American Journal of Ophthalmology - Articles in Press

Outcomes and Complications of Rhegmatogenous Retinal Detachment Repair with Selective Sutureless 25-Gauge Pars Plana Vitrectomy - Corrected Proof

Dan H. Bourla, Elite Bor, Ruth Axer-Siegel, Karin Mimouni, Dov Weinberger — 2010-02-08

Purpose: To evaluate the outcomes and complications associated with the repair of rhegmatogenous retinal detachment (RRD) using 25-gauge pars plana vitrectomy (PPV) with selective sclerotomy suturing.Design: Retrospective case series.Methods: Analysis of consecutive 25-gauge pars plana vitrectomy cases performed for treating RRD was conducted. Reviewed parameters included demographics, ophthalmic history, results of ocular examinations, and intraoperative as well as postoperative complications. Analysis of the surgery digital video disc recordings revealed complications such as iatrogenic retinal breaks and retinal or subretinal tugging by the soft-tip cannula.Results: Forty-two eyes with RRD were evaluated with a follow-up of at least 3 months. The preoperative best-corrected visual acuity (BCVA) of 20 eyes with macula-on RRD ranged between 20/20 and 20/40 (mean, 20/30). Twenty-two eyes with macula-off RRD had preoperative BCVA ranging between 20/70 and hand movements (mean, 20/400). The single-surgery success rate was 97.4%. The final BCVA of the macula-on eyes ranged between 20/20 and 20/40 (mean, 20/30). In the eyes with macula-off RRD, the postoperative BCVA ranged between 20/30 and 20/400 (mean, 20/73). Sutures were placed on at least 1 scleral wound because of intraoperative gas leakage in 36.4% of the eyes. On the first postoperative day, all the eyes receiving gas tamponade had a 100% fill. None of the eyes in the study had postoperative hypotony, ciliochoroidal effusion, or choroidal hemorrhage. No cases of postoperative subconjunctival gas or oil leakage were noted.Conclusions: Modification of the standard 25-gauge sutureless technique with selective scleral wound suturing may contribute to preventing wound leakage and possible postoperative complications of hypotony or partial tamponade.

Test–Retest Reliability of Health-Related Quality-of-Life Questionnaires in Adults with Strabismus - Corrected Proof

David A. Leske, Sarah R. Hatt, Jonathan M. Holmes — 2010-02-08

Purpose: To report the test–retest variability of two health-related quality-of-life instruments: the new Adult Strabismus 20 (AS-20) and the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), in adults with strabismus.Design: Prospective case series.Methods: Fifty-five adult patients in a clinical practice with stable strabismus completed the AS-20 and the NEI VFQ-25 at 2 visits, without intervening treatment. Questionnaires were completed the second time either at a subsequent office visit, immediately before surgery, or by mail. Intraclass correlation coefficients were calculated. Ninety-five percent limits of agreement and 95% confidence intervals around the 95% limits of agreement also were calculated.Results: There was excellent agreement of overall questionnaire scores for the AS-20 (intraclass correlation coefficient, 0.92) and NEI VFQ-25 (intraclass correlation coefficient, 0.94). The 95% limits of agreement for overall scores were 14.3 points (95% confidence interval, 10.9 to 17.7) for the AS-20 and 11.1 points (95% confidence interval, 8.5 to 13.8) for the NEI VFQ-25. The lower test–retest variability of the VFQ-25 seemed to be partly the result of ceiling effects with many scores at the normal end of the range.Conclusions: The new AS-20 and the NEI VFQ-25 show excellent test–retest reliability in adults with strabismus. Change exceeding 95% limits of agreement (14 points on the AS-20 and 11 points on the VFQ-25) is indicative of real change in an individual patient. The AS-20 may be more useful than the VFQ-25 because it is less prone to ceiling effects in adults with strabismus.

