2013-05-19T13:36:48Z http://www.dovepress.com/oai.php

oai:dovepress.com/278 2007-10-05 OPTH

The relationship of graft survival and herpes simplex virus latency in recipient corneal buttons Gundogan, Nimet Clinical Ophthalmology Orhan Aydemir1, Peykan Türkçüoglu1, Yasemin Bulut2, Ahmet Kalkan31Firat University School of Medicine, Department of Ophthalmology, Elazig, Turkey; 2Firat University School of Medicine, Department of Microbiology, Elazig, Turkey; 3Firat University School of Medicine, Department of Infectious Diseases, Elazig, TurkeyPurpose: To demonstrate relationship between herpes simplex virus (HSV) corneal latency and graft survival.Methods: Prospective case control study. 28 recipient corneal buttons and donor cornea-scleral remnants were examined for HSV DNA with polymerase chain reaction (PCR). None of the recipient had a history of HSV infection. Serum samples of graft recipients were analyzed for the presence of anti-HSV IgG and IgM with enzyme-linked immunosorbent assay technique. All corneas were free of stromal scarring or epithelial defect before sampling and had an endothelial cell density of >2000 cells/mm2.Results: In twenty three patients (82%) anti-HSV IgG was detected in serum. In none of the recipients anti-HSV IgM was positive. HSV DNA was positive in six out of twenty eight (21%) of the recipient corneal buttons and none of the donor cornea-scleral remnants. In eighteen months follow-up period three out of six (50%) HSV DNA positive and one out of twenty-two (4.5%) HSV DNA negative patients experienced late endothelial failure that was statistically significantly different (p = 0.022). Conclusion: Even without a history of HSV keratitis, presence of latent HSV virus in recipient cornea is an important risk factor for subsequent graft survival.Keywords: herpes simplex virus, polymerase chain reaction, corneal latency, corneal graft survival Dove Press Orhan Aydemir, Peykan Türkçüoglu, Yasemin Bulut, Ahmet Kalkan 2007-10-05 PDF http://www.dovepress.com/getfile.php?fileID=1295 http://www.dovepress.com/the-relationship-of-graft-survival-and-herpes-simplex-virus-latency-in-peer-reviewed-article-OPTH English

oai:dovepress.com/340 2008-03-18 OPTH

Fluoroquinolones compared to 1% azithromycin in DuraSite® for bacterial conjunctivitis [from Lichenstein and Granet] and Response to correspondence [from Friedlaender and Protzko] ||FREE PAPER|| Lichtenstein, Steven Clinical Ophthalmology Steven J Lichtenstein1, David B Granet21Associate Clinical Professor of Pediatrics and Surgery, University of Illinois College of Medicine at Peoria and Chicago, Peoria, IL, USA, 2Anne F. Ratner Professor of Ophthalmology and Pediatrics, University of California at San Diego, San Diego, CA, USAIn a recent issue of Clinical Ophthalmology, Friedlaender and Protzko (2007) review the development and efficacy of 1% azithromycin in DuraSite® (AzaSite™, Inspire Pharmaceuticals, Inc., Durham, NC) for the treatment of bacterial conjunctivitis. The authors conclude that 1% azithromycin in DuraSite offers a simplified dosing regimen with sustained bactericidal levels that decrease resistance development. While 1% azithromycin in DuraSite is a new formulation of azithromycin that allows topical ocular use, azithromycin and DuraSite have been around for many years. Evidence demonstrates a greater potential for emerging resistance with azithromycin, an older drug, especially when formulated in a vehicle that prolongs low levels of antibiotic exposure over time. Mitchell H Friedlaender1, Eugene Protzko21Division of Ophthalmology, Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA, 92037 USA; 2Seidenberg Protzko Eye Associates, 930 Revolution St, Havre De Grace, MD, 21014 USAIn our review of the development and efficacy of 1% azithromycin in DuraSite® (AzaSite™, InSite Vision, Alameda, CA, USA) published in Clinical Ophthalmology (Friedlaender and Protzko 2007), we describe azithromycin as a well known anti-infective agent with pharmacokinetic properties that were not sufficiently exploited for topical use in the eye until the development of AzaSite. A sustained release ocular antibiotic, AzaSite delivers sufficiently high concentrations of azithromycin to the eye to eradicate common causative pathogens of bacterial conjunctivitis. The means by which azithromycin is delivered to the eye in the AzaSite formulation gives it much greater tissue concentrations than expected. Dove Press Steven J Lichtenstein, David B Granet, Mitchell H Friedlaender, Eugene Protzko 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2317 http://www.dovepress.com/fluoroquinolones-compared-to-1-azithromycin-in-durasitesupregsup-for-b-peer-reviewed-article-OPTH English

oai:dovepress.com/341 2008-03-18 OPTH

An intractable case of Pseudomonas aeruginosa infection after scleral buckling for rhegmatogenous retinal detachment Nishikiori, Nami Clinical Ophthalmology Nami Nishikiori, Hiroshi OhguroDepartment of Ophthalmology, Sapporo Medical University School of MedicineBackground: Scleral buckling is still a common procedure to repair rhematogenous retinal detachment, and acute or chronic infection of the scleral explant is rare. We report an intractable case of acute scleral explant infection by Pseudomonas aeruginosa.Case: A 36-year-old man suffered from acute scleral explant infection by P. aeruginosa forty-eight hours after scleral buckling for rhegmatogenous retinal detachment. The infection was treated by intravenous administration of various appropriate antibiotics for eighteen days and washing the scleral explant with appropriate antibiotics, and appeared to be resolved. However, three months after the initial surgery, we had to remove the scleral explant because of recurrent infection.Observations: We encountered an intractable case of acute scleral explant infection by P. aeruginosa, that recurred and forced the removal of the scleral explant.Conclusions: We found that recurrence of infection necessitated removal of the scleral explant, even though the organism was sensitive to the antibiotics used to treat the infection, and there was an appropriate duration of treatment. Early diagnosis and countermeasures, first considering conservative management, which may have a role in delaying buckle removal, and thus reduce the risk of retinal redetachment, and help prolong the time until surgical treatment such as removing the scleral explant is required.Keywords: acute scleral explant infection, Pseudomonas aeruginosa, rhegmatogenous retinal detachment Dove Press Nami Nishikiori, Hiroshi Ohguro 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2316 http://www.dovepress.com/an-intractable-case-of-pseudomonas-aeruginosa-infection-after-scleral--peer-reviewed-article-OPTH English

oai:dovepress.com/342 2008-03-17 OPTH

Corneal endothelial cell density and morphology in Phramongkutklao Hospital Sopa, narumon Clinical Ophthalmology Narumon Sopapornamorn1, Manapon Lekskul1, Suthee Panichkul21Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand; 2Department of Obstetrics and Gynecology, Phramongkutklao College of Medicine, Bangkok, ThailandObjective: To describe the corneal endothelial density and morphology in patients of Phramongkutklao Hospital and the relationship between endothelial cell parameters and other factors.Methods: Four hundred and four eyes of 202 volunteers were included. Noncontact specular microscopy was performed after taking a history and testing the visual acuity, intraocular pressure measurement, Schirmer’s test and routine eye examination by slit lamp microscope. The studied parameters included mean endothelial cell density (MCD), coefficient of variation (CV), and percentage of hexagonality.Results: The mean age of volunteers was 45.73 years; the range being 20 to 80 years old. Their MCD (SD), mean percentage of CV (SD) and mean (SD) percentage of hexagonality were 2623.49(325) cell/mm2, 39.43(8.23)% and 51.50(10.99)%, respectively. Statistically, MCD decreased significantly with age (p < 0.01). There was a significant difference in the percentage of CV between genders. There was no statistical significance between parameters and other factors.Conclusion: The normative data of the corneal endothelium of Thai eyes indicated that, statistically, MCD decreased significantly with age. Previous studies have reported no difference in MCD, percentage of CV, and percentage of hexagonality between gender. Nevertheless, significantly different percentages of CV between genders were presented in this study.Keywords: Corneal endothelial cell, parameters, age, gender, smoking, Thailand Dove Press Narumon Sopapornamorn, Manapon Lekskul, Suthee Panichkul 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2303 http://www.dovepress.com/corneal-endothelial-cell-density-and-morphology-in-phramongkutklao-hos-peer-reviewed-article-OPTH English

oai:dovepress.com/343 2008-03-18 OPTH

Histology of corneal wound healing after deep lamellar endothelial keratoplasty Zhang, Chaoran Clinical Ophthalmology Chaoran Zhang1, Jianjiang Xu1, Rongjia Chen21Ophthalmology Department, 2Pathology Department, Eye and Ear Nose Throat Hospital, Fudan University, Shanghai, ChinaAbstract: Deep lamellar endothelial keratoplasty (DLEK) has become an alternative procedure for bullous keratopathy. Herein, the histopathological characteristics of corneal wound healing after DLEK were reported. A 71-year-old man suffering from left psuedophakia bullous keratopathy received small incision DLEK. Twenty months later, another penetrating keratoplasty (PK) was performed because of the graft failure. The histopathology of the corneal button removed during PK demonstrated the regularity of stromal fiber alignment at the graft interface. Fibrotic repair was limited to the peripheral margins.Keywords: Deep lamellar endothelial keratoplasty, DLEK, bullous keratopathy, penetrating keratoplasty Dove Press Chaoran Zhang, Jianjiang Xu, Rongjia Chen 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2307 http://www.dovepress.com/histology-of-corneal-wound-healing-after-deep-lamellar-endothelial-ker-peer-reviewed-article-OPTH English

oai:dovepress.com/344 2008-03-18 OPTH

Ischemic maculopathy in zidovudine-induced anemia in an HIV-positive man Yoganathan, Kathir Clinical Ophthalmology Kathir Yoganathan1, Michael Austin21Department of Genito-Urinary Medicine, 2Department of Ophthalmology, Singleton Hospital, Sketty, Swansea, SA2 8QA, UKAbstract: Opportunistic cytomegalovirus (CMV) infection is common in severely immunocompromised HIV-positive patients. The retina is the commonest site of involvement with hemorrhages a prominent feature. CMV retinitis affects 40% of HIV positive patients who have CD4 count of less than 100 cell/mm3, and in these circumstances clinicians are likely to consider commencing anti-CMV therapy without considering other causes. We report a man with HIV who developed bilateral retinal hemorrhages and ischemic maculopathy in association with zidovudine (AZT)-induced anemia. Retinal hemorrhages resolved following blood transfusion.Keywords: Ischemic maculopathy, retinal hemorrhages, anemia, zidovudine, HIV Dove Press Kathir Yoganathan, Michael Austin 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2315 http://www.dovepress.com/ischemic-maculopathy-in-zidovudine-induced-anemia-in-an-hiv-positive-m-peer-reviewed-article-OPTH English

oai:dovepress.com/345 2008-03-18 OPTH

Pyocele of the lachrymal sac: A late and unusual complication after surgery for a juvenile nasopharyngeal angiofibroma Philippe, Eloy Clinical Ophthalmology Philippe Eloy, Vincent Bachy, Véronique Grulois, Bernard BertrandDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Mont-Godinne, Université Catholique de Louvain, Yvoir, BelgiumAbstract: JNA (Juvenile nasopharyngeal angiofibroma) is a benign but highly vascular and aggressive tumor that takes its origin in the basisphenoid region close to the sphenopalatine foramen. It occurs invariably in male teenagers. Surgery is the treatment of choice. In the past, external transfacial approaches were recommended. Nowadays endonasal endoscopic approach is performed by experienced teams even for extended tumor. The authors report a case of a pyocele of the lachrymal sac occurring 60 years after a transantral surgery for a JNA. The patient was then successfully operated with an endonasal endoscopic dacryocystorhinostomy using a powered instrumentation and a navigation system. This case confirms the necessity of a long follow-up for all the patients who had a transantral surgery with resection of the medial wall of the maxillary sinus and dissection of the nasolacrymal duct.Keywords: pyocele of the lachrymal sac, complication, surgery for JNA, JNA, endonasal DCR, navigation system Dove Press Philippe Eloy, Vincent Bachy, Véronique Grulois, Bernard Bertrand 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2305 http://www.dovepress.com/pyocele-of-the-lachrymal-sac-a-late-and-unusual-complication-after-sur-peer-reviewed-article-OPTH English

oai:dovepress.com/346 2008-03-17 OPTH

False negative results in glaucoma detection with Heidelberg Retina Tomograph II Zeyen, Thierry Clinical Ophthalmology Catherine Deghislage, Lidwine Van Malderen, Thierry G ZeyenDepartment of Ophthalmology, University Hospitals, Leuven, B-3000, BelgiumPurpose: To evaluate the rate of false negative results with the Heidelberg Retina Tomograph (HRT II) in a glaucoma practice.Design: Cross-sectional study.Methods: We analyzed the HRTs taken between October 2002 and October 2003 in our glaucoma clinic, and selected the patients who had a good quality image (SD < 40 µ) with a normal Moorfield’s Regression Analysis (MRA). A masked independent observer classified those patients as normal, glaucoma suspect, or glaucomatous on the basis of optic disc stereo photos (ODP) and at least 2 consecutive reliable automated perimetries. The diagnosis of glaucoma was based on a glaucomatous optic disc with a congruent, reproducible visual field defect.Results: Four hundred and fifty patients who had undergone an HRT examination were analyzed. One hundred and nine patients had an HRT classified as normal on the MRA, and a good quality image. Fifteen of those 109 patients (13.7%) were classified as glaucomatous on the basis of an abnormal ODP with corresponding visual field defect. Seven (6.4%) patients were classified as glaucoma suspect.Conclusion: Fourteen percent of glaucoma patients with glaucoma remained undetected with the HRT II Moorfield’s regression analysis as a sole means to detect glaucoma.Keywords: glaucoma detection, false negative results, Heidelberg Retina Tomograph II Dove Press Catherine Deghislage, Lidwine Van Malderen, Thierry G Zeyen 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2306 http://www.dovepress.com/false-negative-results-in-glaucoma-detection-with-heidelberg-retina-to-peer-reviewed-article-OPTH English

oai:dovepress.com/347 2008-03-17 OPTH

Automated detection of proliferative retinopathy in clinical practice Jelinek, Herbert Clinical Ophthalmology Audrey Karperien1, Herbert F Jelinek1,2, Jorge JG Leandro3, João VB Soares3, Roberto M Cesar Jr3, Alan Luckie41School of Community Health, Charles Sturt University, Albury, Australia; 2Centre for Research in Complex Systems, Charles Sturt University, Albury, Australia; 3Creative Vision Research Group, Department of Computer Science, IME – University of São Paulo, Brazil; 4Albury Eye Clinic, Albury, AustraliaAbstract: Timely intervention for diabetic retinopathy (DR) lessens the possibility of blindness and can save considerable costs to health systems. To ensure that interventions are timely and effective requires methods of screening and monitoring pathological changes, including assessing outcomes. Fractal analysis, one method that has been studied for assessing DR, is potentially relevant in today’s world of telemedicine because it provides objective indices from digital images of complex patterns such as are seen in retinal vasculature, which is affected in DR. We introduce here a protocol to distinguish between nonproliferative (NPDR) and proliferative (PDR) changes in retinal vasculature using a fractal analysis method known as local connected dimension (Dconn) analysis. The major finding is that compared to other fractal analysis methods, Dconn analysis better differentiates NPDR from PDR (p = 0.05). In addition, we are the first to show that fractal analysis can be used to differentiate between NPDR and PDR using automated vessel identification. Overall, our results suggest this protocol can complement existing methods by including an automated and objective measure obtainable at a lower level of expertise that experts can then use in screening for and monitoring DR.Keywords: diabetes, proliferative retinopathy, automated clinical assessment, fractal dimension, complex systems Dove Press Audrey Karperien, Herbert F Jelinek, Jorge JG Leandro, João VB Soares, Roberto M Cesar Jr, Alan Luckie 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2292 http://www.dovepress.com/automated-detection-of-proliferative-retinopathy-in-clinical-practice-peer-reviewed-article-OPTH English

oai:dovepress.com/348 2008-03-17 OPTH

Clinical findings following Ahmed Glaucoma Valve™ implantation in pediatric glaucoma Pirouzian, Amir Clinical Ophthalmology Amir Pirouzian1, Joseph L Demer21Department of Ophthalmology, San Diego Children’s Hospital, San Diego, UCSD, San Diego, CA, USA; 2Department of Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USAPurpose: To describe clinical findings after Ahmed valve drainage implantation in children.Design: All records in one practice were reviewed to identify and describe clinical findings in all children who had undergone Ahmed Glaucoma ValveTM S2 model insertion for uncontrolled primary or secondary glaucoma.Results: A total of 6 patients were identified, ranging in age from 2–15 years. Mean follow-up time averaged from 2–5 years from the time of tube insertion. Three patients exhibited pupillary peaking towards the tube of the valve. All patients required additional surgery or additional medications to control intraocular pressure. Lenticular opacification near the tube site developed in one patient. Gradual tube extrusion was also noted in another two patients.Conclusion: Multiple clinical events follow the Ahmed valve insertion in children. Pupillary irregularity is the most commonly noted event in this series. To avoid or reduce the risk of this complication, additional or modification of surgical procedures could be considered. The mechanism of such occurrence will further be discussed.Keywords: Ahmed Glaucoma Valve, children, pediatric glaucoma Dove Press Amir Pirouzian, Joseph L Demer 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2297 http://www.dovepress.com/clinical-findings-following-ahmed-glaucoma-valvetrade-implantation-in--peer-reviewed-article-OPTH English

oai:dovepress.com/349 2008-03-17 OPTH

Effect of water-in-oil microemulsions and lamellar liquid crystalline systems on the precorneal tear film of albino New Zealand rabbits Alany, Raid Clinical Ophthalmology Judy Chan1, Gamal M El Maghraby1,2, Jennifer P Craig3, Raid G Alany11Drug Delivery Research Unit (2DRU), School of Pharmacy, The University of Auckland, Auckland, New Zealand; 2Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Department of Ophthalmology, The University of Auckland, Auckland, New ZealandAbstract: The aim of this study is to investigate the effect of phase transition water-in-oil (w/o) microemulsions (ME) and liquid crystalline systems (LC) on the precorneal tear film (PCTF). The study used six albino NZ rabbits and monitored the integrity and stability of the PCTF before and after instillation of test formulations. The effects were evaluated by assessment of the PCTF lipid layer using interferometry, tear evaporation rate measurements, and indirect estimation of tear volume. Ocular application of test formulations changed the appearance of the PCTF lipid layer, indicating lipid layer disruption. The recovery time was longer in case of ME compared with an aqueous solution (SOL). The tear evaporation rate was increased after application of both ME and LC systems compared with the SOL, with the LC system showing the greatest effect. Tear volume measurement results revealed minimal changes associated with the instillation of both ME systems. Whilst phase transition w/o ME systems can interact with the PCTF lipid layer in albino New Zealand rabbits, their effect on the volume of resident tears was found to be minimal.Keywords: ocular microemulsion; tear film; dry eye Dove Press Judy Chan, Gamal M El Maghraby, Jennifer P Craig, Raid G Alany 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2298 http://www.dovepress.com/effect-of-water-in-oil-microemulsions-and-lamellar-liquid-crystalline--peer-reviewed-article-OPTH English

oai:dovepress.com/350 2008-03-17 OPTH

Adjunctive intravitreal dexamethasone in the treatment of acute endophthalmitis following cataract surgery Zacks, David Clinical Ophthalmology Edward F Hall1, Garrett R Scott1, David C Musch1,2, David N Zacks11Department of Ophthalmology and Visual Sciences, Medical School; 2Department of Epidemiology, School of Public Health; University of Michigan, Ann Arbor, MI, USAPurpose: Controversy exists regarding the use of intravitreal dexamethasone (IVD) as an anti-inflammatory adjunct to intravitreal antibiotics in patients with acute endophthalmitis following cataract surgery. The purpose of this project was to evaluate our experience regarding the effect of adjunctive IVD use on visual outcomes in such patients.Design: Retrospective, comparative case series.Methods: Study population: Patients treated for acute endophthalmitis following cataract surgery from 1995–2004. Intervention: In addition to standard intravitreal antibiotic treatment, some patients also received a single adjunctive injection of IVD. Primary outcome measures: Median visual acuity at last follow-up and percentage of patients achieving a ≥3-line improvement in visual acuity. Secondary outcome measures: Inflammatory index scoring, including amount of cell and flare, height of hypopyon, and presence of fibrin as a function of time after treatment.Results: Twenty-six eyes were treated with and 38 eyes without adjunctive IVD. Median presenting visual acuity was Hand Motion in both groups. Median visual acuity at last followup measured 20/40 in the IVD group and 20/50 in the No-IVD group (p = 0.75). Seventy-three percent of patients in the IVD group and 82% of patients in the No-IVD group achieved a ≥3-line improvement in visual acuity (p = 0.42). No significant difference was detected between the IVD and No-IVD groups for any of the three measures of inflammation.Conclusion: The use of IVD did not significantly improve the final median visual acuity, the chance of achieving a ≥3-line improvement in visual acuity, or the amount of intraocular inflammation. Based on these findings, and the possible detrimental effect of IVD on visual outcomes previously reported in the literature, the use of IVD does not appear to be warranted as a routine adjunctive treatment in postoperative endophthalmitis.Keywords: endophthalmitis, dexamethasone, intravitreal injection Dove Press Edward F Hall, Garrett R Scott, David C Musch, David N Zacks 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2300 http://www.dovepress.com/adjunctive-intravitreal-dexamethasone-in-the-treatment-of-acute-endoph-peer-reviewed-article-OPTH English

oai:dovepress.com/352 2008-03-17 OPTH

Combined intravitreal bevacizumab and photodynamic therapy with vertiporfin for management of choroidal neovascularization secondary to age-related macular degeneration Elbatarny, Ashraf Clinical Ophthalmology Mamdouh M Kabeel1, Ashraf M El-Batarny2, Mohamed K Tameesh3, Moustafa A Abou El Enein11Tanta University, Egypt, currently affiliated to Magrabi Eye and Ear Hospital, KSA, Vitreoretinal Service; 2Tanta University, Egypt, currently affiliated to Magrabi Eye and Ear Hospital, Muscat, Oman, Vitreoretinal Service; 3Tanta University, Egypt, currently affiliated to Saad Specialist Hospital, KSA, Vitreoretinal ServicePurpose: To test the results for patients treated with combined photodynamic therapy (PDT) with vertiporfin (Visudyne, Novartis AG) and intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).Patients and methods: This is a prospective study including 18 eyes with subfoveal or juxtafoveal CNV secondary to AMD. Patients were treated with intravitreal bevacizumab 2.5 mg in the morning then PDT with vertiporfin in the evening of the same day. All patients were followed up for 6 months. The main outcome measures were stabilization (no change) or improvement of best corrected visual acuity (BCVA) with no leakage in fluorescein angiography (FLA) and reduction of central retinal thickness, and retreatment rate.Results: At the end of 6 months follow up, all cases had either stabilization or improved BCVA. Fifteen eyes (80%) showed improved BCVA. The overall mean improvement in BCVA (n = 18) was 2.17 lines. Fifteen eyes (80%) required single combined treatment. Only 3 eyes (20%) required retreatment with the same protocol. No systemic or ocular complications were reported.Conclusion: Combined intravitreal bevacizumab and PDT as a treatment of CNV secondary to AMD either for predominantly classic or occult subtypes has a positive therapeutic effect with stabilization or improvement of final BCVA and also might reduce the need for retreatment compared with literature retreatment rates of either modality alone.Summary: Eighteen patients receiving combined therapy with PDT and intravitreal bevacizumab for CNV secondary to AMD, showed not only significant visual improvement but also reduction in the frequency of retreatment when compared to the results of monotherapy with each modality.Keywords: intravitreal bevacizumab, photodynamic therapy, vertiporfin, choroidal neovascularization, age-related macular degeneration Dove Press Mamdouh M Kabeel, Ashraf M El-Batarny, Mohamed K Tameesh, Moustafa A Abou El Enein 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2308 http://www.dovepress.com/combined-intravitreal-bevacizumab-and-photodynamic-therapy-with-vertip-peer-reviewed-article-OPTH English

oai:dovepress.com/353 2008-03-17 OPTH

Pars plana vitrectomy for primary rhegmatogenous retinal detachment Schwartz, Stephen Clinical Ophthalmology Stephen G Schwartz, Harry W Flynn JrDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USAAbstract: Pars plana vitrectomy (PPV) is growing in popularity for the treatment of primary rhegmatogenous retinal detachment (RD). PPV achieves favorable anatomic and visual outcomes in a wide variety of patients, especially in pseudophakic RD. A growing number of clinical series, both retrospective and prospective, have demonstrated generally comparable outcomes comparing PPV and scleral buckling (SB) under a variety of circumstances. The Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment (SPR) study is a multicenter, randomized, prospective, controlled clinical trial comparing SB versus PPV. This study should provide useful guidelines in the future. At this time, the choice of SB versus PPV should be based on the characteristics of the RD, the patient as a whole, and the experience and preference of the individual retinal surgeon.Keywords: pars plana vitrectomy, rhegmatogneous retinal detachment, scleral buckling Dove Press Stephen G Schwartz, Harry W Flynn Jr 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2290 http://www.dovepress.com/pars-plana-vitrectomy-for-primary-rhegmatogenous-retinal-detachment-peer-reviewed-article-OPTH English

oai:dovepress.com/354 2008-03-17 OPTH

Combined treatment of exudative age related macular degeneration with photodynamic therapy and intravitreal triamcinolone Ruiz-Moreno , Jose Clinical Ophthalmology José Mª Ruiz-Moreno1,2, Javier A Montero21Department of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain; 2Vitreo-Retinal Unit, Alicante Institute of Ophthalmology, Alicante, SpainAbstract: Choroidal neovascularization (CNV) secondary to age related macular degeneration is among the leading causes of legal blindness in developed countries. Photodynamic therapy (PDT) with verteporfin induces CNV closure causing little damage to healthy tissue, but the need to re-treat may lead to low final visual acuity at an unacceptable cost. The association of intravitreous triamcinolone or antiangiogenic drugs with PDT has been used in order to reduce these limitations of the therapy. The combination of PDT and intravitreous triamcinolone, its complications and outcome at one and two-year follow-up are discussed.Keywords: age related macular degeneration, choroidal neovascularization, photodynamic therapy, steroid, triamcinolone Dove Press José Mª Ruiz-Moreno, Javier A Montero 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2294 http://www.dovepress.com/combined-treatment-of-exudative-age-related-macular-degeneration-with--peer-reviewed-article-OPTH English

oai:dovepress.com/356 2008-03-18 OPTH

Acute onset of retinal detachment after posterior chamber phakic intraocular lens implantation Domenech, Nuria Clinical Ophthalmology Núria Planas Domènech, Luís Arias, Sergi Prades, Octavi Pujol, Marc Rubio, Jose M CaminalDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainCase report: A 34-year-old man with severe myopia, presented with acute visual loss in his right eye. This occurred 3 hours after a posterior chamber phakic (PCP) intraocular lens (IOL) implantation, and was associated with a rhegmatogenous retinal detachment. Retinal retachment surgery was performed without complications, with the outcome showing good anatomical and functional results during a 2-year follow-up period.Discussion: Despite the fact that several authors have described retinal detachments following PCP IOL implantation in highly myopic patients, there is no evidence that this procedure increases the risk of retinal detachment in these patients. The occurrence of the retinal detachment immediately after the phakic IOL implantation supports the hypothesis that the surgical procedure could induce iatrogenic changes in patients with high myopia, which could increase the incidence of retinal detachment. In contrast to other reports, the interval between the PCP IOL implantation and the retinal detachment was only 3 hours in our patient. We believe this demonstrates the importance of performing a complete preoperative vitreoretinal examination in patients with severe myopia.Keywords: retinal detachment, phakic intraocular lens, myopia Dove Press Núria Planas Domènech, Luí­s Arias, Sergi Prades, Octavi Pujol, Marc Rubio, Jose M Caminal 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2311 http://www.dovepress.com/acute-onset-of-retinal-detachment-after-posterior-chamber-phakic-intra-peer-reviewed-article-OPTH English

oai:dovepress.com/357 2008-03-18 OPTH

Experimental effect of retinoic acids on apoptosis during the development of diabetic retinopathy Nishikiori, Nami Clinical Ophthalmology Nami Nishikiori1,2, Makoto Osanai2, Hideki Chiba2, Takashi Kojima2, Shuichiro Inatomi1,2, Hiroshi Ohguro1, Norimasa Sawada2Departments of 1Ophthalmology and 2Pathology, Sapporo Medical University School of MedicinePurpose: This study was conducted to investigate whether retinoic acids (RAs) had any effect on apoptosis during the development of diabetic retinopathy.Methods: To investigate whether RAs had any effect on apoptosis during the development of diabetic retinopathy, we housed 32 C57BL/6 male mice and induced diabetes in 24 by intra peritoneal injections of streptozotocin (STZ; Sigma, St Louis, MO) and treated 16 of the diabetic mice with the RAs, all-trans-retinoic acid (ATRA) (seven mice) and 4-[(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthalenyl)carboxamido] benzoic acid (Am580) (nine mice). The other eight mice were used as diabetic controls. We then measured apoptosis in the retina by TdT-dUTP terminal nick-end labeling assay.Results: RAs inhibited the apoptosis of retinal cells in diabetic retinopathy. Many apoptotic cells were observed in retinas of the eight diabetic control mice (mean value and SD: 37.8 ± 6.9), whereas when diabetic mice were treated with RAs, the number of apoptotic cells significantly decreased (mean value and SD: 9.9 ± 6.4 for the seven ATRA-treated diabetic mice and 9.8 ± 5.9 for the nine Am580-treated diabetic mice) (p < 0.05).Conclusion: Treatment with RAs decreases apoptosis during the development of diabetic retinopathy.Keywords: retinoic acids, apoptosis, diabetic retinopathy, glial cell line-derived neurotrophic factor Dove Press Nami Nishikiori, Makoto Osanai, Hideki Chiba, Takashi Kojima, Shuichiro Inatomi, et al 2008-03-18 PDF http://www.dovepress.com/getfile.php?fileID=2314 http://www.dovepress.com/experimental-effect-of-retinoic-acids-on-apoptosis-during-the-developm-peer-reviewed-article-OPTH English

oai:dovepress.com/358 2008-03-17 OPTH

Use of viscoelastic substance in ophthalmic surgery — focus on sodium hyaluronate Higashide, T Clinical Ophthalmology Tomomi Higashide, Kazuhisa SugiyamaDepartment of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, JapanAbstract: Among viscoelastic substances, sodium hyaluronate has become the most popular for intraocular surgeries since the introduction of Healon® (sodium hyaluronate 1%, 4 × 106 daltons) in 1979. This review focuses on the recent development of a new generation of sodium hyaluronate agents with new rheologic properties and the relevant new techniques used in cataract, glaucoma, corneal, and vitreoretinal surgeries. The introduction of sodium hyaluronate agents with different rheologic properties has improved the safety and reliability of intraocular surgeries. Although there have been numerous studies reporting the effectiveness of viscoelastic substances in intraocular surgeries, rigorous validation by multi-center randomized control trials is lacking in many cases. At present, no single viscoelastic agent is most suitable to all of the various intraocular surgical techniques. Therefore, ophthalmologic surgeons should keep up with recent developments of viscoelastic agents and relevant surgical techniques for better patient care.Keywords: sodium hyaluronate, cataract surgery, glaucoma surgery, corneal transplantation, vitreoretinal surgery Dove Press Tomomi Higashide, Kazuhisa Sugiyama 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2288 http://www.dovepress.com/use-of-viscoelastic-substance-in-ophthalmic-surgerynbspmdash-focus-on--peer-reviewed-article-OPTH English

oai:dovepress.com/360 2008-03-17 OPTH

Treatment of age-related macular degeneration: focus on ranibizumab Spitzer, Martin Clinical Ophthalmology Martin S Spitzer, Focke Ziemssen, Karl U Bartz-Schmidt, Faik Gelisken, Peter SzurmanTuebingen University Eye Center, University of Tuebingen, GermanyAbstract: Ranibizumab, a humanized antigen-binding fragment (Fab) that binds all isoforms of VEGF-A, significantly slows down loss of vision and causes significant visual improvement in many patients with choroidal neovascularization (CNV) due to exudative age-related macular degeneration (AMD). These benefits of intravitreal ranibizumab apply to all angiographic subtypes of neovascular AMD and across all lesion sizes when the drug is injected at monthly intervals as shown in two pivotal phase III trials (ANCHOR and MARINA). The results from the PrONTO study suggest that less frequent treatment with ranibizumab through a variable dosing regimen dependent on optical coherence tomography (OCT) findings is a treatment option that results in comparably favorable visual outcomes. Currently, it is unclear whether combination therapy of ranibizumab with photodynamic therapy (PDT) provides any significant advantage over ranibizumab monotherapy (FOCUS trial); however, the combination of PDT and ranibizumab may decrease the need for frequent retreatment. This question will be addressed in the SUMMIT trial. Therapy with ranibizumab is generally very well tolerated with a low rate of seriously adverse ocular events or systemic side-effects. The advent of vascular endothelial growth factor (VEGF) inhibitors has revolutionized the therapy of neovascular AMD. Ranibizumab at the moment appears to be the most effective approved treatment for neovascular AMD.Keywords: Lucentis, ranibizumab, vascular endothelial growth factor (VEGF), age-related macular degeneration (AMD), neovascular, exudative AMD, treatment Dove Press Martin S Spitzer, Focke Ziemssen, Karl U Bartz-Schmidt, Faik Gelisken, Peter Szurman 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2296 http://www.dovepress.com/treatment-of-age-related-macular-degeneration-focus-on-ranibizumab-peer-reviewed-article-OPTH English

oai:dovepress.com/361 2008-03-17 OPTH

Differences in optic nerve structure between individuals of predominantly African and European ancestry: Implications for disease detection and pathogenesis Girkin, Christopher Clinical Ophthalmology Christopher A GirkinUniversity of Alabama at Birmingham School of Medicine, Birmingham, AL, USAAbstract: Glaucoma disproportionately affects individual of African ancestry. Additionally, racial differences in the optic nerve head have been well described that may alter the vulnerability to intraocular pressure related injury and, in addition, alter the clinical ability to detect the presence of early optic nerve injury. This paper will review the literature describing racial differences in the optic nerve head between individuals of African and European ancestry with regards to the potential effects of these differences on the ability to detect glaucoma in different racial groups and to potential differences in the pathogenesis of glaucomatous injury.Keywords: primary open angle glaucoma, African American, optic nerve, optic disc, retinal nerve fiber layer Dove Press Christopher A Girkin 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2293 http://www.dovepress.com/differences-in-optic-nerve-structure-between-individuals-of-predominan-peer-reviewed-article-OPTH English

oai:dovepress.com/362 2008-03-17 OPTH

Managing refractory glaucoma with a fixed combination of bimatoprost (0.03%) and timolol (0.5%) Katz, L J Clinical Ophthalmology Moataz E Gheith, Jason R Mayer, Ghada A Siam, Daniela S Monteiro de Barros,  Tricia L Thomas, L Jay KatzFrom the Glaucoma Service Department of Wills Eye Institute, Jefferson Medical College, Philadelphia, PA, USAAbstract: Glaucoma is a chronic progressive optic neuropathy characterized by progressive loss of retinal ganglion cells, which manifests clinically with loss of optic disc neuroretinal rim tissue, defects in the retinal nerve fiber layer, and deficits on functional visual field testing. The goal of glaucoma treatment is to reduce the intraocular pressure to a level that prevents or minimizes the progressive loss of vision. The current standard of management for the newly diagnosed primary open angle glaucoma (PAOG) patient is to start topical medication. Available topical medications include: beta-adrenergic antagonists, alpha-adrenergic agonists, carbonic anhydraze inhibitors, prostaglandin analogues and miotics. In some patients, IOP is not adequately controlled by monotherapy. In those refractory patients, where more efficacy is required, shifting to another medication or adding a second medication is indicated. The complimentary action between two drugs serves as the basis for combination medications. One avenue of delivering a second medication is through a fixed combination medication that has the advantage of providing two medicines within one drop. Bimatoprost/timolol represents a new fixed combination which is clinically and statistically more effective than either of its active constituents for patients with refractory glaucoma. As regard the safety of the combination, there were no signs or symptoms of intolerance and the incidence of conjunctival hyperemia was clinically and statistically significantly less than each of the two components separately. Bimatoprost/timolol fixed combination offers cost and time savings, which may enhance compliance; also reducing the amount of preservative applied to the eye, will improve tolerability and may also favorably improve eventual surgical outcomes in patients who might require filtering procedures.Keywords: fixed combination, refractory glaucoma, timolol/bimatoprost Dove Press Moataz E Gheith, Jason R Mayer, Ghada A Siam, Daniela S Monteiro de Barros, Tricia L Thomas, L Jay Katz 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2287 http://www.dovepress.com/managing-refractory-glaucoma-with-a-fixed-combination-of-bimatoprost-0-peer-reviewed-article-OPTH English

oai:dovepress.com/363 2008-03-17 OPTH

Development of ocular hypertension and persistent glaucoma after intravitreal injection of triamcinolone Kocabora, M.Selim Clinical Ophthalmology M Selim Kocabora, Cemil Yilmazli, Muhittin Taskapili, Gokhan Gulkilik, Sahan DurmazVakif Gureba Education and Research Hospital, Istanbul, TurkeyPurpose: This study evaluates intraocular pressure (IOP) elevation secondary to intravitreal injection of triamcinolone acetonide (IVTA) and discusses its management.Methods: The records of 175 patients who underwent IVTA treatment and regular eye examinations in the period 2003–2006 were reviewed. One hundred and twenty-two of these patients were included in the study, of which 147 eyes that received IVTA (4 mg/0.1 ml) were followed for at least 9 months. Mean IOPs observed after IVTA injection as well as IOP elevations defined as moderate (≥5 mm Hg), important (≥10 mm Hg) and severe (>25 mm Hg) during the follow-up period were evaluated and compared statistically.Results: Overall, the mean IOPs following IVTA injection were statistically significantly higher than the preinjection IOP (15.8 ± 2.6), after the first hour (17.7 ± 2.9), the first week (18.7 ± 4.1), the first month (19.6 ± 6.2), the second month (19.1 ± 6.1), the third month (18.0 ± 4.1), the sixth month (17.3 ± 4.0), and the ninth month (17.0 ± 2.7), but not after the first day (16.3 ± 7.6). Important IOP elevations were observed mostly in the first (17.7%) and second months (10.2%). In 40 (27.7%) eyes, topical antiglaucomatous therapy was needed and 7 later required surgical intervention to lower the IOP. Of the remaining 33 eyes, topical treatment was continued in 14 (9.5%) because of IOPs ≥20 mm Hg.Conclusion: The persistence of IOP elevation beyond the IVTA clearance period and the development of intractable secondary glaucoma requiring surgical intervention substantiate the need for careful consideration of IVTA indication and follow-up.Keywords: intravitreal triamcinolone, intraocular pressure, steroid-induced glaucoma Dove Press M Selim Kocabora, Cemil Yilmazli, Muhittin Taskapili, Gokhan Gulkilik, Sahan Durmaz 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2309 http://www.dovepress.com/development-of-ocular-hypertension-and-persistent-glaucoma-after-intra-peer-reviewed-article-OPTH English

oai:dovepress.com/364 2008-03-17 OPTH

Review of moxifloxacin hydrochloride ophthalmic solution in the treatment of bacterial eye infections Miller, Darlene Clinical Ophthalmology Darlene MillerAbrams Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, Miller School of Medicine-University of Miami, FL, USAAbstract: Moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox®) is the ocular formulation/adaptation of moxifloxacin. Moxifloxacin is a broad spectrum 8-methoxyfluoroquinolone which terminates bacterial growth by binding to DNA gyrase (topoisomerase II) and topoisomerase IV, essential bacterial enzymes involved in the replication, translation, repair and recombination of deoxyribonucleic acid. Affinity for both enzymes improves potency and reduces the probability of selecting resistant bacterial subpopulations. Vigamox is a bactericidal, concentration dependent, anti-infective. It is preservative free, and well tolerated with minimal ocular side effects. It provides increased penetration into ocular tissues and fluids with improved activity against Streptococci and Staphylococci species and moderate to excellent activity against clinically relevant, gram- negative ocular pathogens.Keywords: moxifloxacin, vigamox, pharmacodynamic indices, minimal inhibitory concentrations Dove Press Darlene Miller 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2295 http://www.dovepress.com/review-of-moxifloxacin-hydrochloride-ophthalmic-solution-in-the-treatm-peer-reviewed-article-OPTH English

oai:dovepress.com/365 2008-03-17 OPTH

Clinical treatment options for patients with homonymous visual field defects Lane, Alison Clinical Ophthalmology Alison R Lane, Daniel T Smith, Thomas SchenkCognitive Neuroscience Research Unit, Durham University, Durham, UKAbstract: The objective of this review is to evaluate treatments for homonymous visual field defects (HVFDs). We distinguish between three treatments: visual restoration training (VRT), optical aids, and compensatory training. VRT is both the most ambitious and controversial approach, aiming to restore portions of the lost visual field. While early studies suggested that VRT can reduce the visual field defect, recent studies using more reliable means of monitoring the patients’ fixation could not confirm this effect. Studies utilizing modern optical aids have reported some promising results, but the extent to which these aids can reliably reduce the patients’ visual disability has yet to be confirmed. Compensatory approaches, which teach patients more effective ways of using their eyes, are currently the only form of treatment for which behavioral improvements have been demonstrated. However, with the exception of one study using a reading training, placebo-controlled clinical evaluation studies are lacking. It is also not yet clear whether the training benefits found in laboratory tasks lead to reliable improvements in activities of daily living and which of the various forms of compensatory training is the most promising. It is therefore too early to recommend any of the currently available treatment approaches.Keywords: homonymous hemianopia, rehabilitation, treatment outcome Dove Press Alison R Lane, Daniel T Smith, Thomas Schenk 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2310 http://www.dovepress.com/clinical-treatment-options-for-patients-with-homonymous-visual-field-d-peer-reviewed-article-OPTH English

oai:dovepress.com/366 2008-03-17 OPTH

Retinopathy among type 2 diabetic patients seen at a tertiary hospital in Nigeria: a preliminary report Ashaye, A O Clinical Ophthalmology Adeyinka Ashaye1, Ayodeji Arije2, Modupe Kuti3, Bolutife Olusanya1, Ezekiel Ayeni1, Adesoji Fasanmade4, Kehinde Akinlade3, Millicent Obajimi5, Jokotade Adeleye41Ophthalmology Department, College of Medicine, University of Ibadan, Nigeria; 2Renal Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria; 3Department of Chemical Pathology, College of Medicine, University of Ibadan, Nigeria; 4Endocrine Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria; 5Radiology Department, College of Medicine, University of Ibadan, NigeriaObjective: To determine the prevalence of diabetic retinopathy among patients attending the diabetic clinics of a tertiary hospital in Nigeria.Methodology: We examined the eyes of 76 patients with type 2 diabetes mellitus between July 2003 and January 2004 using dilated fundoscopy at the eye clinic of the University College Hospital, Ibadan. The results were compared with published figures.Results: Mean age of patients was 57.5 ± 10.4 years. Thirty–two patients (42.1%) had diabetic retinopathy. Of these, one patient had features of proliferative diabetic retinopathy while the other patients had non-proliferative diabetic retinopathy. Majority (53.1%) of those who had retinopathy had diabetes for more than 10 years, while 21.4% of patients without retinopathy had diabetes for more than 10 years (p = 0.005). The mean serial post-prandial plasma glucose of those who had retinopathy was higher when compared with the mean for those who did not have retinopathy (248.7 mg/dl vs 178.3 mg/dl; p = 0.003).Conclusion: The prevalence of diabetic retinopathy in our patients is higher than was previously reported in earlier studies. Patients with diabetes ought to be referred for ophthalmological evaluation and follow-up which they should be actively encouraged to attend.Keywords: diabetic retinopathy, tertiary hospital patients, Africans Dove Press Adeyinka Ashaye, Ayodeji Arije, Modupe Kuti, Bolutife Olusanya, Ezekiel Ayeni, et al 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2291 http://www.dovepress.com/retinopathy-among-type-2-diabetic-patients-seen-at-a-tertiary-hospital-peer-reviewed-article-OPTH English

oai:dovepress.com/367 2008-03-17 OPTH

Modeling spectral sensitivity at low light levels based on mesopic visual performance Viikari, Meri Clinical Ophthalmology Meri Viikari, Aleksanteri Ekrias, Marjukka Eloholma, Liisa HalonenLighting Laboratory, Helsinki University of Technology, FinlandAbstract: The spectral sensitivity of the eye at low light levels, ie, mesopic conditions, is determined by the rod and cone photoreceptors of the retina operating together in varying degree as adaptation luminance shifts between the scotopic and photopic. Thus mesopic spectral sensitivity is different from photopic, where only cones contribute to vision. There are definite needs for a practical system of mesopic photometry to be used in assessing light at low light levels, especially in road and other outdoor lighting applications. However, neither of the recently proposed systems of mesopic photometry, the MOVE-model or the X-model, is found satisfactory by common consent of the lighting community. The most active debate has considered the upper luminance limit of the mesopic region, which is regarded to be too high for the MOVE-model and too low for the X-model. The present paper proposes a new modified MOVE-model whose upper luminance limit is adjusted to meet the actual road and street lighting luminance values measured in different weather conditions. The paper compares the MOVE-model, X-model, and the proposed modified MOVE-model with three independent visual performance data sets provided by different European universities. Based on the comparison, recommendations are given for future actions towards internationally accepted practice for mesopic photometry.Keywords: spectral sensitivity, mesopic, visual performance, mesopic model, photometry, night-time driving Dove Press Meri Viikari, Aleksanteri Ekrias, Marjukka Eloholma, Liisa Halonen 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2312 http://www.dovepress.com/modeling-spectral-sensitivity-at-low-light-levels-based-on-mesopic-vis-peer-reviewed-article-OPTH English

oai:dovepress.com/368 2008-03-17 OPTH

Long-time visual functional results of cataract surgery on low vision patients Monestam, Eva Clinical Ophthalmology Eva I Mönestam, Britta M Lundqvist, Åsa C JonssonDepartment of Clinical Sciences/Ophthalmology, Umeå University, Umeå, SwedenBackground/aims: To assess longitudinal 5-year results of cataract surgery on low vision patients.Methods: In this prospective, long-time, observational case-series, we report the outcome regarding the subjective visual function (n = 35) assessed by a visual function questionnaire (VF-14) and the visual acuity (n = 30) of surviving low vision patients 5 years after surgery. We compare with data recorded on the same patients before surgery and 4 months postoperatively.Results: Five years after surgery, 57% had unchanged or better VF-14 score compared with preoperatively, and 37% compared with postoperatively. Maculopathy patients had a significantly larger deterioration 5 years after surgery compared with postoperatively (40.2 versus 51.7, p = 0.004), but for the glaucoma patients there was no significant change (52.6 versus 53.1). There were no significant associations between age of the patient and change in VF-14 score or change in visual acuity 5 years after surgery, neither compared with before surgery nor postoperatively.Conclusion: Results suggest a favorable functional outcome 5 years after cataract surgery on most low-vision patients. Glaucoma patients have a more stable outcome than patients with macular degeneration. The severity of the disease-process for each individual patient might be the most important factor affecting the long-time results.Keywords: low vision, cataract surgery outcome, long-time results Dove Press Eva I Mönestam, Britta M Lundqvist, Åsa C Jonsson 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2313 http://www.dovepress.com/long-time-visual-functional-results-of-cataract-surgery-on-low-vision--peer-reviewed-article-OPTH English

oai:dovepress.com/369 2008-03-17 OPTH

Sub-Tenon′s triamcinolone for post-partum Purtscher′s-like retinopathy Olson, Jeffrey Clinical Ophthalmology Jeffrey Olson, Behnaz Rouhani, Naresh MandavaRocky Mountain Lions Eye Institute, University of Colorado Health Sciences Center, Department of Ophthalmology, Denver, CO, USAAbstract: Sub-Tenon’s injection of triamcinolone was performed in the right eye of a patient with bilateral Purtscher’s-like retinopathy after childbirth. The response of macular edema to local triamcinolone was investigated with optical coherence tomography. Five weeks following the injection, optical coherence tomography improvement was seen following unilateral sub-Tenon’s triamcinolone injection.Keywords: Purtscher’s-like retinopathy; triamcinolone; post-partum decreased vision Dove Press Jeffrey Olson, Behnaz Rouhani, Naresh Mandava 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2299 http://www.dovepress.com/sub-tenonprimes-triamcinolone-for-post-partum-purtscherprimes-like-ret-peer-reviewed-article-OPTH English

oai:dovepress.com/370 2008-03-17 OPTH

Forgotten exogenous corticosteroid as a cause of central serous chorioretinopathy Hardwig, Paul Clinical Ophthalmology Paul W Hardwig1, Amila O Silva2, Jose S Pulido11Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 2Kaiser Permanente Fontana Medical Center, Fontana, CA, USAAbstract: Central serous chorioretinopathy (CSCR) is an idiopathic ocular condition – first described in 1866 – that is well known to ophthalmologists. It is less well known to other practitioners. Glucocorticoids have been strongly implicated as a pathogenic factor. We report three patients who developed CSCR following exogenous administration of corticosteroid. Because our patients did not suspect the use of corticosteroid to be important or causative, they did not volunteer the historical detail, and admitted to exogenous corticosteroid injection only with intensive questioning. For their part, physicians should be cognizant of the risk of corticosteroid-induced CSCR, particularly in patients with a prior history of the potentially sight-threatening disease. The development of CSCR is an important iatrogenic and often unrecognized side effect of exogenously administered corticosteroid.Keywords: exogenous corticosteroid, ocular complication, central serous chorioretinopathy Dove Press Paul W Hardwig, Amila O Silva, Jose S Pulido 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2301 http://www.dovepress.com/forgotten-exogenous-corticosteroid-as-a-cause-of-central-serous-chorio-peer-reviewed-article-OPTH English

oai:dovepress.com/371 2008-03-17 OPTH

Ligneous conjunctivitis in a patient with Crohn′s disease Herreras, Jose Clinical Ophthalmology Graciana Fuentes-Páez1, José M Herreras1, M del C Méndez2, MA Saorni1,21Ocular Immunology and Uveitis Unit, Institute of Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain and Hospital Universitario de Valladolid, Spain; 2Ocular Pathology and Lab Registry “Miguel N. Burnier”, Institute of Ophthalmobiology (IOBA), University of Valladolid, Valladolid, SpainObjective: Report the case of a patient with Crohn´s disease and ligneous conjunctivitis.Methods: Interventional case report of a 27-year old female patient, with a 4-year history of Crohn´s disease, was seen for right eye conjunctival ulcer after resolved chemical trauma. Conjunctival biopsy was performed for histopathology, immunofluorescence microscopy, and immunohistochemistry testing.Results: Microbiology tests were negative for bacteria and fungi. PCR was negative for atypical mycobacteria and Herpes. Ocular Crohn´s disease, Whipple disease, and amyloidosis were ruled out. Immunofluorescence microscopy revealed characteristic IgG κ and λ light chain deposits, and fibrin deposition was confirmed through Lendrum´s Martius, Scarlet, and Blue technique. Endogenous plasminogen levels were normal. Recurrent ulcers did not resolve after treatment with infliximab, but only after four surgeries, topical steroids, 1% cyclosporine, heparin (5000 units/ml), and hyaluronidase (1.5 mg/ml). After 9 months of follow-up, nasal symblepharon was observed as sequela.Conclusions: We report the case of a patient with unilateral ligneous conjunctivitis, triggered by chemical injury, and Crohn´s disease.Keywords: Crohn´s disease, immunofluorescence microscopy, ligneous conjunctivitis, plasminogen, ulcerative conjunctivitis Dove Press Graciana Fuentes-Páez, José M Herreras, M del C Méndez, MA Saorni 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2302 http://www.dovepress.com/ligneous-conjunctivitis-in-a-patient-with-crohnprimes-disease-peer-reviewed-article-OPTH English

oai:dovepress.com/372 2008-03-17 OPTH

Inverse Argyll Robertson pupil in Burkitt′s lymphoma Chalam, Kakarla Clinical Ophthalmology Kakarla V Chalam, Shailesh K Gupta, Vikram S BrarDepartment of Ophthalmology, University of Florida Health Science Center, Jacksonville, FL, USAAbstract: We present a case of an 18 year old white male with Burkitt’s lymphoma who was operated on for hydrocephalus and subsequently referred for evaluation of new onset diplopia. On examination, his visual acuity (VA) was 20/20 in both eyes with a right superior oblique palsy. His pupillary reaction to light was intact while on near gaze there was no constriction of the pupils, bilaterally. The other two responses of the near gaze triad ie, convergence and accommodation were present. These findings were suggestive of an Inverse Argyll Robertson pupil (IARP), a rare entity in the literature. We could not find a specific cause attributable to this manifestation in this patient, though we feel it may be secondary to infiltration from Burkitt’s lymphoma and/or compression from elevated intracranial pressure of the efferent pupillary near reflex pathway.Keywords: Inverse Argyll Robertson pupil, Argyll Robertson pupil, pupillary abnormalities, Burkitt’s lymphoma Dove Press Kakarla V Chalam, Shailesh K Gupta, Vikram S Brar 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=2304 http://www.dovepress.com/inverse-argyll-robertson-pupil-in-burkittprimes-lymphoma-peer-reviewed-article-OPTH English

oai:dovepress.com/1776 2008-06-30 OPTH

Micropulse diode laser trabeculoplasty (MDLT): A phase II clinical study with 12 months follow-up Fea, Antonio Clinical Ophthalmology Antonio Maria Fea, Alex Bosone, Teresa Rolle, Beatrice Brogliatti, Federico Maria GrignoloIstituto di Fisiopatologia Clinica, Clinica Oculistica dell’ Università di Torino, Torino, ItalyObjective: This pilot study evaluates the pressure lowering potential of subthreshold micropulse diode laser trabeculoplasty (MDLT) for a clinically meaningful duration in patients with medically uncontrolled open angle glaucoma (OAG).Design: prospective interventional case series.Participants: Thirty-two eyes of 20 consecutive patients with uncontrolled OAG (12 bilateral and 8 unilateral).Methods: Confluent subthreshold laser applications over the inferior 180° of the anterior TM using an 810 nm diode laser in a micropulse operating mode. The intraocular pressure (IOP) was measured at baseline and at 1 hour, 1 day, 1 week, 3, 6, 9, and 12 months post-treatment. Flare was measured with a Kowa FM 500 flare-meter at baseline and at 3 hours, 1 day, 1 week, and 12 months post-treatment. After treatment, the patients were maintained on their pre-treatment drug regimen.Main outcome measures: Criteria for treatment response were IOP reduction ≥3 mm Hg and IOP ≤21 mm Hg within the first week after MDLT. Eyes not complying to the above criteria during the follow-up were considered treatment failure. Mean IOP change and percentage of IOP reduction during the follow-up were calculated.Results: One eye was analyzed for bilateral patients. A total of 20 eyes were thus included. Four eyes (20%) did not respond to treatment during the first week. One additional eye failed at the 6 month visit. The treatment was successful in 15 eyes (75%) at 12 months. The IOP was significantly lower throughout follow-up (p < 0.01). At 12 months, the mean percentage of IOP reduction in the 15 respondent eyes was 22.1% and 12 eyes (60%) had IOP reduction higher than 20%. During the first two postoperative days, one eye with pigmentary glaucoma experienced a significant increase of flare associated with an IOP spike (34 mm Hg) that was controlled with systemic drugs; afterwards it qualified as a respondent and completed the study. No increase of flare was found in any other patient. No peripheral anterior synechiae formed.Conclusions: In this case series, MDLT was effective in reducing IOP in 75% of medically insufficiently controlled OAG eyes without significant complications. This justifies randomized clinical studies to compare MDLT with current IOP lowering strategies.Keywords: open angle glaucoma, trabeculoplasty, diode laser, micropulse, subthreshold Dove Press Antonio Maria Fea, Alex Bosone, Teresa Rolle, Beatrice Brogliatti, Federico Maria Grignolo 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2937 http://www.dovepress.com/micropulse-diode-laser-trabeculoplasty-mdlt-a-phase-ii-clinical-study--peer-reviewed-article-OPTH English

oai:dovepress.com/1777 2008-06-30 OPTH

Pegaptanib sodium treatment in neovascular age-related macular degeneration: clinical experience in Germany Feucht, Nikolaus Clinical Ophthalmology Nikolaus Feucht, Huebner Matthias, Chris P Lohmann, Mathias MaierAugenklinik rechts der Isar, Technical University Munich, GermanyBackground: The VEGF Inhibition Study In Ocular Neovascularisation (VISION) reported the efficacy of intravitreal (ITV) vascular endothelial growth factor (VEGF) inhibition with pegaptanib sodium (Macugen®) for the treatment of neovascular age-related macular degeneration (AMD). This paper reports clinical experience with pegaptanib sodium for the treatment of occult or minimally classic choroidal neovascularization (CNV) due to AMD.Material and methods: The study included 50 eyes (in 49 patients) with either occult CNV or minimally classic CNV secondary to neovascular AMD who were not eligible for photodynamic therapy (PDT). Study data were analyzed retrospectively. During the 6-month study, patients were administered an average 2.74 injections of 0.3 mg ITV pegaptanib sodium. Angiography and optical coherence tomography (OCT) examinations were carried out and intraocular pressure (IOP) and visual acuity (VA) were measured at baseline, at 3 months and at 6 months. An eye examination was performed and VA was measured the 2 days following treatment and then again at weeks 4–6, and at 3 and 6 months. OCT, VA, and IOP were also assessed at 1 month.Results: ITV pegaptanib sodium was well tolerated and no treatment complications arose. Mean VA was measured as: 0.37 ± 0.24 at baseline; 0.37 ± 0.25 at 1 month; 0.37 ± 0.25 at 3 months and 0.40 ± 0.26 at 6 months. VA was stabilized in approximately 90% of eyes treated with pegaptanib sodium. OCT examination showed a minimal change in central retinal thickness (CRT) during the course of the study, from 251.19 µm at baseline to 251.63 µm at 6 months. No elevation in IOP was measured during treatment at 4–6 months in patients receiving pegaptanib sodium.Conclusions: ITV therapy with pegaptanib sodium for occult and minimally classic CNV secondary to neovascular AMD offered good efficacy with a favorable adverse events profile. The majority of patients showed stabilization in all assessed parameters. In clinical practice, careful consideration should be given to the use of nonselective VEGF inhibition in patients with a high cardiovascular risk profile or in those with a history of thromboembolic events.Keywords: Intravitreal (ITV) injection, age-related macular degeneration (AMD), choroidal neovascularization (CNV), anti-VEGF therapy, pegaptanib sodium Dove Press Nikolaus Feucht, Huebner Matthias, Chris P Lohmann, Mathias Maier 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2953 http://www.dovepress.com/pegaptanib-sodium-treatment-in-neovascular-age-related-macular-degener-peer-reviewed-article-OPTH English

oai:dovepress.com/1778 2008-07-14 OPTH

Topical application of nucleotides increase lysozyme levels in tears Mosallaei, Mahnaz Clinical Ophthalmology Assumpta Peral1, Patricia Loma2, Benjamin Yerxa3, Jesús Pintor21Departamento de Óptica II (Optometría y Visión), Escuela Universitaria de Óptica, Universidad Complutense de Madrid, Madrid, Spain; 2Departamento de Bioquímica y Biología Molecular IV, Escuela Universitaria de Óptica, Universidad Complutense de Madrid, Madrid, Spain; 3Inspire Pharmaceuticals, Inc. Durham, North Carolina, USAAbstract: The present work studies the effects of topical application of nucleotides on rabbit tear lysozyme levels. Lysozyme values were determined by the diffusion in Agar method described by van Bijsterveld in 1974, and the protein amount was obtained by measuring the inhibitory halos around a Whatman nº1 paper disc of 5 mm in diameter. The tested nucleotides were UTP, Ap4A and Up4U. These compounds were topically instilled in a single-dose in one eye (with the contralateral eye as a control) and the lysozyme halos were measured along 5 hours. The obtained results showed an increase in the lysozyme concentrations of 67%, 93%, and 119% for UTP, Ap4A, and Up4U, respectively, over the basal levels of lysozyme. For this reason, we suggest these molecules as a potential treatment for the reinforcement of the tear film barrier against ocular infection.Keywords: lysozyme, nucleotides, tear film, ocular infection, ocular protection, ocular surface Dove Press Assumpta Peral, Patricia Loma, Benjamin Yerxa, Jesús Pintor 2008-07-14 PDF http://www.dovepress.com/getfile.php?fileID=2928 http://www.dovepress.com/topical-application-of-nucleotides-increase-lysozyme-levels-in-tears-peer-reviewed-article-OPTH English

oai:dovepress.com/1779 2008-06-30 OPTH

Intravitreal triamcinolone acetonide: Pattern of secondary intraocular pressure rise and possible risk factors Noureddin, Bahaa Clinical Ophthalmology Ziad F Bashshur1, Abdallah M Terro1, Christelle P El Haibi1, Akaber M Halawi1, Alexandre Schakal2, Baha’ N Noureddin11The Department of Ophthalmology, American University of Beirut, Lebanon; 2The Department of Ophthalmology, Hotel Dieu de France (St. Joseph University), LebanonPurpose: To determine the pattern of increase in intraocular pressure (IOP) following intravitreal triamcinolone acetonide (IVTA) and identify possible risk factors associated with this rise in IOP.Methods: We carried out a retrospective review of records for 185 patients (226 eyes) who received 4 mg of IVTA at the American University of Beirut Medical Center and Hotel Dieu de France eye clinics between 2003 and 2005.Results: Mean follow-up was 8.17 months (range 6 to 24 months). The mean number of IVTA injections per eye was 1.31 ± 0.69. The mean IOP increased after the first IVTA injection from 15.04 ± 3.18 mmHg at baseline to a mean maximum of 17.20 ± 5.75 mmHg (p < 0.0001, paired t-test) at month 3 of follow-up with a return to mean baseline IOP (15.49 ± 4.79 mmHg) at month 12. Fifty nine of 226 eyes showed IOP higher than 21 mmHg during follow-up. Nine eyes started to have IOP greater than 21 mmHg, 6 to 12 months after a single injection. Intraocular pressure lowering medications were started when IOP exceeded 25 mmHg in 15 of the 226 eyes studied. No risk factors have been found to predict this IOP rise.Conclusions: IOP elevation can occur in a significant number of eyes receiving 4 mg of IVTA. This phenomenon seems to be transient and a small number of eyes required treatment during this period. Eyes that received IVTA need to be monitored for IOP changes especially during the first 3 months, but the IOP may still rise 6 months and even 12 months after a single injection. This study did not show any risk factor that may predict this IOP rise.Keywords: intravitreal triamcinolone acetonide, intraocular pressure elevation, diabetic macular edema, choroidal neovascular membrane due to age-related macular degeneration, central retinal vein occlusion, Branch retinal vein occlusion, Uveitis Dove Press Ziad F Bashshur, Abdallah M Terro, Christelle P El Haibi, Akaber M Halawi, Alexandre Schakal, Baha’ N Noureddin 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2930 http://www.dovepress.com/intravitreal-triamcinolone-acetonide-pattern-of-secondary-intraocular--peer-reviewed-article-OPTH English

oai:dovepress.com/1780 2008-06-30 OPTH

Correlation of histological findings from a large ciliochoroidal melanoma with CT perfusion and 3T MRI dynamic enhancement studies McCollough, Cynthia Clinical Ophthalmology Jose S Pulido1, Norbert G Campeau2, Ernst Klotz3, Andrew N Primak2, Osama Saba3, Kaan Gunduz1, Herbert Cantrill5, Diva Salomão1,4, Cynthia H McCollough21Department of Ophthalmology; 2Department of Radiology; 3Siemens Medical Solutions, Malvern, PA, USA; 4Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA; 5VitreoRetinal Surgery, Minneapolis, MN, USABackground: The initial use of a 64-slice computed tomography (CT) scanner for obtaining quantitative perfusion data from a large ciliochoroidal melanoma, and correlation with 3T magnetic resonance imaging (MRI) dynamic enhancement and tumor histology.Methods: The CT perfusion scan was performed using 80 kVp, 250 mA and 1-sec rotation time for 40 sec. The analysis was performed using commercial perfusion analysis software with a prototype 3-dimensional motion correction tool. Dynamic contrast-enhanced 3-Tesla MRI measured the kinetics of enhancement to estimate the vascular permeability. The time-dependent enhancement patterns were obtained using the average signal intensity using Functool analysis software. The involved globe was enucleated and microscopic evaluation of the tumor was performed.Results: The perfusion parameters blood flow, blood volume and permeability surface area product in the affected eye determined by CT perfusion analysis were 118 ml/100 ml/min, 11.3 ml/100 ml and 48 ml/100 ml/min. Dynamic MRI enhancement showed maximal intensity increase of 111%. The neoplasm was a ciliochoroidal spindle cell melanoma which was mitotically active (13 mitoses/40 hpf). Vascular loops and arcades were present throughout the tumor. The patient developed metastases within 9 months of presentation.Conclusion: Quantitative CT perfusion analysis of ocular tumors is feasible with motion correction software.Keywords: ciliochoroidal melanoma, CT perfusion imaging, MR enhancement imaging, tumor blood volume, tumor blood flow, tumor permeability Dove Press Jose S Pulido, Norbert G Campeau, Ernst Klotz, Andrew N Primak, Osama Saba, et al 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2934 http://www.dovepress.com/correlation-of-histological-findings-from-a-large-ciliochoroidal-melan-peer-reviewed-article-OPTH English

oai:dovepress.com/1781 2008-06-30 OPTH

Reasons for revision surgery after orbital decompression for Graves’ orbitopathy Franceschini, Stefano Clinical Ophthalmology Stefano Sellari-Franceschini1, Luca Muscatello1, Veronica Seccia1, Riccardo Lenzi1, Amelia Santoro1, Marco Nardi2, Barbara Mazzi3, Aldo Pinchera3, Claudio Marcocci31Department of Neuroscience, 1st ENT division, 2Ophthalmology Division, 3Department of Endocrinology and Metabolism, Orthopaedics and Traumatology, Occupational Medicine, University of Pisa, ItalyObjectives: An analysis of complications and causes of failure in orbital decompression necessitating a second operation.Methods: Between December 1992 and April 2007, 375 patients (719 orbits) were operated on using various techniques. Fourteen patients were initially operated on in our unit: 8 (group A1) were re-operated on after a short time due to complications connected with the decompression operation, 7 (group A2) were operated on after some time due to recurrence of the illness or unsatisfactory decompression (one patient is in both group A1 and A2). Five patients (group B) underwent a first operation elsewhere.Results: For group A1 the most serious complications were connected to the nasal approach. For group A2 the operations were performed either because of a neuropathy recurrence or for further proptosis reduction due to recurrence or patient dissatisfaction. Lack of preoperative data hinders conclusions about group B, apart from one patient where the operation had not resolved a serious optic neuropathy after decompression based on Olivari technique combined with three-wall operation according to Mourits and colleagues (1990).Conclusions: We can deduce from group A1 that extreme attention is necessary during endonasal access, from group A2 that balancing the eyes is advisable, sacrificing maximum proptosis reduction to gain greater patient satisfaction, and from group B that decompression of the orbital apex is fundamental in the case of neuropathy.Keywords: orbital decompression, Graves’ orbitopathy, revision surgery Dove Press Stefano Sellari-Franceschini, Luca Muscatello, Veronica Seccia, Riccardo Lenzi, Amelia Santoro, et al 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2940 http://www.dovepress.com/reasons-for-revision-surgery-after-orbital-decompression-for-gravesrsq-peer-reviewed-article-OPTH English

