2007/05/15

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Items 1 - 26 of 26
1: Am J Ophthalmol. 2007 May 10; [Epub ahead of print]

Clinical Features Associated With an Asp380His Myocilin Mutation in a US Family With Primary Open-Angle Glaucoma.

Casey Eye Institute, Department of Ophthalmology (M.K.W., J.R.S., N.D.G.).

PURPOSE: To determine the glaucoma phenotype of an American pedigree with the myocilin Asp380His. DESIGN: An observational case series study. METHODS: An observational case series study was used to examine a family in which an Asp380His myocilin mutation was segregating. Thirteen family members were examined and medical records were obtained on the remaining two individuals. Blood samples were collected from all 15 participants following the tenets of the Helsinki declaration under the auspices of the Oregon Health & Sciences University Institutional Review Board and screened for myocilin variants by denaturing high-performance liquid chromatography (dHPLC). Any DNA samples with dHPLC data different from the control sample were sequenced for base pair analysis. RESULTS: An Asp380His myocilin mutation was identified in eight members, seven of whom had primary open-angle glaucoma (POAG). The eighth individual had high intraocular pressures (IOPs). The disease presents in this family with extremely high IOPs requiring trabeculectomies to control the pressure. The age at diagnosis ranged from 30 to 45. CONCLUSIONS: This family with an Asp380His myocilin mutation presents with an intermediate phenotype between juvenile- and adult-onset glaucoma. The Asp380 amino acid residue appears to be important in myocilin function based on the finding that substitution of this amino acid with four different amino acids (His, Ala, Asn, or Gly) all result in a similar presentation of POAG that is intermediate between the more severe clinical presentations observed in individuals with the Pro370Leu or Lys423Glu variant and the milder findings in patients with the Gln368Stop mutation.

PMID: 17499207 [PubMed - as supplied by publisher]

2: Am J Ophthalmol. 2007 May 10; [Epub ahead of print]

Porous Orbital Implants, Wraps, and Peg Placement in the Pediatric Population After Enucleation.

Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan.

PURPOSE: To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. RESULTS: Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. CONCLUSIONS: Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.

PMID: 17499206 [PubMed - as supplied by publisher]

3: Prog Retin Eye Res. 2007 Apr 1; [Epub ahead of print]

Contact lens-induced changes in the anterior eye as observed in vivo with the confocal microscope.

Institute of Health and Biomedical Innovation, and School of Optometry, Queensland University of Technology, Corner Musk Avenue and Blamey Street, Kelvin Grove, Queensland 4059, Australia.

The availability of the confocal microscope over the past decade has allowed clinicians and researchers to refine their understanding of the physiological and pathological basis of the ocular response to contact lens wear, and to discover previously unknown phenomena. Mucin balls, which form in the tear layer in patients wearing silicone hydrogel lenses, can penetrate the full thickness of the epithelium, leading to activation of keratocytes in the underlying anterior stroma. Epithelial cell size increases in response to all forms of lens wear, with lenses of higher oxygen transmissibility (Dk/t) interfering least with the normal process of epithelial desquamation. A higher density of Langerhans' cells is observed in the layer of the sub-basal nerve plexus among contact lens wearers, suggesting that contact lens wear may be altering the immune status of the cornea. Dark lines and folds are observed in the oedematous cornea in response to contact lens wear. Mechanical stimulation of the corneal surface, due to the physical presence of a contact lens, and the consequent release of inflammatory mediators, is the likely cause of reduced keratocyte density associated with lens wear. Highly reflective stromal 'microdot deposits' are observed throughout the entire stroma in higher numbers in lens wearers. 'Blebs' in the endothelium have a bright centre surrounded by a dark annular shadow; this appearance is explained with the aid of an optical model. The confocal microscope has considerable clinical utility in diagnosing Acanthamoeba and fungal keratitis. At the limbus, contact lenses can induce structural changes such as increases in basal epithelial cell size. An increased number of rolling leucocytes is observed in limbal vessels in response to low Dk/t lenses. It is concluded that the confocal microscope has considerable utility in contact lens research and practice.

PMID: 17498998 [PubMed - as supplied by publisher]

4: J AAPOS. 2007 May 9; [Epub ahead of print]

Fluorescein angiographic findings in a male infant with incontinentia pigmenti.

University of Calgary, Calgary, Alberta, Canada.

Incontinentia pigmenti is a rare, X-linked dominant, genodermatosis and is almost always lethal in males. It is characterized by cutaneous, ocular, dental, and central nervous system (CNS) abnormalities and about 35% of patients develop some form of ocular abnormality,(1) which may include retinal vascular abnormalities, ischemic retinal infarctions, retinal detachments, cataracts, uveitis, strabismus, and nystagmus.(2,3) Incontinentia pigmenti has been linked to the NEMO gene, which is mapped to Xq28.(4).

PMID: 17498989 [PubMed - as supplied by publisher]

5: J AAPOS. 2007 May 9; [Epub ahead of print]

Botulinum toxin in the management of internuclear ophthalmoplegia.

LV Prasad Eye Institute, Pediatric Ophthalmology and Strabismus, Andhra Pradesh, India.