Peripapillary Dark Choroid Ring as a Helpful Diagnostic Sign in Advanced Stargardt Disease - Corrected Proof

2010-02-08

Purpose: To investigate the prevalence of a peripapillary dark choroid ring on fluorescein angiography (FA) and the associated clinical features in patients with Stargardt disease.Design: Retrospective review of 135 patients with Stargardt disease.Methods: The presence or absence of a peripapillary dark choroid ring on FA was noted and was compared with patient demographics and clinical features.Results: Thirty-seven percent (50/135) had a peripapillary dark choroid ring on FA. When evaluated in subgroups, this sign was present in 41% (9/22) of patients with 2 causative ABCA4 mutations, in 28% (5/18) of patients with 1 causative ABCA4 mutation and a clinical diagnosis of Stargardt disease, and in 38% (36/95) of patients with a clinical diagnosis of Stargardt disease pending mutational analysis. Ninety-four percent (44/47) of patients for whom mutational testing confirmed the presence of ABCA4 mutations demonstrated a dark choroid sign. The peripapillary dark choroid ring sign was associated with diffuse flecks (P < .001), worse logarithm of the minimal angle of resolution visual acuity (P = .03), larger central scotoma size (P = .0146), and the presence of complete macular atrophy (P = .0017) compared with patients without this sign.Conclusions: The presence of a peripapillary dark choroid ring on FA should prompt further evaluation for Stargardt disease by examination of peripheral retinal FA images for a dark choroid sign, followed by subsequent ABCA4 mutation screening.

Long-term Results of Riboflavin Ultraviolet A Corneal Collagen Cross-linking for Keratoconus in Italy: The Siena Eye Cross Study - Corrected Proof

Aldo Caporossi, Cosimo Mazzotta, Stefano Baiocchi, Tomaso Caporossi — 2010-02-08

Purpose: To report the long-term results of 44 keratoconic eyes treated by combined riboflavin ultraviolet A collagen cross-linking in the first Italian open, nonrandomized phase II clinical trial, the Siena Eye Cross Study.Design: Perspective, nonrandomized, open trial.Methods: After Siena University Institutional Review Board approval, from September 2004 through September 2008, 363 eyes with progressive keratoconus were treated with riboflavin ultraviolet A collagen cross-linking. Forty-four eyes with a minimum follow-up of 48 months (mean, 52.4 months; range, 48 to 60 months) were evaluated before and after surgery. Examinations comprised uncorrected visual acuity, best spectacle-corrected visual acuity, spherical spectacle-corrected visual acuity, endothelial cells count (I Konan, Non Con Robo; Konan Medical, Inc., Hyogo, Japan), optical (Visante OCT; Zeiss, Jena, Germany) and ultrasound (DGH; Pachette, Exton, Pennsylvania, USA) pachymetry, corneal topography and surface aberrometry (CSO EyeTop, Florence, Italy), tomography (Orbscan IIz; Bausch & Lomb Inc., Rochester, New York, USA), posterior segment optical coherence tomography (Stratus OCT; Zeiss, Jena, Germany), and in vivo confocal microscopy (HRT II; Heidelberg Engineering, Rostock, Germany).Results: Keratoconus stability was detected in 44 eyes after 48 months of minimum follow-up; fellow eyes showed a mean progression of 1.5 diopters in more than 65% after 24 months, then were treated. The mean K value was reduced by a mean of 2 diopters, and coma aberration reduction with corneal symmetry improvement was observed in more than 85%. The mean best spectacle-corrected visual acuity improved by 1.9 Snellen lines, and the uncorrected visual acuity improved by 2.7 Snellen lines.Conclusions: The results of the Siena Eye Cross Study showed a long-term stability of keratoconus after cross-linking without relevant side effects. The uncorrected visual acuity and best spectacle-corrected visual acuity improvements were supported by clinical, topographic, and wavefront modifications induced by the treatment.

Risk Factors for Radiation Maculopathy after Ophthalmic Plaque Radiation for Choroidal Melanoma - Corrected Proof

2010-02-08

Purpose: To determine how tumor characteristics and radiation dose affect the incidence of radiation maculopathy (RM).Design: Retrospective, consecutive case series.Methods: A consecutive case series of 384 uveal melanomas irradiated (mean apical dose, 71.2 Gy) were followed up for a mean 47.2 months. Tumor locations included: 122 (32%) centered anterior to the equator, 27 (7%) equatorial, and 235 (61%) posterior. Tumor sizes were American Joint Committee on Cancer class T1 (n = 180), T2 (n = 150), T3 (n = 47), and T4 (n = 7).Results: RM occurred in 8 (7%) eyes with anterior uveal melanomas. In contrast, it was found in 82 (41%) eyes with posterior tumors. Multivariate analysis revealed the risk related to posterior location was greater compared with anterior location with a hazard ratio of 6.66 (95% confidence interval [CI], 4.94 to 22.50; P = .0001). Tumor height (> 6.0 mm) also demonstrated a high risk for RM (hazard ratio, 4.5; 95% CI, 2.68 to 10.17; P = .0001). A significant dose-response relationship was found between dose to fovea and RM (P = .0005, for trend). As compared with a dose of < 35 Gy, the risk of RM was 1.74 (95% CI, 0.98 to 3.1) for doses from 35 to 70 Gy, and the risk of RM was 2.43 (95% CI, 1.48 to 4.0) for doses of 70 Gy or more. Of interest, those anterior melanomas with RM had a mean apical height of 9.4 mm, as compared with a mean height of 3.3 mm for anterior tumors not associated with RM. Visual acuity was preserved if the fovea dose was less than 35 Gy.Conclusions: This study suggests that tumor location, tumor thickness, and radiation dose to the fovea are risk factors for the development of RM.

