1: Ophthalmology. 2010 Mar 6; [Epub ahead of print] 

Selective Serotonin Reuptake Inhibitors and the Risk of Cataracts A Nested
Case-Control Study.

Etminan M, Mikelberg FS, Brophy JM.

Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, Canada; Department of Medicine, Faculty of
Medicine, University of British Columbia, Vancouver, Canada.

OBJECTIVE: Older-generation antidepressants have been associated with increasing
the risk of cataracts. Although animal studies have alluded to a potential link
between selective serotonin reuptake inhibitors (SSRIs) and the development of
cataracts, no large population based-study has addressed this potential
association. This study sought to quantify the risk of cataracts with SSRIs by
conducting a pharmacoepidemiologic study using the linked administrative
databases in the province of Quebec, Canada. DESIGN: Nested case-control study.
PARTICIPANTS: A cohort of subjects who had received a coronary revascularization
procedure from 1995 through 2004 in the province of Quebec, Canada. METHODS:
Using an administrative data set, a case-control study was conducted within a
cohort of Quebec residents who had received a coronary revascularization
procedure from 1995 through 2004. Cases were defined as those with the first
diagnosis of a cataract diagnosed by an ophthalmologist. For each case, 10
controls were selected and matched to the cases by index date, age, and cohort
entry. Crude and adjusted rate ratios (RRs) and corresponding confidence
intervals (CIs) were computed for current use of SSRIs. Rate ratios were
adjusted for gender, corticosteroid use, statins, high blood pressure,
antihypertensives, and antidiabetics. MAIN OUTCOME MEASURES: First International
Classification for Disease (Ninth Revision) code for a cataract diagnosed by an
ophthalmologist. RESULTS: Eighteen thousand seven hundred eighty-four cases and
187 840 controls met our study inclusion criteria. The adjusted RR for cataracts
among current users of SSRIs was 1.15 (95% CI, 1.08-1.23). The risk of cataracts
was highest with fluvoxamine (RR, 1.39; 95% CI, 1.07-1.80), followed by
venlafaxine (RR, 1.33; 95% CI, 1.14-1.55) and paroxetine for cataract surgery
(RR, 1.23; 95% CI, 1.05-1.45). The average time to diagnosis of cataracts while
on SSRI therapy was 656 days. CONCLUSIONS: A possible association was found
between current exposure to SSRIs, especially fluvoxamine and venlafaxine, and a
future diagnosis of cataracts. The possibility that this observation may be the
result of the effect of smoking, which could not be controlled for in the study,
cannot be excluded. Future studies are needed to confirm this association in
other populations. 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: 20207418  [PubMed - as supplied by publisher]

2: Ophthalmology. 2010 Mar 6; [Epub ahead of print] 

Effect of Patient-Centered Communication Training on Discussion and Detection of
Nonadherence in Glaucoma.

Hahn SR, Friedman DS, Quigley HA, Kotak S, Kim E, Onofrey M, Eagan C, Mardekian
J.

Albert Einstein College of Medicine, Bronx, New York; Medintel On-Call,
Pleasantville, New York.

PURPOSE: To assess communication about adherence and to determine the impact of
communication skills training on physicians' approach to nonadherence. DESIGN:
Sociolinguistic analysis of videotaped community ophthalmologists' encounters
with patients with glaucoma before and after training. Patients in both phases
and physicians in phase I knew communication was being studied but not what the
focus of the study was. In phase II, physicians knew the targeted communication
behaviors. PARTICIPANTS: Twenty-three ophthalmologists and 100 regularly
scheduled patients with glaucoma (50 per phase). METHODS: An educational program
with videotaped vignettes of simulated patient encounters using audience
response and role play to teach patient-centered communication skills, including
a 4-step adherence assessment and the use of open-ended questions in
ask-tell-ask sequences. MAIN OUTCOME MEASURES: Physician eliciting an
acknowledgment of nonadherence during a clinical encounter compared with
acknowledgment of nonadherence during a postvisit research interview (primary
outcome), and performance of targeted communication and substantive discussion
of adherence. RESULTS: After intervention, physicians increased the proportion
of open-ended questions (15% vs 6%; P = 0.001) and specifically about medication
taking (82% compared with 18% of encounters; P<0.001). Compared with the absence
of ask-tell-ask communication, 32% of phase II encounters included a complete
ask-tell-ask sequence, 78% included an ask-tell sequence, and 32% a tell-ask
sequence (P<0.001). Three of 4 steps for assessment of adherence were more
common in phase II, and substantial discussions of adherence occurred in 86%
versus 30% of encounters (P<0.001). In phase II, physicians elicited
acknowledgment of nonadherence in 78% (7/9) of those who acknowledged
nonadherence in the postvisit interview compared with 25% in phase I (3/12; P =
0.03). CONCLUSIONS: This study demonstrates that experienced community
physicians significantly improved their communication strategies and ability to
detect and address nonadherence after a 3-hour educational program. 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: 20207417  [PubMed - as supplied by publisher]

3: Ophthalmology. 2010 Mar 4; [Epub ahead of print] 

Success Rates of Retinal Buckling Surgery: Relationship to Refractive Error and
Lens Status: Results from a Large German Case Series.