oai:dovepress.com/1782 2008-06-30 OPTH

The rate of symptomatic improvement of congenital nasolacrimal duct obstruction in Japanese infants treated with conservative management during the 1st year of age Kakizaki, Hirohiko Clinical Ophthalmology Hirohiko Kakizaki1, Yasuhiro Takahashi2, Shinsuke Kinoshita1, Kunihiko Shiraki2, Masayoshi Iwaki11Department of Ophthalmology, Aichi Medical University, Aichi, Japan; 2Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka, JapanAbstract: This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO) in Japanese infants treated with conservative management within the 1st year of age. Thirty-five lacrimal ducts in 27 patients diagnosed with CNLDO were included in the study. During the observational period, lacrimal ducts were massaged. As well, antibiotic eye drops, to be administered 4 times a day, were sometimes prescribed for obvious conjunctivitis. Two lacrimal ducts in 2 patients were probed before the 1st year of age because of dacryocystitis or severe blepharitis; these patients were included in the unimproved group. Twenty-nine lacrimal ducts in 21 patients resolved during the period (82.9%); with 16 lacrimal ducts resolving before six months of age. Therefore, a comparatively high percentage of resolution for CNLDO (82.9%) following conservative management was shown before the 1st year of age in Japanese infants.Keywords: congenital nasolacrimal duct obstruction, symptomatic improvement, conservative management, massage, probing Dove Press Hirohiko Kakizaki, Yasuhiro Takahashi, Shinsuke Kinoshita, Kunihiko Shiraki, Masayoshi Iwaki 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2944 http://www.dovepress.com/the-rate-of-symptomatic-improvement-of-congenital-nasolacrimal-duct-ob-peer-reviewed-article-OPTH English

oai:dovepress.com/1783 2008-06-30 OPTH

Autoimmune destruction of pericytes as the cause of diabetic retinopathy Adams, Duncan Clinical Ophthalmology Duncan D AdamsFaculty of Medicine, University of Otago, Dunedin, New ZealandAbstract: In diabetic retinopathy, collapse of the retinal vasculature is associated with loss of the pericytes. These are contractile cells that together with endothelial cells form the terminal arterioles of the retina. The cause of the loss of pericytes is not known. Recently, it has been discovered that type 1 diabetes is caused by forbidden clones of cytotoxic T lymphocytes, which destroy the insulin-making cells with exquisite specificity. In the light of this, I postulate that an antigenically-related forbidden clone of cytotoxic T lymphocytes selectively destroys the pericytes and that this is the cause of the vascular collapse of diabetic retinopathy. If this is so, the therapeutic implications are immense, involving a switch from ineffectual tight glycemic control to immunotherapy. This is already used as immunosuppression to prevent organ transplant rejection, and as the immune ablation and autologous bone marrow cell reconstitution that has saved the lives of patients with lethally-severe scleroderma. Once the pericyte surface auto-antigen for the T lymphocytes has been isolated, selective destruction of the pathogenic T lymphocytes would be possible by manufacture and use of cytotoxic auto-antigen complexes, which arrests progression of the retinopathy.Keywords: pericytes, diabetic retinopathy, autoimmunity, T cell forbidden clones, immunotherapy Dove Press Duncan D Adams 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2947 http://www.dovepress.com/autoimmune-destruction-of-pericytes-as-the-cause-of-diabetic-retinopat-peer-reviewed-article-OPTH English

oai:dovepress.com/1784 2008-06-30 OPTH

Inferior oblique muscle thickness in Asians Kakizaki, Hirohiko Clinical Ophthalmology Yasuhiro Takahashi1, Hirohiko Kakizaki2, Takashi Nakano3, Ken Asamoto3, Masayoshi Iwaki21Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan; 2Department of Ophthalmology; 3Anatomy, Aichi Medical University, Nagakute, Aichi, JapanAbstract: The purpose of this study was to examine the inferior oblique muscle (IOM) thickness in Asians by the quasi-sagittal plane of the orbits. Specimens were examined from 23 orbits of 18 Asians (9 orbits in males, 14 in females), aged 63 to 97 years at death. All specimens were fixed in 10% buffered formalin before use. The orbital contents were incised parallel to the optic nerve, after which the lengths of both short and long axes of the IOM were measured and the ratio of short to long axes was calculated. The mean lengths of each short or long axis of the IOM were 2.27 ± 0.49 mm and 7.23 ± 0.97 mm, respectively. The average ratio was 0.32 ± 0.07. There were no significant differences in laterality or gender. This study determined the normal IOM thickness in Asian cadavers, the outcome of which could be useful for detection of IOM involvement in Graves’ orbitopathy.Keywords: inferior oblique muscle, Asian, thickness, quasi-sagittal plane Dove Press Yasuhiro Takahashi, Hirohiko Kakizaki, Takashi Nakano, Ken Asamoto, Masayoshi Iwaki 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2948 http://www.dovepress.com/inferior-oblique-muscle-thickness-in-asians-peer-reviewed-article-OPTH English

oai:dovepress.com/1785 2008-06-30 OPTH

Efficacy and tolerability of a large scale change in regimen from latanoprost to travoprost in glaucoma patients at the Manhattan Veterans Administration Hospital Farris, Edmund Clinical Ophthalmology Edmund P FarrisNew York University, New York, NY; Manhattan Veterans Administration Hospital, New York, NY; New York Medical College, Valhalla, NY, USAObjective: This retrospective study was designed to investigate the efficacy and tolerability of travoprost 0.004% substituted for latanoprost 0.005% in glaucoma patients at the Manhattan Veterans Administration Hospital.Research design and methods: We conducted a chart review of patients with stable intraocular pressure (IOP) undergoing a formulary change in regimen from latanoprost 0.005% to travoprost 0.004%. Diagnoses included primary open angle glaucoma, ocular hypertension, pigment dispersion glaucoma, and pseudoexfoliation glaucoma. Main outcome measures: The primary outcome measures were IOP change between baseline and 6 months and patient-reported adverse events throughout the study.Results: In the single therapy group (N = 60 eyes), the mean baseline IOP on latanoprost was 15.8 mmHg; after 6 months on travoprost, it was 14.9 mmHg (p < 0.1). In the concomitant therapy group (N = 126 eyes), the mean baseline IOP was 16.7 mmHg; after 6 months on travoprost, it was 15.9 mmHg (p < 0.01). A reduction of IOP ≥ 3 mmHg occurred in 28 eyes of 21 patients at 6 months. An increase of IOP ≥ 3 mmHg occurred in 5 eyes of 4 patients at 6 months. One patient was switched back to latanoprost due to irritation at 3 months. No other patient-reported adverse events, including increased hyperemia, were observed throughout the follow-up period.Conclusions: A change in therapeutic regimen from latanoprost 0.005% to travoprost 0.004% maintained IOP control in stable patients, and in some produced a further reduction in IOP. A change in therapy from latanoprost to travoprost was effective and well-tolerated for the glaucoma patients in this study.Keywords: glaucoma, intraocular pressure, prostaglandin analogue, retrospective studies, travoprost, latanoprost Dove Press Edmund P Farris 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2949 http://www.dovepress.com/efficacy-and-tolerability-of-a-large-scale-change-in-regimen-from-lata-peer-reviewed-article-OPTH English

oai:dovepress.com/1786 2008-06-30 OPTH

A study of the safety and efficacy of travoprost 0.004%/timolol 0.5% ophthalmic solution compared to latanoprost 0.005% and timolol 0.5% dosed concomitantly in patients with open-angle glaucoma or ocular hypertension Rhee, Doug Clinical Ophthalmology Douglas J Rhee1, James H Peace2, Sushanta Mallick3, Theresa A Landry3, Michael VW Bergamini3, and the Study Group*1Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, USA; 2Diabetic Eye Medical Clinic, Inglewood, CA, USA; 3Alcon Laboratories, Inc., Ft. Worth, TX, USA; *Study Group members listed in AppendixBackground/Aims: To compare the intraocular pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% in fixed combination with the unfixed combination of latanoprost 0.005% and timolol 0.5% in open-angle glaucoma or ocular hypertension patients with IOP levels below 18 mmHg on the unfixed combination of latanoprost 0.005% and timolol 0.5%.Methods: Following a 30-day open-label run-in with latanoprost QD PM and timolol QD AM, subjects with intraocular pressure below 18 mmHg were randomized to continue concomitant latanoprost QD PM and timolol QD AM or switch to travoprost 0.004%/timolol 0.5% QD AM and vehicle QD PM in masked fashion and were followed for 3 months. The primary efficacy endpoint was mean IOP reduction from baseline.Results: There were no clinically relevant or statistically significant differences in mean IOP, mean IOP change from baseline, or percentage IOP change from baseline between the two treatment groups. Between-group differences in mean IOP were within ±0.3 mmHg at all time points (p ≥ 0.384), and between-group differences in mean IOP change from baseline were within ±0.4 mmHg at all time points. Overall, 88% of patients whose IOP was less than 18 mmHg on the unfixed combination of latanoprost and timolol remained well controlled on the same regimen in the masked portion of the study, compared with 92% who remained well controlled after switching to travoprost/timolol.Conclusion: Travoprost 0.004%/timolol 0.5% administered once daily and concomitant administration of timolol 0.5% and latanoprost 0.005% produce similar maintenance of IOP-lowering effect in patients who were previously well controlled on concomitant administration of latanoprost and timolol. Patients who are well controlled on latanoprost and timolol concomitant therapy can be switched to once-daily therapy with travoprost 0.004%/timolol 0.5% with no expected compromise in the safety and efficacy of their treatment.Keywords: travoprost, timolol, glaucoma, intraocular pressure, fixed combination Dove Press Douglas J Rhee, James H Peace, Sushanta Mallick, Theresa A Landry, Michael VW Bergamini, and the Study Group* 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2951 http://www.dovepress.com/a-study-of-the-safety-and-efficacy-of-travoprost-0004timolol-05-ophtha-peer-reviewed-article-OPTH English

oai:dovepress.com/1787 2008-06-30 OPTH

Costs and persistence of alpha-2 adrenergic agonists versus carbonic anhydrase inhibitors, both associated with prostaglandin analogues, for glaucoma as recorded by The United Kingdom General Practitioner Research Database Berdeaux, Gilles Clinical Ophthalmology Philippe Denis1, Antoine Lafuma2, Gilles Berdeaux31Hôpital Edouard Herriot, Lyon, France; 2Cemka, Bourg-la-Reine, France; 3Alcon France, Rueil-Malmaison, FranceAbstract: The persistence and costs of carbonic anhydrase inhibitors + prostaglandin analogues (CAIs + PGAs) vs alpha-2 adrenergic agonists + prostaglandin analogues (alpha-2 agonists + PGAs) were compared, based on The United Kingdom General Practitioner Research Database. Patients with a diagnosis of ocular hypertension, glaucoma, or treated for this, were selected. Selected patients were prescribed CAIs + PGAs or alpha-2 agonists + PGAs. Treatment failure was defined as a prescription change (adding, removing, or replacing glaucoma treatment, or initiating laser or surgery). Times to treatment failure were compared with a Cox model adjusted by a propensity score. Mean patient age was 69.0 years and 47.6% were males. Treatment failure at 1 year was experienced by 58.8% receiving CAIs + PGAs and 66.0% of patients receiving alpha-2 agonists + PGAs (p < 0.001). The hazard ratio for failure was 0.82 (p < 0.001) in favor of CAIs + PGAs after adjusting on age, gender, comorbidities, and duration of follow-up. Adjusted annual costs of glaucoma management did not differ significantly between treatments, £440.63 with alpha-2 agonists + PGAs and £413.37 with CAIs + PGAs. CAIs + PGAs therapies appear more persistent than alpha-2 agonist + PGA in everyday clinical practice, at a similar cost.Keywords: glaucoma, alpha-2 adrenergic agonists, carbonic anhydrase inhibitor, prostaglandin, effectiveness economics, costs Dove Press Philippe Denis, Antoine Lafuma, Gilles Berdeaux 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2952 http://www.dovepress.com/costs-and-persistence-of-alpha-2-adrenergic-agonists-versus-carbonic-a-peer-reviewed-article-OPTH English

oai:dovepress.com/1788 2008-06-30 OPTH

Efficacy and tolerability of a fixed-dose moxifloxacin – dexamethasone formulation for topical prophylaxis in LASIK: a comparative, double-masked clinical trial Belfort, Rubens Clinical Ophthalmology Mauro Campos, Mariana Ávila, Anelise Wallau, Cristina Muccioli, Ana Luisa Höfling-Lima, Rubens Belfort JrDepartment of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, BrazilPurpose: To compare the efficacy and tolerability of a fixed-dose combination of 0.5% moxifloxacin and 0.1% dexamethasone formulation (MFLX/DEX) vs conventional dosing with both agents dosed separately for prophylaxis after laser-assisted in situ keratomileusis (LASIK).Methods: A prospective, randomized, double-masked, parallel-group study of 64 patients undergoing bilateral LASIK. Patients received either combined MFLX/DEX and placebo or moxifloxacin and dexamethasone dosed separately in both eyes. Baseline and postoperative assessments were made on surgery days –2, 1, 3, 8, and 15 and consisted of uncorrected visual acuity (UCVA), intraocular pressure (IOP), severity of inflammation, endothelial cell loss, ocular pain, burning, and itching sensation. The posterior segment was evaluated at the screening and exit visits.Results: Of the 64 patients treated, 7 eyes did not meet the inclusion criteria and were excluded from the analysis. No ocular infection or persistent inflammation developed. Postoperatively there were no statistical differences between treatments for most parameters measured. More eyes in the combined MFLX/DEX group reported pruritus and burning post operatively; however, differences were also observed at baseline.Conclusion: Topical prophylaxis with MFLX/DEX eye drops was well tolerated and is therapeutically equivalent to conventional dosing with moxifloxacin and dexamethasone from individual bottles.Keywords: moxifloxacin, dexamethasone, LASIK, prophylaxis Dove Press Mauro Campos, Mariana Ávila, Anelise Wallau, Cristina Muccioli, Ana Luisa Höfling-Lima, Rubens Belfort Jr 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2955 http://www.dovepress.com/efficacy-and-tolerability-of-a-fixed-dose-moxifloxacin-ndash-dexametha-peer-reviewed-article-OPTH English

oai:dovepress.com/1789 2008-06-30 OPTH

Role of pegaptanib sodium in the treatment of neovascular age-related macular degeneration Sivaprasad, Sobha Clinical Ophthalmology Sobha SivaprasadLaser and Retinal Research Unit, King’s College Hospital, UKAbstract: Age-related macular degeneration (AMD) is responsible for more than half the blind registration in the United Kingdom. Retinal manifestations of AMD can be categorized as either atrophic or neovascular. The hallmark of AMD is the development of choroidal neovascularization (CNV). Until recently, there have been few, limited treatment modalities (eg, photodynamic therapy [PDT]) for this condition and the mainstay of treatment has comprised social and lifestyle support. However, increased understanding of the molecular processes at work in neovascular AMD and CNV in recent years has led to the introduction of new antiangiogenic agents that target vascular endothelial growth factor (VEGF). These agents either inhibit a selected VEGF isoform (eg, VEGF165 inhibition by pegaptanib sodium) or inhibit all forms of the VEGF isoform (eg, non-selective VEGF blockade by ranibizumab). The trial data suggest that non-selective inhibition of VEGF offers better treatment outcomes in neovascular AMD. As a result, agents that inhibit all VEGF isoforms are now widely used as first-line therapy for this condition. However, it is known that VEGF plays an important role in maintaining the intergrity of the cardiovascular system and, particularly as the age of patients with AMD places them at an elevated risk of thromboembolic events, long-term post-marketing surveillance data are essential to determining whether non-selective VEGF blockade confers any increased risk. Theoretically, selective VEGF inhibition may reduce any risk associated with pan-VEGF blockade, yet on the basis of initial trials, their use remains more limited at this time. However, clinical practice suggests that initial trials may have under-estimated the efficacy of selective-VEGF inhibition. Observational studies also indicate that better treatment outcomes may be possible by combining VEGF inhibitors sequentially with each other, or with existing therapies (eg, photodynamic therapy [PDT]). The optimum role and indications of anti-VEGF agents will come through careful consideration of the available efficacy and safety data, from the outcomes of long-term follow-up studies, and through assessment of the relative merits of the two approaches to VEGF inhibition in clinical practice. At this time, further head-to-head trials, and economic evaluations, comparing the treatment alternatives are needed.Keywords: age-related macular degeneration (AMD), choroidal neovascularization (CNV), vascular endothelial growth factor (VEGF), cardiovascular, ranibizumab, pegaptanib sodium Dove Press Sobha Sivaprasad 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2946 http://www.dovepress.com/role-of-pegaptanib-sodium-in-the-treatment-of-neovascular-age-related--peer-reviewed-article-OPTH English

oai:dovepress.com/1790 2008-06-30 OPTH

Pegaptanib sodium for neovascular age-related macular degeneration: clinical experience in the UK Sivaprasad, Sobha Clinical Ophthalmology Sobha Sivaprasad, Nachiketa Acharya, Phil HykinMoorfields Eye Hospital, London, UKAbstract: The pathogenesis of age-related macular degeneration (AMD) is unclear, but it can take either a neovascular/exudative/wet form, characterized by choroidal neovascularization (CNV), or a dry form. No treatments are available for the dry form, but there are a number of pharmacological interventions that inhibit vascular endothelial growth factor (VEGF), which is central to the pathogenesis of CNV and neovascular AMD. Available anti-VEGF agents either target all active VEGF isoforms (eg, ranibizumab), or take a more selective approach and inhibit only VEGF165 (eg, pegaptantib sodium). Current guidance on their use is equivocal and restrictive at best, resulting in associated difficulties in securing adequate, timely funding for treatment. The Moorfields Eye Hospital undertook an audit of 70 patients receiving intravitreal (ITV) pegaptanib sodium on a pro re nata (prn) dosing schedule. Despite initial funding delays, the audit recorded superior treatment outcomes compared with those reported in the VISION trials at 12 weeks: 88% of audit patients maintained stable vision, 29% gained vision and 6% experienced severe vision loss compared with 70%, ≥6% and ≤10% of patients in VISION at 54 weeks, respectively. The audit indicates a positive correlation between patients with better baseline visual acuity (VA) and improved therapeutic benefits, including a greater likelihood of both vision gain and vision preservation. Experience at Moorfields also suggests that pegaptanib sodium is more useful in occult lesions than minimally classic lesions, and clinical experience suggests that combination therapies may offer the best approach with anti-VEGF therapies. Further randomized clinical trials will help better determine the optimal treatment strategies with pegaptanib sodium in neovascular AMD.Keywords: age-related macular degeneration, choroidal neovascularization, vascular endothelial growth factor, pegaptanib sodium, visual outcomes, funding Dove Press Sobha Sivaprasad, Nachiketa Acharya, Phil Hykin 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2945 http://www.dovepress.com/pegaptanib-sodium-for-neovascular-age-related-macular-degeneration-cli-peer-reviewed-article-OPTH English

oai:dovepress.com/1791 2008-06-30 OPTH

Topical ophthalmic NSAIDs: a discussion with focus on nepafenac ophthalmic suspension Gaynes, Bruce Clinical Ophthalmology Bruce I Gaynes1,2, Anne Onyekwuluje11Departments of Ophthalmology and 2Pharmacology, Rush College of Medicine, Chicago, Illinois, USAAbstract: The removal of diclofenac sodium ophthalmic solution as a viable pharmaceutical entity in September 1999 from the US market spurred considerable interest in the general safety and effectiveness of topical ophthalmic NSAIDs for treatment of anterior segment inflammation. In late 1999 the use of topical ocular NSAIDs declined in the US as a result of incidents involving corneal melts and toxicity surrounding use of generic diclofenac. However, since the removal of diclofenac sodium ophthalmic solution from the marketplace, ophthalmic NSAIDs have regained use as viable pharmacotherapeutic entities. Moreover, several new ophthalmic NSAID products have recently been introduced for commercial use in the US including the novel chemical entity nepafenac. The purpose of this report is to revisit the use of topical ophthalmic NSAIDs for the treatment of surgically induced anterior segment inflammation with a particular focus on nepafenac. Nepafenac is unique among ophthalmic NSAIDs in that it is a prodrug deaminated to amfenac, a highly effective non-selective cyclooxygenase inhibitor. In the case of topical ophthalmic NSAIDs, practitioners should carefully weigh the cost-benefit of implementing “highly potent” new drug products because perturbations in pharmacodynamic response due to the inherent novelty in terms of chemical designs may outweigh the demonstrated replicative pharmacologic action of all topical ophthalmic NSAIDs.Keywords: ophthalmic NSAIDs, nepafenac, ocular inflammatory disease Dove Press Bruce I Gaynes, Anne Onyekwuluje 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2925 http://www.dovepress.com/topical-ophthalmic-nsaids-a-discussion-with-focus-on-nepafenac-ophthal-peer-reviewed-article-OPTH English

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Treatment of neovascular age-related macular degeneration in patients with diabetes Cummings, Michael Clinical Ophthalmology Michael Cummings1, José Cunha-Vaz21Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Portsmouth, UK; 2Department of Ophthalmology, University Hospital of Coimbra, Centre of Ophthalmology, Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, and Association for Innovation and Biomedical Research on Light and Image, Coimbra, PortugalAbstract: The number of patients with type 2 diabetes continues to rise; an anticipated 300 million people will be affected by 2025. The immense social and economic burden of the condition is exacerbated by the initial asymptomatic nature of type 2 diabetes, resulting in a high prevalence of micro- and macrovascular complications at presentation. Diabetic retinopathy, one of the potential microvascular complications associated with diabetes, and neovascular age-related macular degeneration (AMD) are the two most frequent retinal degenerative diseases, and are responsible for the majority of blindness due to retinal disease. Both conditions predominantly affect the central macula, and are associated with the presence of retinal edema and an aggressive inflammatory repair process that accelerates disease progression. The associated retinal edema and the inflammatory repair process are directly involved in the breakdown of the blood-retinal barrier (BRB). Yet, the underlying alterations to the BRB caused by the diseases are very different. The coexistence of the two conditions appears to be relatively uncommon, suggesting that diabetes may even protect patients from developing neovascular AMD. However, it is thought that the inflammatory repair responses associated with diabetic retinopathy and neovascular AMD may be cumulative and, in patients affected by both, could result in chronic diffuse cystoid edema. Treatment considerations in such patients should, therefore, include the role of retinal edema and the increased susceptibility of patients with diabetes to potential systemic side effects associated with agents administered repeatedly for neovascular AMD treatment.Keywords: diabetes, diabetic retinopathy, neovascular age-related macular degeneration, retina, edema Dove Press Michael Cummings, José Cunha-Vaz 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2941 http://www.dovepress.com/treatment-of-neovascular-age-related-macular-degeneration-in-patients--peer-reviewed-article-OPTH English

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Current and emerging therapies for the treatment of age-related macular degeneration Lauer, Andreas Clinical Ophthalmology M Vaughn Emerson, Andreas K LauerCasey Eye Institute, Oregon Health and Science University, Portland, OR, USAAbstract: Age-related macular degeneration (AMD) is the leading cause of vision loss in the industrialized world. In the last few decades, the mainstay of treatment for choroidal neovascularization (CNV) due to AMD has been thermal laser photocoagulation. In the last decade, photodynamic therapy with verteporfin extended treatment for more patients. While both of these treatments have prevented further vision loss in a subset of patients, improvement in visual acuity is rare. Anti-vascular endothelial growth factor A (VEGF) therapy has revolutionized the treatment of AMD-related CNV. Pegaptanib, an anti-VEGF aptamer prevents vision loss in CNV, although the performance is similar to that of photodynamic therapy. Ranibizumab, an antibody fragment and bevacizumab, a full-length humanized monoclonal antibody against VEGF have both shown promising results with improvements in visual acuity with either agent. VEGF trap, a modified soluble VEGF receptor analogue, binds VEGF more tightly than all other anti-VEGF agents and has also shown promising results in early trials. Other treatment strategies to decrease the effect of VEGF have used small interfering ribonucleic acid (RNA) to inhibit VEGF production and VEGF receptor production. Steroids, including anecortave acetate in the treatment and prevention of CNV, have shown promise in controlled trials. Receptor tyrosine kinase inhibitors, such as vatalanib, inhibit downstream effects of VEGF, and have been effective in the treatment of CNV in early studies. Squalamine lactate inhibits plasma membrane ion channels with downstream effects on VEGF, and has shown promising results with systemic administration. Other growth factors, including pigment epithelium-derived growth factor that has been administered via an adenoviral vector has shown promising initial results. In some patients ciliary neurotrophic factor is currently being studied for the inhibition of progression of geographic atrophy. Combination therapy has been investigated, and may prove to be more effective in the management of AMD-associated CNV. Ongoing and future studies will be crucial for optimizing the treatment of patients with AMD.Keywords: age related macular degeneration, macular degeneration, VEGF, VEGF antagonist, anti-VEGF, choroidal neovascularization Dove Press M Vaughn Emerson, Andreas K Lauer 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2926 http://www.dovepress.com/current-and-emerging-therapies-for-the-treatment-of-age-related-macula-peer-reviewed-article-OPTH English

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Rational use of the fixed combination of dorzolamide – timolol in the management of raised intraocular pressure and glaucoma Francis, Brian Clinical Ophthalmology Jason Yeh1, Daniel Kravitz2, Brian Francis11Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 2Tulane University, School of Medicine, New Orleans, LA, USAAbstract: Glaucoma is a multifactorial optic neuropathy in which the main therapeutic target is lowering of intraocular pressure (IOP) in order to retard the progression of existing structural and functional damage. The three mainstays of treatment are pharmacologic, laser, and surgical. The primary standard therapy in patients with open-angle glaucoma or ocular hypertension is topical medication. When monotherapy does not adequately lower the intraocular pressure, one or more agents are added or substituted. Combination pharmacotherapy such as Cosopt® is available to improve efficacy and simplify medication regimen. A fixed combination of two ocular hypotensive drugs (the carbonic anhydrase inhibitor dorzolamide and the beta-adrenoceptor antagonist timolol), Cosopt® is indicated for the treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension insufficiently responsive to topical beta-adrenoceptor antagonist monotherapy. Compared with concomitant therapy with the individual components, the primary advantage of fixed combination dorzolamide – timolol is convenience, which may also improve compliance. Clinical trials have demonstrated that the fixed combination dorzolamide – timolol is safe, effective and generally well tolerated in lowering IOP in patients with open angle glaucoma or ocular hypertension, including individuals uncontrolled on beta-adrenoceptor antagonist or other monotherapy.Keywords: glaucoma, ocular hypertension, Cosopt®, fixed combination dorzolamide – timolol, dorzolamide, timolol Dove Press Jason Yeh, Daniel Kravitz, Brian Francis 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2932 http://www.dovepress.com/rational-use-of-the-fixed-combination-of-dorzolamide-ndash-timolol-in--peer-reviewed-article-OPTH English

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Potential bias in ophthalmic pharmaceutical clinical trials Varner, Paul Clinical Ophthalmology Paul VarnerJohn J Pershing Veterans’ Administration Medical Center, Poplar Bluff, Missouri, USAAbstract: To make clinicians aware of potential sources of error in ophthalmic pharmaceutical clinical trials that can lead to erroneous interpretation of results, a critical review of the study design of various pharmaceutical ophthalmic clinical trials was completed. Discrepancies as a result of study shortcomings may explain observed differences between reported ophthalmic trial data and observed clinical results.Keywords: evidence-based medicine, validity, bias, gold standard Dove Press Paul Varner 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2942 http://www.dovepress.com/potential-bias-in-ophthalmic-pharmaceutical-clinical-trials-peer-reviewed-article-OPTH English

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Current and future approaches in the prevention and treatment of diabetic retinopathy Sarraf, David Clinical Ophthalmology Louis K Chang1, David Sarraf1,21Jules Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA; 2Department of Ophthalmology, Greater LA VA Healthcare Center, Los Angeles, CAAbstract: Diabetic retinopathy (DR) is a major cause of blindness worldwide and is the number one cause of blindness in working-age individuals in developed countries. We review the current literature and discuss the pathogenesis, modifying risk factors, genetics, and treatment of DR. Special focus is placed on the rationale and effectiveness of therapeutic modalities, both current and future. Dove Press Louis K Chang, David Sarraf 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2956 http://www.dovepress.com/current-and-future-approaches-in-the-prevention-and-treatment-of-diabe-peer-reviewed-article-OPTH English

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Can macular translocation be a satisfactory management of subfoveal choroidal neovascular membrane? Zsolt, Biro Clinical Ophthalmology Árpád Bereczki1, Zsolt Bíró21“Petz Aladár” County Teaching Hospital, Department of Ophthalmology, Győr, Hungary; 2St Imre Hospital, Department of Ophthalmology, Budapest, HungaryPurpose: To report histopathological observations regarding one of our macular translocation cases.Methods: We have performed macular translocation with 360 degree retinotomy since 1997, and limited macular translocation with or without subretinal membrane removal since 2002. One of our patients died on the fifth postoperative day, so extensive histological examination of the removed neovascular membrane and entire globe was performed.Results: We found that pigment epithelium remained attached to the neurosensory retina during retinal separation, in which case the rotated fovea will be relocated in a partially devoided pigment epithelial zone. In addition, even after complete surgical removal of the membrane during macular translocation, large membrane remnants are still detectable by histological examination.Conclusion: In our opinion, macular translocation is not a satisfactory management of subfoveal neovascular membranes, because of changes in the pigment epithelium during surgery, and large subretinal neovascular membrane remnants.Keywords: age-related macular degeneration (AMD), choroidal neovascularization (CNV), choroidal subretinal membrane, macular translocation, histology Dove Press Árpád Bereczki, Zsolt Bíró 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2929 http://www.dovepress.com/can-macular-translocation-be-a-satisfactory-management-of-subfoveal-ch-peer-reviewed-article-OPTH English

oai:dovepress.com/1800 2008-06-30 OPTH

Epstein-Barr virus and acute retinal necrosis in a 5-year-old immunocompetent child Gallego-Pinazo, Roberto Clinical Ophthalmology Roberto Gallego-Pinazo1,2, Miguel Harto1, Jose J Garcia-Medina2,3, Inmaculada Serra1, Enrique España1, Maria D Pinazo-Duran2,41Ophthalmology Department, University Hospital, La Fe, Valencia, Spain; 2Ophthalmology Research Unit “Santiago Grisolia”, Valencia, Spain; 3Ophthalmology Department, Hospital La inmaculada, Huercal-Overa, Spain; 4Ophthalmology Department, Hospital Punta de Europa, Algeciras, SpainObjective: To describe a case of bilateral acute retinal necrosis syndrome (ARNS) in a 5-year-old boy.Method: A retrospective, interventional case is described in one child attending the pediatric ophthalmology section, complaining of sudden bilateral red eye and haze-impaired vision. A standardized ophthalmologic examination and specific serological probes supported the diagnosis of severe bilateral ARNS in an immunocompetent child.Results: The reduced visual acuity (<20/400), the ocular fundus signs (perivasculitis, thrombosis and retinal edema) and the positive immunoglobulin M anti-Epstein Barr virus serology, lead us to the ARNS definitive diagnosis. Antiviral therapy (Acyclovir; Zovirax®), ciclopentolate dilating eye drops, and antiplatelet treatment (acetil salicylic acid; Aspirin®) were administered until recovering the final visual acuity (20/40).Conclusions: The ARNS is an ocular disease with poor prognosis, which in turns may display better course when determining the etiopathogenic virus and selecting the appropriate and precocious therapy.Keywords: retinal necrosis, Epstein-Barr virus, antiviral serology, antiviral therapy Dove Press Roberto Gallego-Pinazo, Miguel Harto, Jose J Garcia-Medina, Inmaculada Serra, Enrique España, Maria D Pinazo-Duran 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2931 http://www.dovepress.com/epstein-barr-virus-and-acute-retinal-necrosis-in-a-5-year-old-immunoco-peer-reviewed-article-OPTH English

oai:dovepress.com/1801 2008-06-30 OPTH

Bilateral herpes simplex keratitis in a patient with chronic graft-versus-host disease Hayashi, Takahiko Clinical Ophthalmology Takahiko Hayashi1, Misaki Ishioka2, Norihiko Ito1, Yoko Kato1, Hisashi Nakagawa3, Hiroshi Hatano4, Nobuhisa Mizuki11Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan; 2Ryogoku Eye Clinic, Tokyo, Japan; 3Tokushima Eye Clinic, Higashimurayama-shi, Tokyo, Japan; 4Lumine Hatano Eye Clinic, Fujisawa, Fujisawa-shi, Kanagawa, JapanPurpose: To describe a case of bilateral herpes simplex keratitis accompanying chronic graft-versus-host disease (GVHD).Design: Observational case report.Case report: An 11-year-old boy with myelocytic leukemia underwent allogeneic bone marrow transplantation. He developed symptoms of the skin, eyes, and mouth, and lip biopsy indicated chronic GVHD. Persistent keratitis with corneal filaments and neovascularization was noted in both eyes. Sodium hyaluronate, autoserum, and 0.1% fluorometholone eyedrops were instilled for approximately 2 years to treat this keratitis, and there were no other ocular changes. Bilateral herpes simplex keratitis developed with geographic ulcers after topical betamethasone therapy, but responded to acyclovir ointment.Conclusions: Herpes keratitis should be considered in the differential diagnosis of bilateral keratitis in patients with reduced immunocompetence. During the course of chronic GVHD, corneal herpes may occur, so ocular treatment with topical corticosteroids should be managed by an ophthalmologist to monitor sight-threatening conditions such as corneal herpes.Keywords: chronic graft-versus-host disease, bone marrow transplant, corneal herpes, bilateral herpes simplex keratitis, dry eyes Dove Press Takahiko Hayashi, Misaki Ishioka, Norihiko Ito, Yoko Kato, Hisashi Nakagawa, et al 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2933 http://www.dovepress.com/bilateral-herpes-simplex-keratitis-in-a-patient-with-chronic-graft-ver-peer-reviewed-article-OPTH English

oai:dovepress.com/1802 2008-06-30 OPTH

Optical coherence tomography findings in paraneoplastic pseudovitelliform lesions in melanoma-associated retinopathy Lim, Jenny Clinical Ophthalmology Michael Javaheri1, Rahul N Khurana1, Rizwan A Bhatti1, Jennifer I Lim21Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA; 2Eye and Ear Infirmary, Department of Ophthalmology, University of Illinois, Chicago, IL, USAPurpose: To report an unusual case of paraneoplastic pseudovitelliform lesions associated with melanoma-associated retinopathy (MAR).Design: Observational case report.Methods: Retrospective review of the ophthalmic examination, fundus photography, fluorescein angiography, electroretinogram (ERG), and optical coherence tomography (OCT) of a patient with MAR.Results: A 65-year-old Caucasian man with a two-year history of metastatic melanoma was referred for evaluation of a six-month history of nyctalopia. Funduscopic examination in both eyes revealed multiple, creamy, yellow, pseudovitelliform lesions in the posterior pole, varying in size from 100–500 µm, at the level of the outer retinal/retinal pigment epithelium (RPE) junction, coalescing along the inferior portion, with overlying macular neurosensory detachments. OCT showed bilateral macular neurosensory detachments with multiple small areas of high refl ectivity at the level of the outer retinal/RPE junction. ERG demonstrated a selective loss of the b-wave and a normal a-wave under dark adapted, scotopic conditions.Conclusion: Clinicians should be aware of this atypical presentation of MAR that may include pseudovitelliform retinal findings.Keywords: cancer-associated retinopathy, melanoma-associated retinopathy, optical coherence tomography, paraneoplastic syndrome, paraneoplastic pseudovitelliform retinopathy Dove Press Michael Javaheri, Rahul N Khurana, Rizwan A Bhatti, Jennifer I Lim 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2936 http://www.dovepress.com/optical-coherence-tomography-findings-in-paraneoplastic-pseudovitellif-peer-reviewed-article-OPTH English

oai:dovepress.com/1803 2008-06-30 OPTH

Bilateral permanent concentric visual field defect secondary to severe pre-eclampsia Citirik, Mehmet Clinical Ophthalmology Mehmet Citirik, Tulay Simsek, Orhan ZileliogluSB Ankara Ulucanlar Eye Education and Research Hospital, Ankara, TurkeyPurpose: To present a patient with bilateral permanent concentric visual field defect secondary to severe pre-eclampsia.Case report: A forty-year-old woman presented to the ophthalmology department with partial visual field defect affecting her both eyes. She gave a history of emergent uterine curettage for severe uncontrolled pre-eclampsia in the 24th week of her second gestation which was 10 years before. Two days after the procedure, the patient complained of peripheral visual field defect in her both eyes which persisted until her last presentation. Her best-corrected visual acuity, color vision, intraocular pressures, and anterior segment examination findings were normal bilaterally. Fundus examination showed a normal optic nerve head with reduction of arteriole to vein ratio in both eyes. Humphrey Field Analyzer revealed a bilateral concentric visual field defect. Visual Evoked Potentials (VEP) and Electroretinography (ERG) were within normal limits in both eyes. Cranial magnetic resonance imaging (MRI) was normal.Discussion: Herein, we presented a case of permanent concentric visual field defect which developed as a complication of severe uncontrolled pre-eclampsia. To the best of our knowledge; such a case has not been reported to date.Keywords: pregnancy, pre-eclampsia, concentric visual field defect Dove Press Mehmet Citirik, Tulay Simsek, Orhan Zilelioglu 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2938 http://www.dovepress.com/bilateral-permanent-concentric-visual-field-defect-secondary-to-severe-peer-reviewed-article-OPTH English

oai:dovepress.com/1804 2008-06-30 OPTH

Bilateral leukocoria in infant with afibrinogenemia Unlu, Nurten Clinical Ophthalmology M Necati Demir1, Mehmet Akif Acar1, Yusuf Ziya Aral2, Nurten Ünlü11Ankara Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey; 2Aydin Menderes University, Faculty of Medicine, Department of Pediatric Hematology, Aydin, TurkeyPurpose: To report a bilateral leukocoria case in a patient suffering from afibrinogenemia.Methods: An observational case where congenital afibrinogenemia was presented with bilateral retinal and vitreous hemorrhages that proceeded to vitreoretinal surgery was presented. In addition, complete ophthalmic and radiological examinations and vitreoretinal surgery were performed.Results: Right eye had a complete recovery while the left eye showed serious proliferative vitreoretinopathy and shortened retina. Three years after the surgery clinical examination showed that the right eye was aphacic with an attached retina and clear ocular media while the left eye was phtysic.Conclusion: We recommend broad clotting profile for infants suffering from vitreous or retinal hemorrhages with no obvious physical abuse. Our present case furthermore implies that afibrinogenemia can lie beneath the pathogenesis of bilateral leukocoria and should alert physician for the presence of an afibrinogenemia among several types of bleeding predispositions.Keywords: afibrinogenemia, retinal hemorrhage, vitreous hemorrhage, vitrectomy Dove Press M Necati Demir, Mehmet Akif Acar, Yusuf Ziya Aral, Nurten Ünlü 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2939 http://www.dovepress.com/bilateral-leukocoria-in-infant-with-afibrinogenemia-peer-reviewed-article-OPTH English

oai:dovepress.com/1805 2008-06-30 OPTH

A case of superior segmental optic hypoplasia accompanied by a glaucomatous optic neuropathy Ohguro, Hiroshi Clinical Ophthalmology Ikuyo Ohguro, Hiroshi OhguroDepartment of Ophthalmology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, JapanAbstract: This is the first case report of a bilateral superior segmental optic hypoplasia (SSOH) accompanied by a glaucomatous optic neuropathy (GON). A 47-year-old man incidentally diagnosed as having bilateral SSOH, simultaneously disclosed glaucomatous optic disc appearances, including enlargements of the cup of the optic nerve heads and a thinning of the infero-temporal neuroretinal rim with laminar dot sign accompanied by a retinal nerve fiber layer (RNFL) local defect of infero-temporal region in the right eye. The visual field examination revealed that the corresponding nasal step, arcuate scotoma and RNFL field defects in the right eye.Keyword: retinal nerve fiber layer Dove Press Ikuyo Ohguro, Hiroshi Ohguro 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2943 http://www.dovepress.com/a-case-of-superior-segmental-optic-hypoplasia-accompanied-by-a-glaucom-peer-reviewed-article-OPTH English

oai:dovepress.com/1806 2008-06-30 OPTH

Extranodal Rosai-Dorfman disease with bilateral orbital involvement: Report of a case treated with systemic steroid alone Yilmaz, Safiye Clinical Ophthalmology Safiye Yilmaz1, Melih Ture1, Ahmet Maden1, Mine Tunakan21Department of Ophthalmology, 2Department of Pathology, Izmir Atatürk Training and Research Hospital, Izmir, TurkeyAbstract: We report the case of a 41-year-old female with bilateral orbital Rosai-Dorfman disease (RDD) and the result of corticosteroid therapy. The patient developed a swollen mass of bilateral upper and lower eye-lid over a six-month period. Diagnosis was based on the characteristic histopathologic features. She was treated with oral corticosteroids 60 mg/per day for ten days and the dose of corticostreoid was tapered every week. She is currently being treated with 10 mg/per day for 4 months. In general, the prognosis is good, with experiencing remission following a course of oral corticosteroids. There is no evidence that corticosteroids are beneficial in the treatment of RDD in the literature, but data regarding such treatment are sparse. A more formalized surveillance of these cases would help to define more clearly the natural history of the disease and the effects of various treatment modalities.Keywords: Rosai-Dorfman Disease, orbital involvement, treatment, corticosteroid Dove Press Safiye Yilmaz, Melih Ture, Ahmet Maden, Mine Tunakan 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2950 http://www.dovepress.com/extranodal-rosai-dorfman-disease-with-bilateral-orbital-involvement-re-peer-reviewed-article-OPTH English

oai:dovepress.com/1807 2008-06-30 OPTH

Patients treated with intravitreal triamcinolone acetonide [from Gallenga and Lobefalo] and Response to correspondence [from Kocabora]  ||FREE PAPER|| Gallenga, Pier Clinical Ophthalmology Pier E Gallenga1, Lucio Lobefalo21University Eye Clinic, G.D’Annunzio University, Chieti, Italy; 2Ethical Committee, Italian Ophthalmological Society – SOI, ItalyThe paper by Kocabora and coworkers (2008) underlines the message that patients treated with intravitreal triamcinolone acetonide are at risk of increased intraocular pressure (IOP) even after the clearance period of the drug. Furthermore, the development of intractable secondary glaucoma requiring surgical intervention is clear advice to monitor these patients carefully. M Selim KocaboraVatan caddesi, Vakif Gureba Egitim ve Arastirma Hastanesi, Fatih, 34 000, Istanbul, Turkey.We thank Dr. Gallenga and Dr. Lobefalo for their interest in our article (Kocabora et al 2008) and for their comments. We agree with them on the importance of pharmacovigilance and of warning the ophthalmology community about the potential risks of intravitreal triamcinolone (IVTA). We should always follow the principle of primum, non nocere in our medical practices. ... Dove Press Pier E Gallenga, Lucio Lobefalo, M Selim Kocabora 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2954 http://www.dovepress.com/patients-treated-with-intravitreal-triamcinolone-acetonide-from-gallen-peer-reviewed-article-OPTH English

oai:dovepress.com/1796 2008-06-30 OPTH

Age and disease-related structural changes in the retinal pigment epithelium Bonilha, Vera Clinical Ophthalmology Vera L BonilhaCole Eye Institute, The Cleveland Clinic, Cleveland, OH, USAAbstract: As the retinal pigment epithelium (RPE) ages, a number of structural changes occur, including loss of melanin granules, increase in the density of residual bodies, accumulation of lipofuscin, accumulation of basal deposits on or within Bruch’s membrane, formation of drusen (between the basal lamina of the RPE and the inner collagenous layer of Bruch’s membrane), thickening of Bruch’s membrane, microvilli atrophy and disorganization of the basal infoldings. Although these changes are well known, the basic mechanisms involved in them are frequently poorly understood. These age-related changes progress slowly and vary in severity in different individuals. These changes are also found in age-related macular degeneration (AMD), a late onset disease that severely impacts the RPE, but they are much more pronounced than during normal aging. However, the changes in AMD lead to severe loss of vision. Given the many supporting functions which the RPE serves for the retina, it is important to decipher the age-related changes in this epithelium in order to understand age-related changes in vision.Keywords: retinal pigment epithelium, aging, age-related macular degeneration (AMD), ocular disorders, retinal disease Dove Press Vera L Bonilha 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2935 http://www.dovepress.com/age-and-disease-related-structural-changes-in-the-retinal-pigment-epit-peer-reviewed-article-OPTH English

oai:dovepress.com/1798 2008-06-30 OPTH

Clinical applications of corneal confocal microscopy Malik, Rayaz Clinical Ophthalmology Mitra Tavakoli1, Parwez Hossain2, Rayaz A Malik11Division of Cardiovascular Medicine, University of Manchester and Manchester Royal Infirmary, Manchester, UK; 2University of Southampton, Southampton Eye Unit, Southampton General Hospital, Southampton, UKAbstract: Corneal confocal microscopy is a novel clinical technique for the study of corneal cellular structure. It provides images which are comparable to in-vitro histochemical techniques delineating corneal epithelium, Bowman’s layer, stroma, Descemet’s membrane and the corneal endothelium. Because, corneal confocal microscopy is a non invasive technique for in vivo imaging of the living cornea it has huge clinical potential to investigate numerous corneal diseases. Thus far it has been used in the detection and management of pathologic and infectious conditions, corneal dystrophies and ecstasies, monitoring contact lens induced corneal changes and for pre and post surgical evaluation (PRK, LASIK and LASEK, flap evaluations and Radial Keratotomy), and penetrating keratoplasty. Most recently it has been used as a surrogate for peripheral nerve damage in a variety of peripheral neuropathies and may have potential in acting as a surrogate marker for endothelial abnormalities.Keywords: corneal confocal microscopy, cornea, infective keratitis, corneal dystrophy, neuropathy Dove Press Mitra Tavakoli, Parwez Hossain, Rayaz A Malik 2008-06-30 PDF http://www.dovepress.com/getfile.php?fileID=2927 http://www.dovepress.com/clinical-applications-of-corneal-confocal-microscopy-peer-reviewed-article-OPTH English

oai:dovepress.com/2353 2008-10-05 OPTH

Clinical experience with pegaptanib sodium Staurenghi, Giovanni Clinical Ophthalmology Chiara Rosina, Ferdinando Bottoni, Giovanni StaurenghiLuigi Sacco Hospital, University of Milano, ItalyAbstract: Pegaptanib sodium (Macugen®) blocks the extracellular vascular endothelial growth factor (VEGF) isoform VEGF165, whose elevated levels are associated with the development of choroidal neovascularization (CNV). This selective inhibition prevents binding to the VEGF receptors and the development of the increased vascular permeability and the CNV associated with neovascular age-related degeneration (AMD). The VEGF Inhibition Study In Ocular Neovascularization (VISION) demonstrated that pegaptanib sodium confers clinically meaningful benefit in the treatment of all angiographic subtypes of neovascular AMD. It also has a favorable safety profile after 1 and 2 years of continuous treatment, and recent data suggest that the agent has a disease-modifying effect. Post hoc analysis of VISION suggests that treatment benefit may be greatest in patients with early lesions, in whom 80% achieved the primary endpoint of <15 letters lost, 47% maintained visual acuity (VA), and 20% gained ≥15 letters of vision. Similarly, our own clinical experience indicates that pegaptanib sodium achieves better outcomes in early lesions than in established lesions, particularly in patients with previously untreated minimally classic and occult lesions in whom VA improvement and lesion size stabilization has been recorded. Observations indicate that pegaptanib sodium has a slower mode of action than unselective VEGF inhibitors, resulting in an average of 3–4 injections being required to stabilize VA and lesion size. Pegaptanib sodium has good efficacy and safety profiles and represents a good treatment option for patients with early CNV membranes associated with neovascular AMD.Keywords: vascular endothelial growth factor (VEGF), choroidal neovasularization (CNV), age-related macular degeneration (AMD), pegaptanib sodium, early lesions, visual acuity (VA) Dove Press Chiara Rosina, Ferdinando Bottoni, Giovanni Staurenghi 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3551 http://www.dovepress.com/clinical-experience-with-pegaptanib-sodium-peer-reviewed-article-OPTH English

oai:dovepress.com/2355 2008-10-05 OPTH

Topical treatment options for conjunctival neoplasms Kim, Jonathan Clinical Ophthalmology Jonathan W Kim, David H AbramsonOphthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: Topical therapies offer a nonsurgical method for treating conjunctival tumors by delivering high drug concentrations to the ocular surface. Over the past ten years, topical agents have been used by investigators to treat various premalignant and malignant lesions of the conjunctiva, such as primary acquired melanosis with atypia, conjunctival melanoma, squamous intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and pagetoid spread of the conjunctiva arising from sebaceous cell carcinoma. Despite the enthusiasm generated by the success of these agents, there are unanswered questions regarding the clinical efficacy of this new nonsurgical approach, and whether a single topical agent can achieve cure rates comparable with traditional therapies. Furthermore, the long-term consequences of prolonged courses of topical chemotherapeutic drugs on the ocular surface are unknown, and the ideal regimen for each of these agents is still being refined. In this review, we present specific guidelines for treating both melanocytic and squamous neoplasms of the conjunctiva, utilizing the available data in the literature as well as our own clinical experience at the Memorial Sloan-Kettering Cancer Center.Keywords: topical therapies, conjunctival neoplasms melanosis, Mitomycin-C, 5-Fluorouracil Dove Press Jonathan W Kim, David H Abramson 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3528 http://www.dovepress.com/topical-treatment-options-for-conjunctival-neoplasms-peer-reviewed-article-OPTH English

oai:dovepress.com/2356 2008-10-05 OPTH

Brinzolamide ophthalmic suspension: a review of its pharmacology and use in the treatment of open angle glaucoma and ocular hypertension Iester, Michele Clinical Ophthalmology Michele IesterClinica Oculistica, University of Genoa, ItalyAbstract: Brinzolamide is a white powder commercially formulated as a 1% ophthalmic suspension to reduce intraocular pressure (IOP). Pharmacologically, brinzolamide is a highly specific, non-competitive, reversible, and effective inhibitor of carbonic anhydrase II (CA-II), able to suppress formation of aqueous humor in the eye and thus to decrease IOP. Several clinical trials have evaluated its safety and the most commonly ocular adverse events are blurred vision (3%–8%), ocular discomfort (1.8%–5.9%), and eye pain (0.7%–4.0%). Brinzolamide has been introduced to treat ocular hypertension and primary open-angle glaucoma. In some clinical studies it has been estimated that brinzolamide reduced IOP by was about 18%. Brinzolamide can be added to beta-blockers and prostaglandins. In the latter combination, because prostaglandin derivatives improve the uveoscleral outflow but also increase the activity of CA in ciliary epithelium with a secondary increase in aqueous humor secretion, and slightly reduce the efficacy of prostaglandin analogues, theoretically topical CA inhibitors (CAI) decrease IOP by inhibiting CA-II, thus improving prostaglandin efficacy as well as lowering IOP. Brinzolamide could have a secondary possible effect on ocular flow too. Some clinical studies showed a mild improvement of ocular blood flow. Theoretically, CAI could give rise to metabolic acidosis, with secondary vasodilatation and improvement of blood flow. Systemic acidosis can occur in the setting of oral CAI therapy, and local acidosis within ocular tissues is theoretically possible with topical CAI therapy, with the potential for a local increase in ocular blood flow. In conclusion, topical CAI treatment has efficacy in IOP-lowering ranging from 15% to 20%. From published data, brinzolamide can be used as first-line medication, even if other medications have a higher efficacy, with few side effects and it is a good adjunctive treatment. In some type of glaucoma patients with a vascular dysregulation, topical CAI could have a double effect: reducing IOP and improving ocular blood flow.Keywords: brinzolamide, ocular hypertension, glaucoma, intraocular pressure, ocular blood flow, safety, treatment Dove Press Michele Iester 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3549 http://www.dovepress.com/brinzolamide-ophthalmic-suspension-a-review-of-its-pharmacology-and-us-peer-reviewed-article-OPTH English

oai:dovepress.com/2357 2008-10-05 OPTH

Treatment of allergic conjunctivitis with olopatadine hydrochloride eye drops Uchio, Eiichi Clinical Ophthalmology Eiichi UchioDepartment of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, JapanAbstract: Olopatadine hydrochloride exerts a wide range of pharmacological actions such as histamine H1 receptor antagonist action, chemical mediator suppressive action, and eosinophil infiltration suppressive action. Olopatadine hydrochloride 0.1% ophthalmic solution (Patanol®) was introduced to the market in Japan in October 2006. In a conjunctival allergen challenge (CAC) test, olopatadine hydrochloride 0.1% ophthalmic solution significantly suppressed ocular itching and hyperemia compared with levocabastine hydrochloride 0.05% ophthalmic solution, and the number of patients who complained of ocular discomfort was lower in the olopatadine group than in the levocabastine group. Conjunctival cell membrane disruption was observed in vitro in the ketotifen fumarate group, epinastine hydrochloride group, and azelastine hydrochloride group, but not in the olopatadine hydrochloride 0.1% ophthalmic solution group, which may potentially explain the lower discomfort felt by patients on instillation. Many other studies in humans have revealed the superiority of olopatadine 0.1% hydrochloride eye drops to several other anti-allergic eye drops. Overseas, olopatadine hydrochloride 0.2% ophthalmic solution for a once-daily regimen has been marketed under the brand name of Pataday®. It is expected that olopatadine hydrochloride ophthalmic solutions may be used in patients with a more severe spectrum of allergic conjunctival diseases, such as vernal keratoconjunctivitis or atopic keratoconjunctivitis, in the near future.Keywords: olopatadine, eye drop, allergic conjunctivitis, anti-histaminergic Dove Press Eiichi Uchio 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3550 http://www.dovepress.com/treatment-of-allergic-conjunctivitis-with-olopatadine-hydrochloride-ey-peer-reviewed-article-OPTH English

oai:dovepress.com/2358 2008-10-05 OPTH

SUNCT syndrome: The materialization of a headache syndrome Sjaastad, Ottar Clinical Ophthalmology Ottar SjaastadDepartment of Neurology, St. Olav´s Hospital, 7006 Trondheim University Hospitals, Trondheim, NorwayAbstract: Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache, described by our group in 1989. This overview presents our early studies of SUNCT pathogenesis. Due to the conspicuous ictal, ocular phenomena, ie, conjunctival injection and tearing, our studies started out with ocular parameters: intraocular pressure and corneal indentation pulse amplitudes, both of which showed clear ictal increments, symptomatic side. Beat-to-beat, noninvasive blood pressure measurements during attack showed instant, systolic blood pressure rise and corresponding pulse rate decrease. Carotid body, the principal peripheral chemoreceptor, seemed to function normally. The middle cerebral artery was dilated during attacks, particularly on the symptomatic side. Finally, some viewpoints are added regarding terminology. SUNCT is a workable and accepted term. There does not seem to be any need for another, fictitious term to describe the same clinical picture.Keywords: SUNCT syndrome, intraocular blood flow, intraocular pressure, median artery blood flow, carotid body function, hypothalamic stimulation Dove Press Ottar Sjaastad 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3552 http://www.dovepress.com/sunct-syndrome-the-materialization-of-a-headache-syndrome-peer-reviewed-article-OPTH English

oai:dovepress.com/2359 2008-10-05 OPTH

Fixed combination of topical brimonidine 0.2% and timolol 0.5% for glaucoma and uncontrolled intraocular pressure Lee, Anne Clinical Ophthalmology Anne J Lee1, Peter McCluskey1,21Department of Ophthalmology, Liverpool Hospital, Liverpool, NSW, Australia; 2Faculty of Medicine, University of New South Wales, Randwick, NSW, AustraliaAbstract: Lowering IOP is the most readily modifiable risk factor to delay the development and progression of glaucoma (POAG). The fixed combination of brimonidine tartrate 0.2% and timolol maleate 0.5% (FCBT) combines a highly selective α2-adrenergic agonist (brimonidine) with a non-selective β-blocker (timolol). FCBT reduces aqueous production and enhances uveoscleral outflow. Concomitant brimonidine and timolol have additive effects on reducing intraocular pressure (IOP). Multi-center randomized control trials have documented superiority of FCBT twice daily on IOP control compared with monotherapy with the individual components, and equal efficacy compared with concomitant therapy. IOP reduction with FCBT versus fixed combination dorzolamide 2% and timolol 0.5% (FCDT) was similar in a small study. Other studies (n > 293) evaluating concomitant brimonidine and timolol have shown that it is not inferior to FCDT. However, concomitant brimonidine and timolol administered twice daily was significantly less efficacious in IOP reduction than fixed combination latanoprost 0.005% and timolol 0.5% (FCLT). There are no published studies comparing FCBT with FCLT. The side effect profile for FCBT reflects that of its individual components. FCBT was generally well tolerated, with less ocular side effects than brimondine alone, but more than timolol alone. Documented systemic effects were few, although this could be confounded by selection bias. FCBT is a safe and effective IOP lowering agent for POAG and ocular hypertension.Keywords: brimonidine, timolol, combigan, glaucoma, combination, ocular hypertension Dove Press Anne J Lee, Peter McCluskey 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3554 http://www.dovepress.com/fixed-combination-of-topical-brimonidine-02-and-timolol-05-for-glaucom-peer-reviewed-article-OPTH English

oai:dovepress.com/2360 2008-10-05 OPTH

Thrombophilic screening in retinal artery occlusion patients Nagy, Valeria Clinical Ophthalmology Valeria Nagy1, Lili Takacs1, Zita Steiber1, György Pfliegler2, Andras Berta11Department of Ophthalmology, 2Division of Rare Diseases, University of Debrecen Medical and Health Science Center, Debrecen, HungaryBackground: Retinal artery occlusion (RAO) is an ischemic vascular damage of the retina, which frequently leads to sudden, mostly irreversible loss of vision. In this study, blood thrombophilic factors as well as cardiovascular risk factors were investigated for their relevance to this pathology. Thrombophilic risk factors so far not evaluated were included in the study.Patients and methods: 28 RAO patients and 81 matched control subjects were examined. From blood samples, protein C, protein S, antithrombinopathy, and factor V (Leiden) mutation (FV), factor II gene polymorphism, factor VIII C level, plasminogen activity, lipoprotein(a) and fibrinogen levels, hyperhomocysteinemia and presence of anticardiolipin – antiphospholipid antibodies were investigated. Possibly relevant pathologies such as diabetes mellitus, hypertension, and ischemic heart disease were also registered. Statistical analysis by logistic regression was performed with 95% confidence intervals.Results: In the group of patients with RAO only the incidence of hypertension (OR: 3.33, 95% CI: 1.30–9.70, p = 0.014) as an average risk factor showed significant difference, but thrombophilic factors such as hyperfibrinogenemia (OR: 2.9, 95% CI: 1.29–6.57, p = 0.010) and the presence of FV (Leiden mutation) (OR: 3.9, 95% CI: 1.43–10.96, p = 0.008) increased the chances of developing this disease.Conclusions: Our results support the assumption that thrombophilia may contribute to the development of RAO besides vascular damage due to the presence of cardiovascular risk factors. Further studies are needed, however, to justify the possible use of secondary prophylaxis in form of anticoagulant/antiplatelet therapy.Keywords: retinal arterial occlusion, risk factors, thrombophilia Dove Press Valeria Nagy, Lili Takacs, Zita Steiber, György Pfliegler, Andras Berta 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3526 http://www.dovepress.com/thrombophilic-screening-in-retinal-artery-occlusion-patients-peer-reviewed-article-OPTH English

oai:dovepress.com/2361 2008-10-05 OPTH

Oriental oculopalpebral dimensions: Quantitative comparison between Orientals from Japan and Brazil Schellini, Silvana Clinical Ophthalmology Rodrigo U Takahagi1, Silvana A Schellini1, Carlos R Padovani1, Shinji Ideta2, Nobutada Katori2, Yasuhisa Nakamura21Department of Ophthalmology, Faculdade de Medicina de Botucatu, Botucatu, Sao Paulo State, Brazil; 2Department of Oculoplastic and Orbital Surgery, Hamamatsu Seirei General Hospital, Hamamatsu, Shizuoka-ken, JapanObjectives: Quantitative evaluation of palpebral dimensions of Japanese residents in Japan and Japanese descendant (Nikkeis) who live in Brazil, in order to define if environmental factors may influence these parameters.Methods: A prospective study evaluating 107 Nikkeis from Brazil and 114 Japanese residents in Japan, aged 20 years or older. Exclusion criteria were those with palpebral position alterations, prior palpebral surgery, and crossbreeding. Images were obtained with a digital camera, 30 cm from the frontal plane at pupil height, with the individual in a primary position and the eye trained on the camera lens. Images were transferred to computer and processed by the Scion Image program. Measurements were made of distance between medial canthi, distance between pupils (IPD), superior eyelid crease position, distance between the superior lid margin and corneal reflexes (MRD), horizontal width, height, area, and obliquity of the palpebral fissure. Data were analyzed using analysis of variance for a three factor model and respective multiple comparison tests.Results: Japanese residents and Nikkeis living in Brazil have similar measurements. Statistical differences were found for some age groups concerning distance between pupils, horizontal, and vertical fissures, palpebral fissure area, and obliquity with native Japanese presenting discretely higher measurements than Nikkeis.Conclusion: Environmental factors do not affect palpebral dimensions of Nikkeis living in Brazil.Keywords: eyelid dimensions, Japanese, Nikkeis, digital image Dove Press Rodrigo U Takahagi, Silvana A Schellini, Carlos R Padovani, Shinji Ideta, Nobutada Katori, Yasuhisa Nakamura 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3529 http://www.dovepress.com/oriental-oculopalpebral-dimensions-quantitative-comparison-between-ori-peer-reviewed-article-OPTH English

oai:dovepress.com/2362 2008-10-05 OPTH

Visual and refractive outcome of one-site phacotrabeculectomy compared with temporal approach phacoemulsification Vaideanu, Daniela Clinical Ophthalmology Daniela Vaideanu, Kaveri Mandal, Anthony Hildreth, Scott G Fraser, Peter S PhelanGlaucoma Unit, Sunderland Eye Infirmary, Sunderland, UKBackground: We aimed to compare visual and refractive outcome following phacoemulsification and intraocular lens implant (IOL) and combined one-site phacotrabeculectomy.Method: We performed a retrospective study of case records of patients who had temporal incision phacoemulsification with IOL or one-site phacotrabeculectomy, between June 1997 and June 2001. The patients were matched for age group, operating list and IOL type. All patients were operated on under local anesthesia by the same surgeon. Each arm of the study had 90 patients, age range 60 to 75 years. We collected pre- and postoperative visual acuity, pre- and postoperative refraction within six months after surgery, and intended refraction. The intraocular pressure control was not recorded, as it was not the aim of our study.Results: In the phacotrabeculectomy group, 76.6% of patients achieved aimed spherical equivalent, 15.5% of patients had against-the-rule (ATR) astigmatism induced by the surgery, and 90% of the patients had best corrected visual acuity (BCVA) more than 6/12. In the temporal incision phacoemulsification group, 81.1% of patients achieved aimed spherical equivalent, 10% of the patients had induced ATR by the surgery and 95.55% of patients achieved BCVA more than 6/12.Conclusion: In this study the visual outcome of the phacotrabeculectomy group did not differ significantly from the visual outcome of temporal approach phacoemulsification.Keywords: refractive outcome, phacoemulsifi cation, phacotrabeculectomy, astigmatism Dove Press Daniela Vaideanu, Kaveri Mandal, Anthony Hildreth, Scott G Fraser, Peter S Phelan 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3530 http://www.dovepress.com/visual-and-refractive-outcome-of-one-site-phacotrabeculectomy-compared-peer-reviewed-article-OPTH English

oai:dovepress.com/2363 2008-10-05 OPTH

Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Chen, Zhang Clinical Ophthalmology Chen Zhang, Yanchuang Liang, Shijing Deng, Zhiqun Wang, Ran Li, Xuguang SunDepartment of Ocular Microbiology, Beijing Institute of Ophthalmology, Beijing Tongren hospital, Capital University of Medical Science, BeijingObjective: To study on the distribution of bacterial keratitis isolates and the resistance to antibiotics in China from 2001 to 2004.Methods: 1985 specimens from the bacterial keratitis at the Beijing Tong Ren Eye Center were cultured and identified. In vitro susceptibility testing of positive isolates to antibiotics was determined by the Kirby-Bauer disk diffusion method and interpreted according to Clinical and Laboratory Standards Institute.Results: Out of 1985 specimens, 279 were culture positive. The percentage of positive culture was 14.06%. Gram-positive cocci and gram-negative bacilli represented 42.65% (119/270) and 35.13% (98/279) respectively. Pseudomonas sp. was the most common organism (20.07%), followed by Corynebacterium sp. (16.85%) and Staphylococcus epidermidis (13.98%). Resistance to ofloxacin, ciprofloxacin, levofloxacin, and tobramycin was 20.2%, 35.9%, 15.5%, and 29.4% respectively. Gram-negative bacilli showed higher resistance to ciprofloxacin. Staphycoccus sp. revealed significant resistance to ciprofloxacin. Streptococcus sp. showed high resistance to tobramycin. The resistance of isolates from older patients (≥60Y) to ciproloxacin, levofloxacin, and tobramycin was higher than that from adult patients (>14 to 59Y).Conclusion: Staphylococcus sp., Pseudomonas sp., and Corynebacterium sp. were the most common bacterial keratitis isolates in China. Attentions should be paid to the increase of the resistance to levofloxacin.Keywords: bacteria keratitis resistance Dove Press Chen Zhang, Yanchuang Liang, Shijing Deng, Zhiqun Wang, Ran Li, Xuguang Sun 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3531 http://www.dovepress.com/distribution-of-bacterial-keratitis-and-emerging-resistance-to-antibio-peer-reviewed-article-OPTH English

oai:dovepress.com/2364 2008-10-05 OPTH

Quantitative determination of glycosaminoglycans in tears of diabetic patients Moschos, Marilita Clinical Ophthalmology Marilita M Moschos1, Alexandros A Rouvas1, Spyridon Papadimitriou1, Athanasios Kotsolis1, Nikolaos Sitaras2, Michael Apostolopoulos11Department of Ophthalmology; 2Department of Pharmacology, University of Athens, GreecePurpose: To determine the amount of glycosaminoglycans (GAGs) in tears of patients with diabetic retinopathy (DR) and to compare it with normal subjects.Methods: 38 patients with DR and 24 normal volunteers were included. Thirty subjects suffered from background diabetic retinopathy (BDR) and 8 from proliferate diabetic retinopathy (PDR). For the GAGs assay, the uronic carbazole reaction was used.Results: The mean concentration of GAGs was significantly higher in patients with DR than in normal subjects. The GAGs concentration in patients with BDR or PDR was significantly higher than in normal subjects.Conclusion: The measurement of GAGs in tears of diabetic patients could be a tool in order to assess the stability or not of the disease.Keywords: glycosaminoglycans, tears, diabetic retinopathy Dove Press Marilita M Moschos, Alexandros A Rouvas, Spyridon Papadimitriou, Athanasios Kotsolis, Nikolaos Sitaras, Michael Apostolopoulos 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3537 http://www.dovepress.com/quantitative-determination-of-glycosaminoglycans-in-tears-of-diabetic--peer-reviewed-article-OPTH English

oai:dovepress.com/2365 2008-10-05 OPTH

Infantile nystagmus syndrome: Broadening the high-foveation-quality field with contact lenses Dell'Osso, LF Clinical Ophthalmology Giovanni Taibbi1,4,5, Zhong I Wang1,3, Louis F Dell’Osso1–31The Daroff-Dell’Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and CASE Medical School; 2Department of Neurology; 3Department of Biomedical Engineering, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA; 4Pediatric Ophthalmology and Strabismus Unit, San Paolo Hospital, Milan, Italy; 5University of Milan, Milan, ItalyAbstract: We investigated the effects of contact lenses in broadening and improving the high-foveation-quality field in a subject with infantile nystagmus syndrome (INS). A high-speed, digitized video system was used for the eye-movement recording. The subject was asked to fixate a far target at different horizontal gaze angles with contact lenses inserted. Data from the subject while fixating at far without refractive correction and at near (at a convergence angle of 60 PD), were used for comparison. The eXpanded Nystagmus Acuity Function (NAFX) was used to evaluate the foveation quality at each gaze angle. Contact lenses broadened the highfoveation-quality range of gaze angles in this subject. The broadening was comparable to that achieved during 60 PD of convergence although the NAFX values were lower. Contact lenses allowed the subject to see “more” (he had a wider range of high-foveation-quality gaze angles) and “better” (he had improved foveation at each gaze angle). Instead of being contraindicated by INS, contact lenses emerge as a potentially important therapeutic option. Contact lenses employ afferent feedback via the ophthalmic division of the V cranial nerve to damp INS slow phases over a broadened range of gaze angles. This supports the proprioceptive hypothesis of INS improvement.Keywords: contact lenses, infantile nystagmus, visual function Dove Press Giovanni Taibbi, Zhong I Wang, Louis F Dell’Osso 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3542 http://www.dovepress.com/infantile-nystagmus-syndrome-broadening-the-high-foveation-quality-fie-peer-reviewed-article-OPTH English