Evaluation of the Aspheric Tecnis Multifocal Intraocular Lens: One-Year Results from the First Cohort of the Food and Drug Administration Clinical Trial - Corrected Proof

2010-02-08

Purpose: To evaluate the safety and effectiveness of the aspheric diffractive Tecnis multifocal ZM900 (TCMF) intraocular lens (IOL; Abbott Medical Optics, Inc, Santa Ana, California, USA).Design: One-year, nonrandomized, multicenter, evaluator-masked, bilateral, parallel-group comparative clinical evaluation.Methods: Subjects underwent bilateral implantation with the TCMF IOL or the CeeOn 911A monofocal (CEMN) IOL (Abbott Medical Optics, Inc) according to subject preference.Results: One-year results were available for 244 eyes of 125 TCMF IOL subjects and for 245 eyes of 123 CEMN IOL subjects. Mean distance visual acuities (VAs) were statistically and clinically equivalent between the 2 groups. Mean binocular and monocular uncorrected and distance-corrected near VAs were significantly better for the TCMF IOL versus the CEMN IOL group (P < .0001). A greater proportion of TCMF IOL versus CEMN IOL subjects achieved binocular combined VAs of 20/25 distance and 20/32 near (84.2% [96/114] vs 6.2% [7/113]; P < .0001). The TCMF IOL group had excellent depth of focus, maintaining a mean of 20/40 or better for far, intermediate, and near distances. Mean contrast sensitivity scores were lower for the TCMF IOL versus the CEMN IOL group, but the differences were not considered clinically significant. Halos and night glare were more common in the TCMF IOL versus the CEMN IOL groups. Both reading acuity (20/20 vs 20/47; P < .0007) and speed (148 vs 117 words/minute; P < .0001) were significantly better for the TCMF IOL versus the CEMN IOL group, as were the proportions of the TCMF IOL group versus the CEMN IOL group that achieved spectacle independence (84.8% vs 5.2%; P < .0001) and that functioned comfortably at near without glasses (96.4% vs 30.4%; P < .0001).Conclusions: The TCMF IOL provided enhanced near VA, reading acuity per speed, depth of focus, and spectacle independence compared with the monofocal IOL.

Tear Measurement in Prosthetic Eye Users with Fourier-Domain Optical Coherence Tomography - Corrected Proof

Sung Eun Kim, Jin Sook Yoon, Sang Yeul Lee — 2010-02-08

Purpose: To investigate whether Fourier-domain (FD) optical coherence tomography (OCT) can measure the tear meniscus of anophthalmic patients using prosthetic eyes and to compare the characteristics of normal and artificial eyes.Design: Prospective, nonrandomized, observational case series.Methods: Thirty-one patients who had undergone anophthalmic surgery in 1 eye and had been wearing artificial eyes for more than 6 months were included. Subjects with socket inflammation, contracted sockets, or other known lid disorders were excluded. Patients were asked to complete a questionnaire regarding their demographic status and dry eye symptoms before treatment, and FD OCT scanning and the Schirmer test were performed. Three images were obtained by FD OCT on each normal and anophthalmic eye, and the tear meniscus height, tear meniscus depth, and tear meniscus angle were measured with computer calipers.Results: FD OCT was able to visualize the tear meniscus of both normal and artificial eyes. The mean tear meniscus height of artificial eyes was significantly lower than that of normal eyes (200.59 ± 79.68 μm vs 261.24 ± 86.17 μm; P < .001). Mean tear meniscus depth, tear meniscus area, and tear meniscus volume also were significantly lower in artificial eyes than in normal eyes. The dry eye symptom score showed significantly negative correlation with tear meniscus height. The Schirmer test results correlated with tear meniscus parameters in normal eyes, but not in artificial eyes.Conclusions: FD OCT is a valuable clinical tool in the evaluation of tear meniscus height in normal and artificial eyes. In addition, tear meniscus height can be a useful clinical parameter that estimates symptoms of ocular dryness and discomfort in both normal and artificial eyes.