Thelen U, Amler S, Osada N, Gerding H.

Eye Hospital University of Munster, Munster, Germany.

OBJECTIVE: First, to evaluate the anatomic success rates of scleral buckling
surgery in the treatment of rhegmatogenous retinal detachment and possible
differences in outcome depending on patients' refractive error and lens status.
Second, to evaluate demographic characteristics of patients with retinal
detachment to contribute to our knowledge of the epidemiology of this important
and sight-threatening disease. DESIGN: Retrospective interventional case series.
PARTICIPANTS: The Munster Study on Therapy Achievements in Retinal Detachment
(MUSTARD) is one of the largest case series of patients with retinal detachment
and their outcome after buckling surgery ever established, with 4325 subjects
who underwent surgery between 1980 and 2001. METHODS: All 4325 patients with
retinal detachment underwent scleral buckling surgery. MAIN OUTCOME MEASURES:
Complete anatomic attachment of the retina. RESULTS: The overall success rate in
all 4325 MUSTARD cases was 83.98%. The highest success rate was achieved in
patients aged 51 to 60 years, with 86.72%. With regard to refractive error,
success rates were highest in moderate myopes, that is, in 707 patients with a
refractive error between -2.75 and -8.0 diopters (86.70%) and in 573 patients
with mild myopia between -0.5 and -2.0 diopters (86.21%). The lens status did
not play a significant role in outcome. In patients with nontrauma-related
retinal detachment, success rates were 84.45% for phakic patients, 82.88% for
pseudophakic patients, and 81.88% for aphakic patients. An epidemiologically
surprising result was the lower than expected number of myopic individuals among
patients with retinal detachment: Only approximately one quarter had myopia of
-2.75 diopters or more. In phakic patients aged 51 to 80 years, only 16% were
myopic. CONCLUSIONS: Scleral buckling is an established and generally successful
method for the treatment of retinal detachment. As our case series has
demonstrated, myopia, aphakia, and pseudophakia do not constitute factors that
might diminish the chances of success. 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: 20207006  [PubMed - as supplied by publisher]

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

Long-term Pattern of Progression of Myopic Maculopathy A Natural History Study.

Hayashi K, Ohno-Matsui K, Shimada N, Moriyama M, Kojima A, Hayashi W, Yasuzumi
K, Nagaoka N, Saka N, Yoshida T, Tokoro T, Mochizuki M.

Department of Ophthalmology and Visual Science, Tokyo Medical and Dental
University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113, Japan.

OBJECTIVE: To investigate the long-term progression pattern of myopic
maculopathy and to determine the visual prognosis of each progression stage.
DESIGN: Retrospective, observational case series. PARTICIPANTS: The medical
records of 806 eyes of 429 consecutive patients with high myopia (refractive
error more than -8.00 diopters [D] or axial length >/=26.5 mm) who were followed
for 5-32 years were reviewed. METHODS: Participants had complete
ophthalmological examinations including best-corrected visual acuity, axial
length measurements, fluorescein angiography, and color fundus photography, at
least once a year. The presence and type of posterior staphyloma was determined
by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy
included tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy,
patchy chorioretinal atrophy, choroidal neovascularization (CNV), and macular
atrophy. None of the patients had received any type of treatment for the
maculopathy. MAIN OUTCOME MEASURES: The longitudinal long-term progression
pattern and the visual prognosis of each type of fundus lesion. RESULTS: During
the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%)
showed a progression of the myopic maculopathy. The most commonly observed
patterns were from tessellated fundus to the development of diffuse atrophy and
lacquer cracks, an increase in the width and progression to patchy atrophy in
eyes with lacquer cracks, an enlargement of the diffuse atrophy, and the
development of patchy atrophy in eyes with diffuse atrophy, and an enlargement
and fusion of patches of atrophic areas in eyes with patchy atrophy. Eyes with
tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at the
initial examination progressed to the development of CNV. Eyes with CNV
developed macular atrophy. The fusion of patchy atrophy, the development of CNV,
and macular atrophy all led to significant visual decreases. A posterior
staphyloma was observed more frequently in eyes that showed progression from
tessellated fundus, diffuse atrophy, and patchy atrophy than those without a
progression. CONCLUSIONS: These findings indicate that myopic maculopathy tends
to progress in approximately 40% of highly myopic eyes, and the pattern of
progression affects the visual prognosis. Preventive therapy targeting posterior
staphyloma should be considered to prevent the visual impairment caused by the
progression of myopic maculopathy. FINANCIAL DISCLOSURES: The authors have no
proprietary or commercial interest in any of the materials discussed in this
article. Copyright (c) 2009 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 20207005  [PubMed - as supplied by publisher]

5: Ophthalmology. 2010 Mar 2; [Epub ahead of print] 

Accidental Macular Injury from Prolonged Viewing of a Plasma Flash Produced by a
Femtosecond Laser.

