectively). Those with advanced AMD (CNV or GA) were significantly
less likely to consume fish/shellfish high in omega-3 fatty acids (odds ratio
0.4; confidence interval, 0.2-0.8). There was no relationship of AMD with intake
of crab and oysters combined, each of which has high levels of zinc.
CONCLUSIONS: These data support a protective effect of fish/shellfish intake
against advanced AMD. FINANCIAL DISCLOSURE(S): Proprietary or commercial
disclosure may be found after the references. Copyright (c) 2010 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 20630597  [PubMed - as supplied by publisher]

11: Ophthalmology. 2010 Jul 12; [Epub ahead of print] 

Tear Cytokine Profile in Medicated Glaucoma Patients Effect of Monocyte
Chemoattractant Protein 1 on Early Posttrabeculectomy Outcome.

Chong RS, Jiang YZ, Boey PY, Juan Yu S, Htoon HM, Aung T, Khaw PT, Wong TT.

Singapore National Eye Centre, Singapore, Republic of Singapore; NIHR Biomedical
Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology,
London, England.

PURPOSE: To determine the tear cytokine profile from medicated glaucoma patients
scheduled for trabeculectomy and to establish whether a specifically elevated
cytokine level is related to early postoperative scarring. DESIGN: Prospective
case-control study. PARTICIPANTS: Sixty-one patients treated with topical
antiglaucoma medications and 29 normal subjects with no prior topical treatment
were recruited for the study. METHODS: Schirmer strips were used to collect tear
samples. A multiplex bead assay was used to quantify the presence of
proinflammatory cytokines in the tears. The patients were followed up for 6
months after surgery to determine whether any postoperative intervention to
maintain filtering bleb function was required. MAIN OUTCOME MEASURES: The level
of cytokines in tear specimens from medicated glaucoma patients was the main
outcome measure for the study. The need for postoperative bleb needling within 6
months was a secondary outcome measure. RESULTS: Of the 17 cytokines assayed,
only monocyte chemoattractant protein 1 (MCP-1) was elevated significantly in
the medicated eyes compared with the unmedicated eyes (P<0.0004). At 6 months
after surgery, 18 (30%) of the 61 eyes required postoperative intervention. A
much higher MCP-1 level was detected in these eyes compared with the remaining
43 that did not require intervention (P<0.0001). The duration of use of topical
medication correlated with increasing levels of MCP-1, although the types of
glaucoma medication and the number of bottles of medications did not have any
significant relationship with the level of MCP-1. CONCLUSIONS: In tears from
topically medicated glaucoma eyes in an Asian population, MCP-1 was found to be
the predominant cytokine elevated. Eyes with a propensity to scar in the early
postoperative period have a significantly raised level of MCP-1. FINANCIAL
DISCLOSURE(S): Proprietary or commercial disclosure may be found after the
references. Copyright (c) 2010 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 20630596  [PubMed - as supplied by publisher]

12: Ophthalmology. 2010 Jul 12; [Epub ahead of print] 

Antagonism of Vascular Endothelial Growth Factor for Macular Edema Caused by
Retinal Vein Occlusions: Two-Year Outcomes.

Campochiaro PA, Hafiz G, Channa R, Shah SM, Nguyen QD, Ying H, Do DV,
Zimmer-Galler I, Solomon SD, Sung JU, Syed B.

The Department of Ophthalmology, The Johns Hopkins University School of
Medicine, Baltimore, Maryland.