BACKGROUND: Internuclear ophthalmoplegia (INO) presents as a complex ocular motility problem due to medial longitudinal fasciculus damage. The symptoms are disabling and challenging to manage. We evaluate the efficacy of botulinum toxin in the management of INO. METHODS: A retrospective review of 16 patients with INO managed by botulinum toxin A injection into one or more extraocular muscles over the past 20 years was performed. The age, sex, etiology, symptoms, angle of deviation, and binocular function pre- and postinjection were analyzed. RESULTS: The mean age at presentation was 45.1 years with a male/female ratio of 9:7. The most common etiologies included brainstem hemorrhage in five and multiple sclerosis in four. After injection diplopia reduced in 14 (87.5%), appearance improved in 9 (56.3%), and the head posture improved in 4 (25%). Convergence recovered in two patients (12.5%) and stereopsis improved in three patients (18.8%). Complications included transient ptosis in one patient, and one patient had an overcorrection. Two patients complained of transient vertical diplopia that resolved within 3 weeks. At final follow-up, five (31.5%) patients continued on maintenance injections, three (18.8%) were stable and discharged, while the rest were managed by occlusion (five), prisms (one), or surgery (two). CONCLUSIONS: We report on the management of INO by botulinum toxin. Benefit was noted in terms of reduced diplopia and occasionally improved binocular function. Though the benefits are limited by the need for repeated injections, for patients with this debilitating condition, botulinum toxin provides some symptomatic relief.

PMID: 17498988 [PubMed - as supplied by publisher]

6: J AAPOS. 2007 May 9; [Epub ahead of print]

Incidence, progression, and duration of retinopathy of prematurity in Hispanic and white non-Hispanic infants.

Virginia Commonwealth University School of Medicine, Richmond, Virginia.

PURPOSE: To compare the incidence, progression, and duration of retinopathy of prematurity (ROP) in low-birth-weight Hispanic and white non-Hispanic infants. METHODS: A total of 671 white non-Hispanic infants and 128 Hispanic infants with birth weights less than 1751 g were retrospectively evaluated to determine the incidence of both ROP and subthreshold or worse ROP. Multiple regression analysis was used to control for birth weight, gestational age at birth, year of birth, and newborn intensive care unit as contributing factors in the risk of ROP. The duration of ROP in untreated infants was calculated and compared for the two ethnic groups. RESULTS: There was no significant difference in the percentage of infants with ROP in the white non-Hispanic group (38.3%) versus the Hispanic group (41.4%). There was also no significant difference between white non-Hispanics (11.8%) and Hispanics (15.6%) in the risk of developing subthreshold or worse ROP. Multiple regression analysis showed no contribution of ethnicity to the risk of developing ROP (t = -0.34, p = 0.74) or subthreshold or worse ROP (t = 0.75, p = 0.45). The average duration of untreated ROP in white non-Hispanics (8.6 +/- 5.4 weeks) and Hispanics (8.9 +/- 7.0 weeks) also was not significantly different. However, Hispanic infants showed significantly higher variance in duration than white non-Hispanic infants (p = 0.04). CONCLUSIONS: ROP occurs with similar frequency in Hispanic and white non-Hispanic premature infants, as does subthreshold or worse ROP. Some Hispanic infants had an unusually short or long duration of ROP before regression, implying that the natural history of ROP may be somewhat different for the two ethnic groups.

PMID: 17498987 [PubMed - as supplied by publisher]

7: J AAPOS. 2007 May 9; [Epub ahead of print]

Presenting features suggestive for later recurrence of idiopathic sixth nerve paresis in children.

Department of Neuroscience, New York College of Osteopathic Medicine at New York Institute of Technology, Old Westbury, New York.

BACKGROUND: Although idiopathic sixth (abducens) nerve paresis of childhood typically resolves within a few months, the paresis recurs in a minority of cases. The purpose of this study is to describe clinical features at presentation that are associated with later recurrence. METHODS: Retrospective literature review and novel case report. RESULTS: Thirty-five articles were reviewed, revealing 54 nonrecurrent and 41 recurrent cases. One previously unreported recurrent case is also included in our review. Patients with recurrence were typically girls (p < 0.05) and were typically affected in the left eye (p < 0.05). All children who initially presented under 14 months of age and/or whose initial presentation was associated with vaccination developed recurrence. Seventy-three percent of second episodes occurred within one year of initial presentation. No children who initially presented after 12 years of age developed recurrence. CONCLUSIONS: When an otherwise normal child is diagnosed with idiopathic sixth nerve paresis, clinical features suggestive of later recurrence are female gender, left eye involvement, younger age, and recent vaccination. Recurrence is less likely if it has not occurred within one year of the initial event.

PMID: 17498986 [PubMed - as supplied by publisher]

8: J AAPOS. 2007 May 9; [Epub ahead of print]

Infantile high myopia in Bohring-Opitz syndrome.

The Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, Devon, United Kingdom.