oai:dovepress.com/2366 2008-10-05 OPTH

Relationships between central corneal thickness and optic disc topography in eyes with glaucoma, suspicion of glaucoma, or ocular hypertension Gunvant, Pinakin Clinical Ophthalmology Pinakin Gunvant1, Lucia Porsia2, Russell J Watkins3, Henrietta Bayliss-Brown2, David C Broadway21Department of Research, Southern College of Optometry, Memphis, TN, USA; 2Department of Ophthalmology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK; 3Department of Pathology, Algernon Firth Buildings, Leeds General Infirmary, Leeds, UKPurpose: To identify relationships between central corneal thickness (CCT) and optic disc topography, as determined by scanning laser ophthalmoscopy (SLO), for patients seen in a specialist glaucoma service.Methods: 272 eyes of 144 patients with primary open angle glaucoma (POAG; n = 71), normal tension glaucoma (NTG; n = 50), ocular hypertension (OH; n = 48) and those considered to be suspicious for glaucoma (GS; n = 103) underwent ultrasonic pachymetry and optic disc topography by SLO. Correlations between CCT and SLO parameter values were identified. A Bonferroni correction for multiple comparisons was performed and a p value of 0.0042 was considered significant.Results: Mean CCT values were 533 μm (POAG), 530 μm (NTG), 550 μm (GS), and 565 μm (OH). As a group the GS and OH eyes had signifi cantly thicker CCT values than eyes with POAG. In addition, the NTG eyes had signifi cantly thinner CCT values than GS and OH eyes. Overall multiple SLO parameters correlated with CCT even after accounting for co-variance with age, refraction and inclusion of both eyes. Sub-group analysis indicated that ‘optic disc rim area’ positively correlated with CCT (r = 0.378) and ‘cup to disc area ratio’ negatively correlated with CCT (r = −0.370) in the POAG group. In the GS group the parameter ‘area below reference’ (a measure of cup volume) and ‘mean cup depth’ had negative correlations with CCT (r = −0.297 and −0.323) indicating that eyes with thinner than average corneal thickness measurements had larger and deeper cups.Conclusion: Thinner corneas appear to be associated with larger and deeper optic disc cups in the eyes of patients seen in a specialist glaucoma service.Keywords: central corneal thickness, optic disc topography, optic disc compliance, glaucoma Dove Press Pinakin Gunvant, Lucia Porsia, Russell J Watkins, Henrietta Bayliss-Brown, David C Broadway 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3545 http://www.dovepress.com/relationships-between-central-corneal-thickness-and-optic-disc-topogra-peer-reviewed-article-OPTH English

oai:dovepress.com/2367 2008-10-05 OPTH

The prevalence rates of refractive errors among children, adolescents, and adults in Germany Jobke, Sandra Clinical Ophthalmology Sandra Jobke1, Erich Kasten2, Christian Vorwerk31Institute of Medical Psychology, 3Department of Ophthalmology, Otto-von Guericke-University of Magdeburg, Magdeburg, Germany; 2Institute of Medical Psychology, University Hospital Schleswig-Holstein, Luebeck, GermanyPurpose: The prevalence rates of myopia vary between 5% in Australian Aborigines to 84% in Hong Kong and Taiwan, 30% in Norwegian adults, and 49.5% in Swedish schoolchildren. The aim of this study was to determine the prevalence of refractive errors in German children, adolescents, and adults.Methods: The parents (aged 24–65 years) and their children (516 subjects aged 2–35 years) were asked to fill out a questionnaire about their refractive error and spectacle use. Emmetropia was defined as refractive status between +0.25D and –0.25D. Myopia was characterized as ≤−0.5D and hyperopia as ≥+0.5D. All information concerning refractive error were controlled by asking their opticians.Results: The prevalence rates of myopia differed significantly between all investigated age groups: it was 0% in children aged 2–6 years, 5.5% in children aged 7–11 years, 21.0% in adolescents (aged 12–17 years) and 41.3% in adults aged 18–35 years (Pearson’s Chi-square, p = 0.000). Furthermore, 9.8% of children aged 2–6 years were hyperopic, 6.4% of children aged 7–11 years, 3.7% of adolescents, and 2.9% of adults (p = 0.380). The prevalence of myopia in females (23.6%) was significantly higher than in males (14.6%, p = 0.018). The difference between the self-reported and the refractive error reported by their opticians was very small and was not significant (p = 0.850).Conclusion: In Germany, the prevalence of myopia seems to be somewhat lower than in Asia and Europe. There are few comparable studies concerning the prevalence rates of hyperopia.Keywords: Germany, hyperopia, incidence, myopia, prevalence Dove Press Sandra Jobke, Erich Kasten, Christian Vorwerk 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3546 http://www.dovepress.com/the-prevalence-rates-of-refractive-errors-among-children-adolescents-a-peer-reviewed-article-OPTH English

oai:dovepress.com/2368 2008-10-05 OPTH

Analysis of sFas IL-6 levels in thyroid-associated ophthalmopathy: Pre- or poststeroid pulse treatment Maeda, Kimihito Clinical Ophthalmology Kimihito Maeda, Yuichiro Ohara, Masato Hashimoto, Hiroshi OhguroDepartment of Ophthalmology, Sapporo Medical University, School of Medicine, Sapporo, JapanPurpose: To investigate whether serum levels of soluble Fas (sFas) and interleukin-6 (IL-6) could function as an index of the efficacy of steroid pulse treatment, we examined the serum level of these proteins before and after steroid pulse treatment in thyroid-associated ophthalmopathy patients.Methods: We gathered the blood of thyroid-associated ophthalmopathy patients before or after steroid pulse treatment, obtained serum with a centrifuge, and measured the serum levels of sFas and IL-6 by enzyme-linked immunosorbent assay (ELISA).Results: There was no difference in serum IL-6 value between pre- and poststeroid pulse treatment. Serum sFas value was significantly decreased in both pre- and poststeroid pulse treatment. Furthermore, there was a recognizable improvement in the degree of the extraocular muscle thickening after treatment in cases in whom the serum sFas value was lower than 3 ng/ml prior to the beginning of the therapy. In patients who had a serum sFas value of more than 3 ng/ml, there was no improvement in the degree of thickening of the extraocular muscle.Conclusions: Serum level of sFas is an accurate index of the outcome of steroid pulse treatment in thyroid-associated ophthalmopathy and may become a useful index to gauge the status of convalescence.Keywords: sFas, IL-6, ELISA, thyroid associated ophthalmopathy, steroid pulse treatment Dove Press Kimihito Maeda, Yuichiro Ohara, Masato Hashimoto, Hiroshi Ohguro 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3548 http://www.dovepress.com/analysis-of-sfas-il-6-levels-in-thyroid-associated-ophthalmopathy-pre--peer-reviewed-article-OPTH English

oai:dovepress.com/2370 2008-10-05 OPTH

A patient preference comparison of Azarga™ (brinzolamide/timolol fixed combination) vs Cosopt® (dorzolamide/timolol fixed combination) in patients with open-angle glaucoma or ocular hypertension Notivol, Ricardo Clinical Ophthalmology Thomas K Mundorf1, Steven H Rauchman2, Robert D Williams3, Ricardo Notivol4, Brinzolamide/Timolol Preference Study Group51Mundorf Eye Center, Charlotte, NC, USA; 2North Valley Eye Medical Group, Mission Hills, CA, USA; 3Taustine Eye Center, Louisville, KY, USA; 4Alcon, Barcelona, Spain; 5Ophthalmology Clinics, USAPurpose: To determine patient preference of and ocular discomfort with fixed combination brinzolamide/timolol compared with fixed combination dorzolamide/timolol.Methods: In a prospective, double-masked, randomized, active-controlled, crossover, multicenter study, patients received 1 drop of brinzolamide/timolol and dorzolamide/timolol in both eyes on consecutive days in random order. Ocular discomfort was rated 1 minute after instillation of each medication, and preference was noted on Day 2. Adverse events, if any, were solicited at each visit.Results: 127 subjects with ocular hypertension or open-angle glaucoma were included in the intent-to-treat analysis. Of the 106 subjects who expressed a drug preference, 79.2% preferred brinzolamide/timolol (p < 0.0001). Ocular discomfort scores were significantly higher with dorzolamide/timolol than brinzolamide/timolol (2.9 vs 1.4, respectively; p < 0.0001). Significantly more patients reported ocular pain and discomfort after dorzolamide/timolol instillation and transient blurred vision after brinzolamide/timolol instillation.Conclusions: Patients with ocular hypertension or open-angle glaucoma preferred the brinzolamide/timolol fixed combination over the dorzolamide/timolol fixed combination. This is likely due to the greater ocular discomfort associated with dorzolamide/timolol. The differences in preference, discomfort, and adverse events are likely attributable to formulation differences given the similarities of the active ingredients. Stronger patient preference for brinzolamide/timolol may lead to better therapeutic compliance.Keywords: brinzolamide/timolol, dorzolamide/timolol, patient preference, ocular discomfort, open-angle glaucoma or ocular hypertension Dove Press Thomas K Mundorf, Steven H Rauchman, Robert D Williams, Ricardo Notivol, Brinzolamide/Timolol Preference Study Group 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=3556 http://www.dovepress.com/a-patient-preference-comparison-of-azargatrade-brinzolamidetimolol-fix-peer-reviewed-article-OPTH English

oai:dovepress.com/2380 2008-10-06 OPTH

One month use of Systane® improves ocular surface parameters in subjects with moderate symptoms of ocular dryness Versura, Piera Clinical Ophthalmology Piera Versura, Vincenzo Profazio, Emilio C CamposDepartment of Surgery and Anesthesiology, Section of Ophthalmology, Alma Mater Studiorum University at Bologna, Bologna, ItalyThe data in this paper were first presented at the 9th International Ocular Inflammation Society (IOIS) Annual Meeting, September 17–20, 2007, Paris, France, and the European Association for Vision and Eye Research (EVER) Congress, October 3–6, 2007, Portoroz, SloveniaObjective: To evaluate the efficacy of Systane® Lubricating Eye Drops in improving the symptoms of moderate ocular dryness.Methods: Fifty subjects with moderate symptoms of ocular dryness were enrolled in this open label study. The mean age of subjects was 57.6 ± 15.4 years. To be eligible, subjects’ tear film break-up time (TFBUT) had to be <10 seconds, and subjects had to have at least one ocular discomfort symptom in addition to dryness. Saline was used for a wash-out period of 3–5 days. Subjects were re-examined, and those continuing to meet the inclusion criteria were dispensed Systane® and re-examined again after 28 days. At each visit, slitlamp examination was conducted, and ocular discomfort symptoms and TFBUT were evaluated. Subjects rated their overall satisfaction at baseline and on the last visit.Results: No significant changes in TFBUT or ocular discomfort symptoms were observed after saline use, compared with screening visit. After 28 days of Systane® use there was statistically significant improvement of TFBUT (p = 0.0001) compared with baseline. Subjects experienced significant symptomatic relief for all 6 ocular discomfort symptoms at the endpoint visit.Conclusion: Systane® effectively relieved the symptoms associated with moderate ocular dryness, with measurable improvement in objective TFBUT, subjective symptoms, and overall satisfaction.Keywords: Systane, lubricant eye drops, TFBUT, ocular dryness, ocular symptoms Dove Press Piera Versura, Vincenzo Profazio, Emilio C Campos 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3553 http://www.dovepress.com/one-month-use-of-systanesupregsup-improves-ocular-surface-parameters-i-peer-reviewed-article-OPTH English

oai:dovepress.com/2383 2008-10-06 OPTH

Optic nerve sheath fenestration in cryptococcal meningitis Turbin, Roger Clinical Ophthalmology Tatyana Milman1, Neena Mirani1,2, Roger E Turbin11Ophthalmology Department, Institute of Ophthalmology and Visual Science, 2Pathology Department, University Hospital, New Jersey Medical School, Newark, NJ, USAAbstract: A patient with acquired immunodeficiency syndrome (AIDS) developed crytpococcal meningitis, complicated by papilledema and severe progressive visual loss despite medical therapy. Bilateral optic sheath fenestration resulted in significant improvement in vision and resolution of papilledema. Histopathologic evaluation of the optic nerve sheath demonstrated numerous cryptococci. Optic nerve sheath fenestration may be an effective treatment method when high intracranial pressure is contributing to visual loss, even in the presence of involvement of the optic nerve sheath by the fungus.Keywords: optic nerve sheath, cryptococcal, meningitis, fenestration Dove Press Tatyana Milman, Neena Mirani, Roger E Turbin 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3532 http://www.dovepress.com/optic-nerve-sheath-fenestration-in-cryptococcal-meningitis-peer-reviewed-article-OPTH English

oai:dovepress.com/2384 2008-10-06 OPTH

Pigmented basal cell carcinoma of the eyelid in Hispanics Chang, Eli Clinical Ophthalmology Lily Koo Lin1, Han Lee2, Eli Chang11Department of Oculoplastics, Doheny Eye Institute, Los Angeles, CA, USA; 2Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USABackground: Pigmented basal cell carcinoma (PBCC) of the eyelid has not been well cited in the literature, and is often overlooked in the differential diagnosis of pigmented eyelid lesions. We aim to describe PBCC of the eyelid in Hispanic patients.Methods: Retrospective review of patients with eyelid skin cancer who presented to the Department of Dermatology at the Keck School of Medicine of the University of Southern California and the Doheny Eye Institute from January 2002 to November 2005.Results: Sixty-nine of the 79 patients with eyelid skin cancer had basal cell carcinoma. Eight of these patients were Hispanic. Four of the eight Hispanic patients had PBCC.Conclusions: Although eyelid PBCC is regarded as a rare condition, it may occur more commonly in the Hispanic population and should be remembered in the differential diagnosis of pigmented eyelid lesions.Keywords: pigmented basal cell carcinoma, eyelid, skin cancer, lesions Dove Press Lily Koo Lin, Han Lee, Eli Chang 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3533 http://www.dovepress.com/pigmented-basal-cell-carcinoma-of-the-eyelid-in-hispanics-peer-reviewed-article-OPTH English

oai:dovepress.com/2385 2008-10-06 OPTH

Transient band keratopathy associated with ocular inflammation and systemic hypercalcemia Dunn, james Clinical Ophthalmology Anat Galor, Henry A Leder, Jennifer E Thorne, James P DunnThe Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of MedicinePurpose: To report a case of visually significant band keratopathy associated with ocular inflammation and systemic hypercalcemia which markedly decreased in severity after treatment of these underlying factors.Methods: Retrospective case report.Results: A 53-year-old Asian female with granulomatous panuveitis in the left eye presented with diffuse band keratopathy through the central cornea. The serum calcium was elevated. The patient was treated with topical prednisolone acetate 1% and oral prednisone with marked improvement in inflammation. The band keratopathy lessened in severity with clearing of the central cornea and improvement in visual acuity.Conclusions: Early medical treatment of underlying factors may allow reversal of band keratopathy.Keywords: ocular inflammation, transient band keratopathy Dove Press Anat Galor, Henry A Leder, Jennifer E Thorne, James P Dunn 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3534 http://www.dovepress.com/transient-band-keratopathy-associated-with-ocular-inflammation-and-sys-peer-reviewed-article-OPTH English

oai:dovepress.com/2388 2008-10-06 OPTH

Bilateral horizontal Vogt’s striae in keratoconus Gungor, Inci Clinical Ophthalmology Inci Ulu Güngör, Ümit Beden, Baris SönmezOndokuz Mayis University, School of Medicine, Department of Ophthalmology, Samsun, TurkeyPurpose: To report a keratoconus case with bilateral horizontal Vogt’s striae.Method: The clinical findings of the patient and the development of the direction of striae are discussed.Results: Vogt’s striae, defined as vertical stress lines, are rarely horizontal. One patient with unilateral horizontal stress lines on his left eye has been reported in the literature. Our patient has horizontal Vogt’s striae in both eyes.Conclusion: Horizontal Vogt’s striae may be seen in keratoconus as a rare slit-lamp biomicroscopic finding.Keywords: keratoconus, Vogt’s striae, horizontal stress lines Dove Press Inci Ulu Güngör, Ümit Beden, Baris Sönmez 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3536 http://www.dovepress.com/bilateral-horizontal-vogtrsquos-striae-in-keratoconus-peer-reviewed-article-OPTH English

oai:dovepress.com/2389 2008-10-06 OPTH

Posterior capsule opacification and neovascularization treated with intravitreal bevacizumab and Nd:YAG capsulotomy Velez-Montoya, Raul Clinical Ophthalmology Grimelda Yuriana Sánchez-Castro1, Alejandra Hitos-Fájer1, Erick Mendoza-Schuster1, Raul Velez-Montoya2, Cecilio Francisco Velasco-Barona11Asociación para Evitar la Ceguera en México. Hospital “Dr. Luis Sánchez Bulnes”, México, D.F. Ophthalmology Department – Anterior Segment; 2Asociación para Evitar la Ceguera en México. Hospital “Dr. Luis Sánchez Bulnes”, México, D.F. Ophthalmology Department – Retina departmentAbstract: We reported a 75-year-old diabetic man, who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient was treated with two injections of 2.5 mg of intravitreal bevacizumab. The treatment produced an important regression of the posterior capsular new vessels, allowing us to perform a successful Nd:YAG capsulotomy, clearing the visual axis and improving the visualization of the posterior pole. Even though, best corrected visual acuity was 20/200 due to diabetic macular edema.Keywords: posterior capsule opacification, posterior capsule neovascularization, cataract surgery, postoperative complications, intravitreal bevacizumab Dove Press Grimelda Yuriana Sánchez-Castro, Alejandra Hitos-Fájer, Erick Mendoza-Schuster, Raul Velez-Montoya, Cecilio Francisco Velasco-Barona 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3538 http://www.dovepress.com/posterior-capsule-opacification-and-neovascularization-treated-with-in-peer-reviewed-article-OPTH English

oai:dovepress.com/2408 2008-10-08 OPTH

Optic nerve sheath meningocele Mesa-Gutierrez, Juan Clinical Ophthalmology Juan Carlos Mesa-Gutiérrez, Silvia Muñoz Quiñones, Jorge Arruga GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainAbstract: A 53-year-old man presented with a 5-month history of visual loss in his left eye. Visual acuity could be corrected to 20/20 with an increased hyperopic correction. Dilated funduscopy showed faint choroidal folds and elevation of the left optic disc. The coronal view of T2-weighted magnetic resonance imaging demonstrated a fluid-filled dilated sheath surrounding normal optic nerves. General physical examination and cerebrospinal fluid analysis were normal. The subject was diagnosed as having dural ectasia of the optic nerve sheath and followed a course of acetazolamide 250 mg twice daily for three months, and displayed good anatomical and functional results during a 2-year follow-up period. Despite the fact that several authors have recommended an optic nerve decompression, most of the patients follow a benign clinical course. The role of corticosteroids is not described in the literature. Raised levels of proteins in the cerebrospinal fluid in the perioptic subarachnoidal space could be a determining factor. On the basis of an osmotic gradient between the cerebral subarachnoid space and perioptic subarachnoid space, carbonic anhydrase inhibitors could be beneficial. In contrast to other reports, we believe that surgical intervention could be reserved for patients with rapid or progressive optic nerve dysfunction.Keywords: optic nerve, perineural subaracnoid space, optic nerve meningocoele, optic nerve tumors Dove Press Juan Carlos Mesa-Gutiérrez, Silvia Muñoz Quiñones, Jorge Arruga Ginebreda 2008-10-08 PDF http://www.dovepress.com/getfile.php?fileID=3539 http://www.dovepress.com/optic-nerve-sheath-meningocele-peer-reviewed-article-OPTH English

oai:dovepress.com/2409 2008-10-08 OPTH

Impending central retinal vein occlusion associated with cilioretinal artery obstruction Bottos, Juliana Clinical Ophthalmology Juliana Mantovani Bottós, Fabio Bom Aggio, Eduardo Dib, Michel Eid FarahVision Institute, Department of Ophthalmology, Federal University of São Paulo, BrazilAbstract: We report a case of a patient with an impending central retinal vein occlusion (CRVO) with cilioretinal artery obstruction, which may help to understand the nature of the retinal hemodynamic changes associated with CRVO which shows direct evidence of arterial vasospasm, suggesting an increased contractility of retinal arteries. The clinical course, with initial retinal whitening along a cilioretinal artery followed by signs of venous stasis, seems to confirm the pathogenesis hypothesis concerning a primary arterial affection due to arterial vasospasm.Keywords: retinal vein occlusion, cilioretinal artery obstruction, arterial spasm, fluorescein angiography Dove Press Juliana Mantovani Bottós, Fabio Bom Aggio, Eduardo Dib, Michel Eid Farah 2008-10-08 PDF http://www.dovepress.com/getfile.php?fileID=3540 http://www.dovepress.com/impending-central-retinal-vein-occlusion-associated-with-cilioretinal--peer-reviewed-article-OPTH English

oai:dovepress.com/2422 2008-10-09 OPTH

The characteristics of keratomycosis by Beauveria bassiana and its successful treatment with antimycotic agents Araki-Sasaki, Kaoru Clinical Ophthalmology Hiroko Sonoyama1, Kaoru Araki-Sasaki1, Shigeyasu Kazama1, Tsutomu Kawasaki1, Hidenao Ideta1, Atsuko Sunada2, Seishi Asari2, Yoshitsugu Inoue3, Kozaburo Hayashi41Ideta Eye Hospital, Kumamoto, Kumamoto, Japan; 2Department of Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan; 3Division of Ophthalmology and Visual Science, Department of Medicine of Sensory and Motor Organ, Tottori University, Yonago, Tottori, Japan; 4Immunology and Virology Section Lab, Immunology, NEI, NIH, Bethesda, MD, USAAbstract: Clinical findings and treatment of keratomycosis caused by Beauveria bassiana, an entomopathogenic filamentous fungus, are described for an 80-year-old woman, who was referred to the hospital for ocular pain and redness on the 9th day after an ocular injury caused by the frame of her glasses. She had a long history of recurrent diabetic iritis and continuously used topical antibiotics and corticosteroids. At her first visit, a slit-lamp examination indicated a corneal ulcer confined within the superficial stromal layer, along with a slight infiltration and edema. Only a very few inflammatory cells were seen in the anterior chamber. Direct microscopic examination of corneal scrapings revealed septate fungal hyphae with zig-zag rachis and budding that was subsequently identified as B. bassiana by slide culture. Topical voriconazole with miconazole, pimaricin and oral itraconazole were effective and the lesion disappeared leaving only a mild scar at 2 months. The sensitivity of B. bassiana to various antimycotic agents was confirmed by broth microdilution, agar dilution with the Clinical Laboratory Standard Institute standard, and a disk method using topically applied concentrations. B. bassiana, which exhibits a characteristic appearance in smears and causes superficial keratomycosis, is sensitive to voriconazole with miconazole, pimaricin, and itraconazole.Keywords: Beauveria bassiana, keratomycosis, filamentous fungus, voriconazole, corneal infection Dove Press Hiroko Sonoyama, Kaoru Araki-Sasaki, Shigeyasu Kazama, Tsutomu Kawasaki, Hidenao Ideta, et al 2008-10-09 PDF http://www.dovepress.com/getfile.php?fileID=3543 http://www.dovepress.com/the-characteristics-of-keratomycosis-by-embeauveria-bassianaem-and-its-peer-reviewed-article-OPTH English

oai:dovepress.com/2423 2008-10-09 OPTH

Sudden unilateral visual loss after autologous fat injection into the nasolabial fold Kyoung-Seek, Clinical Ophthalmology Sang Hyouk Park, Hae Jung Sun, Kyung Seek ChoiDepartment of ophthalmology, Soonchunhyang University College of Medicine, Seoul, KoreaAbstract: A 27-year-old female presented with sudden visual loss of her right eye after receiving an autologous fat injection into the right nasolabial fold. Fundus examination of the right eye showed multiple whitish patchy lesions with macular edema. Fluorescein angiogram showed deterioration of choroidal circulation with patchy choroidal filling and arm-to-retina circulation time and retinal arteriovenous passage time were delayed to 30 seconds and 20 seconds, respectively. There was no response in flash visual evoked potential (VEP). High dose steroid therapy (methylprednisolone 1 g/day/i.v.) was done and about 2 weeks later, the disc edema subsided and retinal arteriovenous passage time of fluorescein angiogram was normalized but there was no improvement in visual acuity. Absence of a cherry red spot, deterioration of choroidal circulation with patchy choroidal fillings seen in fluorescein angiogram, and no response in flash VEP suggests multiple choroidal infarction due to perfusion defect of the short posterior ciliary artery. The autologous fat injected is thought to have entered the dorsal nasal artery and the retrograde migration of the emboli to the ophthalmic artery might have caused the multiple occlusions of the short posterior ciliary artery.Keywords: autologous fat injection, ciliary artery occlusion, ischemic optic neuropathy Dove Press Sang Hyouk Park, Hae Jung Sun, Kyung Seek Choi 2008-10-09 PDF http://www.dovepress.com/getfile.php?fileID=3544 http://www.dovepress.com/sudden-unilateral-visual-loss-after-autologous-fat-injection-into-the--peer-reviewed-article-OPTH English

oai:dovepress.com/2424 2008-10-09 OPTH

Primary localized conjunctival amyloidosis: A case report with a ten-year follow-up period Mesa-Gutierrez, Juan Clinical Ophthalmology Juan Carlos Mesa-Gutiérrez, Tomás Martí Huguet, Noemí Barnils Garcia, Jorge Arruga GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainAbstract: A 57-year-old woman consulted our department about a plaque that had been present in her left eye for one year. Ophthalmological examination revealed a solid mass in the left conjunctival semilunar fold. An excitional biopsy was peformed, revealing an amyloid deposition. The patient was referred to the Internal Medicine Department for systemic study. All studies were negative for systemic amyloidosis. Throughout ten years of follow-up study, the patient has shown neither conjunctival recurrence nor any evidence of systemic amylodosis. Despite the fact that several authors have described ocular amyloidosis as an ophthalmologic manifestation of systemic amyloidosis, conjunctival location of amyloidosis is a very rare condition. Amyloid characterization in ocular structures should not be considered a final diagnosis since involvement of systemic underlying diseases must be ruled out. We report a case of localized conjunctival amyloidosis with a ten-year follow-up period that excluded ocular or systemic diseases.Keywords: conjuctival amyloidosis, ocular amyloidosis, hyaline protein Dove Press Juan Carlos Mesa-Gutiérrez, Tomás Martí Huguet, Noemí Barnils Garcia, Jorge Arruga Ginebreda 2008-10-09 PDF http://www.dovepress.com/getfile.php?fileID=3547 http://www.dovepress.com/primary-localized-conjunctival-amyloidosis-a-case-report-with-a-ten-ye-peer-reviewed-article-OPTH English

oai:dovepress.com/2421 2008-10-09 OPTH

Posterior placoid chorioretinitis: An unusual ocular manifestation of syphilis Chen, Jennifer Clinical Ophthalmology Jennifer Chen1,3, Lawrence Lee1,21City Eye Centre, Brisbane, Australia; 2Department of Ophthalmology, University of Queensland, Royal Brisbane Hospital, Brisbane, Australia; 3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, AustraliaAbstract: There appears to be a re-emergence of syphilis in recent times despite a steady decline in incidence for the past decade. Diagnosis of syphilis can be clinically challenging and ocular manifestations of syphilis have a myriad of presentations and severity. Ocular syphilis can occur at any stage of the disease and may also be the only presenting sign of syphilis. We report a case of acute unilateral maculopathy, due to posterior placoid chorioretinitis associated with syphilis, in an immuno-competent patient. Ophthalmoscopy revealed a unilateral yellowish placoid lesion at the macula. Syphilis serology was positive confi rming active infection. There were no other systemic signs of syphilis. The patient was treated with intravenous benzylpenicillin 1.2 g every four hours for two weeks. The lesion resolved with treatment and the retinal appearance returned to normal. This case highlights the importance of raising clinical suspicion of syphilis in view of unexplained decreased vision and ocular inflammation.Keywords: syphilis, treponema, chorioretinitis, posterior uveitis, syphilitic posterior placoid chorioretinitis Dove Press Jennifer Chen, Lawrence Lee 2008-10-09 PDF http://www.dovepress.com/getfile.php?fileID=3541 http://www.dovepress.com/posterior-placoid-chorioretinitis-an-unusual-ocular-manifestation-of-s-peer-reviewed-article-OPTH English

oai:dovepress.com/2386 2008-10-06 OPTH

Conjunctival-corneal melt in association with carotid artery stenosis Stewart, Rosalind Clinical Ophthalmology Rosalind MK Stewart1, Say Aun Quah1, Dan Q Nguyen2, Stephen B Kaye11Royal Liverpool University Hospital, Liverpool, UK; 2Bristol Eye Hospital, Bristol, UKPurpose: To report a case of severe conjunctival-corneal melt in association with carotid artery stenosis.Methods: Observational case report.Results: A 76-year-old man with a history of bilateral severe carotid artery occlusion and nonarteritic ischemic optic neuropathy developed a spontaneous bulbar conjunctival defect. Despite intensive lubrication, and attempts at surgical closure including an amniotic membrane patch graft, it progressed with subsequent adjacent corneal perforation. Thorough investigations revealed no underlying disease, except markedly delayed episcleral vessel filling on anterior segment fluorescein angiography.Conclusions: Neovascularisation is a known factor in the inhibition of ulceration. In light of the findings in this report, ocular ischemia should be considered as a cause or contributing factor in the differential diagnosis of conjunctival-corneal melt.Keywords: conjunctival melt, corneal melt, ocular ischemia, carotid artery stenosis Dove Press Rosalind MK Stewart, Say Aun Quah, Dan Q Nguyen, Stephen B Kaye 2008-10-06 PDF http://www.dovepress.com/getfile.php?fileID=3535 http://www.dovepress.com/conjunctival-corneal-melt-in-association-with-carotid-artery-stenosis-peer-reviewed-article-OPTH English

oai:dovepress.com/2625 2008-11-25 OPTH

ReGAE 5: Can we improve the surgical journey for African-Caribbean patients undergoing glaucoma filtration surgery? Some preliminary findings Cross, Vinette Clinical Ophthalmology Vinette Cross, Peter Shah, Martin Glynn, Shivani ChidrawarCentre for Health and Social Care Improvement, University of Wolverhampton, Wolverhampton, United KingdomAim: To explore the experiences of African-Caribbean patients who had undergone filtration surgery for advanced glaucoma.Methods: Semi-structured qualitative interviews were used to collect the data and an interview guide was developed. Participants recounted when they first became aware of a problem with their eyes and their feelings at the time. Subsequently they were probed about their subjective experiences of becoming a glaucoma patient, receiving treatment, the decision to undergo surgery, and its aftermath. The perceptions of three participants from three different generations of African-Caribbean men were selected from the larger study for presentation in this paper. Interview transcripts were subjected to narrative analysis.Results: The concept of patient-partnership was re-framed in terms of mentorship. Surgeon–patient relationships are central to developing effective coping strategies. Support to face the ordeals ahead, challenge to take on new responsibilities, and help to envision a meaningful life with glaucoma are fundamental to fostering trust and maintaining motivation to continue.Conclusions: The use of patient narratives provides a valuable a resource for enhancing communication skills and patient-centered care in the hospital eye service.Keywords: glaucoma, secondary eye-care, African-Caribbean, filtration surgery, trabeculectomy Dove Press Vinette Cross, Peter Shah, Martin Glynn, Shivani Chidrawar 2008-11-25 PDF http://www.dovepress.com/getfile.php?fileID=3913 http://www.dovepress.com/regae-5-can-we-improve-the-surgical-journey-for-african-caribbean-pati-peer-reviewed-article-OPTH English

oai:dovepress.com/2626 2008-11-25 OPTH

Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide Kahook, Malik Clinical Ophthalmology Malik Y Kahook1, Larissa Camejo2, Robert J Noecker21Department of Ophthalmology, The Rocky Mountain Lions Eye Institute, University of Colorado Health Sciences Center, Aurora, CO, USA; 2UPMC Eye Center, Eye and Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USAAbstract: Use of topical steroids is an important component of postoperative care after filtration surgery. Efficacy of postoperative medications is affected by patient adherence and physical limitations in the elderly population often prohibit proper dosing of ophthalmic drops. We describe a technique for the use of intraoperative retrobulbar triamcinolone acetonide in trabeculectomy surgery and report on postoperative outcomes. This technique appears safe and may be an attractive method of delivering a steroid depot at the time of trabeculectomy.Keywords: glaucoma, trabeculectomy, steroids Dove Press Malik Y Kahook, Larissa Camejo, Robert J Noecker 2008-11-25 PDF http://www.dovepress.com/getfile.php?fileID=3912 http://www.dovepress.com/trabeculectomy-with-intraoperative-retrobulbar-triamcinolone-acetonide-peer-reviewed-article-OPTH English

oai:dovepress.com/2639 2008-11-27 OPTH

Treatment of patients with keratoconjunctivitis sicca with Optive™: results of a multicenter, open-label observational study in Germany Buchholz, Patricia Clinical Ophthalmology Thomas Kaercher1, Patricia Buchholz2, Friedemann Kimmich31Augenarztpraxis, Heidelberg, Germany; 2Allergan Europe, Ettlingen, Germany; 3Eyecons, Pfinztal, GermanyObjective: To evaluate the efficacy and tolerability of OptiveTM, a new dry eye product containing sodium carboxymethylcellulose (0.5%) and glycerol (0.9%), in patients with keratoconjunctivitis sicca (KCS).Methods: This was a non-interventional and observational study including patients with dry eye who required a change of medication or were naïve to dry eye treatment (N = 5,277). Disease severity, tear break-up time (TBUT), tolerability, and change in clinical symptoms were recorded at baseline and at final visit (2 to 4 weeks after first treatment).Results: The severity of KCS was mild in 18.6%, moderate in 59.9%, and severe in 21.5% of patients based on physicians’ assessment. TBUT was measured in 4,338 patients before switching to or initiating therapy with Optive and at final visit. Baseline measurement of mean TBUT was 7.7 ± 3.9 seconds. This value increased to 10.0 ± 4.7 seconds at final visit. Most patients (85.4%) reported improvement in local comfort. The majority (75.1%) of patients felt an improvement in symptoms after changing their treatment. Two percent of patients reported adverse events, and 0.4% were treatment-related.Conclusions: Optive was well tolerated and improved the symptoms of dry eye after 2 to 4 weeks.Keywords: keratoconjunctivitis sicca, dry eye, sodium carboxymethylcellulose, glycerol, OptiveTM Dove Press Thomas Kaercher, Patricia Buchholz, Friedemann Kimmich 2008-11-27 PDF http://www.dovepress.com/getfile.php?fileID=3927 http://www.dovepress.com/treatment-of-patients-with-keratoconjunctivitis-sicca-with-optivetrade-peer-reviewed-article-OPTH English

oai:dovepress.com/2529 2008-11-02 OPTH

Intravitreal triamcinolone for intraocular inflammation and associated macular edema Steven Couch, Steven Clinical Ophthalmology Steven M Couch, Sophie J BakriMayo Clinic Department of Ophthalmology, Mayo Clinic, Rochester, MN, USAAbstract: Triamcinolone acetonide (TA) is a corticosteroid that has many uses in the treatment of ocular diseases because of its potent anti-inflammatory and anti-permeability actions. Intraocular inflammation broadly referred to as uveitis can result from several causes, including the immune system and after ophthalmic surgery. One of the most common reasons for vision loss with uveitis is macular edema. TA has been used for many years as an intravitreal injection for the treatment of ocular diseases. Several case control studies have been reported showing the efficacy of TA in the treatment of intraocular inflammation and associated macular edema caused by Behcet’s disease, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia and white dot syndromes. It has also been shown efficacious in cases of pars planitis and idiopathic posterior uveitis. Some authors have reported its use in postoperative cystoid macular edema. Many of the studies on the use of TA in controlling intraocular inflammation and concomitant macular edema showed its effect to be transient in many patients requiring reinjection. Complications can arise from intravitreal injection of TA including elevated intraocular pressure and cataract. Rarely, it can be associated with infectious and non-infectious endophthalmitis. TA may be useful as an adjuvant in the treatment of uveitis and its associated macular edema, especially in patients resistant or intolerant to standard treatment.Keywords: triamcinolone acetonide, Behcet’s disease, sympathetic ophthalmia, Vogt-Koyanagi-Harada syndrome, white dot syndromes, uveitis, cataract surgery, macular edema, endophthalmitis Dove Press Steven M Couch, Sophie J Bakri 2008-11-02 PDF http://www.dovepress.com/getfile.php?fileID=3944 http://www.dovepress.com/intravitreal-triamcinolone-for-intraocular-inflammation-and-associated-peer-reviewed-article-OPTH English

oai:dovepress.com/2657 2008-12-02 OPTH

Photodynamic therapy of choroidal neovascularization with enlargement of the spot size to include the feeding complex Georgalas, Ilias Clinical Ophthalmology Ilias Georgalas, Alexandros A Rouvas, Dimitrios A Karagiannis, Athanasios I Kotsolis, Ioannis D LadasDepartment of Ophthalmology, Medical School of Athens University, Athens, GreeceAbstract: This is a case report of a 83-year-old man with choroidal neovascularization (CNV), due to age-related macular degeneration (AMD) in his right eye. Digital fluorescein (FA) and indocyanine green angiography (ICG) were performed, which disclosed predominantly classic subfoveal CNV and a dilated and tortuous feeding complex. The visual acuity was 20/800. Anti-vascular endothelial growth factor (anti-VEGF) treatment was suggested, however, the patient was not keen to receive an intraocular injection. Modified photodynamic therapy (PDT) with spot size enlarged, to include not only the CNV lesion but the feeding complex as well, was performed. Ten days after one session of PDT, ICG showed absence of leakage from the CNV and complete occlusion of the feeding complex. The visual acuity gradually improved to 20/100 and remained stable during the following 23 months. No evidence of CNV leakage was seen in the FA and ICG during the follow up period. Adjustment of the PDT spot size to include the detectable by ICG feeding complex might be an additional option in order to close the subfoveal CNV and might be considered as an alternative to intravitreal injection of anti-VEGF in selected cases where anti-VEGF treatment is not available.Keywords: age-related macular degeneration, choroidal neovascularization, photodynamic treatment, feeder vessel Dove Press Ilias Georgalas, Alexandros A Rouvas, Dimitrios A Karagiannis, Athanasios I Kotsolis, Ioannis D Ladas 2008-12-02 PDF http://www.dovepress.com/getfile.php?fileID=3966 http://www.dovepress.com/photodynamic-therapy-of-choroidal-neovascularization-with-enlargement--peer-reviewed-article-OPTH English

oai:dovepress.com/2236 2008-09-17 OPTH

Comparing techniques for pterygium surgery Ugurbas, Suat Clinical Ophthalmology Atilla Alpay, Suat Hayri Ugurbas, Berktug ErdoganDepartment of Ophthalmology, Faculty of Medicine, Zonguldak, Karaelmas University, Zonguldak, TurkeyPurpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique.Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia; mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia; 18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction; and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years.Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were  observed. There were no major complications threatening visual ability in the surgical patients.Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.Keywords: pterygium, comparing, techniques, mitomycin C Dove Press Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan 2008-09-17 PDF http://www.dovepress.com/getfile.php?fileID=3973 http://www.dovepress.com/comparing-techniques-for-pterygium-surgery-peer-reviewed-article-OPTH English

oai:dovepress.com/2403 2008-10-07 OPTH

The role of inflammation and antiinflammation therapies in keratoconjunctivitis sicca Cavanagh, H. Clinical Ophthalmology Koray Gumus1, Dwight H Cavanagh21Department of Ophthalmology, Erciyes University School of Medicine, Kayseri, Turkey; 2Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, Texas, USAPurpose: To review and integrate recent advances in identifying the role of inflammation in the pathogenesis of dry eye conditions and the biological rationale and practical clinical aspects of newer, antiinflammatory theories.Methods: A comprehensive literature survey. Results and conclusion: Keratoconjunctivitis Sicca (KCS) is a multifactorial and complex disorder in which ocular surface infl ammations play a central role. Identification of specific CD4-T-Cell pathways and the recent recognition of targeting of alpha-fodrin suggest a case for novel new therapeutic aspects such as anti-CD4 monoclonal antibodies, systemic linoleic and gamma-linolenic acids, and omega-6 essential fatty acids. Replacement of tear volume with nonpreserved wetting agents and standard typical antiinflammatory corticosteroid and/or cyclosporine A continues to be central current conventional therapy for KCS.Keywords: dry eye, keratoconjunctivitis sicca, antiinflammatory therapy Dove Press Koray Gumus, Dwight H Cavanagh 2008-10-07 PDF http://www.dovepress.com/getfile.php?fileID=3974 http://www.dovepress.com/the-role-of-inflammation-and-antiinflammation-therapies-in-keratoconju-peer-reviewed-article-OPTH English

oai:dovepress.com/2028 2008-08-28 OPTH

Proton beam radiotherapy in the management of uveal melanoma: Clinical experience in Scotland Aziz, Samir Clinical Ophthalmology Samir Aziz1, Alex Taylor1, Andrzej McConnachie3, Alex Kacperek2, Ewan Kemp11Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK; 2Clatterbridge Centre for Oncology, Wirral, England, UK; 3Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UKAim: To evaluate proton-beam radiotherapy (PBRT) in the management of uveal melanoma in Scotland.Methods: A retrospective review was undertaken on all patients receiving PBRT for uveal melanoma (1994–2005). Data obtained included: gender, past ocular/medical history, age, presenting complaint(s), diagnosis, laterality, tumor location/ultrasound characteristics, visual acuity (VA) and intraocular pressure. At post-treatment reviews (3, 6, 12, and 24 months), the following data was obtained: VA, intraocular pressure, tumor appearance and ultrasound characteristics. Mean follow up was 38.8 months.Results: Seventy-six patients were included. Mean age was 64 years; male to female ratio was 1.1:1. Ninety-seven percent demonstrated initial treatment response; 87% had successful control of tumor growth. Mean pre-treatment tumor height was 6.2 mm v.s. 4.8 mm post-irradiation (p < 0.001). Pre-irradiation VA was <3/60 in 18.5% compared with 74% post-irradiation (p < 0.0001). There was a statistically significant association between adverse events (enucleation, metastasis) and greater maximal basal tumor diameter. Eighteen eyes were enucleated. The median survival time was estimated to be 54 months.Conclusion: In our experience, PBRT is a precise, reliable and effective treatment in the management of large, and previously treated uveal melanomas. It prevents enucleation in the majority at short term follow-up.Keywords: proton-beam radiotherapy, uveal melanoma, visual acuity, enucleation, tumor Dove Press Samir Aziz, Alex Taylor, Andrzej McConnachie, Alex Kacperek, Ewan Kemp 2008-08-28 PDF http://www.dovepress.com/getfile.php?fileID=3975 http://www.dovepress.com/proton-beam-radiotherapy-in-the-management-of-uveal-melanoma-clinical--peer-reviewed-article-OPTH English

oai:dovepress.com/2280 2008-09-28 OPTH

Registration of visual impairment due to diabetic retinopathy in a subpopulation of Cambridgeshire Gordon-Bennett, Patel Clinical Ophthalmology Patel Gordon-Bennett1, Aseema Misra2, Wendy Newsom1, Declan Flanagan21Eye Department, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK; 2Eye Department, Addenbrookes Hospital, Hills Road, Cambridge, Cambridgeshire, UKBackground/Aims: The UK National Screening Committee (NSC) has set 18 standards for diabetic retinopathy (DR) screening services in England and Wales, the first of which is to reduce new visual impairment (VI) due to DR by 10% within 5 years. This study examined the incidence of VI due to DR in Cambridgeshire (City, South, and Huntingdonshire) in order to establish a baseline rate of VI registration.Methods: A retrospective review of all certificates of visual impairment (CVI) for 2004 and 2005 was conducted. Hospital records of patients registered due to DR were reviewed to ascertain conformity to NSC Standards. The incidence of VI registration due to DR was calculated.Results: The number of registrations predominantly due to DR was 18; 13 visually impaired and 5 with severe VI. The rates of VI and severe VI predominantly due to DR were 17.1 and 6.5 per million per year, respectively. The VI and severe VI registration rates in the diabetic population were 600 and 230 per million per year, respectively.Conclusion: The severe VI registration rate due to DR lies within the national standard. The VI registration rate exceeds 1990–1991 national standards but lies within 1999–2000 national figures.Keywords: diabetic retinopathy, visual impairment, severe visual impairment, registration, certification of visual impairment Dove Press Patel Gordon-Bennett, Aseema Misra, Wendy Newsom, Declan Flanagan 2008-09-28 PDF http://www.dovepress.com/getfile.php?fileID=3976 http://www.dovepress.com/registration-of-visual-impairment-due-to-diabetic-retinopathy-in-a-sub-peer-reviewed-article-OPTH English

oai:dovepress.com/2270 2008-09-25 OPTH

Does titration of mitomycin C as an adjunct to trabeculectomy significantly influence the intraocular pressure outcome? Shields, M. Clinical Ophthalmology Susan J Lee1, Augusto Paranhos2, M Bruce Shields11Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA; 2Federal University of São Paulo, São Paulo, BrazilPurpose: To evaluate the benefit of titrating the concentration and exposure time of mitomycin C (MMC) as an adjunct to trabeculectomy.Methods: This report consists of a retrospective study and a review of the literature. In the study, consecutive glaucoma patients were evaluated who underwent trabeculectomy with adjunctive MMC that was titrated for concentration and exposure time, based on patient’s risk factors for surgical failure. After minimum follow-up of 6 months, patients were divided into success (intraocular pressure 7–17 mmHg), hypertension (>17 mmHg) and hypotony (<7 mmHg) groups, which were compared with regard to MMC protocol and patient variables. The literature review included reports of trabeculectomy and adjunctive MMC with and without titration.Results: One hundred and fifty-five eyes of 155 patients were studied. There were no significant differences between the three outcome groups and MMC protocol (p > 0.05). The only significant patient variable was older age in the hypotony group (p = 0.009). The literature is conflicting regarding the value of titrating MMC as an adjunct in trabeculectomy.Conclusion: The outcome of trabeculectomy with adjunctive MMC appears to represent a complex interaction of patient and surgical variables. While there is some support for a benefit of titrating MMC according to individual patient variables, there is inadequate evidence at the present time to claim superiority for any MMC protocol, with or without titration.Keywords: glaucoma surgery, trabeculectomy, mitomycin C, intraocular pressure Dove Press Susan J Lee, Augusto Paranhos, M Bruce Shields 2008-09-25 PDF http://www.dovepress.com/getfile.php?fileID=3979 http://www.dovepress.com/does-titration-of-mitomycin-c-as-an-adjunct-to-trabeculectomy-signific-peer-reviewed-article-OPTH English

oai:dovepress.com/2033 2008-08-29 OPTH

Choroidal neovascularization in patient undergoing growth hormone treatment Dias, Joao Clinical Ophthalmology João R de Oliveira Dias1, Eduardo B Rodrigues2, Maurício Martinazzo2, Michel E Farah21Faculty of Medicine, University of Passo Fundo, Rio Grande do Sul, Brazil; 2Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, BrazilAbstract: The association between growth-hormone (GH) and neovascular retinopathies in nondiabetic patients has been reported in earlier series. We report occurrence of choroidal neovascularization (CNV) in a 15-year-old male patient undergoing long-term GH therapy. The CNV could be a consequence of the GH-intake in a susceptible myopic patient.Keywords: choroidal neovascularization, growth hormone, optical coherence tomography, retina, angiogenesis Dove Press João R de Oliveira Dias, Eduardo B Rodrigues, Maurício Martinazzo, Michel E Farah 2008-08-29 PDF http://www.dovepress.com/getfile.php?fileID=3978 http://www.dovepress.com/choroidal-neovascularization-in-patient-undergoing-growth-hormone-trea-peer-reviewed-article-OPTH English

oai:dovepress.com/2517 2008-10-30 OPTH

International patenting in ophthalmology: An analysis of its structure and relevance for the development of drugs and diagnostics Mucke, Hermann Clinical Ophthalmology Hermann AM Mucke, Peter Mucke, Eva MuckeHM Pharma Consultancy, Vienna, AustriaAbstract: While investigative ophthalmologists access peer-reviewed journals as part of their daily routine, and while they regularly visit scientific congresses, they rarely peruse patent documents as an information source. Among the reasons for this negligence are the incompatibility of patent search algorithms with those known from journal databases, a legalistic and frequently redundant language, and misconceptions about the nature of the patenting system. Here we present key data and analyses from the ophthalmology module of a patent database system that we are developing to address some of these problems. We show that international patent applications consistently reflect developer interest in the ocular drug and diagnostics field; that they are technically focused lead indicators of developments that frequently feature in peer-reviewed patenting only much later; and that patenting targets are well aligned with the unmet therapeutic needs of populations in industrialized countries. Most applications (74%–78% in years since 2006) are supported with experimental data, and most (on average, 80%–90%) faced at least one objection to patentability during their initial stage of examination. In contrast to the peer-reviewed scenery that is highly diverse, the corresponding patenting arena shows a pronounced focus on the United States.Keywords: ophthalmology, eye diseases, iontophoresis, intellectual property, patents as topic, bibliographic databases Dove Press Hermann AM Mucke, Peter Mucke, Eva Mucke 2008-10-30 PDF http://www.dovepress.com/getfile.php?fileID=3982 http://www.dovepress.com/international-patenting-in-ophthalmology-an-analysis-of-its-structure--peer-reviewed-article-OPTH English

oai:dovepress.com/2505 2008-10-23 OPTH

Diclofenac prevents temporal increase of intraocular pressure after uneventful cataract surgery with longer operation time Shimura, Masahiko Clinical Ophthalmology Masahiko Shimura1, Toru Nakazawa2, Kanako Yasuda1, Takashi Shiono3, Kohji Nishida21Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan; 2Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan; 3Department of Ophthalmology, Shiono Eye Center, Sendai, JapanPurpose: This study compares the effect of topical diclofenac with that of betamethasone against postoperative increase of intraocular pressure (IOP) after cataract surgery in normal patients, and also investigated the risk factors for postoperative increase of IOP in each group.Methods: Fifty consecutive patients without systemic disease who have bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (100 eyes in total). Postoperatively, topical diclofenac was applied 4 times daily to one eye, and topical betamethasone to the other eye in each patient. IOP and best corrected logMAR visual acuity (BCVA) in each eye were measured up to 8 weeks. Total surgery time and effective phacoemulsification time (EPT) for each case was recorded.Results: BCVA in both diclofenac- and betamethasone-treated eyes significantly improved after the cataract surgery; however, no statistical difference in VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observation period. IOP in the diclofenac-treated eyes decreased with time, in contrast to the IOP in the betamethasone-treated eyes, which showed a slight increase. At 4 and 8 weeks postoperatively, there was significant difference between these two eye groups. Multiple regression analysis revealed that postoperative increase in IOP at 8 weeks in the betamethasone-treated eyes was closely correlated with total surgery time and EPT, but the IOP in the diclofenac-treated eyes showed no correlation with any surgical or clinical parameters.Conclusions: Postoperative increase in IOP after cataract surgery was affected by total surgery time and EPT in the betamethasone-treated eye. The time for surgery and EPT is longer in complicated cases including patients with a hard nucleus or small pupils, and also longer for beginning surgeons and in older patients. In these cases, diclofenac in place of betamethasone as a postoperative topical antiinflammatory drug is recommended for the prevention of postoperative increase in IOP.Keywords: intraocular pressure, cataracts, visual acuity, betamethasone, diclofenac Dove Press Masahiko Shimura, Toru Nakazawa, Kanako Yasuda, Takashi Shiono, Kohji Nishida 2008-10-23 PDF http://www.dovepress.com/getfile.php?fileID=3981 http://www.dovepress.com/diclofenac-prevents-temporal-increase-of-intraocular-pressure-after-un-peer-reviewed-article-OPTH English

oai:dovepress.com/2212 2008-09-10 OPTH

Intravitreal injection of tissue plasminogen activator as treatment for an occluded pars plana glaucoma tube Tsui, Irena Clinical Ophthalmology Irena Tsui, Suzanna Airiani, Angie Wen, Tarek El-Sawy, Howard F Fine, Peter JG Maris JrDepartment of Ophthalmology, Columbia University, New York, NY, USAAbstract: Implanting glaucoma tubes through the pars plana in the setting of a corneal transplant is becoming more common, and there are unique problems associated with such a procedure. A 42-year-old man with multiple previous eye surgeries presented with a nonfunctioning pars plana glaucoma tube. There was no view to the tube tip, but it was presumed to be clogged with fibrin. Intravitreal tissue plasminogen activator (tPA) was injected through the pars plana which resulted in intraocular pressure control without further surgery. This new application of intravitreal tPA has not been reported previously. Future research should investigate the optimal effective and safe dose of intravitreal tPA injection to relieve such occlusions.Keywords: tissue plasminogen activator (tPA), Ahmed Glaucoma Valve Dove Press Irena Tsui, Suzanna Airiani, Angie Wen, Tarek El-Sawy, Howard F Fine, Peter JG Maris Jr 2008-09-10 PDF http://www.dovepress.com/getfile.php?fileID=3977 http://www.dovepress.com/intravitreal-injection-of-tissue-plasminogen-activator-as-treatment-fo-peer-reviewed-article-OPTH English

oai:dovepress.com/2664 2008-12-02 OPTH

Prevalence and risk factors for refractive errors in the South Indian adult population: The Andhra Pradesh Eye disease study Krishnaiah, S Clinical Ophthalmology Sannapaneni Krishnaiah1,2,3, Marmamula Srinivas1,2,3, Rohit C Khanna1,2, Gullapalli N Rao1,2,31L V Prasad Eye Institute, Banjara Hills, Hyderabad, India; 2International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India; 3Vision CRC, University of New South Wales, Sydney, NSW, AustraliaAim: To report the prevalence, risk factors and associated population attributable risk percentage (PAR) for refractive errors in the South Indian adult population.Methods: A population-based cross-sectional epidemiologic study was conducted in the Indian state of Andhra Pradesh. A multistage cluster, systematic, stratified random sampling method was used to obtain participants (n = 10293) for this study.Results: The age-gender-area-adjusted prevalence rates in those ≥40 years of age were determined for myopia (spherical equivalent [SE] < −0.5 D) 34.6% (95% confidence interval [CI]: 33.1–36.1), high-myopia (SE < −5.0 D) 4.5% (95% CI: 3.8–5.2), hyperopia (SE > +0.5 D) 18.4% (95% CI: 17.1–19.7), astigmatism (cylinder < −0.5 D) 37.6% (95% CI: 36–39.2), and anisometropia (SE difference between right and left eyes >0.5 D) 13.0% (95% CI: 11.9–14.1). The prevalence of myopia, astigmatism, high-myopia, and anisometropia significantly increased with increasing age (all p < 0.0001). There was no gender difference in prevalence rates in any type of refractive error, though women had a significantly higher rate of hyperopia than men (p < 0.0001). Hyperopia was significantly higher among those with a higher educational level (odds ratio [OR] 2.49; 95% CI: 1.51–3.95) and significantly higher among the hypertensive group (OR 1.24; 95% CI: 1.03–1.49). The severity of lens nuclear opacity was positively associated with myopia and negatively associated with hyperopia.Conclusions: The prevalence of myopia in this adult Indian population is much higher than in similarly aged white populations. These results confirm the previously reported association between myopia, hyperopia, and nuclear opacity.Keywords: refractive errors, risk factors, population attributable risk percent, population-based cross-sectional study, southern India Dove Press Sannapaneni Krishnaiah, Marmamula Srinivas, Rohit C Khanna, Gullapalli N Rao 2008-12-02 PDF http://www.dovepress.com/getfile.php?fileID=3980 http://www.dovepress.com/prevalence-and-risk-factors-for-refractive-errors-in-the-south-indian--peer-reviewed-article-OPTH English

oai:dovepress.com/2699 2008-12-10 OPTH

Giant cell arteritis: A rare cause of posterior vasculitis Moschos, Marilita Clinical Ophthalmology Marilita M Moschos1, Yan Guex-Crosier21Department of Ophthalmology, University of Athens, Greece; 2Jules Gonin Eye Hospital, University of Lausanne, SwitzerlandPurpose: To report three cases of posterior vasculitis associated with subacute giant cell arteritis (GCA).Methods: Three patients with decreased vision underwent complete ophthalmologic examination and fluorescein angiography.Results: All patients presented posterior vasculitis. Patient 1 had an erythrocyte sedimentation rate (ESR) of 38 mm/hr and a C-reactive protein (CRP) of 28mg/L. Patient 2 and 3 had an ESR of 104 and 95 mm/hr and a CRP of 42 and 195 mg/L accordingly. Diagnosis was established by temporal artery biopsy. Resolution was observed after systemic prednisolone therapy.Conclusion: GCA should be suspected when posterior vasculitis and relatively high ESR and CRP are present.Keywords: giant cell arteritis, posterior vasculitis Horton’s disease, temporal arteritis, uveitis Dove Press Marilita M Moschos, Yan Guex-Crosier 2008-12-10 PDF http://www.dovepress.com/getfile.php?fileID=4044 http://www.dovepress.com/giant-cell-arteritis-a-rare-cause-of-posterior-vasculitis-peer-reviewed-article-OPTH English

oai:dovepress.com/2707 2008-12-11 OPTH

Clinical efficacy and neuroprotective effects of brimonidine in the management of glaucoma and ocular hypertension Goldberg, Ivan Clinical Ophthalmology Anna Galanopoulos1, Ivan Goldberg21Senior Visiting Ophthalmologist, South Australian Institute of Ophthalmology and Dept of Ophthalmology and Visual Sciences, University of Adelaide, South Australia; 2Clinical Associate Professor, University of Sydney, Australia; Head, Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia, Director, Eye Associates, Sydney, AustraliaAbstract: Elevated intraocular pressure (IOP) is a significant risk factor for the development and progression of glaucomatous optic neuropathy, but increasingly we appreciate that non-pressure dependent factors, are key to our understanding of the pathophysiology of these neurodegenerative diseases, that target the retinal ganglion cell. As we try to expand therapy beyond IOP control, medications are being assessed for their neuroprotective abilities. Brimonidine is an effective ocular hypotensive treatment both as a first and second line agent, in the management of glaucoma and ocular hypertension. Brimonidine tartrate 0.2% is generally safe and well tolerated, with its safety profile further enhanced in the altered formulation brimonidine-Purite™ 0.1%. Beyond brimonidine’s pressure lowering capacity, laboratory and early clinical evidence supports its neuroprotective potential. We await validation of this in human clinical trials.Keywords: brimonidine, neuroprotection, clinical effectiveness, tolerability Dove Press Anna Galanopoulos, Ivan Goldberg 2008-12-11 PDF http://www.dovepress.com/getfile.php?fileID=4055 http://www.dovepress.com/clinical-efficacy-and-neuroprotective-effects-of-brimonidine-in-the-ma-peer-reviewed-article-OPTH English

oai:dovepress.com/2708 2008-12-11 OPTH

Clinical evaluation of a rapid, pupil-based assessment of retinal damage associated with glaucoma Fraser, Scott Clinical Ophthalmology Nicholas Wride1, Majed Habib1, Keith Morris2, Steve Campbell3, Scott Fraser11Sunderland Eye Infirmary, City Hospitals Sunderland NHS Foundation Trust, Sunderland, Tyne and Wear, UK; 2Applied Neurodiagnostics Ltd, Cramlington, Northumberland, UK; 3School of Health, University of New England, New South Wales, AustraliaAims: To evaluate the effectiveness of a new test, the Pupilmetrix™ PLR60, which uses the pupillary light reflex (PLR) to detect asymmetric retinal damage in patients diagnosed with glaucoma.Methods: 30 patients, clinically diagnosed as having glaucoma, were recruited to the study, 29 of whom completed testing using the PLR60. A control group of 30 patients who had glaucoma excluded by clinical examination were also recruited and tested using the same protocol on the PLR60.Results: Of the 110 eyes with test outcomes, overall agreement between the PLR60 result and clinical diagnosis (glaucoma positive or negative) per eye was 84.7%. Sensitivity was 93.1% (95% CI 77.2%–99.2%) and specificity was 76.7% (95% CI 57.7%–90.1%). Average (SD) test times (min:sec) for both eyes were 3:21 (0:33) minutes for the glaucoma group and 2:40 (0:35) minutes for the non-glaucoma group.Conclusions: The results of this preliminary study suggest that the PLR as used in the Pupilmetrix™ PLR60 test is able to discriminate between patients with glaucomatous retinal defects and those with clinically normal retinas with a diagnostic accuracy that is potentially useful for screening for glaucoma. Test times were markedly quicker than with standard visual field testing.Keywords: glaucoma, pupillary light reflex, retina, Pupilmetrix Dove Press Nicholas Wride, Majed Habib, Keith Morris, Steve Campbell, Scott Fraser 2008-12-11 PDF http://www.dovepress.com/getfile.php?fileID=4056 http://www.dovepress.com/clinical-evaluation-of-a-rapid-pupil-based-assessment-of-retinal-damag-peer-reviewed-article-OPTH English

oai:dovepress.com/2734 2008-12-17 OPTH

Skin rash associated with intravitreal bevacizumab in a patient with macular choroidal neovascularization Moschos, Marilita Clinical Ophthalmology Ioannis D Ladas, Marilita M Moschos, Thanos D Papakostas, Athanasios I Kotsolis, Ilias Georgalas, Michail ApostolopoulosDepartment of Ophthalmology, “G. Gennimatas” Hospital of Athens, University of Athens, Athens, GreecePurpose: The purpose of this observational case report is to describe a case of skin rash after intravitreal use of bevacizumab.Methods: A 50-year-old man with choroidal neovascularization in the right eye due to age-related macular degeneration was treated with three intravitreal injections of bevacizumab.Results: Twelve days after the first injection, the patient developed a maculopapular rash on his forehead and on both temporal regions around his eyes. The rash disappeared eight days after treatment with topical corticosteroids. A skin rash with the same distribution reappeared 14 days after the second and 10 days after the third injection. Similarly, it disappeared five and seven days after the use of the same treatment. The follow-up period was 15 months after the third injection. During the follow-up period the rash did not reappear.Conclusion: This case report may initiate further investigation of similar cases to support this observation, as there are a lack of reports of skin rash after intravitreal administration of bevacizumab.Keywords: skin rash, bevacizumab, age-related macular degeneration Dove Press Ioannis D Ladas, Marilita M Moschos, Thanos D Papakostas, Athanasios I Kotsolis, Ilias Georgalas, Michail Apostolopoulos 2008-12-17 PDF http://www.dovepress.com/getfile.php?fileID=4085 http://www.dovepress.com/skin-rash-associated-with-intravitreal-bevacizumab-in-a-patient-with-m-peer-reviewed-article-OPTH English

oai:dovepress.com/2369 2008-10-05 OPTH

Efficacy, safety, and improved tolerability of travoprost BAK-free ophthalmic solution compared with prior prostaglandin therapy Stewart, Jeanette Clinical Ophthalmology J Charles Henry1, James H Peace2, Jeanette A Stewart3,4, William C Stewart3,41Little Rock Eye Clinic, Little Rock, AR, USA; 2Diabetic Eye Medical Clinic, Inglewood, CA, USA; 3PRN Pharmaceutical Research Network, LLC, Dallas,TX, USA; 4Carolina Eye Institute, University of South Carolina, School of Medicine, Columbia, SC, USAPurpose: To evaluate the efficacy, safety and tolerability of changing to travoprost BAK-free from prior prostaglandin therapy in patients with primary open-angle glaucoma or ocular hypertension.Design: Prospective, multi-center, historical control study.Methods: Patients treated with latanoprost or bimatoprost who needed alternative therapy due to tolerability issues were enrolled. Patients were surveyed using the Ocular Surface Disease Index (OSDI) to evaluate OSD symptoms prior to changing to travoprost BAK-free dosed once every evening. Patients were re-evaluated 3 months later.Results: In 691 patients, travoprost BAK-free demonstrated improved mean OSDI scores compared to either latanoprost or bimatoprost (p < 0.0001). Patients having any baseline OSD symptoms (n = 235) demonstrated significant improvement after switching to travoprost BAK-free (p < 0.0001). In 70.2% of these patients, symptoms were reduced in severity by at least 1 level. After changing medications to travoprost BAK-free, mean intraocular pressure (IOP) was significantly decreased (p < 0.0001). Overall, 72.4% preferred travoprost BAK-free (p < 0.0001, travoprost BAK-free vs prior therapy). Travoprost BAK-free demonstrated less conjunctival hyperemia than either prior therapy (p < 0.0001).Conclusions: Patients previously treated with a BAK-preserved prostaglandin analog who are changed to travoprost BAK-free have clinically and statistically significant improvement in their OSD symptoms, decreased hyperemia, and equal or better IOP control.Keywords: glaucoma, prostaglandin analog, travoprost, latanoprost, bimatoprost, preservative, benzalkonium chloride, ocular surface disease Dove Press J Charles Henry, James H Peace, Jeanette A Stewart, William C Stewart 2008-10-05 PDF http://www.dovepress.com/getfile.php?fileID=4094 http://www.dovepress.com/efficacy-safety-and-improved-tolerability-of-travoprost-bak-free-ophth-peer-reviewed-article-OPTH English

oai:dovepress.com/2770 2009-01-08 OPTH

Age-related macular degeneration: current treatments Hubschman, Jean-Pierre Clinical Ophthalmology Jean Pierre Hubschman, Shantan Reddy, Steven D SchwartzJules Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles, California, USAPurpose: Although important progress has been made in understanding age-related macular degeneration (AMD), management of the disease continues to be a challenge. AMD research has led to a widening of available treatment options and improved prognostic perspectives. This essay reviews these treatment options.Design: Interpretative essay.Methods: Literature review and interpretation.Results: Current treatments to preserve vision in patients with non-exudative AMD include antioxidant vitamins and mineral supplementations. Exudative AMD is currently most often treated monthly with anti-VEGF intra-vitreal injections. However, investigators are beginning to experiment with combination therapy and surgical approaches in an attempt to limit the number of treatment and reduce the financial burden on the health care system.Conclusion: By better understanding the basis and pathogenesis of AMD, newer therapies will continue to be developed that target specific pathways in patients with AMD, with the hoped for outcome of better management of the disease and improved visual acuity.Keywords: age-related macular degeneration, VEGF, photodynamic therapy, laser, surgery Dove Press Jean Pierre Hubschman, Shantan Reddy, Steven D Schwartz 2009-01-08 PDF http://www.dovepress.com/getfile.php?fileID=4129 http://www.dovepress.com/age-related-macular-degeneration-current-treatments-peer-reviewed-article-OPTH English

oai:dovepress.com/2733 2008-12-17 OPTH

Nonarteritic anterior ischemic optic neuropathy associated with chronic anemia: a case series of myelodysplastic syndrome patients Brouzas, D. Clinical Ophthalmology Dimitrios Brouzas, Antonios Charakidas, Ioannis Ladas, Michael ApostolopoulosDepartment of Ophthalmology, University of Athens, Athens, GreeceIntroduction: We report on three cases of visual loss due to nonarteritic anterior ischemic optic neuropathy that developed during the course of refractory anemia, a subtype of myelodysplastic syndrome.Patients and methods: Patients underwent fundus, visual field examination, and fluorescein angiography. A thrombophilic tendency investigation including prothrombin time, partial thromboplastin time, protein C, free protein S, and antithrombin III, polymerase chain reaction and hybridisation to allele-specific oligonucleotide probes and a bone marrow biopsy were also performed.Results: Relative recovery of visual function was noted in two patients, a 58-year-old man and a 67-year-old woman, whereas the vision of the third patient, a 62-year-old man, showed only marginal improvement during the follow-up period. Two patients received vigorous blood transfusion during hospitalization, while dosage adjustment of the erythropoietin infusion was decided for the third one. Thrombophilic tendency was not identified in any patient.Discussion: Chronic anemia, as presented in myelodysplastic syndrome’s refractory anemia subtype, probably in the presence of additional factors, such as hypotension, is likely to be complicated by optic neuropathy, possibly through a mechanism of anemic hypoxia and/or microvascular insufficiency.Keywords: myelodysplastic syndrome, anemia, optic neuropathy Dove Press Dimitrios Brouzas, Antonios Charakidas, Ioannis Ladas, Michael Apostolopoulos 2008-12-17 PDF http://www.dovepress.com/getfile.php?fileID=4137 http://www.dovepress.com/nonarteritic-anterior-ischemic-optic-neuropathy-associated-with-chroni-peer-reviewed-article-OPTH English