PURPOSE: To determine the long-term effects of intraocular antagonism of
vascular endothelial growth factor (VEGF) in patients with macular edema caused
by retinal vein occlusions (RVOs). DESIGN: Prospective randomized trial.
PARTICIPANTS: Twenty patients with macular edema caused by branch RVOs (BRVOs)
and 20 patients with central RVOs (CRVOs). METHODS: After the month 3 primary
end point, patients were seen every 2 months and received injections of an
anti-VEGF agent as needed for recurrent edema. MAIN OUTCOME MEASURES: Mean
change from baseline best-corrected visual acuity (BCVA) at month 24 with
assessment of other parameters of visual function and center subfield thickness
(foveal thickness [FTH]). RESULTS: For 17 patients with BRVO who completed 2
years of follow-up, the mean improvement from baseline in BCVA at month 24 was
17.8 letters compared with 15.6 letters at month 3. Improvement by at least 6,
3, or 2 lines occurred in 18%, 59%, and 76% of patients, respectively. The
Snellen equivalent BCVA at month 24 was 20/40 or better in 10 patients. With an
average of 2 injections of ranibizumab during year 2, the mean FTH at month 24
was 245.8 mum compared with 217.1 mum at month 3 and 481.5 mum at baseline. For
14 patients with CRVO who completed 2 years of follow-up, the mean improvement
in BCVA at month 24 was 8.5 letters compared with 12.0 letters at month 3.
Improvement by at least 6, 3, or 2 lines occurred in 14%, 21%, and 43% of
patients, respectively. The Snellen equivalent BCVA at month 24 was 20/40 or
better in 4 patients. With an average of 3.5 injections of ranibizumab in year
2, mean FTH at month 24 was 338 mum compared with 278 mum at month 3 and 533 mum
at baseline. Duration of RVO >1 year at study entry and nonperfusion of
perifoveal capillaries for 360 degrees correlated with reduced visual outcomes.
CONCLUSIONS: Antagonism of VEGF provides substantial long-term benefit to
patients with macular edema caused by RVO, but frequent injections are required
in some patients with BRVO and most patients with CRVO. FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 20630595  [PubMed - as supplied by publisher]

13: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

Laser Photocoagulation at Birth Prevents Blindness in Norrie's Disease Diagnosed
Using Amniocentesis.

Chow CC, Kiernan DF, Chau FY, Blair MP, Ticho BH, Galasso JM, Shapiro MJ.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences,
University of Illinois at Chicago, Chicago, Illinois.

OBJECTIVE: To report the first case of prophylactic laser treatment to prevent
blindness in a patient who was diagnosed with Norrie's disease by genetic
testing with amniocentesis. DESIGN: Case report. PARTICIPANTS: A 2-year-old
white boy with Norrie's disease. METHODS: A 37-week gestational age male with a
family history of Norrie's disease was born via Cesarean section after the
mother had undergone prenatal amniocentesis fetal-genetic testing at 23 weeks of
gestation. A C520T (nonsense) mutation was found in the Norrie's disease gene.
After examination under anesthesia confirmed the diagnosis on the first day of
life, laser photocoagulation was applied to the avascular retina bilaterally.
The patient was followed closely by ophthalmology, pediatrics, and occupational
therapy departments. MAIN OUTCOME MEASURES: Functional outcome, as documented by
Teller visual acuity and formal occupational therapy testing, and anatomic
outcome, as documented by Retcam photography and fluorescein angiography.
RESULTS: Complete regression of extraretinal fibrovascular proliferation was
observed 1 month after laser treatment. No retinal detachment had occurred to
date at 24 months. Teller visual acuity at 23 months of life was 20/100 in both
eyes. The patient's vision and developmental milestones were age appropriate.
CONCLUSIONS: Pre-term genetic diagnosis with immediate laser treatment after
birth may preserve vision in individuals affected with Norrie's disease.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial
interest in any materials discussed in this article. Copyright (c) 2010 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 20619898  [PubMed - as supplied by publisher]

14: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

Visual and Anatomic Outcomes With or Without Surgery in Persistent Fetal
Vasculature.

Sisk RA, Berrocal AM, Feuer WJ, Murray TG.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine,
Miami, Florida.