Ocular Risk Factors for Age-Related Macular Degeneration: The Los Angeles Latino Eye Study (LALES) - Corrected Proof

2010-02-08

Purpose: To assess the association between ocular factors and age-related macular degeneration (AMD) in Latinos.Design: Population-based, cross-sectional study of 6357 self-identified Latinos aged 40 years and older.Methods: Ophthalmic examination included subjective refraction, measurement of axial length, evaluation of iris color, Lens Opacities Classification System II (LOCS II) grading of cataracts, and stereoscopic macular photographs for AMD lesions. Generalized estimating equation analysis incorporated data from both eyes to estimate odds ratios (OR) adjusted for covariates.Results: After controlling for confounders (age, gender, and smoking), prior cataract surgery was associated with advanced AMD (OR, 2.8; 95% CI, 1.01, 7.8), increased retinal pigment (OR, 1.6; 95% CI, 1.02, 1.5), and retinal pigment epithelial depigmentation (OR, 2.2; 95% CI, 1.1, 4.4). The presence of any lens opacity was associated with soft drusen (OR, 1.2; 95% CI, 1.002, 1.5). Longer axial length (per mm) was associated with decreased odds of soft drusen, increased retinal pigment, and geographic atrophy (GA) (ORs, 0.8 [95% CI, 0.7, 0.9], 0.8 [95% CI, 0.7, 0.9], 0.7 [95% CI, 0.5, 0.9], respectively). Myopia was inversely associated with soft drusen (OR, 0.8; 95% CI, 0.7, 0.99). Lighter-colored irises were associated with GA (OR, 5.0; 95% CI, 1.0, 25.3).Conclusions: Cross-sectional associations of ocular factors such as cataract, cataract surgery, and refractive errors with early AMD lesions found in Latinos are consistent with those in non-Hispanic Whites. Additionally, prior cataract surgery was associated with advanced AMD.

Observations by Spectral-Domain Optical Coherence Tomography Combined with Simultaneous Scanning Laser Ophthalmoscopy: Imaging of the Vitreous - Corrected Proof

2010-02-08

Purpose: To determine the ability to detect normal vitreous structure, evolving posterior vitreous detachment (PVD), and related vitreoretinal changes with combined spectral-domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscopy (SLO).Design: Observational cross-sectional study.Methods: Simultaneous SD-OCT and SLO imaging instruments (SD-OCT/SLO) were used to image both eyes of patients with symptoms of PVD. The vitreous cortex, preretinal lacunae, hyaloid, and its relations to the retinal surface were analyzed. In addition, ultrasound was performed in a subset of patients to determine the stage of PVD.Results: Two-hundred two eyes of 113 subjects were scanned. There was a high correlation between diagnosis of complete PVD by clinical examination and OCT (95 vs 93 eyes, respectively; κ, 0.82). A partial PVD was detected more frequently by SD-OCT/SLO than by biomicroscopy examination (45 vs 7 eyes; P < .0001). Ultrasound was performed in a subset of 30 eyes. A high agreement was found between ultrasound and SD-OCT/SLO results for both complete PVD (κ, 0.933) and incomplete PVD (κ, 0.91). Vitreous cortex was detected in 181 eyes, and posterior precortical vitreous pocket was detected in 85 eyes. The effects of PVD, including vitreoretinal traction, paravascular lamellar holes, and fine changes at the fovea, could be visualized reliably in detail only with SD-OCT/SLO. In all these eyes, SD-OCT/SLO allowed improved visualization of the vitreoretinal relationship.Conclusions: SD-OCT/SLO provides unprecedented in vivo information about the physiologic and pathologic vitreous structure; it allows an extremely detailed analysis of the vitreoretinal interface, and it is particularly useful for defining focal changes and PVD.