Bohring-Opitz syndrome is a rare genetic condition of uncertain inheritance. It was first delineated by Bohring and coworkers in 1999(1) and up to 15 possible cases have been reported.(1-8) It has both ophthalmic and systemic features and represents a unique syndrome considered to be distinct from Opitz C trigonocephaly syndrome. The classic features of Bohring-Opitz syndrome include prominent metopic suture, exophthalmos, hypertelorism, cleft lip and palate, flexion deformities of the upper limbs, nevi flammei, and significant neurodevelopmental delay. We report a child with Bohring-Opitz syndrome and infantile high myopia. Bohring's original description of the phenotype did not include myopia but since then both this case and two others(5,6) have reported this association. The presence of high myopia may be helpful in identifying suitable candidate genes and elucidating the genetic mechanism, as well as alerting ophthalmologists to the importance of refraction for affected children.

PMID: 17498985 [PubMed - as supplied by publisher]

9: Ophthalmology. 2007 May 9; [Epub ahead of print]

Incidence of Uveal Melanoma in Europe.

Department of Ophthalmology, University of Florence, Florence, Italy.

PURPOSE: To estimate incidence rates of uveal melanoma in Europe from 1983 to 1994. DESIGN: Incidence analysis of data from cancer registries adhering to the European Cancer Registry-based study on survival and care of cancer patients (EUROCARE) (cases diagnosed from 1983 to 1994). PARTICIPANTS: Data of 6673 patients with ocular melanoma (as defined by International Classification of Oncology morphology codes 8720 to 8780 [melanoma] and International Classification of Diseases 9 (ICD9) codes 190.0 [iris and ciliary body], 190.5 [retina], 190.6 [choroid], and 190.9 [unspecified ocular location]) from 33 cancer registries of 16 European countries. METHODS: Incidence rate ratios (IRRs) were obtained from a multilevel Poisson regression model. MAIN OUTCOME MEASURES: Incidence rates and IRRs associated with demographic and geographic variables. RESULTS: Standardized incidence rates increased from south to north across registries, from a minimum of <2 per million in registries of Spain and southern Italy up to >8 per million in Norway and Denmark. The inclusion of tumors with unspecified ocular location (code 190.9) increased incidence rates in most United Kingdom registries, but not in the other geographic areas, where this code was seldom used for uveal melanomas. Incidence increased noticeably up to age 55 (IRR, 1.46 per 5 years; 95% confidence interval [CI], 1.36-1.57) but leveled off after age 75 (IRR, 0.99 per 5 years; 95% CI, 0.93-1.05), with intermediate levels midway (IRR, 1.18 per 5 years; 95% CI, 1.12-1.23). It was also higher in males (IRR, 1.22; 95% CI, 1.16-1.28). Rates were stable during the study period, but a cohort effect was evidenced, accounting for higher incidence rates in people born during the period 1910 to 1935 (P = 0.005). Incidence increased with latitude (P = 0.008), which explained most differences in rates among areas. CONCLUSIONS: In this large series of uveal melanomas, we found stable incidence during the years 1983 to 1994. The north-to-south decreasing gradient supports the protective role of ocular pigmentation. European ophthalmologists should develop guidelines to standardize the coding of tumors treated conservatively using the ICD classification to improve the registration and surveillance of uveal melanoma by cancer registries.

PMID: 17498805 [PubMed - as supplied by publisher]

10: Ophthalmology. 2007 May 9; [Epub ahead of print]

A New Classification of Calcification of Intraocular Lenses.

Laboratories for Ophthalmic Devices Research, Moran Eye Center, University of Utah, Salt Lake City, Utah; University Eye Hospital Tuebingen, Tuebingen, Germany.

OBJECTIVE: To define and classify the major types of intraocular lens (IOL) calcification. DESIGN: Retrospective observational case series with clinicopathologic correlation. PARTICIPANTS: More than 400 IOLs explanted because of opacification. METHODS: The authors reviewed the clinical information and histologic findings of all IOLs that had been explanted because of opacification or calcification of the IOLs accessioned in their laboratory between January 1999 and December 2004. MAIN OUTCOME MEASURE: The proposed mechanism that led to calcification of each IOL design. RESULTS: Three major types of calcification were identified: (1) primary calcification, (2) secondary calcification, and (3) false-positive calcification or pseudocalcification. The primary form refers to calcification that is inherent in the IOL, that is, is based on possible inadequate formulation of the polymer, fabrication of the IOL, or issues with its packaging process. The calcification presumably occurs in otherwise normal eyes and generally is not associated with preexisting diseases. The secondary form refers to deposition of calcium onto the surface of the IOL most likely the result of environmental circumstances (e.g., changes in the aqueous milieu surrounding the implanted IOL associated with preexisting or concurrent diseases or indeed any condition that has disrupted the blood-aqueous barrier). By definition, it is not related to any problem with the IOL itself. The false-positive or pseudocalcification refers to those cases in which other pathology is mistaken for calcification or false-positive staining for calcium occurs. CONCLUSIONS: When evaluating the pathogenesis and nature of IOL calcification in or on any given design, one should categorize it according to these types. Primary calcification is IOL related and the IOL should be withdrawn or modified to correct the problem. After the cause is identified and the lens is implanted again, patients should be followed up for up to 2 years to be sure the problem is alleviated. Secondary calcification is by definition not IOL related; it may occur with virtually all IOL designs implanted under various adverse circumstances. No IOL, hydrophilic or hydrophobic, is immune to secondary calcification. The false-positive form is recognized readily in the laboratory and this erroneous diagnosis is avoided.