oai:dovepress.com/2775 2009-01-11 OPTH

Reproducibility of measurements and variability of the classification algorithm of Stratus OCT in normal, hypertensive, and glaucomatous patients Pazos, Marta Clinical Ophthalmology Alfonso Antón1,2,3, Marta Castany1,2, Marta Pazos-Lopez1,2, Ruben Cuadrado3, Ana Flores3, Miguel Castilla11Hospital de la Esperanza-Hospital del Mar (IMAS), Barcelona, Spain; 2Institut Català de la Retina (ICR), Barcelona, Spain. Glaucoma Department; 3Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, EspañaPurpose: To assess the reproducibility of retinal nerve fiber layer (RNFL) measurements and the variability of the probabilistic classification algorithm in normal, hypertensive and glaucomatous eyes using Stratus optical coherence tomography (OCT).Methods: Forty-nine eyes (13 normal, 17 ocular hypertensive [OHT] and 19 glaucomatous) of 49 subjects were included in this study. RNFL was determined with Stratus OCT using the standard protocol RNFL thickness 3.4. Three different images of each eye were taken consecutively during the same session. To evaluate OCT reproducibility, coefficient of variation (COV) and intraclass correlation coefficient (ICC) were calculated for average thickness (AvgT), superior average thickness (Savg), and inferior average thickness (Iavg) parameters. The variability of the results of the probabilistic classification algorithm, based on the OCT normative database, was also analyzed. The percentage of eyes with changes in the category assigned was calculated for each group.Results: The 50th percentile of COV was 2.96%, 4.00%, and 4.31% for AvgT, Savg, and Iavg, respectively. Glaucoma group presented the largest COV for all three parameters (3.87%, 5.55%, 7.82%). ICC were greater than 0.75 for almost all measures (except from the inferior thickness parameter in the normal group; ICC = 0.64, 95% CI 0.334–0.857). Regarding the probabilistic classification algorithm for the three parameters (AvgT, Savg, Iavg), the percentage of eyes without color-code category changes among the three images was as follows: normal group, 100%, 84.6% and 92%; OHT group, 89.5%, 52.7%, 79%; and Glaucoma group, 82%, 70.6%, and 76.5%, respectively. A probabilistic category switch from pathologic to normal or vice versa was observed in three eyes (15.8%) of the glaucomatous group for the Savg parameter and in two eyes of the OHT group: one eye (5,9%) for the AvgT and one eye (5.9%) for the Savg parameter.Conclusions: OCT RNFL measurements showed a good reproducibility in normal, OHT, and glaucoma eyes. The probabilistic classification for the three main parameters showed certain variability, especially in glaucoma group and OHT group. Therefore, one isolated category result should be interpreted with caution before clinical classification of the patient.Keywords: optical coherence tomography, glaucoma, nerve fiber layer, algorithm classification, reproducibility Dove Press Alfonso Antón, Marta Castany, Marta Pazos-Lopez, Ruben Cuadrado, Ana Flores, Miguel Castilla 2009-01-11 PDF http://www.dovepress.com/getfile.php?fileID=4139 http://www.dovepress.com/reproducibility-of-measurements-and-variability-of-the-classification--peer-reviewed-article-OPTH English

oai:dovepress.com/2776 2009-01-11 OPTH

Treatment of neovascular age-related macular degeneration: Current therapies Augustin, Albert Clinical Ophthalmology Albert J Augustin, Stefan Scholl, Janna KirchhofDepartment of Ophthalmology, Klinikum Karlsruhe, GermanyAbstract: Choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is now the leading cause of blindness and severe vision loss among people over the age of 40 in the Western world. Its prevalence is certain to increase substantially as the population ages. Treatments currently available for the disease include laser photocoagulation, verteporfin photodynamic therapy, and intravitreal injections of corticosteroids and anti-angiogenic agents. Many studies have reported the benefits of each of these treatments, although none is without its risks. No intervention actually cures AMD, nor the neovascularization associated with it. However, its symptoms are treated with varying degrees of success. Some treatments stabilize or arrest the progress of the disease. Others have been shown to reverse some of the damage that has already been done. These treatments can even lead to visual improvement. This paper will review the major classes of drugs and therapies designed to treat this condition.Keywords: wet AMD, neovascularization, PDT, steroids, anti-angiogenesis Dove Press Albert J Augustin, Stefan Scholl, Janna Kirchhof 2009-01-11 PDF http://www.dovepress.com/getfile.php?fileID=4140 http://www.dovepress.com/treatment-of-neovascular-age-related-macular-degeneration-current-ther-peer-reviewed-article-OPTH English

oai:dovepress.com/2788 2009-01-13 OPTH

Investigation of the association between the GLC3A locus and normal tension glaucoma in Japanese patients by microsatellite analysis Meguro, Akira Clinical Ophthalmology M Kamio1*, A Meguro1*, M Ota2, N Nomura1, K Kashiwagi3, F Mabuchi3, H Iijima3, K Kawase4, T Yamamoto4, M Nakamura5, A Negi5, T Sagara6, T Nishida6, M Inatani7, H Tanihara7, M Aihara8, M Araie8, T Fukuchi9, H Abe9, T Higashide10, K Sugiyama10, T Kanamoto11, Y Kiuchi11, A Iwase12, S Ohno13, H Inoko14, N Mizuki11Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan; 2Department of Legal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan; 3Department of Ophthalmology, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan; 4Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan; 5Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; 6Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; 7Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; 8Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan; 9Division of Ophthalmology and Visual Science, Graduated School of Medical and Dental Sciences, Niigata University, Niigata, Japan; 10Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan; 11Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; 12Department of Ophthalmology, Tajimi Municipal Hospital, Tajimi, Gifu, Japan; 13Department of Ophthalmology, Hokkaido University School of Medicine, Sapporo, Japan; 14Department of Genetic Information, Division of Molecular Life Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan; *These authors contributed equally to this reportPurpose: To investigate whether the GLC3A locus harboring the CYP1B1 gene is associated with normal tension glaucoma (NTG) in Japanese patients.Materials and Methods: One hundred forty-two Japanese patients with NTG and 101 Japanese healthy controls were recruited. Patients exhibiting a comparatively early onset were selected as this suggests that genetic factors may show stronger involvement. Genotyping and assessment of allelic diversity was performed on 13 highly polymorphic microsatellite markers in and around the GLC3A locus.Results: There were decreased frequencies of the 444 allele of D2S0416i and the 258 allele of D2S0425i in cases compared to controls (P = 0.022 and P = 0.034, respectively). However, this statistical significance disappeared when corrected (Pc > 0.05). We did not find any significant association between the remaining 11 microsatellite markers, including D2S177, which may be associated with CYP1B1, and NTG (P > 0.05).Conclusions: Our study showed no association between the GLCA3 locus and NTG, suggesting that the CYP1B1 gene, which is reportedly involved in a range of glaucoma phenotypes, may not be an associated factor in the pathogenesis of NTG.Keywords: GLCA3, microsatellite, normal tension glaucoma, polymorphism Dove Press M Kamio, A Meguro, M Ota, N Nomura, K Kashiwagi, et al 2009-01-13 PDF http://www.dovepress.com/getfile.php?fileID=4153 http://www.dovepress.com/investigation-of-the-association-between-the-glc3a-locus-and-normal-te-peer-reviewed-article-OPTH English

oai:dovepress.com/2790 2009-01-13 OPTH

Age-related macular degeneration: experimental and emerging treatments Hubschman, Jean-Pierre Clinical Ophthalmology Jean Pierre Hubschman, Shantan Reddy, Steven D SchwartzJules Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles, California, USAPurpose: This essay reviews the experimental treatments and new imaging modalities that are currently being explored by investigators to help treat patients with age-related macular degeneration (AMD).Design: Interpretative essay.Methods: Literature review and interpretation.Results: Experimental treatments to preserve vision in patients with exudative AMD include blocking vascular endothelial growth factor (VEGF), binding VEGF, and modulating the VEGF receptors. Investigators are also attempting to block signal transduction with receptor tyrosine kinase inhibitors. Experimental treatments for non-exudative AMD include agents that target inflammation, oxidative stress, and implement immune-modulation. The effectiveness of these newer pharmacologic agents has the potential to grow exponentially when used in combination with new and improved imaging modalities that can help identify disease earlier and follow treatment response more precisely.Conclusion: With a better understanding, at the genetic and molecular level, of AMD and the development of superior imaging modalities, investigators are able to offer treatment options that may offer unprecedented visual gains while reducing the need for repetitive treatments.Keywords: age-related macular degeneration, VEGF, SiRNA, PEDF Dove Press Jean Pierre Hubschman, Shantan Reddy, Steven D Schwartz 2009-01-13 PDF http://www.dovepress.com/getfile.php?fileID=4155 http://www.dovepress.com/age-related-macular-degeneration-experimental-and-emerging-treatments-peer-reviewed-article-OPTH English

oai:dovepress.com/2800 2009-01-20 OPTH

Treatment of cystoid macular edema with the new-generation NSAID nepafenac 0.1% Hariprasad, Seenu Clinical Ophthalmology Seenu M Hariprasad1, Levent Akduman2, Joseph A Clever2, Michael Ober3,4, Franco M Recchia5, William F Mieler1,61Department of Ophthalmology and Visual Sciences, Vitreoretinal Service; 6Department of Ophthalmology and Visual Sciences, University of Chicago, Chicago, IL, USA; 2Vitreoretinal Service, Saint Louis University Eye Institute, Saint Louis, MO, USA; 3Vitreoretinal Service, Henry Ford Health Systems, West Bloomfield, MI, USA; 4Retinal Consultants of Michigan, Southfield, MI, USA; 5Vitreoretinal Service, Vanderbilt Eye Institute, Nashville, TN, USAPurpose: To describe the use of nepafenac 0.1% for cystoid macular edema (CME).Methods: This was a multicenter retrospective review of 22 CME cases (20 patients) treated with nepafenac 0.1% (six with concomitant prednisolone acetate 1%) from December 2005 to April 2008: three acute pseudophakic CME cases, 13 chronic/recalcitrant pseudophakic CME cases, and six cases of uveitic CME. Pre- and post-treatment retinal thickness and visual acuity were reported.Results: Following treatment for six weeks to six months, six eyes with uveitic CME showed a mean retinal thickness improvement of 227 ± 168.1 μm; mean best-corrected visual acuity (BCVA) improvement was 0.36 ± 0.20 logMAR. All three cases of acute pseudophakic CME improved after four to 10 weeks of nepafenac, with a mean improvement in retinal thickness of 134 ± 111.0 μm. BCVA improved in two patients (0.16 and 0.22 logMAR) but not in the third due to underlying retinal pigment epithelium changes. Thirteen eyes with chronic/recalcitrant pseudophakic CME demonstrated a mean improvement in retinal thickness of 178 ± 128.7 μm after nepafenac and mean BCVA improvement of 0.33 ± 0.19 logMAR.Conclusion: The positive outcomes of these 22 eyes strongly suggest that nepafenac 0.1% is a promising drug for the treatment of CME. Additional study under randomized controlled conditions is warranted.Keywords: macular edema, NSAID, nepafenac, cataract surgery, uveitis Dove Press Seenu M Hariprasad, Levent Akduman, Joseph A Clever, Michael Ober, Franco M Recchia, et al 2009-01-20 PDF http://www.dovepress.com/getfile.php?fileID=4172 http://www.dovepress.com/treatment-of-cystoid-macular-edema-with-the-new-generation-nsaid-nepaf-peer-reviewed-article-OPTH English

oai:dovepress.com/2822 2009-01-27 OPTH

A comfort comparison of travoprost BAK-free 0.004% versus latanoprost 0.005% in patients with primary open-angle glaucoma or ocular hypertension Stewart, William Clinical Ophthalmology David A Godfrey1, Lee S Peplinski2, Jeanette A Stewart3, William C Stewart31Glaucoma Associates of Texas, Dallas, TX, USA; 2Kentuckiana Institute for Eye Research, Louisville, KY, USA; 3PRN Pharmaceutical Research Network, LLC, Dallas, TX, USAPurpose: To determine the short-term comfort after a single dose of travoprost BAK-free compared to latanoprost in primary open-angle glaucoma or ocular hypertensive patients.Design: Prospective, double-masked, randomized comparison of two separate active agents dosed once in opposite eyes.Methods: At Visit 1, qualified patients began a glaucoma medicine-free period for three days. At Visit 2, patients were randomly assigned to travoprost BAK-free or latanoprost in opposite eyes. Following dosing in each eye, patients completed a visual analog scale (VAS score, 0–100 mm) at specified time intervals and a comfort survey.Results: In 54 completed subjects, no difference existed five seconds after dosing, in comfort on the VAS between latanoprost (7.1 ± 16.2 mm) and travoprost BAK-free (7.8 ± 16.1 mm, P = 0.53). Also no differences existed between treatments following dosing for discomfort at individual timepoints past five seconds, peak discomfort or the time required to return to baseline comfort (P > 0.05). In addition, the comfort survey demonstrated no difference between products for burning, stinging, foreign body sensation, overall comfort and general acceptance between the products, both for absolute levels and changes from baseline (P > 0.05).Conclusion: Following a single instillation, both latanoprost and travoprost BAK-free exhibit similar comfort scores.Keywords: comfort, travoprost BAK-free, latanoprost, glaucoma, ocular hypertension Dove Press David A Godfrey, Lee S Peplinski, Jeanette A Stewart, William C Stewart 2009-01-27 PDF http://www.dovepress.com/getfile.php?fileID=4254 http://www.dovepress.com/a-comfort-comparison-of-travoprost-bak-free-0004-versus-latanoprost-00-peer-reviewed-article-OPTH English

oai:dovepress.com/2821 2009-01-27 OPTH

Prevalence and etiologies of visual handicaps in leprosy patients in the south of Cameroon Omgbwa Eballe, André Clinical Ophthalmology André Omgbwa Eballé1, Didier Owono2, Alphonse Um Book2, Assumpta Lucienne Bella2, Come Ebana Mvogo2, Nsom Mba31Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; 3National Programme for Leprosy Control, Ministry of Public Health, Yaoundé, CameroonAbstract: We report on a prospective study undertaken in April 2008, in 11 leper villages of the Southern Cameroon. Our aim was to determine the prevalence and the causes of bilateral blindness, low vision and unilateral blindness in the population of leprosy patients, irrespective of the clinical aspects of the illness.Results: Two hundred thirty-five known and newly diagnosed leprosy patients were examined. These patients included 149 cases (63.4%) of multibacillary leprosy and 86 cases (36.6%) of paucibacillary leprosy. There were 111 case of visual handicap, representing 47.2% of the population. These visual handicap cases were subdivided into 45 cases (19%) of bilateral blindness, 35 cases (15%) of unilateral blindness and 31 cases (13.2%) of low vision.Discussion: The prevalence of visual handicap among leprosy patients in Cameroon is too high. Causes in the majority of cases are age-related degenerative pathologies, and one third of cases are linked to the leprosy mycobacterium.Conclusion: Discovering a cure for ophthalmic pathologies is important in order to provide a better quality of life for this particular population.Keywords: leprosy, eye, blindness, Cameroon Dove Press André Omgbwa Eballé, Didier Owono, Alphonse Um Book, Assumpta Lucienne Bella, Come Ebana Mvogo, Nsom Mba 2009-01-27 PDF http://www.dovepress.com/getfile.php?fileID=4299 http://www.dovepress.com/prevalence-and-etiologies-of-visual-handicaps-in-leprosy-patients-in-t-peer-reviewed-article-OPTH English

oai:dovepress.com/2850 2009-02-08 OPTH

Antiglaucoma drugs for achieving monovision after laser in situ keratomileusis Kamiya, Kazutaka Clinical Ophthalmology Kazutaka Kamiya, Kimiya ShimizuDepartment of Ophthalmology, University of Kitasato School of Medicine, JapanAbstract: We report on a patient in whom the use of antiglaucoma drugs has been beneficial for the attainment of monovision after laser in situ keratomileusis (LASIK). A 57-year-old woman undergoing LASIK complained of blurred vision in the right eye. After a successful trial of monovision with contact lenses, antiglaucoma drugs (2.5% nipradilol) were administered topically to the right eye twice a day to establish monovision. In the right eye, the manifest refraction was changed from −4.0, −1.0 × 80, with an uncorrected visual acuity (UCVA) of 0.3 for near vision before treatment, to −2.5, −1.0 × 80, with an UCVA of 0.9 for near vision after treatment, while, in the left eye, it was 0, −1.0 × 100, with an UCVA of 0.9 for far vision. Binocular UCVA was improved from 0.3 for near and 0.9 for distance vision before treatment, to 0.9 for near and 1.0 for distance vision after treatment. No complications were observed and the manifest refraction remained stable during the 6-month follow-up period. The use of antiglaucoma drugs may be helpful for the achievement of monovision by reduction of myopic regression after LASIK.Keywords: antiglaucoma drugs, regression, monovision, LASIK Dove Press Kazutaka Kamiya, Kimiya Shimizu 2009-02-08 PDF http://www.dovepress.com/getfile.php?fileID=4351 http://www.dovepress.com/antiglaucoma-drugs-for-achieving-monovision-after-laser-in-situ-kerato-peer-reviewed-article-OPTH English

oai:dovepress.com/2404 2008-10-07 OPTH

Topical nepafenac in the treatment of diabetic macular edema Callanan, David Clinical Ophthalmology David Callanan, Patrick WilliamsTexas Retina Associates, Arlington, TX, USAPurpose: To determine the safety and efficacy of topical nepafenac 0.1% in the treatment of diabetic macular edema.Methods: A consecutive case series was performed of patients treated with nepafenac monotherapy twice daily for diabetic macular edema. Visual acuities (VA) at baseline and final visit were recorded. Foveal thickness, based on optical coherence tomography, was also recorded.Results: Six eyes of 5 patients were included in this study. Median initial Snellen vision was 20/100 (range, 20/40–20/400). After a mean of 210 days (range, 182–259), median final VA was 20/75 (range, 20/40–20/400). Four eyes gained vision and two eyes maintained vision. Mean pre-treatment vision was 0.78 logMAR and final VA was 0.67 logMAR, for a statistically significant improvement (p < 0.05). Mean initial foveal thickness was 417 microns (range, 286–599). After a mean of 178 days (range, 91–259), mean foveal thickness was 267 microns (range, 158–423), showing a statistically significant improvement (p < 0.05). Each eye had an improvement in foveal thickness.Conclusion: The results from these 6 eyes suggest that nepafenac 0.1% may have activity against diabetic macular edema and warrants further investigation.Keywords: diabetes, diabetic macular edema, inflammation, macular edema, nepafenac, NSAIDs Dove Press David Callanan, Patrick Williams 2008-10-07 PDF http://www.dovepress.com/getfile.php?fileID=4385 http://www.dovepress.com/topical-nepafenac-in-the-treatment-of-diabetic-macular-edema-peer-reviewed-article-OPTH English

oai:dovepress.com/2854 2009-02-08 OPTH

Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy Elbatarny, Ashraf Clinical Ophthalmology Ashraf M El-BatarnyAssistant Professor of Ophthalmology, Tanta University, Egypt; Chief of Vitreoretinal Service, Magrabi Eye and Ear Hospital, Muscat, Sultanate of OmanPurpose: To evaluate the effect of intravitreal injection of Avastin, bevacizumab (IVA) on diabetic vitrectomy and on the postoperative course.Methods: Thirty patients undergoing diabetic vitrectomy were distributed to standard vitrectomy (group 1) or vitrectomy with preoperative IVA (group 2). Bevacizumab was injected 5 to 7 days before surgery. Patients of both groups were matched as much as possible according to surgical indication and preoperative visual acuity. Main outcome measures were the feasibility of surgery and the postoperative complications. Feasibility of surgery was evaluated through recording surgical time, intraoperative bleeding, use of endodiathermy, relaxing retinotomies, use of perfluorocarbon liquid (PFCL) and silicone oil tamponade.Results: Follow up ranged between 7 and 18 months. There was significant reduction of mean surgical time, bleeding frequency, and diathermy use in group 2 compared to group 1. The rate of PFCL use and relaxing retinotomies were less in group 2 in comparison to group 1. Gas or air was used in 80% of patients in group 2 while silicone oil represented 60% of group 1. Postoperative visual acuity improvement was highly significant in both groups but the difference in both groups was not statistically significant. Vision improved in 87% in group 2 and 80% in group 1. Primary anatomical attachment was achieved in 90.3% in group 2 and 86.6% in group 1. Rate of subsequent surgeries and persistent cataract were higher in group 1. Postoperative bleeding was reported in 26.6% of cases in group 1 and none in group 2. In group 2, no complications related to avastin injection or progression of traction were reported during the preoperative period.Conclusion: Preoperative IVA was helpful in achieving the surgical and anatomical goals by reducing the time of surgery, the intraoperative and postoperative bleeding, and the use of silicone oil with subsequent reduction of second surgery.Keywords: intravitreal bevacizumab, proliferative diabetic retinopathy, diabetic vitrectomy, vascular endothelial growth factor, diabetic vitreous hemorrhage Dove Press Ashraf M El-Batarny 2009-02-08 PDF http://www.dovepress.com/getfile.php?fileID=4376 http://www.dovepress.com/intravitreal-bevacizumab-as-an-adjunctive-therapy-before-diabetic-vitr-peer-reviewed-article-OPTH English

oai:dovepress.com/1690 2008-06-19 OPTH

Viscoless microincision cataract surgery Sallet, Guy Clinical Ophthalmology Guy SalletDepartment of Opthamology, Aalsters Stedelijk Ziekenhuis, BelgiumAbstract: A cataract surgery technique is described in which incisions, continuous circular capsulorhexis and hydrodissection are made without the use of any viscoelastics. Two small incisions are created through which the different parts of the procedure can take place, maintaining a stable anterior chamber under continuous irrigation. Subsequent bimanual phacoemulsification can be done through these microincisions. At the end of the procedure, an intraocular lens can be inserted through the self-sealing incision under continuous irrigation. 50 consecutive cataract patients were operated on without the use of viscoelastics and then compared with a group of 50 patients who had been helped with viscoelastics. No difference in outcome, endothelial cell count or pachymetry was noted between the two groups. No intraoperative complication was encountered. Viscoless cataract surgery was a safe procedure with potential advantages.Keywords: ophthalmic visco-surgical device, viscoless cataract surgery, microincision Dove Press Guy Sallet 2008-06-19 PDF http://www.dovepress.com/getfile.php?fileID=4355 http://www.dovepress.com/viscoless-microincision-cataract-surgery-peer-reviewed-article-OPTH English

oai:dovepress.com/2589 2008-11-18 OPTH

Idiopathic intracranial hypertension in pediatric patients Jiraskova, Nada Clinical Ophthalmology Naďa Jirásková, Pavel RozsívalDepartment of Ophthalmology, University Hospital, Hradec Králové, Czech RepublicPurpose: To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH) in children.Methods: Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H2O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy.Results: Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients). Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients.Conclusions: Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.Keywords: idiopathic intracranial hypertension, pediatric, treatment Dove Press Naďa Jirásková, Pavel Rozsíval 2008-11-18 PDF http://www.dovepress.com/getfile.php?fileID=4356 http://www.dovepress.com/idiopathic-intracranial-hypertension-in-pediatric-patients-peer-reviewed-article-OPTH English

oai:dovepress.com/1683 2008-06-18 OPTH

Intravitreal bevacizumab has initial clinical benefit lasting eight weeks in eyes with neovascular age-related macular degeneration Johnson, Mark Clinical Ophthalmology P William Conrad, David N Zacks, Mark W JohnsonDepartment of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USAPurpose: To determine whether the effect of a single initial intravitreal injection of bevacizumab for neovascular age-related macular degeneration (AMD) persists for 8 weeks.Methods: We reviewed the records of 25 consecutive patients with neovascular AMD treated with intravitreal bevacizumab. Patients were included (n = 15) if follow up data were available from 4 and 8 week visits after a single initial injection. Additionally, optical coherence tomography (OCT) images were graded qualitatively in a masked fashion by a single reader.Results: Baseline mean visual acuity was 20/200, improving to 20/125 at 4 weeks (p = 0.0153) and 20/100 at 8 weeks (p = 0.0027). Mean central retinal thickness was 316 ± 107 µm at baseline and decreased to 223 ± 70 µm and 206 ± 45 µm at 4 and 8 weeks post-injection, respectively (p = 0.0003 and 0.0005). By masked OCT grading, macular fluid was resolved in 10/15 (66.7%) and 11/15 (73.3%) eyes at 4 and 8 weeks, respectively, and 3/15 (20%) eyes had continued reduction in residual macular fluid between 4 and 8 weeks.Conclusions: A single initial bevacizumab injection has persistent clinical benefit lasting 8 weeks in most eyes with neovascular AMD. Results of prospective randomized studies are needed before changes in treatment regimens can be recommended.Keywords: age-related macular degeneration, bevacizumab, choroidal neovascular membrane, optical coherence tomography Dove Press P William Conrad, David N Zacks, Mark W Johnson 2008-06-18 PDF http://www.dovepress.com/getfile.php?fileID=4361 http://www.dovepress.com/intravitreal-bevacizumab-has-initial-clinical-benefit-lasting-eight-we-peer-reviewed-article-OPTH English

oai:dovepress.com/1720 2008-07-07 OPTH

Alpha antagonists and intraoperative floppy iris syndrome: A spectrum Issa, Sharif Clinical Ophthalmology Sharif A Issa, Omar H Hadid, Oliver Baylis, Margaret DayanDepartment of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UKBackground: To determine occurrence of features of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients taking systemic alpha-antagonists (AA).Methods: We prospectively studied patients on AA and who underwent phacoemulsification. The following were recorded: pupil diameter preoperatively, iris flaccidity, iris prolapse and peroperative miosis.Results: We studied 40 eyes of 31 subjects. Mean age was 78 years. Overall, 14 eyes (13 patients) showed signs of IFIS: 9/13 (69%) eyes of patients on tamsulosin, 1/18 (6%) eyes in the doxazosin group, 2/2 prazosin patients, 1/4 eyes in the indoramin group, and 1/2 eyes in two patients on a combination of doxazosin and tamsulosin. Most cases (92%) had only one or two signs of IFIS. Bilateral cataract surgery was undertaken in 9 patients but only one patient (on tamsulosin) had features of IFIS in both eyes, while 4 patients (2 on tamsulosin and 2 on other AA) showed signs of IFIS in one eye only, and 4 patients did not show IFIS in either eye.Conclusion: Most AA were associated with IFIS, but it tends to present as a spectrum of signs rather than full triad originally described. Tamsulosin was most likely to be associated with IFIS; however, its intake does not necessarily mean that IFIS will occur. For patients on AA, the behavior of the iris intraoperatively in one eye is a poor predictor of the other eye. Surgeons should anticipate the occurrence of IFIS in any patient on AA.Keywords: alpha blocker, alpha antagonist, cataract surgery, intraoperative floppy iris syndrome, tamsulosin. Dove Press Sharif A Issa, Omar H Hadid, Oliver Baylis, Margaret Dayan 2008-07-07 PDF http://www.dovepress.com/getfile.php?fileID=4362 http://www.dovepress.com/alpha-antagonists-and-intraoperative-floppy-iris-syndrome-a-spectrum-peer-reviewed-article-OPTH English

oai:dovepress.com/1967 2008-08-10 OPTH

Increased expression of IRE1α and stress-related signal transduction proteins in ischemia-reperfusion injured retina Hata, Natsuyo Clinical Ophthalmology Natsuyo Hata1, Toshiyuki Oshitari1,2, Akiko Yokoyama1,3, Yoshinori Mitamura1, Shuichi Yamamoto11Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan; 2Department of Ophthalmology, Kimitsu Central Hospital, Kisarazu City, Chiba, Japan; 3Department of Ophthalmology, Inoue Memorial Hospital, Chuo-ku, Chiba, JapanAbstract: The purpose of this study was to determine whether the expression of ER stress-related factors IRE1α, apoptosis signal-regulating kinase 1 (ASK1), SAPK/ERK kinase 1 (SEK1) and c-Jun N-terminal kinase (JNK) is associated with the damaged retinal neurons induced by ischemia-reperfusion injury. After 60 minutes of ischemia, the rat retinas were reperfused, and retinas were isolated and fixed after 6, 9, 12, 18, and 24 hours, and 2, 5, and 9 days of reperfusion. Cryosections were immunostained with Fluoro-Jade B, a degenerating neuron marker to label degenerating neurons. Semi-quantitative analysis of the expression of IRE1α, ASK1, SEK1, and JNK were performed in both control and ischemic retinas. In ischemic retinas, the intensities of IRE1α immunoreactivity in the ganglion cell layer (GCL) were significantly higher than in the control retinas. In ischemic retinas, the numbers of SEK1-, ASK1-, and JNK-positive cells were significantly increased in the GCL compared to those in the control retinas. In addition, the cells that were positive for SEK1-, ASK1-, and JNK were also positive for Fluoro-Jade B-positive cells. These results indicate that the increased expression of ER stress-related factors was, in part, associated with the retinal neuronal abnormalities after ischemia-reperfusion injury in rat retinas.Keywords: endoplasmic reticulum, IRE1α, apoptosis signal-regulating kinase 1, SAPK/ERK kinase 1, c-Jun N-terminal kinase, Fluoro-Jade B, ischemia-reperfusion injury Dove Press Natsuyo Hata, Toshiyuki Oshitari, Akiko Yokoyama, Yoshinori Mitamura, Shuichi Yamamoto 2008-08-10 PDF http://www.dovepress.com/getfile.php?fileID=4366 http://www.dovepress.com/increased-expression-of-ire1alpha-and-stress-related-signal-transducti-peer-reviewed-article-OPTH English

oai:dovepress.com/1685 2008-06-18 OPTH

Course of the vertical portion of the lower lacrimal canaliculus Kakizaki, Hirohiko Clinical Ophthalmology Hirohiko Kakizaki1, Yasuhiro Takahashi2, Takashi Nakano3, Ken Asamoto3, Shinsuke Kinoshita1, Masayoshi Iwaki1Departments of 1Ophthalmology and 3Anatomy, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, JapanAbstract: The nomenclature of each part of the lacrimal canaliculus, for example the vertical portion, does not always reflect the true course. Since we have sometimes observed findings suggesting the so called vertical portion of the lower lacrimal canaliculus inclined laterally, we re-examined the course of the vertical portion. Twenty-eight postmortem lower eyelids in 16 Japanese were examined and divided into 2 groups. The first group was 14 lower eyelids of 7 cadavers. Eyelids were incised sagittally from the lower lacrimal punctum. The second group was 14 lower eyelids of 9 cadavers; these were incised from the lower lacrimal punctum with 5 degrees lateral inclination to the sagittal plane. In the first group, 10 canaliculi of 7 cadavers were interrupted at the halfway point of the vertical portion. Four canaliculi of 4 cadavers included the whole length of the vertical portion. In the second group, all specimens included the whole length of the vertical portion. Most vertical portions of the lower lacrimal canaliculus demonstrated a laterally inclined course of approximately 5 degrees, although some took a completely vertical course.Keywords: vertical portion, lacrimal canaliculus, lower, laterally Dove Press Hirohiko Kakizaki, Yasuhiro Takahashi, Takashi Nakano, Ken Asamoto, Shinsuke Kinoshita, Masayoshi Iwaki 2008-06-18 PDF http://www.dovepress.com/getfile.php?fileID=4367 http://www.dovepress.com/course-of-the-vertical-portion-of-the-lower-lacrimal-canaliculus-peer-reviewed-article-OPTH English

oai:dovepress.com/1980 2008-08-12 OPTH

Risk factors for progression to blindness in high tension primary open angle glaucoma: Comparison of blind and nonblind subjects Kooner, Karanjit Clinical Ophthalmology Karanjit S Kooner1, Mohannad AlBdoor1, Byung J Cho3, Beverley Adams-Huet21Department of Ophthalmology, 2Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA; 3Konkuk University Hospital, Seoul, KoreaAims: To determine which risk factors for blindness were most critical in patients diagnosed with high tension primary open angle glaucoma (POAG) in a large ethnically diverse population managed with a uniform treatment strategy.Methods: A longitudinal observational study was designed to follow 487 patients (974 eyes) with POAG for an average of 5.5 ± 3.6 years. Detailed ocular and systemic information was collected on each patient and updated every six months. For this study, blindness was defined as visual acuity of 20/200 or worse and/or visual field less than 20° in either eye. Known risk factors were compared between patients with blindness in at least one eye versus nonblind patients.Results: The patients with blindness had on average: higher intraocular pressure (IOP, mmHg): (24.2 ± 11.2 vs. 22.1 ± 7.7, p = 0.03), wide variation of IOP in the follow-up period (5.9 vs. 4.1 mmHg, p = 0.031), late detection (p = 0.006), poor control of IOP (p < 0.0001), and noncompliance (p < 0.0003). Other known risk factors such as race, age, myopia, family history of glaucoma, history of ocular trauma, hypertension, diabetes, vascular disease, smoking, alcohol abuse, dysthyoidism, and steroid use were not significant.Conclusions: The most critical factors associated with the development of blindness among our patients were: elevated initial IOP, wide variations and poor control of IOP, late detection of glaucoma, and noncompliance with therapy.Keywords: primary open angle glaucoma, blindness, intraocular pressure, risk factors, and noncompliance Dove Press Karanjit S Kooner, Mohannad AlBdoor, Byung J Cho, Beverley Adams-Huet 2008-08-12 PDF http://www.dovepress.com/getfile.php?fileID=4368 http://www.dovepress.com/risk-factors-for-progression-to-blindness-in-high-tension-primary-open-peer-reviewed-article-OPTH English

oai:dovepress.com/378 2008-05-27 OPTH

Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus Schechter, Clyde Clinical Ophthalmology Clyde B Schechter1, Charles E Basch2, Arlene Caban3, Elizabeth A Walker41Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; 2Department of Health Behavior Studies, Teachers College, Columbia University, New York, NY, USA; 3Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; 4Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USAAbstract: In a clinical trial, we have previously shown that a telephone intervention can significantly increase participation in dilated fundus examination (DFE) screening among low-income adults with diabetes. Here the costs and cost-effectiveness ratio of this intervention are calculated. Intervention effectiveness was estimated as the difference in DFE utilization between the telephone intervention and print groups from the clinical trial multiplied by the size of the telephone intervention group. A micro-costing approach was used. Personnel time was aggregated from logs kept during the clinical trial of the intervention. Wage rates were taken from a commercial compensation database. Telephone charges were estimated based on prevailing fees. The cost-effectiveness ratio was calculated as the ratio of total costs of the intervention to the number of DFEs gained by the intervention. A sensitivity analysis estimated the cost-effectiveness of a more limited telephone intervention. A probabilistic sensitivity analysis using bootstrap samples from the clinical trial results quantified the uncertainties in resource utilization and intervention effectiveness. Net intervention costs were US$18,676.06, with an associated gain of 43.7 DFEs and 16.4 new diagnoses of diabetic retinopathy. The cost-effectiveness ratio is US$427.37 per DFE gained. A restricted intervention limiting the number of calls to 5, as opposed to 7, would achieve the same results, but would cost approximately 17% less. In the probabilistic sensitivity analysis, the 5th and 95th percentiles of the cost-effectiveness ratio were US$304.05 and US$692.52 per DFE gained, respectively. Our telephone intervention is more expensive than simple mail or telephone reminders used in other settings to promote preventive care; it is, however, also considerably more effective, and is effective in a low-income minority population at greater risk for diabetes complications. The costs are dominated by labor costs, and may be substantially defrayed, without loss of effectiveness, by restricting the number of telephone calls to 5 per patient.Keywords: cost-effectiveness, diabetes mellitus, dilated fundus examination Dove Press Clyde B Schechter, Charles E Basch, Arlene Caban, Elizabeth A Walker 2008-05-27 PDF http://www.dovepress.com/getfile.php?fileID=4371 http://www.dovepress.com/cost-effectiveness-of-a-telephone-intervention-to-promote-dilated-fund-peer-reviewed-article-OPTH English

oai:dovepress.com/1973 2008-08-11 OPTH

Effect of audible and visual reminders on adherence in glaucoma patients using a commercially available dosing aid Ho, Lawrence Clinical Ophthalmology Lawrence Y Ho1, Larissa Camejo1, Malik Y Kahook2, Robert Noecker11UMPC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; 2Rocky Mountain Lions Institute, University of Colorado, CO, USAAbstract: We studied the effects of audible and visual alarms on adherence with a recommended dosing regimen in the management of glaucoma. Forty-two patients were begun on therapy with the Travatan® Dosing Aid (TDA) and randomly divided into two observation groups-one with visual and audible alarm functions turned on and the other with alarms off. Dosing information was analyzed for mean rates of adherence, missed days, and dosing at the wrong time. Twenty patients were randomized to the TDA alarm on group and 22 to the alarm off group. The rates of adherence were 87.9% and 79.7% (p = 0.02), rates of missed dosing were 7.6% and 14.4% (p = 0.03), and rates of dosing at the incorrect times were 7.1% and 9.8% (p = 0.19), respectively for alarm on versus alarm off groups. In the alarm on group, the adherence rate was significantly higher and proportion of missed dosing was significantly lower. It is still yet to be determined whether there is a relationship between adherence and progression of glaucoma.Keywords: adherence, glaucoma, Travatan® Dosing Aid, audible alarms, visual alarms Dove Press Lawrence Y Ho, Larissa Camejo, Malik Y Kahook, Robert Noecker 2008-08-11 PDF http://www.dovepress.com/getfile.php?fileID=4373 http://www.dovepress.com/effect-of-audible-and-visual-reminders-on-adherence-in-glaucoma-patien-peer-reviewed-article-OPTH English

oai:dovepress.com/2243 2008-09-18 OPTH

Is reduction in the risk of vision loss the only benefit of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization? Ghazi, Nicola Clinical Ophthalmology Nicola G Ghazi, rian P Conway, James S Tiedeman, Steven J YoonUniversity of Virginia Health System, Department of Ophthalmology, Charlottesville, VA, USAPurpose: To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV).Methods: A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT.Results: After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001).Conclusion: This study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.Keywords: age-related macular degeneration, choroidal neovascularization, classic choroidal neovascularization, disciform scarring, fluorescein angiography, photodynamic therapy Dove Press Nicola G Ghazi, Brian P Conway, James S Tiedeman, Steven J Yoon 2008-09-18 PDF http://www.dovepress.com/getfile.php?fileID=4377 http://www.dovepress.com/is-reduction-in-the-risk-of-vision-loss-the-only-benefit-of-photodynam-peer-reviewed-article-OPTH English

oai:dovepress.com/2150 2008-09-02 OPTH

Pupillography of automated swinging flashlight test in amblyopia Miki, Atsushi Clinical Ophthalmology Atsushi Miki1, Atsuhiko Iijima2, Mineo Takagi1, Kiyoshi Yaoeda1, Tomoaki Usui1, Shigeru Hasegawa1, Haruki Abe1, Takehiko Bando21Department of Ophthalmology; 2Department of Physiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JapanAbstract: Relative afferent pupillary defects (RAPDs) in amblyopia have been reported, and it is widely accepted that amblyopes can have an RAPD. We investigated whether or not this could be confirmed by the use of binocular pupillography. We examined twelve patients (6 males and 6 females, aged 7–57 years) with unilateral amblyopia associated with anisometropia and/or strabismus, using binocular infrared video pupillography (Newopto, Kawasaki, Japan). Eight normal subjects were also tested in the same manner. Two patients’ data had to be excluded because of poor recording quality. Only one patient with moderate anisometropic amblyopia was found to have reduced contraction amplitude in the amblyopic eye, and one patient with a borderline pupillary defect. The other amblyopes, some of whom showed even denser amblyopia, did not have a pupillary defect. This study has confirmed that only a small proportion of amblyopes have a reduced pupillary contraction amplitude in the affected eye, as established by pupillographic recordings, and even these amblyopes are not necessarily associated with dense amblyopia.Keywords: relative afferent pupillary defect, amblyopia, pupillography Dove Press Atsushi Miki, Atsuhiko Iijima, Mineo Takagi, Kiyoshi Yaoeda, Tomoaki Usui, et al 2008-09-02 PDF http://www.dovepress.com/getfile.php?fileID=4380 http://www.dovepress.com/pupillography-of-automated-swinging-flashlight-test-in-amblyopia-peer-reviewed-article-OPTH English

oai:dovepress.com/2152 2008-09-02 OPTH

Intravitreal bevacizumab (Avastin) in the treatment of macular edema secondary to retinal vein occlusion Mesa-Gutierrez, Juan Clinical Ophthalmology Juan Carlos Mesa Gutiérrez, Luis Arias Barquet, Josep Maria Caminal Mitjana, Sergi Prades Almolda, Nùria Planas Domènech, Octavi Pujol Goita, Marc Rubio Caso, Jorge Arruga GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainObjective: To evaluate efficacy and safety of intravitreal injections of bevacizumab in the treatment of macular edema secondary to retinal vein occlusion (RVO).Methods: Prospective study, noncomparative, interventional case series. Twelve consecutive patients (12 eyes) with macular edema associated with nonischemic retinal vein occlusion were treated with intravitreal bevacizumab (1.25 mg). All subjects underwent standardized ophthalmic evaluation at baseline and at weeks 1, 4, 12, and 24, consisting of visual acuity (VA) measurement using ETDRS charts, and imaging with ocular coherence tomography evaluating changes in foveal thickness (FT) and macular volume (MV).Results: The median age was 66 years (± 4.16), and the median duration of symptoms was 4 months (± 1.81). There were six cases of inferior branch vein occlusion and six cases of superior branch retinal vein occlusion. Mean VA improved from 1.32 ± 0.24 (logMAR values) at baseline to 0.8 ± 0.15 (p = 0.0003) at the 6-month follow-up. The macular edema responded promptly, and a trend to restoration of normal macular anatomy was observed at by the seventh day. Mean FT improved from 615.50 ± 116.29 microns to 420 ± 72.53 microns (p = 0.001), and the mean MV improved from 19.81 ± 2.31mm3 to 9.23 ± 1.38 (p = 0.0001) at the 6-month follow-up.Keywords: Bevacizumab, retinal vein occlusion, intravitreal injection, vascular endothelial growth factor Dove Press Juan Carlos Mesa Gutiérrez, Luis Arias Barquet, Josep Maria Caminal Mitjana, Sergi Prades Almolda, Nùria Planas Domènech, et al 2008-09-02 PDF http://www.dovepress.com/getfile.php?fileID=4382 http://www.dovepress.com/intravitreal-bevacizumab-avastin-in-the-treatment-of-macular-edema-sec-peer-reviewed-article-OPTH English

oai:dovepress.com/2439 2008-10-09 OPTH

A comparison of pneumolysin activity and concentration in vitro and in vivo in a rabbit endophthalmitis model Sanders, Melissa Clinical Ophthalmology Melissa E Sanders1, Erin W Norcross1, Quincy C Moore III1, Chinwendu Onwubiko1, Lauren B King1, et al1Department of Microbiology; 2Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USAAbstract: The purpose of this study was to determine whether the in vitro activity and concentration of Streptococcus pneumoniae pneumolysin correlated to the pathogenesis of S. pneumoniae endophthalmitis. Five S. pneumoniae clinical endophthalmitis strains were grown in media to similar optical densities (OD), and extracellular milieu was tested for pneumolysin activity by hemolysis of rabbit red blood cells. Pneumolysin concentration was determined using a sandwich ELISA. Rabbit vitreous was injected with 102 colony-forming units (CFU) of 1 of 2 different strains with low hemolytic activity (n = 10 and 12 for strains 4 and 5, respectively) or 1 of 3 different strains with high hemolytic activity (n = 12 per strain). Pathogenesis of endophthalmitis infection was graded by slit lamp examination (SLE) at 24 hours post-infection. Bacteria were recovered from infected vitreous and quantitated. The SLE scores of eyes infected with strains having high hemolytic activity were significantly higher than the scores of those infected with strains having low hemolytic activity (P > 0.05). Pneumolysin concentration in vitro, however, did not correlate with hemolysis or severity of endophthalmitis. Bacterial concentrations from the vitreous infected with 4 of the strains were not significantly different (P > 0.05). These data suggest that pneumolysin hemolytic activity in vitro directly correlates to the pathogenesis of S. pneumoniae endophthalmitis. The protein concentration of pneumolysin, however, is not a reliable indicator of pneumolysin activity.Keywords: Streptococcus pneumoniae, endophthalmitis, pneumolysin, pneumococcal Dove Press Melissa E Sanders, Erin W Norcross, Quincy C Moore III, Chinwendu Onwubiko, Lauren B King, et al 2008-10-09 PDF http://www.dovepress.com/getfile.php?fileID=4384 http://www.dovepress.com/a-comparison-of-pneumolysin-activity-and-concentration-emin-vitroem-an-peer-reviewed-article-OPTH English

oai:dovepress.com/2859 2009-02-09 OPTH

A clinical study of annular cyclitis Moschos, Marilita Clinical Ophthalmology Marilita Michael Moschos1, Yan Guex-Crosier2, Ioannis Margetis1, Leonidas Zografos21Department of Ophthalmology, University of Athens, Greece; 2Jules Gonin Eye Hospital, University of Lausanne, SwitzerlandPurpose: To investigate six cases of annular cyclitis.Methods: All patients with impairment of visual acuity underwent complete ophthalmologic examination, color fundus photography, laboratory tests and fluorescein angiography. Indocyanine green (ICG) angiography and B-scan ultrasonography were also performed in three cases in order to diagnose the disease.Results: All patients presented a unilateral or bilateral granulomatous uveitis, associated with inflammatory annular cyclitis. They had a shallow anterior chamber, a mildly elevated intraocular pressure (under 25 mm Hg) and an annular serous retinal detachment. A resolution was observed after specific therapy associated with systemic prednisolone therapy and antiglaucomatous drops.Conclusion: This is the first description of an observational study of six patients with inflammatory annular cyclitis.Keywords: cyclitis, uveitis, malignant glaucoma Dove Press Marilita Michael Moschos, Yan Guex-Crosier, Ioannis Margetis, Leonidas Zografos 2009-02-09 PDF http://www.dovepress.com/getfile.php?fileID=4403 http://www.dovepress.com/a-clinical-study-of-annular-cyclitis-peer-reviewed-article-OPTH English

oai:dovepress.com/2760 2008-12-23 OPTH

A new agent for the treatment of noninfectious uveitis: rationale and design of three LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to Treatment) trials of steroid-sparing voclosporin Anglade, Eddy Clinical Ophthalmology Eddy Anglade1, Launa J Aspeslet2, Sidney L Weiss11Lux Biosciences Inc., Jersey City, NJ, USA; 2Isotechnika Inc., Edmonton, AB, CanadaAbstract: Uveitis is an inflammatory, putative Th1-mediated autoimmune disease that affects various parts of the eye and is a leading cause of visual loss. Currently available therapies are burdened with toxicities and/or lack definitive evidence of efficacy. Voclosporin, a rationally designed novel calcineurin inhibitor, exhibits a favorable safety profile, a strong correlation between pharmacokinetic and pharmacodynamic response, and a wide therapeutic window. The LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to TrEatment) clinical development program was initiated in 2007 to assess the safety and efficacy of voclosporin for the treatment, maintenance, and control of all forms of noninfectious uveitis. If LUMINATE is successful, voclosporin will become the first Food and Drug Administration-approved corticosteroid-sparing agent for this condition.Keywords: voclosporin, calcineurin inhibitors, LX211, LUMINATE trials, ophthalmic diseases, uveitis, ISA247 Dove Press Eddy Anglade, Launa J Aspeslet, Sidney L Weiss 2008-12-23 PDF http://www.dovepress.com/getfile.php?fileID=4359 http://www.dovepress.com/a-new-agent-for-the-treatment-of-noninfectious-uveitis-rationale-and-d-peer-reviewed-article-OPTH English

oai:dovepress.com/2563 2008-11-11 OPTH

Glial and endothelial blood-retinal barrier responses to amyloid-β in the neural retina of the rat Anderson, Peter Clinical Ophthalmology Peter JB Anderson1,a, HR Watts1,a, CJ Hille3, KL Philpott3, P Clark4, M Croucher, S Gentleman2, Ling-Sun Jen11Department of Cellular and Molecular Neuroscience; 2Department of Clinical Neuroscience, Division of Neuroscience and Mental Health, Imperial College London, Charing Cross Hospital Campus, London, UK; 3Neurosciences, Centre of Excellence for Drug Discovery, GlaxoSmithKline Pharmaceuticals, Harlow, Essex, UK; 4Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK; aThese researchers contributed equally to this paperAbstract: The effects of an intravitreal or subretinal injection of soluble or aggregated forms of Aβ1–42 on retinal nestin-immunoreactivity (-IR) and glial fibrillary acidic protein (GFAP)-IR in astrocytes and Müller glial cells and the integrity of the blood-retinal barrier (BRB) were tested in the in vivo rat vitreal-retinal model. Retinas were exposed for 1, 2, 3, 5 or 30 days. We present novel data demonstrating that aggregated Aβ1–42 up-regulates nestin-IR in astrocytes and Müller cells, with a graded response directly related to the length of pre-injection aggregation time. Similar results were obtained with GFAP-IR, but the signal was weaker. An intravitreal injection of aggregated Aβ1–42 led to VEGF-IR up-regulation, particularly in the GCL and to a lesser extent in the INL. VEGFR1-IR (Flt1) was also increased, particularly in Müller cells and this was accompanied by marked leakage of albumin into the retinal parenchyma of the injected eye, but not in the contralateral eye.Keywords: amyloid-β, Müller cells, blood-retinal barrier Dove Press Peter JB Anderson, HR Watts, CJ Hille, KL Philpott, P Clark, et al 2008-11-11 PDF http://www.dovepress.com/getfile.php?fileID=4386 http://www.dovepress.com/glial-and-endothelial-blood-retinal-barrier-responses-to-amyloid-beta--peer-reviewed-article-OPTH English

oai:dovepress.com/2004 2008-08-21 OPTH

Foveal thickness after phacoemulsification as measured by optical coherence tomography Georgalas, Ilias Clinical Ophthalmology Gerasimos Th Georgopoulos, Dimitrios Papaconstantinou, Maria Niskopoulou, Marilita Moschos, Ilias Georgalas, Chrysanthi KoutsandreaGlaucoma Department, Medical School, Athens University, Athens, GreeceBackground: Despite a significant body of research, no consistency on postoperative foveal thickness as measured by optical coherence tomography (OCT), can be recorded. The purpose of our study was to evaluate the effect of uncomplicated cataract surgery in the thickness of the retina in the foveal area during the early postoperative period.Methods: In a prospective study, 79 eyes were assessed by OCT, on day 1, and weeks 2 and 4 after uncomplicated phacoemulsification with intraocular lens implantation in the Athens University Clinic. The outcome measure was the thickness of the retina in the foveal area.Results: The thickness of the retina preoperatively is significantly smaller (150.4 ± 18.8) (p < 0.05) than the thickness of the retina on day 1 (171.8 ± 21) and week 2 (159.7 ± 19) and returned to the initial levels on week 4 (152 ± 17.1). The estimated correlation coefficients between preoperative and postoperative thickness of the retina were significant (p < 0.05). Conversely, no association was found between postoperative visual acuity and thickness of the retina, neither between the phacoemulsification energy and retinal thickness. Operation time, although inversely related with postoperative visual acuity, was not associated with the thickness of the retina.Conclusions: Following phacoemulsification, an increase in the foveal thickness was detected in the early postoperative period, quantified and followed up by OCT. The foveal thickness returned to the preoperative level, 1 month following surgery in our study. No association was shown between intraoperative parameters and increased postoperative retinal thickness.Keywords: optical coherence tomography, phacoemulsification, retinal thickness Dove Press Gerasimos Th Georgopoulos, Dimitrios Papaconstantinou, Maria Niskopoulou, Marilita Moschos, Ilias Georgalas, Chrysanthi Koutsandrea 2008-08-21 PDF http://www.dovepress.com/getfile.php?fileID=4390 http://www.dovepress.com/foveal-thickness-after-phacoemulsification-as-measured-by-optical-cohe-peer-reviewed-article-OPTH English

oai:dovepress.com/2516 2008-10-30 OPTH

Misregulation of rhodopsin phosphorylation and dephosphorylation found in P23H rat retinal degeneration Ohguro, Hiroshi Clinical Ophthalmology Yoshiyuki Saito1, Hiroshi Ohguro1, Ikuyo Ohguro1, Noriyuki Sato2, Futoshi Ishikawa3, Hitoshi Yamazaki3, Tomomi Metoki3, Tadashi Ito3, Mitsuru Nakazawa31Department of Ophthalmology; 2Department of Pathology (Section 1), Sapporo Medical University School of Medicine, Sapporo, Japan; 3Department of Ophthalmology, Hirosaki University School of Medicine, Hirosaki, JapanAbstract: To examine rhodopsin (Rho) functions in P23H rat, kinetics of Rho regeneration and dephosphorylation were investigated by spectrophotometric analysis and immunofluorescence labeling method using specific antibodies toward phosphorylated 334Ser or 338Ser site. Rho dephosphorylation at both sites was extremely delayed in P23H retina as compared to normal ones. Kinetics of Rho regeneration was not altered between normal and P23H rats under dark adaptation. Next, to study the effects of several Ca2+ channel blockers on this model, retinal function and morphology were evaluated. Among them, nilvadipine showed a significant protective effect against P23H retinal degeneration. Neurotrophic factor, fibroblast growth factor-2 and Arc, known to suppress the apoptosis in the central nervous system, were significantly upregulated upon administration of nilvadipine. The present study indicates that misregulation of Rho phosphorylation may be involved as an important step in retinal degeneration of P23H and administration of nilvadipine may be a potential therapeutic agent for the retinal degenerations.Keywords: rhodopsin, P23H rat, retinitis pigmentosa, mutation Dove Press Yoshiyuki Saito, Hiroshi Ohguro, Ikuyo Ohguro, Noriyuki Sato, Futoshi Ishikawa, et al 2008-10-30 PDF http://www.dovepress.com/getfile.php?fileID=4396 http://www.dovepress.com/misregulation-of-rhodopsin-phosphorylation-and-dephosphorylation-found-peer-reviewed-article-OPTH English

oai:dovepress.com/1934 2008-08-04 OPTH

Treatment of chronic dry eye: focus on cyclosporine Kymionis, George Clinical Ophthalmology George D Kymionis, Dimitrios I Bouzoukis, Vassilios F Diakonis, Charalambos SiganosDepartment of Ophthalmology, Vardinoyannion Eye Institute of Crete, University of Crete, GreeceAbstract: To review the current treatment of chronic dry eye syndrome, focusing on cyclosporine A (CsA), a systematic literature search was performed using PubMed databases in two steps. The first step was oriented to articles published for dry eye. The second step was focused on the use of CsA in dry eye. A manual literature search was also undertaken based on citations in the published articles. The knowledge on the pathogenesis of dry eye syndrome has changed dramatically during the last few years. Inflammation and the interruption of the inflammatory cascade seem to be the main focus of the ophthalmologic community in the treatment of dry eye, giving the anti-inflammatory therapy a new critical role. The infiltration of T-cells in the conjuctiva tissue and the presence of cytokines and proteasis in the tear fluid were the main reason introducing the use of immunomodulator agents such as corticosteroids, cyclosporine, and doxycicline in order to treat dry eye syndrome. CsA emulsion is approved by the FDA for the treatment of dry eye, while clinical trials of this agent have demonstrated efficacy and safety of CsA. CsA seems to be a promising treatment against dry eye disease. New agents focused on the inflammatory pathogenesis of this syndrome in combination with CsA may be the future in the quest of treating dry eye. More studies are needed to determine the efficacy, safety, timing, and relative cost/effect of CsA.Keywords: dry eye, cyclosporine A, inflammation, immunomodulator agents Dove Press George D Kymionis, Dimitrios I Bouzoukis, Vassilios F Diakonis, Charalambos Siganos 2008-08-04 PDF http://www.dovepress.com/getfile.php?fileID=4354 http://www.dovepress.com/treatment-of-chronic-dry-eye-focus-on-cyclosporine-peer-reviewed-article-OPTH English

oai:dovepress.com/2245 2008-09-18 OPTH

Molecular markers of susceptibility to ocular toxoplasmosis, host and guest behaving badly Vallochi, Adriana Clinical Ophthalmology Adriana Lima Vallochi1, Anna Carla Goldberg2, Angela Falcai3, Rajendranath Ramasawmy4, Jorge Kalil4, Cláudio Silveira5, Rubens Belfort Jr5, Luiz Vicente Rizzo31Oswaldo Cruz Institution (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil; 2NUCEL – Cellular and Molecular Therapy Center, University of São Paulo, São Paulo, SP, Brazil; 3Department of Immunology, Biomedical Science Institute, University of São Paulo, São Paulo, SP, Brazil; 4Laboratory of Immunology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil; 5Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, BrazilAbstract: Infection with Toxoplasma gondii results in retinochoroiditis in 6% to 20% of immunocompetent individuals. The outcome of infection is the result of a set of interactions involving host genetic background, environmental, and social factors, and the genetic background of the parasite, all of which can be further modified by additional infections or even reinfection. Genes that encode several components of the immune system exhibit polymorphisms in their regulatory and coding regions that affect level and type of expression in response to stimuli, directing the immune response into different pathways. These variant alleles have been associated with susceptibility to immune-mediated diseases and with severity of pathology. We have investigated polymorphisms in several of these genes, identified as candidates for progression to retinochoroiditis caused by toxoplasmosis, namely chemokine (C-C motif) receptor 5 (CCR5), toll-like receptor-2 (TLR2), and TLR4. Furthermore, because interleukin-12 (IL-12) has been shown to be fundamental both in mice and in man to control a protective response against T. gondii, molecules that have a key function in IL-12 production will be emphasized in this review, in addition to discussing the importance of the genetic background of the parasite in the establishment of ocular disease.Keywords: ocular toxoplasmosis, IL-12, TLR, CCR5, immunity Dove Press Adriana Lima Vallochi, Anna Carla Goldberg, Angela Falcai, Rajendranath Ramasawmy, Jorge Kalil, et al 2008-09-18 PDF http://www.dovepress.com/getfile.php?fileID=4357 http://www.dovepress.com/molecular-markers-of-susceptibility-to-ocular-toxoplasmosis-host-and-g-peer-reviewed-article-OPTH English

oai:dovepress.com/411 2008-04-30 OPTH

Dysfunctional regulation of ocular blood flow: A risk factor for glaucoma? Harris, Alon Clinical Ophthalmology Danny Moore, Alon Harris, Darrell WuDunn, Nisha Kheradiya, Brent Siesky1Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: Primary open angle glaucoma (OAG) is a multifactorial optic neuropathy characterized by progressive retinal ganglion cell death and associated visual field loss. OAG is an emerging disease with increasing costs and negative outcomes, yet its fundamental pathophysiology remains largely undetermined. A major treatable risk factor for glaucoma is elevated intraocular pressure (IOP). Despite the medical lowering of IOP, however, some glaucoma patients continue to experience disease progression and subsequent irreversible vision loss. The scientific community continues to accrue evidence suggesting that alterations in ocular blood flow play a prominent role in OAG disease processes. This article develops the thesis that dysfunctional regulation of ocular blood flow may contribute to glaucomatous optic neuropathy. Evidence suggests that impaired vascular autoregulation renders the optic nerve head susceptible to decreases in ocular perfusion pressure, increases in IOP, and/or increased local metabolic demands. Ischemic damage, which likely contributes to further impairment in autoregulation, results in changes to the optic nerve head consistent with glaucoma. Included in this review are discussions of conditions thought to contribute to vascular regulatory dysfunction in OAG, including atherosclerosis, vasospasm, and endothelial dysfunction.Keywords: glaucoma, autoregulation, blood flow, atherosclerosis, vasospasm, endothelial dysfunction Dove Press Danny Moore, Alon Harris, Darrell WuDunn, Nisha Kheradiya, Brent Siesky 2008-04-30 PDF http://www.dovepress.com/getfile.php?fileID=4364 http://www.dovepress.com/dysfunctional-regulation-of-ocular-blood-flow-a-risk-factor-for-glauco-peer-reviewed-article-OPTH English

oai:dovepress.com/420 2008-05-28 OPTH

Collagen cross-linking: Strengthening the unstable cornea Tomkins, Oren Clinical Ophthalmology Oren Tomkins, Hanna J GarzoziDepartment of Ophthalmology, Bnai Zion Medical Center, Haifa, IsraelAbstract: Corneal ectasia, a weakening of corneal integrity, occurs both due to acquired and congenital conditions such as keratoconus. It is a progressing condition that affects both visual acuity, and corneal stability. Various methods exist for correcting this impairment, however none address the inherit pathology, an increase laxity of the corneal stroma. Collagen crosslinking, a new, minimally invasive method, aims to strengthen the stroma by inducing cross links between neighboring collagen fibers. This method results in an increase in corneal tensile strength, with no medium term adverse effects on its normal architecture. Clinically, treated patients display improvement in both visual acuity and keratometric readings. This method may provide clinicians with easily accessible tools to stop the progression, and even correct visual deterioration due to corneal ectasia. Here we review the current information regarding this new method, as well as discuss its potential benefits and downfalls.Keywords: corneal cross-linking, corneal ectasia, keratoconus, stroma, cornea Dove Press Oren Tomkins, Hanna J Garzozi 2008-05-28 PDF http://www.dovepress.com/getfile.php?fileID=4365 http://www.dovepress.com/collagen-cross-linking-strengthening-the-unstable-cornea-peer-reviewed-article-OPTH English

oai:dovepress.com/1711 2008-07-02 OPTH

Bifocal contact lenses: History, types, characteristics, and actual state and problems Hiroshi Toshida, Hiroshi Clinical Ophthalmology Hiroshi Toshida, Kozo Takahashi, Kazushige Sado, Atsushi Kanai, Akira MurakamiDepartment of Ophthalmology, Juntendo University School of Medicine, Tokyo, JapanAbstract: Since people who wear contact lenses (CL) often continue using CL even when they develop presbyopia, there are growing expectations for bifocal CL. To understand actual state and problems, history, types, and their characteristics are summarized in this review. Bifocal CL have a long history over 70 years. Recently, bifocal CL have achieved remarkable progress. However, there still is an impression that prescription of bifocal CL is not easy. It should also be remembered that bifocal CL have limits, including limited addition for near vision, as well as the effects of aging and eye diseases in the aged, such as dry eye, astigmatism, cataract, etc. Analysis of the long-term users of bifocal CL among our patients has revealed the disappearance of bifocal CL that achieved unsatisfactory vision and poor contrast compared with those provided by other types of CL. Changing the prescription up to 3 times for lenses of the same brand may be appropriate. Lenses that provide poor contrast sensitivity, suffer from glare, or give unsatisfactory vision have been weeded out. The repeated replacement of products due to the emergence of improved or new products will be guessed.Keywords: bifocal contact lens, presbyopia, accommodation Dove Press Hiroshi Toshida, Kozo Takahashi, Kazushige Sado, Atsushi Kanai, Akira Murakami 2008-07-02 PDF http://www.dovepress.com/getfile.php?fileID=4369 http://www.dovepress.com/bifocal-contact-lenses-history-types-characteristics-and-actual-state--peer-reviewed-article-OPTH English

oai:dovepress.com/1978 2008-08-12 OPTH

Hypoxia-ischemia and retinal ganglion cell damage Kaur, Charanjit Clinical Ophthalmology Charanjit Kaur1, Wallace S Foulds2, Eng-Ang Ling11Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2Singapore Eye Research Institute, SingaporeAbstract: Retinal hypoxia is the potentially blinding mechanism underlying a number of sight-threatening disorders including central retinal artery occlusion, ischemic central retinal vein thrombosis, complications of diabetic eye disease and some types of glaucoma. Hypoxia is implicated in loss of retinal ganglion cells (RGCs) occurring in such conditions. RGC death occurs by apoptosis or necrosis. Hypoxia-ischemia induces the expression of hypoxia inducible factor-1α and its target genes such as vascular endothelial growth factor (VEGF) and nitric oxide synthase (NOS). Increased production of VEGF results in disruption of the blood retinal barrier leading to retinal edema. Enhanced expression of NOS results in increased production of nitric oxide which may be toxic to the cells resulting in their death. Excess glutamate release in hypoxic-ischemic conditions causes excitotoxic damage to the RGCs through activation of ionotropic and metabotropic glutamate receptors. Activation of glutamate receptors is thought to initiate damage in the retina by a cascade of biochemical effects such as neuronal NOS activation and increase in intracellular Ca2+ which has been described as a major contributing factor to RGC loss. Excess production of proinflammatory cytokines also mediates cell damage. Besides the above, free-radicals generated in hypoxic-ischemic conditions result in RGC loss because of an imbalance between antioxidant- and oxidant-generating systems. Although many advances have been made in understanding the mediators and mechanisms of injury, strategies to improve the damage are lacking. Measures to prevent neuronal injury have to be developed.Keywords: retinal hypoxia, retinal ganglion cells, glutamate receptors, neuronal injury, retina Dove Press Charanjit Kaur, Wallace S Foulds, Eng-Ang Ling 2008-08-12 PDF http://www.dovepress.com/getfile.php?fileID=4374 http://www.dovepress.com/hypoxia-ischemia-and-retinal-ganglion-cell-damage-peer-reviewed-article-OPTH English

oai:dovepress.com/2268 2008-09-24 OPTH

Use of triamcinolone during vitrectomy surgery to visualize membranes and vitreous Bakri, Sophie Clinical Ophthalmology Steven M Couch, Sophie J BakriMayo Clinic Department of Ophthalmology, Mayo Clinic, Rochester, MN, USAAbstract: Triamcinolone is a corticosteroid that is used to treat many ophthalmic diseases. Recently, its use has been advocated to aid in visualization of transparent tissue in ophthalmic surgery. It can be used in anterior segment surgery to help manage vitreous loss during complicated cataract surgery. It has been used to visualize the posterior cortical vitreous during pars plana vitrectomy. In addition, it can be useful in the visualization and peeling of the internal limiting membrane. Triamcinolone has been advocated in surgical repair of proliferative vitreoretinopathy both for its visualizing properties and its anti-inflammatory properties. Overall, triamcinolone use in surgery is safe with low incidence of complications including elevated intraocular pressure, cataract and endophthalmitis.Keywords: cataract surgery, chromovitrectomy, epiretinal membrane, internal limiting membrane, triamcinolone acetonide, vitrectomy Dove Press Steven M Couch, Sophie J Bakri 2008-09-24 PDF http://www.dovepress.com/getfile.php?fileID=4375 http://www.dovepress.com/use-of-triamcinolone-during-vitrectomy-surgery-to-visualize-membranes--peer-reviewed-article-OPTH English

oai:dovepress.com/2801 2009-01-20 OPTH

Latanoprost ophthalmic solution in the treatment of open angle glaucoma or raised intraocular pressure: a review Quaranta, Luciano Clinical Ophthalmology Andrea Russo, Ivano Riva, Teodoro Pizzolante, Federico Noto, Luciano QuarantaCattedra di Malattie dell’Apparato Visivo, Università degli studi di Brescia, USVD “Centro per lo studio del Glaucoma” Spedali Civili di BresciaAbstract: Latanoprost is a prostaglandin F2-alpha isopropyl ester prodrug which is rapidly hydrolyzed by esterases in the cornea to the biologically active latanoprost acid. When latanoprost is topically administered into the eye, the cornea seems to act like as a slow-release depot to the anterior segment. One hour after administration maximum concentration is found in the iris, followed by the anterior chamber and the ciliary body. Despite extensive research, controversy remains about the real mechanism of action of this drug. Immunohistochemical data have shown that the intraocular pressure (IOP) reduction with topical prostaglandin F2-alpha is associated with a reduction of collagens within the uveoscleral outflow pathway. Evidence from several experimental and clinical studies suggests that latanoprost is a valuable addition first-line treatment alternatives for glaucoma, ocular hypertension and even angle-closure glaucoma. Strong points are its efficacy, which is demonstrated to be higher than that of brimonidine, dorzolamide and timolol with fewer systemic adverse effects; a convenient administration schedule; and the IOP-controlling pattern, which is relatively flat compared with timolol and dorzolamide, and enables better control in glaucoma progression, since large fluctuations may be associated with the risk of developing glaucoma in untreated ocular hypertensive subjects.Keywords: latanoprost, intraocular pressure, glaucoma, ocular hypertension Dove Press Andrea Russo, Ivano Riva, Teodoro Pizzolante, Federico Noto, Luciano Quaranta 2009-01-20 PDF http://www.dovepress.com/getfile.php?fileID=4370 http://www.dovepress.com/latanoprost-ophthalmic-solution-in-the-treatment-of-open-angle-glaucom-peer-reviewed-article-OPTH English

