1: Ophthalmology. 2012 Jan 30; [Epub ahead of print] 

Comparative Study of Limbal Stem Cell Deficiency Diagnosis Methods: Detection of
MUC5AC mRNA and Goblet Cells in Corneal Epithelium.

Garcia I, Etxebarria J, Boto-de-Los-Bueis A, Diaz-Valle D, Rivas L,
Martinez-Soroa I, Saenz N, Lopez C, Del-Hierro-Zarzuelo A, Mendez R, Soria J,
Gonzalez N, Suarez T, Acera A.

Bioftalmik, Parque Tecnologico de Vizcaya, Vizcaya, Spain.

PURPOSE: To evaluate a limbal stem cell deficiency (LSCD) diagnosis method based
on the detection of the MUC5AC transcript by reverse transcription-polymerase
chain reaction (RT-PCR) in comparison with the standard diagnostic method based
on goblet cell detection by periodic acid-Schiff (PAS)-hematoxylin staining,
using samples obtained from corneal epithelium impression cytology (IC). DESIGN:
Transversal, comparative case series. PARTICIPANTS: We studied 59 eyes from 43
patients clinically diagnosed with LSCD. METHODS: Impression cytology was used
to gather cells from corneal and conjunctival epithelium from the same eye. The
presence of goblet cells in the cornea was determined by PAS-hematoxylin
staining, whereas the presence of the MUC5AC transcript was detected by RT-PCR
using a custom-designed primer pair. MAIN OUTCOME MEASURES: Goblet cells in the
corneal epithelium were detected by light microscopy, and the MUC5AC transcript
was detected as the corresponding PCR amplicon in agarose gels. RESULTS: Our
study included 59 corneal samples, together with their respective conjunctival
samples for RT-PCR assays. Of these, 47 samples were also available for
comparative PAS-hematoxylin staining. The MUC5AC amplicon was detected in 56 of
59 (94.9%) corneal epithelium samples. In contrast, conventional IC staining
detected goblet cells in only 17 of 47 (36.2%) samples; these were not found in
27 of 47 (57.4%) samples (negative results), and 3 of 47 (6.4%) showed
inconclusive results. CONCLUSIONS: The detection of the MUC5AC transcript in
corneal epithelium is a more sensitive method to diagnose LSCD than the
conventional PAS-hematoxylin method, although a minimum RNA concentration of 1.2
ng/mul is required for negative results to be reliable. Moreover, RT-PCR is a
highly specific and more objective technique. Overall, these findings indicate
that molecular analysis facilitates a more precise clinical diagnosis of LSCD,
thereby reducing the risk of surgical failure. FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Copyright (c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 22297031  [PubMed - as supplied by publisher]

2: Ophthalmology. 2012 Jan 30; [Epub ahead of print] 

Intraoperative Ultrasonography-Guided Positioning of Iodine 125 Plaque
Brachytherapy in the Treatment of Choroidal Melanoma.

Chang MY, Kamrava M, Demanes DJ, Leu M, Agazaryan N, Lamb J, Moral JN, Almanzor
R, McCannel TA.

Department of Ophthalmology and Jules Stein Eye Institute, University of
California, Los Angeles, Los Angeles, California.

PURPOSE: To report intraoperative ultrasonography-guided positioning of iodine
125 (I(125)) plaques for brachytherapy of choroidal melanoma as a quality
improvement measure. DESIGN: Retrospective, single-center, consecutive
case-cohort study. PARTICIPANTS: One hundred fifty consecutive patients with
choroidal melanoma. METHODS: Patients with choroidal melanoma who were treated
with I(125) plaque brachytherapy from January 2007 through January 2011 with at
least 6 months of clinical follow-up were included. MAIN OUTCOME MEASURES:
Patient and tumor characteristics at diagnosis were tabulated. The need for
plaque repositioning if intraoperative ultrasonography showed the plaque to be
either not centered on the tumor or if there was less than 1.0 mm of plaque
margin beyond the tumor border was recorded. The rate of local treatment failure
and occurrence of distant metastasis were determined. RESULTS: The average
interval from surgery to last follow-up was 21.5 months. Fifty-four (36%) of 150
patients required plaque repositioning. Of tumors located in the macula,
equator, and periphery, 15 (36.6%), 26 (36.6%), and 13 (34.2%) required
repositioning. There was no case of local treatment failure during a mean
follow-up of 21.5 months (range, 6-48 months). Clinical evidence of choroidal
melanoma metastasis developed in 9 patients. The cumulative 2-year Kaplan-Meier
rate of local treatment failure in the cohort was statistically lower compared
with the Collaborative Ocular Melanoma Study, which did not require
ultrasonography-guided plaque positioning. CONCLUSIONS: Intraoperative
ultrasonography identified the need to reposition I(125) plaques to achieve
centration and plaque margin (>1.0 mm) beyond the tumor border in 36% of eyes.
Neither tumor size nor tumor location correlated with the need to reposition the
plaque. There was no case of local treatment failure during follow-up in this
series. Correct plaque position is an essential component of quality outcomes in
brachytherapy. Intraoperative ultrasonography reduces geographic errors in
placement in eye plaque therapy and may help to reduce local treatment failure
in choroidal melanoma. FINANCIAL DISCLOSURE(S): The author(s) have no
proprietary or commercial interest in any materials discussed in this article.
Copyright (c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 22297030  [PubMed - as supplied by publisher]

3: Ophthalmology. 2012 Jan 31; [Epub ahead of print] 

Postcataract Surgery Endophthalmitis in the United States Analysis of the
Complete 2003 to 2004 Medicare Database of Cataract Surgeries.

Keay L, Gower EW, Cassard SD, Tielsch JM, Schein OD.

Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, The Johns
Hopkins University School of Medicine, Baltimore, Maryland; The George Institute
for Global Health, University of Sydney, Sydney, Australia.

OBJECTIVE: To estimate endophthalmitis incidence after cataract surgery
nationally and at the state level in 2003 and 2004 and to explore risk factors.
DESIGN: Analysis of Medicare beneficiary claims data. PARTICIPANTS: We evaluated
billed claims for cataract surgery and endophthalmitis diagnosis and treatment
for all Medicare fee-for-service beneficiaries in 2003-2004. METHODS: Cataract
surgeries were identified by procedure codes and merged with demographic
information. Cataract annual surgical volume was calculated for all surgeons.
Presumed postoperative endophthalmitis cases were identified by International
Classification of Diseases-9 Clinical Modification Codes on claims within 42
days after surgery. Endophthalmitis rates and 95% confidence intervals (CI) were
calculated at state and national levels. Logistic regression was used to
investigate the association between developing endophthalmitis and surgery
location and surgeon factors. MAIN OUTCOME MEASURES: Endophthalmitis incidence
and risk factors. RESULTS: We included 4006 cases of presumed endophthalmitis,
which occurred after 3 280 966 cataract surgeries. The national rate in 2003 was
1.33 per 1000 surgeries (95% CI, 1.27-1.38) and decreased to 1.11 per 1000 (95%
CI, 1.06-1.16) in 2004. Males (relative risk [RR], 1.23; 95% CI, 1.15-1.31),
older individuals (RR, 1.53; 95% CI, 1.38-1.69; >/=85 compared with 65-74
years), blacks (RR, 1.17; 95% CI, 1.03-1.33), and Native Americans (RR, 1.72;
95% CI, 1.07-2.77) had increased risk of disease. After adjustment, surgeries by
surgeons with low annual volume (RR, 3.80; 95% CI, 3.13-4.61 for 1-50 compared
with >/=1001 annual surgeries) and less experience (RR, 1.41; 95% CI, 1.25-1.59
for 1-10 compared with >/=30 years), and surgeries performed in 2003 (RR, 1.20;
95% CI, 1.13-1.28) had increased endophthalmitis risk. CONCLUSIONS:
Endophthalmitis rates are lower than previous yearly US estimates, but remain
higher than rates reported from a series of studies from Sweden; patient factors
or methodologic differences may contribute to differences across countries.
Patient age, gender, and race, and surgeon volume and years of experience are
important risk factors. FINANCIAL DISCLOSURE(S): The authors have no proprietary
or commercial interest in any of the materials discussed in this article.
Copyright (c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 22297029  [PubMed - as supplied by publisher]

4: Ophthalmology. 2012 Jan 31; [Epub ahead of print] 

Detection of New-Onset Choroidal Neovascularization Using Optical Coherence
Tomography The AMD DOC Study.

Do DV, Gower EW, Cassard SD, Boyer D, Bressler NM, Bressler SB, Heier JS,
Jefferys JL, Singerman LJ, Solomon SD.