The Multicenter Uveitis Steroid Treatment Trial: Rationale, Design, and Baseline Characteristics - Corrected Proof

The Multicenter Uveitis Steroid Treatment Trial Research Group — 2010-01-25

Purpose: To describe the design and methods of the Multicenter Uveitis Steroid Treatment (MUST) trial and the baseline characteristics of enrolled patients.Design: Baseline data from a 1:1 randomized, parallel treatment design clinical trial at 23 clinical centers comparing systemic corticosteroid therapy (and immunosuppression when indicated) with fluocinolone acetonide implant placement.Methods: Eligible patients had active or recently active noninfectious intermediate uveitis, posterior uveitis, or panuveitis. The study design had 90% power (2-sided type I error rate, 0.05) to detect a 7.5-letter (1.5-line) difference between groups in the mean visual acuity change between baseline and 2 years. Secondary outcomes include ocular and systemic complications of therapy and quality of life. Baseline characteristics include demographic and clinical characteristics, quality of life, and reading center gradings of lens and fundus photographs, optical coherence tomography images, and fluorescein angiograms.Results: Over 3 years, 255 patients were enrolled (481 eyes with uveitis). At baseline, 50% of eyes with uveitis had best-corrected visual acuity worse than 20/40 (16% worse than 20/200). Lens opacities (39% of gradeable phakic eyes), macular edema (36%), and epiretinal membrane (48%) were common. Mean health utility was 74.1.Conclusions: The MUST trial will compare fluocinolone acetonide implant versus systemic therapy for management of intermediate uveitis, posterior uveitis, and panuveitis. Patients with intermediate uveitis, posterior uveitis, or panuveitis enrolled in the trial had a high burden of reduced visual acuity, cataract, macular edema, and epiretinal membrane; overall quality of life was lower than expected based on visual acuity.

Comparison of Intravitreal Triamcinolone Acetonide with Photodynamic Therapy and Intravitreal Bevacizumab with Photodynamic Therapy for Retinal Angiomatous Proliferation - Corrected Proof

Masaaki Saito, Chieko Shiragami, Fumio Shiraga, Mariko Kano, Tomohiro Iida — 2010-01-05

Purpose: To compare the efficacy of combined therapy with intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT; IVTA plus PDT) with intravitreal bevacizumab (IVB) and PDT (IVB plus PDT) for patients with retinal angiomatous proliferation (RAP).Design: Retrospective, observational case series.Methods: We retrospectively reviewed 25 treatment-naïve eyes of 22 Japanese patients (11 men, 11 women) with retinal angiomatous proliferation. Twelve eyes of 11 patients were treated with combined therapy of IVTA plus PDT from September 1, 2004, through July 31, 2006. Thirteen eyes of 11 patients were treated with combined therapy of IVB plus PDT from February 1, 2007, through January 31, 2008.Results: In 12 eyes treated with IVTA plus PDT, the mean best-corrected visual acuity (BCVA) levels at baseline and 12 months were 0.29 and 0.13, respectively. A significant (P < .05) decline in the mean BCVA from baseline was observed at 12 months. In 13 eyes treated with IVB plus PDT, the mean BCVA levels at baseline and 12 months were 0.25 and 0.37. A significant (P < .05) improvement in the mean BCVA from baseline was observed. At 12 months, the difference in BCVA between the 2 groups was significant (P < .05). The mean numbers of treatments at 12 months in the IVTA plus PDT group and the IVB plus PDT group were 2.7 and 1.6, respectively. The difference between the 2 treatments reached significance (P < .05). No complications developed.Conclusions: Compared with IVTA plus PDT, IVB plus PDT was significantly more effective in maintaining and improving visual acuity and in reducing the number of treatment for patients with retinal angiomatous proliferation.

Acute Endophthalmitis After Cataract Surgery: 250 Consecutive Cases Treated at a Tertiary Referral Center in the Netherlands - Corrected Proof

2010-01-05

Purpose: To evaluate the clinical characteristics, bacterial culture, and visual outcome of patients with acute endophthalmitis after cataract surgery.Design: Retrospective consecutive interventional case series.Methods: Clinical notes from patients treated for acute endophthalmitis after cataract surgery in a single center from 1996 to 2006 were reviewed. Patients with less than 1 month of follow-up and missing bacterial cultures were excluded. Vitreous biopsy or primary vitrectomy followed by intravitreal injection of vancomycin and ceftazidime (± prednisolone) was performed. Main outcome measures were bacterial culture and final visual acuity.Results: Bacterial cultures (total 250 cases) showed bacterial growth in 166 cases (66.4%). From these 166 cultures, 89 (53.6%) revealed gram-positive coagulase-negative, 63 (38.0%) other gram-positive, 10 (6.0%) gram-negative, and 4 (2.4%) polymicrobial cultures. Vitreous biopsy with intravitreal antibiotics injection was performed in 225 (90.0%) of cases. Primary vitrectomy with intravitreal antibiotics was performed in 25 eyes (10.0%). Final visual acuity ≥0.5 was achieved in 129 (51.6%) of all cases, 54 (60.7%) of the 89 gram-positive coagulase-negative cultures, 20 (31.7%) of the 63 other gram-positive cultures, 5 (50.0%) of the 10 gram-negative cultures, and 9 (45.0%) of the 20 Staphylococcus aureus cultures. There was no additional effect for treatment by primary vitrectomy or intravitreal prednisolone.Conclusions: Treatment outcome after endophthalmitis is highly dependent on the causative organism. Treatment outcomes for gram-negative bacteria and S. aureus may be better than previously reported. Prompt treatment of endophthalmitis remains essential and the role of complete primary vitrectomy remains subject to debate.