oai:dovepress.com/2032 2008-08-29 OPTH

The clinical and cellular basis of contact lens-related corneal infections Robertson, Danielle Clinical Ophthalmology Danielle M Robertson, H Dwight CavanaghDepartment of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, USAAbstract: Microbial keratitis (MK) is the most visually devastating complication associated with contact lens wear. Pseudomonas aeruginosa (PA) is highly invasive in the corneal epithelium and is responsible for more than half of the reported cases of contact lens-related MK. To protect against Pseudomonas-mediated MK, the corneal epithelium has evolved overlapping defense mechanisms that function to protect the ocular surface from microbial invasion. Research has shown that contact lens wear disrupts these protective mechanisms through breakdown of normal homeostatic surface renewal as well as damaging the corneal surface, exposing underlying cell membrane receptors that bind and internalize PA through the formation of lipid rafts. Human clinical trials have shown that initial adherence of PA with resulting increased risk for microbial infection is mediated in part by contact lens oxygen transmissibility. Recently, chemical preserved multipurpose solutions (MPS) have been implicated in increasing PA adherence to corneal epithelial cells, in addition to inducing significant levels of toxic staining when used in conjunction with specific silicone hydrogel lenses. This review summarizes what is currently known about the relationship between contact lenses, the corneal epithelium, MPS, and infection.Keywords: cornea, epithelium, contact lens, microbial keratitis Dove Press Danielle M Robertson, H Dwight Cavanagh 2008-08-29 PDF http://www.dovepress.com/getfile.php?fileID=4372 http://www.dovepress.com/the-clinical-and-cellular-basis-of-contact-lens-related-corneal-infect-peer-reviewed-article-OPTH English

oai:dovepress.com/2406 2008-10-07 OPTH

Cystoid macular edema Rotsos, Tryfon Clinical Ophthalmology Tryfon G Rotsos1, Marilita M Moschos21Medical Retina Service, Moorfields Eye Hospital, London, UK; 2Department of Ophthalmology, University of Athens, GreeceAbstract: We review the epidemiology, pathophysiology, and etiology of cystoid macular edema (CME). Inflammatory, diabetic, post-cataract, and macular edema due to age-related macular degeneration is described. The role of chronic inflammation and hypoxia and direct macular traction is evaluated in each case according to different views from the literature. The different diagnostic methods for evaluating the edema are described. Special attention is given to fluoroangiography and the most modern methods of macula examination, such as ocular coherence tomography and multifocal electroretinography. Finally, we discuss the treatment of cystoid macular edema in relation to its etiology. In this chapter we briefly refer to the therapeutic value of laser treatment especially in diabetic maculopathy or vitrectomy in some selected cases. Our paper is focused mainly on recent therapeutic treatment with intravitreal injection of triamcinolone acetonide and anti-VEGF factors like bevacizumab (Avastin), ranibizumab (Lucentis), pegaptamid (Macugen), and others. The goal of this paper is to review the current status of this treatment for macular edema due to diabetic maculopathy, central retinal vein occlusion and post-cataract surgery. For this reason the results of recent multicenter clinical trials are quoted, as also our experience on the use of intravitreal injections of anti-VEGF factors and we discuss its value in clinical practice.Keywords: cystoid macular edema, anti-VEGF, fluoroangiography, OCT, multifocal electroretinography Dove Press Tryfon G Rotsos, Marilita M Moschos 2008-10-07 PDF http://www.dovepress.com/getfile.php?fileID=4391 http://www.dovepress.com/cystoid-macular-edema-peer-reviewed-article-OPTH English

oai:dovepress.com/424 2008-06-05 OPTH

The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up Fea, Antonio Clinical Ophthalmology Antonio M Fea, Monica Dogliani, Federica Machetta, Gabriella Lale-Lacroix, Beatrice Brogliatti, Federico MGrignoloIstituto di Fisiopatologia Clinica, Clinica Oculistica, Università di Torino, ItalyPurpose: To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment.Design: Observational case report.Methods: We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field.Results: The patient’s intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged.Conclusions: We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur.Keywords: stent, trabecular bypass, intraocular pressure, glaucoma Dove Press Antonio M Fea, Monica Dogliani, Federica Machetta, Gabriella Lale-Lacroix, Beatrice Brogliatti, Federico MGrignolo 2008-06-05 PDF http://www.dovepress.com/getfile.php?fileID=4358 http://www.dovepress.com/the-trabecular-bypass-stent-in-a-pseudophakic-glaucoma-patient-a-1-yea-peer-reviewed-article-OPTH English

oai:dovepress.com/2242 2008-09-18 OPTH

Bacterial endophthalmitis following 25-gauge transconjunctival sutureless vitrectomy Hainsworth, Dean Clinical Ophthalmology Drew N Sommerville, Dean P HainsworthThe Mason Eye Institute, University of Missouri, Columbia, Missouri, USAPurpose: To report a case of endophthalmitis following 25-gauge transconjunctival sutureless vitrectomy.Design: Observational case report.Methods: An 87-year-old male who underwent sutureless 25-gauge vitrectomy developed unilateral endophthalmitis. Vitreous culture revealed Staphylococcus coagulase-negative bacteria. He was subsequently treated with intravitreal antibiotics and oral prednisone.Results: The endophthalmitis resolved with a best corrected visual acuity of 6/200 with the presence of an epiretinal membrane.Conclusions: Possible contributing factors to endophthalmitis following sutureless vitrectomy include decreased vitreous irrigation/lavage, lack of a watertight wound, and/or vitreous wicking, all of which may promote intraocular bacterial entrance. A sutureless vitrectomy system may increase the risk of vitrectomy-associated endophthalmitis.Keywords: endophthalmitis, 25-gauge vitrectomy, vitreous wick, sutureless, high flow lavage Dove Press Drew N Sommerville, Dean P Hainsworth 2008-09-18 PDF http://www.dovepress.com/getfile.php?fileID=4360 http://www.dovepress.com/bacterial-endophthalmitis-following-25-gauge-transconjunctival-suturel-peer-reviewed-article-OPTH English

oai:dovepress.com/377 2008-06-05 OPTH

Acute visual loss and intraocular hemorrhages associated with endoscopic spinal surgery Moschos, Marilita Clinical Ophthalmology Marilita M Moschos, Alexandros Rouvas, Alexios Papaspirou, Michael ApostolopoulosDepartment of Ophthalmology, University of Athens, GreecePurpose: To report a case of acute visual loss after endoscopic spinal surgery.Methods: A patient was immediately referred to our department after epidural endoscopy with severe bilateral visual impairment and underwent complete ophthalmologic examination.Results: Visual acuity was decreased in both eyes. Fundus examination revealed the presence of retinal and vitreous hemorrhages bilaterally. Four months later, visual acuity increased and the hemorrhages were remarkably resolved.Conclusion: The present case represents an extremely rare incidence of intraocular hemorrhage following epiduroscopy.Keywords: visual acuity, hemorrhage, intraocular, BCVA Dove Press Marilita M Moschos, Alexandros Rouvas, Alexios Papaspirou, Michael Apostolopoulos 2008-06-05 PDF http://www.dovepress.com/getfile.php?fileID=4378 http://www.dovepress.com/acute-visual-loss-and-intraocular-hemorrhages-associated-with-endoscop-peer-reviewed-article-OPTH English

oai:dovepress.com/1693 2008-06-19 OPTH

Bilateral idiopathic orbital inflammation 3 years before systemic Wegener´s granulomatosis in a 7-year-old girl Mencía-Gutiérrez, Enrique Clinical Ophthalmology Juan D Martínez-Gutiérrez1, Enrique Mencía-Gutiérrez1, Esperanza Gutiérrez-Díaz1, José L Rodríguez-Peralto2Departments of 1Ophthalmology and 2Pathology, 12 de Octubre Hospital, Complutense University, Madrid, SpainAbstract: Wegener’s granulomatosis (WG) is a necrotizing granulomatous vasculitis characterized by the involvement of the upper or lower airways, lungs, and kidneys, but it can affect almost any organ including the orbit. WG is rare in childhood. This case report describes a 7-year-old girl who presented bilateral idiophatic orbital inflammation and antineutrophil cytoplasmic antibodies-negative titres. Computed tomography scan and magnetic resonance imaging showed enlargement of both lacrimal glands with infiltration. Treatment with corticosteroids achieved remission of the disease. Three years later, she developed a systemic affectation with tracheal stenosis, pulmonary affectation, renal failure, and respiratory tract mucosa inflammation. Lacrimal gland biopsy showed perivascular nonspecific granulomas and ANCA titres remain negative. Treatment with corticosteroids and cyclophosphamide was done. A relapse occurred 2 years later, with complete remission with antitumor necrosis factor-alpha. No other symptoms have appeared after 9 years of follow-up. Early diagnosis and treatment is crucial to increase the survival rate in these patients.Keywords: ANCA, children, idiopathic orbital inflammation, exophthalmos, vasculitis, Wegener’s granulomatosis Dove Press Juan D Martínez-Gutiérrez, Enrique Mencía-Gutiérrez, Esperanza Gutiérrez-Díaz, José L Rodríguez-Peralto 2008-06-19 PDF http://www.dovepress.com/getfile.php?fileID=4381 http://www.dovepress.com/bilateral-idiopathic-orbital-inflammation-3-years-before-systemic-wege-peer-reviewed-article-OPTH English

oai:dovepress.com/2623 2008-11-24 OPTH

Successful resection of the recurrence of a cavernous malformation of the optic chiasm Scholz, Martin Clinical Ophthalmology Martin Scholz, Albrecht Harders, Sebastian Lücke, Ioannis Pechlivanis, Martin Engelhardt, Kirsten SchmiederDepartment of Neurosurgery, Ruhr-University Bochum, Knappschaftskrankenhaus, GermanyAbstract: The case of a 33-year-old female who suffered from a recurrence of an intrachiasmatic cavernous malformation is presented. She had already undergone surgery in 1991 and 2001 and was admitted to our hospital with reduced vision in the right eye. After MRI, and diagnosis of recurrence of the cavernoma, a neurosurgical operation was performed using the pterional approach. The intraoperative situation was documented with micro photographs. The postoperative course was uneventful. The female described a minimal improvement of her vision. No postoperative complications were observed. To our knowledge, microsurgically complete extirpation of a recurrence of an intrachiasmatic cavernoma has not yet been reported in the literature.Keywords: optic chiasm, pterional approach, cavernous malformation Dove Press Martin Scholz, Albrecht Harders, Sebastian Lücke, Ioannis Pechlivanis, Martin Engelhardt, Kirsten Schmieder 2008-11-24 PDF http://www.dovepress.com/getfile.php?fileID=4363 http://www.dovepress.com/successful-resection-of-the-recurrence-of-a-cavernous-malformation-of--peer-reviewed-article-OPTH English

oai:dovepress.com/2607 2008-11-20 OPTH

Anterior segment granuloma and optic nerve involvement as the presenting signs of systemic sarcoidosis Moschos, Marilita Clinical Ophthalmology Marilita M Moschos1, Yan Guex-Crosier21Department of Ophthalmology, University of Athens, Athens, Greece; 2Jules Gonin Eye Hospital, University of Lausanne, Lausanne, SwitzerlandPurpose: To report a case with anterior and posterior nodules associated with systemic sarcoidosis.Methods: A patient with decreased vision underwent complete ophthalmologic examination, ultrasound biomicroscopy, fluorescein and indocyanine green (ICG) angiography.Results: The patient presented a nodule of the iris of the OS and of the optic nerves of both eyes. Chest computed tomography and tissue biopsy established the diagnosis.Conclusions: Fluorescein and ICG angiography are the only objective exams to demonstrate the extent of ocular involvement in a patient with sarcoidosis.Keywords: sarcoidosis, fluorescein angiography, indocyanine angiography Dove Press Marilita M Moschos, Yan Guex-Crosier 2008-11-20 PDF http://www.dovepress.com/getfile.php?fileID=4379 http://www.dovepress.com/anterior-segment-granuloma-and-optic-nerve-involvement-as-the-presenti-peer-reviewed-article-OPTH English

oai:dovepress.com/2861 2009-02-10 OPTH

Vision loss associated with the use and removal of intraocular silicone oil Fuller, Christopher Clinical Ophthalmology Patrick D Williams1, Christopher G Fuller1, Ingrid U Scott2, Dwain G Fuller1, Harry W Flynn Jr31Texas Retina Associates, Dallas, TX, USA; 2Departments of Ophthalmology and Health Evaluation Sciences, Penn State College of Medicine, Hershey, PA, USA; 3Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USAPurpose: To describe vision loss associated with the use or removal of silicone oil retinal tamponade.Methods: Records were reviewed of all patients with a decrease in visual acuity of at least 3 Snellen lines from best acuity with 5000 centistoke silicone oil in place or after removal of silicone oil at a single retina-only practice between 1996 and 2006.Results: Nine patients (6 men, 3 women) with a mean age of 48 years (range, 16–61) met study inclusion criteria. Seven patients lost at least three Snellen lines of vision while the silicone oil was in place. Four patients had late modest improvements in acuity when compared to their final recorded Snellen vision before silicone oil removal, however no patients exhibited visual improvement when comparing their final recorded visual acuities after oil removal with best recorded acuities under oil tamponade. Loss of the foveal depression was a consistent feature on optical coherence tomography.Conclusions: Vision loss is a possible complication of silicone oil use and removal. Late visual improvement may occur in some patients. Further research is warranted to elucidate the mechanism(s) of vision loss associated with the use or removal of silicone oil.Keywords: retinal tamponade, visual acuity, snellen vision, silicone oil Dove Press Patrick D Williams, Christopher G Fuller, Ingrid U Scott, Dwain G Fuller, Harry W Flynn Jr 2009-02-10 PDF http://www.dovepress.com/getfile.php?fileID=4383 http://www.dovepress.com/vision-loss-associated-with-the-use-and-removal-of-intraocular-silicon-peer-reviewed-article-OPTH English

oai:dovepress.com/1961 2008-08-08 OPTH

Cytomegalovirus retinitis presenting as vasculitis in a patient with Wegener’s granulomatosis Georgalas, Ilias Clinical Ophthalmology Paris G Tranos1, Ilias Georgalas2, Panagiota Founti1, Ioannis Ladas21Papageorgiou University Hospital, Thessaloniki, Greece; 2Department of Ophthalmology, “G.Genimatas” Hospital, Athens, GreecePurpose: To present an unusual case of cytomegalovirus (CMV) retinitis in a patient with Wegener’s granulomatosis.Results: A 54-year-old lady with Wegener’s granulomatosis presented with decreased vision in her left eye. Wegener’s retinal vasculitis was diagnosed initially and the patient received treatment with oral steroids. Three days later the patient developed typical CMV retinitis.Conclusion: The likelihood of CMV retinitis in patients with Wegener’s granulomatosis should not be overlooked. Increased awareness in such cases is very important since CMV retinitis may present with less typical manifestations, which makes the correct diagnosis more challenging.Keywords: cytomegalovirus retinitis, Wegener’s granulomatosis, ganciclovir Dove Press Paris G Tranos, Ilias Georgalas, Panagiota Founti, Ioannis Ladas 2008-08-08 PDF http://www.dovepress.com/getfile.php?fileID=4389 http://www.dovepress.com/cytomegalovirus-retinitis-presenting-as-vasculitis-in-a-patient-with-w-peer-reviewed-article-OPTH English

oai:dovepress.com/2862 2009-02-10 OPTH

Intraocular live male filarial Loa loa worm Omgbwa Eballe, André Clinical Ophthalmology André Omgbwa Eballe1, Emillienne Epée2, Godefroy Koki2, Didier Owono2, Côme Ebana Mvogo2, Assumpta Lucienne Bella21Gynaeco Obstetric and Paediatric Hospital of Yaoundé, Yaoundé, Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, CameroonAbstract: We report a case of Loa loa filariasis in an 8-month-old child who presented with a 3-month history of irritated acute red eye and insomnia. Examination revealed a living and active adult Loa loa worm in the anterior chamber of the left eye. The worm was extracted under general anesthetic.Keywords: Loa loa, red eye, Cameroon Dove Press André Omgbwa Eballe, Emillienne Epée, Godefroy Koki, Didier Owono, Côme Ebana Mvogo, Assumpta Lucienne Bella 2009-02-10 PDF http://www.dovepress.com/getfile.php?fileID=4392 http://www.dovepress.com/intraocular-live-male-filarial-loa-loa-worm-peer-reviewed-article-OPTH English

oai:dovepress.com/2755 2008-12-23 OPTH

Cytomegalovirus retinitis mimicking intraocular lymphoma Gooi, Patrick Clinical Ophthalmology Patrick Gooi1, James Farmer2, Bernard Hurley3, Elliott Brodbaker41Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada; 2Department of Pathology and Lab Medicine University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada; 3Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada; 4Faculty of Medicine, University of Ottawa, Ottawa, Ontario, CanadaAbstract: We present a case of an unusual retinal infiltrate requiring retinal biopsy for definitive diagnosis. A 62-year-old man with treated lymphoma presented with decreased vision in the right eye associated with a white retinal lesion, which extended inferonasally from an edematous disc. Intraocular lymphoma was considered as a diagnosis; thus, the patient was managed with vitrectomy and retinal biopsy. Cytological analysis of the vitreous aspirate could not rule out a lymphoproliferative disorder. The microbial analysis was negative. Histology of the lesion showed extensive necrosis and large cells with prominent nucleoli. To rule out lymphoma, a battery of immunostains was performed and all were negative. However the limited amount of tissue was exhausted in the process. Subsequently, a hematoxylin and eosin (H/E) slide was destained, on which a CMV immunostain was performed. This revealed positivity in the nuclei and intranuclear inclusions within the large atypical cells. A diagnosis of CMV retinitis was made. Retinal biopsy may provide a definitive diagnosis and direct patient care toward intravenous gancyclovir in the case of CMV or toward radiation and chemotherapy for intraocular lymphoma. When faced with a limited amount of tissue, destaining regular H/E slides is a possible avenue to performing additional immunohistochemical studies.Keywords: CMV retinitis, retinal biopsy, immunohistochemistry, destaining Dove Press Patrick Gooi, James Farmer, Bernard Hurley, Elliott Brodbaker 2008-12-23 PDF http://www.dovepress.com/getfile.php?fileID=4393 http://www.dovepress.com/cytomegalovirus-retinitis-mimicking-intraocular-lymphoma-peer-reviewed-article-OPTH English

oai:dovepress.com/2674 2008-12-04 OPTH

A randomized clinical evaluation of the safety of Systane® Lubricant Eye Drops for the relief of dry eye symptoms following LASIK refractive surgery Durrie, Daniel Clinical Ophthalmology Daniel Durrie, Jason StahlDurrie Vision, Overland Park, Kansas, USAPurpose: To evaluate the safety of Systane® Lubricant Eye Drops in relieving the symptoms of dry eye following laser-assisted in situ keratomileusis (LASIK) surgery.Methods: This was a randomized, double-masked, single-center, placebo-controlled, contralateral eye study of 30 patients undergoing LASIK surgery. The mean age of patients was 42.4 ± 10.7 years, and the mean spherical equivalent was −3.29 (range, +1.75 to −7.38). Patients’ right and left eyes were randomized to receive either Systane® or placebo – a preserved, thimerosal-free saline solution – beginning from the day of surgery and ending 30 days following surgery. Outcome measures included tear film break up time (TFBUT), visual acuity, degree of corneal and conjunctival staining, and treatment-related adverse events.Results: Preoperatively, placebo-treated eyes had statistically significantly higher sum corneal staining score than Systane®-treated eyes (p = 0.0464); however, the difference was clinically insignificant (p = 0.27). Two weeks post operatively, the average TFBUT in the Systane®-treated eyes was 1.23 seconds longer than that of the placebo-treated eyes (p = 0.028). All other evaluated variables were comparable between the two treatments. No adverse events were reported in the study.Conclusion: Systane® Lubricant Eye Drops are safe for use following LASIK surgery to relieve the discomfort symptoms of dry eye associated with the procedure.Keywords: Systane®, safety, dry eye, LASIK Dove Press Daniel Durrie, Jason Stahl 2008-12-04 PDF http://www.dovepress.com/getfile.php?fileID=4397 http://www.dovepress.com/a-randomized-clinical-evaluation-of-the-safety-of-systanesupregsup-lub-peer-reviewed-article-OPTH English

oai:dovepress.com/2515 2008-10-30 OPTH

Correlation of central corneal thickness and axial length to the optic disc and peripapillary atrophy among healthy individuals, glaucoma and ocular hypertension patients Tomais, George Clinical Ophthalmology George Tomais1, Gerasimos Georgopoulos2, Chryssanthi Koutsandrea2, Michalis Moschos21University of Athens, Department of Ophthalmology, Athens, Greece; 2Athens University Medical School, Department of Ophthalmology, Athens, GreecePurpose: Clinical observational study for the correlation between the central corneal thickness (CCT), axial length (AXL), optic disc area (D), cupping area (C) and peripapillary atrophy (PPA), in healthy eyes (group A), eyes with primary open angle glaucoma (POAG) (group B) and eyes with ocular hypertension (OH) (group C), in order to assess the possible contribution of this correlation to the diagnosis or prognosis of glaucoma.Methods: Ninety eyes of 90 persons participated in the study (30 eyes of 30 persons in each group). All eyes underwent intraocular pressure measurement, visual field testing, endothelial cell count (ECC), measurement of the CCT and AXL, and gonioscopy. After dilation of the pupil, a digital photograph of each optic disc was performed, followed by PPA, D area and C area measurements.Results: We found a statistically significant difference in the C/D area ratio between healthy and POAG eyes and a moderate negative relationship between AXL and D in healthy eyes. We also found a moderate negative relationship between CCT and C/D area ratio in POAG eyes and a strong negative relationship between PPA and D in OH eyes.Conclusions: CCT was not correlated with PPA and AXL in any one of the three groups. OH eyes seem to have more tolerant and stable disc and peripapillary area compared to healthy and POAG eyes.Keywords: glaucoma, peripapillary, cupping, corneal thickness, axial length, optic disc Dove Press George Tomais, Gerasimos Georgopoulos, Chryssanthi Koutsandrea, Michalis Moschos 2008-10-30 PDF http://www.dovepress.com/getfile.php?fileID=4394 http://www.dovepress.com/correlation-of-central-corneal-thickness-and-axial-length-to-the-optic-peer-reviewed-article-OPTH English

oai:dovepress.com/2024 2008-08-28 OPTH

Metastasis rates and sites after treatment for choroidal melanoma by proton beam irradiation or by enucleation Chryssanthi, Koutsandrea Clinical Ophthalmology Chryssanthi Koutsandrea, Marilita M Moschos, Michael Dimissianos, Gerasimos Georgopoulos, Ioannnis Ladas, Michael ApostolopoulosDepartment of Ophthalmology, Athens University, Athens, GreecePurpose: To investigate tumor thickness and location, the interval of time between treatment for choroidal melanoma (proton beam irradiation or enucleation) and diagnosis of metastatic disease, and rates and sites of metastasis.Design: Retrospective, interventional, noncomparative case series.Methods: Follow-up of 152 patients with primary choroidal melanoma, between 1992 and 2006 (14 years). One hundred and twenty-one patients were treated with proton beam irradiation and 31 patients were treated with enucleation. Baseline and annual or semiannual ophthalmic examination, B-scan ultrasonography, systemic and laboratory evaluations (liver enzymes, chest X-ray, ultrasonography or magnetic resonance imaging of the liver) were performed according to a standard protocol.Results: Nineteen patients (12.5%) were diagnosed with metastasis during follow-up time after treatment for choroidal melanoma. Thirteen patients (10.7%) of the irradiation group and 6 patients (19.3%) of the enucleation group were diagnosed with metastasis. Eight patients (6.6%) of the irradiation group and 5 patients (16.1%) of the enucleation group were diagnosed with liver metastasis. Ocular complications after proton beam irradiation were recorded. Fifty-nine patients (48.7%) of the irradiation group presented with cataract. Other complications were retinal detachment, retinopathy, vitreous haemorrhage, iris neovascularization, neovascular glaucoma, optic neuropathy, and corneal opacification.Conclusions: In our series, 10.7% of the irradiation group and 19.3% of the enucleation group were diagnosed with metastasis. The liver was the most common site of metastasis in both groups. Cataract was the most common complication in the irradiation group.Keywords: melanoma, metastasis, irradiation, enucleation Dove Press Chryssanthi Koutsandrea, Marilita M Moschos, Michael Dimissianos, Gerasimos Georgopoulos, Ioannnis Ladas, Michael Apostolopoulos 2008-08-28 PDF http://www.dovepress.com/getfile.php?fileID=4388 http://www.dovepress.com/metastasis-rates-and-sites-after-treatment-for-choroidal-melanoma-by-p-peer-reviewed-article-OPTH English

oai:dovepress.com/2774 2009-01-11 OPTH

Findings of an experimental study in a rabbit model on posterior capsule opacification after implantation of hydrophobic acrylic and hydrophilic acrylic intraocular lenses Trakos, Nikolaos Clinical Ophthalmology Nikolaos Trakos1, Elli Ioachim2, Elena Tsanou2, Miltiadis Aspiotis1, Konstantinos Psilas1, Chris Kalogeropoulos11University Eye Clinic of Ioannina, Ioannina, Greece; 2Pathology Department, University of Ioannina, Ioannina, GreecePurpose: Study on cell growth on the posterior capsule after implantation of hydrophobic acrylic (Acrysof SA 60 AT) and hydrophilic acrylic (Akreos Disc) intraocular lenses (IOL) in a rabbit model and comparison of posterior capsule opacification (PCO).Methods: Phacoemulsification was performed in 22 rabbit eyes, and two different IOL types (Acrysof SA60 AT and Akreos Disc) were implanted. These IOLs had the same optic geometry (square edged) but different material and design. Central PCO (CPCO), peripheral PCO (PPCO), Sommering’s ring (SR) formation, type of growth, extension of PCO, cell type, inhibition, and fibrosis were evaluated three weeks after surgery. Histological sections of each globe were prepared to document the evaluation of PCO.Results: No statistically significant difference was observed between a hydrophobic acrylic IOL and a hydrophilic acrylic IOL in relation to the CPCO, PPCO, type of growth, extension, cell type, inhibition, and fibrosis. Statistically significant difference was observed in relation to the formation of SR with Acrysof SA 60 AT group presenting more SR than Akreos Disc group.Conclusion: PCO was not influenced by the material of the IOL or the design of the haptics of the IOLs we studied.Keywords: posterior capsule opacification, intraocular lenses, rabbit model Dove Press Nikolaos Trakos, Elli Ioachim, Elena Tsanou, Miltiadis Aspiotis, Konstantinos Psilas, Chris Kalogeropoulos 2009-01-11 PDF http://www.dovepress.com/getfile.php?fileID=4395 http://www.dovepress.com/findings-of-an-experimental-study-in-a-rabbit-model-on-posterior-capsu-peer-reviewed-article-OPTH English

oai:dovepress.com/2168 2008-09-05 OPTH

Efficacy and safety of combination therapy with latanoprost after a change in therapeutic regimen from timolol to brinzolamide in Japanese adult patients with primary open-angle glaucoma and ocular hypertension: open, non-randomized 12-week study Ishikawa, Shusaku Clinical Ophthalmology Shusaku Ishikawa1, Yoshimi Nakamura1, Yuko Nakamura1, Hiroshi Sakai1, Shoichi Sawaguchi1, Kazuo Terashima2, Makoto Kanno2, Hidetoshi Yamashita21Department of Ophthalmology, University of the Ryukyus Faculty of Medicine, Okinawa, Japan; 2Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine, Yamagata, JapanPurpose: To compare the efficacy of brinzolamide in Japanese patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) after a change from timolol in combination therapy with latanoprost.Methods: A 12-week, prospective, open-label, comparative study was performed in 20 patients [11 males and 9 females, mean age of 64.5 ± 11.0 (SD)y] with POAG or OH treated with both latanoprost once daily and timolol 0.5% twice daily. During the study brinzolamide was substituted for timolol. Intraocular pressure (IOP) was measured at baseline, 4, 8, and 12 weeks. Blood pressure (BP), pulse rate (PR), and adverse events were also recorded.Results: IOPs at baseline, 4, 8, and 12 weeks were 18.6 ± 2.1 mmHg, 17.8 ± 2.6 mmHg, 17.4 ± 2.5 mmHg, and 17.3 ± 3.5 mmHg, respectively. IOP reduction at 4 and 8 weeks was statistically significant (p < 0.05). The PR was significantly increased at 12 weeks (p < 0.01), but BP was not significantly affected. Four ocular adverse events were noted, but all were mild and transient.Conclusions: Substituting brinzolamide 1% for timolol 0.5% in combination therapy with latanoprost 0.005% demonstrated significant IOP reduction with improvement in PR with POAG or OH. Combination therapy using latanoprost and brinzolamide may be recommended for better IOP control with fewer systemic adverse events.Keywords: open-angle glaucoma, brinzolamide/latanprost combination therapy, timolol/latanoprost combination therapy, intraocular pressure Dove Press Shusaku Ishikawa, Yoshimi Nakamura, Yuko Nakamura, Hiroshi Sakai, Shoichi Sawaguchi, et al 2008-09-05 PDF http://www.dovepress.com/getfile.php?fileID=4387 http://www.dovepress.com/efficacy-and-safety-of-combination-therapy-with-latanoprost-after-a-ch-peer-reviewed-article-OPTH English

oai:dovepress.com/2883 2009-02-25 OPTH

Differential effects of interleukin-1β and S100B on amyloid precursor protein in rat retinal neurons Anderson, Peter Clinical Ophthalmology Peter JB Anderson1, Helena R Watts1, Sheila Jen1, Stephen M Gentleman2, Juliet A Moncaster1, et al1Department of Cellular and Molecular Neuroscience and 2Department of Clinical Neuroscience, Division of Neuroscience and Mental Health, Imperial College London, Burlington Danes Building, Hammersmith Hospital, London, UKPurpose: Interleukin-1β (IL-1β) and S100B calcium binding protein B (S100B) have been implicated in the pathogenesis of Alzheimer’s disease. Both are present in and around senile plaques and have been shown to increase levels of amyloid precursor protein (APP) mRNA in vitro. However, it is not known how either of these substances affects APP in vivo.Methods: We have studied the effects of IL-1β and S100B on the expression and processing of APP using a retinal-vitreal model. We have also investigated the effect of amyloid beta peptide (Aβ) on APP in the same system and the regulation of S100B production by Aβ and IL-1β from retinal glial cells.Results: Retinal ganglion cells constitutively express APP. However, after intravitreal injection of IL-1β or Aβ there was a marked reduction in APP levels as detected by Western blotting and IL-1β produced a decrease in APP immunoreactivity (IR). Nissl staining showed that the integrity of the injected retinas was unchanged after injection. Two days after S100B injection, there was a small reduction in APP-IR but this was accompanied by the appearance of some intensely stained large ganglion cells and there was some up-regulation in APP holoprotein  levels on Western blot. Seven days post-S100Β injection, these large, highly stained cells had increased in number throughout the retina. Injection of Aβ and IL-1β also caused an increase in S100B production within the retinal Müller glial cells.Conclusion: These results support the hypothesis that S100B (a glial-derived neurotrophic factor) and IL-1β (a pro-infl ammatory cytokine) can modulate the expression and processing of APP in vivo and so may contribute to the progression of Alzheimer’s disease.Keywords: Alzheimer’s disease, interleukin 1β, S100B, amyloid precursor protein, amyloid-β, retina Dove Press Peter JB Anderson, Helena R Watts, Sheila Jen, Stephen M Gentleman, Juliet A Moncaster, et al 2009-02-25 PDF http://www.dovepress.com/getfile.php?fileID=4506 http://www.dovepress.com/differential-effects-of-interleukin-1beta-and-s100b-on-amyloid-precurs-peer-reviewed-article-OPTH English

oai:dovepress.com/2893 2009-02-26 OPTH

Candida albicans keratitis modified by steroid application Araki-Sasaki, Kaoru Clinical Ophthalmology Kaoru Araki-Sasaki1, Hiroko Sonoyama1, Tsutomu Kawasaki1, Nariyasu Kazama1, Hidenao Ideta1, Yoshitsugu Inoue21Ideta Eye Hospital, Kumamoto City, Kumamoto, Japan; 2Department of Ophthalmology, Tottori University, Koyama-Minami, Tottori, Japan Abstract: The paper reports on Candida albicans ocular infection modified by steroid eye drops. A 74-year-old male complained of conjunctival injection and pain in his right eye three months after pterygium and cataract surgery. After treatment with antibiotics and steroid eye drops for three days, he was referred to our hospital. Clear localized corneal endothelial plaque with injection of ciliary body was observed. No erosion of the corneal epithelium, or infiltration of stromal edema was observed, suggesting that the pathological organism derived from the intracameral region. Because ocular infection was suspected, steroid eye drops were stopped, which led immediately to typical infectious keratitis in the pathological region, with epithelial erosion, fluffy abscess, stromal infiltration, and edema. For diagnostic purposes, the plaque was surgically removed with forceps and the anterior chamber was irrigated with antibiotics. The smear and culture examination from the plaque revealed C. albicans surrounded by neutrophils. However, aqueous fluid and fibrous tissue after gonio procedure contained no mycotic organisms. Topical fluconazole, micafungin, and pimaricin with oral itraconazole (150 mg/day) were effective. Special attention is needed when prescribing steroid eye drops to treat corneal disease especially postoperatively. Diagnosing infectious keratitis is sometimes difficult because of modification by some factors, such as postoperative conditions, scarring, and drug-induced masking. Here, we report on mycotic keratitis modified by postoperative steroid administration. Keywords: Candida albicans, cataract surgery, steroid, mycotic keratitis Dove Press Kaoru Araki-Sasaki, Hiroko Sonoyama, Tsutomu Kawasaki, Nariyasu Kazama, Hidenao Ideta, et al. 2009-02-26 PDF http://www.dovepress.com/getfile.php?fileID=4518 http://www.dovepress.com/candida-albicans-keratitis-modified-by-steroid-application-peer-reviewed-article-OPTH English

oai:dovepress.com/2894 2009-02-26 OPTH

Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac Cervantes, Guadalupe Clinical Ophthalmology Guadalupe Cervantes-Coste, Yuriana G Sánchez-Castro, Mónica Orozco-Carroll, Erick Mendoza-Schuster, Cecilio Velasco-BaronaAsociación Para Evitar la Ceguera en México I.A.P. Hospital “Dr Luis Sánchez Bulnes”, México City, MéxicoObjective: To evaluate the effectiveness of prophylactic administration of nepafenac 0.1% in maintaining mydriasis and in preventing postoperative macular edema following cataract surgery.Methods: This was a prospective, randomized, single-masked comparative study in 60 patients undergoing phacoemulsification cataract surgery. Patients were randomized to either the nepafenac or the control group. Nepafenac was administered 3 times daily 1 day before surgery and continued for 6 weeks. The control group received tobramycin-dexamethasone treatment only. Trans-operative mydriasis was measured before surgery, after nuclear emulsification, following cortex aspiration, and at the conclusion of surgery. Macular optical coherence tomography determined central foveal thickness (FT) and total macular volume (TMV) before surgery and at 2 and 6 weeks after surgery. All patients received tobramycin-dexamethasone for 2 weeks after surgery.Results: The difference in mean pupil size, at the end of surgery, between the control group (6.84 ± 0.93 mm) and the nepafenac group (7.91 ± 0.74 mm) was statistically significant (p < 0.001). There were no significant differences in FT values between the two groups at any time point; however, TMV at 2 and at 6 weeks was statistically significantly different (p < 0.001), with higher TMV in the control group.Conclusion: Prophylactic use of nepafenac was effective in reducing macular edema after cataract surgery and in maintaining trans-operative mydriasis.Keywords: nepafenac, mydriasis, macular edema, prophylactic, cataract surgery  Dove Press Guadalupe Cervantes-Coste, Yuriana G Sánchez-Castro, Mónica Orozco-Carroll, Erick Mendoza-Schuster, Cecilio Velasco-Barona 2009-02-26 PDF http://www.dovepress.com/getfile.php?fileID=4519 http://www.dovepress.com/inhibition-of-surgically-induced-miosis-and-prevention-of-postoperativ-peer-reviewed-article-OPTH English

oai:dovepress.com/2915 2009-03-05 OPTH

Management of ocular inflammation and pain following cataract surgery: focus on bromfenac ophthalmic solution Cho, Hyung Clinical Ophthalmology Hyung Cho1, Kenneth J Wolf1, Eric J Wolf21Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA; 2Department of Ophthalmology, Edward S. Harkness Eye Institute of Columbia University College of Physicians and Surgeons, New York, NY, USAAbstract: Recently, several new ophthalmic NSAID products have been introduced for commercial use in the United States. The purpose of this review is to briefly overview the ophthalmic NSAIDs currently in use and to discuss the management of postoperative ocular inflammation and pain following cataract surgery with a particular focus on bromfenac ophthalmic solution 0.09%. Bromfenac ophthalmic solution 0.09% is indicated for the reduction of ocular pain and inflammation following cataract surgery. Studies have shown that bromfenac ophthalmic solution 0.09% has equivalent efficacy to the other topical NSAIDs in reducing postsurgical inflammation and controlling pain. The unique chemical structure of bromfenac makes it both a potent inhibitor of the COX-2 enzyme and a highly lipophilic molecule that rapidly penetrates to produce early and sustained drug levels in all ocular tissues. Clinically, these pharmacokinetic features are manifested in a rapid reduction of postsurgical inflammation and pain with bid dosing. Bromfenac ophthalmic solution 0.09% is a versatile agent and is effective when used as either monotherapy or as an adjunct therapy to steroids.Keywords: bromfenac, ophthalmic NSAIDs, ocular inflammation Dove Press Hyung Cho, Kenneth J Wolf, Eric J Wolf 2009-03-05 PDF http://www.dovepress.com/getfile.php?fileID=4533 http://www.dovepress.com/management-of-ocular-inflammation-and-pain-following-cataract-surgery--peer-reviewed-article-OPTH English

oai:dovepress.com/2921 2009-03-10 OPTH

Eyelash inversion in epiblepharon: Is it caused by redundant skin? Kakizaki, Hirohiko Clinical Ophthalmology Hirohiko Kakizaki1, Igal Leibovitch2, Yasuhiro Takahashi3, Dinesh Selva41Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan; 2Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel; 3Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; 4South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, AustraliaPurpose: To evaluate the effect of redundant lower eyelid skin on the eyelash direction in epiblepharon.Materials and methods: Asian patients with epiblepharon participated in this study. The lower eyelid skin was pulled downward in the upright position with the extent just to detach from eyelash roots, and the direction of the eyelashes was examined. These evaluations were repeated before surgery while the patients were lying supine under general anesthesia. Results: The study included 41 lower eyelids of 25 patients (17 females, 8 males, average age; 5.6 years, 16 cases bilateral, 9 unilateral). In the upright position, without downward traction of the skin, the eyelashes were vertically positioned and touching the cornea. The redundant skin touched only the eyelash roots and had minimal contribution to eyelash inversion. With downward skin traction, there was no significant change in the eyelash direction. In the supine position, the eyelashes were touching the cornea, and there was marked redundant skin that was pushing the eyelashes inward. With downward skin traction, there was no significant change.Conclusions: The direction of lower eyelashes in patients with epiblepharon was less influenced by lower eyelid skin redundancy than previously considered. The redundant skin is only a possible aggravating factor to epiblepharon.Keywords: epiblepharon, skin redundancy, upright, eyelash Dove Press Hirohiko Kakizaki, Igal Leibovitch, Yasuhiro Takahashi, Dinesh Selva 2009-03-10 PDF http://www.dovepress.com/getfile.php?fileID=4545 http://www.dovepress.com/eyelash-inversion-in-epiblepharon-is-it-caused-by-redundant-skin-peer-reviewed-article-OPTH English

oai:dovepress.com/2929 2009-03-10 OPTH

Overriding of the preseptal orbicularis oculi muscle in Caucasian cadavers Kakizaki, Hirohiko Clinical Ophthalmology Hirohiko Kakizaki1,2, Weng Onn Chan2, Yasuhiro Takahashi3, Dinesh Selva21Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Australia; 3Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan Abstract: We aimed to microscopically examine whether Caucasian eyelids demonstrate overriding of preseptal orbicularis oculi muscle (OOM) over the pretarsal OOM in both lower and upper eyelids. Full thickness sections of 13 lower eyelids and 11 upper eyelids from seven Caucasian cadavers were examined. In the lower eyelids, all 13 specimens demonstrated clear overriding of preseptal OOM over the pretarsal OOM. The overriding part extended almost to the level of lower eyelid margin. However, in the upper eyelids, only one of the 11 eyelids demonstrated overriding, and the overriding part only extended to the level of mid-tarsal plate. Our result strongly supports the hypothesis of overriding of the preseptal OOM over the pretarsal OOM as an etiology of involutional lower eyelid entropion. The relatively low frequency of upper eyelid overriding preseptal OOM in our study reflects and may explain the rare occurrence of involutional upper eyelid entropion.Keywords: Caucasian, overriding, orbicularis oculi muscle, preseptal, pretarsal Dove Press Hirohiko Kakizaki, Weng Onn Chan, Yasuhiro Takahashi, Dinesh Selva 2009-03-10 PDF http://www.dovepress.com/getfile.php?fileID=4554 http://www.dovepress.com/overriding-of-the-preseptal-orbicularis-oculi-muscle-in-caucasian-cada-peer-reviewed-article-OPTH English

oai:dovepress.com/2934 2009-03-11 OPTH

Preliminary results following the use of a fixed combination of timolol–brimonidine in patients with ocular hypertension and primary open-angle glaucoma Georgalas, Ilias Clinical Ophthalmology Dimitris Papaconstantinou1, Ilias Georgalas2, Nikolaos Kourtis1, Christos Pitsas1, Efthimios Karmiris1, Chrysanthi Koutsandrea1, Ioannis Ladas1, Gerasimos Georgopoulos11Department of Ophthalmology, “G Gennimatas” Hospital of Athens, University of Athens, Athens, Greece; 2Department of Ophthalmology, “G Gennimatas” Hospital of Athens, NHS, Athens, Greece Purpose: The purpose of this prospective study was to evaluate the efficacy in intraocular pressure (IOP) control and the tolerance of a topically administered fixed combination of timolol–brimonidine in 50 patients with ocular hypertension and primary open-angle glaucoma.Methods: After determining a baseline IOP, the fixed combination timolol–brimonidine was used twice daily for two months, while IOP, ophthalmic signs, and/or symptoms were monitored.Results: The mean IOP value was decreased from 23.09 mm Hg (±1.98 SD) to 17.46 mm Hg (±1.47 SD) during the 1st month (paired Student’s t test = 9.88 και p < 0.001), and to 17.51 mm Hg (±1.43 SD) in the 2nd month. Between the 1st and 2nd month, no statistical difference was observed (paired Student’s t test = 0.02 και p < 0.1). In 8% of the patients during the 1st month and 10% of patients in the 2nd month, some ophthalmic signs were observed, while only mild ophthalmic symptoms were reported in 6% and 8% of the patients, respectively.Conclusions: In conclusion, the fixed combination of timolol–brimonidine has a satisfactory IOP-lowering effect without any serious side effects due to the topical use. Keywords: fixed combination 0.2% brimonidine–0.5% timolol, ocular hypertension, primary open-angle glaucoma Dove Press Dimitris Papaconstantinou, Ilias Georgalas, Nikolaos Kourtis, Christos Pitsas, et al. 2009-03-11 PDF http://www.dovepress.com/getfile.php?fileID=4561 http://www.dovepress.com/preliminary-results-following-the-use-of-a-fixed-combination-of-timolo-peer-reviewed-article-OPTH English

oai:dovepress.com/2952 2009-03-13 OPTH

Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma Georgalas, Ilias Clinical Ophthalmology Dimitris Papaconstantinou1, Ilias Georgalas2, George Kalantzis1, Efthimios Karmiris1, Chrysanthi Koutsandrea1, Andreas Diagourtas1, Ioannis Ladas1, Gerasimos Georgopoulos11Department of Ophthalmology, University of Athens, Athens, Greece; 2“G Genimatas” Hospital, NHS, Athens, GreecePurpose: To study acquired color vision and visual field defects in patients with ocular hypertension (OH) and early glaucoma.Methods: In a prospective study we evaluated 99 eyes of 56 patients with OH without visual field defects and no hereditary color deficiencies, followed up for 4 to 6 years (mean = 4.7 ± 0.6 years). Color vision defects were studied using a special computer program for Farnsworth–Munsell 100 hue test and visual field tests were performed with Humphrey analyzer using program 30–2. Both tests were repeated every six months. Results: In fifty-six eyes, glaucomatous defects were observed during the follow-up period. There was a statistically significant difference in total error score (TES) between eyes that eventually developed glaucoma (157.89 ± 31.79) and OH eyes (75.51 ± 31.57) at the first examination (t value 12.816, p < 0.001). At the same time visual field indices were within normal limits in both groups. In the glaucomatous eyes the earliest statistical significant change in TES was identified at the first year of follow-up and was –20.62 ± 2.75 (t value 9.08, p < 0.001) while in OH eyes was −2.11 ± 4.36 (t value 1.1, p = 0.276). Pearson’s coefficient was high in all examinations and showed a direct correlation between TES and mean deviation and corrected pattern standard deviation in both groups.Conclusion: Quantitative analysis of color vision defects provides the possibility of follow-up and can prove a useful means for detecting early glaucomatous changes in patients with normal visual fields.Keywords: color vision defects, glaucoma, hereditary, vision field Dove Press Dimitris Papaconstantinou, Ilias Georgalas, George Kalantzis, Efthimios Karmiris, et al. 2009-03-13 PDF http://www.dovepress.com/getfile.php?fileID=4580 http://www.dovepress.com/acquired-color-vision-and-visual-field-defects-in-patients-with-ocular-peer-reviewed-article-OPTH English

oai:dovepress.com/2963 2009-03-17 OPTH

Vasoactive neuropeptides in clinical ophthalmology: An association with autoimmune retinopathy? Marshall-Gradisnik, Sonya Clinical Ophthalmology Donald R Staines1,2, Ekua W Brenu2, Sonya Marshall-Gradisnik21Queensland Health, Gold Coast Population Health Unit, Southport, Gold Coast, Queensland, Australia; 2Faculty of Health Science and Medicine, Population Health and Neuroimmunology Unit, Bond University, Robina, Queensland, AustraliaAbstract: The mammalian eye is protected against pathogens and inflammation in a relatively immune-privileged environment. Stringent mechanisms are activated that regulate external injury, infection, and autoimmunity. The eye contains a variety of cells expressing vasoactive neuropeptides (VNs), and their receptors, located in the sclera, cornea, iris, ciliary body, ciliary process, and the retina. VNs are important activators of adenylate cyclase, deriving cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP). Impairment of VN function would arguably impede cAMP production and impede utilization of ATP. Thus VN autoimmunity may be an etiological factor in retinopathy involving perturbations of purinergic signaling. A sound blood supply is necessary for the existence and functional properties of the retina. This paper postulates that impairments in the endothelial barriers and the blood–retinal barrier, as well as certain inflammatory responses, may arise from disruption to VN function. Phosphodiesterase inhibitors and purinergic modulators may have a role in the treatment of postulated VN autoimmune retinopathy.Keywords: retinopathy, autoimmune, vasoactive neuropeptides, phosphodiesterase inhibitors Dove Press Donald R Staines, Ekua W Brenu, Sonya Marshall-Gradisnik 2009-03-17 PDF http://www.dovepress.com/getfile.php?fileID=4590 http://www.dovepress.com/vasoactive-neuropeptides-in-clinical-ophthalmology-an-association-with-peer-reviewed-article-OPTH English

oai:dovepress.com/2971 2009-03-18 OPTH

Unilateral retinitis pigmentosa and cone-rod dystrophy Farrell, Donald Clinical Ophthalmology Donald F FarrellEEG and Clinical Neurophysiology Laboratory, University of Washington Medical Center, Seattle, WA, USAPurpose: The purpose of this paper is to report 14 new cases of unilateral retinitis pigmentosa and three new cases of cone-rod dystrophy and to compare the similarities and dissimilarities to those found in the bilateral forms of these disorders.Methods: A total of 272 cases of retinitis pigmentosa and 167 cases of cone-rod dystrophy were studied by corneal full field electroretinograms and electrooculograms. The student t-test was used to compare categories.Results: The percentage of familial and nonfamilial cases was the same for the bilateral and unilateral forms of the disease. In our series, unilateral retinitis pigmentosa makes up approximately 5% of the total population of retinitis pigmentosa, while unilateral cone-rod dystrophy makes up only about 2% of the total. In the familial forms of unilateral retinitis pigmentosa the most common inheritance pattern was autosomal dominant and all affected relatives had bilateral disease.Conclusion: Unilateral retinitis pigmentosa and cone-rod dystrophy appear to be directly related to the more common bilateral forms of these disorders. The genetic mechanisms which account for asymmetric disorders are not currently understood. It may be a different unidentified mutation at a single loci or it is possible that nonlinked mutations in multiple loci account for this unusual disorder.Keywords: unilateral retinitis pigmentosa, unilateral cone-rod dystrophy, nonlinked mutations, correlations, age of onset Dove Press Donald F Farrell 2009-03-18 PDF http://www.dovepress.com/getfile.php?fileID=4607 http://www.dovepress.com/unilateral-retinitis-pigmentosa-and-cone-rod-dystrophy-peer-reviewed-article-OPTH English

oai:dovepress.com/2979 2009-03-19 OPTH

An evaluation of dry eye symptoms and signs in a cohort of children with juvenile idiopathic arthritis Kotaniemi, Kaisu Clinical Ophthalmology Kaisu M Kotaniemi1, Pirjo M Salomaa1, Kristiina Sihto-Kauppi1, Hanna M Säilä2, Markku J Kauppi31Department of Ophthalmology;2Pediatric Rheumatology;3Rheumatology, Rheumatism Foundation Hospital, Heinola, FinlandObjective: To determine the prevalence of dry eye symptoms and signs in children with juvenile idiopathic arthritis (JIA).Patients and methods: A total of 192 children with JIA: 48 oligo-, 39 extended oligo-, 79 polyarthritis, and 26 with other types of arthritis (eight juvenile spondyloarthritis, five juvenile psoriatic arthritis, three mixed connective tissue diseases, two systemic onset arthritis, and eight undetermined arthritis) were interviewed for dry eye symptoms and tested with Schirmer test with anesthetic. Two thirds of the patients were female and the mean age of the patients was 13.1 years (range 10–16) and the mean duration of arthritis was six years (SD 4, 4). Thirty-one percent of the patients had a history of uveitis. Dry eye was defined as Schirmer test score ≤5 mm in five minutes. The type of arthritis, a history of uveitis, and the ocular and systemic medication used were evaluated for their correlation with dry eye symptoms and signs by using chi-square tests and the Mann–Whitney Monte Carlo analysis.Results: Altogether 17% of this cohort had decreased basal tear secretion. The most common symptoms of dry eye were discharge secretion, itching, and watering. The intensity of symptoms and signs did not correlate. The type of arthritis, a history or presence of uveitis, and the medication used did not correlate with the occurrence of dry eyes.Conclusion: Dry eye symptoms and signs are common in JIA, and Schirmer test with anesthetic is a useful tool in evaluating these patients.Keywords: dry eyes, Schirmer test, juvenile idiopathic arthritis Dove Press Kaisu M Kotaniemi, Pirjo M Salomaa, Kristiina Sihto-Kauppi, Hanna M Säilä, Markku J Kauppi 2009-03-19 PDF http://www.dovepress.com/getfile.php?fileID=4616 http://www.dovepress.com/an-evaluation-of-dry-eye-symptoms-and-signs-in-a-cohort-of-children-wi-peer-reviewed-article-OPTH English

oai:dovepress.com/2990 2009-03-25 OPTH

Cost of cataract surgery after implantation of three intraocular lenses Berdeaux, Gilles Clinical Ophthalmology Catherine Boureau1, Antoine Lafuma2, Viviane Jeanbat2, Andrew F Smith3, Gilles Berdeaux41Clinique Geoffroy St Hilaire, Paris, France; 2Cemka-Eval, Bourg la Reine, France; 3Alcon Laboratories Ltd, Hemel Hempstead, UK and Nuffield Laboratory of Ophthalmology, University of Oxford, UK; 4Alcon France, Rueil Malmaison, France; Conservatoire National des Arts et Métiers, Paris, FranceBackground: Posterior capsule opacification is one of the most frequent adverse events following cataract surgery. This manuscript reports the lifetime cost of complications linked to posterior capsule opacification using three types of intraocular lens with square edges.Methods: Costs were estimated from a retrospective study of patients who underwent cataract surgery and data from the literature. The lenses studied were hydrophobic acrylic (SA60AT and AR40E) and hydrophilic acrylic (XL-Stabi) lenses with square edges. The frequency of Nd-Yag laser capsulotomies after 4 years’ survival was estimated by two methods: the first involved linear adjustment of the rate at 5 and 6 years follow-up and then application of a constant rate after 6 years; the second involved linear adjustment after 5 years follow-up. The economic perspective was that of the French Sickness Fund.Results: After 3 years’ follow-up the percentage of patients who had not undergone laser Nd-Yag capsulotomy was 86.9% with SA60AT, 76.6% with AR40E and 54.6% with XL-Stabi lenses (p < 0.001). The total cost of capsulotomy and management of complications per patient lifetime was estimated to be €90.5 for SA60AT, €189.5 for AR40E and €288.0 for XL-Stabi lenses by the first extrapolation method. With the second method of extrapolation the costs were €94.8, €200.0 and €300.2, respectively.Interpretation: Lower costs for cataract surgery and management of related complications were observed with the two hydrophobic acrylic lenses; the lowest costs were observed with SA60AT lenses as they were associated with fewer Nd-Yag laser capsulotomies.Keywords: cataract surgery, Nd-Yag laser, capsulotomy, adverse event, cost, budget impact Dove Press Catherine Boureau, Antoine Lafuma, Viviane Jeanbat, Andrew F Smith, Gilles Berdeaux 2009-03-25 PDF http://www.dovepress.com/getfile.php?fileID=4629 http://www.dovepress.com/cost-of-cataract-surgery-after-implantation-of-three-intraocular-lense-peer-reviewed-article-OPTH English

oai:dovepress.com/2994 2009-03-26 OPTH

Effects of prostaglandin analog therapy on the ocular surface of glaucoma patients Kahook, Malik Clinical Ophthalmology Michael B Horsley, Malik Y KahookRocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado Denver, Aurora, CO, USAPurpose: To quantify changes in tear break-up time (TBUT), corneal staining and ocular surface disease index (OSDI) in glaucoma patients after switching therapy from latanoprost with 0.02% benzalkonium chloride (BAK) to travoprost with sofZia™.Methods: Prospective consecutive case series evaluating patients before and 8 weeks after switching from latanoprost with BAK to travoprost with sofZia™ in patients with baseline TBUT less than 6 seconds.Results: Forty eyes of 20 consecutive patients using latanoprost with BAK were switched to travoprost with sofZia™. Mean TBUT prior to starting travoprost was 2.02 ± 0.71 seconds and increased to 6.34 ± 1.31 seconds 8 weeks after the switch (p < 0.001). Mean inferior corneal staining scores decreased from 2.40 ± 0.87 to 1.38 ± 0.59 (p < 0.001). Mean OSDI scores decreased from 26.31 ± 8.25 to 16.56 ± 6.19 (p < 0.001).Discussion: This report focuses on the status of the ocular surface, as documented by TBUT, corneal staining and OSDI, in patients switched from latanoprost with BAK to travoprost without BAK. The switch resulted in a statistically significant increase in TBUT and decreases in corneal staining and OSDI in patients with low baseline TBUT values.Conclusion: BAK, a common preservative for glaucoma drops, may increase OSD by disrupting the tear film and increasing conjunctival inflammation. In this study, a change from a BAK-preserved prostaglandin analog (PGA) to a non-BAK-preserved PGA resulted in a measurable improvement of TBUT, corneal staining and OSDI. Further studies are needed to better understand the impact of BAK-preserved medications on the ocular surface.Keywords: ocular surface, glaucoma, benzalkonium chloride, prostaglandin analog Dove Press Michael B Horsley, Malik Y Kahook 2009-03-26 PDF http://www.dovepress.com/getfile.php?fileID=4633 http://www.dovepress.com/effects-of-prostaglandin-analog-therapy-on-the-ocular-surface-of-glauc-peer-reviewed-article-OPTH English

oai:dovepress.com/3006 2009-03-30 OPTH

Contemporary aspects in the prognosis of traumatic hyphemas Georgalas, Ilias Clinical Ophthalmology Dimitris Papaconstantinou1, Ilias Georgalas2, Nikos Kourtis1, Eftimios Karmiris1, Chrysanthi Koutsandrea1, et al1Department of Ophthalmology, University of Athens, Athens, Greece; 2“G Genimatas” Hospital, NHS, Athens, GreecePurpose: The present study concerns traumatic hyphemas and their prognostic factors and signs. The aim of this study is to determine the prognostic factors and signs of traumatic hyphemas. Methods: During the last five years, 72 young individuals were hospitalized with the diagnosis of suffering a traumatic hyphema and were divided in three groups according to the extent of their hyphema. The first group concerns 38 patients with a small hyphema 3–4 mm, the second group concerns 22 patients with moderate hyphema reaching the pupillary border, and the third group concerns 12 patients with a total hyphema.Results: The hyphema was absorbed in 63 patients and the IOP was controlled with medical treatment after 3–24 days. However, surgical management was necessary for two patients. Finally, antiglaucomatous treatment was administered in seven patients with persistent high intraocular pressure.Conclusions: The important clinical signs that determine the prognosis of such hyphemas are the size of hyphema, the blood color, recurrent hemorrhage, the absorption time, the increase of intraocular pressure, and blood staining of the cornea.Keywords: traumatic hyphema, IOP rise, prognostic signs, blood staining of the cornea Dove Press Dimitris Papaconstantinou, Ilias Georgalas, Nikos Kourtis, Eftimios Karmiris, Chrysanthi Koutsandrea, et al 2009-03-30 PDF http://www.dovepress.com/getfile.php?fileID=4646 http://www.dovepress.com/contemporary-aspects-in-the-prognosis-of-traumatic-hyphemas-peer-reviewed-article-OPTH English

oai:dovepress.com/3014 2009-04-01 OPTH

Comparison of one-site versus two-site phacotrabeculectomy without the use of antimetabolites intraoperatively in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma Bagli, Eleni Clinical Ophthalmology Eleni Bagli, Christos Gartzios, Ioannis Asproudis, Georgios KitsosUniversity Eye Clinic of Ioannina, Ioannina, GreecePurpose: The comparison of one-site versus two-site phacotrabeculectomy in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG), with respect to intraocular pressure (IOP), antiglaucomatous medication (AM) requirements and visual acuity (VA).Methods: Forty-seven patients (eyes) with cataract and POAG and 46 sex- and age-matched patients with cataract and PEXG were randomized to one- or two-site phacotrabeculectomy and reviewed with a follow-up at three years.Results: Mean preoperative IOP was 22.04 ± 2.27 mmHg and 22.92 ± 2.35 mmHg in POAG and PEXG groups (p > 0.05) using a mean of 2.76 ± 0.74, 2.74 ± 0.69 AM, respectively (p > 0.05). After three years of follow-up, the mean IOP was 15.04 ± 1.57 mmHg in the one-site, 15.04 ± 1.99 mmHg in the two-site group with POAG, 15 ± 1.8 mmHg in the one-site, 15.32 ± 1.31 mmHg in the two-site group with PEXG, using a mean of 0.68 ± 0.69, 0.84 ± 0.75, 0.96 ± 0.67, and 0.8 ± 0.62 AM, respectively. Mean IOP and AM postoperatively were significantly less compared to preoperatively for each group (p < 0.05). No difference was observed in mean IOP and AM between the four groups at three years postoperatively (p > 0.05). VA improved similarly in four groups at the three-year follow-up (p < 0.05). Intraoperative, postoperative complications, and need for 5-fluorouracil injections were similar between the surgical groups.Conclusion: One-site and two-site phacotrabeculectomy without the use of antimetabolites intraoperatively were similarly safe and effective in IOP control over a three-year follow-up period in patients with POAG and PEXG.Keywords: phacotrabeculectomy, pseudoexfoliation, glaucoma Dove Press Eleni Bagli, Christos Gartzios, Ioannis Asproudis, Georgios Kitsos 2009-04-01 PDF http://www.dovepress.com/getfile.php?fileID=4653 http://www.dovepress.com/comparison-of-one-site-versus-two-site-phacotrabeculectomy-without-the-peer-reviewed-article-OPTH English

oai:dovepress.com/3018 2009-04-02 OPTH

Association of microsatellite polymorphisms of the GPDS1 locus with normal tension glaucoma in the Japanese population Meguro, Akira Clinical Ophthalmology Kayo Nakamura1*, Masao Ota2*, Akira Meguro1, et al1Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan; 2Departmentof Legal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, JapanBackground: To investigate whether the GPDS1 locus, a potential causative locus of pigment-dispersion syndrome, is associated with normal-tension glaucoma (NTG) in Japanese patients. Materials and methods: We used polymerase chain reaction amplification with sequencespecific primers to analyze 20 polymorphic microsatellite markers in and around the GPDS1 locus with an automated DNA analyzer and automated fragment detection by fluorescent-based technology. The DNA samples used for these analyses were obtained from ethnicity- and gendermatched patients, including 141 Japanese patients with NTG and 101 healthy controls. Patients exhibiting a comparatively early onset were selected as this suggests that genetic factors may show stronger involvement.Results: One allele of D7S2462 exhibited a frequency that was significantly decreased in NTG cases compared to controls (P = 0.0013, Pc = 0.019, OR = 0.48, 95% CI = 0.30&ndash;0.75). Alleles at another six microsatellite loci were positively or negatively associated with NTG, but these associations did not retain statistical significance after Bonferroni correction (P&nbsp;&lt; 0.05, Pc&nbsp;&gt; 0.05).Conclusion: Our study showed a significant association between the GPDS1 locus and NTG, suggesting that there may be some genetic risk factor(s) in the development of NTG.Keywords: microsatellite, normal tension glaucoma, glaucoma-related pigment dispersion syndrome, GPDS1, DPP6 Dove Press Kayo Nakamura<font face="GillSansMT" size="1">, Masao Ota, </font><font face="GillSansMT" size="1">Akira Meguro, et al</font> 2009-04-02 PDF http://www.dovepress.com/getfile.php?fileID=4654 http://www.dovepress.com/association-of-microsatellite-polymorphisms-of-the-gpds1-locus-with-no-peer-reviewed-article-OPTH English

oai:dovepress.com/3025 2009-04-03 OPTH

New nonlinear multivariable model shows the relationship between central corneal thickness and HRTII topographic parameters in glaucoma patients Kourkoutas, Dimitrios Clinical Ophthalmology Dimitrios Kourkoutas1,2, Gerasimos Georgopoulos1, Antonios Maragos1, et al1Department of Ophthalmology, Medical School, Athens University, Athens, Greece; 2Department of Ophthalmology, 417 Hellenic Army Shared Fund Hospital, Athens, GreecePurpose: In this paper a new nonlinear multivariable regression method is presented in order to investigate the relationship between the central corneal thickness (CCT) and the Heidelberg Retina Tomograph (HRTII) optic nerve head (ONH) topographic measurements, in patients with established glaucoma.Methods: Forty nine eyes of 49 patients with glaucoma were included in this study. Inclusion criteria were patients with (a) HRT II ONH imaging of good quality (SD 30&nbsp;&lt; &mu;m), (b) reliable Humphrey visual field tests (30-2 program), and (c) bilateral CCT measurements with ultrasonic contact pachymetry. Patients were classified as glaucomatous based on visual field and/or ONH damage. The relationship between CCT and topographic parameters was analyzed by using the new nonlinear multivariable regression model.Results: In the entire group, CCT was 549.78 &plusmn; 33.08 &mu;m (range: 484&ndash;636 &mu;m); intraocular pressure (IOP) was 16.4 &plusmn; 2.67 mmHg (range: 11&ndash;23 mmHg); MD was &minus;3.80 &plusmn; 4.97 dB (range: 4.04 &ndash; [&minus;20.4] dB); refraction was &minus;0.78 &plusmn; 2.46 D (range: &minus;6.0 D to +3.0 D). The new nonlinear multivariable regression model we used indicated that CCT was significantly related (R2 = 0.227, p&nbsp;&lt; 0.01) with rim volume nasally and type of diagnosis.Conclusions: By using the new nonlinear multivariable regression model, in patients with established glaucoma, our data showed that there is a statistically significant correlation between CCT and HRTII ONH structural measurements, in glaucoma patients.Keywords: central corneal thickness, glaucoma, optic nerve head, HRT&nbsp; Dove Press Dimitrios Kourkoutas, Gerasimos Georgopoulos, Antonios Maragos, et al 2009-04-03 PDF http://www.dovepress.com/getfile.php?fileID=4665 http://www.dovepress.com/new-nonlinear-multivariable-model-shows-the-relationship-between-centr-peer-reviewed-article-OPTH English

oai:dovepress.com/355 2008-03-17 OPTH

The challenge of dry eye diagnosis Savini, Giacomo Clinical Ophthalmology Giacomo Savini1, Pinita Prabhawasat2, Takashi Kojima3, Martin Grueterich4, Edgar Espana5, Eiki Goto61Centro Salus, Bologna, Italy; 2Department of Ophthalmology, Siriraj Hospital, Mahidol University, Thailand; 3Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA; 4Department of Ophthalmology, Ludwig&ndash;Maximilians University, Munich, Germany; 5Department of Ophthalmology, University of Mississippi, Jackson, MS, USA; 6Department of Ophthalmology, School of Dental Medicine, Tsurumi University, Yokohama City, Kanagawa, JapanAbstract: The currently available methods for the diagnosis of dry eye are still far from being perfect for a variety of reasons. This review attempts to highlight the advantages and disadvantages of both traditional tests (such as Schirmer&rsquo;s test, break-up time and ocular surface staining) and innovative noninvasive procedures, including tear meniscus height measurement, corneal topography, functional visual acuity, tear interferometry, tear evaporimetry and tear osmolarity assessment. Dove Press Giacomo Savini, Pinita Prabhawasat, Takashi Kojima, Martin Grueterich, Edgar Espana, Eiki Goto 2008-03-17 PDF http://www.dovepress.com/getfile.php?fileID=4715 http://www.dovepress.com/the-challenge-of-dry-eye-diagnosis-peer-reviewed-article-OPTH English