Yang X, Jiang F, Song Y, Peng C, Sheng S, Li X.

Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China.

OBJECTIVE: To report a case of macular injury caused by prolonged exposure to a
flash from the plasma formed at the focus of a femtosecond laser. DESIGN:
Interventional case report. PARTICIPANT: A patient with macular injury caused by
sustained observation of the plasma flash produced by a femtosecond laser.
INTERVENTION: The patient was examined with complete ophthalmologic evaluation
(including Amsler grid test, funduscopy, fluorescein angiography, and optical
coherence tomography [OCT]) at 3 hours, 1 month, and 6 months after injury. The
injured right eye received a retrobulbar injection of 40 mg triamcinolone
acetonide (TransTon), at 4 hours and at 10 days after injury, respectively. MAIN
OUTCOME MEASURES: Visual acuity, ophthalmoscopic, and OCT findings. RESULTS:
Three hours after injury, the best-corrected visual acuity of the right eye was
20/30 with a very small relative scotoma nasal to fixation. Funduscopy disclosed
a well-circumscribed, yellow-white spot lesion located immediately temporal to
the foveal center. As time passed, the patient's vision returned to 20/20 and
the scotoma and retinal abnormalities had become less prominent, but were still
present. In the acute stage, OCT showed a hyperreflective lesion involved all
foveal retinal layers. At 1 and 6 months of follow-up, OCT revealed abnormal
reflectivity located within the outer foveal retina. CONCLUSIONS: Prolonged
viewing of a plasma flash induced by a focused femtosecond laser in the air
without eye protection may produce persistent damage to the retina. The observed
macular injury was probably the result of a combination of thermal and
photochemical damage. 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: 20202686  [PubMed - as supplied by publisher]

6: Ophthalmology. 2010 Mar 2; [Epub ahead of print] 

Identification of Genome-wide Copy Number Variations and a Family-based
Association Study of Avellino Corneal Dystrophy.

Bae JS, Cheong HS, Chun JY, Park TJ, Kim JO, Kim EM, Park M, Kim DJ, Lee EJ, Kim
EK, Lee JY, Shin HD.

Laboratory of Genomic Diversity, Department of Life Science, Sogang University,
Shinsu-dong, Mapo-gu, Seoul, Republic of Korea.

OBJECTIVE: To determine the association of identified copy number variations
(CNVs) in whole genome with the risk of Avellino corneal dystrophy (ACD) in a
Korean population. DESIGN: Case-control study. PARTICIPANTS: A total of 146
patients with ACD and 226 control subjects. METHODS: A total of 193 trios were
genotyped by the Illumina HumanHapCNV370-Duo BeadChip (370 404 markers)
(Illumina, Inc., San Diego, CA). The intensity signal (log R ratio) and allelic
intensity ratio (B allele frequency) of each marker in all individuals were
obtained by Illumina BeadStudio software (Illumina, Inc.). To obtain authentic
CNVs in this study, we performed a family-based CNV validation and family-based
boundary mapping using the PennCNV algorithm, which incorporates multiple
factors, including total log R ratio, B allele frequency, and family
information, based on an integrated hidden Markov model. MAIN OUTCOME MEASURES:
Statistical comparison and identification of CNVs between case and control using
family information. RESULTS: We identified 27 267 individual trio CNVs with a
median size of 16.2 kb, aggregated in 2245 CNV regions. Most of the identified
trio CNVs in this study showed well-defined CNV boundaries and overlapped with
those in the Database of Genomic Variants (DGV) (83.4% in number and 79.2% in
length). With the common CNV regions (264 CNV regions >5%), we performed a
family-based association test with the risk of ACD. CONCLUSIONS: Two CNV regions
(chr6:29978470-29987783 and chr14:59896944-59916129) were significantly
associated with the risk of ACD (P=0.05 approximately 0.003 and P=0.008,
respectively). This study describes the first results of a genome-wide
association analysis of individual CNVs with the risk of ACD and shows that 2
novel CNV loci may be involved in the risk of ACD. 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: 20202685  [PubMed - as supplied by publisher]

7: Ophthalmology. 2010 Mar 2; [Epub ahead of print] 

Sustained Ocular Delivery of Fluocinolone Acetonide by an Intravitreal Insert.

Campochiaro PA, Hafiz G, Shah SM, Bloom S, Brown DM, Busquets M, Ciulla T,
Feiner L, Sabates N, Billman K, Kapik B, Green K, Kane F; Famous Study Group().