One-Year Results of Reduced-Fluence Photodynamic Therapy for Polypoidal Choroidal Vasculopathy - Corrected Proof

Ayana Yamashita, Fumio Shiraga, Chieko Shiragami, Aoi Ono, Kaori Tenkumo — 2009-12-30

Purpose: To report 1-year results of reduced-fluence photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) in Japanese patients.Design: Prospective interventional case series.Methods: In the present study, 28 treatment-naïve eyes of 28 consecutive patients underwent PDT with a reduced laser fluence of 25 J/cm2. Patients were followed up at baseline and 1 week and 3, 6, 9, and 12 months after PDT. Choroidal perfusion changes were evaluated by indocyanine green angiography (ICGA) and leakage from PCV lesions and exudative changes by fluorescein angiography and optical coherence tomography. Treatment safety was assessed according to visual acuity (VA) and adverse events. The best-corrected VA (BCVA) obtained by Landolt ring tests was converted into the logarithm of the minimal angle of resolution (logMAR).Results: At baseline, the mean logMAR BCVA was 0.45 (geometric mean: 7/20). At 12 months, the mean logMAR BCVA significantly improved to 0.29 (geometric mean: 10/20) (P = 0.0001). The logMAR BCVA was stable or improved by ≥0.2 in 26 eyes (93%) at 1-year follow-up. In 10 eyes with VA better than 20/40 at baseline, the mean logMAR BCVA was significantly improved compared with baseline at 12 months. Although 16 of 28 eyes (57%) showed mild to moderate nonperfusion of choriocapillaris in early ICGA at 1 week, 27 eyes (96%) showed recovery to pretreatment levels at 3 months. Mean number of treatment sessions during the 12 months was 1.3. No severe side effects related to treatment were encountered.Conclusions: Reduced-fluence PDT is an effective treatment for PCV and could improve vision even in eyes with VA better than 20/40.

Paretic Side/Normal Side Ratios of Cross-Sectional Areas of the Superior Oblique Muscle Vary Largely in Idiopathic Superior Oblique Palsy - Corrected Proof

Eriko Uchiyama, Toshihiko Matsuo, Sayuri Imai, Emi Itoshima — 2009-12-30

Purpose: To search for a new definition of muscle hypoplasia in congenital or idiopathic superior oblique muscle palsy.Design: Retrospective case-control study.Methods: Cross-sectional areas of the superior oblique and 4 rectus muscles near the eye globe–optic nerve junction were measured by an image analysis software on magnetic resonance images of 50 patients with congenital or idiopathic superior oblique muscle palsy and 45 patients with other disease conditions serving as a control. The paretic side/contralateral normal side ratios of the cross-sectional areas and the left side/right side ratios were calculated for the superior oblique muscle palsy patients and the control patients, respectively.Results: The 95% confidence intervals in paretic side/contralateral side ratios of cross-sectional areas of the superior oblique muscle were 0.55 to 0.80 in the right-side superior oblique muscle palsy, and 0.48 to 0.75 in the left-side palsy, while the 95% confidence interval in the left side/right side ratios was 0.99 to 1.00 in the control. The 95% confidence intervals in the left side/right side ratios of the 4 rectus muscles were 1.00, both in the superior oblique muscle palsy and in the control.Conclusions: The muscle hypoplasia could be defined as such when the paretic side/contralateral side ratios of cross-sectional areas of the superior oblique muscle on magnetic resonance images fell outside the 95% confidence interval of the ratios in normal controls.