PMID: 17498804 [PubMed - as supplied by publisher]

11: Eye Contact Lens. 2007 Mar;33(2):111-3.

Role of mini-scleral gas-permeable lenses in the treatment of corneal disorders.

From Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

PURPOSE.: Case report on the clinical implications of mini-scleral gas-permeable contact lenses in the treatment of corneal disorders. METHODS.: Three patients with different corneal disorders were fitted with Jupiter design mini-scleral gas-permeable contact lenses. RESULTS.: All three patients achieved excellent vision and comfort. The contact lenses were tolerated well, and no complications were observed. CONCLUSIONS.: Mini-scleral gas-permeable contact lenses provide a good option for patients who require gas-permeable contact lenses for optimal visual function but do not tolerate corneal contact lenses. Mini-scleral lenses are also an excellent therapeutic tool in the treatment of at least some forms of severe dry eyes.

PMID: 17496707 [PubMed - in process]

12: Eye Contact Lens. 2007 Mar;33(2):109-10.

Microbial keratitis in keratoglobus-associated vernal keratoconjunctivitis and atopic dermatitis.

From the Department of Ophthalmology (D.Q.N., R.S., A.K.B.), Musgrove Park Hospital, Taunton, United Kingdom; and the Department of Ophthalmology (D.Q.N.), Bristol Eye Hospital, Bristol, United Kingdom.

PURPOSE.: The authors describe a patient with keratoglobus and a history of vernal keratoconjunctivitis and atopic dermatitis who acutely developed corneal hydrops and severe microbial keratitis. The infectious keratitis responded poorly to medical management and resulted in enucleation of the eye. METHODS.: A 25-year-old man presented with an acutely painful, red left eye. He had an ocular history of keratoglobus in association with vernal keratoconjunctivitis and atopic dermatitis. His visual acuity was light perception in the left eye and 20/40 in the right eye. Ocular examination showed a grossly edematous cornea with breaks in Descemet's membrane, a central infiltrative ulcer, and hypopyon. RESULTS.: Corneal scrapings showed gram-positive beta-hemolytic streptococci, for which topical treatment of ceftazidime and benzylpenicillin every 30 minutes by day and night was commenced with an oral course of ciprofloxacin 750 mg twice a day. Despite aggressive therapy, the microbial keratitis progressed, and the hypopyon increased in size. The patient subsequently underwent enucleation of his left eye. CONCLUSIONS.: This is the first reported case of microbial keratitis with corneal hydrops in a patient with keratoglobus, vernal keratoconjunctivitis, and atopic dermatitis. His ocular and dermatologic comorbidity may have impaired corneal integrity and allowed penetration of organisms, resulting in a severe case of keratitis that responded poorly to medical management.

PMID: 17496706 [PubMed - in process]

13: Eye Contact Lens. 2007 Mar;33(2):106-8.

Corneal nerve structure and function in keratoconus: a case report.

From The University of Manchester, Manchester, United Kingdom.

PURPOSE.: To investigate corneal nerve structure and function in a 24-year-old patient with keratoconus and prominent corneal nerves. METHODS.: Corneal nerve appearance was assessed by using a corneal confocal microscope, and corneal nerve function was assessed by using a Cochet-Bonnet aesthesiometer. Findings were compared to those of an age-matched control subject without keratoconus. RESULTS.: The patient with keratoconus was found to have thicker nerve fiber bundles in the stroma (keratoconus vs. control, 9.8 +/- 5.0 mum vs. 5.4 +/- 2.7 mum) and reduced nerve fiber density in the subepithelial plexus (keratoconus vs. control, 269.7 +/- 145.6 mum vs. 1,258 +/- 254.8 mum) compared to the control subject. The patient with keratoconus was found to have reduced corneal sensitivity compared to the control subject (keratoconus vs. control 0.39 gr/mm vs. 1.59 gr/mm). CONCLUSIONS.: Corneal confocal microscopy proved to be a useful in vivo technique for assessing corneal nerve structure in this patient with keratoconus. Although the total number of stromal nerve fiber bundles was reduced in the patient with keratoconus versus the control subject, the increased tortuosity and increased nerve fiber diameter may explain why the corneal nerves appear more visible in this patient with keratoconus.

PMID: 17496705 [PubMed - in process]

14: Eye Contact Lens. 2007 Mar;33(2):103-5.

A Retrospective Case Series: Use of SoftPerm Contact Lenses in Patients With Keratoconus.

From 1st Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey.

PURPOSE.: To evaluate the performance of the SoftPerm contact lens in patients with irregular astigmatism caused by keratoconus. METHODS.: Twenty-four eyes of 14 patients with keratoconus who had intolerance to rigid gas-permeable contact lenses and were fitted with SoftPerm lenses at Kartal Training and Research Hospital between August 1998 and January 2002 were evaluated retrospectively. The average follow-up time was 23 months. Patients were between the ages of 16 and 39 years. All patients were examined by corneal topography before a SoftPerm contact lens trial. A standard protocol was used to select the initial trial lens on the basis of computer-generated topographic keratometric readings. Final lens selection was based on clinical performance. Visual acuity and complications were analyzed after fitting. RESULTS.: Best-corrected spectacle visual acuity of 20/40 or better was noted in 12.5% of eyes before the SoftPerm contact lens trial and increased to 83.3% after the SoftPerm contact lens fitting. Lens damage especially related to separation at the junction was observed in 29.1% of patients, discomfort in 29.1%, giant papillary conjunctivitis in 25%, and peripheral corneal neovascularization in 25%. Discomfort was the most common reason for discontinuation. CONCLUSIONS.: SoftPerm lenses can be considered when high astigmatism is encountered in patients with keratoconus who have better visual acuity with SoftPerm lenses than with spectacles and who are intolerant of rigid gas-permeable lenses.