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

PURPOSE: To compare Iluvien intravitreal inserts that release 0.2 or 0.5 mug/day
of fluocinolone acetonide (FA) in patients with diabetic macular edema (DME).
DESIGN: Prospective, randomized, interventional, multicenter clinical trial.
PARTICIPANTS: We included 37 patients with DME. METHODS: Subjects with
persistent DME despite >/=1 focal/grid laser therapy were randomized 1:1 to
receive an intravitreal insertion of a 0.2- or a 0.5-mug/day insert. MAIN
OUTCOME MEASURES: The primary end point was aqueous levels of FA throughout the
study with an important secondary outcome of the change from baseline in
best-corrected visual acuity (BCVA) at month 12. RESULTS: The mean aqueous level
of FA peaked at 3.8 ng/ml at 1 week and 1 month after administration of a
0.5-mug/day insert and was 3.4 and 2.7 ng/ml 1 week and 1 month after
administration of a 0.2-mug/day insert. For both inserts, FA levels decreased
slowly thereafter and were approximately 1.5 ng/ml for each at month 12. The
mean change from baseline in BCVA was 7.5, 6.9, and 5.7 letters at months 3, 6,
and 12, respectively, after administration of a 0.5 mug/day-insert and was 5.1,
2.7, and 1.3 letters at months 3, 6, and 12, respectively, after administration
of a 0.2-mug/day insert. There was a mild increase in mean intraocular pressure
after administration of 0.5-mug/day inserts, but not after administration of
0.2-mug/day inserts. CONCLUSIONS: The FA intravitreal inserts provide excellent
sustained intraocular release of FA for >/=1 year. Although the number of
patients in this trial was small, the data suggest that the inserts provide
reduction of edema and improvement in BCVA in patients with DME with mild
effects on intraocular pressure over the span of 1 year. 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: 20202684  [PubMed - as supplied by publisher]

8: BMC Ophthalmol. 2010 Mar 2;10(1):5 [Epub ahead of print] 

Persistence on prostaglandin ocular hypotensive therapy: an assessment using
medication possession and days covered on therapy.

Reardon G, Schwartz GF, Kotak S.

ABSTRACT: BACKGROUND: Prior research has demonstrated that medication
persistence (continued acquisition of therapy over time) is far from optimal
among patients with glaucoma. The purpose of the present study was to evaluate
persistence with prostaglandin analogs among glaucoma patients in the first
therapy year using a modification of a previously published technique. METHODS:
This retrospective analysis of medical and pharmacy claims database included
treatment-naive patients dispensed bimatoprost, latanoprost, or travoprost
between 1/1/04-12/31/04. "Index agent" was defined as the first agent filled;
"index date" was defined as the fill date. Follow-up continued for 358 days.
Persistence measures for first therapy year: (1) whether last fill had
sufficient days supply to achieve medication possession at year's end, and (2)
number of days for which index agent was available (days covered). Associations
between index agent and medication possession (logistic regression) and days
covered (linear regression) were evaluated. Models were adjusted for gender,
age, and previous ocular hypertension diagnosis. RESULTS: 7873 patients met
inclusion criteria (bimatoprost, n=1464; latanoprost, n=4994; travoprost,
n=1415). Medication possession was 28% and days covered was 131 when using the
unadjusted (pharmacy-reported) days supply estimates and rose to 47-48% and days
covered to 228-236 days when days supply was imputed. Compared to latanoprost,
odds of achieving medication possession at first year's end were 26-34% lower
for bimatoprost and 34-36% lower for travoprost (p [less than or equal to]0.001
for all comparisons). Days covered in the first year were 21-29 days lower for
bimatoprost and 33-42 days lower for travoprost (p [less than or equal to]0.001
for all comparisons). Failure to refill the index agent within the initial 90
days was a strong predictor of poor persistence. CONCLUSIONS: Persistence with
ocular prostaglandin therapy remains a problem. Latanoprost users had greater
odds of achieving medication possession and had more days covered during the
first therapy year.

PMID: 20196848  [PubMed - as supplied by publisher]

9: Ophthalmology. 2010 Feb 27; [Epub ahead of print] 

Deep Lamellar Endothelial Keratoplasty Up to 5-Year Follow-up.

Mashor RS, Kaiserman I, Kumar NL, Sansanayudh W, Rootman DS.

University of Toronto, Toronto, Canada.