PURPOSE: To determine visual and anatomic outcomes for patients with persistent
fetal vasculature (PFV) observed or treated with surgery. DESIGN: Retrospective
interventional consecutive case series. PARTICIPANTS: A total of 165 eyes of 150
patients diagnosed with PFV between January 1, 1983, and December 31, 2006, at
the Bascom Palmer Eye Institute. INTERVENTION: Patients with media opacity,
progressive glaucoma, or retinal detachment who were deemed to have visual
potential underwent lensectomy, 3-port vitrectomy, or both, through a limbal or
pars plicata/plana approach. MAIN OUTCOME MEASURES: Vision, postsurgical retinal
attachment, lens status, need for eye removal, and rate of complications.
RESULTS: Of the 81 eyes that underwent surgical repair, 70 had at least 6 months
of follow-up (median 47 months) and 49 (70.0%) had form vision, defined as
finger counting, fix-and-follow, or better. Twenty (95.2%) of 21 eyes without
form vision had a significant posterior component of PFV (P < 0.001). Forty eyes
had limbal incisions, and 30 eyes had pars plicata incisions. The choice of
surgical approach did not have a statistically significant effect on final
visual acuity or rate of complications (P=0.43). Postoperative events occurred
in 28 eyes (40.0%). Retinal attachment was achieved in 54 eyes (77.1%), and 61
eyes (87.1%) were left aphakic. Eighty-four eyes were not offered surgery, of
which 78 eyes (92.9%) had a posterior component of PFV. The median age at
diagnosis was greater compared with the surgical group (197 vs. 67.5 days,
P=0.00545). Fifty-eight eyes (69.0%) lacked form vision, and 39 eyes (46.4%) had
no light perception. Posterior manifestations of PFV, bilaterality, and
microphthalmia were associated with poorer visual outcomes (P < 0.001, 0.041,
and 0.002, respectively). CONCLUSIONS: The majority of patients receiving
surgical intervention for PFV achieved form vision. Posterior disease,
microphthalmia, glaucoma, and amblyopia limited visual acuity outcomes even
after aggressive intervention. The choice of limbal versus pars plicata approach
produced similar visual and anatomic outcomes without a significant difference
in rate of complications. FINANCIAL DISCLOSURE(S): The author(s) have no
proprietary or commercial interest in any materials discussed in this article.
Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 20619897  [PubMed - as supplied by publisher]

15: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

A Comparative Study of Resident Performance on Standardized Training
Examinations and the American Board of Ophthalmology Written Examination.

Johnson GA, Bloom JN, Szczotka-Flynn L, Zauner D, Tomsak RL.

Department of Ophthalmology and Visual Sciences, Case Western Reserve University
School of Medicine, Cleveland, Ohio.

PURPOSE: To investigate the relationships between ophthalmology resident
performance on the United States Medical Licensing Examination (USMLE), the
Ophthalmic Knowledge Assessment Program (OKAP) exam and the American Board of
Ophthalmology written qualifying examination (ABO-WQE). DESIGN: Cohort study.
PARTICIPANTS: We included 76 residents from 15 consecutive training classes
(1991-2006) at 1 ophthalmologic residency training program. METHODS: Numeric
scores on the USMLE Step 1 and OKAP examinations during the 3 years of
residency, and first attempt pass rate on the ABO-WQE were recorded for 76
residents. Age and gender were also noted. Spearman's rank correlations and
univariate and multivariate logistic analyses were performed to determine
relevant associations. MAIN OUTCOME MEASURES: First-time attempt pass rate on
the ABO-WQE and/or successful completion of the ABO-WQE within 3 years of
graduation from the residency program. RESULTS: The ABO-WQE first-attempt pass
rate was 72.6%, consistent with the national average. Resident USMLE scores were
not significantly associated with ABO-WQE performance. The ABO-WQE pass rate was
significantly associated with OKAP examination scores during the 3 residency
years (year 1: odds ratio [OR], 8.85 and 95% confidence interval [CI]
1.82-42.79; year 2: OR, 5.28 and 95% CI, 1.15-25.27; year 3: OR, 11.08 and 95%
CI, 1.86-68.96). Passing the OKAP examinations in all 3 years during residency
training was associated with 5.43-fold increased odds of passing the ABO-WQE and
failing all 3 OKAP examinations was associated with >9-fold lower odds of
passing the ABO-WQE on the first attempt. CONCLUSIONS: Our results suggest that
OKAP examination performance is a predictor of a resident's success in passing
the ABO-WQE on the first attempt, as well as within 3 years of graduation from
an ophthalmologic training program. Awareness of this association may permit
identification of residents at risk for failing the ABO-WQE and encourage
educational remediation to prevent this failure. FINANCIAL DISCLOSURE(S): The
authors have no proprietary or commercial interest in any of the materials
discussed in this article. Copyright (c) 2010 American Academy of Ophthalmology.
Published by Elsevier Inc. All rights reserved.