PMID: 17496704 [PubMed - in process]

15: Eye Contact Lens. 2007 Mar;33(2):98-102.

Contrast visual acuity with bifocal contact lenses.

From Ueda Eye Clinic (K.U.), Shimonoseki, Japan; and Eye Clinic Aoi (Y.I.), Nagoya, Japan.

PURPOSE.: To compare the quality of vision of a bifocal rigid gas-permeable contact lens versus a bifocal soft contact lens in subjects with presbyopia. METHODS.: Sixteen healthy presbyopic subjects with no ocular disease but experienced with contact lens wear were enrolled in the study. Subjects randomly wore both types of bifocal lenses for 30 minutes with a washout period of 30 minutes each in a crossover manner. The primary outcome measure was the difference in contrast visual acuity. Distance and near contrast visual acuities with the two bifocal lens types were measured in different lighting environments and at multiple contrast levels. After the measurement, subjects were asked to rate their subjective vision by using the four categories with both lens types throughout the study. At the end of the study, subjects were also asked which of the two lens types they preferred. RESULTS.: Under photopic conditions, distance and near visual acuities decreased at the 25% and 10% contrast levels, respectively, in subjects wearing bifocal soft contact lenses (P<0.05). Under scotopic conditions, distance visual acuity decreased at the 5% contrast level with the bifocal rigid gas-permeable contact lenses (P<0.05). For subjective responses of clarity, there were no differences between lens types for distance vision (P>0.05), but bifocal rigid gas-permeable lenses were clearer than bifocal soft contact lenses for near vision (P<0.05). CONCLUSIONS.: Bifocal rigid gas-permeable contact lenses showed better visual performance than bifocal soft contact lenses did.

PMID: 17496703 [PubMed - in process]

16: Eye Contact Lens. 2007 Mar;33(2):91-97.

External Factors Affecting Data Acquisition During Corneal Topography Examination.

From the Department of Physics (Optometry) (J.M.G.-M., A.Q., J.J., P.F., J.B.A.), School of Sciences, University of Minho, Braga, Portugal; the Department of Applied Physics (Optics) (A.C.), School of Optometry, University of Santiago de Compostela, A. Coruna, Spain; and the School of Life and Health Sciences (A.C.), Aston University, Birmingham, United Kingdom.

PURPOSE.: To analyze the factors affecting data acquisition during corneal topography examination with the Medmont E-300 videokeratoscope and to provide strategies to minimize their effects. METHODS.: Sixty eyes from thirty young adults were examined. A second observer registered incidences with the potential to affect data acquisition. Those factors were correlated with the difficulty of measurements as judged subjectively by the practitioner who performed the examination. Measurements of axial curvature were analyzed to evaluate the variability expressed as intrasession and intersession coefficient of variation and the standard error of the mean (SEM). RESULTS.: The level of difficulty rated by the practitioner was in general low, with 70% of the eyes being easy or very easy to measure. For the remaining 30% of the eyes, corneal topography measurements were considered to be difficult (27%) or very difficult (3%). Of the external parameters investigated, only fixation instability (P<0.001, chi) and the need for head repositioning (P=0.024, chi) were associated significantly with a higher level of difficulty, as rated subjectively by the practitioner. Further analysis showed that some external factors, including those previously mentioned and others related to tear instability, affect the variability of measurements at certain corneal locations, particularly in the vertical meridian when related to tear instability and in the horizontal meridian when related to the need for head repositioning on the chin rest owing to physiognomy interferences with the keratoscope cone. Intersession SEM improved when three readings from each session were considered. CONCLUSIONS.: The level of subjective difficulty found during videokeratoscopy examination is correlated strongly with fixation instability and the need for head reorientation in the chin rest, whereas tear-related events seem to be less relevant in the practitioner perception of test ease or difficulty. Those factors have relevance in measurement variability.

PMID: 17496702 [PubMed - as supplied by publisher]

17: Eye Contact Lens. 2007 Mar;33(2):89-90.

Insertion of a bandage contact lens with minims.

From the Department of Ophthalmology, Doncaster and Bassetlaw Hospitals, Doncaster, United Kingdom.

PURPOSE.: To describe a new technique for the insertion of a bandage contact lens with the help of sterile Minims. METHODS.: The bandage contact lens is picked up with the nozzle of the Minims by suction. The lens is then taken to the patient, placed on the cornea, and released by breaking the vacuum. RESULTS.: Examination of the contact lens under the microscope after insertion showed no damage. CONCLUSIONS.: Insertion of a bandage contact lens with Minims is a nontouch, inexpensive, easy, and patient-friendly method. It can reduce the risk of infection in already compromised eyes.