PURPOSE: To evaluate the outcomes of small-incision deep lamellar endothelial
keratoplasty (DLEK) for the treatment of endothelial dysfunction at up to 5
years of follow-up. DESIGN: Prospective, noncomparative case series.
PARTICIPANTS: Sixty eyes of 55 consecutive patients who had corneal edema as a
result of Fuchs' dystrophy, pseudophakic bullous keratopathy, bullous
keratopathy secondary to glaucoma tube placement, failed graft, or deep
endothelial scar. METHODS: Patients underwent DLEK surgery at the Toronto
Western Hospital. MAIN OUTCOMES MEASURES: Best spectacle-corrected visual acuity
(BSCVA), manifest refraction, corneal endothelial cell density (ECD), and
postoperative complications. RESULTS: Data were available for 57, 49, 46, 23,
and 7 eyes for examination at 1, 2, 3, 4, and 5 years, respectively. The mean
spherical equivalent and refractive astigmatism were -0.18+/-1.62 diopters (D)
and 1.67+/-1.36 D, respectively, at 1 year after surgery and remained stable at
2, 3, and 4 years after DLEK. Eliminating eyes with known significant macular or
optic nerve disease, BSCVA of 20/188.5 before surgery improved to 20/56.9 at 1
year after surgery (P = 0.0002) and remained stable with BSCVA of 20/52.3,
20/46.2, and 20/56.8 at 2, 3, and 4 years, respectively, (P = 0.59, P = 0.31, P
= 0.24, respectively). The number of patients who achieved 20/40 or better
visual acuity, increased from a preoperative level of 13.5% to 44.1%, to 40%, to
48.4%, and to 50% at 1, 2, 3, and 4 years after surgery, respectively. The mean
donor ECD before surgery was 2762+/-536 cells/mm(2) and decreased by 43% at 1
year after surgery (1604+/-787 cells/mm(2); P<0.0001), an additional yearly
decrease by 14% (1257+/- 684 cells/mm(2); P = 0.03), by 4% (1136+/-613
cells/mm(2); P = 0.41), and by 1% (1064+/-515 cells/mm(2); P = 0.68) was found
at 2, 3, and 4 years, respectively. Complications included 4 graft dislocations,
2 primary graft failures, 5 rejections, and 12 secondary failures, with 27.5%
graft failure at 4 years. CONCLUSIONS: Small-incision DLEK provides good and
stable refractive and visual outcomes. The accelerated endothelial cell loss
reported during the first 2 years after DLEK was shown to decrease and stabilize
at low rates during the longer-term follow-up, which reduces the concern about
progressive cell loss and secondary late endothelial failure. 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: 20189655  [PubMed - as supplied by publisher]

10: Ophthalmology. 2010 Feb 27; [Epub ahead of print] 

Vision-Related Function after Ranibizumab Treatment by Better- or Worse-Seeing
Eye Clinical Trial Results from MARINA and ANCHOR.

Bressler NM, Chang TS, Suner IJ, Fine JT, Dolan CM, Ward J, Ianchulev T; MARINA
and ANCHOR Research Groups.

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

OBJECTIVE: To examine the effects of ranibizumab on the National Eye Institute
Visual Function Questionnaire-25 (NEI VFQ-25) scores in neovascular age-related
macular degeneration (AMD) according to whether the study eye was the better- or
worse-seeing eye at baseline. DESIGN: Within 2 randomized, double-masked
clinical trials (MARINA and ANCHOR), the NEI VFQ-25 was administered at 0, 1, 2,
3, 6, 9, 12, 18, and 24 months. PARTICIPANTS: We included 646 MARINA and 379
ANCHOR patients. INTERVENTION: Patients were randomized 1:1:1 to monthly
intravitreal ranibizumab (0.3 or 0.5 mg) or control (sham injections for MARINA;
photodynamic therapy [PDT] with verteporfin for ANCHOR). MAIN OUTCOME MEASURE:
Mean change from baseline in NEI VFQ-25 scores at 12 and 24 months. RESULTS:
Across all treatment arms, 21% to 38% of enrolled eyes were the better-seeing
eye. At the 24-month follow-up visit, mean change in composite scores with
ranibizumab seemed to be better than control for both better-seeing eyes (8.4
[95% confidence interval (CI), 5.2-11.6], 7.5 [95% CI, 3.7-11.4], and -9.4 [95%
CI, -12.5 to -6.3] for the 0.3-mg, 0.5-mg, and sham groups, respectively) and
worse-seeing eyes (1.7 [95% CI, -1.1 to 4.4], 1.7 [95% CI, -0.7 to 4.1], and
-5.4 [95% CI, -7.9 to -2.8] for the 0.3-mg, 0.5-mg, and sham groups,
respectively) in MARINA, as well as the better-seeing eye in ANCHOR (11.3 [95%
CI, 5.3-17.3], 13.3 [95% CI, 7.7-19.0], and -2.7 [95% CI, -9.0 to 3.7] for the
0.3-mg, 0.5-mg, and PDT groups, respectively). When the worse-seeing eye was
treated in ANCHOR, such differences could not be detected at 24 months (1.3 [95%
CI, -1.7 to 4.2], 2.6 [95% CI, -1.1 to 6.3], and 0.1 [95% CI, -3.5 to 3.7] for
the 0.3-mg, 0.5-mg, and PDT groups, respectively). CONCLUSIONS: Analysis of
patient perception of vision-related function in phase III trials evaluating
ranibizumab for neovascular AMD demonstrates improved patient-reported outcomes
regardless of whether the treated eye is the better- or worse-seeing eye at
onset of treatment, and supports treatment of such lesions with ranibizumab,
even those in the worse-seeing eye. 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: 20189654  [PubMed - as supplied by publisher]

11: Ophthalmology. 2010 Feb 26; [Epub ahead of print] 

The Efficacy, Sensitivity, and Specificity of In Vivo Laser Confocal Microscopy
in the Diagnosis of Meibomian Gland Dysfunction.

Ibrahim OM, Matsumoto Y, Dogru M, Adan ES, Wakamatsu TH, Goto T, Negishi K,
Tsubota K.

Johnson & Johnson Ocular Surface and Visual Optics Department, Keio University
School of Medicine, Tokyo, Japan.; Department of Ophthalmology, Keio University
School of Medicine, Tokyo, Japan.