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

PURPOSE: To determine the sensitivity of time domain optical coherence
tomography (OCT) in detecting conversion to neovascular age-related macular
degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV),
compared with detection using fluorescein angiography (FA) as the gold standard.
DESIGN: Prospective, multicenter, observational study. PARTICIPANTS: Individuals
aged >/=50 years with nonneovascular AMD at high risk of progressing to CNV in
the study eye and evidence of neovascular AMD in the fellow eye. METHODS: At
study entry and every 3 months through 2 years, participants underwent
best-corrected visual acuity, supervised Amsler grid testing, preferential
hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs
with FA, and OCT imaging. A central Reading Center graded all images. MAIN
OUTCOMES MEASURES: The sensitivity of OCT in detecting conversion to neovascular
AMD by 2 years, using FA as the reference standard. Secondary outcomes included
comparison of sensitivity, specificity, positive predictive value, and negative
predictive value of OCT, PHP, and supervised Amsler grid relative to FA for
detecting incident CNV. RESULTS: A total of 98 participants were enrolled; 87
(89%) of these individuals either completed the 24-month visit or exited the
study after developing CNV. Fifteen (17%) study eyes had incident CNV confirmed
on FA by the Reading Center. The sensitivity of each modality for detecting CNV
was: OCT 0.40 (95% confidence interval [CI], 0.16-0.68), supervised Amsler grid
0.42 (95% CI, 0.15-0.72), and PHP 0.50 (95% CI, 0.23-0.77). Treatment for
incident CNV was recommended by the study investigator in 13 study eyes.
Sensitivity of the testing modalities for detection of CNV in these 13 eyes was
0.69 (95% CI, 0.39-0.91) for OCT, 0.50 (95% CI, 0.19-0.81) for supervised Amsler
grid, and 0.70 (95% CI, 0.35-0.93) for PHP. Specificity of the OCT was higher
than that of the Amsler grid and PHP. CONCLUSIONS: Time-domain OCT, supervised
Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset
CNV compared with FA. Optical coherence tomography has greater specificity than
Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA
remains the best method to detect new-onset CNV. FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Copyright (c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 22297028  [PubMed - as supplied by publisher]

5: Ophthalmology. 2012 Jan 30; [Epub ahead of print] 

Enhanced Depth Imaging Optical Coherence Tomography of Choroidal Nevus in 104
Cases.

Shah SU, Kaliki S, Shields CL, Ferenczy SR, Harmon SA, Shields JA.

Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University,
Philadelphia, Pennsylvania.

PURPOSE: To describe the characteristics of choroidal nevus using the enhanced
depth imaging (EDI) feature of spectral-domain optical coherence tomography
(OCT). DESIGN: Retrospective, observational case series. PARTICIPANTS: One
hundred four eyes with choroidal nevus. METHODS: Spectral-domain EDI OCT was
performed with a Heidelberg Spectralis HRA+OCT (Heidelberg Engineering,
Heidelberg, Germany) using a custom scan acquisition protocol of up to 13 raster
lines of 9-mm scan length with automatic real-time image averaging set at 100
images. The thickness of choroidal nevus was measured by combining Heidelberg's
autosegmentation with manual segmentation. MAIN OUTCOME MEASURES: Imaging
features and thickness correlation of choroidal nevus by EDI OCT versus standard
ultrasonography. RESULTS: Of 104 eyes with choroidal nevus imaged with EDI OCT,
51 (49%) displayed image detail suitable for study. The remaining 53 cases were
suboptimal because of statistically identified factors of age older than 60
years (P = 0.027), female gender (P = 0.008), extramacular location of nevus
(P<0.001), mean distance from foveola more than 3 mm (P = 0.002), mean distance
from optic disc more than 4 mm (P<0.001), and mean maximal basal diameter more
than 5 mm (P = 0.006). Of the 51 suitable cases, mean nevus thickness was 685
mum (median, 628 mum; range, 184-1643 mum) by EDI OCT compared with 1500 mum
(median, 1500 mum; range, 1000-2700 mum) by ultrasonography. The most common EDI
OCT imaging features included partial (59%) or complete (35%) choroidal
shadowing deep to the nevus, choriocapillaris thinning overlying the nevus
(94%), retinal pigment epithelial (RPE) atrophy (43%), RPE loss (14%), RPE
nodularity (8%), photoreceptor loss (43%), inner segment-outer segment junction
(IS-OS) irregularity (37%), IS-OS loss (6%), external limiting membrane
irregularity (18%), outer nuclear and outer plexiform layer irregularity (8%),
and inner nuclear layer irregularity (6%). Overlying subretinal fluid was
identified by EDI OCT (16%), ophthalmoscopic examination (8%), and
ultrasonographic evaluation (0%). A comparison of pigmented versus nonpigmented
nevus showed only 1 significant difference of more intense choroidal shadowing
with pigmented nevus (P = 0.046). CONCLUSIONS: Imaging of choroidal nevus with
EDI OCT enables precise measurement of tumor thickness with comparatively
reduced thickness relative to ultrasonography. Using EDI OCT, 94% of choroidal
nevi were found to have overlying choriocapillaris thinning. FINANCIAL
DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any
materials discussed in this article. Copyright (c) 2012 American Academy of
Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22297027  [PubMed - as supplied by publisher]

6: Ophthalmology. 2012 Jan 24; [Epub ahead of print] 

Immunocytochemical Diagnosis as Inflammation by Vitrectomy Cell Blocks in
Patients with Vitreous Opacity.

Matsuo T, Ichimura K.

Department of Ophthalmology, Okayama University Medical School and Okayama
University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences,
Okayama City, Japan.

PURPOSE: To describe the clinical and cytopathologic characteristics in patients
with vitreous opacity of unknown cause or preceding inflammation, diagnosed
cytopathologically as inflammation. DESIGN: Retrospective case series.
PARTICIPANTS: Forty-three consecutive patients (61 eyes) who underwent
vitrectomy for vitreous opacity of unknown cause or preceding inflammation and
were diagnosed cytopathologically with inflammation at one institution in 6
years from 2005 to 2010. During the same period, 11 consecutive patients with
vitreous opacity of unknown cause were diagnosed cytopathologically with
lymphoma (large B-cell lymphoma) and were excluded from the study. METHODS: Cell
blocks were made by centrifugation of vitrectomy fluid and embedded in paraffin
for immunocytochemistry. MAIN OUTCOME MEASURES: Cytopathologic and
immunocytochemical diagnosis using vitrectomy cell blocks. RESULTS: Histiocytes
(macrophages), small lymphocytes, neutrophils, and eosinophils were predominant
cells, with no atypical large cells on hematoxylin-eosin staining.
Immunocytochemically, most predominant cells were CD68-positive histiocytes
(macrophages), followed by CD3-positive T cells, but CD20- or CD79a-positive B
cells were rarely present. Epithelioid cells, positive for CD68, were found in 4
patients with or without an established diagnosis of sarcoidosis, and giant
multinucleated cells were found in 2 patients with suspected preceding
self-limiting Vogt-Koyanagi-Harada disease, based on the presence of depigmented
red fundi. Inflammation was diagnosed in 2 patients with vitreous opacity who
had a preceding onset of brain lymphoma or systemic lymphoma. CONCLUSIONS: The
presence of macrophages, combined with small T lymphocytes, was a major sign in
intravitreal inflammation, manifesting as vitreous opacity. A simple technique
of cytopathology and immunocytochemistry, using vitrectomy cell blocks, can be
performed in most pathology laboratories. FINANCIAL DISCLOSURE(S): The author(s)
have no proprietary or commercial interest in any materials discussed in this
article. Copyright (c) 2012 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 22281090  [PubMed - as supplied by publisher]

7: Ophthalmology. 2012 Jan 24; [Epub ahead of print] 

Choroidal Thickness and Volume Mapping by a Six Radial Scan Protocol on
Spectral-Domain Optical Coherence Tomography.

Shin JW, Shin YU, Lee BR.

Department of Ophthalmology, Hanyang University College of Medicine, Seoul,
Korea.

PURPOSE: To report a 6 radial scan protocol, which simply generates a
topographic map of choroidal thickness and volume on a commercial
spectral-domain optical coherence tomography (SD-OCT) device. We analyzed the
features of the resulting choroidal maps in healthy eyes. DESIGN: Prospective,
noncomparative case series. PARTICIPANTS: Eighty eyes from 40 healthy volunteers
who visited the healthcare clinic of Hanyang University Hospital from December
2010 to February 2011. METHODS: All participants underwent a 6 radial scanning
protocol using an SD-OCT device. In a single session, the device produces 6
high-resolution averaging B-scan images. For segmentation of the choroid layer,
the reference lines of the retinal boundary (internal limiting membrane-retinal
pigment epithelium) were adjusted to the choroidal boundary (retinal pigment
epithelium-choroid/sclera junction) in each of the 6 radial B-scans. A
topographic map of choroidal thickness and volume was automatically generated by
built-in software according to the Early Treatment Diabetic Retinopathy Study
(ETDRS) layout. A statistical analysis was conducted to compare the choroidal
thickness and volume measurements for each ETDRS subfield. MAIN OUTCOME
MEASURES: An ETDRS-style topographic map of choroidal thickness and volume.
RESULTS: The mean time required for segmentation adjustment was 167.4+/-15.8
seconds. The mean choroidal thickness of all ETDRS subfields was 285.9+/-53.0
mum, and the mean total choroidal volume of the entire ETDRS area was 7.72+/-1.2
mm(3). The nasal outer macula area was significantly smaller than any other
ETDRS subfield (P<0.05) except for the adjacent superior and inferior outer
macula subfields. Refractive error was correlated with choroidal thickness in
all ETDRS subfields. Age was also correlated with choroidal thickness for almost
all of the ETDRS subfields except for the temporal inner, nasal outer, and
temporal outer macula areas. The total choroidal volume was correlated with the
refractive error and age. CONCLUSIONS: A 6 radial scan protocol, using a
commercial SD-OCT device, enables the production of reliable choroidal thickness
and volume maps with an ETDRS layout. By using this protocol, more comprehensive
choroidal evaluation is possible in clinical practice or research. FINANCIAL
DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any
materials discussed in this article. Copyright (c) 2012 American Academy of
Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22281089  [PubMed - as supplied by publisher]

8: Ophthalmology. 2012 Jan 24; [Epub ahead of print] 

Clinicopathologic and Molecular Analysis of a Choroidal Pigmented Schwannoma in
the Context of a PTEN Hamartoma Tumor Syndrome.