PMID: 20619896  [PubMed - as supplied by publisher]

16: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

Subconjunctival/Perilesional Recombinant Interferon alpha2b for Ocular Surface
Squamous Neoplasia A 10-Year Review.

Karp CL, Galor A, Chhabra S, Barnes SD, Alfonso EC.

Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

PURPOSE: To evaluate the biologic effect of subconjunctival recombinant
interferon alpha2b (IFNalpha2b) for the treatment of ocular surface squamous
neoplasia (OSSN). DESIGN: Retrospective study. PARTICIPANTS: Patients with
primary or recurrent OSSN treated with subconjunctival injections of recombinant
IFNalpha2b were studied retrospectively. INTERVENTION: Patients were given
perilesional subconjunctival injections of 3 million international units in 0.5
ml of IFNalpha2b (Intron; Schering-Plough, Kenilworth, NJ) until tumor
resolution. MAIN OUTCOME MEASURES: Patients were followed up clinically and
photographically for evidence of tumor resolution and were monitored for
evidence of tumor recurrence. RESULTS: The authors present a series of 15 eyes
(14 patients) that were treated with perilesional, subconjunctival, recombinant
IFNalpha2b. Clinical resolution of the tumor occurred in 13 of 15 eyes. The
median time to resolution was 1.4 months (range, 0.6-5.7). In the time of
follow-up after lesion resolution (median, 55 months), only 1 of the 15 eyes in
the study exhibited disease recurrence, and this occurred 4 months after
clinical resolution. CONCLUSIONS: Perilesional subconjunctival recombinant
IFNalpha2b may be a viable medical alternative for the treatment of OSSN. Future
studies will be needed to evaluate the ideal treatment regimen of IFNalpha2b.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial
interest in any materials discussed in this article. Copyright (c) 2010 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 20619462  [PubMed - as supplied by publisher]

17: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

Quality of Life in High Myopia before and after Implantable Collamer Lens
Implantation.

Ieong A, Hau SC, Rubin GS, Allan BD.

Moorfields Eye Hospital, London, United Kingdom; City University, London, United
Kingdom.

PURPOSE: To examine changes in vision-related quality of life after implantable
Collamer lens (ICL) implantation for the correction of myopia. DESIGN:
Prospective, interventional, consecutive case series. PARTICIPANTS: We included
34 consecutive patients (68% female; mean age, 37 years [range, 23-49]) with
preoperative myopia (mean+/-standard deviation [SD] refraction spherical
equivalent, -11.0+/-3.12). INTERVENTION: Bilateral ICL implantation. MAIN
OUTCOME MEASURE: Quality of life Impact of Refractive Correction (QIRC) score.
RESULTS: The median postoperative interval before questionnaire administration
was 4 months (range, 3-7). The QIRC scores were significantly higher
postoperatively (preoperative QIRC score [mean+/-SD], 40.45+/-4.83;
postoperative QIRC score 53.79+/-5.60; P<0.001), with significant improvements
(P<0.01) for 14 of 19 items. Nineteen (58%) patients reported a worsening in
night vision symptoms (mostly nonspecific glare and halo or arc effects) after
surgery, but overall levels of satisfaction were high; 88% were either satisfied
or very satisfied with the results of surgery. No patients reported overall
dissatisfaction. In free text responses, 11 patients (32%) described ICL
implantation as life changing or wished that they had opted for the surgery
sooner. CONCLUSIONS: Implantation of an ICL for myopia is associated with
significant improvements in quality of life. Any dissatisfaction with the
procedure largely relates to night vision symptoms, which are common in the
early postoperative period. FINANCIAL DISCLOSURE(S): The authors have no
proprietary or commercial interest in any of the materials discussed in this
article. Copyright (c) 2010 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 20619461  [PubMed - as supplied by publisher]

18: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

The Utility of the Monocular Trial Data from the Ocular Hypertension Treatment
Study.