PMID: 17496701 [PubMed - in process]

18: Eye Contact Lens. 2007 Mar;33(2):81-88.

Contact Lens Fitting Profile in Portugal in 2005: Strategies for First Fits and Refits.

From the Department of Physics (Optometry) (J.M.G-M., J.J., J.B.A.), School of Sciences, University of Minho, Braga, Portugal; and the Department of Surgery (Ophthalmology) (M.A.P.), School of Optics and Optometry, University of Santiago de Compostela, Santiago de Compostela, Spain.

PURPOSE.: To evaluate the standards of contact lens practice in Portugal, with particular attention paid to the characteristics of first fits and refits regarding aspects such as symptoms of dryness, overnight wear, silicone hydrogel and multifocal prescriptions, and care systems. METHODS.: A questionnaire was distributed to 300 contact lens practitioners in Portugal, and they were asked to complete them with the following first 10 fittings (only right eye of each patient). Fifty-six questionnaires were returned to total 529 fittings. RESULTS.: The mean age of contact lens wearers was 28.1 +/- 10.1 years, and 94.4% of the wearers were fitted with soft contact lenses (67.9% hydrogel lenses, 21.2% silicone hydrogel lenses, and 5.2% biomimetic soft contact lenses). Sixty percent of patients wore their contact lenses for 9 to 12 hours per day. The lenses were replaced on a monthly basis in 71% of cases, and 82.8% of wearers used a multipurpose solution for lens cleaning and disinfection. Significant differences were found between first fits and refits regarding the prevalence of dryness symptoms (higher incidence of frequent symptoms in the evening in the refitting group, P < 0.01, chi), replacement schedule (lower incidence of monthly disposable lenses in refits compared to first fits, P < 0.05, chi), and care regimen (lower incidence of multipurpose solutions and higher incidence of hydrogen peroxide in refits, P < 0.01, chi). CONCLUSIONS.: Statistical analysis of the current trends in the Portuguese contact lens fitting profile showed that contact lens practitioners in Portugal are receptive to use innovations in contact lens products, such as silicone hydrogel and biomimetic materials, and daily-disposable contact lenses to refit patients who have not succeeded with previous lenses. Multifocal lenses also experienced a significant increase in their prevalence among refits and new fits. Rigid gas-permeable materials maintained and even experienced a slight increase in refits. Conversely, there is still a low incidence of extended-wear prescriptions, most of them being made with low-Dk soft contact lenses.

PMID: 17496700 [PubMed - as supplied by publisher]

19: Eye Contact Lens. 2007 Mar;33(2):74-80.

Long-term Clinical Results: 3 Years of Up to 30-Night Continuous Wear of Lotrafilcon A Silicone Hydrogel and Daily Wear of Low-Dk/t Hydrogel Lenses.

From Pacific University School of Optometry (P.B.), Forest Grove, OR; CIBA Vision Corporation (P.B., B.L., S.D.), Duluth, GA; The Ohio State University College of Optometry (J.T.B.), Columbus, OH; University of Connecticut Health Center (P.D.), Bloomfield, CT; Private practice (G.S.), Huntington Beach, CA; Groat Eyecare Associates (J.Y.), Greensboro, NC; and Indiana University, Bloomington, IN (R.L.C.).

PURPOSE.: To summarize results of a 3-year clinical trial assessing subjective and objective experience with lotrafilcon A silicone hydrogel (SH) lenses for up to 30 nights of continuous wear or low-Dk/t daily-wear (LDW) hydrogel lenses. METHODS.: Nineteen sites dispensed SH lenses to 317 subjects (286 current wearers and 31 new wearers) and 2-week replacement LDW lenses to 81 new wearers in a 3-year study. RESULTS.: For the SH cohort, limbal redness, conjunctival redness, and corneal neovascularization improved among 23%, 21%, and 13% of eyes, respectively (P<0.001), with no signs increasing significantly. For the LDW cohort, limbal redness, papillary conjunctivitis, and corneal staining increased among 11%, 21%, and 13% of eyes, respectively (P<0.02), with no signs improving significantly. The change in average spherical equivalent power was -0.03 diopters for the age-matched SH cohort and -0.40 diopters for the LDW cohort (P=0.007). During the 3 years, the SH group reported significantly less frequent dryness during and at the end of the day, redness, photophobia, lens awareness, and blurred vision. Significantly more LDW lens wearers reported frequent during-the-day and end-of-day dryness and blurred vision. CONCLUSIONS.: During the 3 years, lotrafilcon A lens wearers who wore their lenses continuously for up to 30 nights showed stable, long-term improvements in many signs of corneal health and symptoms along with less myopic progression versus daily wearers of low-Dk/t hydrogel lenses. Many biomicroscopy signs and symptoms worsened among neophytes wearing daily-wear low-Dk/t hydrogel lenses. The use of lotrafilcon A lenses may minimize many ocular changes from soft contact lens wear.

PMID: 17496699 [PubMed - as supplied by publisher]

20: Eye Contact Lens. 2007 Mar;33(2):70-3.

Trends in microbial keratitis in Japan.

From the Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan.