Venturini G, Moulin AP, Deprez M, Uffer S, Bottani A, Zografos L, Rivolta C.

Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland.

PURPOSE: To report the first case of choroidal schwannoma in a patient affected
by PTEN hamartoma tumor syndrome (PHTS) and investigate the molecular
involvement of the phosphatase and tensin homolog (PTEN) and neurofibromin 2
(NF2) genes in this rare intraocular tumor. DESIGN: Observational case report.
PARTICIPANT: A 10-year-old girl diagnosed with PHTS. METHODS: The enucleated
specimen underwent histologic, immunohistochemical, and transmission electronic
microscopy. The expression of PTEN and NF2 and their protein products were
evaluated by reverse transcription-polymerase chain reaction and
immunohistochemistry. Somatic mutations of PTEN and NF2, as well as allelic
loss, were investigated by direct sequencing of DNA extracted from the tumor.
PTEN epigenetic silencing was investigated by pyrosequencing. MAIN OUTCOME
MEASURES: Histopathologic and molecular characterization of a choroidal
pigmented schwannoma. RESULTS: Histopathologic, immunohistochemical, and
electron microscopic analysis demonstrated features consistent with a pigmented
cellular schwannoma of the choroid. We found no loss of heterozygosity at the
genomic level for the PTEN germline mutation and no promoter hypermethylation or
other somatic intragenic mutations. However, we observed an approximate 40%
reduction of PTEN expression at both the mRNA and the protein level, indicating
that the tumor was nonetheless functionally deficient for PTEN. Although DNA
sequencing of NF2 failed to identify any pathologic variants, its expression was
abolished within the tumor. CONCLUSIONS: We report the first description of a
pigmented choroidal schwannoma in the context of a PHTS. This rare tumor showed
a unique combination of reduction of PTEN and absence of NF2 expression.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial
interest in any materials discussed in this article. Copyright (c) 2012 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22281088  [PubMed - as supplied by publisher]

9: BMC Ophthalmol. 2012 Jan 24;12(1):2 [Epub ahead of print] 

Results at seven years after the use of Intracamerular cefazolin as an
endophthalmitis prophylaxis in cataract surgery.

Romero-Aroca P, Mendez-Marin I, Salvat-Serra M, Fernandez-Ballart J,
Almena-Garcia M, Reyes-Torres J.

ABSTRACT:  BACKGROUND: To evaluate results after seven years using prophylactic
intracameral cefazolin for the prevention of endophthalmitis in cataract
surgery.  METHODS: A prospective, observational study of all patients submitted
to cataract surgery over the period January 1996 to December 2009. All cases of
postoperative endophthalmitis over that period were reviewed. The patients were
classified in two groups: Group 1 (11,696 patients) operated on between January
1996 and December 2002, Group 2 (13,305 patients) between January 2003 and
December 2009 (in whom a 1mg/0.1 bolus of intracameral cefazolin was instilled).
RESULTS: During the study period, 76 cases of endophthalmitis were observed in
Group 1, and seven in Group 2. The rate of postoperative endophthalmitis reduced
from 0.63% to 0.05% with a cefazolin injection.  The relative risk (RR) for
endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84,
p<0.001]. CONCLUSIONS: An intracameral bolus injection of cefazolin (1mg in 0.1
ml solution) at the conclusion of the cataract surgery significantly reduced the
rate of postoperative endophthalmitis.

PMID: 22272570  [PubMed - as supplied by publisher]

10: Ophthalmology. 2012 Jan 20; [Epub ahead of print] 

Integrating Event- and Trend-Based Analyses to Improve Detection of Glaucomatous
Visual Field Progression.

Medeiros FA, Weinreb RN, Moore G, Liebmann JM, Girkin CA, Zangwill LM.

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

PURPOSE: To present and evaluate a new method of integrating event- and
trend-based analyses of visual field progression in glaucoma. DESIGN:
Observational cohort study. PARTICIPANTS: The study included 711 eyes of 357
glaucoma patients or suspects followed up for an average of 5.0+/-2.0 years with
an average of 7.7+/-2.3 standard automated perimetry visual fields. An
additional group of 55 eyes of 55 glaucoma patients underwent repeated tests
over a short period to test the specificity of the method. METHODS: Event-based
analysis of progression was performed using the Guided Progression Analysis
(GPA; Carl-Zeiss Meditec, Inc., Dublin, CA). Trend-based assessment used the
visual field index (VFI). A hierarchical Bayesian model was built to incorporate
results from the GPA in the prior distribution for the VFI slopes, allowing the
event-based method to influence the inferences made for the trend-based
assessment. MAIN OUTCOME MEASURES: The Bayesian method was compared with the
conventional ordinary least squares (OLS) regression method of trend-based
assessment. RESULTS: Of the 711 eyes followed up over time, 64 (9%) had
confirmed progression with GPA. Bayesian slopes of VFI change were able to
detect 63 of these eyes (98%). An additional group of 49 eyes (7%) had
progression by Bayesian slopes, but not by GPA. Slopes of VFI change calculated
by the OLS method were able to identify only 32 of the 64 eyes (50%) with GPA
progression. The agreement with GPA was significantly better for the Bayesian
compared with the OLS method (kappa = 0.68 vs. 0.43, respectively; P<0.001).
Eyes progressing only by the Bayesian method had faster rates of change than
those progressing only by the OLS method. When applied to the 50 eyes in the
stable glaucoma group, both the Bayesian and the OLS methods had a specificity
of 96%. CONCLUSIONS: A Bayesian hierarchical modeling approach for integrating
event- and trend-based assessments of visual field progression performed better
than either method used alone. Estimates of rates of change obtained from the
Bayesian model had increased precision and may be superior to the conventional
OLS method for providing information on the risk of development of functional
impairment in the disease. FINANCIAL DISCLOSURE(S): Proprietary or commercial
disclosure may be found after the references. Copyright (c) 2012 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22266109  [PubMed - as supplied by publisher]

11: Ophthalmology. 2012 Jan 23; [Epub ahead of print] 

Infectious Endophthalmitis in Adult Eyes Receiving Boston Type I
Keratoprosthesis.

Ramchandran RS, Diloreto DA Jr, Chung MM, Kleinman DM, Plotnik RP, Graman P,
Aquavella JV.

Flaum Eye Institute, Department of Ophthalmology, University of Rochester School
of Medicine and Dentistry, Rochester, New York.

PURPOSE: To report the clinical characteristics of infectious endophthalmitis
after Boston type I keratoprosthesis (K-Pro) implantation. DESIGN: Retrospective
study. PARTICIPANTS: One hundred forty-one adult eyes receiving a K-Pro at a
single institution from May 2004 through July 2008. METHODS: A retrospective
chart review was performed of all adult eyes receiving a K-Pro at the University
of Rochester from May 2004 through July 2008. Those patients identified as
having been treated for exogenous bacterial endophthalmitis were reviewed for
demographic data, indication for K-Pro, bandage contact lens use, prophylactic
antibiotic use, timing and clinical presentation of endophthalmitis, gram stain
and culture results of intraocular fluid, timing and presentation of any
subsequent episodes of endophthalmitis (recurrent endophthalmitis), and
preoperative and postoperative visual acuity through August 2010. MAIN OUTCOME
MEASURES: Incidence of endophthalmitis, time to occurrence, recurrence rates,
visual outcomes, and risk factors associated with K-Pro endophthalmitis.
RESULTS: Ten (7.1%) of 141 eyes of 130 adult patients were diagnosed and treated
for bacterial endophthalmitis. Average time to endophthalmitis developing after
K-Pro was 9.8 months (standard deviation [SD], 6.2 months; range, 2-25 months).
Coagulase-negative staphylococci were identified in 7 eyes. In 7 of the 10 eyes,
recurrent endophthalmitis developed that occurred at a mean of 4 months (SD, 3.9
months; range, 1-13 months) after resolution of the initial episode. At each
episode of endophthalmitis, no eye was receiving vancomycin ophthalmic drops and
most eyes were receiving only fluoroquinolone ophthalmic drops for prophylaxis.
CONCLUSIONS: Infectious endophthalmitis after K-Pro implantation has a higher
incidence, delayed onset, and high risk for recurrence compared with
postoperative endophthalmitis associated with more common intraocular procedures
such as cataract surgery. The concurrent use of topical vancomycin is
recommended because it seems to be important in reducing the incidence and
recurrence of endophthalmitis and because fluoroquinolone ophthalmic drops do
not seem to be sufficient prophylaxis in these eyes. FINANCIAL DISCLOSURE(S):
The author(s) have no proprietary or commercial interest in any materials
discussed in this article. Copyright (c) 2012 American Academy of Ophthalmology.
Published by Elsevier Inc. All rights reserved.

PMID: 22266108  [PubMed - as supplied by publisher]

12: Ophthalmology. 2012 Jan 18; [Epub ahead of print] 

Clinical Course, Genetic Etiology, and Visual Outcome in Cone and Cone-Rod
Dystrophy.

Thiadens AA, Phan TM, Zekveld-Vroon RC, Leroy BP, van den Born LI, Hoyng CB,
Klaver CC; Writing Committee for the Cone Disorders Study Group Consortium:;
Roosing S, Pott JW, Schooneveld MJ, Moll-Ramirez NV, Genderen MM, Boon CJ,
Hollander AI, Bergen AA, Baere ED, Cremers FP, Lotery AJ.

Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands;
Department of Human Genetics, Radboud University Nijmegen Medical Center,
Nijmegen, The Netherlands.