Bhorade AM, Wilson BS, Gordon MO, Palmberg P, Weinreb RN, Miller E, Chang RT,
Kass MA; for the Ocular Hypertension Treatment Study Group.

Department of Ophthalmology & Visual Sciences, Washington University School of
Medicine, St. Louis, Missouri; Department of Ophthalmology, Stanford University,
Stanford, California.

OBJECTIVE: To determine whether adjusting the intraocular pressure (IOP) change
of the trial eye for the IOP change of the fellow eye (i.e., monocular trial) is
a better assessment of medication response than testing each eye independently.
DESIGN: Analysis of data from a prospective, randomized, clinical trial.
PARTICIPANTS: Two hundred six participants with ocular hypertension randomized
to the observation group and later started on a topical prostaglandin analog
(PGA). METHODS: Participants were started on a topical PGA in 1 eye and returned
in approximately 1 month to determine medication response. The IOP response of
the trial eye was determined by the IOP change between baseline and 1 month in
the trial eye alone (unadjusted method) and by adjusting for the IOP change in
the fellow eye between the same visits (adjusted method). Our "gold standard"
for medication response was the IOP change in the trial eye between up to 3 pre-
and 3 posttreatment visits on the same medication. Pearson correlation was used
to compare the gold standard with the unadjusted and adjusted methods. In
addition, symmetry of IOP response between trial and fellow eyes to the same
medication was determined by correlating the trial eye IOP change between up to
3 pre- and 3 posttreatment visits to the fellow eye IOP change between the same
visits. MAIN OUTCOME MEASURES: Correlations of IOP change of the trial eye using
the gold standard to the IOP change of the trial eye using the unadjusted and
adjusted methods. RESULTS: The correlations of IOP change using the gold
standard to the IOP change using the unadjusted and adjusted methods were r =
0.40 and r = 0.41, respectively. The correlation of IOP change of both eyes
between the same pre- and posttreatment visits was r = 0.81. CONCLUSIONS: The
monocular trial (i.e., adjusted method) appears equivalent to testing each eye
independently (i.e., unadjusted method); however, neither method is adequate to
determine medication response to topical PGAs. Both eyes have a similar IOP
response to the same PGA. Further studies to understand IOP fluctuation are
necessary to improve current methods of assessing medication response. FINANCIAL
DISCLOSURE(S): Proprietary or commercial disclosure may be found after the
references. Copyright (c) 2010 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 20619460  [PubMed - as supplied by publisher]

19: Ophthalmology. 2010 Jul 8; [Epub ahead of print] 

The Intraocular Pressure-Lowering Effect of Prostaglandin Analogs Combined with
Topical beta-Blocker Therapy A Systematic Review and Meta-analysis.

Webers CA, Beckers HJ, Zeegers MP, Nuijts RM, Hendrikse F, Schouten JS.

Department of Ophthalmology, Maastricht University Hospital, Maastricht, The
Netherlands.