oai:dovepress.com/3064 2009-04-23 OPTH

Management of allergic conjunctivitis: an evaluation of the perceived comfort and therapeutic efficacy of olopatadine 0.2% and azelastine 0.05% from two prospective studies Epstein, Art Clinical Ophthalmology Arthur B Epstein1, Peter T Van Hoven2, Alan Kaufman3, Warner W Carr41North Shore Contact Lens and Vision Consultants, Roslyn Heights, NY, USA; 2Primary Eyecare Group PC, Brentwood, TN, USA; 3Adult Allergy Clinic and the Division of Allergy and Immunology, Our Lady of Mercy Medical Center, Bronx, NY, USA; 4Southern California Research, Mission Viejo, CA, USAPurpose: Results from 2 patient-reported outcome studies of allergic conjunctivitis sufferers who used olopatadine 0.2% and azelastine 0.05% are analyzed.Methods: The PACE (Pataday Allergic Conjunctivitis Evaluation) multi-center, prospective, open-label study examined patient perceptions of olopatadine 0.2% once daily (qd) and previous twice daily (bid) allergic conjunctivitis medications via questionnaire in allergic conjunctivitis sufferers who had previously used bid medication and then initiated olopatadine. A second conjunctival antigen challenge (CAC) study evaluated comfort of 4 allergic conjunctivitis medications. Results: Forty-nine patients from the PACE study (N = 125) with prior azelastine use were examined. Significantly more patients rated themselves &ldquo;very satisfied&rdquo; with current olopatadine use compared with past azelastine use on drop comfort (p &lt; 0.0001), speed of relief (p = 0.0004), and overall satisfaction (70% vs 16%, p &lt; 0.0001). Significantly more patients reported olopatadine &ldquo;very effective&rdquo; against swelling compared with azelastine (47% vs 8%, p = 0.0404). In the CAC study (N = 36), data from olopatadine (n = 8), azelastine (n = 9) and placebo (N = 36) groups were reported. Olopatadine was rated significantly more comfortable than azelastine upon instillation (p = 0.0223), at 30 seconds (p = 0.0479), and at 1 minute after instillation (p = 0.0240).Conclusion: In the reported studies, olopatadine 0.2% qd was more comfortable than azelastine 0.05% and preferred by patients with allergic conjunctivitis by a ratio of 4:1.Keywords: allergic conjunctivitis, azelastine, ocular allergy, olopatadine, patient perceptions Dove Press Arthur B Epstein, Peter T Van Hoven, Alan Kaufman, Warner W Carr 2009-04-23 PDF http://www.dovepress.com/getfile.php?fileID=4716 http://www.dovepress.com/management-of-allergic-conjunctivitis-an-evaluation-of-the-perceived-c-peer-reviewed-article-OPTH English

oai:dovepress.com/3073 2009-04-24 OPTH

Central retinal artery occlusion following severe blow-out fracture in young adult Kunikata, Hiroshi Clinical Ophthalmology Noriko Himori, Hiroshi Kunikata, Takaaki Otomo, Nobuo Fuse, Kohji NishidaDepartment of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, JapanAbstract: A 20-year-old woman was involved in a traffic accident while riding a motorcycle. The vision in her right eye was severely reduced. At the first examination, the eyelids of her right eye were severely swollen, and the eye could barely be seen. The fundus was not visible. She had no light perception in her vision. Computed tomography revealed a severe blow-out fracture in her right eye. Surgery was immediately performed to correct the fracture and the eye globe was replaced in the orbit. On the fourth postoperative day, the right fundus was visible and a cherry-red spot and milky-white edema were seen. Fluorescein angiography showed an arterial filling defect. Four months later, her visual acuity was light perception. Our case shows that a central retinal artery occlusion can be a complication of a blow-out fracture of the lower orbital wall and can lead to severe visual loss even with early surgical repair.Keywords: central retinal artery occlusion, blow out fracture, trauma, young adult Dove Press Noriko Himori, Hiroshi Kunikata, Takaaki Otomo, Nobuo Fuse, Kohji Nishida 2009-04-24 PDF http://www.dovepress.com/getfile.php?fileID=4725 http://www.dovepress.com/central-retinal-artery-occlusion-following-severe-blow-out-fracture-in-peer-reviewed-article-OPTH English

oai:dovepress.com/3098 2009-05-06 OPTH

Comparison of intraocular pressure measurements with the portable PT100 noncontact tonometer and Goldmann applanation tonometry Netland, Peter Clinical Ophthalmology Sarwat Salim, Daniel J Linn, James R Echols II, Peter A NetlandHamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USAPurpose: Noncontact tonometers are useful when regulations preclude use of contact tonometers by medical students and other nonophthalmologists. Our study compared the measurements by the portable, noncontact tonometer (PT100) with Goldmann applanation tonometry (GAT). Methods: This was a prospective study of 98 eyes from 98 patients. Intraocular pressure (IOP) was measured by GAT and the PT100 (Reichert, Buffalo, NY).Results: Mean IOP measurements showed no significant differences in measurements performed by the two tonometers (P = 0.64). Measurements by the two tonometers were in agreement by &le;3 mmHg in 92.8% of eyes. Linear regression analysis of PT100 vs GAT measurements revealed a slope of 0.98 with r2 = 0.58. Bland&ndash;Altman analysis showed a mean difference of measurements by GAT and PT100 of -0.3 mmHg with two standard deviation = 7.1 mmHg.Conclusion: The portable noncontact PT100 tonometer provides IOP measurements comparable to GAT within the normal range of IOP. Keywords: applanation tonometer, intraocular pressure, noncontact tonometry Dove Press Sarwat Salim, Daniel J Linn, James R Echols II, Peter A Netland 2009-05-06 PDF http://www.dovepress.com/getfile.php?fileID=4753 http://www.dovepress.com/comparison-of-intraocular-pressure-measurements-with-the-portable-pt10-peer-reviewed-article-OPTH English

oai:dovepress.com/3103 2009-05-08 OPTH

Administration of the fixed combination of latanoprost 0.005% and timolol 0.5% in glaucoma patients with an intraocular pressure over 30 mmHg Ozkurt, Yelda Clinical Ophthalmology Yelda Buyru &Ouml;zkurt, Tomris Sengor, Tufan Evciman, Melih Haboglu, G&ouml;k&ccedil;en Baş, Sevda AydınFatih Sultan Mehmet Training and Research Hospital, Istanbul, TurkeyPurpose: To evaluate the intraocular pressure (IOP) reducing effect of a fixed combination of 0.005% latanoprost and 0.5% timolol in patients with an IOP of 30 mmHg or higher.Design: Prospective, randomized clinical trial.Participants: Twenty-eight patients.Methods: Patients had received no prior medical glaucoma treatment. Routine ophthalmic examinations and visual field tests were performed before and after treatment for each patient.Results: Mean IOP was 32.28 &plusmn; 0.92 mmHg before treatment. Mean IOP levels were 18.75 &plusmn; 0.68 for the first day, 17.96 &plusmn; 0.90 for the first week and 17.64 &plusmn; 0.66 for the first month after treatment.Conclusion: A fixed combination of latanoprost 0.005% and timolol 0.5% is effective in significantly reducing IOP in glaucoma patients with an IOP greater than 30 mmHg.Keywords: latanoprost, timolol, combination, glaucoma, intraocular pressure&nbsp; Dove Press Yelda Buyru &Ouml;zkurt, Tomris Sengor, Tufan Evciman, Melih Haboglu, G&ouml;k&ccedil;en Baş, Sevda Aydın 2009-05-08 PDF http://www.dovepress.com/getfile.php?fileID=4795 http://www.dovepress.com/administration-of-the-fixed-combination-of-latanoprost-0005-and-timolo-peer-reviewed-article-OPTH English

oai:dovepress.com/3137 2009-05-15 OPTH

Intracameral dexamethasone reduces inflammation on the first postoperative day after cataract surgery in eyes with and without glaucoma Chang, Diane Clinical Ophthalmology Diane TW Chang, Michael C Herceg, Richard A Bilonick, Larissa Camejo, Joel&nbsp;S Schuman, Robert J NoeckerDepartment of Ophthalmology, University of Pittsburgh Medical Center, Eye Center, Pittsburgh, PA, USAPurpose: To evaluate whether dexamethasone injected intracamerally at the conclusion of surgery can safely and effectively reduce postoperative inflammation and improve surgical outcomes in eyes with and without glaucoma.Methods: Retrospective chart review of 176 consecutive eyes from 146 patients receiving uncomplicated phacoemulsification (PE) (n = 118 total, 82 with glaucoma), glaucoma drainage device (GDD) (n = 35), combined PE/GDD (n = 11) and combined PE/endoscopic cyclophotocoagulation (n = 12). Ninety-one eyes from 76 patients were injected with 0.4 mg dexamethasone intracamerally at the conclusion of surgery. All eyes received standard postoperative prednisolone and ketorolac eyedrops. Outcomes were measured for four to eight weeks by subjective complaints, visual acuity (VA), slit-lamp biomicroscopy, intraocular pressure (IOP) and postoperative complications.Results: Dexamethasone significantly reduced the odds of having an increased anterior chamber (AC) cell score after PE (p = 0.0013). Mean AC cell score &plusmn; SD in nonglaucomatous eyes was 1.3 &plusmn; 0.8 in control and 0.8 &plusmn; 0.7 with dexamethasone; scores in glaucomatous eyes were 1.3 &plusmn; 0.7 in control and 0.9 &plusmn; 0.8 with dexamethasone. Treated nonglaucomatous eyes had significantly fewer subjective complaints after PE (22.2% vs 64.7% in control; p = 0.0083). Dexamethasone had no significant effects on VA, corneal changes, IOP one day and one month after surgery, or long-term complications.Conclusions: Intracameral dexamethasone given at the end of cataract surgery significantly reduces postoperative AC cells in eyes with and without glaucoma, and improves subjective reports of recovery in nonglaucomatous eyes. There were no statistically significant risks of IOP elevation or other complications in glaucomatous eyes.Keywords: cataract surgery, glaucoma, steroid, dexamethasone, inflammation, intraocular pressure Dove Press Diane TW Chang, Michael C Herceg, Richard A Bilonick, Larissa Camejo, et al. 2009-05-15 PDF http://www.dovepress.com/getfile.php?fileID=4803 http://www.dovepress.com/intracameral-dexamethasone-reduces-inflammation-on-the-first-postopera-peer-reviewed-article-OPTH English

oai:dovepress.com/3248 2009-06-11 OPTH

Oral versus topical carbonic anhydrase inhibitors in ocular hypertension after scleral tunnel cataract surgery Al-Barrag, A Clinical Ophthalmology Abdulmoghni Al-Barrag1, Motaher Al-Shaer1, Nabil Al-Matary2, Mahfoud Bamashmous11Ophthalmic Department, Faculty of Medicine and Health Sciences, Sana&rsquo;a University, Sana&rsquo;a, Republic of Yemen; 2Ophthalmic Department, Military Hospital, Sana&rsquo;a, Republic of YemenPurpose: To compare the effect of oral acetazolamide and topical 2% dorzolamide in prevention of ocular hypertension after scleral tunnel cataract surgery.Setting: Ophthalmic department, Sana&rsquo;a University, Yemen Sana&rsquo;a from March 2007 to October 2007.Methods: This prospective double-blind, randomized study included 150 eyes undergoing scleral tunnel cataract surgery with hard posterior chamber intraocular implantation. Methylcellulose was used as the viscoelastic in all surgery cases. Patients were assigned to one of three groups: group 1: topical gentamicin eye drops (control; n = 52); group 2: systemic acetazolamide 250 mg (n = 45); and group 3: topical 2% dorzolamide (n = 53). Acetazolamide patients received one 250 mg tablet, one hour before surgery, then half a tablet every eight hours. A topical dorzolamide 2% or gentamicin was applied in one drop one hour before surgery then every eight hours, for three days postoperatively. Intraocular pressures (IOP) were measured by Goldman applanation tonometry one hour preoperatively and 16, 24, and 48 hours postoperatively. Results: At 16 hours, IOP between the three groups increased significantly with a statistically significant p-value of 0.008, but the mean IOP of acetazolamide patients was less than other groups. IOP nearly returned to the normal level 24 and 48 hours postoperatively, but this was not statistically significant (p = 0.452 and 0.138, respectively).Conclusion: Acetazolamide offers better IOP control than topical dorzolamide 2% in preventing ocular hypertension after scleral tunnel cataract surgery. Keywords: cataract surgery, ocular hypertension, viscoelastic, dorzolamide, intraocular pressure Dove Press Abdulmoghni Al-Barrag, Motaher Al-Shaer, Nabil Al-Matary, Mahfoud Bamashmous 2009-06-11 PDF http://www.dovepress.com/getfile.php?fileID=4943 http://www.dovepress.com/oral-versus-topical-carbonic-anhydrase-inhibitors-in-ocular-hypertensi-peer-reviewed-article-OPTH English

oai:dovepress.com/3262 2009-06-17 OPTH

Effect of heparin in the intraocular irrigating solution on postoperative inflammation in the pediatric cataract surgery Ozkurt, Yelda Clinical Ophthalmology Yelda B &Ouml;zkurt, Arzu Taşkıran, Nadire Erdogan, Baran Kandemir, &Ouml;mer K Dog˘anDepartment of Ophthalmology, Kartal Training and Research Hospital, Istanbul, TurkeyPurpose: To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. Setting: Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey.Design: Randomized prospective double-blind study.Methods: Fourteen consecutive eyes from 14 patients aged 8.9 &plusmn; 5.9 years, (range 3&ndash;18 years) (group 1) and 19 eyes from 19 patients aged 9.1 &plusmn; 5.2 (range 1.5&ndash;18 years) (group 2) underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc) and 1 ml of heparin sodium (concentration 10 IU/ml) added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA) while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared.Results: Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day.Conclusion: Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.Keywords: pediatric, cataract, surgery, inflammation Dove Press Yelda B &Ouml;zkurt, Arzu Taşkıran, Nadire Erdogan, Baran Kandemir, et al. 2009-06-17 PDF http://www.dovepress.com/getfile.php?fileID=4958 http://www.dovepress.com/effect-of-heparin-in-the-intraocular-irrigating-solution-on-postoperat-peer-reviewed-article-OPTH English

oai:dovepress.com/3275 2009-06-18 OPTH

Phakic anterior chamber intraocular lens (Verisyse&trade;) implantation in children for treatment of severe ansiometropia myopia and amblyopia: Six-month pilot clincial trial and review of literature Pirouzian, Amir Clinical Ophthalmology Amir Pirouzian1,3, Kenneth C Ip2, Henry S O&rsquo;Halloran31The Permanente Medical Group, Santa Clara, CA, USA; 2The Permanente Medical Group, San Francisco, CA, USA; 3Rady&rsquo;s Children&rsquo;s Hospital of San Diego, San Diego, CA, USAPurpose: The current study aims to evaluate both safety and efficacy of Verisyse&trade; (AMO, Irvine, CA) phakic anterior chamber intraocular lens (IOL) in the reduction of clinically significant (&gt;-8 D) myopic anisometropia in children who are noncompliant to traditional medical treatment including spectacle correction or contact lenses.Design: Retrospective interventional case series.Methods: Six anisometropic myopic pediatric patients in one practice were identified through chart-review. None of the patients were compliant with specatacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity (mean &lt;20/400). All patients underwent Verisyse&trade; phakic IOL implantation in the more myopic eye by one surgeon (AP). Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible.Results: The age of patients ranged from 5&ndash;11 years. The mean post-operative follow-up time was six months from the time of IOL insertion. Improvement in visual acuity &gt;6 lines was achieved in four patients (mean visual acuity of 20/70 at six months). Improvement in stereoacuity was noted in all six patients (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by randot stereoacuity testing). Improvement of &gt;2 lines of visual acuity lines was achieved in the other two patients. No patient lost any lines of visual acuity. Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. No intra/post-operative complications were noted.Discussion: Irreversible or intractable amblyopia secondary to severe anisometropic myopia is a serious medical concern in the pediatric population. Failure of compliance with contact lens therapy consistently leads to visual loss. Anterior chamber phakic IOLs may provide a safe alternative in treatment of noncompliant anisometropic myopic patients who do not accept spectacle wear or contact lens therapy.Conclusion: To reduce or eliminate highly significant anisometropic myopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation may be considered as an alternative modality of treatment. Keywords: amblyopia, anisometropia, myopia, intraocular lens implant Dove Press Amir Pirouzian, Kenneth C Ip, Henry S O&rsquo;Halloran 2009-06-18 PDF http://www.dovepress.com/getfile.php?fileID=4974 http://www.dovepress.com/phakic-anterior-chamber-intraocular-lens-verisysetrade-implantation-in-peer-reviewed-article-OPTH English

oai:dovepress.com/3299 2009-06-25 OPTH

Comparative studies of RNFL thickness measured by OCT with global index of visual fields in patients with ocular hypertension and early open angle glaucoma Taliantzis, Clinical Ophthalmology Sergios Taliantzis, Dimitris Papaconstantinou, Chrysanthi Koutsandrea, Michalis Moschos, Michalis Apostolopoulos, Gerasimos GeorgopoulosAthens University Medical School, Department of Ophthalmology, Athens, GreecePurpose: To compare the functional changes in visual fields with optical coherence tomography (OCT) findings in patients with ocular hypertension, open angle glaucoma, and suspected glaucoma. In addition, our purpose is to evaluate the correlation of global indices with the structural glaucomatous defect, to assess their statistical importance in all the groups of our study, and to estimate their validity to the clinical practice.Methods: One hundred sixty nine eyes (140 patients) were enrolled. The patients were classified in three groups. Group 1 consisted of 54 eyes with ocular hypertension, group 2 of 42 eyes with preperimetric glaucoma, and group 3 of 73 eyes with chronic open angle glaucoma. All of them underwent ophthalmic examination according to a prefixed protocol, OCT exam (Stratus 3000) for retinal nerve fiber layer (RNFL) thickness measurement with fast RNFL thickness protocol and visual fields (VF) examination with Octopus perimeter (G2 program, central 30&ndash;2 threshold strategy). Pearson correlation was calculated between RNFL thickness and global index of VF.Results: A moderate correlation between RNFL thickness and indices mean sensitivity (MS), mean defect (MD) and loss variance (LV) of VF (0.547, -0.582, -0.527, respectively; P &lt; 0.001) was observed for all patients. Correlations of the ocular hypertension and preperimetric groups are weak. Correlation of RNFL thickness with global indices becomes stronger as the structural alterations become deeper in OCT exam. Correlation of RNFL thickness with the global index of VF, in respective segments around optic disk was also calculated and was found significant in the nasal, inferior, superior, and temporal segments.Conclusion: RNFL average thickness is not a reliable index for early diagnosis of glaucoma and for the follow-up of patients with ocular hypertension. Segmental RNFL thickness seems to be a more reliable index. Deep structural alterations with OCT examination constitute an important indication of early functional changes, even if they are not still detected with achromatic perimetry. The MD index of VF seems to be more sensitive for the follow-up of patients with ocular hypertension.Keywords: glaucoma, ocular hypertension, OCT, visual fields, RNFL thickness Dove Press Sergios Taliantzis, Dimitris Papaconstantinou, Chrysanthi Koutsandrea, Michalis Moschos, et al. 2009-06-25 PDF http://www.dovepress.com/getfile.php?fileID=5000 http://www.dovepress.com/comparative-studies-of-rnfl-thickness-measured-by-oct-with-global-inde-peer-reviewed-article-OPTH English

oai:dovepress.com/3308 2009-06-29 OPTH

The role of difluprednate ophthalmic emulsion in clinical practice Callanan, David Clinical Ophthalmology Karim N Jamal1,2, David G Callanan11Texas Retina Associates, Arlington, Texas, USA; 2Current affiliation: Retinal Consultants of Arizona, Phoenix, Arizona, USAAbstract: The mainstay in the treatment of ocular inflammation, either post-surgical or endogenous, is the use of steroids. While these agents effectively address inflammation, they are not without their risks, including ocular hypertension and acceleration of cataract formation. The most notorious culprits are the strong steroids, such as prednisolone acetate and betamethasone. This review aims to cover the biochemistry and drug development of difluprednate, a novel synthetic strong steroid emulsion. In vivo pharmacokinetics as well as ocular distribution and metabolism are discussed, followed by a comprehensive summary of phase I, II, and III clinical trials evaluating safety and efficacy in patients suffering from postoperative inflammation or anterior uveitis. The objective is to provide an increased familiarity with this newly approved medication as a welcome addition to the ophthalmologist&rsquo;s armamentarium.Keywords: difluprednate, steroid, emulsion, ophthalmic surgery Dove Press <p align="left">Karim N Jamal, David G Callanan</p> 2009-06-29 PDF http://www.dovepress.com/getfile.php?fileID=5009 http://www.dovepress.com/the-role-of-difluprednate-ophthalmic-emulsion-in-clinical-practice-peer-reviewed-article-OPTH English

oai:dovepress.com/3321 2009-07-01 OPTH

24-hour intraocular pressure in glaucoma patients randomized to receive dorzolamide or brinzolamide in combination with latanoprost Oishi, Yoshimi Clinical Ophthalmology Yoshimi Nakamura, Shusaku Ishikawa, Yuko Nakamura, Hiroshi Sakai, Ichiko Henzan, Shoichi SawaguchiDepartment of Ophthalmology, University of the Ryukyus Faculty of Medicine, Okinawa, JapanPurpose: To investigate the efficacy of dorzolamide 1% (bid or tid) or brinzolamide 1% bid on 24-hour intraocular pressure (IOP) control as well as patients&rsquo; preference for either drug when added in combination with latanoprost against glaucoma (IOP, &ge;18 mmHg).Methods: In this randomized crossover study patients were assigned to receive latanoprost plus either dorzolamide or brinzolamide for four weeks. Thereafter, patients underwent 24-hour IOP monitoring while continuing to receive dorzolamide (for two successive days/nights: at first bid then tid) or brinzolamide bid (once overnight). They were then switched over to receive the other test medication for a further four weeks and subsequently reexamined for 24-hour IOP. A questionnaire survey on treatment satisfaction was performed.Results: In 20 patients dorzolamide bid or tid or brinzolamide bid exerted significant (p &lt; 0.001) reductions of IOP from baseline at all time-points over 24 hours; no difference was detected among the treatment regimens. Significantly (p &lt; 0.05) more patients preferred dorzolamide (n = 9) over brinzolamide (n = 2), whereas nine patients gave a neutral answer. Conclusion: Dorzolamide bid or tid and brinzolamide bid when combined with latanoprost therapy elicited significant IOP reduction for 24 hours. It is rational to consider patients&rsquo; preference of therapeutic regimen especially long-term users such as those with glaucoma.Keywords: glaucoma, brinzolamide, dorzolamide, latanoprost combination therapy, 24-hour intraocular pressure (IOP), questionnaire survey Dove Press Yoshimi Nakamura, Shusaku Ishikawa, Yuko Nakamura, Hiroshi Sakai, et al. 2009-07-01 PDF http://www.dovepress.com/getfile.php?fileID=5025 http://www.dovepress.com/24-hour-intraocular-pressure-in-glaucoma-patients-randomized-to-receiv-peer-reviewed-article-OPTH English

oai:dovepress.com/3322 2009-07-01 OPTH

Absence of lateral palpebral raphe in Caucasians Kakizaki, Hirohiko Clinical Ophthalmology Lucy Goold1, Hirohiko Kakizaki1,2,3, Raman Malhotra3, Dinesh Selva11South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Australia; 2Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 3Corneoplastic Unit and Eye Bank, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, United KingdomAbstract: Classical anatomical teaching reports the presence of the lateral palpebral raphe formed at the union in the preseptal and orbital parts of the orbicularis oculi muscle, or by the tendon adhering these to the underlying zygomatic bone. The lateral palpebral raphe has been shown to be absent in Asian cadavers. The current study uses both evidence from the anatomical dissection of five eyelids from three Caucasian cadavers, and histological assessment of the lateral canthus of 13 eyelids from seven Caucasian cadavers to illustrate the absence of the lateral palpebral raphe in Caucasian population.Keywords: lateral palpebral raphe, orbicularis oculi muscle, Caucasian, cadavers Dove Press Lucy Goold, Hirohiko Kakizaki, Raman Malhotra, Dinesh Selva 2009-07-01 PDF http://www.dovepress.com/getfile.php?fileID=5026 http://www.dovepress.com/absence-of-lateral-palpebral-raphe-in-caucasians-peer-reviewed-article-OPTH English

oai:dovepress.com/3325 2009-07-01 OPTH

A retrospective randomized study to compare the energy delivered using CDE with different techniques and OZil settings by different surgeons in phacoemulsification Chen, Ming Clinical Ophthalmology Ming Chen1, Henry W Sweeney2, Becky Luke3, Mindy Chen4, Mathew Brown51University of Hawaii, Honolulu, Hawaii, USA; 2Research Support Services, the Queens Medical Center, Honolulu, Hawaii, USA; 3Surgical Suite, Honolulu, Hawaii, USA; 4University of California, Irvine, CA, USA; 5University of California, San Diego, CA, USAAbstract: Cumulative dissipated energy (CDE) was used with Infiniti&reg; Vision System (Alcon Labs) as an energy delivery guide to compare four different phaco techniques and phaco settings. The supracapsular phaco technique and burst mode is known for efficiency and surgery is faster compared with the old phaco unit. In this study, we found that supracapsular phaco with burst mode had the least CDE in both cataract and nuclear sclerosis cataract with the new Infiniti&reg; unit. We suggest that CDE can be used as one of the references to modify technique and setting to improve outcome for surgeons, especially for new surgeons. Keywords: CDE (cumulative dissipated energy), cataract surgery, phacoemulsification, supracapsular, burst mode, Divide&ndash;Conquer Dove Press Ming Chen, Henry W Sweeney, Becky Luke, Mindy Chen, et al. 2009-07-01 PDF http://www.dovepress.com/getfile.php?fileID=5029 http://www.dovepress.com/a-retrospective-randomized-study-to-compare-the-energy-delivered-using-peer-reviewed-article-OPTH English

oai:dovepress.com/3335 2009-07-07 OPTH

Etiology, prevalence, and treatment of dry eye disease Gayton, Johnny Clinical Ophthalmology Johnny L GaytonEyesight Associates, Warner Robins, GA, USAPurpose: This review article examines the prevalence, etiology, and current therapies of dry eye disease, with special focus on postmenopausal women.Method: A systematic literature search utilizing MEDLINE was conducted to identify peer-reviewed articles related to dry eye published prior to September 2008. The terms &ldquo;dry eye&rdquo; and &ldquo;women&rdquo; were searched in combination with one or more of the following words or phrases: prevalence, postmenopausal, etiology, risk factors, therapy, medications, surgery, tear film, and quality of life. Articles were selected based on their direct applicability to the subject matter. A manual search was also conducted based on citations in the published literature.Results: Epidemiologic studies identified prevalence rates ranging from 7% in the United States to 33% in Taiwan and Japan. Risk factors include advanced age, female sex, smoking, extreme heat or cold weather conditions, low relative humidity, use of video display terminals, refractive surgery, contact lens wear, and certain medications.Conclusion: The last decade has brought about a better understanding of the etiology of dry eye disease. New therapies that can alleviate the signs and symptoms of dry eye disease and, consequently, improve the quality of life of dry eye patients are available in the market.Keywords: dry eye disease, etiology, prevalence, postmenopausal women Dove Press <p align="left">Johnny L Gayton</p> 2009-07-07 PDF http://www.dovepress.com/getfile.php?fileID=5041 http://www.dovepress.com/etiology-prevalence-and-treatment-of-dry-eye-disease-peer-reviewed-article-OPTH English

oai:dovepress.com/3364 2009-07-20 OPTH

Spectral domain optical coherence tomographic findings at convalescent stage of acute zonal occult outer retinopathy Ohta, Kouichi Clinical Ophthalmology Kouichi Ohta, Atsuko Sato Emi FukuiDepartment of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, JapanPurpose: To describe the morphology of the retina at the convalescent stage of acute zonal occult outer retinopathy (AZOOR) from images obtained by spectral domain optical coherence tomography (SD-OCT).Methods: The visual fields, electroretinograms (ERGs), and OCT images were reviewed in two women aged 24 and 33 years. The patients were followed for one and four years, respectively.Results: In both cases, the anterior and posterior segments were almost normal, although both patients had a sudden unilateral vision decrease and photopsia. Goldmann perimetry revealed enlarged blind spots and scotomas. The ERGs were reduced in both cases. SD-OCT showed that the junction of the inner and outer segment, the IS/OS line, of the photoreceptors was irregular or lost in the affected retinas. The retina in these areas was thinner due to a decrease in the thickness of both the outer nuclear layer (ONL) and inner nuclear layer (INL) in Case 2. Conclusions: The decrease in retinal thickness at the convalescent stage of AZOOR is most likely due to a shortening of not only the photoreceptors and ONL but also to a thinning of the INL in a severe case.Keywords: AZOOR, SD-OCT, IS/OS, ONL Dove Press Kouichi Ohta, Atsuko Sato Emi Fukui 2009-07-20 PDF http://www.dovepress.com/getfile.php?fileID=5072 http://www.dovepress.com/spectral-domain-optical-coherence-tomographic-findings-at-convalescent-peer-reviewed-article-OPTH English

oai:dovepress.com/3368 2009-07-21 OPTH

A comparison of manifest refractions, cycloplegic refractions and retinoscopy on the RMA-3000 autorefractometer in children aged 3 to 15 years Rotsos, Tryfon Clinical Ophthalmology T Rotsos,1 D Grigoriou,2 A Kokkolaki,2&nbsp;N Manios21Moorfields eye hospital, London, UK; 2Department of Ophthalmology, General Children&rsquo;s Hospital, Penteli, Athens, GreecePurpose: The study was conducted to compare the accuracy of readings of the RMA-3000 autorefractometer (Topcon, Tokyo, Japan) with traditional retinoscopy as a means of determining the approximate subjective refraction in children after cycloplegia.Methods: 142 children aged 3 to 15 years were included. All children had their refractive status measured with the RMA-3000 autorefractometer (noncycloplegic autorefraction [AR]). Subsequently all children underwent cycloplegia and the refractive status was estimated again with the autorefractometer (cycloplegic autorefraction [ARC]) and traditional retinoscopy (RC) by examiners who were unaware of the results from the other techniques.Results: From 69 right eyes with negative sphere we observed that the sphere power was significantly higher (more than 0.5 diopters) in AR than in ARC (P = 0.0001) and RC (P = 0.0001). From the 73 normal and hyperopic right eyes we observed that the sphere power was significantly lower (more than 0.5 diopters) in AR than in ARC (P = 0.0001) and RC (P = 0.0001). Conclusions: The use of the autorefractometer in children (in whom accommodation is more active than older patients) without cycloplegia may underestimate the actual hyperopia and overestimate the actual myopia. Manual retinoscopy is still the most accurate technique to estimate refractive status in children.Keywords: refractometer, cycloplegia, retinoscopy, myopia, hyperopia, astigmatism Dove Press <p align="left">T Rotsos, D Grigoriou, A Kokkolaki, et al</p> 2009-07-21 PDF http://www.dovepress.com/getfile.php?fileID=5076 http://www.dovepress.com/a-comparison-of-manifest-refractions-cycloplegic-refractions-and-retin-peer-reviewed-article-OPTH English

oai:dovepress.com/3377 2009-07-23 OPTH

Causes of blindness in rural Myanmar (Burma): Mount Popa Taung-Kalat Blindness Prevention Project Nemet, Arie Clinical Ophthalmology Arie Y Nemet1, Pinhas Nemet2, Geoff Cohn3, Gina Sutton, Gerald Sutton4, Richard Rawson41Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia; 2Sackler School of Medicine, Tel-Aviv University, Israel; 3Departments of Ophthalmology, University of New South Wales, Sydney, Australia; 4Department of Ophthalmology, University of Sydney, AustraliaPurpose: This study is a review of the major causes of visual impairment (VI) and severe visual impairment/blindness (SVI/BL) in Mount Popa Taung-Kalat, a rural region in Myanmar (Burma).Methods: A review of our clinical records of consecutive patients attending clinics was conducted. Participants of all ages (n = 650) of the population of Mount Popa Taung-Kalat and villages in its vicinity underwent ophthalmic interview and a detailed dilated ocular evaluation by trained Australian ophthalmologists and ophthalmic nurses. This evaluation included anterior segment examination with a slit lamp, intraocular pressure recording, and direct or indirect ophthalmoscopy. VI and SVI/BL were defined by the World Health Organization (WHO) criteria. Results: Six hundred fifty subjects were screened, with a mean age of 49.0 &plusmn; 20.6 years (range, 1&ndash;99). One hundred five patients (16.2%) were children (ages 1&ndash;18). Five hundred thirty-one eyes of the total 1,300 eyes (39.5%) had VI/SVI/BL, and 40 eyes of the children (38.1%) (average age 15.3 &plusmn; 13.3) had VI/SVI/BL. The leading causes of VI/SVI/BL were cataract with 288 cases (54.2%), glaucoma with 84 cases (15.8%), and corneal pathology with 78 cases (14.7%). Of all the VI/SVI/BL cases, 8.4% were preventable, 81.9% were treatable, and total of 90.5% were avoidable.Conclusions: In the current study, cataracts were the major cause of blindness and visual impairment, and most of the ophthalmic pathology causing blindness is avoidable. These results highlight the lack of basic ophthalmologist eye care and optician resources in rural regions in Myanmar.Keywords: blindness, visual loss, cataract, Myanmar, Burma, epidemiology study Dove Press Arie Y Nemet, Pinhas Nemet, Geoff Cohn et al. 2009-07-23 PDF http://www.dovepress.com/getfile.php?fileID=5087 http://www.dovepress.com/causes-of-blindness-in-rural-myanmar-burma-mount-popa-taung-kalat-blin-peer-reviewed-article-OPTH English

oai:dovepress.com/3396 2009-07-31 OPTH

The quality of life impact of peripheral versus central vision loss with a focus on glaucoma versus age-related macular degeneration Evans, Keith Clinical Ophthalmology Keith Evans1, Simon K Law2, John Walt3, Patricia Buchholz4, Jan Hansen31Global Health Outcomes, Wolters Kluwer Health, Chester, United Kingdom; 2Jules Stein Eye Institute, Los Angeles, CA, USA; 3Global Health Outcomes Strategy and Research, Allergan Inc., Irvine, CA, USA; 4Health Economics, Pricing, and Reimbursement, Allergan GmbH, Ettlingen, GermanyPurpose: It is well accepted that conditions that cause central vision loss (CVL) have a negative impact on functional ability and quality of life (QoL), but the impact of diseases that cause peripheral vision loss (PVL) is less well understood. Focusing on glaucoma and age-related macular degeneration (ARMD), the effects of CVL and PVL on QoL were compared. Methods: A systematic literature review of publications reporting QoL in patients with CVL or PVL identified 87 publications using four generic (Short-Form Health Survey-36 and -12, EuroQoL EQ-5D and Sickness Impact Profile) and five vision-specific (National Eye Institute Visual Function Questionnaire-51, -39, and -25, Impact of Vision Impairment and Visual Function-14) QoL instruments; 33 and 15 publications reported QoL in ARMD and glaucoma, respectively.Results: QoL was impaired to a similar extent by diseases associated with PVL and CVL, but different domains were affected. In contrast to ARMD, mental aspects appeared to be affected more than physical aspects in patients with glaucoma.Conclusions: The differential impact upon QoL might be a function of the pathology of the diseases, for example potential for blindness and better ability to perform physical tasks due to retention of central vision may explain these observations in glaucoma.Keywords: vision loss, quality of life, glaucoma, age-related macular degeneration, diabetic macular edema, cataracts Dove Press Keith Evans, Simon K Law, John Walt, et al 2009-07-31 PDF http://www.dovepress.com/getfile.php?fileID=5110 http://www.dovepress.com/the-quality-of-life-impact-of-peripheral-versus-central-vision-loss-wi-peer-reviewed-article-OPTH English

oai:dovepress.com/3397 2009-07-31 OPTH

Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis Mills, Edward Clinical Ophthalmology Oghenowede Eyawo1, Jean Nachega2,3, Pierre Lefebvre4, David Meyer5, Beth Rachlis6, Chia-Wen Lee7, Steven Kelly7, Edward Mills81Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; 2Division of Clinical Pharmacology and Medicine, University of Cape Town, Cape Town, South Africa; 3Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; 4Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; 5Department of Ophthalmology, Stellenbosch University, Cape Town, South Africa; 6Department of Public Health, University of Toronto, Toronto, Canada; 7Outcome Research and Evidence Based Medicine, Pfizer Ltd UK. Tadworth, UK; 8Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, CanadaBackground: First-line therapy for primary open-angle glaucoma and ocular hypertension generally involves prostaglandin analogue therapy. The relative efficacy of differing prostaglandin therapy is disputed.Methods: A meta-analysis was conducted of head-to-head randomized trials of prostaglandin therapies. We included randomized trials assessing head-to-head evaluations of prostaglandin analogues travoprost, latanoprost and bimatoprost in patients with predominantly primary open-angle glaucoma or ocular hypertension. Findings were interpreted in light of equivalence margins.Results: Our search identified 16 eligible trials, of which 15 were included in the meta-analysis. Trials were, in general, poorly reported. We pooled 9 trials assessing IOP-lowering effects of travoprost vs latanoprost (total n = 1098, weighted mean difference [WMD], &ndash;0.24 mmHg, 95% CI, &ndash;0.87 to 0.38, P = 0.45, I2 = 56%, 95% CI, 0 to 0.77, heterogeneity P = 0.01). Eight trials assessed travoprost vs bimatoprost (total n = 714, WMD, 0.88 mmHg, 95% CI, 0.13 to 1.63, P = 0.02, I2 = 56%, 95% CI, 0% to 78%, heterogeneity P = 0.02). And 8 trials assessed latanoprost vs bimatoprost (total n = 943, WMD, 0.73 mmHg, 95% CI, 0.10 to 1.37, P = 0.02, I2 = 47%, 95% CI, 0% to 74%, heterogeneity P = 0.06). Travoprost was associated with greater incidence of conjunctival hyperemia than latanoprost (RR 5.71, 95% CI, 1.81 to 18.02, P &le; 0.001, I2 = 97%, 95% CI, 95 to 98, P &le; 0.001). Five trials assessing latanoprost and bimatoprost revealed an elevated risk of conjunctival hyperemia with bimatoprost (RR 1.59, 95% CI, 1.02 to 2.48, P = 0.04, I2 = 76%, 95% CI, 16 to 88, P = 0.002).Conclusion: Randomized head-to-head evaluations of prostaglandin therapy demonstrate similar efficacy effects, but differing hyperemia effects.Keywords: prostaglandin analogues, primary open-angle glaucoma, ocular hypertension, travoprost, latanoprost, bimatoprost Dove Press Oghenowede Eyawo, Jean Nachega, Pierre Lefebvre, et al 2009-07-31 PDF http://www.dovepress.com/getfile.php?fileID=5111 http://www.dovepress.com/efficacy-and-safety-of-prostaglandin-analogues-in-patients-with-predom-peer-reviewed-article-OPTH English

oai:dovepress.com/3408 2009-08-04 OPTH

Massive choroidal hemorrhage after intravitreal administration of bevacizumab (Avastin&reg;) for AMD followed by controlateral sympathetic ophthalmia Brouzas, D. Clinical Ophthalmology Dimitrios Brouzas, Chryssanthi Koutsandrea, Marilita Moschos, Spiros Papadimitriou, Ioannis Ladas, Michael Apostolopoulos1st Eye Department , University of Athens, Athens, GreecePurpose: To report a severe ocular complication initiated ten days after intravitreal administration of bevacizumab (Avastin&reg;), in a patient with exudative age-related macular degeneration (AMD).Patients and method: Case report.Results: Ten days after intravitreal injection of 1.25 mg Avastin&reg;, the patient manifested acute loss of vision with excruciating pain. An extensive choroidal detachment was evident in close contact with the lens, which necessitated an emergency sclerotomy with reconstruction of the anterior chamber. Four months later, the eye proceeded to phthisis bulbi. Five months after the injection, the patient complained of mild pain, photophobia, and visual acuity deterioration from the fellow eye. The diagnosis of sympathetic ophthalmia was suggested and treated with intravitreal injections of triamcinolone acetonide every three months with good response, complicated by elevation of intraocular pressure which we managed with Ahmet valve implantation.Conclusion: Serious ocular complications after intravitreal of Avastin&reg; can not be excluded, including massive choroidal hemorrhage and sympathetic ophthalmia of the fellow eye.Keywords: Avastin&reg; complication, intravitreal injection, choroidal detachment, Phthisis bulbi, sympathetic ophthalmia Dove Press Dimitrios Brouzas, Chryssanthi Koutsandrea, Marilita Moschos, et al 2009-08-04 PDF http://www.dovepress.com/getfile.php?fileID=5125 http://www.dovepress.com/massive-choroidal-hemorrhage-after-intravitreal-administration-of-beva-peer-reviewed-article-OPTH English

oai:dovepress.com/3426 2009-08-06 OPTH

Efficacy of patterned scan laser in treatment of macular edema and retinal neovascularization Modi, Clinical Ophthalmology Dimple Modi, Paulpoj Chiranand, Levent AkdumanSaint Louis University School of Medicine, Department of Ophthalmology, Saint Louis University Eye Institute, St. Louis, Missouri, USAPurpose: To analyze the benefits, efficacy, and complications of the PASCAL&reg; photocoagulation laser system (OptiMedica, Santa Clara, CA, USA) in patients treated at our institution.Methods: We conducted a retrospective chart review of 19 patients (28 eyes) who underwent laser treatment using the PASCAL&reg; photocoagulation system from November 2006 to November 2007. These 28 eyes were divided into two groups; group 1 eyes underwent macular grid laser and group 2 eyes underwent panretinal photocoagulation. Treatment was performed for macular edema or for iris or retinal neovascularization. Outcomes measured included best-corrected visual acuity (BCVA), efficacy of laser treatment, complications, duration of the procedure, and pain perception, which were noted in the charts for panretinal treatments.Results: Follow-up was 5.9 &plusmn; 2.6 months for group 1 and 5.9 &plusmn; 4.0 months for group 2. In group 1, 9/28 eyes required a second treatment for remaining edema. BCVA was stable or better in 66% (14/21) and average central foveal thickness on ocular coherence tomography improved in 71% (15/21). Time to completion for a number of laser patterns for grid photocoagulation was felt to be too long for completing the total pattern safely, although we have not noted any related complications. In group 2, the neovascularization regressed at least partially in 3/7 patients. Patient-reported pain perception was 3.6 on a scale of 1 to 10 for group 2. Occasional hemorrhages occurred secondary to irregular laser uptake at different spots in the patterns. We observed no visual outcome consequences because of these hemorrhages during follow-up.Conclusions: Retinal photocoagulation by the PASCAL&reg; laser has comparable efficacy to historical results with conventional retinal photocoagulation in short-term follow-up. PASCAL&reg; photocoagulation can be performed quicker with less discomfort for patients.Keywords: diabetic retinopathy, laser, macular edema, PASCAL, patterned scan laser, photocoagulation, retinal neovascularization Dove Press Dimple Modi, Paulpoj Chiranand, Levent Akduman 2009-08-06 PDF http://www.dovepress.com/getfile.php?fileID=5143 http://www.dovepress.com/efficacy-of-patterned-scan-laser-in-treatment-of-macular-edema-and-ret-peer-reviewed-article-OPTH English

oai:dovepress.com/3413 2009-08-05 OPTH

Unilateral childhood blindness: a hospital-based study in Yaound&eacute;, Cameroon Omgbwa Eballe, André Clinical Ophthalmology Andr&eacute; Omgbwa Eballe1, Emilienne Ep&eacute;e2, Godefroy Koki2, Lucienne Bella2, C&ocirc;me Ebana Mvogo21Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaound&eacute; I, Yaound&eacute;, CameroonIntroduction: We performed an analytic and prospective study over a period of 12 months from January 2nd to December 31st, 2008, at the Gynaeco-Obstetric and Paediatric Hospital of Yaound&eacute;, Cameroon. Our aim was to determine the prevalence and causes of unilateral blindness in school children aged 6 to 15 years.Results: Among the 1,266 children aged 6 to 15 years who were recruited, 60 presented with unilateral blindness (4.7%): 42 boys (6.96%) and 18 girls (2.71%). The mean age was 10.15 &plusmn; 3.4 years. In patients with unilateral blindness, 65% was due to ocular trauma.Discussion: The hospital-based prevalence of unilateral blindness in children is relatively high and ocular trauma is the leading etiology.Conclusion: Unilateral blindness in school children is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Early management of nontraumatic diseases such as infantile glaucoma and some tumors could improve outcome and avoid blindness.Keywords: unilateral blindness, ocular trauma, prevalence, education Dove Press Andr&eacute;; Omgbwa Eballe, Emilienne Ep&eacute;e, Godefroy Koki, et al 2009-08-05 PDF http://www.dovepress.com/getfile.php?fileID=5162 http://www.dovepress.com/unilateral-childhood-blindness-a-hospital-based-study-in-yaoundegrave--peer-reviewed-article-OPTH English

oai:dovepress.com/3453 2009-08-16 OPTH

Daily costs of prostaglandin analogues as monotherapy or in fixed combinations with timolol, in Denmark, Finland, Germany and Sweden Berdeaux, Gilles Clinical Ophthalmology Anders Bergstr&ouml;m1, Fr&eacute;d&eacute;rique Maurel2, Claude Le Pen3, Emilie Lamure2, Michael Kent4, Isabelle Bardoulat2, Gilles Berdeaux5,61Lund Hospital, Lund, Sweden; 2IMS France, Puteaux, France; 3Universit&eacute; Paris-Dauphine, Paris, France; 4Alcon Inc, Fort Worth, Texas, USA; 5Alcon France SA, Rueil-Malmaison, France; 6Conservatoire National des Arts et M&eacute;tiers, Paris, FranceBackground: To compare the daily costs of 3 prostaglandin analogues (bimatoprost, latanoprost, travoprost), alone, and associated with timolol in 4 European countries (Denmark, Finland, Germany, and Sweden).Methods: Six glaucoma products were sampled by buying 5 bottles from 1 suburban pharmacy in each of the 4 countries. Drops were weighed by a single operator at 1 site according to standardized procedures. Residual drops were then counted. Unit bottle costs were estimated from tariff lists. Eye-drop weights were entered into a nested analysis of variance comprising drug, instillation day, country, the interaction, and a sample factor nested within the country factor. Effectiveness was represented by treatment failure rates estimated from a meta-analysis and a general practitioner survey.Results: Every drug bottle contained sufficient drops to treat 1 patient for 28/31 days. Drop-size heterogeneity between countries was observed for bimatoprost and bimatoprost/timolol. Mean travoprost and travoprost/timolol drop-sizes were the smallest, and drop-counts per bottle were the lowest for latanoprost, or latanoprost/timolol. In all 4 countries annual costs were least for travoprost and travoprost/timolol.Conclusions: On taking into account drug costs and effectiveness, travoprost and travoprost/timolol were cheaper and more effective than latanoprost and latanoprost/timolol and were cheaper than bimatoprost and bimatoprost/timolol.Keywords: prostaglandin analogue, economics, daily cost Dove Press Anders Bergstr&ouml;m, Fr&eacute;d&eacute;rique Maurel, Claude Le Pen, et al 2009-08-16 PDF http://www.dovepress.com/getfile.php?fileID=5170 http://www.dovepress.com/daily-costs-of-prostaglandin-analogues-as-monotherapy-or-in-fixed-comb-peer-reviewed-article-OPTH English

oai:dovepress.com/3503 2009-09-02 OPTH

Ocular blood flow levels and visual prognosis in a patient with nonischemic type central retinal vein occlusion Maeda, Kimihito Clinical Ophthalmology Kimihito Maeda, Futoshi Ishikawa, Hiroshi OhguroDepartment of Ophthalmology, Sapporo Medical University, School of Medicine, Sapporo, JapanAbstract: We look at the case of a 39-year-old female patient suffering from a sudden decrease in her left visual acuity (0.08). Her macular edema was examined using optical coherence tomography, and her optic disc blood flow was examined with laser speckle flowgraphy (LSFG). Additionally, the degree of seriousness of the central vein occlusion was evaluated through fluorescein angiography (FA). Ocular fundus findings revealed central vein occlusion associated with macular edema, and FA determined her disease type as a nonischemic-central vein occlusion. Daily doses of 100 mg of aspirin were administered orally to the patient. Upon administration, her ocular blood flow almost immediately increased. In this study, we demonstrate the potential of LSFG as a means to investigate ocular blood flow.Keywords: ocular blood flow, nonischemic central retinal vein occlusion, laser speckle flowgraphy Dove Press Kimihito Maeda, Futoshi Ishikawa, Hiroshi Ohguro 2009-09-02 PDF http://www.dovepress.com/getfile.php?fileID=5222 http://www.dovepress.com/ocular-blood-flow-levels-and-visual-prognosis-in-a-patient-with-nonisc-peer-reviewed-article-OPTH English

oai:dovepress.com/3504 2009-09-02 OPTH

Changes in visual function and thickness of macula after photodynamic therapy for age-related macular degeneration Okada, Kyoko Clinical Ophthalmology Kyoko Okada, Mariko Kubota-Taniai, Masayasu Kitahashi, Takayuki Baba, Yoshinori Mitamura, Shuichi YamamotoDepartment of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, JapanPurpose: To determine the correlation between the changes in the central retinal sensitivity and the changes in the foveal thickness (FT) after photodynamic therapy (PDT) for age-related macular degeneration (AMD).Methods: Nineteen eyes of 19 patients with choroidal neovasularizations (CNVs) secondary to AMD were studied. The pretreatment values of the central retinal sensitivity determined by Micro Perimeter 1 (MP1; Nidek Technologies), best-corrected visual acuity (BCVA), and optical coherence tomography (OCT)-determined FT were compared to the postoperative values at three and six months after PDT.Results: At six months, the retinal sensitivity within the central 10&deg; was significantly improved (P = 0.02) and the FT was significantly thinner (P = 0.016). The BCVA, however, did not change significantly (P = 0.80). The changes in the retinal sensitivities were significantly correlated with the changes in the decrease in the FT (r = -0.59, P = 0.012 within the central 10&deg;) at six months after PDT.Conclusion: Significant improvements in retinal sensitivities within the central 10&deg; and a decrease in FT were observed even though the BCVA was not significantly improved. The measurement of retinal sensitivity by MP1 may be a better method to assess central visual function than the conventional visual acuity after PDT.Keywords: age-related macular degeneration, fundus-related microperimetry, optical coherence tomography, photodynamic therapy Dove Press Kyoko Okada, Mariko Kubota-Taniai, Masayasu Kitahashi, et al 2009-09-02 PDF http://www.dovepress.com/getfile.php?fileID=5223 http://www.dovepress.com/changes-in-visual-function-and-thickness-of-macula-after-photodynamic--peer-reviewed-article-OPTH English

oai:dovepress.com/3507 2009-09-03 OPTH

Effects of brinzolamide vs timolol as an adjunctive medication to latanoprost on circadian intraocular pressure control in primary open-angle glaucoma Japanese patients Ishikawa, Makoto Clinical Ophthalmology Makoto Ishikawa1,2, Takeshi Yoshitomi11Department of Ophthalmology, Akita University Faculty of Medicine, Akita, Japan; 2Department of Ophthalmology, Ogachi Central Hospital, Akita, JapanPurpose: To study the effect of the concomitant use of brinzolamide and latanoprost on the 24-hour variation in intraocular pressure (IOP) in primary open-angle glaucoma (POAG) patients first treated with timolol and latanoprost.Methods: We studied 30 eyes from 30 POAG patients previously treated with latanoprost monotherapy. After a washout of four weeks in both eyes, all patients were treated with 0.5% timolol and latanoprost. Three months after the initiation of treatment with timolol and latanoprost, the 24-hour IOP variation was measured. Thereafter, all patients were treated with concomitant 1% brinzolamide and latanoprost. Three months after changing the therapeutic regimen, the 24-hour IOP variation was measured a second time. Latanoprost was administered once a day, and timolol and brinzolamide were twice a day. IOP was measured with a noncontact tomometer.Results: On treatment with brinzolamide and latanoprost, a significant decrease in IOP compared to timolol and latanoprost was observed at all time points except at 3 PM and 6 PM. As a group, the patients had a significantly lower diurnal mean IOP and nocturnal mean IOP during treatment with brinzolamide and latanoprost than with timolol and latanoprost.Conclusions: Treatment of POAG with a combination of brinzolamide and latanoprost demonstrated improved hypotensive effects compared with timolol and latanoprost during a 24-hour period.Keywords: circadian intraocular pressure, adverse effects, timolol, brinzolamide Dove Press Makoto Ishikawa, Takeshi Yoshitomi 2009-09-03 PDF http://www.dovepress.com/getfile.php?fileID=5227 http://www.dovepress.com/effects-of-brinzolamide-vs-timolol-as-an-adjunctive-medication-to-lata-peer-reviewed-article-OPTH English

oai:dovepress.com/3536 2009-09-11 OPTH

The effects of lubricant eye drops on visual function as measured by the Inter-blink interval Visual Acuity Decay test Torkildsen, Gail Clinical Ophthalmology Gail TorkildsenAndover Eye Associates, Andover, MA, USAObjective: The purpose of the current study was to evaluate the effects of two marketed ocular lubricants on the visual decay in dry eye patients using the Inter-blink interval Visual Acuity Decay (IVAD) test.Methods: This controlled, randomized, double-masked crossover study compared the effects of a polyethylene glycol/propylene glycol-based (PEG/PG) tear and a carboxymethylcellulose sodium (CMC)/glycerin tear on the visual acuity decay between blinks of dry eye patients. At visit 1 (Day 0), baseline IVAD measurements were recorded prior to instillation of a single drop of randomized study medication. IVAD testing was repeated at 15-, 45-, and 90-minutes post-instillation. Reading rate and functional blink rate were also evaluated. At the second visit (Day 7 &plusmn; 3), study procedures were repeated using crossover treatment.Results: Forty-eight (48) subjects with dry eye (61.1 &plusmn; 14.8 years old, 79.2% female, 95.8% white) completed the study. Treatment with the PEG/PG-based tear demonstrated statistically significantly longer time to one-line loss of best-corrected visual acuity (BCVA) as determined by the IVAD test at 90 minutes post-instillation compared to the CMC/glycerin tear (P = 0.0365). Measurements of median time at BCVA, reading rate, and functional blink rate were similar for both treatments. Both formulations were well tolerated in the population studied.Conclusions: Treatment with the PEG/PG-based tear demonstrated statistically significant improved maintenance of visual acuity between blinks at 90 minutes post-instillation compared to the CMC/glycerin tear. This is the first study to demonstrate the ability of an artificial tear to extend visual acuity maintenance between blinks, as measured by the IVAD test.Keywords: dry eye, visual function, artificial tears, ocular lubricant Dove Press Gail Torkildsen 2009-09-11 PDF http://www.dovepress.com/getfile.php?fileID=5261 http://www.dovepress.com/the-effects-of-lubricant-eye-drops-on-visual-function-as-measured-by-t-peer-reviewed-article-OPTH English

oai:dovepress.com/3549 2009-09-16 OPTH

Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics Bertino, J S Clinical Ophthalmology Joseph S Bertino Jr1,21College of Physicians and Surgeons, Columbia University, New York, N Y, USA; 2Principal, Bertino Consulting, Schenectady, NY, USAPurpose: This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections.Design: Interpretive assessment.Methods: Literature review and interpretation.Results: Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be developed and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the development of resistance are needed.Conclusions: New antimicrobial agents that treat ocular infections effectively and have a low potential for the development of resistance could be a part of strategies to prevent the global increase in ocular pathogen resistance.Keywords: ocular infections, emerging pathogen drug resistance, fluoroquinolones, besifloxacin Dove Press Joseph S Bertino Jr 2009-09-16 PDF http://www.dovepress.com/getfile.php?fileID=5274 http://www.dovepress.com/impact-of-antibiotic-resistance-in-the-management-of-ocular-infections-peer-reviewed-article-OPTH English

oai:dovepress.com/3554 2009-09-17 OPTH

A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis Kamiya, Kazutaka Clinical Ophthalmology Kazutaka Kamiya, Masayuki Kasahara, Kimiya ShimizuDepartment of Ophthalmology, University of Kitasato School of Medicine, JapanAbstract: We report on a patient in whom intractable infectious keratitis and subsequent lamellar flap necrosis necessitating flap amputation after laser in situ keratomileusis (LASIK). A 34-year-old woman undergoing LASIK complained of blurred vision and pain in the left eye. The best spectacle-corrected visual acuity was 0.01, and slit-lamp examination showed a marked presence of stromal infiltrates involving the flap and the underlying stroma in that eye. The patient was treated topically with hourly instillation of micronomicin, levofloxacin, and cefmenoxime, together with systemic administration of imipenem, but the left eye developed corneal flap necrosis. We performed surgical debridement of the diseased stroma and excised the lamellar flap. Since nontuberculous mycobacterium was detected on the surgical instruments, we then added oral clarithromycin, and substituted systemic administration of amikacin with that of imipenem. At one month after the flap removal, the visual acuity gradually improved to 0.7, but the stromal opacity of the central cornea and hyperopic shift of +3.0 diopters remained. LASIK can cause intractable keratitis, resulting in significant visual disturbance that presumably results from insufficient antisepsis of the medical instruments used for this surgery, supporting the importance of strict sterilization of these instruments.Keywords: infectious keratitis, flap necrosis, nontuberculous mycobacterium, sterilization, LASIK Dove Press Kazutaka Kamiya, Masayuki Kasahara, Kimiya Shimizu 2009-09-17 PDF http://www.dovepress.com/getfile.php?fileID=5279 http://www.dovepress.com/a-case-of-intractable-infectious-keratitis-and-subsequent-flap-necrosi-peer-reviewed-article-OPTH English

oai:dovepress.com/3568 2009-09-23 OPTH

Peripheral T-cell lymphoma of the eyelid Ishikawa, Makoto Clinical Ophthalmology Makoto Ishikawa, Hiroshi Watabe, Masahiro Hayakawa, Takeshi YoshitomiDepartment of Ophthalmology, Akita University Faculty of Medicine, Akita, JapanPurpose: To report a case of a 25-year-old woman with previously treated peripheral T-cell lymphoma (PTCL) presenting with a recurrent lower eyelid lesion.Patients and method: Case report.Results: A 25-year-old young woman with previously treated PTCL noted an induration in the skin of her left lower eyelid. Upon diagnosis of a chalazion, antibiotic eye drops and ointments as well as steroid eye drops were administered. However, the condition worsened rapidly and swelling of the lower eyelid became remarkable. An excisional biopsy revealed that the palpebral lesion was diagnosed as recurrence of PTCL. Electron irradiation was applied as a radical treatment, and the prognosis was satisfactory without recurrence at 10 months after the last irradiation.Conclusions: Although lymphoma isolated to the ocular adnexa is rare, it should always be included in the differential diagnosis of any patient presenting with progressive swelling of the eyelid or ocular region.Keywords: peripheral T-cell lymphoma, chalazion, eyelid Dove Press Makoto Ishikawa, Hiroshi Watabe, Masahiro Hayakawa, et al 2009-09-23 PDF http://www.dovepress.com/getfile.php?fileID=5293 http://www.dovepress.com/peripheral-t-cell-lymphoma-of-the-eyelid-peer-reviewed-article-OPTH English

oai:dovepress.com/3573 2009-09-24 OPTH

The effect of combined renal and pancreatic transplantation on diabetic retinopathy Shipman, Kate Clinical Ophthalmology Kate&nbsp;E Shipman, Chetan K PatelOxford Eye Hospital, John Radcliffe Hospital, Headington, Oxford, UKAbstract: This case report describes the effect of simultaneous pancreas kidney transplant (SPK) on the diabetic retinopathy (DR) of two male type 1 diabetic patients. The literature on the effect of SPK on DR is reviewed and the evidence surrounding visual function outcomes is discussed.Keywords: diabetic retinopathy, pancreas transplant diabetes mellitus, simultaneous pancreas kidney transplant, visual acuity Dove Press Kate&nbsp;E Shipman, Chetan K Patel 2009-09-24 PDF http://www.dovepress.com/getfile.php?fileID=5298 http://www.dovepress.com/the-effect-of-combined-renal-and-pancreatic-transplantation-on-diabeti-peer-reviewed-article-OPTH English

oai:dovepress.com/3586 2009-09-30 OPTH

Central corneal thickness in subjects with glaucoma and in normal individuals (with or without pseudoexfoliation syndrome) Kitsoso, G Clinical Ophthalmology Georgios Kitsos, Christos Gartzios, Ioannis Asproudis, Eleni BagliOphthalmology Department, University of Ioannina, Ioannina, GreeceObjective: The evaluation of central corneal thickness (CCT) in subjects with pesudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG), and in normotensive individuals with or without pseudoexfoliation syndrome (PXS). Study design/patients and methods: CCT was evaluated with ultrasound pachymetry in a total of 179 individuals: 32 had bilateral PEXG, 55 had bilateral POAG, 35 had PXS, and 57 were healthy individuals without PXS.Results: CCT in PEXG eyes (526.00 &plusmn; 34.30 &micro;m) was significantly thinner compared to POAG eyes (549.36 &plusmn; 39.3 &micro;m) (P = 0.027) and normal control eyes with (550.64 &plusmn; 39.0 &micro;m) or without PXS (547.36 &plusmn; 33.1 &micro;m), (P = 0.039 and 0.048 respectively). No statistically significant difference was found comparing CCT values of POAG eyes to control group eyes.Conclusion: The evaluation of CCT is necessary in all patients with glaucoma and especially in those with PEXG due to the thinner cornea and the risk of underestimation of intraocular pressure.Keywords: CCT, pesudoexfoliation syndrome, glaucoma Dove Press Georgios Kitsos, Christos Gartzios, Ioannis Asproudis, et al 2009-09-30 PDF http://www.dovepress.com/getfile.php?fileID=5313 http://www.dovepress.com/central-corneal-thickness-in-subjects-with-glaucoma-and-in-normal-indi-peer-reviewed-article-OPTH English

oai:dovepress.com/3628 2009-10-15 OPTH

Intraocular penetration of sequentially instilled topical moxifloxacin, gatifloxacin, and levofloxacin Sugioka, Koji Clinical Ophthalmology Koji Sugioka1, Masahiko Fukuda1, Shohei Komoto1, Motoki Itahashi1, Masakazu Yamada2, Yoshikazu Shimomura11Department of Ophthalmology, Kinki University School of Medicine, Osaka-Sayama City, Osaka, Japan; 2Division for Vision Research, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, JapanPurpose: The objective of the study was to compare the intraocular penetration levels of the newer fluoroquinolones, moxifloxacin, gatifloxacin, and levofloxacin in the rabbit&rsquo;s cornea, aqueous humor, and conjunctiva after topical instillation.Methods: 0.5% moxifloxacin, 0.3% gatifloxacin, and 0.5% levofloxacin were instilled in random sequence in both eyes of nine New Zealand White rabbits at two-minute intervals. Instillation was repeated every 15 minutes for a total of three drops of each fluoroquinolone per eye. Three additional animals had only moxifloxacin instilled bilaterally using the same schedule. Sixty minutes after the final instillation, the rabbits were sacrificed for determination of corneal, aqueous humor, and conjunctival fluoroquinolone concentrations using highperformance liquid chromatography.Results: Moxifloxacin achieved significantly higher concentrations than levofloxacin and gatifloxacin in the cornea (P = 0.0102 and P = 0.0006, respectively), aqueous humor (P = 0.0015 and P &lt; 0.0001, respectively), and conjunctiva (P = 0.0191 and P = 0.0236, respectively). Conclusions: 0.5% moxifloxacin eyedrops provided superior intraocular penetration in rabbits&rsquo;&nbsp;eyes compared with the two other fluoroquinolones, 0.5% levofloxacin and 0.3% gatifloxacin.Keywords: fluoroquinolone, gatifloxacin, levofloxacin, moxifloxacin, penetration, rabbit Dove Press Koji Sugioka, Masahiko Fukuda, Shohei Komoto, Motoki Itahashi, et al. 2009-10-15 PDF http://www.dovepress.com/getfile.php?fileID=5364 http://www.dovepress.com/intraocular-penetration-of-sequentially-instilled-topical-moxifloxacin-peer-reviewed-article-OPTH English

oai:dovepress.com/3634 2009-10-15 OPTH

Update on thyroid eye disease and management Harrison, Andrew Clinical Ophthalmology Erick D Bothun,1,2 Ryan A Scheurer,1 Andrew&nbsp;R Harrison,1,3 Michael S Lee1,4,51Departments of Ophthalmology, 2Pediatrics, 3Otolaryngology, 4Neurosurgery, and 5Neurology, University of Minnesota, Minneapolis, Minnesota, USAAbstract: Thyroid eye disease is a heterogeneous autoimmune orbital reaction typically manifesting in middle age. The inflammation may parallel or remain isolated from a related inflammatory cascade in the thyroid called Graves&rsquo; disease. The orbital manifestations can lead to severe proptosis, dry eyes, strabismus, and optic neuropathy. In this article, we will discuss this unique condition including the ophthalmic findings and management. Keywords: Graves&rsquo; disease, thyroid eye disease, proptosis, orbital decompression, enlarged extraocular muscles Dove Press Erick D Bothun, Ryan A Scheurer, Andrew&nbsp;R Harrison, et al 2009-10-15 PDF http://www.dovepress.com/getfile.php?fileID=5369 http://www.dovepress.com/update-on-thyroid-eye-disease-and-management-peer-reviewed-article-OPTH English

oai:dovepress.com/3639 2009-10-16 OPTH

Interferons and their potential in the treatment of ocular inflammation Mackensen, Friederike Clinical Ophthalmology Friederike Mackensen,1 Regina Max,2 Matthias D Becker31Department of Ophthalmology, 2Department of Internal Medicine, Interdisciplinary Uveitis Center, University of Heidelberg, Germany; 3Department of Ophthalmology, Triemli Hospital Z&uuml;rich, SwitzerlandAbstract: Since their discovery in the 1950s interferons have been the scope of investigation in many diseases as therapeutic as well as pathogenetic factors. We know they have immune stimulatory and immune regulatory effects. This apparently counter-intuitive mechanism can be summarized as immunomodulatory action and seems to be very effective in a number of ocular inflammatory diseases. We review the current knowledge of interferons in immunity and autoimmunity and show their use in clinical ophthalmologic practice.Keywords: interferon, uveitis, treatment, inflammation Dove Press Friederike Mackensen, Regina Max, Matthias D Becker 2009-10-16 PDF http://www.dovepress.com/getfile.php?fileID=5374 http://www.dovepress.com/interferons-and-their-potential-in-the-treatment-of-ocular-inflammatio-peer-reviewed-article-OPTH English

oai:dovepress.com/3640 2009-10-16 OPTH

Current trends in the management of ocular symptoms in Adamantiades-Beh&ccedil;et&rsquo;s disease Foster, Stephen Clinical Ophthalmology Fouad&nbsp;R Zakka,1 Peter Y Chang,1 Gian P Giuliari,1 C Stephen Foster1,21Massachusetts Eye Research and Surgery institution (MERSI), Cambridge, Massachusetts, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USAAbstract: Adamantiades-Beh&ccedil;et&rsquo;s disease (ABD) is a multisystemic vasculitic disease. It is most prevalent in the Eastern Mediterranean countries and the Eastern region of Asia. Its effect on the eye can range from mild to debilitating, resulting in total blindness. A necrotizing and obliterative vasculitis affects both arteries and veins of organs. Recurrent attacks of uveitis, oral aphthous ulcers, skin lesions, and genital ulcers are common. Topical and systemic corticosteroids have been the mainstay in the treatment of ocular inflammation for many years; however, due to the several known side effects of corticosteroids and thanks to scientific advances, more novel approaches to ABD treatment have been emerging. Antimetabolites such as methotrexate and azathioprine have been utilized with the latter showing positive results. Chlorambucil has been utilized effectively for ocular manifestations of ABD. Interferon alpha has shown encouraging results in the management of refractory ocular inflammation associated with ABD, either alone or in combination with other immunosuppressive agents. Surgical interventions to deal with complications from ABD can be safely done if adequate control of inflammation is achieved peri-operatively. Early detection and aggressive treatment, when needed, have proven to be essential in the management of this relentlessly explosive disease.Keywords: Adamantiades-Beh&ccedil;et&rsquo;s disease, Beh&ccedil;et&rsquo;s disease, ocular inflammation, uveitis, immunomodulatory therapy, immunosuppressive therapy Dove Press Fouad&nbsp;R Zakka, Peter Y Chang, Gian P Giuliari, C Stephen Foster 2009-10-16 PDF http://www.dovepress.com/getfile.php?fileID=5375 http://www.dovepress.com/current-trends-in-the-management-of-ocular-symptoms-in-adamantiades-be-peer-reviewed-article-OPTH English