OBJECTIVE: To evaluate the clinical course, genetic etiology, and visual
prognosis in patients with cone dystrophy (CD) and cone-rod dystrophy (CRD).
DESIGN: Clinic-based, longitudinal, multicenter study. PARTICIPANTS: Consecutive
probands with CD (N = 98), CRD (N = 83), and affected relatives (N = 41 and N =
17, respectively) from various ophthalmogenetic clinics in The Netherlands,
Belgium, and the United Kingdom. METHODS: Data on best-corrected Snellen visual
acuity, color vision, ophthalmoscopy, fundus photography, Goldmann perimetry,
and full-field standard electroretinogram (ERG) from all patients were
registered from medical charts over a mean follow-up of 19 years. The ABCA4,
CNGB3, KCNV2, PDE6C, and RPGR genes were analyzed by direct sequencing in
autosomal recessive (AR) and X-linked (XL), respectively. Genotyping was not
undertaken for autosomal-dominant cases. MAIN OUTCOME MEASURES: The 10-year
progression of all clinical parameters and cumulative lifetime risk of low
vision and legal blindness were assessed. RESULTS: The mean age onset for CD was
16 years (standard deviation, 11), and of CRD 12 years (standard deviation, 11;
P = 0.02). The pattern of inheritance was AR in 92% of CD and 90% of CRD. Ten
years after diagnosis, 35% of CD and 51% of CRD had a bull's eye maculopathy;
70% of CRD showed absolute peripheral visual field defects and 37% of CD
developed rod involvement on ERG. The mean age of legal blindness was 48
(standard error [SE], 3.1) years in CD, and 35 (SE, 1.1; P<0.001) years in CRD.
ABCA4 mutations were found in 8 of 90 (9%) of AR-CD, and in 17 of 65 (26%) of
AR-CRD. Other mutations were detected in CNGB3 (3/90; 3%), KCNV2 (4/90; 4%), and
in PDE6C (1/90; 1%). The RPGR gene was mutated in the 2 XL-CD and in 4 of 5
(80%) of XL-CRD. ABCA4 mutations as well as age of onset <20 years were
significantly associated with a faster progression to legal blindness (P<0.001).
CONCLUSIONS: Although CD had a slightly more favorable clinical course than CRD,
both disorders progressed to legal blindness in the majority of patients.
Mutations in the ABCA4 gene and early onset of disease were independent
prognostic parameters for visual loss. Our data may serve as an aid in
counseling patients with progressive cone disorders. FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Copyright (c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 22264887  [PubMed - as supplied by publisher]

13: Ophthalmology. 2012 Jan 18; [Epub ahead of print] 

Retinal Nerve Fiber Layer Imaging with Spectral-Domain Optical Coherence
Tomography A Prospective Analysis of Age-Related Loss.

Leung CK, Yu M, Weinreb RN, Ye C, Liu S, Lai G, Lam DS.

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong
Kong, Hong Kong, P. R. China.

OBJECTIVE: To investigate age-related changes of the retinal nerve fiber layer
(RNFL) imaged by a spectral-domain optical coherence tomography (OCT). DESIGN:
Prospective, cross-sectional, and longitudinal studies. PARTICIPANTS: One
hundred normal individuals were recruited for cross-sectional analysis, 35 of
whom were randomly selected for longitudinal analysis. METHODS: The
circumpapillary average and quadrant RNFL thicknesses were measured by the
Cirrus HD-OCT. In the longitudinal study, participants were followed at 4-month
intervals for a mean of 30 months (range, 24-41 months) for RNFL and visual
field measurements. Cross-sectional RNFL data were analyzed with multiple linear
regression models with adjustment of spherical error, optic disc area, and
signal strength. Longitudinal RNFL measurements were analyzed with linear mixed
models with fixed coefficients on follow-up duration, baseline RNFL thickness,
spherical error, optic disc area, and signal strength. Factors influencing the
rate of change of RNFL measurements were analyzed in the interaction terms with
"duration" in the linear mixed models. MAIN OUTCOME MEASURES: Rates of change of
average and quadrant RNFL thicknesses. RESULTS: In the cross-sectional analysis,
significant negative correlations were found between age and average (-0.33
mum/year; P = 0.011), inferior (-0.45 mum/year; P = 0.037), and temporal (-0.31
mum/year; P = 0.046) RNFL thicknesses. In the longitudinal analysis, the mean
rates of change of average, superior, and inferior RNFL thicknesses were -0.52
(95% confidence interval [CI], -0.86 to -0.17), -1.35 (95% CI, -2.05 to -0.65)
and -1.25 mum/year (95% CI, -1.78 to -0.71), respectively, after adjusting for
baseline RNFL thickness, spherical error, disc area, and signal strength. There
was no detectable RNFL reduction in the nasal and temporal quadrants. The only
significant factor influencing the rates of change of RNFL measurements was the
baseline RNFL thickness. A greater baseline RNFL thickness was associated with a
faster rate of change. CONCLUSIONS: Progressive, age-related decline of RNFL
thickness can be detected with longitudinal OCT imaging. Rate estimates derived
from trend analysis for detection of glaucomatous RNFL progression should be
interpreted with reference to the normal ranges of age-related reduction,
particularly when the baseline RNFL measurement is large. FINANCIAL
DISCLOSURE(S): Proprietary or commercial disclosure may be found after the
references. Copyright (c) 2012 American Academy of Ophthalmology. Published by
Elsevier Inc. All rights reserved.

PMID: 22264886  [PubMed - as supplied by publisher]

14: Ophthalmology. 2012 Jan 18; [Epub ahead of print] 

Efficacy and Safety of Long-term Corticosteroid Eye Drops after Penetrating
Keratoplasty A Prospective, Randomized, Clinical Trial.

Shimazaki J, Iseda A, Satake Y, Shimazaki-Den S.

Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital,
Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine,
Tokyo, Japan.

PURPOSE: Endothelial rejection remains a major cause of graft failure after
penetrating keratoplasty (PKP). Topical corticosteroids are the gold standard
for preventing rejection; however, protocols for corticosteroid treatment have
been diverse. The aim of the present study was to examine the efficacy and
safety of long-term use of corticosteroid eye drops after PKP in a randomized,
clinical trial. DESIGN: Randomized, nonblinded, clinical trial. PARTICIPANTS: We
enrolled 42 patients (21 males and 21 females) with a mean age of 65.3 years who
underwent PKP and maintained graft clarity for >1 year with topical steroid eye
drops. INTERVENTION: Patients were randomly assigned to 1 of 2 groups:
Administration of 0.1% fluorometholone 3 times a day (steroid group) or
discontinuation of steroid eye drops (no steroid group). All patients were
followed for 12 months. MAIN OUTCOME MEASURES: Proportion of eyes without
endothelial rejection and the proportion of eyes with clear grafts and the
incidence of local or systemic side effects. RESULTS: Of the initial 42
patients, 4 in the steroid group and 6 in the no steroid group did not complete
the trial. Of the patients who completed the trial, 1 patient in the steroid
group and 6 in the no steroid group developed endothelial rejection at an
average of 5.2+/-4.5 (mean +/- standard deviation) months after study
enrollment. The difference in the incidence of rejection between groups was
found to be significant by both chi-square (P = 0.027) and Kaplan-Meier analyses
(log-rank test, P = 0.032). No difference was observed between the 2 groups in
visual acuity, intraocular pressure, epithelial damage, tear-film break-up time,
cataract progression, infection, or incidence of systemic side effects.
CONCLUSIONS: Prolonged use of 0.1% fluorometholone was beneficial for the
prevention of rejection after PKP. Because no adverse consequences were noted,
we recommend continuing use of the low-dose corticosteroids, even in
non-high-risk cases. FINANCIAL DISCLOSURE(S): The authors have no proprietary or
commercial interest in any of the materials discussed in this article. Copyright
(c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All
rights reserved.

PMID: 22264885  [PubMed - as supplied by publisher]

15: Ophthalmology. 2012 Jan 18; [Epub ahead of print] 

Blepharospasm and Apraxia of Eyelid Opening Associated with Anti-Hu
Paraneoplastic Antibodies A Case Report.

Choe CH, Gausas RE.

Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania
School of Medicine, Philadelphia, Pennsylvania.

PURPOSE: To report a case of blepharospasm associated with anti-Hu
paraneoplastic antibodies that was treated successfully with botulinum toxin A.
DESIGN: Case report. PARTICIPANTS: A 57-year-old man had altered mental status
and a 20-pound weight loss at presentation. Evaluation revealed an occult
small-cell lung cancer. Despite initiating appropriate chemotherapy, his mental
status worsened and over the course of several weeks, he was unable to open his
eyes because of forceful orbicularis contractions. Neuroimaging and
cerebrospinal fluid studies found no evidence of intracranial metastases.
However, his paraneoplastic panel was positive for anti-Hu antibodies. He was
diagnosed with paraneoplastic encephalitis and blepharospasm. INTERVENTION:
Intravenous Solu-Medrol (Pharmacia & Upjohn, Co, Bridgewater, NJ) and periocular
injections of botulinum toxin A. MAIN OUTCOME MEASURES: Ocular disease control.
RESULTS: Intravenous Solu-Medrol improved his mental status, but did not change
his ocular symptoms. Subsequent botulinum toxin A injections allowed spontaneous
eyelid opening. CONCLUSIONS: Although paraneoplastic blepharospasm is rare, it
is an important diagnosis to be aware of because paraneoplastic disorders often
herald an occult tumor. This is the only case of paraneoplastic blepharospasm
that the authors know of that was the result of anti-Hu antibodies as well as
the only case that was treated with botulinum toxin A. FINANCIAL DISCLOSURE(S):
The author(s) have no proprietary or commercial interest in any materials
discussed in this article. Copyright (c) 2012 American Academy of Ophthalmology.
Published by Elsevier Inc. All rights reserved.