PURPOSE: To evaluate the efficacy, sensitivity and specificity of confocal
microscopy (CM) parameters: meibomian gland (MG) acinar longest diameter
(MGALD), MG acinar shortest diameter (MGASD), inflammatory cell density (ICD),
and MG acinar unit density (MGAUD) in the diagnosis of MG dysfunction (MGD).
DESIGN: Prospective, controlled, single-center study. PARTICIPANTS: Twenty MGD
patients (9 males, 11 females; mean age, 63.5 +/- 16.5 years) and 26 age- and
gender-matched control subjects (13 males, 13 females; mean age, 53.2 +/- 15.7
years) were recruited. METHODS: All subjects underwent slit-lamp examinations,
tear film break-up time (BUT) measurements, assessment of tear evaporation rate
from the ocular surface (TEROS), vital stainings, Schirmer test, meibography, MG
expressibility, and CM of the MG. Data were compared between the 2 groups using
the Mann-Whitney and chi-square tests. MAIN OUTCOME MEASURES: The correlation
between the clinical findings of tear functions, vital staining scores, and the
4 CM parameters were tested by Spearman's correlation coefficient by rank test.
Receiver operating characteristic curve technique was used to evaluate the
sensitivity, specificity, and cutoff values of CM parameters. RESULTS: The mean
tear film BUT, vital staining scores, TEROS values, MG expressibility, and MG
dropout grades by meibography were significantly worse in MGD patients compared
with controls (P<0.001). The mean values of the MGALD, MGASD, ICD, and MGAUD in
MGD patients were significantly worse than those observed in the controls with
CM. All CM parameters showed a strong, significant correlation with tear
functions, ocular surface vital stainings, MG expressibility, and MG dropout
grades. The cutoff values for MGALD, MGASD, ICD, and MGAUD in the diagnosis of
MGD were 65 mum, 25 mum, 300 cells/mm(2), and 70 glands/mm(2), respectively. The
sensitivity and specificity values of these parameters under these cutoff values
were 90% and 81% for MGALD, 86% and 96% for MGASD, 100% and 100% for ICD, 81%
and 81% for MGAUD. CONCLUSIONS: Confocal microscopy has the potential to
diagnose the simple MGD with high sensitivity and specificity. The CM-based
diagnostic parameters correlated significantly and strongly with the status of
the ocular surface disease. 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: 20189653  [PubMed - as supplied by publisher]

12: Ophthalmology. 2010 Feb 26; [Epub ahead of print] 

Centrifugal Fundus Abnormalities in Pseudoxanthoma Elasticum.

Issa PC, Finger RP, Gotting C, Hendig D, Holz FG, Scholl HP.

Nuffield Laboratory of Ophthalmology, University of Oxford, United Kingdom;
Department of Ophthalmology, University of Bonn, Bonn, Germany.

PURPOSE: To investigate the Bruch's membrane-retinal pigment epithelium (RPE)
complex in pseudoxanthoma elasticum (PXE) by imaging techniques capable of
visualizing deep retinal structures with high contrast. DESIGN: Prospective
cross-sectional study. PARTICIPANTS: Patients with PXE, confirmed by mutation
analysis, skin histopathologic examination, or both. METHODS: Sixteen patients
were investigated by indocyanine green (ICG) and fluorescein angiography,
confocal near-infrared reflectance (NIR), and fundus autofluorescence imaging
using a confocal scanning laser ophthalmoscope (Spectralis HRA-OCT; Heidelberg
Engineering, Heidelberg, Germany). Composite digital fundus photography also was
performed. MAIN OUTCOME MEASURES: Characterization and topographic distribution
of abnormalities detected by retinal imaging. RESULTS: On late-phase ICG
angiography, a central area of decreased fluorescence centered on the posterior
pole was a characteristic finding in all patients. A second area characterized
by increased fundus reflectivity on NIR reflectance imaging extended further
into the periphery. A third and most eccentric area showed neither decreased ICG
fluorescence nor increased fundus reflectivity. These 3 areas were separated by
2 transition zones, the second being the equivalent of peau d'orange. Angioid
streaks did not extend into the third area. CONCLUSIONS: The abnormalities
detected by this multimethod imaging approach suggest a centrifugal spread of
the retinal pathologic features of the Bruch's membrane-RPE complex in PXE.
Decreased fluorescence on late-phase ICG angiography is a consistent sign of
retinal pathologic features in PXE. Bruch's membrane calcification may be the
underlying cause for the increased reflectivity observed on NIR reflectance
imaging. 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: 20189652  [PubMed - as supplied by publisher]

13: Ophthalmology. 2010 Mar;117(3):645-6. 

Past, present, and future of ophthalmic surgery.

Bohigian G.

Publication Types:
    Comment
    Letter

PMID: 20189045  [PubMed - in process]

14: Ophthalmology. 2010 Mar;117(3):644-644.e4. 

Lacrimal canaliculus.

Kakizaki H, Asamoto K, Nakano T, Selva D, Leibovitch I.