Protective Effect of Paraoxonase 1 Gene Variant Gln192Arg in Age-Related Macular Degeneration - Corrected Proof

2009-12-30

Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness among older adults, in which oxidative damage may play a pivotal role. Paraoxonase 1 (PON1) protects against oxidative damage and has been evaluated for its involvement in aging diseases including AMD. This study investigated whether PON1 gene polymorphisms associate with AMD.Design: Case-control association study.Methods: We studied 1037 individuals with AMD subcategorized using AREDS criteria and 370 control subjects without retinal disease. Participants were primarily Caucasian of European descent. All exons of PON1 were evaluated by single-strand conformation polymorphism and direct sequence analysis.Results: Six missense changes (Leu55Met, Met127Arg, His155Arg, Gln192Arg, Gln192Glu, Ala252Gly) were identified in PON1. We observed a weak association of Leu55Met with an increased risk of wet AMD (P = .02), but not with dry AMD or when combining all patient categories. A significantly higher allele frequency for Gln192Arg was detected in controls than in the combined AMD patient population (P < .0001), and when category 2, 3, and 4 patients were separately considered (P = .004, P = .002, and P < .0001, respectively). For category 4 AMD, the Arg192 allele was significantly less prevalent in the wet form (P < .0001), but not in the dry form (P = .377).Conclusion: We report a weak association of PON1 Leu55Met with an increased risk of wet AMD, replicating previous reports. Our findings indicate a protective role for Gln192Arg, particularly for patients with the wet form. Gln192Glu warrants consideration, as this variant alters the same amino acid as Gln192Arg and was identified only in category 4 AMD patients. We believe that Met127Arg, His155Arg, and Ala252Gly play minor roles in AMD susceptibility because of their limited frequency and/or location within the PON1 gene. The functional and biological mechanism by which Gln192Arg is acting to decrease AMD susceptibility remains to be determined.

Retinal Thickness Analysis by Race, Gender, and Age Using Stratus OCT - Corrected Proof

2009-12-30

Purpose: To detect differences in retinal thickness among patients of different race, gender, and age using Stratus OCT.Design: Cross-sectional study.Methods: In a multicenter, university-based study, 126 patients with no history of ocular disease were enrolled (78 diabetics without retinopathy and 48 nondiabetics). Optical coherence tomography measurements were performed using Stratus OCT. Statistical comparisons of center point foveal thickness and mean foveal thickness were made using generalized estimating equations adjusting for diabetic status, race, age, and gender.Results: The study population consisted of 36% male subjects, 39% Caucasian, 33% African-American, and 28% Hispanic. Mean foveal thickness was 191.6 ± 2.7 μm and 194.5 ± 2.7 μm for diabetics and nondiabetics, respectively (P = .49). Mean foveal thickness in male subjects was significantly larger than in female (201.8 ± 2.7 μm and 186.9 ± 2.6 μm, respectively; P < .001). Mean foveal thickness was 200.2 ± 2.7 μm for Caucasian, 181.0 ± 3.7 μm for African-American, and 194.7 ± 3.9 μm for Hispanic subjects. Mean foveal thickness was significantly less for African-American than Caucasian (P < .0001) or Hispanic subjects (P = .005). Center point foveal thickness and mean foveal thickness showed a significant increase with age.Conclusions: There are statistically significant differences in retinal thickness between subjects of different race, gender, and age. When compared to Caucasian and Hispanic subjects, African-American race is a predictor of decreased mean foveal thickness; and male sex (regardless of race) is a significant predictor of increased mean foveal thickness. Mean foveal thickness is similar among diabetics and nondiabetics when data are controlled for age, race, and sex. These results suggest that studies comparing OCT measurements should carefully control for age-based, race-based, and gender-based variations in retinal thickness.

Mycophenolate Mofetil for Ocular Inflammation - Corrected Proof

2009-12-30

Purpose: To evaluate mycophenolate mofetil as a single noncorticosteroid immunosuppressive treatment for noninfectious ocular inflammatory diseases.Design: Retrospective cohort study.Methods: Characteristics of patients with noninfectious ocular inflammation treated with mycophenolate mofetil at 4 subspecialty clinics from 1995 to 2007 were abstracted by expert reviewers in a standardized chart review of every eye at every visit. Main outcomes measured were control of inflammation, corticosteroid-sparing effects, and discontinuation of mycophenolate mofetil (including the reasons for discontinuation). Survival analysis was used to estimate the incidence of outcomes, and to identify risk factors for each.Results: Among 236 patients (397 eyes) treated with mycophenolate mofetil monotherapy, 20.3%, 11.9%, and 39.8% had anterior uveitis, intermediate uveitis, and posterior uveitis or panuveitis respectively; 14% had scleritis; 7.6% had mucous membrane pemphigoid; and 6.4% had other ocular inflammatory diseases. By Kaplan-Meier estimation, complete control of inflammation—sustained over consecutive visits spanning at least 28 days—was achieved in 53% and 73% of patients within 6 months and 1 year respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less, while maintaining sustained control of inflammation, in 41% and 55% of patients in 6 months and 1 year respectively. Twelve percent of patients discontinued mycophenolate mofetil within the first year because of side effects of therapy.Conclusions: Given sufficient time, mycophenolate mofetil was effective in managing ocular inflammation in approximately half of the treated patients. Treatment-limiting side effects were observed in 12% of patients and typically were reversible.