PMID: 22264884  [PubMed - as supplied by publisher]

16: BMC Ophthalmol. 2012 Jan 18;12(1):1 [Epub ahead of print] 

The improving outcomes in intermittent exotropia study: outcomes at 2 years
after diagnosis in an observational cohort.

Buck D, Powell CJ, Rahi J, Cumberland P, Tiffin P, Taylor R, Sloper J, Davis H,
Dawson E, Clarke MP.

ABSTRACT:  BACKGROUND: The purpose of this study was to investigate current
patterns of management and outcomes of intermittent distance exotropia [X(T)] in
the UK. METHODS: This was an observational cohort study which recruited 460
children aged <12 years with previously untreated X(T).  Eligible subjects were
enrolled from 26 UK hospital ophthalmology clinics between May 2005 and December
2006.  Over a 2-year period of follow-up, clinical data were prospectively
recorded at standard intervals from enrolment. Data collected included angle,
near stereoacuity, visual acuity, control of X(T) measured with the Newcastle
Control Score (NCS), and treatment.  The main outcome measures were change in
clinical outcomes (angle, stereoacuity, visual acuity and NCS) in treated and
untreated X(T), 2 years from enrolment (or, where applicable, 6 months after
surgery).  Change over time was tested using the chi-square test for
categorical, Wilcoxon test for non-parametric and paired-samples t-test for
parametric data. RESULTS: At follow-up, data were available for 371 children
(81% of the original cohort). Of these: 53% (195) had no treatment;  17% (63)
had treatment for reduced visual acuity only (pure refractive error and
amblyopia); 13% (50) had non surgical treatment for control (spectacle lenses,
occlusion, prisms, exercises) and 17% (63) had surgery. Only 0.5% (2/371)
children developed constant exotropia. The surgically treated group was the only
group with clinically significant improvements in angle or NCS.  However, 8% (5)
of those treated surgically required second procedures for overcorrection within
6 months of the initial procedure and at 6-month follow-up 21% (13) were
overcorrected. CONCLUSIONS: Many children in the UK with X(T) receive active
monitoring only. Deterioration to constant exotropia, with or without treatment,
is rare. Surgery appears effective in improving angle of X(T) and NCS, but rates
of overcorrection are high.

PMID: 22257496  [PubMed - as supplied by publisher]

17: Ophthalmology. 2012 Jan 13; [Epub ahead of print] 

Epidemiologic Characteristics of Intraocular Pressure in the Korean and
Mongolian Populations: The Healthy Twin and the GENDISCAN Study.

Lee MK, Cho SI, Kim H, Song YM, Lee K, Kim JI, Kim DM, Chung TY, Kim YS, Seo JS,
Ham DI, Sung J.

Department of Epidemiology and Institute of Environment and Health, School of
Public Health, Seoul National University, Seoul, Korea.

PURPOSE: The purpose of this study was to demonstrate a negative association
between intraocular pressure (IOP) and age in 2 Asian populations. In addition,
we evaluated genetic and nongenetic factors associated with IOP. DESIGN:
Family-based cohort study. PARTICIPANTS: Study subjects >10 years of age from
one Korean (The Healthy Twin; n = 1431) and 2 Mongolian populations (The
GENDISCAN; n = 859 and 806) with IOP values. METHODS: The IOP values were
measured with a noncontact tonometer. Each participant received a standard
health examination and received questionnaires, which include candidate risk
factors on IOP. Mixed models were used to identify risk factors for IOP.
Variance-component methods were applied to estimate the heritability of IOP.
MAIN OUTCOME MEASURES: The negative trend of IOP with aging and evaluation of
impact of genetic and nongenetic components on IOP. RESULTS: The mean ages were
43.6, 34.1, and 36.3 years for the Korean, Orhontuul, and Dashbalbar
populations, respectively. The mean IOPs were 14.4 mmHg (95% confidence interval
[CI], 14.3-14.6) in the Koreans and 14.1 mmHg (95% CI, 13.9-14.3) and 12.6 mmHg
(95% CI, 12.4-12.9) in the Orhontuul and Dashbalbar populations, respectively.
In the 3 populations, the IOP decreased as age increased. We replicated an
association of systolic blood pressure (SBP) with IOP. In addition, components
of the metabolic syndrome (MS), such as plasma glucose, lipid level, and body
mass index, showed positive associations with IOP, after adjusting for age and
SBP. The IOP also had strong genetic contributions in all populations
(heritability, 0.47-0.51). CONCLUSIONS: Negative associations between age and
IOP were observed in all 3 populations, which cannot be explained by the
increasing prevalence of myopia in the younger generation. The different age
trend in IOP may in part be responsible for differences in the prevalence of
glaucoma subtypes. Our findings suggest that associations between IOP and MS
components were independent of established risk factors such as SBP or age. In
addition, the importance of inherited risks requires further genetic dissection
of IOP determinants for biological understandings of underlying pathophysiology.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest
in any materials discussed in this article. Copyright (c) 2011 American Academy
of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22244945  [PubMed - as supplied by publisher]

18: Ophthalmology. 2012 Jan 13; [Epub ahead of print] 

Outcomes and Bleb-Related Complications of Trabeculectomy.

Jampel HD, Solus JF, Tracey PA, Gilbert DL, Loyd TL, Jefferys JL, Quigley HA.

Glaucoma Service and Dana Center for Preventive Ophthalmology, Wilmer
Ophthalmological Institute, Johns Hopkins University School of Medicine,
Baltimore, Maryland.

PURPOSE: To determine rates of success and complications of trabeculectomy
surgery. DESIGN: Case series. PARTICIPANTS: Consecutive patients undergoing
trabeculectomy by 2 surgeons between May 2000 and October 2008. INTERVENTION: By
using the Wilmer Institute's billing database, we identified all patients at
least 12 years of age coded as having undergone trabeculectomy between May 2000
and October 2008 by 1 of 2 glaucoma surgeons and whose surgery was not combined
with another operation. From the chart, we abstracted demographic information on
the patients and clinical characteristics of the eyes. The Kaplan-Meier
product-limit method and Cox proportional hazard models were used to look at
success rates and characteristics associated with inadequate intraocular
pressure (IOP) reduction. Complications were tabulated. MAIN OUTCOME MEASURES:
(1) Success rate of trabeculectomy, as determined by the achievement of each of
4 different IOP goals, with or without IOP-lowering medications; and (2)
incidence of surgical complications. RESULTS: During the study period, 797 eyes
of 634 persons underwent trabeculectomy without concurrent surgery. The success
rates 4 years after surgery, with or without the use of IOP-lowering eye drops,
were 70%, 72%, 60%, and 44%, for achievement of target IOP, /=20% IOP reduction, /=25% reduction, and /=30%
reduction, respectively. Increased chance of success was associated with
European-derived race; use of mitomycin C (MMC); higher concentrations of MMC,
when used; and higher preoperative IOP. Age and previous intraocular surgery
were not associated with surgical success. Complications included worsening lens
opacity in 242 of 443 phakic eyes (55%), loss of >/=3 lines of acuity (Snellen)
in 161 eyes (21%), surgery for bleb-related problems in 70 eyes (8.8%), and
infection occurring >6 weeks after surgery in 27 eyes (3.4%). A total of 101
eyes of 94 patients had at least 1 subsequent operation for inadequate IOP
control. CONCLUSIONS: Trabeculectomy surgery performed by 2 experienced glaucoma
specialists achieved target IOP at 4 years in 70% of those operated and was
associated with progressive cataract and small risks of bleb-related
complications. These results are comparable to those reported in smaller series.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial
interest in any materials discussed in this article. Copyright (c) 2012 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22244944  [PubMed - as supplied by publisher]

19: Ophthalmology. 2012 Jan 11; [Epub ahead of print] 

Interim Results from the International Trial of Second Sight's Visual
Prosthesis.

Humayun MS, Dorn JD, da Cruz L, Dagnelie G, Sahel JA, Stanga PE, Cideciyan AV,
Duncan JL, Eliott D, Filley E, Ho AC, Santos A, Safran AB, Arditi A, Del Priore
LV, Greenberg RJ.

Doheny Eye Institute, University of Southern California, Los Angeles,
California.

PURPOSE: This study evaluated the Argus II Retinal Prosthesis System (Second
Sight Medical Products, Inc., Sylmar, CA) in blind subjects with severe outer
retinal degeneration. DESIGN: Single-arm, prospective, multicenter clinical
trial. PARTICIPANTS: Thirty subjects were enrolled in the United States and
Europe between June 6, 2007, and August 11, 2009. All subjects were followed up
for a minimum of 6 months and up to 2.7 years. METHODS: The electronic
stimulator and antenna of the implant were sutured onto the sclera using an
encircling silicone band. Next, a pars plana vitrectomy was performed, and the
electrode array and cable were introduced into the eye via a pars plana
sclerotomy. The microelectrode array then was tacked to the epiretinal surface.
MAIN OUTCOME MEASURES: The primary safety end points for the trial were the
number, severity, and relation of adverse events. Principal performance end
points were assessments of visual function as well as performance on orientation
and mobility tasks. RESULTS: Subjects performed statistically better with the
system on versus off in the following tasks: object localization (96% of
subjects), motion discrimination (57%), and discrimination of oriented gratings
(23%). The best recorded visual acuity to date is 20/1260. Subjects' mean
performance on orientation and mobility tasks was significantly better when the
system was on versus off. Seventy percent of the patients did not have any
serious adverse events (SAEs). The most common SAE reported was either
conjunctival erosion or dehiscence over the extraocular implant and was treated
successfully in all subjects except in one, who required explantation of the
device without further complications. CONCLUSIONS: The long-term safety results
of Second Sight's retinal prosthesis system are acceptable, and most subjects
with profound visual loss perform better on visual tasks with system than
without it. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be
found after the references. Copyright (c) 2011 American Academy of
Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22244176  [PubMed - as supplied by publisher]

20: Ophthalmology. 2012 Jan 7; [Epub ahead of print] 

Comparison of Limbus-Based and Fornix-Based Trabeculectomy: Success,
Bleb-Related Complications, and Bleb Morphology.