Publication Types:
    Letter

PMID: 20189044  [PubMed - in process]
15: id: 20189043 Error occurred: The following PMID is not available: 20189043 

16: Ophthalmology. 2010 Mar;117(3):643-4. 

Melanoma, vitiligo, and uveitis.

Albert DM.

Publication Types:
    Comment
    Letter

PMID: 20189042  [PubMed - in process]
17: id: 20189041 Error occurred: The following PMID is not available: 20189041 

18: Ophthalmology. 2010 Mar;117(3):642-642.e1. 

OCT interpretations.

Keane PA, Rao NA, Sadda SR.

Publication Types:
    Comment
    Letter

PMID: 20189040  [PubMed - in process]

19: Ophthalmology. 2010 Mar;117(3):641-641.e2. 

Foreign body from an eyeglass screw.

Piven I, Ben-Simon G.

Publication Types:
    Letter

PMID: 20189039  [PubMed - in process]

20: Ophthalmology. 2010 Mar;117(3):640. 

Normal-tension glaucoma or PVL?

Brodsky MC.

Publication Types:
    Comment
    Letter

PMID: 20189038  [PubMed - in process]
21: id: 20189037 Error occurred: The following PMID is not available: 20189037 
22: id: 20189036 Error occurred: The following PMID is not available: 20189036 

23: Ophthalmology. 2010 Mar;117(3):639. 

DSAEK graft evaluation using C:P ratio.

Kymionis GD, Kontadakis GA, Yoo SH.

Publication Types:
    Comment
    Letter

PMID: 20189035  [PubMed - in process]

24: Ophthalmology. 2010 Mar;117(3):638-638.e3. 

Quality of life after limbal transplants.

Miri A, Mathew M, Dua HS.

Publication Types:
    Letter

PMID: 20189034  [PubMed - in process]

25: Ophthalmology. 2010 Mar;117(3):637.e3-4. 

Freely mobile subconjunctival cyst.

Savar A, Nakra T.

Publication Types:
    Letter

PMID: 20189033  [PubMed - in process]

26: Ophthalmology. 2010 Mar;117(3):637.e1-2. 

Merkel cell carcinoma of the conjunctiva.

Kase S, Ishijima K, Ishida S, Rao NA.

Publication Types:
    Letter

PMID: 20189032  [PubMed - in process]

27: Ophthalmology. 2010 Mar;117(3):407-8. 

A tale of two systems: health reform in China and the United States.

Congdon NG, Aung T.

Publication Types:
    Comment
    Editorial

PMID: 20189031  [PubMed - in process]

28: Ophthalmology. 2010 Feb 24; [Epub ahead of print] 

Effect of Sleeping in a Head-Up Position on Intraocular Pressure in Patients
with Glaucoma.

Buys YM, Alasbali T, Jin YP, Smith M, Gouws P, Geffen N, Flanagan JG, Shapiro
CM, Trope GE.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto,
Ontario, Canada.

PURPOSE: To determine whether a 30-degree head-up sleeping position decreases
nocturnal intraocular pressure (IOP) compared with lying flat in patients with
glaucoma. DESIGN: Prospective, nonrandomized comparative case series.
PARTICIPANTS: Seventeen eyes of 17 patients with glaucoma with controlled IOP
and new disc hemorrhage. METHODS: Patients with a new disc hemorrhage despite
well-controlled IOP were evaluated in a sleep laboratory on 2 separate nights,
the first night lying flat and the second night in a 30-degree head-up position.
Intraocular pressure and blood pressure (BP) were measured every 2 hours from 6
pm to 8 am. For the 6 pm, 8 pm, 10 pm, and 8 am measurements (awake period) the
subjects were sitting for both nights. For the midnight, 2 am, 4 am, and 6 am
measurements (sleep period), the subjects were supine for the first night and 30
degrees head up for the second night. MAIN OUTCOME MEASURE: Difference in IOP
during the sleep period (midnight to 6 am) between lying flat and 30-degree
head-up positions. RESULTS: Seventeen eyes of 17 patients were included. There
were no significant differences (P=0.68) between the 2 study visits in IOP
during the awake period (6 pm, 8 pm, 10 pm, and 8 am) when patients were sitting
upright. During the sleep period (midnight to 6 am) the mean IOP was 3.2 mmHg
lower in the 30-degree head-up position compared with the flat position (P=0.03;
95% confidence interval, 0.25-6.1 mmHg). Sixteen of 17 patients (94.1%) had
lower IOP in the 30-degree head-up position. The reduction in IOP in the
30-degree head-up position was 20% or more in 35% of patients (6/17). There were
no differences in BP or ocular perfusion pressure between the 2 positions.
CONCLUSIONS: The 30-degree head-up sleeping position lowers IOP compared with
the flat position. Although this effect varies between individual patients, mean
IOP was 20% lower in one third of patients in this series. 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: 20188421  [PubMed - as supplied by publisher]

29: Ophthalmology. 2010 Feb 24; [Epub ahead of print] 

Prevalence and Risk Factors for Primary Glaucomas in Adult Urban and Rural
Populations in the Andhra Pradesh Eye Disease Study.