A Simplified Quantitative Method for Assessing Keratoconjunctivitis Sicca from the Sjögren's Syndrome International Registry - Corrected Proof

2009-12-25

Purpose: To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein.Design: Prospective, observational, multicenter cohort study.Methods: The National Institutes of Health-funded Sjögren's Syndrome International Registry (called Sjögren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjögren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (≥3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both).Results: Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS.Conclusions: This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.

Long-term Follow-up of Full Macular Translocation for Choroidal Neovascularization - Corrected Proof

Yoshihisa Yamada, Noritake Miyamura, Kiyoshi Suzuma, Takashi Kitaoka — 2009-12-25

Purpose: To report the long-term (>5 years) results of full macular translocation in patients with choroidal neovascularization (CNV).Design: Retrospective, interventional case series.Methods: This study involved 32 eyes of 32 patients who had undergone full macular translocation for CNV. The median follow-up was 6.5 years (range, 5.2 to 7.7 years). We evaluated the best-corrected visual acuity, fundus examination results obtained before and 1 and 5 years after operation, and postoperative complications.Results: At the 1-year follow-up, foveal retinal pigment epithelium atrophy was observed in only 3 eyes (12%), and the mean logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) at that time (1.39 ± 0.67) was not significantly changed from that before surgery (logMAR, 1.31 ± 0.66) in 25 eyes with age-related macular degeneration (AMD). However, at 5-year follow-up, foveal retinal pigment epithelium atrophy increased (18 eyes; 72%), and final mean logMAR VA (1.88 ± 0.76) was significantly lower (P < .01). Five eyes with myopic CNV maintained their VA from before operation (mean logMAR, 0.88 ± 0.35) until final follow-up (mean logMAR, 0.73 ± 0.31). The final VA was significantly better in myopic CNV than in exudative age-related macular degeneration on multiple regression analysis (P = .019).Conclusions: Long-term follow-up of full macular translocation showed that the final VA was poor in age-related macular degeneration, but relatively better in myopic CNV.

Wavefront Analysis, Contrast Sensitivity, and Depth of Focus after Cataract Surgery with Aspherical Intraocular Lens Implantation - Corrected Proof

2009-12-25

Purpose: To determine whether implantation of an aspherical intraocular lens (IOL) results in reduced ocular aberrations and improved contrast sensitivity after cataract surgery without critical reduction of depth of focus.Design: Double-blinded, randomized, prospective study.Methods: In an intraindividual study of 25 patients with bilateral cataract, an aspherical IOL (Akreos Advanced Optic [AO]; Bausch & Lomb, Inc., Rochester, New York, USA) was implanted in one eye and a spherical IOL (Akreos Fit; Bausch & Lomb, Inc) in the fellow eye. Higher-order aberrations with a 5- and 6-mm pupil were measured with a dynamic retinoscopy aberrometer at 1 and 3 months after surgery. Uncorrected and best-corrected visual acuity and contrast sensitivity under mesopic and photopic conditions also were measured. Distance-corrected near and intermediate visual acuity were studied as a measurement of depth of focus.Results: There was no statistically significant difference between eyes in uncorrected and best-corrected visual acuity at 1 and 3 months after surgery. There was a statistically significant between-group difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. The Akreos AO group obtained statistically significant lower values of higher-order aberrations and spherical aberration with 5- and 6-mm pupils compared with the Akreos Fit group (P < .05). There was no significant difference in distance-corrected near and intermediate visual acuity between both groups.Conclusions: Aspherical aberration-free Akreos AO IOL induced significantly less higher-order aberrations and spherical aberration than the Akreos Fit. Contrast sensitivity was better under mesopic conditions with the Akreos AO with similar results of depth of focus.