Solus JF, Jampel HD, Tracey PA, Gilbert DL, Loyd TL, Jefferys JL, Quigley HA.

Glaucoma Service and Dana Center for Preventive Ophthalmology, Wilmer
Ophthalmological Institute, Johns Hopkins University School of Medicine,
Baltimore, Maryland.

PURPOSE: To compare the success and complications of trabeculectomy performed
with limbus-based and fornix-based conjunctival approaches. DESIGN:
Retrospective case series with some prospective data collection. PARTICIPANTS:
Consecutive patients undergoing trabeculectomy by 2 surgeons between May 2000
and October 2008. INTERVENTION: We performed limbus-based operations during the
first 4 years and fornix-based operations during the last 4 years. We collected
data by chart review and by examination at the most recent visit. For each
follow-up visit, we defined success as undergoing no further glaucoma procedure
and achieving one of our intraocular pressure (IOP) criteria. We used
Kaplan-Meier survival analysis, Cox proportional hazards models, and generalized
estimating equation (GEE) analysis. During 2009, 439 trabeculectomy sites of 347
patients were quantitatively assessed by the Indiana bleb grading system. MAIN
OUTCOME MEASURES: (1) Success rate of trabeculectomy, as determined by the
achievement of each of our different IOP goals, with or without IOP-lowering
medications; and (2) incidence of surgical complications. RESULTS: During the 4
years after surgery, the success rates of limbus-based and fornix-based
trabeculectomy were not statistically different for any of our IOP criteria.
Blebs after limbus-based surgery were more likely to be graded as higher and to
be avascular (GEE model, both P < 0.0001). Four percent of eyes experienced
late-onset bleb leaks within 4 years after both limbus- and fornix-based
operations; however, limbus-based cases developed bleb leaks significantly later
than did fornix-based cases (2.1 vs. 1.0 years; P=0.002, GEE model). Late
bleb-associated infection during the first 4 years after surgery occurred more
often in limbus-based operations, although statistical significance was
borderline (P=0.054, Cox model). Symptomatic hypotony during all available
follow-up was more common with fornix-based operations (P=0.01, GEE model). Eyes
undergoing the fornix-based operation had a greater risk of cataract surgery in
the 4-year period after surgery (P=0.02, Cox model), and fornix-based cases
requiring cataract surgery had the operation earlier than limbus-based cases
(P=0.002, GEE model). CONCLUSIONS: Success rates are similar between
limbus-based and fornix-based trabeculectomy. Limbus-based procedures produce
higher, more avascular blebs, with a greater risk of infection. Fornix-based
procedures have more symptomatic hypotony and more and earlier cataract
development. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or
commercial interest in any materials discussed in this article. Copyright (c)
2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.

PMID: 22226886  [PubMed - as supplied by publisher]

21: Ophthalmology. 2012 Jan 7; [Epub ahead of print] 

Eyes or Subjects: Are Ophthalmic Randomized Controlled Trials Properly Designed
and Analyzed?

Lee CF, Cheng AC, Fong DY.

Department of Biostatistics, Singapore Clinical Research Institute, Singapore,
Republic of Singapore; Center for Quantitative Medicine, Duke-NUS Graduate
Medical School, Singapore, Republic of Singapore.

OBJECTIVE: In ophthalmic randomized controlled trials (RCTs), each subject may
have 2 potential data points (i.e., eyes) contributing to the clinical trial.
Hence, various study designs may arise requiring different statistical tools.
This study aimed to assess the appropriateness of study design, statistical
tools used, and reporting of results in ophthalmic RCTs. DESIGN: A systematic
review of 69 ophthalmic RCTs. METHODS: The study design, sample size
calculation, statistical analysis, and reporting methodology of all RCTs
published in 4 major general clinical ophthalmology journals in 2009 were
assessed. MAIN OUTCOME MEASURES: The study design of each article under review
is evaluated. RESULTS: The most common study design was a one-eye design (48%).
Within this group, only half described the method of selecting the study eye,
among which 5 chose the study eye by random selection. In the remaining trials,
there were paired-eye design (13%), subject design (19%), and two-eye design
(19%). Among the 13 two-eye design studies, 4 allocated both eyes of the subject
to the same group, 4 allocated the eyes to different groups, and 4 did not
restrict the allocation. None of these studies adjusted for the clustering
effect in sample size calculation. Only 5 studies used statistical methods
adjusting for nonindependence. CONCLUSIONS: There is currently substantial
heterogeneity in the quality among published ophthalmic RCTs in terms of proper
use of study design, sample size calculation, randomization method, and
statistical tools. Future ophthalmic researchers are suggested to consult a
statistician and to follow some guidelines such as the CONSORT statement when
performing an RCT to improve further the quality of clinical trial. FINANCIAL
DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any
materials discussed in this article. Copyright (c) 2012 American Academy of
Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22226885  [PubMed - as supplied by publisher]

22: Ophthalmology. 2012 Jan 6; [Epub ahead of print] 

Multi-Year Follow-up of Fine-Needle Aspiration Biopsy in Choroidal Melanoma.

McCannel TA, Chang MY, Burgess BL.

Department of Ophthalmology and the Jules Stein Eye Institute, University of
California, Los Angeles, California.

PURPOSE: To report the local and systemic follow-up of patients undergoing
transscleral intraoperative fine-needle aspiration biopsy (FNAB) at the time of
iodine-125 plaque brachytherapy for the treatment of choroidal melanoma. DESIGN:
Retrospective, single-center, consecutive case cohort study. PARTICIPANTS: A
total of 170 consecutive patients with choroidal melanoma. METHODS: All patients
with choroidal melanoma treated with iodine-125 brachytherapy and intraoperative
FNAB from January 2005 to January 2010 with at least 1 year of clinical
follow-up were included. MAIN OUTCOME MEASURES: Outcomes examined were
endophthalmitis, orbital dissemination, local treatment failure, rhegmatogenous
retinal detachment, monosomy 3 status, and choroidal melanoma metastasis.
RESULTS: A total of 170 consecutive patients with clinical diagnosis of
choroidal melanoma, intraoperative FNAB, and post-brachytherapy follow-up of 1
to 6 years (mean, 2.7+/-1.3 years) were included. For tumors with height of <3.0
mm, 3.0 to 5.0 mm, and >5.0 mm, sufficient biopsy material for fluorescence in
situ hybridization (FISH) was obtained in 53%, 68%, and 91%, respectively.
During the follow-up period, there was no case of postoperative endophthalmitis,
orbital dissemination, or local treatment failure. Three patients developed
rhegmatogenous retinal detachment. Fourteen patients developed clinical evidence
of metastasis. Of the 14 patients, 8 had monosomy 3 of the primary tumor, 2 had
disomy 3, 1 had trisomy 3, and 3 had insufficient material for FISH. The
cumulative 5-year Kaplan-Meier metastatic rate was 13%. CONCLUSIONS:
Transscleral FNAB at the time of iodine-125 plaque brachytherapy was not
associated with endophthalmitis, orbital dissemination, or local treatment
failure in this series, and post-brachytherapy retinal detachment occurred in 3
eyes. The cumulative Kaplan-Meier 5-year metastatic rate was not statistically
different from the rate of 13% reported by the Collaborative Ocular Melanoma
Study for tumors of the same size treated by brachytherapy without biopsy.
Rhegmatogenous retinal detachment may occur in young patients secondary to
posterior vitreous detachment induced by tumor response to radiation, unrelated
to FNAB. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or
commercial interest in any materials discussed in this article. Copyright (c)
2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.

PMID: 22226884  [PubMed - as supplied by publisher]

23: Ophthalmology. 2012 Jan 5; [Epub ahead of print] 

Intralesional Interferon-alpha for Conjunctival Mucosa-Associated Lymphoid
Tissue Lymphoma Long-term Results.

Blasi MA, Tiberti AC, Valente P, Laguardia M, Sammarco MG, Balestrazzi A,
Larocca LM, Balestrazzi E.

Department of Ophthalmology, Catholic University of Rome, Rome, Italy.

OBJECTIVE: To report the long-term therapeutic results for patients with
conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma who were treated
with intralesional injections of interferon-alpha (IFN-alpha). DESIGN:
Prospective, nonrandomized, interventional case series. PARTICIPANTS: Twenty
eyes of 16 patients with histologically proven conjunctival MALT lymphoma in the
absence of systemic disease. METHODS: Patients were given 1 500 000
international units (IU) of IFN-alpha (Roferon-A; Roche s.p.a., Milano, Italy)
subconjunctivally inside the lesion 3 times weekly for 4 weeks. If there was
even a minimal response, a further cycle of 1 000 000 IU 3 times weekly for 4
weeks was administered. MAIN OUTCOME MEASURES: Patients were followed up
clinically using slit-lamp examination to determine evidence of tumor
disappearance or recurrence. In 10 eyes, an incisional biopsy was performed 6
months after therapy to verify the histologic absence of the lesion. RESULTS: A
complete response was obtained in 15 eyes (75%) at the end of first cycle
treatment, and in 5 eyes (25%) after further cycles. Seventeen eyes (85%) showed
no local recurrence after a median follow-up of 65 months (range, 15-136
months). Three eyes (15%) demonstrated recurrence at variable points after
treatment. One patient with stage IIA lymphoma exhibited systemic lymphoma
progression. CONCLUSIONS: Local immunotherapy with IFN-alpha seems to be an
effective and lasting treatment method and provides an alternative to
radiotherapy for conjunctival MALT lymphomas. Very few transient side effects
were detected. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or
commercial interest in any materials discussed in this article. Copyright (c)
2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.