Garudadri C, Senthil S, Khanna RC, Sannapaneni K, Rao HB.

L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India.

PURPOSE: To compare the prevalence of and risk factors for primary open-angle
glaucoma (POAG) and primary angle-closure glaucoma (PACG) in urban and rural
populations in the Andhra Pradesh Eye Disease Study. DESIGN: A population-based,
cross-sectional study using a stratified, random, cluster, and systematic
sampling strategy. PARTICIPANTS: Between 1996 and 2000, participants from 94
clusters in 1 urban and 3 rural areas representative of the population were
included. METHODS: We performed a detailed eye examination, including
applanation tonometry, gonioscopy, and dilated fundus evaluation after ruling
out risk of angle closure. Humphrey threshold 24-2 visual fields were performed
when indicated. MAIN OUTCOME MEASURES: Glaucoma was diagnosed and categorized
using International Society of Geographical and Epidemiological Ophthalmology
criteria. The prevalence and risk factors for POAG and PACG in subjects aged
>/=40 years were compared between the urban and rural cohorts. RESULTS: There
were 3724 subjects >/=40 years, with 934 in the urban and 2790 in the rural
cohort. The prevalence of POAG was greater in the urban compared with the rural
cohort (4% vs 1.6%; P<0.001). Age and intraocular pressure (IOP) were risk
factors for POAG in both cohorts. Blindness owing to POAG was 11.1% in the rural
and 2.7% in the urban cohort. The prevalence of PACG (1.8% vs 0.7%; P<0.01),
primary angle closure (PAC) (0.8% vs 0.2%; P = 0.02) and primary angle closure
suspect (PACS; 3.5% vs 1.5%; P<0.01) were significantly different between the
urban and rural cohorts. Increasing age was a risk factor in the urban cohort.
Intraocular pressure was a risk factor in both the populations. Blindness owing
to PACG was equal (20%) in both the populations. Female gender was a risk factor
in the rural cohort (P = 0.032). CONCLUSIONS: The prevalence of both POAG and
PACG was greater in urban than in the rural population. Intraocular pressure was
a significant risk factor for both POAG and PACG in both cohorts. Increasing age
was a significant risk factor for POAG in both cohorts and for PACG in the urban
cohort. Female gender was a risk factor for PACG in the rural cohort. There was
more blindness owing to PACG than to POAG. 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: 20188420  [PubMed - as supplied by publisher]

30: Ophthalmology. 2010 Feb 24; [Epub ahead of print] 

Marcus Gunn Jaw-Winking Synkinesis Clinical Features and Management.

Demirci H, Frueh BR, Nelson CC.

Eye Plastic, Orbital and Facial Cosmetic Surgery Service, W.K. Kellogg Eye
Center, University of Michigan, Ann Arbor, Michigan; Department of
Ophthalmology, Henry Ford Hospital, Detroit, Michigan.

OBJECTIVE: To evaluate the clinical features including eyelid excursion and
management of Marcus Gunn jaw-winking synkinesis (MGJWS). DESIGN: Observational
case series. PARTICIPANTS: Forty-eight consecutive patients with MGJWS. METHODS:
Clinical features and management of 48 patients with MGJWS were reviewed
retrospectively. Upper eyelid excursion was measured and graded. Complications
of surgical intervention were evaluated. MAIN OUTCOME MEASURES: Resolution of
MGJWS and symmetry of upper eyelids in primary position. RESULTS: Excursion of
the ptotic eyelid with jaw movement in MGJWS was graded as mild (<2 mm) in 16%
of patients, moderate (2-4 mm) in 76% of patients, and severe (>/=5 mm) in 8% of
patients. Thirty patients with moderate or severe MGJWS underwent disabling of
the involved levator muscle and bilateral or unilateral frontalis suspension and
had more than 6 months of follow-up. After a mean follow-up of 62 months, MGJWS
resolved in 29 (97%) patients and improved from 6 mm to 2 mm in 1 (3%) patient.
Relative upper eyelid height was within 1 mm in 87% of patients in primary
position and within 1 mm in 80% of patients in downgaze. Twenty-six patients had
bilateral frontalis suspension with disabling of unilateral levator muscle on
the involved side. Relative upper eyelid height was within 1 mm in 88% of
patients in the primary position and within 1 mm in 88% of patients in downgaze.
Four non-amblyopic patients had unilateral frontalis suspension with levator
muscle disabling. Relative upper eyelid height was symmetrical in 75% of the
patients in primary position and in 25% of patients in downgaze. Complications
included eyelash ptosis in 10% of the patients, loss of eyelid crease in 10%,
and entropion in 3%. CONCLUSIONS: Most of the patients with MGJWS exhibited
moderate eyelid excursion. Disabling of the involved levator muscle and
bilateral frontalis suspension and, in selected cases, disabling of the involved
levator muscle and unilateral frontalis suspension were effective in the
treatment of MGJWS. Eyelash ptosis and loss of eyelid crease were the most
common complications, each occurring in 10% of the patients. 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: 20188419  [PubMed - as supplied by publisher]