oai:dovepress.com/3647 2009-10-20 OPTH

Two-step LASIK after penetrating keratoplasty Kollias, Aris Clinical Ophthalmology Aris&nbsp;N Kollias, Markus M Schaumberger, Thomas C Kreutzer, Michael W Ulbig, Carlo A LackerbauerUniversity Eye Hospital,&nbsp;Ludwig-Maximilians University, Munich, GermanyPurpose: The point of interest of this retrospective case review is to study refractive changes caused by the hinged lamellar keratotomy and the refractive outcome after laser ablation in a second step within the scope of laser in situ keratomileusis (LASIK) in patients with penetrating keratoplasty.Methods: Data from eight patients obtained before lamellar keratotomy, before laser ablation, and three months later were evaluated. Keratotomies were performed with the Moria&reg; LSK one and the Amadeus&reg; 2 microkeratome, laser ablation was performed with the Schwind&reg; Keratome I and the Wavelight&reg; Allegretto WaveEyeQ. Results: Uncorrected visual acuity (UCVA) improved significantly from 1 [logMar] to 0.4 [logMar] at the last visit. Median gain of UCVA was 7.38 &plusmn; 2.96 Snellen lines. Best spectacle-corrected visual acuity did not change significantly. Preoperative manifest refraction spherical equivalent decreased from -4.02 &plusmn; 4.77 diopters (D) to -1.11 &plusmn; 2.45 D after laser ablation. Mean preoperative manifest astigmatism was -7.27 &plusmn; 3.65 D, after lamellar keratotomy -6.72 &plusmn; 3.68 D, and after laser ablation -2.08 &plusmn; 1.80 D. Manifest astigmatism did not change significantly after the keratotomy.Conclusions: Lamellar keratotomy causes biomechanical changes to the cornea. We favor a two-step LASIK in penetrating keratoplasty patients in order to improve precision and predictability of the refractive outcome.Keywords: two-step, cornea, LASIK, keratoplasty, astigmatism Dove Press Aris&nbsp;N Kollias, Markus M Schaumberger, Thomas C Kreutzer,&nbsp;et al 2009-10-20 PDF http://www.dovepress.com/getfile.php?fileID=5382 http://www.dovepress.com/two-step-lasik-after-penetrating-keratoplasty-peer-reviewed-article-OPTH English

oai:dovepress.com/3649 2009-10-20 OPTH

Transitional cell carcinoma of the nasolacrimal sac Karim, R Clinical Ophthalmology Rushmia Karim, Raf Ghabrial, Betty LinUniversity of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, AustraliaAbstract: Tumors in the lacrimal sac are rare yet important due to their malignant and potentially lethal outcomes if there is a misdiagnosis or delay in treatment. Epithelial tumors predominate with squamous cell carcinoma. We report a transitional cell carcinoma of the lacrimal sac and management course for the patient.Keywords: transitional cell carcinoma, nasolacrimal sac, nasolacrimal ductErratum for this paper has been published Dove Press Rushmia Karim, Raf Ghabrial, Betty Lin 2009-10-20 PDF http://www.dovepress.com/getfile.php?fileID=5384 http://www.dovepress.com/transitional-cell-carcinoma-of-the-nasolacrimal-sac-peer-reviewed-article-OPTH English

oai:dovepress.com/3655 2009-10-21 OPTH

Role of fixed-combination brinzolamide 1%/timolol 0.5% in the treatment of elevated intraocular pressure in open-angle glaucoma and ocular hypertension Beckers, Henny Clinical Ophthalmology Henny JM Beckers, Jan SAG Schouten, Carroll AB WebersUniversity Eye Clinic, Maastricht, The NetherlandsAbstract: Brinzolamide 1%/timolol 0.5% is a new fixed-combination for the treatment of open-angle glaucoma or ocular hypertension. Brinzolamide/timolol has a favorable safety profile, with an incidence of ocular burning and stinging &lt;5%. Published data show that brinzolamide 1%/timolol 0.5% and dorzolamide 2%/timolol 0.5% have similar efficacies for lowering intraocular pressure (IOP). There is some evidence that brinzolamide/timolol may be more comfortable. Although patients receiving brinzolamide/timolol may experience more blurred vision on instillation, some data show a preference for brinzolamide/timolol over dorzolamide/timolol. Although available data to assess the role of brinzolamide/timolol in daily clinical practice are still limited, these first results suggest the agent to be a reasonable alternative for patients who do not reach target IOP with monotherapy. Dove Press Henny JM Beckers, Jan SAG Schouten, Carroll AB Webers 2009-10-21 PDF http://www.dovepress.com/getfile.php?fileID=5390 http://www.dovepress.com/role-of-fixed-combination-brinzolamide-1timolol-05-in-the-treatment-of-peer-reviewed-article-OPTH English

oai:dovepress.com/3662 2009-10-23 OPTH

Safety, efficacy, and patient acceptability of lidocaine hydrochloride ophthalmic gel as a topical ocular anesthetic for use in ophthalmic procedures Fraunfelder, Rick Clinical Ophthalmology Michael A Page, Frederick&nbsp;W FraunfelderDepartment of Ophthalmology (Casey Eye Institute), Oregon Health and Science University, Portland, OR, USAPurpose: To review the current literature on safety, efficacy, and measures of surgeon and patient satisfaction with lidocaine hydrochloride gel as a tool for ocular anesthesia.Methods: Pubmed search using keywords &ldquo;lidocaine gel,&rdquo; &ldquo;ophthalmic,&rdquo; and &ldquo;surgery&rdquo; and compiling cross-references. Twenty-six total references were reviewed, including 15 prospective randomized controlled trials (RCTs, total N = 933, average N = 62), 6 nonrandomized prospective studies (total N = 234, average N = 39), 2 animal studies, 1 microbiologic study, and 2 letters to the editor.Results: The RCTs and nonrandomized prospective studies evaluated a number of measures including timing of onset of anesthesia, duration of anesthesia, intraoperative and postoperative pain, need for additional anesthetic applications, intracameral lidocaine levels, and adverse effects. Control groups received topical drops, subconjunctival anesthetic, retrobulbar anesthetic, or sham gel. Lidocaine gel was shown to be at least as effective for pain control as alternative therapies in all studies, with longer duration of action than topical drops. Patient and surgeon satisfaction were high, and adverse effects were rare and comparable to those for anesthetic drop formulations. Surgical settings included cataract, pterygium, trabeculectomy, strabismus, intravitreal injection, vitrectomy, and penetrating keratoplasty.Conclusions: Lidocaine gel is a safe, effective, and potentially underutilized tool for ophthalmic surgery.Keywords: lidocaine, gel, topical, ophthalmic, ocular, anesthetic Dove Press Michael A Page, Frederick&nbsp;W Fraunfelder 2009-10-23 PDF http://www.dovepress.com/getfile.php?fileID=5396 http://www.dovepress.com/safety-efficacy-and-patient-acceptability-of-lidocaine-hydrochloride-o-peer-reviewed-article-OPTH English

oai:dovepress.com/3694 2009-11-04 OPTH

Spontaneous corneal perforation in a patient with lamellar ichthyosis and dry eye Turgut, Burak Clinical Ophthalmology Burak Turgut1, Orhan Aydemir1, Murat Kaya1, Peykan T&uuml;rk&ccedil;&uuml;og˘ lu2, Tamer Demir1, &Uuml;lk&uuml; &Ccedil;eliker11Fırat University School of Medicine, Department of Ophthalmology, Elazıg, Turkey; 2Inonu University School of Medicine, Department of Ophthalmology, Malatya, TurkeyAbstract: We report spontaneous corneal perforation in a patient with lamellar ichthyosis. The patient presented with complaints of pain, redness, diminished vision, and discharge in her right eye for 15 days. Visual acuities were light perception in the right and 20/400 in the left eye. Cicatricial ectropion in both lower eyelids and 2 mm perforation site in the center of the right cornea were observed. Lamellar ichthyosis was suspected because of scaling and excessive dryness of entire body skin and was confirmed by skin biopsy. Amniotic membrane transplantation and transient tarsorraphy was performed and systemic anti-ichthyosis therapy was started. The follow-up visits were not possible because of patient inconsistency. In patients with cicatricial ectropion secondary to ichthyosis, corneal health should be closely monitored because of the perforation risk.Keywords: lamellar ichthyosis, cornea, spontaneous perforation Dove Press Burak Turgut, Orhan Aydemir, Murat Kaya, et al 2009-11-04 PDF http://www.dovepress.com/getfile.php?fileID=5432 http://www.dovepress.com/spontaneous-corneal-perforation-in-a-patient-with-lamellar-ichthyosis--peer-reviewed-article-OPTH English

oai:dovepress.com/3700 2009-11-06 OPTH

Eye muscle surgery for infantile nystagmus syndrome in the first two years of life Hertle, Richard Clinical Ophthalmology Richard W Hertle1, Joost Felius2, Dongsheng Yang1, Matthew Kaufman11The UPMC and Children&rsquo;s Hospital of Pittsburgh Eye Centers and The Laboratory of Visual and Ocular Motor Physiology Pittsburgh, PA, USA; 2The Retina Foundation of the Southwest, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USAPurpose: To report visual and elctrophysioloigcal effects of eye muscle surgery in young patients with infantile nystagmus syndrome (INS).Methods: Prospective, interventional case cohort of 19 patients aged under 24 months who were operated on for combinations of strabismus, an anomalous head posture, and nystagmus. All patients were followed at least nine months. Outcome measures, part of an institutionally approved study, included Teller acuity, head position, strabismic deviation, and eye movement recordings, from which waveform types and a nystagmus optimal foveation fraction (NOFF). Computerized parametric and nonparametric statistical analysis of data were perfomed using standard software on both individual and group data.Results: Age averaged 17.7 months (13.1-month follow-up). Thirteen (68%) patients had associated optic nerve or retinal disease. 42% had amblyopia, 68% had refractive errors. Group means in binocular Teller acuity (P &lt; 0.05), strabismic deviation (P &lt; 0.05), head posture (P &lt; 0.001), and the NOFF measures (P &lt; 0.01) from eye movement recordings improved in all patients. There was a change in null zone waveforms to more favorable jerk types. There were no reoperations or surgical complications.Conclusions: Surgery on the extraocular muscles in patients aged less than two years with INS results in improvements in multiple aspects of ocular motor and visual function.Keywords: infantile nystagmus, anomalous head posture, eye muscle surgery Dove Press Richard W Hertle, Joost Felius, Dongsheng Yang, et al 2009-11-06 PDF http://www.dovepress.com/getfile.php?fileID=5439 http://www.dovepress.com/eye-muscle-surgery-for-infantile-nystagmus-syndrome-in-the-first-two-y-peer-reviewed-article-OPTH English

oai:dovepress.com/3716 2009-11-11 OPTH

Functional microperimetry and SD-OCT confirm consecutive retinal atrophy from optic nerve pit Chalam, Kakarla Clinical Ophthalmology Vikram&nbsp;S Brar, Ravi K Murthy, K V ChalamUniversity of Florida College of Medicine, Department of Ophthalmology, Jacksonville, FL, USAAbstract: A congenital anomaly, optic nerve pit is often associated with serous retinal detachment involving macula. Long standing serous detachment leads to outer retinal atrophy and decrease in visual sensitivity. Recently, spectral-domain optical coherence tomography (OCT) has been reported to demonstrate a communication between the optic nerve sheath and the subretinal space. Vitreous cavity is proposed as an alternate source of fluid for accumulation in the subretinal space. We imaged a patient with optic nerve pit with Spectralis OCT and report the findings seen including the presence of an area of peripapapillary retinal atrophy, due to the spontaneous resolution of associated long-standing retinal detachment.Keywords: optic nerve pit, SD-OCT, autoflourescence, microperimetry Dove Press Vikram&nbsp;S Brar, Ravi K Murthy, K V Chalam 2009-11-11 PDF http://www.dovepress.com/getfile.php?fileID=5456 http://www.dovepress.com/functional-microperimetry-and-sd-oct-confirm-consecutive-retinal-atrop-peer-reviewed-article-OPTH English

oai:dovepress.com/3725 2009-11-13 OPTH

Efficacy and safety of travoprost/timolol vs dorzolamide/timolol in patients with open-angle glaucoma or ocular hypertension Teus, Miguel Clinical Ophthalmology Miguel A Teus1, Stefano Miglior2, Guna Laganovska3, Lasma Volksone4, Bozena Romanowska-Dixon5, Roman Gos6, G&aacute;bor Holl&oacute;7, for the C-05-25 Study Group81Hospital Pr&iacute;ncipe de Ast&uacute;rias, Universidad de Alcal&aacute;, Madrid, Spain; 2Clinica Oculistica, Policlinico di Monza Universit&agrave; di Milano Bicocca, Monza (MI), Italy; 3Department of Ophthalmology, Stradina Clinical University Hospital, Riga, Latvia; 4Glaucoma Service, Clinical Hospital Gailezera, Riga, Latvia; 5Szpital Uniwersytecki w Krakowie, Krak&oacute;w, Poland; 6Contact-Med, Sp. z o.o., Ł&oacute;dź, Poland; 7Semmelweis University, Department of Ophthalmology, Budapest, Hungary; 8The C-05-25 Study Group: Members are listed under AcknowledgmentsPurpose: To compare the intraocular pressure- (IOP-) lowering efficacy of fixed combinations travoprost 0.004%/timolol 0.5% and dorzolamide 2%/timolol 0.5% in patients with ocular hypertension or open-angle glaucoma.Methods: In this prospective, multicenter, double-masked, randomized clinical trial, 319 qualifying patients received either travoprost/timolol once daily in the morning (n = 157) or dorzolamide/timolol twice daily (n = 162). IOP was assessed morning and evening at 2 and 6 weeks. The primary outcome measure was mean diurnal IOP. Results: Baseline mean IOP values were similar between groups. Mean pooled diurnal IOP was significantly lower in the travoprost/timolol group (16.5 mmHg &plusmn; 0.23) than in the dorzolamide/timolol group (17.3 mmHg &plusmn; 0.23; P = 0.011). Mean IOP was significantly lower in the travoprost/timolol group compared to the dorzolamide/timolol group at the 9 AM time point both at Week 2 (P = 0.006) and Week 6 (P = 0.002). The travoprost/timolol combination produced mean IOP reductions from baseline of 35.3% to 38.5%, while the dorzolamide/timolol combination produced mean IOP reductions from baseline of 32.5% to 34.5%. Conclusions: The fixed combination travoprost 0.004%/timolol 0.5% dosed once daily in the morning demonstrated superior mean diurnal IOP-lowering efficacy compared to dorzolamide 2%/timolol 0.5% dosed twice daily in patients with ocular hypertension or open-angle glaucoma.Keywords: dorzolamide, fixed combination, glaucoma, IOP-lowering therapy, timolol, travoprost Dove Press Miguel A Teus, Stefano Miglior, Guna Laganovska, et al 2009-11-13 PDF http://www.dovepress.com/getfile.php?fileID=5467 http://www.dovepress.com/efficacy-and-safety-of-travoprosttimolol-vs-dorzolamidetimolol-in-pati-peer-reviewed-article-OPTH English

oai:dovepress.com/3727 2009-11-13 OPTH

Characteristics of respondents with glaucoma and dry eye in a national panel survey Schmier, J K Clinical Ophthalmology Jordana K Schmier1, David W Covert21Exponent Inc., Alexandria, VA, USA; 2Alcon Research, Ltd., Fort Worth, TX, USABackground: There is an increasing body of evidence strongly suggesting that glaucoma medications may contribute to ocular surface disease and development of dry eye.Objective: To identify glaucoma patients with dry eye, using a nationally representative sample, and to compare clinical and treatment characteristics with controls without dry eye. Methods: Patients taking intraocular pressure-lowering medications were identified from the Medical Expenditure Panel Survey. A matched cohort without glaucoma served as controls. Dry eye was identified by diagnosis or use of prescription or over-the-counter medications. Demographic and clinical characteristics and medication use patterns were compared. Results: The analysis identified 629 respondents with glaucoma and 6,934 controls without glaucoma. Dry eye was more common among glaucoma respondents than nonglaucoma controls (16.5% vs 5.6%, P &lt; 0.0001). There was a nonsignificant trend for respondents with dry eye to report higher rates of glaucoma adjunctive therapy use compared to those without dry eye (44.2% vs 35.0%, P &lt; 0.076). Prostaglandin analogs were the most common glaucoma medication.Conclusions: This analysis found that the rate of dry eye was higher in patients with glaucoma than in controls. The use of glaucoma adjunctive therapies may increase the rate of dry eye in glaucoma patients.Keywords: dry eye syndromes, health care surveys, glaucoma Dove Press Jordana K Schmier, David W Covert 2009-11-13 PDF http://www.dovepress.com/getfile.php?fileID=5471 http://www.dovepress.com/characteristics-of-respondents-with-glaucoma-and-dry-eye-in-a-national-peer-reviewed-article-OPTH English

oai:dovepress.com/3729 2009-11-16 OPTH

First-year treatment costs among new initiators of topical prostaglandin analogs Schmier, J K Clinical Ophthalmology Jordana K Schmier1, David W Covert2, Alan L Robin3,41Exponent Inc., Alexandria, VA, USA; 2Health Economics, Alcon Research Ltd., Fort Worth, TX, USA; 3Department of Ophthalmology, University of Maryland, Baltimore, MD, USA; 4Wilmer Eye Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USAObjective: To estimate first-year costs among new initiators of topical prostaglandin analogs in a managed care population.Research design and methods: We developed a model to estimate first-year direct medical costs. We derived treatment patterns from a claims database analysis. Published studies were used to estimate visit-related resource use. Costs were obtained from standard sources.Results: The database analysis identified 9,063 patients meeting study criteria, 41% (n = 3,672) of whom remained on their initial prostaglandin therapy for 12 months after initiation. Adjunctive intraocular pressure lowering therapy was needed in 20.7%, 16.5%, 13.9%, and 8.9% of bimatoprost, latanoprost, travoprost, and BAK-free travoprost patients, respectively. Median numbers of days to the first prescription filled for adjunctive therapy (if required) were 69.5, 67.0, 123.0, and 158.5 for patients initiating on bimatoprost, latanoprost, travoprost, and BAK-free travoprost. Total estimated first-year costs were $1,457, $1,360, $1,278, and $1,307 for patients initiating therapy with bimatoprost, latanoprost, travoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis.Conclusions: A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year direct medical costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit projecting findings to all glaucoma patients.Keywords: costs and cost analysis, drug therapy, combination, glaucoma, prostaglandin analogs Dove Press Jordana K Schmier, David W Covert, Alan L Robin 2009-11-16 PDF http://www.dovepress.com/getfile.php?fileID=5473 http://www.dovepress.com/first-year-treatment-costs-among-new-initiators-of-topical-prostagland-peer-reviewed-article-OPTH English

oai:dovepress.com/3732 2009-11-17 OPTH

Role of prostaglandins and specific place in therapy of bimatoprost in the treatment of elevated intraocular pressure and ocular hypertension: A closer look at the agonist properties of bimatoprost and the prostamides Smid, Scott Clinical Ophthalmology Scott D SmidDiscipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, AustraliaAbstract: Bimatoprost is the only representative of a novel class of prostaglandin ethanolamide (prostamide) compounds used therapeutically as an efficacious treatment for glaucoma. The pathways through which bimatoprost works to improve uveoscleral outflow to relieve elevated intraocular pressure are similar to those of the conventional prostaglandins used in glaucoma therapy, with some evidence of a preferential action at the trabecular meshwork. The pharmacology of bimatoprost is however, unclear. Pharmacological evidence supports a specific and distinct receptor-mediated agonist activity of bimatoprost at &lsquo;prostamide&rsquo; receptors, which is selective to the prostamides as a class. However, other studies have reported either activity of bimatoprost at additional prostanoid and nonprostanoid receptors, or a conversion of bimatoprost to metabolites with agonist activity at prostaglandin FP receptors in the human eye. The formation of endogenous prostamides has been demonstrated in vivo, by a novel pathway involving the cyclooxygenase-2-mediated conversion of endogenous cannabinoid (endocannabinoid) substrates. Irrespective of the pharmacology of bimatoprost and the prostamides in general, further studies are needed to determine the biological role and biochemical pathology of prostamides in the human eye, particularly in glaucoma. Such studies may improve our understanding of uveoscleral flow and may offer new treatments for controlling intraocular pressure.Keywords: bimatoprost, endocannabinoid, glaucoma, prostamides, trabecular meshwork Dove Press Scott D Smid 2009-11-17 PDF http://www.dovepress.com/getfile.php?fileID=5477 http://www.dovepress.com/role-of-prostaglandins-and-specific-place-in-therapy-of-bimatoprost-in-peer-reviewed-article-OPTH English

oai:dovepress.com/3741 2009-11-17 OPTH

Differences between the combination of the 25-gauge vitrectomy with phacoemulsification versus 20-gauge vitrectomy and phacofragmentation Romero-Aroca, P Clinical Ophthalmology Pere Romero-Aroca1, Matias Almena-Garcia1, Marc Baget-Bernaldiz1, Juan Fern&aacute;ndez-Ballart2, Isabel M&eacute;ndez-Marin1, Angel Bautista-Perez11Ophthalmic Service, Hospital Universitario Sant Joan, IISPV, Universidad Rovira&nbsp;I Virgili, Reus, Spain; 2Department of Basic Sciences, University Rovira&nbsp;I Virgili, Tarragona, SpainIntroduction: In the present study we determine the differences observed between 25-gauge-vitrectomy combined with phacoemulsification, and the 20-gauge-vitrectomy combined with pars plana phacofragmentation.Methods: A prospective study of a sample of 987 eyes of 661 patients randomly divided into two groups. 25-gauge-vitrectomy plus phacoemulsification included 486 eyes, and 20-gauge-vitrectomy plus phacofragmentation 501 eyes. We evaluated the differences at the time of the surgery, the intra- and postoperative complications, and the variations in intraocular pressure.Results: The final visual outcome was similar in both groups. The most important differences between groups were: surgical time was faster in group 1 than in group 2, (mean time: 35.16 &plusmn; 3.49, 44.74 &plusmn; 5.30 minutes). Intraoperative complications were more numerous in group 1. In group 1, postoperative low levels of intraocular pressure are present in all patients with 2.77% of patients with hypotension (&lt;8 mmHg), and three choroidal effusion. In group 2, intraocular lens decentration and retinal detachment are more frequent (2.38% and 1.39%, respectively). Conclusions: In the present study, both techniques have a similar number of complications and have a similar postoperative outcome, and are valid for the management of the pathologies selected.Keywords: transconjunctival sutureless vitrectomy, sutureless vitrectomy, 25-gauge, 20-gauge, cataract, phacoemulsification, phacofragmentation, hypotony, complications Dove Press Pere Romero-Aroca, Matias Almena-Garcia, Marc Baget-Bernaldiz, et al 2009-11-17 PDF http://www.dovepress.com/getfile.php?fileID=5488 http://www.dovepress.com/differences-between-the-combination-of-the-25-gauge-vitrectomy-with-ph-peer-reviewed-article-OPTH English

oai:dovepress.com/3743 2009-11-18 OPTH

Successful endonasal dacryocystorhinostomy in a patient with Wegener&rsquo;s granulomatosis Eloy, Philippe Clinical Ophthalmology P Eloy, E Leruth, B Bertrand, Ph RombauxENT and HNS department, Cliniques Universitaires de Mont-Godinne, Universit&eacute; Catholique de Louvain, 5530, Yvoir, BelgiumAbstract: Wegener&rsquo;s granulomatosis (WG) is one form of idiopathic autoimmune vasculitis. The disease has a predilection for the upper and lower respiratory tracts (lungs, nose, sinus), and kidneys. WG may be systemic, severe, and potentially lethal, but it may also be limited to the otolaryngological area or to the eyes and the orbits. Obstruction of the lacrimal pathway is a possible complication of the disease that affects approximately 7% of patients with WG. It usually occurs as a direct extension of sinonasal disease and typically is a late manifestation. Management of such a condition is generally viewed as difficult. We report the case of a patient with a quiescent WG limited to the otolaryngological area. This patient presented a bilateral obstruction of the nasolacrimal ducts caused by bilateral extensive adhesions in the nasal cavity. Because she had several episodes of left-side acute dacryocystitis which necessitated several courses of broad-spectrum antibiotics, she successfully underwent an endonasal endoscopic dacryocystorhinostomy using a diode laser and powered instrumentation. The authors describe the clinical case, the surgical technique, and review the literature.Keywords: Wegener&rsquo;s granulomatosis, recurrent dacryocystitis, endonasal DCR, diode, laser, powered instrumentation Dove Press P Eloy, E Leruth, B Bertrand, et al 2009-11-18 PDF http://www.dovepress.com/getfile.php?fileID=5490 http://www.dovepress.com/successful-endonasal-dacryocystorhinostomy-in-a-patient-with-wegenerrs-peer-reviewed-article-OPTH English

oai:dovepress.com/3759 2009-11-19 OPTH

A modified technique of retrograde intubation dacryocystorhinostomy for proximal canalicular obstruction Mavrikakis, I Clinical Ophthalmology Nikolaos Trakos, Emmanouil Mavrikakis, Kostas G Boboridis, Marselos Ralidis, George Dimitriadis, Ioannis MavrikakisOculoplastic Service, Metropolitan Hospital, Athens, GreecePurpose: To describe a modification of the retrograde intubation dacryocystorhinostomy (DCR) in patients with proximal canalicular obstruction.Materials and methods: Interventional case report of a 43-year-old female with a nine-month history of left epiphora following a road traffic accident involving the proximal lower canaliculus. An external DCR approach was performed. Following the creation of a lower canalicular pseudopunctum, the O&rsquo;Donoghue silicone stent was introduced through the common ostium, out through the pseudopunctum of the lower canaliculus, and returned through the punctum of the normal upper canaliculus down through the common ostium into the nose.Results: The patient experienced complete resolution of symptoms and on her last follow-up, two years later, her lower canaliculus was patent to syringing.Conclusion: This modification of the retrograde intubation DCR is an effective technique which decreases the intraoperative time needed to insert the tubes and minimises further trauma to the newly created punctal area.Keywords: retrograde dacryocystorhinostomy, proximal canalicular obstruction, midcanalicular obstruction, conjuctivodacryocystorhinostomy Dove Press Nikolaos Trakos, Emmanouil Mavrikakis, Kostas G Boboridis, et al 2009-11-19 PDF http://www.dovepress.com/getfile.php?fileID=5506 http://www.dovepress.com/a-modified-technique-of-retrograde-intubation-dacryocystorhinostomy-fo-peer-reviewed-article-OPTH English

oai:dovepress.com/3767 2009-11-20 OPTH

Bevacizumab (Avastin&reg;) for the management of anterior chamber neovascularization and neovascular glaucoma Brouzas, D. Clinical Ophthalmology Dimitrios Brouzas, Antonios Charakidas, Marilita Moschos, Chryssanthi Koutsandrea, Michael Apostolopoulos, Stefanos Baltatzis1st Department of Ophthalmology, University of Athens, Athens, GreecePurpose: To establish the efficacy and safety of intravitreal bevacizumab in reducing iris and anterior chamber angle neovascularization and managing neovascular glaucoma.Design: Prospective interventional case series.Patient and methods: Eleven eyes of 11 patients with iris and anterior chamber angle neovascularization with refractory intraocular pressure were treated with intravitreal injection of 1.25 mg bevacizumab (Avastin&reg;). The study group included eight males and three females aged 23 to 77 years (average, 62 years). Out of the 11 cases, five had proliferative diabetic retinopathy, of whom two had undergone vitrectomy for tractional retinal detachment and vitreous hemorrhage, and six were secondary to ischemic central retinal vein occlusion (CRVO). All patients were followed for eight to 16 months (average, 10 months).Results: Iris and anterior chamber angle neovascularization receded in all eyes after one to three injections at monthly intervals. In five eyes, neovascularization recurred during the follow-up period. The intraocular pressure normalized in one eye. Four eyes were controlled with antiglaucoma drops. A cyclodestructive procedure was required in two eyes. An Ahmet drainage valve was implanted in four eyes, including one controlled with additional antiglaucoma drops and one in which the intraocular pressure remained high while on maximum antiglaucoma medication and a cyclodestructive procedure was scheduled.Conclusions: Bevacizumab appears to be effective in reducing iris and anterior chamber angle neovascularization and is likely to extend our therapeutic options in the management of neovascular glaucoma.Keywords: bevacizumab, Avastin&reg;, iris neovascularization, anterior chamber angle neovascularization, neovascular glaucoma Dove Press Dimitrios Brouzas, Antonios Charakidas, Marilita Moschos, et al 2009-11-20 PDF http://www.dovepress.com/getfile.php?fileID=5515 http://www.dovepress.com/bevacizumab-avastinreg-for-the-management-of-anterior-chamber-neovascu-peer-reviewed-article-OPTH English

oai:dovepress.com/3772 2009-11-25 OPTH

Treatment options for ocular adnexal lymphoma (OAL) Cohen, Victoria Clinical Ophthalmology Victoria Mary Lendrum CohenSt. Bartholomew&rsquo;s and Moorfields Eye Hospital, London UKAbstract: Most lymphomas that involve the ocular adnexal structure are low grade, B cell, non-Hodgkin&rsquo;s lymphomas. The treatment depends upon the grade and stage of the disease. High grade lymhoma requires treatment with systemic chemotherapy whereas the localized low grade (extranodal marginal zone lymphoma) can be successfully managed with local radiotherapy. Chlamydia psittaci infection is associated with low grade ocular lymphoma; however there is wide geographic variation in the strength of this association. Blanket antibiotic therapy is not advised unless there is proof of an infective agent. The monoclonal antibody, rituximab, may be successful for CD20 positive lymphoma, although it is likely that rituximab will have better long-term results when used in combination with systemic chemotherapy.Keywords: ocular adnexal lymphoma, mucosa associated lymphoid tissue, extranodal marginal zone lymphoma, Chlamydia psittaci, rituximab, radiotherapy, chemotherapy Dove Press Victoria Mary Lendrum Cohen 2009-11-25 PDF http://www.dovepress.com/getfile.php?fileID=5522 http://www.dovepress.com/treatment-options-for-ocular-adnexal-lymphoma-oal-peer-reviewed-article-OPTH English

oai:dovepress.com/3793 2009-12-02 OPTH

In vivo visualization of photoreceptor layer and lipofuscin accumulation in Stargardt&rsquo;s disease and fundus flavimaculatus by high resolution spectral-domain optical coherence tomography Querques, G Clinical Ophthalmology Giuseppe Querques, Rosy Prato, Gabriel Coscas, Gis&egrave;le Soubrane, Eric&nbsp;H SouiedDepartment of Ophthalmology, Hopital Intercommunal de Creteil, University Paris XII, FranceIntroduction: To assess photoreceptor (PR) layer morphology in patients with Stargardt&rsquo;s disease (STGD) and fundus flavimaculatus (FFM) using high resolution spectral domain optical coherence tomography (HD-OCT; OCT 4000 Cirrus, Humphrey-Zeiss, San Leandro, CA).Methods: This was a prospective observational case series. Sixteen consecutive patients with STGD and FFM underwent a complete ophthalmologic examination. Optical coherence tomography examination was performed with HD-OCT, a high-speed (27,000 axial scans per second) OCT system using spectral/Fourier domain detection, with an axial image resolution of 5 &micro;m.Results: A total of 31 eyes were included in the study. Transverse loss of the PR layer in the foveal region was shown by HD-OCT. Twenty eyes with clinically evident central atrophy had a disruption of either the Verhoeff&lsquo;s membrane (VM) or the layer corresponding to the interface of inner segment (IS) and outer segment (OS) of PR in the foveal region. Among these eyes, 12/20 eyes had a loss of the PR layer (loss of both VM and IS-OS interface) in the foveal region. Eleven eyes (11/31) without clinically evident central atrophy had an intact interface of IS and OS of PR centrally. Moreover, we observed hyperreflective deposits: type 1 lesions located within the retinal pigment epithelium (RPE) layer and at the level of the outer segments of PR, and type 2 lesions located at the level of the outer nuclear layer and clearly separated from the RPE layer. Type 1 lesions alone were associated with absence of loss of the PR layer in the foveal region in all eyes; type 2 lesions were always associated with presence of type 1 lesions, and often (8/12 eyes) associated with loss of the PR layer within the foveal region. Mean best-corrected visual acuity (BCVA) was significantly correlated with loss of the PR layer in the foveal region (P &lt; 0.001), as well as to presence of type 2 flecks (P = 0.03).Conclusion: Type 2 deposits in STGD/FFM patients seem to represent a marker of the possible evolution towards foveal atrophy.Keywords: fundus flavimaculatus, high definition optical coherence tomography, retinal dystrophy, stargardt&rsquo;s disease Dove Press Giuseppe Querques, Rosy Prato, Gabriel Coscas, et al 2009-12-02 PDF http://www.dovepress.com/getfile.php?fileID=5543 http://www.dovepress.com/in-vivo-visualization-of-photoreceptor-layer-and-lipofuscin-accumulati-peer-reviewed-article-OPTH English

oai:dovepress.com/3831 2009-12-16 OPTH

Toxoplasma retinochoroiditis in pregnancy: Using current evidence to inform management Nath, Clinical Ophthalmology Remin Nath1, Edward Guy2, Anne Morrison1, Simon P Kelly11Department of Ophthalmology, Royal Bolton Hospital, Farnworth, Bolton, UK; 2Toxoplasma Reference Laboratory, Singleton Hospital, Sketty, Swansea, UKAbstract: Toxoplasma retinochoroiditis in pregnancy may create considerable patient anxiety and is a dilemma for the treating ophthalmologist. A case report highlighting this clinical issue is presented followed by a review of the literature. Consensus in relation to the management of toxoplasma retinochoroiditis in pregnancy is lacking and is discussed.Keywords: toxoplasma, retinochoroiditis, pregnancy Dove Press Remin Nath, Edward Guy, Anne Morrison, et al 2009-12-16 PDF http://www.dovepress.com/getfile.php?fileID=5591 http://www.dovepress.com/toxoplasma-retinochoroiditis-in-pregnancy-using-current-evidence-to-in-peer-reviewed-article-OPTH English

oai:dovepress.com/3838 2009-12-16 OPTH

Considerations in glaucoma therapy: fixed combinations versus their component medications Higginbotham, Eve Clinical Ophthalmology Eve J HigginbothamMorehouse School of Medicine, Atlanta, GA, USAAbstract: Fixed combinations of medications that lower intraocular pressure (IOP) are increasingly used in the treatment of glaucoma and ocular hypertension and offer several potential advantages over combined use of the separate component medications including enhanced convenience, improved adherence, reduced exposure to preservatives, and possible cost savings. This review aims to examine the current role of IOP-lowering fixed combinations in disease management. The results of studies that compared the efficacy and safety of IOP-lowering fixed combinations with their component medications are summarized, including those fixed combinations that consist of a prostaglandin analog and timolol. The fixed combinations currently available for use in the United States are fixed-combination dorzolamide/timolol (FCDT) and fixed-combination brimonidine/timolol (FCBT). Both of these fixed combinations reduce IOP more effectively than their component medications used separately as monotherapy. FCBT therapy also demonstrates a more favorable safety profile and reduced ocular allergy compared to monotherapy with brimonidine, a component medication. Few studies have directly compared the efficacy and safety of FCDT and FCBT, but available evidence suggests that FCBT is at least as effective as FCDT in lowering IOP and is more comfortable and better tolerated. Additional studies are needed to further evaluate the comparative efficacy and tolerability of FCDT and FCBT in the management of glaucoma and ocular hypertension.Keywords: glaucoma, intraocular pressure, fixed combination, adherence, brimonidine Dove Press Eve J Higginbotham 2009-12-16 PDF http://www.dovepress.com/getfile.php?fileID=5635 http://www.dovepress.com/considerations-in-glaucoma-therapy-fixed-combinations-versus-their-com-peer-reviewed-article-OPTH English

oai:dovepress.com/3881 2009-12-24 OPTH

Trimetazidine for prevention of induced ischemia and reperfusion of guinea pig retina Turgut, Burak Clinical Ophthalmology T Demir1, B Turgut1,&nbsp;I Ozercan2, FC Gul1,&nbsp;N Ilhan3, U Celiker11Department of Ophthalmology, 2Department of Pathology, 3Department of Biochemistry, Fırat University School of Medicine, Elazig, TurkeyObjective: Trimetazidine (TMZ) has been used to protect against ischemia/reperfusion (I/R) injury of many tissues. We aimed to evaluate the effect of TMZ during retinal I/R in a guinea pig model.Study design/patients and methods: An experimental study in retinal I/R. Three groups of five guinea pigs were studied to include a control, placebo, and drug test groups. Prior to the application of 90 minutes of high intraocular pressure (IOP) to induce retinal ischemia followed by 24 hours of reperfusion, we applied intraperitoneal saline to the placebo group and 3 mg/kg of TMZ for the drug test group and repeated the injections at intervals of six hours for four cycles. Both eyes of the animals were enucleated at the end of the reperfusion period. Biochemical assay and histopathologic evaluation was performed on one randomly selected eye of each animal. The level of retinal-free malondialdehyde (MDA) and retinal layer thicknesses were determined and comparisons were then made with the control group.Results: The mean free MDA level increased in the placebo group (P = 0.006) but not in the drug group (P &gt; 0.05). We observed polymorphonucleated leukocyte infiltration, retinal edema and hydropic degeneration in the retina of the placebo group. However, significant histopathologic change was not observed in specimens of the drug group.Conclusions: This study suggests TMZ has a beneficial effect on retinal lipid peroxidation and histopathologic changes due to I/R injury.Keywords: ischemia/reperfusion, retina, trimetazidine Dove Press T Demir, B Turgut,&nbsp;I Ozercan, et al 2009-12-24 PDF http://www.dovepress.com/getfile.php?fileID=5647 http://www.dovepress.com/trimetazidine-for-prevention-of-induced-ischemia-and-reperfusion-of-gu-peer-reviewed-article-OPTH English

oai:dovepress.com/3875 2009-12-22 OPTH

Antiviral selection in the management of acute retinal necrosis Lightman, Sue Clinical Ophthalmology Patrick MK Tam1, Claire Y Hooper2, Susan Lightman21Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, N.T., Hong Kong, People&rsquo;s Republic of China; 2Institute of Ophthalmology, Moorfields Eye Hospital, London, UKAbstract: There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised.Keywords: acute retinal necrosis, acyclovir, herpes, retinitis Dove Press Patrick MK Tam, Claire Y Hooper, Susan Lightman 2009-12-22 PDF http://www.dovepress.com/getfile.php?fileID=5661 http://www.dovepress.com/acyclovir-in-the-management-of-acute-retinal-necrosis-peer-reviewed-article-OPTH English

oai:dovepress.com/3890 2010-01-06 OPTH

A two-week clinical evaluation of the safety of Systane&reg; Ultra in contact lens-wearing patients Kading , David Clinical Ophthalmology David KadingSpecialty Eyecare Group, Kirkland, WA, USAObjective: To evaluate the safety of Systane&reg; Ultra Lubricant Eye Drops (test solution) in contact lens wearers. A currently marketed contact lens rewetting drop was the control solution.Participants: This investigator- and patient-masked, single-site, randomized, and prospective study involved 45 successful contact lens wearers.Methods: Eligible subjects&rsquo; baseline biomicroscopy findings, visual acuity, and corneal staining score were recorded. Subjects received either the test or control solution with masked labeling. Subjects were instructed to instill their assigned solution in both eyes: 15 minutes prior to lens insertion, at least one drop during lens wear and another drop immediately following lens removal. After 14 days, biomicroscopy results, visual acuity, and corneal staining score were recorded.Results: No adverse events were documented for either the test or the control solution. For subjects using Systane&reg; Ultra, no statistically significant change was detected in visual acuity (= 0.7667) or corneal staining score (P = 1.000). For subjects using the control solution, the change in visual acuity (P = 0.0011, mean difference = 1.70 &plusmn; 3.22 standard deviation) was not clinically relevant and there was no significant change in corneal staining score (P = 0.5413).Conclusions: This clinical study provided evidence of safety and compatibility of Systane&reg; Ultra Lubricant Eye Drops in contact lens wearers.Keywords: lubricant eye drop, contact lens, safety, dry eye Dove Press David Kading 2010-01-06 PDF http://www.dovepress.com/getfile.php?fileID=5664 http://www.dovepress.com/a-two-week-clinical-evaluation-of-the-safety-of-systanereg-ultra-in-co-peer-reviewed-article-OPTH English

oai:dovepress.com/3899 2010-01-07 OPTH

Evaluation of ultraviolet light toxicity on cultured retinal pigment epithelial and retinal ganglion cells Chalam, Kakarla Clinical Ophthalmology Sankarathi Balaiya, Ravi K Murthy, Vikram&nbsp;S Brar, Kakarla V ChalamDepartment of Ophthalmology, University of Florida College of Medicine, Jacksonville, FL, USAPurpose: Our study is aimed at evaluating the role of UVB light in inducing cytotoxicity in an in vitro model.Methods: RGC-5 and ARPE-19 cells were exposed to different time periods of UVB light: 0, 15, 30, and 45 min. They were subsequently examined for changes in cell morphology, cell viability (neutral red uptake assay), generation of reactive oxygen species (ROS), expression of bax, bcl-2 and cytochome C by reverse transcriptase polymerase chain reaction and western blot, respectively.Results: Dose-dependent reduction in cell viability to UVB light was demonstrated with parallel increase in ROS. Increased duration of exposure (&gt;15 minutes), was associated with increased expression of bax and cytochrome C, and absence of bcl-2 expression.Conclusion: UVB light exposure results in cell cytotoxicity. The concomitant generation of ROS and expression of apoptotic markers suggests the role of oxidative stress in UVB-mediated apoptosis in an in vitro model of retinal ganglion and pigment epithelial cells.Keywords: ultraviolet light, retinal pigment epithelium, retinal ganglion cell, reactive oxygen species, cytochrome C Dove Press Sankarathi Balaiya, Ravi K Murthy, Vikram&nbsp;S Brar, et al 2010-01-07 PDF http://www.dovepress.com/getfile.php?fileID=5677 http://www.dovepress.com/evaluation-of-ultraviolet-light-toxicity-on-cultured-retinal-pigment-e-peer-reviewed-article-OPTH English

oai:dovepress.com/3906 2010-01-15 OPTH

Kinetics of kill of bacterial conjunctivitis isolates with moxifloxacin, a fluoroquinolone, compared with the aminoglycosides tobramycin and gentamicin Cockrum, Paul Clinical Ophthalmology Rudolph S Wagner1, David B Granet2, Steven J Lichtenstein3, Tiffany Jamison4, Joseph J Dajcs4, Robert D Gross5, Paul Cockrum41New Jersey Medical School, Newark, NJ, USA; 2Ratner Children&rsquo;s Eye Center, University of California &ndash; San Diego, La Jolla, CA, USA; 3University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA; 4Alcon Research, Ltd, Fort Worth, TX, USA; 5Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USAPurpose: To compare the kinetics and speed of kill of Streptococcus pneumoniae and Haemophilus influenzae on exposure to three topical ophthalmic antibiotic solutions.Materials and methods: Bacterial conjunctivitis isolates of S. pneumoniae and H. influenzae were exposed to 1:1000 dilutions of moxifloxacin 0.5%, tobramycin 0.3%, gentamicin 0.3%, and water (control). At 15, 30, 60, 120, and 180 minutes after exposure, aliquots were collected, cells were cultured, and viable cell counts were determined using standard microbiological methods.Results: Moxifloxacin achieved 99.9% kill (3-log reduction) at approximately 2 hours for S. pneumoniae and at 15 minutes for H. influenzae. Tobramycin and gentamicin did not achieve 3-log reduction of S. pneumoniae during the 180-minute study period. An increase in bacterial growth was noted for these isolates. Gentamicin took more than 120 minutes to achieve the 3-log reduction of H. influenzae and tobramycin did not reach the 3-log reduction of this pathogen during the 180-minute study period.Conclusion: Moxifloxacin killed S. pneumoniae and H. influenzae in vitro faster than tobramycin and gentamicin, suggesting its potential clinical benefit as a first-line treatment for bacterial conjunctivitis to minimize patient symptoms and to limit the contagiousness of the disease.Keywords: kinetics of kill, bacterial conjunctivitis, in vitro, Streptococcus pneumoniae, Haemophilus influenzae, fluoroquinolones, aminoglycosides Dove Press Rudolph S Wagner, David B Granet, Steven J Lichtenstein, et al 2010-01-15 PDF http://www.dovepress.com/getfile.php?fileID=5688 http://www.dovepress.com/kinetics-of-kill-of-bacterial-conjunctivitis-isolates-with-moxifloxaci-peer-reviewed-article-OPTH English

oai:dovepress.com/3929 2010-01-26 OPTH

A multicenter investigation of OPTI-FREE(RM) RepleniSH(RM) multi-purpose disinfecting solution impact on soft contact lens patient comfort Corbin, Glenn Clinical Ophthalmology Glenn S Corbin1, Linda Bennett2, Louis Espejo3, Suzanne Carducci4, Andrew Sacco5, Robert Hannigan6, Stuart Schatz71Wyomissing Optometric Center, Wyomissing, PA, USA; 2Bellmont, MA, USA; 3Rockville, MD, USA; 4Gaithersburg, MD, USA; 5Vestal, NY, USA; 6Taunton, MA, USA; 7College Park, MD, USAObjective: Demonstrate that successful soft contact lens wearers using competitive multipurpose solutions report improvement in comfort with OPTI-FREE&reg; RepleniSH&reg; Multi-Purpose Disinfecting Solution (MPDS).Methods: This 30-day, multicentered, open-label study enrolled 109 eligible soft contact lens wearers using COMPLETE&reg; Multi-Purpose Solution (MPS) Easy Rub&reg; or ReNu MultiPlus&reg; MPS. The test solution (OPTI-FREE&reg; RepleniSH&reg; MPDS) was dispensed for use in place of habitual care solutions. Subjects assessed their experience with their habitual solution (baseline) and the test solution (Day 30) using Likert-style questions. Contact lens acuity and biomicroscopy findings were recorded at each visit.Results: The test solution was associated with a statistically significant improvement in instillation comfort (P = 0.02), end of day comfort (P &lt; 0.0001), clear vision (P &lt; 0.0001) and overall satisfaction (P &lt; 0.001). Subjects reported the test solution enhanced their overall lens-wearing experience more effectively than their previous solution (P &lt; 0.0001) and that they would continue test solution use after the study (P &lt; 0.0001).Conclusions: The test solution was effective at improving comfort and overall contact lens experience compared to COMPLETE&reg; MPS Easy Rub&reg; or ReNu MultiPlus&reg; MPS in successful contact lens wearers. These results indicate that changing contact lens care solutions, even in successful lens wearers, may improve comfort and overall lens-wearing experience.Keywords: multipurpose solution, soft contact lens, disinfecting solution, patient comfort Dove Press Glenn S Corbin, Linda Bennett, Louis Espejo, et al 2010-01-26 PDF http://www.dovepress.com/getfile.php?fileID=5715 http://www.dovepress.com/a-multicenter-investigation-of-opti-freerm-replenishrm-multi-purpose-d-peer-reviewed-article-OPTH English

oai:dovepress.com/3936 2010-01-29 OPTH

Exoresection via partial lamellar sclerouvectomy approach for uveal tumors: A successful performance by a novice surgeon Gunduz, K Clinical Ophthalmology Rengin Aslıhan Kurt, Kaan G&uuml;nd&uuml;zDepartment of Ophthalmology, Ankara University Faculty of Medicine, Ankara, TurkeyPurpose: To evaluate the results and complications of exoresection via a partial lamellar sclerouvectomy (PLSU) procedure for uveal tumors performed by a novice surgeon without help from an experienced surgeon.Methods: Medical records of 22 patients who underwent exoresection for uveal tumors between February 1999 and January 2009 were evaluated retrospectively. Exoresection was considered for tumors with their epicenter in the iris or in the ciliary body.Results: Twenty-two patients with a mean age of 45.9 years (range: 19&ndash;72 years) were included in this study. The histopathologic diagnosis was uveal malignant melanoma in 16 patients, iridociliary nevus in 2 patients, iris nevus in 2 patients, and iridociliary melanocytoma in 2 patients. Postoperative complications included cataract in 11 patients (50%), scleral thinning in 4 patients (18%), vitreous hemorrhage in 2 patients (9%), hyphema in 2 patients (9%), secondary glaucoma in 2 patients (9%), iridodialysis in 1 patient (4.5%), bullous keratopathy in 1 patient (4.5%), and posterior synechiae in 1 patient (4.5%). At a mean follow-up of 40.1 months (range: 1&ndash;98 months), there were no recurrences or metastatic events.Conclusions: Exoresection seems to be an effective treatment option in selected cases of iridociliary and ciliary body tumors. Novice surgeons with limited training in PLSU should not discourage themselves from doing this type of surgery. Several postoperative complications inevitably occur and require frequent patient monitoring.Keywords: uveal melanoma, uveal nevus, iris, ciliary body, choroid, iris nevus, iris melanoma, ciliary nevus, ciliary melanoma, choroidal melanoma, ciliochoroidal melanoma, iridociliochoroidal melanoma, partial lamellar sclerouvectomy, exoresectionErratum for this paper has been published Dove Press Rengin Aslıhan Kurt, Kaan G&uuml;nd&uuml;z 2010-01-29 PDF http://www.dovepress.com/getfile.php?fileID=5724 http://www.dovepress.com/exoresection-via-partial-lamellar-sclerouvectomy-approach-for-uveal-tu-peer-reviewed-article-OPTH English

oai:dovepress.com/3949 2010-02-05 OPTH

Transconjunctival sutureless vitrectomy with tissue plasminogen activator, gas and intravitreal bevacizumab in the management of predominantly hemorrhagic age-related macular degeneration Arias, Luis Clinical Ophthalmology Luis Arias1,2, Jordi Mon&eacute;s11Institut de la M&agrave;cula i de la Retina, Centro M&eacute;dico Teknon, Barcelona; 2Hospital Universitari de Bellvitge, L&rsquo;Hospitalet de Llobregat, BarcelonaPurpose: To determine the efficacy and safety of treating predominantly hemorrhagic age-related macular degeneration (AMD) with transconjunctival sutureless vitrectomy (TSV), tissue plasminogen activator (tPA), sulphur hexafluoride (SF6), and intravitreal bevacizumab.Methods: Retrospective study, consecutive case series. Patients with acute hemorrhagic AMD treated with 25- or 23-gauge TSV, subretinal or intravitreal tPA, fluid-air-SF6 exchange and intravitreal injection of bevacizumab. All operations were performed within the first 5 days after the start of symptoms, which consisted of visual acuity (VA) loss and central scotoma.Results: Fifteen eyes from 15 patients were included. The patients&rsquo; mean age was 79.6 years, and the mean follow-up was 11.8 months. Five patients (33%) were receiving oral anticoagulant treatment. At baseline, the mean VA (logMAR values) was 1.5 (20/640 Snellen equivalent). At the last follow-up visit, the mean VA was 1.1 (20/250) (P &lt; 0.0001; paired t-test). The submacular hemorrhage was successfully displaced in all the cases. Complications consisted of three cases of vitreous hemorrhage and a tear or the retinal pigment epithelium. Twelve cases (80%) did not require further treatment during the follow-up period.Conclusion: A surgical approach with 25- or 23-gauge TSV, tPA, SF6 and intravitreal bevacizumab is an efficacious and safe procedure in patients with hemorrhagic AMD. Early treatment is advisable for obtaining the optimal outcome.Keywords: Hemorrhagic age-related macular degeneration, tissue plasminogen activator, intravitreal bevacizumab; transconjunctival sutureless vitrectomy Dove Press Luis Arias, Jordi Mon&eacute;s 2010-02-05 PDF http://www.dovepress.com/getfile.php?fileID=5782 http://www.dovepress.com/transconjunctival-sutureless-vitrectomy-with-tissue-plasminogen-activa-peer-reviewed-article-OPTH English

oai:dovepress.com/3970 2010-02-15 OPTH

Impact of topical bimatoprost 0.01% and bimatoprost 0.03% on conjunctival irritation in rabbits Ogundele, Abayomi Clinical Ophthalmology Abayomi B Ogundele, Guangming Li, Joel J EllisAlcon Research, Ltd., Fort Worth, TX, USAIntroduction: The purpose of this study was to examine and compare the conjunctival irritation (congestion, swelling, and discharge) of topical bimatoprost ophthalmic solution 0.01% and bimatoprost ophthalmic solution 0.03% in rabbits.Methods: Six healthy New Zealand White rabbits were treated with either bimatoprost 0.01% or bimatoprost 0.03% (3 animals/group). One dose (2 drops/dose) of study medication was administered to the right eye of each animal every 30 minutes for 4.5 hours. Approximately 1 hour after the last dose, conjunctival irritation was assessed using a slit-lamp biomicroscope to individually evaluate conjunctival congestion, swelling, and discharge.Results: The mean conjunctival congestion, swelling and discharge scores for bimatoprost 0.03% were 1.67, 0.33 and 0.33, respectively, and for bimatoprost 0.01% were 2.00, 0.33 and 1.33, respectively.Conclusions: Despite the lower drug concentration of the 0.01% formulation, bimatoprost 0.01% does not reduce conjunctival irritation, including conjunctival congestion, swelling, and discharge, in rabbits compared to bimatoprost 0.03%. Further studies would be needed to determine whether the increase in the mean conjunctival congestion and discharge scores may be attributed to the increased BAK concentration in the bimatoprost 0.01% formulation.Keywords: bimatoprost, conjunctiva, ocular toxicity, preclinical, prostaglandin analog, rabbits Dove Press Abayomi B Ogundele, Guangming Li, Joel J Ellis 2010-02-15 PDF http://www.dovepress.com/getfile.php?fileID=5764 http://www.dovepress.com/impact-of-topical-bimatoprost-001-and-bimatoprost-003-on-conjunctival--peer-reviewed-article-OPTH English

oai:dovepress.com/3974 2010-02-16 OPTH

Fibrinogen and rhegmatogenous retinal detachment: a pilot prospective study Theocharis, Ioannis Clinical Ophthalmology IP TheocharisOphthalmology Department, Iaso General Hospital, Athens, GreecePurpose: To examine the correlation, if any, between fibrinogen plasma levels (FPL) and the clinical features of rhegmatogenous retinal detachment (RRD).Methods: FPL were measured preoperatively in 33 patients with primary RRD. Patient characteristics and detachment features such as the numbers of breaks and the extent of the detachment were recorded;Results: No statistically significant correlation was found between FPL and the number of breaks. A statistically significant correlation was found between FPL and the extent of the RRD, even if the influence of the number of breaks was excluded. Conclusions: FPL correlate with retinal detachment extent, which implicates an acute inflammatory response to detachment traumatic phenomenon or a role of the fibrinogen molecule in retinal adhesiveness.Keywords: fibrinogen, retinal detachment, pathogenesis Dove Press <p>IP Theocharis</p> 2010-02-16 PDF http://www.dovepress.com/getfile.php?fileID=5770 http://www.dovepress.com/fibrinogen-and-rhegmatogenous-retinal-detachment-a-pilot-prospective-s-peer-reviewed-article-OPTH English

oai:dovepress.com/3989 2010-02-18 OPTH

Serum free fatty acids levels not associated with normal tension glaucoma Yuki, Kenya Clinical Ophthalmology Kenya Yuki, Itaru Kimura, Kazuo TsubotaDepartment of Ophthalmology, Keio University School of Medicine, Tokyo, JapanPurpose: To determine the free fatty acid levels in the sera of patients with normal-tension glaucoma and compare it with that of normal controls.Methods: Forty-four consecutive patients with newly diagnosed normal-tension glaucoma and forty-four age and gender matched controls were evaluated. The type and level of fatty acids in the sera were measured by gas chromatography (Model GC17A; Shimazu, Kyoto, Japan). Twenty-four fatty acids were identified from 12:0 to 24:1. The values were compared between the normal-tension glaucoma and control groups by Mann&ndash;Whitney U tests.Results: No statistically significant difference was found in the levels of any free fatty acids between the normal-tension glaucoma group and control group.Conclusion: No significant association was found in the serum free fatty acids levels including docosahexaenoic acid and eicosapentaenoic acid between normal-tension glaucoma patients and controls.Keywords: free fatty acid, docosahexaenoic acid, eicosapentaenoic acid, normal tension glaucoma Dove Press Kenya Yuki, Itaru Kimura, Kazuo Tsubota 2010-02-18 PDF http://www.dovepress.com/getfile.php?fileID=5791 http://www.dovepress.com/serum-free-fatty-acids-levels-not-associated-with-normal-tension-glauc-peer-reviewed-article-OPTH English

oai:dovepress.com/4003 2010-02-25 OPTH

Spectacle independence and subjective satisfaction of ReSTOR&reg; multifocal intraocular lens after cataract or presbyopia surgery in two European countries Berdeaux, Gilles Clinical Ophthalmology B&eacute;atrice Cochener1, Luis Fern&aacute;ndez-Vega2, Jose F Alfonso2, Fr&eacute;d&eacute;rique Maurel3, Juliette Meunier4, Gilles Berdeaux5,61Centre Hospitalier de Brest, Brest, France; 2Instituto Oftalmologico Fernandez Vega, Oviedo, Spain; 3IMS Health, Health Economics Department, Puteaux, France; 4Mapi Values, Lyon, France; 5Alcon France, Health Economics Department, Rueil-Malmaison, France; 6Conservatoire National des Arts et M&eacute;tiers, Paris, FrancePurpose: To determine the percentage of patients implanted bilaterally with ReSTOR&reg; requiring spectacles at 18 months, the patient satisfaction, and factors that predict spectacles independence.Methods: The medical and surgical data were collected from patient records. The &lsquo;Freedom from Spectacles Value Scale&rsquo; (FGVS) was used to rank their experiences via telephone interview. A Bayesian network was used to predict postoperative spectacles use.Results: 304 patients (65.6 years) were included. Postoperative visual acuity was &ge;0.8 in 93.3% of patients for near vision and in 88.6% of patients for distance vision. After surgery, 87.2% of the patients were spectacles free. 88.2% of the patients rated their vision as being better following the surgery and 93.1% thought that surgery resulted in a positive change. FGVS mean scores (5 the most favorable rating) were: &lsquo;Practical Advantages&rsquo; 3.8, &lsquo;Psychological Advantages&rsquo; 3.8, &lsquo;Evaluation of the Result&rsquo; 4.5, &lsquo;Feelings&rsquo; 4.4, and &lsquo;Global Judgement&rsquo; 4.4. Patients who stated that spectacles wear was particularly bothersome and those who thought that their appearance was more favorable without spectacles were 3 times more likely not to wear spectacles postoperatively.Conclusion: ReSTOR&reg; provides patients with good distance and near vision, a high rate of spectacles independence, and a high degree of patient satisfaction.Keywords: cataract surgery, multifocal intraocular lens, patient satisfaction, spectacles independence Dove Press B&eacute;atrice Cochener, Luis Fern&aacute;ndez-Vega, Jose F Alfonso, et al 2010-02-25 PDF http://www.dovepress.com/getfile.php?fileID=5811 http://www.dovepress.com/spectacle-independence-and-subjective-satisfaction-of-restorreg-multif-peer-reviewed-article-OPTH English

oai:dovepress.com/4009 2010-02-25 OPTH

Methicillin-resistant Staphylococcus epidermidis isolation from the vitrectomy specimen four hours after initial treatment with vancomycin and ceftazidime Schwartz, Stephen Clinical Ophthalmology Golnaz Javey1, Stephen G Schwartz2, Andrew A Moshfeghi2, Sanjay Asrani3, Harry W Flynn Jr21Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA; 2Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 3Department of Ophthalmology, Duke University Medical Center, Durham, NC, USAAbstract: A patient presented with acute-onset, postoperative endophthalmitis and visual acuity of light perception. Because of a time delay in arranging a pars plana vitrectomy (PPV), the patient was treated with a prompt vitreous tap for culture an injection of vancomycin and ceftazidime. Four hours later, the PPV was performed and additional antibiotics were injected. The cultures from both the initial needle tap and the subsequent PPV isolated methicillin-resistant Staphylococcus epidermidis sensitive to vancomycin, but resistant to fourth-generation fluoroquinolones. The patient eventually recovered a visual acuity of 20/80 before developing retinal detachment. This case illustrates the time lag necessary to sterilize the vitreous cavity, and suggests a possible two-step staged treatment strategy for situations in which access to PPV equipment and support staff may be limited.Keywords: endophthalmitis, pars plana vitrectomy, tap and inject Dove Press Golnaz Javey, Stephen G Schwartz, Andrew A Moshfeghi, et al 2010-02-25 PDF http://www.dovepress.com/getfile.php?fileID=5818 http://www.dovepress.com/methicillin-resistant-staphylococcus-epidermidis-isolation-from-the-vi-peer-reviewed-article-OPTH English

oai:dovepress.com/4016 2010-02-25 OPTH

Bilateral anterior ischemic optic neuropathy after bilateral neck dissection Mencía-Gutiérrez, Enrique Clinical Ophthalmology Mar&iacute;a J Su&aacute;rez-Fern&aacute;ndez, Antonio Clariana-Mart&iacute;n, Enrique Menc&iacute;a-Guti&eacute;rrez, Esperanza Guti&eacute;rrez-D&iacute;az, Teresa Gracia-Garc&iacute;a-MiguelOphthalmology Department, 12 de Octubre Hospital, Complutense University, Madrid, SpainPurpose: The risk of visual loss after nonocular surgeries is very low, between 0.2% and 4.5%. According to the American Society of Anesthesiologists, ischemic optic neuropathy has been reported mostly after spinal surgery (54.2%), followed by cardiac surgery and radical neck dissection (13.3%). It may occur in association with some conditions that include systemic hypotension, acute blood loss and hypovolemia.Case report: A 46-year-old woman, whose diagnosis was laryngeal squamous cell carcinoma, complained of visual loss in her right eye two days after surgery (laryngectomy with bilateral radical neck dissection and left jugular ligature) and one day later in her left eye. The diagnosis was nonarteritic anterior ischemic optic neuropathy.Conclusion: Anterior ischemic optic neuropathy related to nonocular surgery is usually bilateral and its prognosis is very poor, resulting in blindness or severe visual loss. Although rare, patients should be warned about this complication, which has a profound impact on quality of life, since no therapeutic measure, including correction of hypotension and anemia, seems to improve the prognosis of this complication.Keywords: ischemic optic neuropathy, visual loss, radical neck dissection, blood loss Dove Press Mar&iacute;a J Su&aacute;rez-Fern&aacute;ndez, Antonio Clariana-Mart&iacute;n, Enrique Menc&iacute;a-Guti&eacute;rrez, et al 2010-02-25 PDF http://www.dovepress.com/getfile.php?fileID=5826 http://www.dovepress.com/bilateral-anterior-ischemic-optic-neuropathy-after-bilateral-neck-diss-peer-reviewed-article-OPTH English

oai:dovepress.com/4021 2010-03-01 OPTH

Valganciclovir in the treatment of cytomegalovirus retinitis in HIV-infected patients Kuppermann, Barry Clinical Ophthalmology A Jayaprakash Patil1,2,3, Ashish Sharma1,4, M Cristina Kenney1, Baruch D Kuppermann11Department of Ophthalmology, Gavin S Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA; 2Department of Ophthalmology, Summa Health System, Akron, OH, USA; 3Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, OH, USA; 4Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USAAbstract: Oral valganciclovir is a new and highly efficacious alternative to the chronic administration of ganciclovir in the treatment of cytomegalovirus (CMV) retinitis in HIV-infected patients. In addition to its excellent bioavailability and favorable pharmacokinetic profile, valganciclovir has also proved cost effective and is the most widely used drug in the armamentarium for the treatment of CMV retinitis. Valganciclovir is a prodrug of ganciclovir, the erstwhile commonly used therapy. In March 2001, the US Food and Drug Administration approved valganciclovir for the induction and maintenance treatment of CMV disease, including CMV retinitis. Valganciclvoir has compared favorably with both oral and intravenous treatments for induction and maintenance therapy with ganciclovir. The reduced pill burden and the ease of oral administration has helped avoid the risks associated with intravenous therapy. The most serious adverse event is neutropenia, which makes the patient susceptible to infections. In the current review, we have compiled all the available evidence-based information on valganciclovir.Keywords: CMV retinitis, ganciclovir, valganciclovir Dove Press A Jayaprakash Patil, Ashish Sharma, M Cristina Kenney, et al 2010-03-01 PDF http://www.dovepress.com/getfile.php?fileID=5832 http://www.dovepress.com/valganciclovir-in-the-treatment-of-cytomegalovirus-retinitis-in-hiv-in-peer-reviewed-article-OPTH English

oai:dovepress.com/4033 2010-03-03 OPTH

Periocular xanthogranuloma: A forgotten entity? Drosos, Alexandros Clinical Ophthalmology Charalampos Papagoras1, George Kitsos2, Paraskevi V Voulgari1, Anastasia K Zikou3, Maria I Argyropoulou3, Aikaterini Zioga4, Alexandros A Drosos11Rheumatology Clinic, Department of Internal Medicine; 2Department of Ophthalmology; 3Department of Clinical Imaging and Radiology, 4Department of Pathology, Medical School, University of Ioannina, Ioannina, GreeceAbstract: Periocular xanthogranulomatous diseases are a rare group of disorders which are characterized by a predilection to affect the orbit and ocular adnexa and special histopathological features, in particular infiltrates comprising non-Langerhans-derived foamy histiocytes and Touton giant cells. The differential diagnosis is difficult and occasionally definite diagnosis cannot be established even after clinical and histopathological findings are taken together. We describe a case of a middle-aged man who presented with a 10-year history of voluminous eyelid swelling with concomitant late-onset atopic manifestations, namely bronchial asthma and allergic rhinitis with nasal polyps. After thorough clinical and laboratory investigation, including a biopsy of the eyelid, we classified the patient&rsquo;s disease to a rare entity that has been relatively recently described: periocular xanthogranuloma associated with adult-onset asthma. In a review of the literature, no prospective trials concerning the treatment of this disease were found. The literature mainly contained case reports and case series in which corticosteroids and chemotherapy with alkylating agents have been reported to be beneficial. We treated our patient with a combination of oral corticosteroids and cyclophosphamide pulses and we observed substantial regression of the eyelid masses together with a normalization of systemic immunologic abnormalities.Keywords: periocular xanthogranuloma, adult-onset asthma, non-Langerhans histiocytoses, cyclophosphamide, methylprednisolone Dove Press Charalampos Papagoras, George Kitsos, Paraskevi V Voulgari, et al 2010-03-03 PDF http://www.dovepress.com/getfile.php?fileID=5844 http://www.dovepress.com/periocular-xanthogranuloma-a-forgotten-entity-peer-reviewed-article-OPTH English

oai:dovepress.com/4042 2010-03-05 OPTH

Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives Kernt, Marcus Clinical Ophthalmology M Kernt, A KampikDepartment of Ophthalmology, Ludwig Maximilian University, Munich, GermanyAbstract: Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.Keywords: endophthalmitis, intravitreal, antibiotics, victrectomy, moxifloxacin, voriconazole, caspofungin Dove Press M Kernt, A Kampik 2010-03-05 PDF http://www.dovepress.com/getfile.php?fileID=5855 http://www.dovepress.com/endophthalmitis-pathogenesis-clinical-presentation-management-and-pers-peer-reviewed-article-OPTH English

oai:dovepress.com/4054 2010-03-09 OPTH

Sight-threatening optic neuropathy is associated with paranasal lymphoma Hayashi, Takahiko Clinical Ophthalmology Takahiko Hayashi1, Ken Watanabe2, Yukio Tsuura3, Gengo Tsuji4, Shingo Koyama4, Jun Yoshigi4, Naoko Hirata1, Shin Yamane1, Yasuhito Iizima5, Shigeo Toyota6, Satoshi Takeuchi11Department of Ophthalmology, Yokosuka Kyosai Hospital, Japan; 2Department of Hematology, Graduate School of Medicine, Tokyo Medical and Dental University, Japan; 3Department of Pathology, Yokosuka Kyosai Hospital, Japan; 4Department of Radiology, Yokosuka Kyosai Hospital, Japan; 5Department of Ophthalmology, Yokohama City University, Japan; 6Department of Internal Medicine, Yokosuka Kyosai Hospital, JapanAbstract: Malignant lymphoma around the orbit is very rare. We present a rare case of optic neuropathy caused by lymphoma. A 61-year-old Japanese woman was referred to our hospital for evaluation of idiopathic optic neuropathy affecting her right eye. The patient was treated with steroid pulse therapy (methyl-predonisolone 1 g daily for 3 days) with a presumed diagnosis of idiopathic optic neuritis. After she had been switched to oral steroid therapy, endoscopic sinus surgery had been performed, which revealed diffuse large B cell lymphoma of the ethmoidal sinus. Although R-CHOP therapy was immediately started, prolonged optic nerve compression resulted in irreversible blindness. Accordingly, patients with suspected idiopathic optic neuritis should be carefully assessed when they show a poor response, and imaging of the orbits and brain should always be done for initial diagnosis because they may have compression by a tumor.Keywords: optic neuropathy, malignant lymphoma, paranasal lymphoma, rhinogenic optic neuropathy Dove Press Takahiko Hayashi, Ken Watanabe, Yukio Tsuura, et al 2010-03-09 PDF http://www.dovepress.com/getfile.php?fileID=5868 http://www.dovepress.com/sight-threatening-optic-neuropathy-is-associated-with-paranasal-lympho-peer-reviewed-article-OPTH English