PMID: 22226154  [PubMed - as supplied by publisher]

24: Ophthalmology. 2012 Jan 3; [Epub ahead of print] 

Optic Disc Margin Anatomy in Patients with Glaucoma and Normal Controls with
Spectral Domain Optical Coherence Tomography.

Reis AS, Sharpe GP, Yang H, Nicolela MT, Burgoyne CF, Chauhan BC.

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax,
Nova Scotia, Canada; Department of Ophthalmology, University of Sao Paulo, Sao
Paulo, Brazil.

OBJECTIVE: To characterize optic nerve head (ONH) anatomy related to the
clinical optic disc margin with spectral domain-optical coherence tomography
(SD-OCT). DESIGN: Cross-sectional study. PARTICIPANTS: Patients with open-angle
glaucoma with focal, diffuse, and sclerotic optic disc damage, and age-matched
normal controls. METHODS: High-resolution radial SD-OCT B-scans centered on the
ONH were analyzed at each clock hour. For each scan, the border tissue of
Elschnig was classified for obliqueness (internally oblique, externally oblique,
or nonoblique) and the presence of Bruch's membrane overhanging the border
tissue. Optic disc stereophotographs were co-localized to SD-OCT data with
customized software. The frequency with which the disc margin identified in
stereophotographs coincided with (1) Bruch's membrane opening (BMO), defined as
the innermost edge of Bruch's membrane; (2) Bruch's membrane/border tissue,
defined as any aspect of either outside BMO or border tissue; or (3) border
tissue, defined as any aspect of border tissue alone, in the B-scans was
computed at each clock hour. MAIN OUTCOME MEASURES: The SD-OCT structures
coinciding with the disc margin in stereophotographs. RESULTS: There were 30
patients (10 with each type of disc damage) and 10 controls, with a median
(range) age of 68.1 (42-86) years and 63.5 (42-77) years, respectively. Although
28 patients (93%) had 2 or more border tissue configurations, the most
predominant one was internally oblique, primarily superiorly and nasally,
frequently with Bruch's membrane overhang. Externally oblique border tissue was
less frequent, observed mostly inferiorly and temporally. In controls, there was
predominantly internally oblique configuration around the disc. Although the
configurations were not statistically different between patients and controls,
they were among the 3 glaucoma groups. At most locations, the SD-OCT structure
most frequently identified as the disc margin was some aspect of Bruch's
membrane and border tissue external to BMO. Bruch's membrane overhang was
regionally present in the majority of patients with glaucoma and controls;
however, in most cases it was not visible as the disc margin. CONCLUSIONS: The
clinically perceived disc margin is most likely not the innermost edge of
Bruch's membrane detected by SD-OCT. These findings have important implications
for the automated detection of the disc margin and estimates of the neuroretinal
rim. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found
after the references. Copyright (c) 2011 American Academy of Ophthalmology.
Published by Elsevier Inc. All rights reserved.

PMID: 22222150  [PubMed - as supplied by publisher]

25: Ophthalmology. 2012 Jan 3; [Epub ahead of print] 

Comparison of a New Refractive Multifocal Intraocular Lens with an Inferior
Segmental Near Add and a Diffractive Multifocal Intraocular Lens.

Alio JL, Plaza-Puche AB, Javaloy J, Ayala MJ, Moreno LJ, Pinero DP.

Vissum Corporation, Alicante, Spain; Division of Ophthalmology, Universidad
Miguel Hernandez, Alicante, Spain.

PURPOSE: To compare the visual acuity outcomes and ocular optical performance of
eyes implanted with a multifocal refractive intraocular lens (IOL) with an
inferior segmental near add or a diffractive multifocal IOL. DESIGN:
Prospective, comparative, nonrandomized, consecutive case series. PARTICIPANTS:
Eighty-three consecutive eyes of 45 patients (age range, 36-82 years) with
cataract were divided into 2 groups: group A, 45 eyes implanted with Lentis
Mplus LS-312 (Oculentis GmbH, Berlin, Germany); group B, 38 eyes implanted with
diffractive IOL Acri.Lisa 366D (Zeiss, Oberkochen, Germany). METHODS: All
patients underwent phacoemulsification followed by IOL implantation in the
capsular bag. Distance corrected, intermediate, and near with the distance
correction visual acuity outcomes and contrast sensitivity, intraocular
aberrations, and defocus curve were evaluated postoperatively during a 3-month
follow-up. MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA),
corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA),
corrected distance near and intermediate visual acuity (CDNVA), contrast
sensitivity, intraocular aberrations, and defocus curve. RESULTS: A significant
improvement in UDVA, CDVA, and UNVA was observed in both groups after surgery
(PPMID: 22218147  [PubMed - as supplied by publisher]

26: Ophthalmology. 2012 Jan 3; [Epub ahead of print] 

Trends in Use of Ancillary Glaucoma Tests for Patients with Open-Angle Glaucoma
from 2001 to 2009.

Stein JD, Talwar N, Laverne AM, Nan B, Lichter PR.

W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences,
University of Michigan, Ann Arbor.

PURPOSE: To assess trends in the use of ancillary diagnostic tests in the
evaluation of patients with open-angle glaucoma (OAG) and glaucoma suspects over
the past decade. DESIGN: Retrospective, longitudinal cohort analysis.
PARTICIPANTS: A total of 169 917 individuals with OAG and 395 721 individuals
with suspected glaucoma aged >/=40 years enrolled in a national United States
managed care network between 2001 and 2009. METHODS: Claims data were analyzed
to assess trends in visual field (VF) testing, fundus photography (FP), and
other ocular imaging (OOI) testing for patients with OAG or suspected glaucoma
between 2001 and 2009. Repeated-measures logistic regression was performed to
identify differences in the odds of undergoing these procedures in 2001, 2005,
and 2009 and whether differences exist for patients under the exclusive care of
optometrists versus ophthalmologists. MAIN OUTCOME MEASURES: Odds and annual
probabilities of undergoing VF testing, FP, and OOI for OAG from 2001 to 2009.
RESULTS: For patients with OAG, the odds of undergoing VF testing decreased by
36% from 2001 to 2005, by 12% from 2005 to 2009, and by 44% from 2001 to 2009.
By comparison, the odds of having OOI increased by 100% from 2001 to 2005, by
24% from 2005 to 2009, and by 147% from 2001 to 2009. Probabilities of
undergoing FP were relatively low (13%-25%) for both provider types and remained
fairly steady over the decade. For patients cared for exclusively by
optometrists, the probability of VF testing decreased from 66% in 2001 to 44% in
2009. Among those seen exclusively by ophthalmologists, the probability of VF
testing decreased from 65% in 2001 to 51% in 2009. The probability of undergoing
OOI increased from 26% in 2001 to 47% in 2009 for patients of optometrists and
from 30% in 2001 to 46% in 2009 for patients of ophthalmologists. By 2008,
patients with OAG receiving care exclusively by optometrists had a higher
probability of undergoing OOI than VF testing. CONCLUSIONS: From 2001 to 2009,
OOI increased dramatically whereas VF testing declined considerably. Because OOI
has not been shown to be as effective at detecting OAG or disease progression
compared with VF testing, increased reliance on OOI technology, in lieu of VF
testing, may be detrimental to patient care. FINANCIAL DISCLOSURE(S): The
author(s) have no proprietary or commercial interest in any materials discussed
in this article. Copyright (c) 2011 American Academy of Ophthalmology. Published
by Elsevier Inc. All rights reserved.

PMID: 22218146  [PubMed - as supplied by publisher]

27: Ophthalmology. 2012 Jan 2; [Epub ahead of print] 

An Outbreak of Acute Post-Cataract Surgery Pseudomonas sp. Endophthalmitis
Caused by Contaminated Hydrophilic Intraocular Lens Solution.

Ramappa M, Majji AB, Murthy SI, Balne PK, Nalamada S, Garudadri C, Mathai A,
Gopinathan U, Garg P.

Cornea and Anterior Segment Services, L V Prasad Eye Institute, Banjara hills,
Hyderabad, India.