OBJECTIVE: To estimate the intraocular pressure (IOP)-lowering effect of
prostaglandin analogs (PGAs) when added to topical beta-blocker (BB) therapy.
DESIGN: Systematic review and meta-analyses of randomized clinical trials.
PARTICIPANTS: Twenty-nine articles reporting on 33 study arms and 3 control
arms. METHODS: Articles published between January 1, 1990, and August 18, 2009,
were identified in relevant databases. The pooled IOP-lowering effects at the 1-
to 3-month follow-ups were calculated by performing random effects
meta-analyses. MAIN OUTCOME MEASURES: Absolute and relative change in IOP for
mean diurnal curve and highest and lowest IOP decrease on the diurnal IOP curve.
RESULTS: Adding 0.005% latanoprost in the evening to 0.5% timolol twice daily
resulted in a pooled change of -6.3 mmHg (95% CI, -7.1 to -5.5 mmHg, mean IOP
curve); switching to the fixed combination of 0.5% timolol and 0.005%
latanoprost in the morning resulted in a pooled change of -2.8 mmHg (95% CI,
-3.3 to -2.3 mmHg, mean IOP curve). Starting with any fixed combination of 0.5%
timolol and a PGA in the morning resulted in a pooled change of -8.4 mmHg (95%
CI, -9.1 to -7.6 mmHg, mean IOP curve) and varied between -9.1 mmHg (95% CI,
-9.9 to -8.2 mmHg, highest) and -7.9 mmHg (95% CI, -8.5 to -7.2 mmHg, lowest);
starting with any fixed combination of 0.5% timolol and a PGA in the evening
resulted in a pooled change of -8.6 (95% CI, -9.2 to -8.0 mmHg, mean IOP curve)
and varied between -10.1 mmHg (95% CI, -11.0 to -9.2 mmHg, highest) and -7.3
mmHg (95% CI, -8.1 to -6.4 mmHg, lowest). CONCLUSIONS: The concomitant use of
latanoprost and timolol leads to a larger additional IOP reduction when compared
with the fixed combination. There is no difference in mean IOP-lowering effect
between evening and morning dosing of a fixed combination of timolol and a PGA,
although the largest IOP decreases are seen with evening dosing. These findings
are explained by differences in study design. When time points of IOP
measurements close to the peak or trough moment of a drug are included, the
IOP-lowering effect will be overestimated or underestimated, respectively.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after
the references. Copyright (c) 2010 American Academy of Ophthalmology. Published
by Elsevier Inc. All rights reserved.

PMID: 20619459  [PubMed - as supplied by publisher]

20: Ophthalmology. 2010 Jul;117(7):1467-1467.e1. 

H1N1 and uveal effusion syndrome.

Roesel M, Heinz C, Heiligenhaus A.

Publication Types:
    Case Reports
    Letter

PMID: 20610007  [PubMed - indexed for MEDLINE]

21: Ophthalmology. 2010 Jul;117(7):1466-1466.e1. 

Chlorambucil and malignancy.

Birnbaum AD, Oh F, Sahin O, Little DM, Tessler HH, Goldstein DA.

Publication Types:
    Letter

PMID: 20610006  [PubMed - indexed for MEDLINE]

22: Ophthalmology. 2010 Jul;117(7):1465-1465.e1. 

Visual experience during vitrectomy.

Riad W, Tan CS, Kumar CM, Au Eong KG.

Publication Types:
    Comparative Study
    Letter

PMID: 20610004  [PubMed - indexed for MEDLINE]

23: Ophthalmology. 2010 Jul;117(7):1464-5; author reply 1465. 

Mitomycin-C and pediatric Ahmed valves.

Razeghinejad MR, Nowroozzadeh MH.

Publication Types:
    Comment
    Letter

PMID: 20610003  [PubMed - indexed for MEDLINE]

24: Ophthalmology. 2010 Jul;117(7):1463; author reply 1463-4. 

Brimonidine and eye pressure.

Nowroozzadeh MH, Razeghinejad MR.

Publication Types:
    Comment
    Letter

PMID: 20610002  [PubMed - indexed for MEDLINE]

25: Ophthalmology. 2010 Jul;117(7):1462-1462.e1. 

Trypan Blue capsulorhexis.

Smith EF, Desai RU, Schrier A, Enriquez B, Purewal BK.

Publication Types:
    Comment
    Letter
    Randomized Controlled Trial

PMID: 20610000  [PubMed - indexed for MEDLINE]

26: Ophthalmology. 2010 Jul;117(7):1460-1; author reply 1461-2. 