PURPOSE.: To identify microbiologic characteristics of infectious keratitis and predisposing factors. METHODS.: The microorganisms isolated from patients with infectious corneal ulcers during the 5 years between January 1999 and December 2003 were retrospectively examined. Herpetic and other viral infections were excluded from this study. Patient age, sex, risk factors, and isolated organisms were collected. RESULTS.: In 123 eyes of 122 patients, organisms were isolated from 72 (58.5%) eyes. In total, 99 different organisms were isolated. Among these, 77 (77.8%) were gram-positive bacteria; 18 (18.2%) were gram-negative bacteria; six (6.1%) were fungi; and one (1.0%) was acanthamoeba. Contact lens wear was the main risk factor (54.5%), and ocular surface disease and previous ocular surgery were present in 20.5% and 13.1% of cases, respectively. Posttreatment visual acuity was significantly improved by pretreatment in culture-positive groups treated according to the antibiotic susceptibilities (Wilcoxon t test, P<0.01). CONCLUSIONS.: The results are changing to those reported by other countries and generations. Contact lens wear is the most important risk factor in Japan. The results of isolation and culture are essential for improving the cure rate.

PMID: 17496698 [PubMed - in process]

21: Eye Contact Lens. 2007 Mar;33(2):65-9.

Contact lens-induced infectious keratitis in Japan.

From the Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan.

PURPOSE.: To identify microbiologic characteristics of infectious keratitis associated with contact lenses. METHODS.: The authors retrospectively examined the microorganism isolated from patients with microbial corneal ulcer associated with contact lenses during a 5-year period. Herpetic and other viral infections were excluded from this study. Patient age, sex, type of contact lens, and isolated organisms were collected from medical records. RESULTS.: Sixty-seven eyes of 66 patients (54.5%) who possibly had contact lens-induced infectious keratitis were reviewed. Cultures of corneal scrapings or eye discharge were positive in 30 (44.8%) of 67 eyes. A total of 35 strains of bacteria were detected, among which there were 29 (82.9%) gram-positive bacteria, two (5.7%) gram-negative bacteria, three (8.6%) fungi, and one (2.9%) species of Acanthamoeba. The most common type of contact lens was a conventional soft contact lens (25 eyes, including extended wear in seven eyes), whereas hard contact lenses, including rigid gas-permeable contact lenses, were worn in 19 eyes. In addition, frequent-replacement lenses were used in 17 eyes, whereas weekly lenses and daily lenses were used for three eyes each. The largest age group was the 20s for all types of lenses. CONCLUSIONS.: The results of isolation and culture are essential for improving the cure rate, especially for patients who have severe corneal ulcers.

PMID: 17496697 [PubMed - in process]

22: Eye Contact Lens. 2007 Mar;33(2):58-64.

Novel Method for Determining Hydrogel and Silicone Hydrogel Contact Lens Transmission Curves and Their Spatially Specific Ultraviolet Radiation Protection Factors.

From the School of Physics and Facility for Optical Characterization and Spectroscopy Institute (J.E.W., D.P.F.), Dublin Institute of Technology, Dublin, Ireland; and Texas Eye Research and Technology Center (L.V.K., J.P.G.B.), University of Houston, College of Optometry, Houston, TX.

PURPOSE.: Anterior ocular tissues exposed to high levels of toxic ultraviolet (UV) radiation may undergo physiologic changes leading to diseases that can alter the ocular surface, particularly in the stem cell-rich limbal region. UV radiation-blocking hydrogel contact lenses provide protection across the ocular surface, which varies according to the lens thickness. METHODS.: A novel fiber optic spectrophotometer front-end system has been developed to measure lens transmission curves at test points across lens surfaces to determine optical properties based on the Beer-Lambert law. Factors determining the transmission curves include the hydrogel lens used, its refractive index, whether a UV radiation-blocking dopant is incorporated, the water content, and the thickness of the lens. Test lenses of equal power were placed over a detecting fiber optic and illuminated by a deuterium source, and transmission spectra were recorded. The small optical sampling size allowed the spectral transmission profile to be determined across the lens surface, and comparisons were made with different lenses. RESULTS.: Transmission curves across the lenses showed greater UV radiation-blocking capacity at the thicker peripheral region, with the 50% cutoff wavelength moving toward the visible spectrum by 10 nm from the center to the periphery. In addition, the ability to determine the spatially specific absorption coefficient and the related UV radiation protection factor was demonstrated. CONCLUSIONS.: The system measures spatial variation in lens transmission and comparing different lens types while overcoming many of the handling limitations of cuvette-based spectrophotometer methods. The data show good agreement with published transmission curves and allow intralens and interlens comparisons.

PMID: 17496696 [PubMed - as supplied by publisher]

23: Eye Contact Lens. 2007 Mar;33(2):57.

It takes a team.

PMID: 17496695 [PubMed - in process]

24: Br J Ophthalmol. 2007 May 10; [Epub ahead of print]

Long-term outcome of transscleral diode laser cyclophotocoagulation in refractory glaucoma.

Ophthalmology, University of Bern, Switzerland.