OBJECTIVE: To report the investigation for the source of infection and the
clinical course and treatment response of 11 cases of acute post-cataract
surgery endophthalmitis that developed during an outbreak. DESIGN:
Retrospective, consecutive, interventional case series. PARTICIPANTS: Eleven
patients who developed acute postoperative endophthalmitis after an uneventful
cataract surgery with intraocular lens implantation from September 6 to 29,
2010, at a tertiary eye care center in South India. METHODS: Aqueous aspirates,
vitreous aspirates, and environmental surveillance specimens were sampled. All
specimens were subjected to smear and culture. Positive cultures were subjected
to antibiotic susceptibility. Genotypic diversity was determined by polymerase
chain reaction (PCR) with enterobacterial repetitive intergenic consensus (ERIC)
primers of each strain and was used to establish the clonal relationship between
clinical and environmental isolates. The clinical patterns were analyzed. MAIN
OUTCOME MEASURES: Positive microbiology, molecular diagnostic similarity among
the culture positive endophthalmitis cases, and surveillance specimens. RESULTS:
Aqueous and vitreous samples showed gram-negative bacilli in the smears of 8 of
11 eyes, and cultures grew Pseudomonas aeruginosa in 5 of 11 eyes. Among the
samples from various surveillance specimens cultured, only the hydrophilic
acrylic intraocular lenses and their solution grew P. aeruginosa, with
antibiotic susceptibility pattern identical to the clinical isolates. The
isolates from the patients and the intraocular lens solution revealed matching
patterns similar to an American Type Culture Collection (ATCC) strain of P.
aeruginosa on ERIC-PCR. The intraocular lenses of the same make were
discontinued at our hospital, and the endophthalmitis did not recur. The final
visual acuity improved to >/=20/50 in 8 of 11 patients (72.7%). One patient
developed retinal detachment, but was treated successfully, and 2 other patients
progressed to phthisis bulbi. CONCLUSIONS: Positive microbiology and the
ERIC-PCR results proved that contamination of hydrophilic intraocular lenses and
the preservative solution was the source of infection in this outbreak. Early
detection and a planned approach during the outbreak helped us to achieve good
visual and anatomic outcomes, even though the offending organism was identified
as P. aeruginosa. FINANCIAL DISCLOSURE(S): The authors have no proprietary or
commercial interest in any materials discussed in this article. Copyright (c)
2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.

PMID: 22218145  [PubMed - as supplied by publisher]

28: Ophthalmology. 2012 Jan 2; [Epub ahead of print] 

Correlation between Clinical Features, Magnetic Resonance Imaging, and
Histopathologic Findings in Retinoblastoma: A Prospective Study.

Chawla B, Sharma S, Sen S, Azad R, Bajaj MS, Kashyap S, Pushker N, Ghose S.

Ocular Oncology & Pediatric Ophthalmology Service, Dr Rajendra Prasad Center for
Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

OBJECTIVE: To correlate clinical features with histopathology findings in
advanced intraocular retinoblastoma and to determine the diagnostic accuracy of
magnetic resonance imaging (MRI) in detecting tumor invasion. DESIGN:
Prospective, nonrandomized case series. PARTICIPANTS: We included 75 patients
with group E retinoblastoma. METHODS: Demographic and clinical features were
recorded at presentation. Contrast-enhanced MRI was performed to study tumor
characteristics and extent of invasion. Primary enucleation was performed and
histopathologic features noted. Statistical analysis was done using the
Kruskal-Wallis test to determine correlation between clinical features and
histopathology. Sensitivity, specificity, and accuracy of MRI in detecting tumor
invasion were determined. MAIN OUTCOME MEASURES: Significant associations
between clinical findings at presentation and high-risk histopathology, and
correlation between MRI results and histopathologic evidence of tumor invasion.
RESULTS: A significant association was found between iris neovascularization and
choroidal invasion (P = 0.032), intraocular pressure and optic nerve invasion (P
= 0.034), and shallow anterior chamber and iris invasion (P = 0.021). Corneal
diameter did not show any significant correlation with high-risk histopathology.
On MRI, tumor volume showed a significant association with optic nerve invasion
(P = 0.023). The accuracy of MRI in detecting choroidal invasion was 68%
(sensitivity, 60%; specificity, 80%). Prelaminar invasion was correctly
identified in 9 out of 15 eyes (accuracy, 84%; sensitivity, 60%; specificity,
90%), whereas the accuracy of MRI in detecting postlaminar invasion was 76%
(sensitivity, 61.9%; specificity, 81.5%). Ciliary body invasion was correctly
identified in 5 out of 7 eyes (accuracy, 93.3%; specificity, 95.6%) and scleral
invasion in 5 out of 6 eyes (accuracy, 98.7%; specificity, 100%). CONCLUSIONS:
As far as we are aware, this is the first prospective study on the correlation
of clinical features and MRI findings with histopathologic risk factors in eyes
primarily enucleated for retinoblastoma. Neovascularization of iris, intraocular
pressure, shallow anterior chamber, and tumor volume correlated well with
high-risk histopathology. Because MRI has limitations in reliably predicting
microscopic infiltration of the choroid and optic nerve, decision in favor of
neoadjuvant chemotherapy on the basis of suspected postlaminar invasion on MRI
is not justified in the absence of histopathologic evidence of disease.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest
in any materials discussed in this article. Copyright (c) 2011 American Academy
of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22218144  [PubMed - as supplied by publisher]

29: Ophthalmology. 2012 Jan 2; [Epub ahead of print] 

Risk of Corneal Transplant Rejection Significantly Reduced with Descemet's
Membrane Endothelial Keratoplasty.

Anshu A, Price MO, Price FW Jr.

Cornea Research Foundation of America, Indianapolis, Indiana; Price Vision
Group, Indianapolis, Indiana.

PURPOSE: To evaluate the relative risk of immunologic rejection episode in
patients who underwent Descemet's membrane endothelial keratoplasty (DMEK),
Descemet's stripping endothelial keratoplasty (DSEK), and penetrating
keratoplasty (PK). DESIGN: Comparative case series. PARTICIPANTS: One hundred
forty-one eyes treated with DMEK at Price Vision Group, Indianapolis, Indiana.
METHODS: The patients in the DMEK group were compared retrospectively with
cohorts of DSEK (n = 598) and PK (n = 30) patients treated at the same center,
with similar demographics, follow-up duration, and indications for surgery. The
postoperative steroid regimen and rejection criteria were identical in the 3
groups. Kaplan-Meier survival analysis, which takes varying length of follow-up
into consideration, was performed to determine the cumulative probability of a
rejection episode 1 and 2 years after surgery. Proportional hazards analysis was
used to determine the relative risk of rejection episodes between the 3 groups.
P<0.05 was considered significant and calculated using the log-rank test. MAIN
OUTCOME MEASURES: Rejection-free survival and cumulative probability of a
rejection episode. RESULTS: The mean recipient age was 66 years (56% females and
94% Caucasian) and median follow-up duration was 13 months (range, 3-40) in the
DMEK group. Fuchs' dystrophy was the most common indication for surgery (n =
127; 90%) followed by pseudophakic bullous keratopathy (n = 4; 4%) and regrafts
(n = 9; 6.4%). Only 1 patient (0.7%) had a documented rejection episode in the
DMEK group compared with 54 (9%) in the DSEK and 5 (17%) in the PK group. The
Kaplan-Meier cumulative probability of a rejection episode at 1 and 2 years was
1% and 1%, respectively, for DMEK; 8% and 12%, respectively, for DSEK; and 14%
and 18%, respectively, for PK. This was a highly significant difference (P =
0.004). The DMEK eyes had a 15 times lesser risk of experiencing a rejection
episode than DSEK eyes (95% confidence limit [CL], 2.0-111; P = 0.008) and 20
times lower risk than PK eyes (95% CL, 2.4-166; P = 0.006). CONCLUSIONS:
Patients undergoing DMEK had a significantly reduced risk of experiencing a
rejection episode within 2 years after surgery compared with DSEK and PK
performed for similar indications using the same corticosteroid regimen.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest
in any materials discussed in this article. Copyright (c) 2011 American Academy
of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22218143  [PubMed - as supplied by publisher]

30: Ophthalmology. 2012 Jan 3; [Epub ahead of print] 

Vitrectomy without Laser Treatment or Gas Tamponade for Macular Detachment
Associated with an Optic Disc Pit.

Hirakata A, Inoue M, Hiraoka T, McCuen BW 2nd.

Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.

PURPOSE: To evaluate the clinical outcomes after vitrectomy, without gas
tamponade or laser photocoagulation to the margin of the optic nerve, for the
treatment of macular detachment associated with optic disc pits and to
characterize retinal manifestations during treatment of optic pit maculopathy
using optical coherence tomography (OCT). DESIGN: Noncomparative, retrospective,
interventional case series. PARTICIPANTS: Eight consecutive patients (8 to 56
years of age) with unilateral macular detachment associated with optic disc pit.
INTERVENTION: Pars plana vitrectomy with induction of a posterior vitreous
detachment (PVD) was performed in all eyes. No laser or gas injection was
performed in any eye during the original surgery. Patients were followed up for
10 to 46 months (mean, 26 months) after surgery. MAIN OUTCOME MEASURES: Anatomic
outcome as determined by OCT and postoperative visual acuities were the main
outcome parameters. Fundus autofluorescence (FAF) images were obtained in 4 eyes
to document anatomic changes in the macula. RESULTS: Although complete retinal
reattachment was achieved in 7 of 8 eyes, up to about 1 year was necessary for
the retinal detachment to resolve fully. The 1 eye in which macular detachment
failed to resolve completely underwent revision of vitrectomy with a gas
tamponade and laser photocoagulation in the peripapillary area. In the early
postoperative period, despite persistent macular detachment, the visual acuities
improved in 7 eyes. These improved acuities corresponded with remodeling of the
photoreceptor outer segments on OCT and the appearance of granular
hyperfluorescence on FAF imaging. CONCLUSIONS: Vitrectomy with induction of a
PVD at the optic disc without gas tamponade or laser photocoagulation seems to
be an effective method of managing macular detachment resulting from optic disc
pits. The OCT scanning before and after surgery suggests that peripapillary
vitreous traction with the passage of fluid into the retina through the pit is
the cause of the schisis-like separation seen in optic disc pit maculopathy.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial
interest in any materials discussed in this article. Copyright (c) 2011 American
Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID: 22218142  [PubMed - as supplied by publisher]