IOP changes after DSEK.

Prasanth B, Dubey S, Mathur U.

Publication Types:
    Comment
    Letter

PMID: 20609998  [PubMed - indexed for MEDLINE]

27: Ophthalmology. 2010 Jul;117(7):1459-60; author reply 1460. 

Endothelial keratoplasty.

Athanasiadis I, Sharma A.

Publication Types:
    Comment
    Letter

PMID: 20609995  [PubMed - indexed for MEDLINE]

28: Ophthalmology. 2010 Jul;117(7):1458-9; author reply 1459. 

Femtosecond incisions.

van Rij G, Bartels MC, Bleyen I, van Dooren BT, Saelens IE.

Publication Types:
    Comment
    Letter

PMID: 20609994  [PubMed - indexed for MEDLINE]

29: Ophthalmology. 2010 Jul;117(7):1458; author reply 1458. 

Conjunctival squamous cell carcinoma.

Furahini G, Lewallen S.

Publication Types:
    Comment
    Letter

PMID: 20609992  [PubMed - indexed for MEDLINE]

30: Ophthalmology. 2010 Jul;117(7):1367-75.e1. 

Central retinal artery occlusion: local intra-arterial fibrinolysis versus
conservative treatment, a multicenter randomized trial.

Schumacher M, Schmidt D, Jurklies B, Gall C, Wanke I, Schmoor C, Maier-Lenz H,
Solymosi L, Brueckmann H, Neubauer AS, Wolf A, Feltgen N; EAGLE-Study Group.

Clinic of Neuroradiology, University of Freiburg, Germany.
martin.schumacher.nrad@uniklinik-freiburg.de

PURPOSE: The reported outcomes of central retinal artery occlusion (CRAO) with
or without treatment vary considerably. Although local intra-arterial
fibrinolysis (LIF) using recombinant tissue plasminogen activator (rtPA) is a
promising treatment, outcomes have not been compared in randomized trials.
DESIGN: Prospective randomized multicenter clinical trial (the European
Assessment Group for Lysis in the Eye Study) to compare treatment outcome after
conservative standard treatment (CST) and LIF for acute nonarteritic CRAO.
PARTICIPANTS: Between 2002 and 2007, 9 centers in Austria and Germany recruited
84 patients (40 received CST, 44 received LIF), and data for 82 patients were
analyzed. METHODS: Patients (age 18-75 years) with CRAO, symptoms for 20 hours
or less, and best-corrected visual acuity (BCVA) <0.5 logarithm of the minimum
angle of resolution (logMAR) were randomized to the CST or LIF group. MAIN
OUTCOME MEASURES: The primary end point was BCVA after 1 month; the secondary
end point was safety. RESULTS: The mean interval between first symptoms and
therapy was 10.99+/-5.49 hours (CST) and 12.78+/-5.77 hours (LIF). The mean BCVA
(logMAR) improved significantly in both groups (CST: -0.44 [standard deviation
0.55]; LIF: -0.45 [standard deviation 0.55]; both P < 0.0001) and did not differ
between groups (P=0.69). Clinically significant visual improvement (> or = 0.3
logMAR) was noted in 60.0% (CST) and 57.1% (LIF) of patients. Two patients in
the CST group (4.3%) and 13 patients in the LIF group (37.1%) had adverse
reactions. Because of apparently similar efficacy and the higher rate of adverse
reactions in the LIF group, the study was stopped after the first interim
analysis at the recommendation of the data and safety monitoring committee.
CONCLUSIONS: In light of these 2 therapies' similar outcomes and the higher rate
of adverse reactions associated with LIF, we cannot recommend LIF for the
management of acute CRAO. FINANCIAL DISCLOSURE(S): The author(s) have no
proprietary or commercial interest in any materials discussed in this article.
Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All
rights reserved.

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

PMID: 20609991  [PubMed - indexed for MEDLINE]