BACKGROUND: Long-term outcome and complications of diode laser cyclophotocoagulation (DCPC) may be important, since eyes once treated with DCPC are less likely to be subjected to other types of interventions in the further follow-up. METHODS: Retrospective review of 131 eyes of 127 patients treated from 2000 through 2004. Success was defined as IOP at last visit 6-21 mmHg; hypotony: IOP</=5 mmHg. RESULTS: Mean follow-up (FU) was 30.1+/-16.7 months. Mean number of treatment sessions per eye was 1.54, 89% of the eyes having one or two sessions; overall re-treatment rate: 38.9%. Mean total laser energy delivered per eye: 133.9+/-73.7 J; mean energy per treatment episode: 86.8+/-22.0 J. Eyes with 3 or more treatments (11%) had a significantly larger proportion of post-traumatic glaucoma, and patients were significantly younger. All eyes had refractory glaucomas on maximal medication, neovascular glaucoma (NVG) representing the largest subgroup (61%). IOP decreased from 36.9+/-10.7 mmHg pre-treatment to 15.3+/-10.4 mmHg at the end of FU. Success was noted in 69.5% (91 eyes), failure (non-response) in 13%. Hypotony occurred in 17.6% eyes, of which 74% had NVG. Hypotony developed after mean 19.3+/-11.0 months, range 6-36; with 96% of these eyes having received only 1 or 2 treatments; delivered energy did not differ from the one in the successful eyes. CONCLUSIONS: DCPC is an efficient treatment for refractory glaucoma. Hypotony, the most common complication, may develop as late as 36 months post-treatment. Diagnostic category and age seem to influence the outcome stronger than laser protocol and delivered energy.

PMID: 17494956 [PubMed - as supplied by publisher]

25: Br J Ophthalmol. 2007 May 10; [Epub ahead of print]

Familial aggregation of myopia in the Tehran Eye Study: estimation of the sibling and parent-offspring recurrence risk ratios.

Medical Sciences/University of Tehran, School of Public Health, Iran, Islamic Republic of.

BACKGROUND/AIMS: To determine the potential influence of genetic factors on the prevalence of myopia in Tehran. METHODS: Of 6497 citizens of Tehran sampled from 160 clusters using stratified, random cluster sampling, 4565 (70.3%) participated in the study and were referred to a clinic for an extensive eye examination and interview. These were from 1259 nuclear families with the average size of 3.6. Refraction data obtained from 3321 participants aged sixteen years and over are presented. Three definitions of myopia as the spherical equivalent of -0.5, -1 and -2 diopters or less were used. Familial aggregation of myopia was evaluated with odds ratios and recurrence risk ratios (lambdaR ) using a multiple logistic regression with generalized estimating equations (GEE) adjusted for age, sex, height and education. RESULTS: Multivariate analyses showed a strong familial aggregation of myopia among siblings, (lambdaR ranging from 2.09 to 3.86) and parent-offspring pairs (lambdaR ranging from 1.82 to 3.81) adjusted for age, sex, height and education. The aggregation increased with higher myopia thresholds and using cycloplegic refraction. The ORs for spouse pairs were not significantly different from 1.0. The association of myopia with sex, height, and education (and not age) remained significant in the final GEE2 model. CONCLUSION: Findings indicate a relatively high degree of familial aggregation, independent of age, sex, height and education in Tehran's population. This residual aggregation may be due to heredity or the effect of unmeasured common environment.

PMID: 17494955 [PubMed - as supplied by publisher]

26: Br J Ophthalmol. 2007 May 10; [Epub ahead of print]

Novel pressure-to-cornea index (PCI) in glaucoma.

University of Bern, Switzerland.

BACKGROUND: Several conversion tables and formulas have been suggested to correct applanation intraocular pressure (IOP) for central corneal thickness (CCT). CCT is also thought to represent an independent glaucoma risk factor. In an attempt to integrate IOP and CCT into a unified risk factor and avoid uncertain correction for tonometric inaccuracy, we propose a new pressure-to-cornea index (PCI). METHODS: PCI (IOP/CCT(3)) was defined as the ratio between untreated IOP and CCT(3) in mm (ultrasound pachymetry). PCI distribution in 220 normal controls, 53 normal-tension glaucoma (NTG), 76 ocular hypertension (OHT), and 89 primary open-angle glaucoma (POAG) patients was investigated. PCI's ability to discriminate between glaucoma (NTG+POAG) and non-glaucoma (controls+OHT) was compared with that of three published formulas for correcting IOP for CCT. Receiver Operating Characteristic curves (ROC) were built. RESULTS: Mean PCI values were: Controls 92.0+/-24.8, NTG 129.1+/-25.8, OHT 134.0+/-26.5, POAG 173.6+/-40.9. To minimize IOP bias, eyes within the same 2mmHg-range between 16 and 29 mmHg (16-17,18-19,etc) were separately compared: control and NTG eyes as well as OHT and POAG eyes differed significantly. PCI demonstrated larger area under the ROC curve (AUC) and significantly higher sensitivity at fixed 80% and 90% specificities compared with each of the correction formulas; optimum PCI cut-off value 133.8. CONCLUSIONS: PCI range of 120-140 is proposed as the upper limit of "normality", 120 being the cut-off value for eyes with untreated pressures </=21, 140 when untreated pressure >/=22. PCI may reflect individual susceptibility to a given IOP-level, and thus represent a glaucoma risk factor. Longitudinal studies are needed to prove its prognostic value.

PMID: 17494954 [PubMed - as supplied by publisher]

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