oai:dovepress.com/4059 2010-03-10 OPTH

Acrylic toric intraocular lens implantation: a single center experience concerning clinical outcomes and postoperative rotation Tsaousis, Konstantinos Clinical Ophthalmology Ioannis T Tsinopoulos1, Konstantinos T Tsaousis1, Dimitrios Tsakpinis1, Nikolaos G Ziakas2, Stavros A Dimitrakos112nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece; 21st Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, GreecePurpose: To present clinical results of toric intraocular lens (IOL) implantation for preexisting astigmatism correction and determine the time of any postoperative rotation.Patients and methods: Twenty-nine eyes of 19 patients underwent uncomplicated phacoemulsification and were implanted with an Acrysof&copy; toric IOL. Uncorrected visual acuity, residual astigmatism, and postoperative rotation of the IOL were estimated one and six months after the operation.Results: Uncorrected visual acuity was &ge;0.5 in 26 of 29 eyes (89.7%) and &ge;0.8 in 19 of 29 patients (65.5%). The mean toric IOL axis rotation was 2.2 &plusmn; 1.5&deg; (range 0.6&ndash;7.8&deg;) one month postoperation and 2.7 &plusmn; 1.5&deg; (range 0.9&ndash;8.4&deg;) six months postoperation.Conclusion: Implantation of one-piece hydrophobic acrylic toric IOLs appears to have acceptable stability, which encourages visual outcome and emerges as an attractive alternative for correction of refractive astigmatism.Keywords: astigmatism, cataract, stability, implantation Dove Press Ioannis T Tsinopoulos, Konstantinos T Tsaousis, Dimitrios Tsakpinis, et al 2010-03-10 PDF http://www.dovepress.com/getfile.php?fileID=6581 http://www.dovepress.com/acrylic-toric-intraocular-lens-implantation-a-single-center-experience-peer-reviewed-article-OPTH English

oai:dovepress.com/4084 2010-03-12 OPTH

Self-reported quality of life in patients with retinitis pigmentosa and maculopathy of Bothnia type Burstedt, Marie Clinical Ophthalmology Marie SI Burstedt, Eva M&ouml;nestamDepartment of Clinical Sciences/Ophthalmology, University of Ume&aring;, SwedenPurpose: To assess vision-related quality-of-life subscales with objective measurements of visual function in patients affected with retinitis pigmentosa of Bothnia type (BD).Methods: Forty-nine patients answered the NEI-VFQ-25 questionnaire. High- and low-contrast distance acuity (VA), near VA, and visual fields (VF) were measured. Weighted VA (WVA) and low-contrast (10%) VA (WLCVA), binocular VF areas, and central scotoma were calculated. Adjusted mean subscale scores were calculated and associations analyzed.Results: Subscale scores for general, far, and near vision, social functioning, and color vision were lowest while general health, ocular pain, and mental health were highest in the BD phenotype. The correlations were substantial and similar for WVA, WLCVA, and near vision. The degree of measured VF impairment had few associations with the different adjusted subscale scores.Conclusion: The NEI VFQ-25 subscales were well associated with clinical vision measures depending on VA. The progression of VF defects typical for the BD phenotype does not seem to affect the self-perceived quality of life, which might indicate adaptability to this type of progressive VF loss. The BD phenotype has a significant impact on multiple domains of daily life, but there are no signs of accelerating depression related to the increasing visual impairment.Keywords: visual function, low vision, maculopathy, RP, Bothnia dystrophy, visual cycle, RLBP1 Dove Press Marie SI Burstedt, Eva M&ouml;nestam 2010-03-12 PDF http://www.dovepress.com/getfile.php?fileID=5902 http://www.dovepress.com/self-reported-quality-of-life-in-patients-with-retinitis-pigmentosa-an-peer-reviewed-article-OPTH English

oai:dovepress.com/4091 2010-03-16 OPTH

The use of imbricated sutures in radioactive plaque brachytherapy surgery Gunduz, K Clinical Ophthalmology Kaan G&uuml;nd&uuml;z1, Jose S Pulido1, Peter D Yeakel2, Michael King3, Kelly L Classic1, Keith M Furutani21Department of Ophthalmology, 2Department of Radiation Oncology, 3Section of Media Support Services, Mayo Clinic, Rochester, MN, USAAbstract: This paper describes a new technique to suture the radioactive plaque to sclera. The radioactive plaque is conventionally sutured to the sclera using 5/0 nylon sutures. The imbricated suture technique involves using a 1/0 silk or 2/0 mersilene suture imbricated with the 5/0 nylon suture when the nylon suture is tied and cut. The imbricated suture technique allows easy identification of the plaque at removal and provides a surface that separates the 5/0 nylon from the surface of the eyelet platform, making suture cutting easier and safer. The radiation exposure times ranged from 9.1 minutes to 14 minutes (mean: 10.8 minutes) during plaque insertion and from 2.8 to 3.3 minutes (mean: 3.0 minutes) during plaque removal with the imbricated suture technique. This technique may decrease radiation exposure time and may prevent inadvertent scleral damage.Keywords: plaque radiotherapy, Iodine-125, Ruthenium-106, Collaborative Ocular Melanoma Study, choroidal melanoma, ciliary body melanoma, retinoblastoma, plaque placement, plaque removal, radiation exposure Dove Press Kaan G&uuml;nd&uuml;z, Jose S Pulido1, Peter D Yeakel, et al 2010-03-16 PDF http://www.dovepress.com/getfile.php?fileID=5911 http://www.dovepress.com/the-use-of-imbricated-sutures-in-radioactive-plaque-brachytherapy-surg-peer-reviewed-article-OPTH English

oai:dovepress.com/4096 2010-03-16 OPTH

Assessment of phacoaspiration techniques in clear lens extraction for correction of high myopia El-Helw, Mostafa Clinical Ophthalmology Mostafa A El-Helw, Ahmed M EmarahDepartment of Ophthalmology, Cairo University, EgyptPurpose: To evaluate various phacoaspiration techniques in clear lens extraction for the incidence of intraoperative difficulties and complications.Patients and methods: This was a prospective study in which bilateral clear lens extraction was performed on 40 eyes of 20 patients, to correct high myopia. The patients were divided into 2 groups: group A underwent supracapsular phacoaspiration; group B were the contralateral eyes of the same patient. These patients were operated on with endocapsular phacoaspiration with the divide and conquer (D and C) technique. Preoperative ocular examination data were recorded and tested for significance. Intraoperative difficulties and complications such as nucleus cracking, capsule rupture and vitreous loss, and repeated chamber collapse were recorded. Postoperative examination data were recorded.Results: Mean age was 35.65 &plusmn; 5.85 years. Mean follow-up time was 17.1 &plusmn; 8.56 months. In group A mean myopia was -17.3 &plusmn; 5.07 diopters; in group B myopia was -17.9 &plusmn; 4.20 diopters. Mean preoperative uncorrected visual acuity (UCVA) was 0.04 &plusmn; 0.0167, while the mean postoperative UCVA was 0.435 &plusmn; 0.1442. There was a significant difference in pre and postoperative BCVA within both groups, but not between the two groups. In both groups endothelial cell count (ECC) showed a significant difference between pre- and postoperative data; however, there was no statistically significant difference between both groups in postoperative ECC. The effective phacoaspiration time for group A was 4.6 &plusmn; 1.6 seconds, and for group B 9.90 &plusmn; 2.27 seconds (P &lt; 0.005). No cases of capsule rupture occurred in group A, but 3 cases occurred in group B (15 %) (not significant, P = 0.231). Nucleus cracking did not occur in group A, but in group B 13 cases occurred (65%). Chamber collapse occurred in 4 cases (20%) in group A and 5 cases (25%) in group B (not significant, P = 1.000). Three cases of moderate postoperative iritis were recorded in group B in (15%), in which posterior capsular rupture also occurred. No cases of iritis were recorded in group A (not significant, P = 0.231). Two cases of cystoid macular edema were recorded in group B (10%) and none in group A (not significant, P = 0.487).Conclusions: Supracapsular phacoaspiration for clear lens extraction in correction of high myopia seems to present no risk for the posterior capsule, although there is a marginal risk to the ECC.Keywords: clear lens extraction, correction of high myopia, supracapsular phacoaspiration Dove Press Mostafa A El-Helw, Ahmed M Emarah 2010-03-16 PDF http://www.dovepress.com/getfile.php?fileID=5947 http://www.dovepress.com/assessment-of-phacoaspiration-techniques-in-clear-lens-extraction-for--peer-reviewed-article-OPTH English

oai:dovepress.com/4105 2010-03-17 OPTH

Clinical appraisal of tafluprost in the reduction of elevated intraocular pressure (IOP) in open-angle glaucoma and ocular hypertension Aihara , Makoto Clinical Ophthalmology Makoto AiharaDepartment of Ophthalmology, University of Tokyo School of Medicine, Tokyo, JapanAbstract: An elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma, which causes progressive optic neuropathy. Lowering IOP is currently the only therapeutic approach to the treatment of glaucoma. Tafluprost, a novel prostaglandin analogue, was recently launched onto the market as an ocular hypotensive agent. Tafluprost is potent in its affinity for the prostanoid FP receptor and in its intraocular lowering efficacy. Moreover, it enhances the ocular hemodynamics and has neuroprotective effects. Clinical studies have demonstrated its efficacy at decreasing intraocular pressure in patients with open-angle glaucoma or ocular hypertension.Keywords: open-angle glaucoma, normal tension glaucoma, receptor affinity, intraocular pressure Dove Press Makoto Aihara 2010-03-17 PDF http://www.dovepress.com/getfile.php?fileID=5928 http://www.dovepress.com/clinical-appraisal-of-tafluprost-in-the-reduction-of-elevated-intraocu-peer-reviewed-article-OPTH English

oai:dovepress.com/4106 2010-03-17 OPTH

Primary open angle glaucoma due to T377M MYOC: Population mapping of a Greek founder mutation in Northwestern Greece Kitsos, George Clinical Ophthalmology George Kitsos1, Zacharias Petrou2, Maria Grigoriadou3, John R Samples4, Alex W Hewitt5, Haris Kokotas3, Aglaia Giannoulia-Karantana3, David A Mackey6, Mary K Wirtz4, Marilita Moschou7, John PA Ioannidis8, Michael B Petersen31Department of Ophthalmology, University of Ioannina, School of Medicine, Ioannina, Greece; 2Department of Ophthalmology, General Hospital of Ioannina &ldquo;G Chatzikosta&rdquo;, Ioannina, Greece; 3Department of Genetics, Institute of Child Health, Athens, Greece; 4Department of Ophthalmology, Casey Eye Institute-OHS U, Portland, OR; 5Department of Ophthalmology, Flinders University, Adelaide, Australia; 6Center for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; 7Department of Ophthalmology, University of Athens, School of Medicine, Athens, Greece; 8Department Hygiene and Epidemiology, University of Ioannina, School of Medicine, Ioannina, GreeceBackground: Mutations in the MYOC gene have been shown to explain 5% of unrelated primary open angle glaucoma (POAG) in different populations. In particular, the T377M MYOC mutation has arisen at least three separate times in history, in Great Britain, India, and Greece. The purpose of this study is to investigate the distribution of the mutation among different population groups in the northwestern region of Greece.Materials and methods: We explored the distribution of the &ldquo;Greek&rdquo; T377M founder mutation in the Epirus region in Northwestern Greece, which could be its origin. Genotyping was performed in POAG cases and controls by PCR amplification of the MYOC gene, followed by digestion with restriction enzyme. Statistical analyses were performed by an exact test, the Kaplan&ndash;Meier method and the t-test.Results: In the isolated Chrysovitsa village in the Pindus Mountains, a large POAG family demonstrated the T377M mutation in 20 of 66 family members while no controls from the Epirus region (n = 124) carried this mutation (P &lt; 0.001). Among other POAG cases from Epirus, 2 out of 14 familial cases and 1 out of 80 sporadic cases showed the mutation (P = 0.057). The probability of POAG diagnosis with advancing age among mutation carriers was 23% at age 40, and reached 100% at age 75. POAG patients with the T377M mutation were diagnosed at a mean age of 51 years (SD &plusmn; 13.9), which is younger than the sporadic or familial POAG cases: 63.1 (SD &plusmn; 11) and 66.8 (SD &plusmn; 9.8) years, respectively.Conclusions: The T377M mutation was found in high proportion in members of the Chrysovitsa family (30.3%), in lower proportion in familial POAG cases (14.2%) and seems rare in sporadic POAG cases (1.2%), while no controls (0%) from the Epirus region carried the mutation. Historical and geographical data may explain the distribution of this mutation within Greece and worldwide.Keywords: primary open angle glaucoma, GLC1C, myocilin, MYOC, founder mutation Dove Press George Kitsos, Zacharias Petrou2, Maria Grigoriadou, et al 2010-03-17 PDF http://www.dovepress.com/getfile.php?fileID=5929 http://www.dovepress.com/primary-open-angle-glaucoma-due-to-t377m-myoc-population-mapping-of-a--peer-reviewed-article-OPTH English

oai:dovepress.com/4124 2010-03-24 OPTH

Suture-related keratitis following cataract surgery caused by methicillin-resistant Staphylococcus aureus Tarabishy, Ahmad Clinical Ophthalmology Ahmad B Tarabishy1, Thomas L Steinemann21Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; 2Cornea and External Eye Disease, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USAAbstract: A 54-year old-man presented with a two-day history of severe pain and decreased vision. Examination revealed a corneal ulcer associated with a loose suture from cataract surgery done approximately two years ago. The suture was removed and the patient was started on topic antibiotic treatment with cefazolin and gentamycin. Cultures revealed methicillin-resistant Staphylococcus aureus (MRSA). The antibiotic regimen was changed to include vancomycin but the ulcer continued to progress. Three days later, the ulcer had perforated and an emergent corneal patch graft was performed. To our knowledge, this is the first reported case of suture-related MRSA keratitis after uncomplicated clear corneal cataract surgery.Keywords: keratitis, MRSA, suture, staphylococcus aureus Dove Press Ahmad B Tarabishy, Thomas L Steinemann 2010-03-24 PDF http://www.dovepress.com/getfile.php?fileID=5950 http://www.dovepress.com/suture-related-keratitis-following-cataract-surgery-caused-by-methicil-peer-reviewed-article-OPTH English

oai:dovepress.com/4152 2010-03-29 OPTH

Besifloxacin: a novel anti-infective for the treatment of bacterial conjunctivitis Comstock, Timothy Clinical Ophthalmology Timothy L Comstock1, Paul M Karpecki2, Timothy W Morris3, Jin-Zhong Zhang41Global Medical Affairs, Pharmaceuticals, Bausch and Lomb, Inc., Rochester, NY, USA; 2Koffler Vision Group, Lexington, KY, USA; 3Research and Development Microbiology and Sterilization Sciences, Bausch and Lomb, Inc., Rochester, NY, USA; 4Global Preclinical Development, Bausch and Lomb, Inc., Rochester, NY, USAAbstract: Bacterial conjunctivitis, commonly known as pink eye, is demographically unbiased in its prevalence and can be caused by a variety of aerobic and anaerobic bacteria. Timely empiric treatment with a broad-spectrum anti-infective, such as a topical fluoroquinolone, is critical in preventing potentially irreversible ocular damage. However, the rise in ocular methicillin-resistant Staphylococcus aureus isolates and the patterns of fluoroquinolone resistance for patients with other ocular bacterial infections mandate the need for new agents targeted for ocular use. Besifloxacin, a novel broad-spectrum fluoroquinolone, is approved for the treatment of bacterial conjunctivitis. It has a uniquely balanced dual-targeting activity that inhibits both DNA gyrase and topoisomerase IV and is associated with a lower incidence of resistance development. Besifloxacin is not marketed in other formulations, ensuring that its exposure is limited to bacterial populations in and around the eye. This specifically precludes any bacterial exposure to besifloxacin resulting from systemic use, which further reduces the likelihood of emergence of bacterial resistance. In vitro, besifloxacin has demonstrated equivalent or superior activity compared with other commonly used topical antibiotics. In clinical trials, besifloxacin has consistently demonstrated efficacy and safety in the treatment of patients with bacterial conjunctivitis. Besifloxacin is considered safe and is well tolerated with no observed contraindications.Keywords: conjunctivitis, fluoroquinolones, besifloxacin, besivance, bacterial conjunctivitis Dove Press Timothy L Comstock, Paul M Karpecki, Timothy W Morris, et al 2010-03-29 PDF http://www.dovepress.com/getfile.php?fileID=5985 http://www.dovepress.com/besifloxacin-a-novel-anti-infective-for-the-treatment-of-bacterial-con-peer-reviewed-article-OPTH English

oai:dovepress.com/4154 2010-03-30 OPTH

Update and critical appraisal of combined timolol and carbonic anhydrase inhibitors and the effect on ocular blood flow in glaucoma patients Harris, Alon Clinical Ophthalmology Adam M Moss, Alon Harris, Brent Siesky, Deepam Rusia, Kathleen M Williamson, Yochai ShoshaniDepartment of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USAAbstract: Topical hypotensive therapy with both timolol and carbonic anhydrase inhibitors has been shown to be efficacious at reducing intraocular pressure. Many prospective studies have also suggested that carbonic anhydrase inhibitors augment ocular blood flow and vascular regulation independent of their hypotensive effects. Although consistent in their findings, these studies must be cautiously interpreted due to the limitations of study design and specific blood flow imaging modalities. The purpose of this review is to appraise and critically evaluate the current body of literature investigating the effects of combined treatment with topical carbonic anhydrase inhibitors and timolol in patients with glaucoma with respect to ocular blood flow, visual function, and optic nerve head structure.Keywords: ocular blood flow, carbonic anhydrase inhibitor, timolol, glaucoma, visual function, optic nerve head Dove Press Adam M Moss, Alon Harris, Brent Siesky, et al 2010-03-30 PDF http://www.dovepress.com/getfile.php?fileID=5990 http://www.dovepress.com/update-and-critical-appraisal-of-combined-timolol-and-carbonic-anhydra-peer-reviewed-article-OPTH English

oai:dovepress.com/4164 2010-03-30 OPTH

The outer limiting membrane (OLM) revisited: clinical implications Behar-Cohen, Francine Clinical Ophthalmology S Omri1,2,3, B Omri1,2,3, M Savoldelli1,2,3,4, L Jonet1,2,3, B Thillaye-Goldenberg1,2,3, G Thuret5, P Gain5, J C Jeanny1,2,3, P Crisanti1,2,3, Francine Behar-Cohen1,2,3,41INSERM, U872 Physiopathology of ocular diseases: Therapeutic innovations, Paris, France; 2Centre de Recherche des Cordeliers, Universit&eacute; Pierre et Marie Curie &ndash; Paris6, Paris, France; 3Universit&eacute; Paris Descartes, Paris, France; 4Department of Ophthalmology, H&ocirc;tel-Dieu de Paris, France; 5Department of Ophthalmology, Bellevue Hospital, University of Saint-Etienne, FrancePurpose: The outer limiting membrane (OLM) is considered to play a role in maintaining the structure of the retina through mechanical strength. However, the observation of junction proteins located at the OLM and its barrier permeability properties may suggest that the OLM may be part of the retinal barrier.Material and methods: Normal and diabetic rat, monkey, and human retinas were used to analyze junction proteins at the OLM. Proteome analyses were performed using immunohistochemistry on sections and flat-mounted retinas and western blotting on protein extracts obtained from laser microdissection of the photoreceptor layers. Semi-thin and ultrastructure analyses were also reported.Results: In the rat retina, in the subapical region zonula occludens-1 (ZO-1), junction adhesion molecule (JAM), an atypical protein kinase C, is present and the OLM shows dense labeling of occludin, JAM, and ZO-1. The presence of occludin has been confirmed using western blot analysis of the microdissected OLM region. In diabetic rats, occludin expression is decreased and glial cells junctions are dissociated. In the monkey retina, occludin, JAM, and ZO-1 are also found in the OLM. Junction proteins have a specific distribution around cone photoreceptors and M&uuml;ller glia. Ultrastructural analyses suggest that structures like tight junctions may exist between retinal glial M&uuml;ller cells and photoreceptors.Conclusions: In the OLM, heterotypic junctions contain proteins from both adherent and tight junctions. Their structure suggests that tight junctions may exist in the OLM. Occludin is present in the OLM of the rat and monkey retina and it is decreased in diabetes. The OLM should be considered as part of the retinal barrier that can be disrupted in pathological conditions contributing to fluid accumulation in the macula.Keywords: retinal barrier, OLM, junctions, adherent, tight, diabetes Dove Press S Omri, B Omri, M Savoldelli, et al 2010-03-30 PDF http://www.dovepress.com/getfile.php?fileID=6002 http://www.dovepress.com/the-outer-limiting-membrane-olm-revisited-clinical-implications-peer-reviewed-article-OPTH English

oai:dovepress.com/4165 2010-03-30 OPTH

Ranibizumab in the treatment of choroidal neovascularization on the border of an inferior staphyloma associated with tilted disc syndrome Arias, Luis Clinical Ophthalmology Luis Arias1,2, Jordi Mon&eacute;s21Hospital Universitari de Bellvitge, L&rsquo;Hospitalet de Llobregat, Barcelona; 2Institut de la M&agrave;cula i de la Retina, Centro M&eacute;dico Teknon, BarcelonaPurpose: To describe a case of choroidal neovascularization (CNV) on the border of an inferior staphyloma associated with tilted disc syndrome treated with intravitreal ranibizumab.Patients: Observational case report.Methods: A patient with CNV on the border of an inferior staphyloma associated with tilted disc syndrome was imaged using fluorescein angiography, autofluorescence and spectral domain optical coherence tomography, and treated with intravitreal injections of ranibizumab. Results: The patient received 3 ranibizumab injections during the 9-month follow-up. The visual acuity improved from 20/40 to 20/32 and the foveal thickness reduced from 470 microns to 248 microns. The angiograms showed resolution of leakage associated with CNV. There were no adverse events.Conclusion: Intravitreal ranibizumab is an efficacious and safe treatment in the management of choroidal neovascularization on the border of an inferior staphyloma associated with tilted disc syndrome.Keywords: intravitreal ranibizumab, choroidal neovascularization, tilted disc syndrome, inferior staphyloma Dove Press Luis Arias, Jordi Mon&eacute;s 2010-03-30 PDF http://www.dovepress.com/getfile.php?fileID=6003 http://www.dovepress.com/ranibizumab-in-the-treatment-of-choroidal-neovascularization-on-the-bo-peer-reviewed-article-OPTH English

oai:dovepress.com/4166 2010-03-30 OPTH

Corneal lamellar grafting to repair late complications of mitomycin C trabeculectomy Fukuchi, Takeo Clinical Ophthalmology Takeo Fukuchi, Hidenobu Matsuda, Jun Ueda, Akiko Yamada, Kieko Suda, Haruki AbeDivision of Ophthalmology and Visual Science, Graduated School of Medical and Dental Sciences, Niigata University, Niigata, JapanPurpose: To report corneal lamellar grafting to repair the late-onset complications after MMC trabeculectomy.Methods: Multiple case reports.Results: A 76-year-old male with primary open-angle glaucoma (POAG) and a 55-year-old male with late developmental glaucoma complicated by bleb leaks from a microhole 10 and eight years after surgery, respectively. Severe ciliochoroidal detachment and a shallow anterior chamber were persistent in one case and bleb-related infection recurred in another. Additionally, a 46-year-old male with POAG had hypotony maculopathy with a giant ischemic bleb 18 months after surgery. Although these patients were quite resistant to medical and surgical treatments, they were successfully treated by corneal lamellar grafting without complications. Conclusions: Tectonic corneal lamellar grafting is a reliable and final surgical method to improve severe cases of hypotony maculopathy or bleb leak after mitomycin C trabeculectomy.Keywords: mitomycin C, trabeculectomy, postoperative complications, hypotony maculopathy, bleb leak, corneal lamellar grafting Dove Press Takeo Fukuchi, Hidenobu Matsuda, Jun Ueda, et al 2010-03-30 PDF http://www.dovepress.com/getfile.php?fileID=6004 http://www.dovepress.com/corneal-lamellar-grafting-to-repair-late-complications-of-mitomycin-c--peer-reviewed-article-OPTH English

oai:dovepress.com/4167 2010-03-30 OPTH

Paraneoplastic retinopathy associated with retroperitoneal liposarcoma Kondo, M Clinical Ophthalmology Mineo Kondo1, Kumiko Mokuno2, Ai Uemura1, Shu Kachi1, Makoto Nakamura1, Atsuya Kondo3, Hiroko Terasaki11Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 2Department of Ophthalmology, 3Department of Urology, Kariya Toyota General Hospital Kariya, JapanAbstract: We report a case of paraneoplastic retinopathy associated with a retroperitoneal liposarcoma. A 42-year-old man was referred to our hospital with complaints of night blindness and blurred vision in the peripheral field. Electroretinograms showed a progressive amplitude reduction in his both eyes. Abdominal magnetic resonance imaging showed a large retroperitoneal mass, and pathologic examination revealed a dedifferentiated liposarcoma. Western blot analysis showed an antiretinal antibody in the serum of our patient, and his serum reacted with the photoreceptors of a bovine retina. To the best of our knowledge, this is the first case of paraneoplastic retinopathy associated with a liposarcoma.Keywords: paraneoplastic retinopathy, retroperitneal liposarcoma, electroretinogram, cancerassociated retinopathy Dove Press Mineo Kondo, Kumiko Mokuno, Ai Uemura, et al 2010-03-30 PDF http://www.dovepress.com/getfile.php?fileID=6005 http://www.dovepress.com/paraneoplastic-retinopathy-associated-with-retroperitoneal-liposarcoma-peer-reviewed-article-OPTH English

oai:dovepress.com/4182 2010-03-31 OPTH

Selective laser trabeculoplasty for elevated intraocular pressure following subtenon injection of triamcinolone acetonide Inoue, Makoto Clinical Ophthalmology Kenya Yuki1, Makoto Inoue1,2, Daisuke Shiba1, Ryosuke Kawamura1, Susumu Ishida1, Yuichiro Ohtake11Department of Ophthalmology, Keio University School of Medicine, 2Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, JapanPurpose: To report on the efficacy of selective laser trabeculoplasty (SLT) for elevated intraocular pressure (IOP) following subtenon injection of triamcinolone acetonide.Method: SLT was performed on four of 148 eyes in which IOP was elevated after a subtenon injection of triamcinolone acetonide and could not be maintained within normal limits by conventional medications. Postoperative IOP and relative reduction of IOP were evaluated.Results: IOP was reduced in three eyes to within the normal range without any medications six months after SLT alone, but trabeculotomy was performed on one eye. Percentage reduction in IOP after SLT was 21.6% at one month, 45.0% at three months, and 52.7% at nine months.Conclusion: SLT may be effective in reducing elevated IOP following subtenon injection of triamcinolone acetonide and should be considered before glaucoma surgery.Keywords: selective laser trabeculoplasty, steroid glaucoma, subtenon injection, triamcinolone acetonide Dove Press Kenya Yuki, Makoto Inoue, Daisuke Shiba, et al 2010-03-31 PDF http://www.dovepress.com/getfile.php?fileID=6025 http://www.dovepress.com/selective-laser-trabeculoplasty-for-elevated-intraocular-pressure-foll-peer-reviewed-article-OPTH English

oai:dovepress.com/4199 2010-04-01 OPTH

Antiangiogenic drugs in the management of ocular diseases: Focus on antivascular endothelial growth factor Hata, Y Clinical Ophthalmology Yukio Sassa, Yasuaki HataDepartment of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanAbstract: Age-related macular degeneration (AMD) complications are the leading cause of severe vision loss among the aging population in the many western countries. The introduction of molecular inhibitors of vascular endothelial growth factor (VEGF), such as pegaptanib, ranibizumab, and bevacizumab, as treatments for wet AMD has provided new hope for affected patients. Now we have these treatment options, which have the possibility to improve or maintain visual acuity for patients suffering from AMD. The treatment needs to be optimized and this is in progress. Based on emerging evidence, adopting a variable VEGF inhibitor-dosing strategy guided by visual acuity assessment and optical coherence tomography are now being tried to reduce the frequency of injections. VEGF inhibitors in combination with photodynamic therapy are another way to optimize treatment. Physicians are waiting for new guidelines for the management of AMD and the results of current and upcoming trials systematically addressing these issues will be expected to provide it.Keywords: age-related macular degeneration, VEGF inhibitor, verteporfin, pegaptanib, ranibizumab, bevacizumab Dove Press Yukio Sassa, Yasuaki Hata 2010-04-01 PDF http://www.dovepress.com/getfile.php?fileID=6046 http://www.dovepress.com/antiangiogenic-drugs-in-the-management-of-ocular-diseases-focus-on-ant-peer-reviewed-article-OPTH English

oai:dovepress.com/4213 2010-04-07 OPTH

Outcome of monocular surgery for horizontal strabismus in Hyderabad Junejo, Sameen Clinical Ophthalmology Sameen A Junejo, Munawar A AnsariLiaquat University of Medical and Health Sciences/Jamshoro, Hyderabad-Sindh, PakistanBackground and objective: Squint surgery is frequently performed successfully in Hyderabad. However, no study in any detail has been performed on the outcome of monocular surgery for horizontal squint in the region. This study aims to determine the results of monocular surgery for horizontal trabismus.Design: Retrospective/observational study.Subjects and methods: The study was conducted on patients aged under 45 years, presenting with horizontal strabismus and undergoing monocular squint surgery. Anterior segment slit lamp examination, and if possible, posterior segment examination with 90 diopter (D) and 78 D fundoscopes was performed. Angle of deviation was measured. Patients were divided into two groups (esotropia and exotropia). Investigations were performed. Surgery was done under general anesthesia. A second surgical procedure was performed after six months for any residual deviations.Results: After squint surgery, patients in group 1 (79%) and in group 2 (73.3%) had residual deviation of less than 15 prism diopters (PD). The preoperative deviations of 60 PD or less illustrated excellent domino effects with residual deviation of fewer than 15 PD. Three patients with successive deviation underwent a second surgery with excellent outcomes.Conclusion: Few extraocular muscles can be prevented due to monocular squint surgery when multiple surgeries are needed.Keywords: horizontal strabismus, monocular surgery, Hyderabad Dove Press Sameen A Junejo, Munawar A Ansari 2010-04-07 PDF http://www.dovepress.com/getfile.php?fileID=6060 http://www.dovepress.com/outcome-of-monocular-surgery-for-horizontal-strabismus-in-hyderabad-peer-reviewed-article-OPTH English

oai:dovepress.com/4216 2010-04-08 OPTH

Training regimen involving cyclic induction of pupil constriction during far accommodation improves visual acuity in myopic children Horie, Hidenori Clinical Ophthalmology Kenji Yuda1, Hiroshi Uozato2, Naoto Hara3, Wolfram Tetzlaff4, Satoru Hisahara5, Hiroko Horie6, Satomi Nakajima6, Hidenori Horie6,71Kikuna Yuda Eye Clinic, Yokohama, Japan; 2Department of Ophthalmology and Visual Science, Kitasato&nbsp; University, Kanagawa, Japan; 3Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College, Yokohama, Japan; 4ICORD, International Collaboration on Repair Discoveries, Univ. of British Columbia, Vancouver, BC, Canada; 5Panasonic Shikoku Electronics Co., Ltd., Yokohama, Japan; 6TechnoMaster Co., Ltd., Yokohama, Japan; 7Research Center of Brain and Oral Science, Kanagawa Dental College, Yokosuka, JapanPurpose: Myopia in school-age children has become increasingly prevalent in industrialized countries, especially in Asia. A large population of school-age children still suffers from low visual acuity. We have developed a novel, safe and noninvasive training method to activate a pupillary constriction response during far accommodation that results in improved visual acuity.Methods: Myopic children (n = 95) were treated for 3-minute sessions up to twice a week for 12&ndash;106 weeks. We stimulated quick cycles of near/far accommodation by displaying a visual object on a LCD screen and moving the screen in cycles from a near (25 cm) to a far (70 cm) point and back, while keeping the retinal projection size and brightness of the object constant. Results: Mechanistically, we noted pupillary constriction upon far accommodation in trained myopic children, which was not seen in normal subjects or in untrained myopic children. Eighty five percent (52/61) of trained myopic right eyes with two sessions weekly experienced improved visual acuity (VA) by more than 0.1 logMAR units with an average improvement of 0.30 &plusmn; 0.03 standard error of mean (SEM) logMAR units. With maintained training, most eyes&rsquo; improved VA stayed almost constant, for more than 50 weeks in the case of 12 long trained subjects.Conclusions: This simple, short and safe accommodation training greatly improves the quality of vision in a large population suffering from refractive abnormalities.Keywords: accommodation, visual acuity, myopia, pupil constriction, training regimen Dove Press Kenji Yuda, Hiroshi Uozato, Naoto Hara, et al 2010-04-08 PDF http://www.dovepress.com/getfile.php?fileID=6065 http://www.dovepress.com/training-regimen-involving-cyclic-induction-of-pupil-constriction-duri-peer-reviewed-article-OPTH English

oai:dovepress.com/4218 2010-04-08 OPTH

Analyses of ERG in a patient with intraocular lymphoma Ueno, S Clinical Ophthalmology Chieko Yasuda, Shinji Ueno, Mineo Kondo, Nagako Kondo, Chang-Hua Piao, Hiroko TerasakiDepartment of Ophthalmology, Nagoya University School of Medicine, Nagoya, JapanPurpose: To follow the changes in the electroretinograms (ERGs) in a patient with primary intraocular lymphoma (PIOL) who had a complete remission after chemotherapy. Methods: ERGs were recorded in a 41-year-old woman with PIOL during and after complete remission with chemotherapy. The patient was diagnosed with PIOL from both the ocular signs and the medical history of cranial lymphoma.Results: The ERGs were depressed in the subject. The amplitudes of the bright white flash b-waves were smaller than the a-waves, resulting in a &ldquo;negative type&rdquo; ERG. Six weeks after the beginning of chemotherapy, the ocular changes had resolved, and the ERGs, although not of the &ldquo;negative type&rdquo;, still showed signs that the amplitude had not returned to normal levels.Conclusion: The negative type ERGs indicated that the inner retina had been damaged to a greater extent than the outer retina. In the convalescent stage, when the ocular manifestations were resolved, the ERGs were still not fully recovered. Although only one case was studied, we suggest that ERGs can be used to evaluate and follow patients with a PIOL.Keywords: electroretinogram, primary intraocular lymphoma, uveitis masquerade syndrome Dove Press Chieko Yasuda, Shinji Ueno, Mineo Kondo, et al 2010-04-08 PDF http://www.dovepress.com/getfile.php?fileID=6067 http://www.dovepress.com/analyses-of-erg-in-a-patient-with-intraocular-lymphoma-peer-reviewed-article-OPTH English

oai:dovepress.com/4219 2010-04-08 OPTH

Optimal management of cytomegalovirus retinitis in patients with AIDS Stewart, Michael Clinical Ophthalmology Michael W StewartDepartment of Ophthalmology, Mayo School of Medicine, Jacksonville, FL, USAAbstract: Cytomegalovirus (CMV) retinitis is the most common cause of vision loss in patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis afflicted 25% to 42% of AIDS patients in the pre-highly active antiretroviral therapy (HAART) era, with most vision loss due to macula-involving retinitis or retinal detachment. The introduction of HAART significantly decreased the incidence and severity of CMV retinitis. Optimal treatment of CMV retinitis requires a thorough evaluation of the patient&rsquo;s immune status and an accurate classification of the retinal lesions. When retinitis is diagnosed, HAART therapy should be started or improved, and anti-CMV therapy with oral valganciclovir, intravenous ganciclovir, foscarnet, or cidofovir should be administered. Selected patients, especially those with zone 1 retinitis, may receive intravitreal drug injections or surgical implantation of a sustained-release ganciclovir reservoir. Effective anti-CMV therapy coupled with HAART significantly decreases the incidence of vision loss and improves patient survival. Immune recovery uveitis and retinal detachments are important causes of moderate to severe loss of vision. Compared with the early years of the AIDS epidemic, the treatment emphasis in the post-HAART era has changed from short-term control of retinitis to long-term preservation of vision. Developing countries face shortages of health care professionals and inadequate supplies of anti-CMV and anti-HIV medications. Intravitreal ganciclovir injections may be the most cost effective strategy to treat CMV retinitis in these areas.Keywords: cytomegalovirus, AIDS, retinitis, immune recovery uveitis, retinal detachment, treatment Dove Press Michael W Stewart 2010-04-08 PDF http://www.dovepress.com/getfile.php?fileID=6068 http://www.dovepress.com/optimal-management-of-cytomegalovirus-retinitis-in-patients-with-aids-peer-reviewed-article-OPTH English

oai:dovepress.com/4220 2010-04-08 OPTH

Patient persistence with first-line antiglaucomatous monotherapy Belen, Marti Clinical Ophthalmology Alfonso Arias1, Konrad Schargel2, Fernando Ussa3, Maria I Canut4, Amelia y Bel&eacute;n Robles4, Bel&eacute;n Mart&iacute; S&aacute;nchez51Ophthalmology Department, Fundaci&oacute;n Hospital Alcorc&oacute;n, Madrid; 2Ophthalmology Department, Hospital de Torrevieja, Alicante; 3Instituto Universitario de Oftalmobiolog&iacute;a Aplicada, Valladolid; 4Centro de Oftalmolog&iacute;a Barraquer, Barcelona; 5Aut&oacute;noma University of Madrid, Madrid, SpainPurpose: To identify the extent of persistence (period of time of continuous therapy with the drug prescribed) of glaucoma patients treated with prostaglandins (latanoprost, bimatoprost, or travoprost), or &beta;-blocker (timolol) monotherapy.Methods: An observational retrospective study of a 24-month follow-up in 191 patients (from four centers) was done to identify the time elapsed until patients discontinued their antiglaucomatous treatment. The relevant information was extracted from patients&rsquo; medical charts. A descriptive analysis, a Kaplan&ndash;Meier survival analysis, and a Cox regression model were used to determine which drug was associated with greater patient persistence and to detect variables significantly influencing persistence.Results: Descriptive analysis and survival curves showed that after 24 months, latanoprost was associated with a higher persistence in glaucoma treatment than the alternative agents: 81.6% versus 22.9% for bimatoprost, 65.4% for travoprost, and 60.5% for timolol (P &lt; 0.0001). Persistence was significantly influenced by the antiglaucoma agent used as monotherapy (with a six-fold higher risk of treatment discontinuation during the follow-up period due to receiving bimatoprost instead of latanoprost; P &lt; 0.0001) and patient age (P = 0.001). Even though comorbidities could not be directly related to persistence, their occurrence was related to patient age. The main reasons for treatment discontinuation were lack of efficacy, development of intolerance and/or adverse events, which were significant in the bimatoprost group, 28.6% (P &lt; 0.001) and 48.6% (P &lt; 0.001), respectively.Conclusions: Latanoprost shows higher patient persistence compared with travoprost, bimatoprost, and timolol in routine clinical practice, and could lead to better control of intraocular pressure and lower associated economic costs.Keywords: first-line monotherapy, glaucoma, treatment, persistence, Spain Dove Press Alfonso Arias, Konrad Schargel, Fernando Ussa, et al 2010-04-08 PDF http://www.dovepress.com/getfile.php?fileID=6069 http://www.dovepress.com/patient-persistence-with-first-line-antiglaucomatous-monotherapy-peer-reviewed-article-OPTH English

oai:dovepress.com/4221 2010-04-08 OPTH

Is monthly retreatment with intravitreal bevacizumab (Avastin&reg;) necessary in neovascular age-related macular degeneration? Ghazi, Nicola Clinical Ophthalmology Nicola G Ghazi, Tyler Q Kirk, Robert M Knape, James S Tiedeman, Brian P ConwayDepartment of Ophthalmology, University of Virginia Health System, Charlottesville, VA, USAPurpose: To report our short-term experience with bevacizumab in neovascular age-related macular degeneration (AMD) and recommend a new treatment strategy.Methods: Retrospective chart review of 29 consecutive patients receiving 1.25 mg of intravitreal bevacizumab for AMD and completing 12 weeks of follow up. Outcome measures were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness. Injections were repeated if no further improvement was observed.Results: Twenty-nine eyes of 29 patients were included. The average BCVA improved from 20/148 at baseline to 20/106 at twelve weeks (P = 0.041). Of the 29 eyes, 25 (86.2%) had stable or improved BCVA. Average mean central macular thickness measured by OCT improved from 351 &mu;m at baseline to 278 &mu;m at 12 weeks (P = 0.003). Stabilization of vision and improved OCT central macular thickness were maintained for at least eight weeks following only a single injection in the majority of eyes. During the three months of follow up, only five eyes (17.2%) required repeat injections, with only three (10.3%) requiring retreatment at eight weeks and none at four weeks. No significant ocular or systemic side effects were observed. Conclusion: This short-term data suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD. Injections as frequent as every month do not appear to be necessary since initial treatment effect appears to be maintained for at least eight weeks in almost all of our patients.Keywords: retina, Avastin&reg;, bevacizumab, neovascular age-related macular degeneration, AMD Dove Press Nicola G Ghazi, Tyler Q Kirk, Robert M Knape, et al 2010-04-08 PDF http://www.dovepress.com/getfile.php?fileID=6070 http://www.dovepress.com/is-monthly-retreatment-with-intravitreal-bevacizumab-avastinreg-necess-peer-reviewed-article-OPTH English

oai:dovepress.com/4226 2010-04-12 OPTH

Concentrations of besifloxacin, gatifloxacin, and moxifloxacin in human conjunctiva after topical ocular administration Shapiro, Aron Clinical Ophthalmology Gail Torkildsen1, Joel W Proksch2, Aron Shapiro3, Stephanie K Lynch3, Timothy L Comstock21Andover Eye Associates, Andover, Massachusetts, USA; 2Bausch and Lomb, Inc., Rochester, New York, USA; 3Ora, Inc., Andover, Massachusetts, USAPurpose: To evaluate the pharmacokinetic properties of besifloxacin, gatifloxacin, and moxifloxacin in the conjunctival tissue of healthy volunteers after topical application.Methods: One-hundred eight (108) subjects were randomly assigned to receive one drop of besifloxacin (0.6% suspension), gatifloxacin (0.3% solution), or moxifloxacin (0.5% solution) ophthalmic formulations in one eye prior to conjunctival biopsy. Conjunctival samples were taken from subjects at either 15 minutes, 30 minutes, 2 hours, 6 hours, 12 hours, or 24 hours after dosing.Results: All three fluoroquinolones reached a peak mean concentration 15 minutes after dosing. The mean concentrations of besifloxacin, gatifloxacin, and moxifloxacin at 15 minutes were 2.30 &plusmn; 1.42 &mu;g/g, 4.03 &plusmn; 3.84 &mu;g/g, and 10.7 &plusmn; 5.89 &mu;g/g, respectively. Concentrations decreased with each subsequent time point. At 24 hours after dosing, concentrations of besifloxacin were measurable in 4 of 6 subjects, compared with 3 of 6 subjects for gatifloxacin and 2 of 6 subjects for moxifloxacin. Besifloxacin had the greatest mean residence time (4.7 hours) in the conjunctival tissue. With regard to methicillin-resistant strains of Staphylococcus aureus and Staphylococcus epidermidis, besifloxacin had the greatest area-under-the-curve (AUC) to MIC90 ratio. Nine percent (9%) of study subjects (N = 7) experienced a transient reduction in visual acuity.Conclusion: All three fluoroquinolones were well tolerated and reached levels in the conjunctiva above the MIC90s of methicillin-sensitive S. aureus and S. epidermidis for at least 2 hours.Keywords: besifloxacin, fluoroquinolone, conjunctivitis, pharmacokinetics, minimum inhibitory concentration Dove Press Gail Torkildsen, Joel W Proksch, Aron Shapiro, et al 2010-04-12 PDF http://www.dovepress.com/getfile.php?fileID=6079 http://www.dovepress.com/concentrations-of-besifloxacin-gatifloxacin-and-moxifloxacin-in-human--peer-reviewed-article-OPTH English

oai:dovepress.com/4227 2010-04-12 OPTH

The comparison of clinical outcomes of endophthalmitis from fluoroquinolone-resistant and susceptible bacteria Shirodkar, A R Clinical Ophthalmology Anita R Shirodkar, Harry W Flynn Jr, Kyle Alliman, Geeta A Lalwani, Chrisfouad Alabiad, Andrew A Moshfeghi, Darlene MillerDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USAPurpose: To identify patients who developed acute-onset endophthalmitis after clear corneal cataract surgery, and to compare treatment outcomes between cases caused by fluoroquinolone susceptible organisms versus fluoroquinolone resistant organisms.Design: Retrospective case series.Methods: Patients who developed endophthalmitis within six weeks of cataract surgery, and were treated between January 1996 and December 2008 at Bascom Palmer Eye Institute in Miami, Florida, were identified retrospectively. Clinical features, organisms cultured, and visual acuity outcomes were evaluated.Results: A total of 97 patients met study criteria, and 37 (38%) demonstrated in vitro fluoroquinolone resistance. All fluoroquinolone resistant endophthalmitis in the study was caused by either Staphylococcus epidermidis (n = 32) or Staphylococcus aureus (n = 5). Presenting clinical features were similar between fluoroquinolone resistant and fluoroquinolone susceptible groups. Final visual acuity was &ge;20/40 in 49% of fluoroquinolone-resistant cases and 42% of fluoroquinolonesusceptible cases. All fluoroquinolone-resistant isolates were susceptible to vancomycin.Conclusion: In the current study, approximately one-third of isolates were resistant to fluoroquinolones. There was no significant difference in clinical outcomes in this study, regardless of fluoroquinolone susceptibility.Keywords: endophthalmitis, fluoroquinolones Dove Press Anita R Shirodkar, Harry W Flynn Jr, Kyle Alliman, et al 2010-04-12 PDF http://www.dovepress.com/getfile.php?fileID=6080 http://www.dovepress.com/the-comparison-of-clinical-outcomes-of-endophthalmitis-from-fluoroquin-peer-reviewed-article-OPTH English

oai:dovepress.com/4240 2010-04-13 OPTH

Sequential spectral domain OCT documentation of retinal changes after branch retinal artery occlusion Chalam, Kakarla Clinical Ophthalmology RK Murthy, S Grover, KV ChalamDepartment of Ophthalmology, University of Florida-Jacksonville, Jacksonville, FL 32209, USAAbstract: Branch retinal artery occlusions (BRAO) are characterized histopathologically by inner retinal edema initially and atrophy in the presence of persistent ischemia. The duration of ischemia leading to irreversible atrophic retinal changes is not clear. Spectral-domain optical coherence tomography (SD-OCT) provides non-invasive detailed in-vivo histological changes in the retina. In this case report, we show sequential in vivo pathological changes seen in the inner retinal layers, in spite of clinical improvement, following the migration of an intraretinal embolus on the optic nerve head, which had previously resulted in symptomatic BRAO.Keywords: BRAO, optic nerve head plaque, SD-OCT Dove Press RK Murthy, S Grover, KV Chalam 2010-04-13 PDF http://www.dovepress.com/getfile.php?fileID=6094 http://www.dovepress.com/sequential-spectral-domain-oct-documentation-of-retinal-changes-after--peer-reviewed-article-OPTH English

oai:dovepress.com/4261 2010-04-16 OPTH

Triamcinolone acetonide for rare ocular manifestations of pemphigus vulgaris: a case report Tyradellis, Straton Clinical Ophthalmology N Kozeis1, S Tyradellis1, E Dragiotis1, H Eleftheriadis21Department of Ophthalmology, Hippokration Hospital of Thessaloniki, Greece; 2Southend Hospital NHS Trusts, Westcliff-on-Sea, Essex, UKAbstract: We present an interesting case of pemphigus vulgaris with severe and rare eye manifestations. An old lady with systemic and ocular manifestations of pemphigus vulgaris was treated with systemic corticosteroids and immunosuppressants, with no effect. Subconjunctival injection of triamcinolone acetate reduced the ocular signs and led to gradual reduction of the systemic medications.Keywords: pemphigus vulgaris, ocular manifestations, triamcinolone acetate Dove Press N Kozeis, S Tyradellis, E Dragiotis, et al 2010-04-16 PDF http://www.dovepress.com/getfile.php?fileID=6115 http://www.dovepress.com/triamcinolone-acetonide-for-rare-ocular-manifestations-of-pemphigus-vu-peer-reviewed-article-OPTH English

oai:dovepress.com/4262 2010-04-16 OPTH

Treatment of retinal pigment epithelial detachment with antiangiogenic therapy Arias, Luis Clinical Ophthalmology Luis AriasDepartment of Ophthalmology, Bellvitge University Hospital, Barcelona, SpainPurpose: Evaluate the efficacy of pegaptanib, a selective anti-vascular endothelial growth factor (VEGF) agent, and bevacizumab, a nonselective anti-VEGF agent, for retinal pigment epithelial detachment (PED) associated with occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).Methods: Prospective, comparative, nonrandomized pilot study included patients with PED comprising &gt;50% of total lesion in subfoveal location with visual acuity (VA) 20/40&ndash;20/400 and lesions either previously untreated or treated only with photodynamic therapy/verteporfin. Seven patients received pegaptanib 0.3 mg intravitreally (IVT); eight received IVT bevacizumab 1.25 mg. Follow-up occurred every 4&ndash;6 weeks for 6 months. Reinjection of initial medication occurred if there was intra- or subretinal fluid observed by optical coherence tomography (OCT) or increased PED. Endpoints were mean changes from baseline to month 6 in VA (ETDRS) and foveal thickness.Results: At baseline, mean VA was lower, and mean foveal thickness was greater in pegaptanib versus bevacizumab-treated patients (36.1 vs 49.5 letters; 470.4 vs 321.1 &mu;m). Mean improvements to month 6 in VA and foveal thickness were greater for pegaptanib (VA: +9.1 vs +7.2 letters; foveal thickness: &minus;88.2 vs &minus;52.9 &mu;m). On average, pegaptanib-treated patients had slower but more sustained improvement in VA and foveal thickness; bevacizumab-treated patients showed rapid improvement with a slow return towards baseline. Both agents were well tolerated. Conclusion: Intravitreal injections of pegaptanib or bevacizumab are both efficacious and safe treatments for PED associated with occult CNV secondary to AMD.Keywords: bevacizumab, pegaptanib, retinal pigment epithelial detachment Dove Press Luis Arias 2010-04-16 PDF http://www.dovepress.com/getfile.php?fileID=6116 http://www.dovepress.com/treatment-of-retinal-pigment-epithelial-detachment-with-antiangiogenic-peer-reviewed-article-OPTH English

oai:dovepress.com/4276 2010-04-20 OPTH

Graft-free Ahmed tube insertion: a modified method at 5 mm from limbus Mesa-Gutierrez, Juan Clinical Ophthalmology Juan Carlos Mesa-Guti&eacute;rrez, Juan Lillo-Sopena, Anna Mon&eacute;s-Llivina, Silvia Sanz-Moreno, Jorge Arruga-GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L&rsquo;Hospitalet de Llobregat, Barcelona, SpainObjective: To determine the medium-term outcome of Ahmed implants inserted through a needle tract at 5 mm from limbus that eliminates the need for a donor scleral graft.Methods: A retrospective case series of 19 patients undergoing Ahmed implant surgery for refractory glaucoma with a mean follow-up of 12 months. Primary outcome measures included control of intraocular pressure after surgery. Secondary outcome measure included the frequency of intraoperative and postoperative complications.Results: Intraocular pressure was maintained between 6 and 21 mmHg throughout the study. There was no postoperative hypotony. There were no complications related to this modified technique.Conclusion: Needle tract at 5 mm from limbus maintains implant&rsquo;s ability to control intraocular pressure and eliminates the need for a donor scleral graft or heterologous material.Keywords: surgical technique, Ahmed implant, refractory glaucoma, donor scleral graft, tube shunt device Dove Press Juan Carlos Mesa-Guti&eacute;rrez, Juan Lillo-Sopena, Anna Mon&eacute;s-Llivina, et al 2010-04-20 PDF http://www.dovepress.com/getfile.php?fileID=6132 http://www.dovepress.com/graft-free-ahmed-tube-insertion-a-modified-method-at-5-mm-from-limbus-peer-reviewed-article-OPTH English

oai:dovepress.com/4277 2010-04-20 OPTH

Incidence, severity and factors related to drug-induced keratoepitheliopathy with glaucoma medications Fukuchi, Takeo Clinical Ophthalmology Takeo Fukuchi, Kimiko Wakai, Kieko Suda, Tomoko Nakatsue, Hideko Sawada, Hiroaki Hara, Jun Ueda, Takayuki Tanaka, Akiko Yamada, Haruki AbeDivision of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, JapanPurpose: To evaluate the incidence, severity, and factors related to drug-induced keratoepitheliopathy in eyes using antiglaucoma eye drops.Patients and methods: In a cross-sectional study, 749 eyes from 427 patients who had used one or more antiglaucoma eye drops were examined at Niigata University Medical and Dental Hospital or related facilities. The incidence and severity of superficial punctate keratitis (SPK), patient gender and age, type of glaucoma, and type of eye drops were recorded. SPK was graded according to the AD (A, area; D, density) classification. The severity score (SS) was calculated from A &times; D.Results: SPK was observed in 382 (51.0%) of 749 eyes that had received any type of antiglaucoma eye drops. While 254 eyes (33.9%) were classified as A1D1 (SS 1), 34 eyes (4.6%) had severe SPK with SS 4 or more. The number of eye drops and the total dosing frequency per day were significantly greater in SPK-positive eyes than in eyes without SPK. The number of eye drops was proportional to the frequency and severity of SPK. Among eyes that were treated with three or more eye drops, SPK was more severe and more frequent in older patients (&ge;71 years). In addition, a considerable difference was detected for each type of glaucoma.Conclusion: Drug-induced keratoepitheliopathy is often observed in eyes that have received recent antiglaucoma eye drops. The number of eye drops, the total dose frequency per day, patient age, and type of glaucoma may affect this condition. We have to consider not only the effects on intraocular pressure but also the incidence and severity of drug-induced keratoepitheliopathy as a frequent side effect of glaucoma medications.Keywords: glaucoma, medications, eye drops, keratoepitheliopathy, AD classification Dove Press Takeo Fukuchi, Kimiko Wakai, Kieko Suda, et al 2010-04-20 PDF http://www.dovepress.com/getfile.php?fileID=6133 http://www.dovepress.com/incidence-severity-and-factors-related-to-drug-induced-keratoepithelio-peer-reviewed-article-OPTH English

oai:dovepress.com/4287 2010-04-20 OPTH

Juvenile idiopathic arthritis-associated uveitis: Data from a region in western Greece Spiridon, Gorezis Clinical Ophthalmology Ioannis Asproudis1, Felekis Taxiarchis1, Elena Tsanou2, Spiridon Gorezis2, Eikaterini Karali3, Sapfo Alfantaki3, Antigoni Siamopoulou-Mauridou3, Miltiadis Aspiotis11University Eye Clinic of Ioannina, Greece; 2Epirus Vision Center, Ioannina, Greece; 3Department of Child Health, University of Ioannina, GreeceObjective: To evaluate the characteristics and visual prognosis of juvenile idiopathic arthritis-associated uveitis (JIA).Methods: A retrospective review was performed on 56 patients who met the criteria for JIA to identify those with uveitis and related complications. Patients were referred to and were examined in the Pediatric Department of the University Hospital of Ioannina, between 1995 and 2007.Results: The prevalence of JIA-associated uveitis was high. Despite this and the related complications, the final visual outcome was satisfactory in the majority of the cases. Authors did not observe any correlation between prognosis and sex, age at the onset of uveitis or arthritis, pattern of arthritis, or positivity for antinuclear antibodies (ANA).Conclusion: We found a remarkably high prevalence of uveitis and related ocular complications in 7 (28%) of the patients, and the rate of poor visual outcome was 12%.Keywords: idiopathic arthritis, uveitis, visual complications, autoimmune disease Dove Press Ioannis Asproudis, Felekis Taxiarchis, Elena Tsanou, et al 2010-04-20 PDF http://www.dovepress.com/getfile.php?fileID=6271 http://www.dovepress.com/juvenile-idiopathic-arthritis-associated-uveitis-data-from-a-region-in-peer-reviewed-article-OPTH English

oai:dovepress.com/4288 2010-04-20 OPTH

The effect of pterygium surgery on contrast sensitivity and corneal topographic changes Oh, Joo Youn Clinical Ophthalmology Joo Youn Oh, Won Ryang WeeDepartment of Ophthalmology, Seoul National University Hospital, Seoul, KoreaPurpose: To investigate the effect of pterygium surgery on corneal topography and contrast sensitivity.Patient and methods: The IRB approved this prospective, nonrandomized, self-controlled study. Computerized videokeratography (Orbscan II) was performed in 36 patients with primary pterygia, both before and 1 month after pterygium excision with limbal-conjunctival autografting. The topographic parameters were compared. Spatial contrast sensitivity testing was performed using VCTS 6500. Differences between preoperative and postoperative values were evaluated statistically.Results: The mean Sim K astigmatism and irregularity index, significantly decreased after pterygium surgery. The mean refractive power significantly increased after the operation. The &ldquo;with-the-rule&rdquo; astigmatism induced by pterygium became &ldquo;against-the-rule&rdquo; astigmatism after pterygium removal (P = 0.041). The contrast sensitivity of 6, 12, and 18 cycles per degree, significantly increased from 1.55 &plusmn; 0.28, 0.97 &plusmn; 0.47, and 0.29 &plusmn; 0.16 to 1.72 &plusmn; 0.18, 1.21 &plusmn; 0.44, and 0.65 &plusmn; 0.48, respectively (P = 0.007, &lt;0.001, &lt;0.001, respectively).Conclusions: Pterygium surgery significantly reduces corneal topographic astigmatism and improves contrast sensitivity.Keywords: corneal topography, visual acuity Dove Press Joo Youn Oh, Won Ryang Wee 2010-04-20 PDF http://www.dovepress.com/getfile.php?fileID=6144 http://www.dovepress.com/the-effect-of-pterygium-surgery-on-contrast-sensitivity-and-corneal-to-peer-reviewed-article-OPTH English

oai:dovepress.com/4289 2010-04-20 OPTH

Intracameral vancomycin following cataract surgery: An eleven-year study Anijeet, D Clinical Ophthalmology Deepa R Anijeet, Prasad Palimar, Clive O PeckarDepartment of Ophthalmology, Warrington and Halton NHS Trust, UKAim: To compare the incidences of endophthalmitis after cataract operations before and after introduction of intracameral vancomycin at the end of surgery.Methods: A retrospective analysis was performed of presumed infectious endophthalmitis after cataract surgery from January 1, 1998 to December 31, 2008. From January 2001, the practice of using intracameral vancomycin at the end of cataract surgery was introduced. The period before introduction of intracameral vancomycin is considered as period A and that after as period B. The incidences of presumed or culture-proven endophthalmitis during periods A and B were compared.Results: A total of 16,606 cataract surgeries were performed during the study period. The incidence of endophthalmitis per 1000 cataract surgeries was 3.0 during period A and 0.08 during period B. This reduction was statistically significantly (Chi-squared test 36.6, P value &lt; 0.0001). The relative risk of developing endophthalmitis without intracameral vancomycin prophylaxis was 38. The absolute risk reduction was 292 cases of endophthalmitis per 100,000 cataract surgeries.Conclusions: Intracameral vancomycin significantly reduced the incidence of postoperative endophthalmitis after cataract surgery. There is a universal need to adopt this mode of microbial prophylaxis to reduce the burden of endophthalmitis after cataract surgery.Keywords: endophthalmitis, intracameral vancomycin, cataract surgery Dove Press Deepa R Anijeet, Prasad Palimar, Clive O Peckar 2010-04-20 PDF http://www.dovepress.com/getfile.php?fileID=6145 http://www.dovepress.com/intracameral-vancomycin-following-cataract-surgery-an-eleven-year-stud-peer-reviewed-article-OPTH English

oai:dovepress.com/4299 2010-04-21 OPTH

Bimatoprost in the treatment of eyelash hypotrichosis Law, Simon Clinical Ophthalmology Simon K LawJules Stein Eye Institute, University of California, Los Angeles, California, USAAbstract: Eyelashes hypotrichosis is a condition indicated by an inadequate amount of eyelashes. Hypertrichosis of eyelashes, characterized by excessive eyelash growth, is a regular phenomenon associated with ophthalmic prostaglandin and prostamide analogs. Recently, the US Food and Drug Administration approved Latisse&reg; (bimatoprost 0.03% solution), identical to the ophthalmic solution for glaucoma treatment, for increasing eyelash length, thickness and darkness in patients with hypotrichosis of the eyelashes. When prostaglandin and prostamide analogs interact with the prostanoid receptors in the hair follicle, this most likely stimulates the resting follicles (telogen phase) to growing follicles (anagen phase). Prostaglandin and prostamide analogs may also prolong the anagen phase of eyelashes, leading to an increase of eyelash length. Although bimatoprost is effective in promoting increased growth of healthy eyelashes and adnexal hairs, its effectiveness in patients with eyelash alopecia areata is debatable and its protective effect is not yet studied in patients with eyelash loss secondary to radiation or chemotherapy. Bimatoprost is generally safe when applied to the base of the eyelashes at the lid margin with minimum side effects. However, other ocular or systemic side effects associated with ophthalmic prostaglandin and prostamide analogs may occur when instilled on the surface of the eye, and patients must be informed and monitored.Keywords: bimatoprost, Latisse, prostaglandin, prostamide, eyelash, hypotrichosis Dove Press Simon K Law 2010-04-21 PDF http://www.dovepress.com/getfile.php?fileID=6156 http://www.dovepress.com/bimatoprost-in-the-treatment-of-eyelash-hypotrichosis-peer-reviewed-article-OPTH English

oai:dovepress.com/4317 2010-04-26 OPTH

Corneal abrasion Fraser, Scott Clinical Ophthalmology Scott FraserSunderland Eye Infirmary, Sunderland, UKDate of preparation: 25th June 2009Conflict of interest: None declaredClinical question: What is the best treatment for traumatic corneal abrasion?Results: Eye patching does not reduce pain in patients with corneal abrasions. Topical diclofenac does reduce pain in patients with corneal abrasionsImplementation: Pitfalls to avoid when treating abrasions:&bull; Treatment of small abrasions&bull; Treatment of larger abrasions&bull; When to refer for specialist treatment Dove Press Scott Fraser 2010-04-26 PDF http://www.dovepress.com/getfile.php?fileID=6226 http://www.dovepress.com/corneal-abrasion-peer-reviewed-article-OPTH English

oai:dovepress.com/4319 2010-04-26 OPTH

Alternative approach to treating malignant glaucoma after trabeculectomy with unplanned zonulectomy Kimura, I Clinical Ophthalmology Naoki Ozeki1, Kenya Yuki1, Itaru Kimura1,21Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan, 2Department of Ophthalmology, Juntendo University Urayasu Hospital, Chiba, JapanPurpose: To report the role of Healon5TM injection combined with medications in patient with malignant glaucoma after trabeculectomy with unplanned zonulectomy.Methods: Two days after trabeculectomy with unplanned zonulectomy for neovascular glaucoma in an eye with diabetic retinopathy, a patient developed malignant glaucoma due to the ciliovitreal block caused by the vitreous herniation through the peripheral iridectomy to the limbal incision with flat bleb and anterior chamber, and the intraocular pressure was elevated to 33 mmHg. The medications for the management of malignant glaucoma failed to relieve the malignant mechanism, and Healon5TM, a viscoadaptive, viscoelastic, and ophthalmic viscosurgical device, was injected through a paracentesis until the anterior chamber became deep enough to block the vitreous herniation to the limbal incision. Results: After Healon5TM injection, the intraocular pressure was reduced enough that the bleb was re-formed, and the anterior chamber remained deep, even without medication.Conclusions: In patients presenting with malignant glaucoma after trabeculectomy with unplanned zonulectomy, Healon5TM injection, combined with medications, may be a safe and effective approach before performing vitrectomy.Keywords: malignant glaucoma, unplanned zonulectomy, ophthalmic viscosurgical device, corneal endothelial cell Dove Press Naoki Ozeki, Kenya Yuki, Itaru Kimura 2010-04-26 PDF http://www.dovepress.com/getfile.php?fileID=6183 http://www.dovepress.com/alternative-approach-to-treating-malignant-glaucoma-after-trabeculecto-peer-reviewed-article-OPTH English

oai:dovepress.com/4333 2010-04-29 OPTH

Patients&rsquo; knowledge and perspectives on wet age-related macular degeneration and its treatment Kandula, Sushma Clinical Ophthalmology Sushma Kandula1, Jeffrey C Lamkin1, Teresa Albanese2, Deepak P Edward11Department of Ophthalmology, 2Health Service Research and Education Institute, SUMMA Health System, Akron OH, USASummary: There have been no studies examining the level of understanding age-related macular degeneration (ARMD) patients have about their disease, or their perceptions about intraocular injections as treatment. In this study, patient knowledge about ARMD risk factors was low but patients appeared more optimistic than fearful when confronted with intraocular antivascular endothelial growth factor (anti-VEGF) injections as treatment.Purpose: In recent years there has been an increase in our understanding of wet ARMD, and a dramatic shift in the treatment paradigm. However, to our knowledge, no studies have examined how much ARMD patients understand their disease, or how they feel about receiving intraocular injections as treatment. The primary objectives of this study are to identify areas in which ARMD patients may be uninformed about their disease, and to recognize specific fears or expectations that patients may have regarding treatment with intraocular anti-VEGF injections.Design: Prospective, survey-based study.Methods: This is a prospective survey-based study. An anonymous 32-item questionnaire was compiled and distributed to patients with wet ARMD who underwent at least one intraocular anti-VEGF injection. Eighty-three patients from a retina practice in a suburban setting completed the questionnaire that gauged both their knowledge of ARMD and their perspectives on its treatment. Data was analyzed using chi-square testing.Results: Seventy-eight percent of patients received most of their knowledge of ARMD from their physician. Eighty-nine percent of patients prefer to receive more information on ARMD, if needed, directly from their physician. Only 21%, 48%, 37%, 48%, and 36%, respectively, correctly identified how diet, special vitamins, high blood pressure, family history, and smoking can affect ARMD. Sixty percent felt somewhat afraid or very afraid about getting their first intraocular injection but this did not correlate with pain or discomfort during treatment (P = 0.075, P = 0.117). Eighty-nine percent were very satisfied and 11% were somewhat satisfied with the explanation their physician gave them about the injections. Eighty percent reported feeling hopeful (significantly more than any other emotion) when they were first told they needed an intraocular injection for treatment of their disease.Conclusions: Knowledge of risk factors and risk factor modification among patients with ARMD is low. Since the vast majority of ARMD patients prefer to receive information directly from their physician, patient education is crucial in improving risk factor modification and alleviating fears of treatment. With the advent of anti-VEGF agents, patients appear more hopeful of regaining vision than they are fearful of treatment with intraocular injections.Keywords: age-related macular degeneration, patient education, fear of needles, anti-VEGF, macular degeneration risk factors, macular degeneration treatment, ranibizumab Dove Press Sushma Kandula, Jeffrey C Lamkin, Teresa Albanese, et al 2010-04-29 PDF http://www.dovepress.com/getfile.php?fileID=6200 http://www.dovepress.com/patientsrsquo-knowledge-and-perspectives-on-wet-age-related-macular-de-peer-reviewed-article-OPTH English

oai:dovepress.com/4343 2010-04-30 OPTH

Pathogenesis of thyroid-associated ophthalmopathy: does autoimmunity against calsequestrin and collagen XIII play a role? Wall, J R Clinical Ophthalmology Hooshang Lahooti, Kishan R Parmar, Jack R WallThe Department of Medicine, University of Sydney, Nepean Clinical School, Penrith, NSW, AustraliaAbstract: Thyroid-associated ophthalmopathy (TAO), or thyroid eye disease, is a complex inflammatory disorder of the eye that, as its name implies, is associated with thyroid disease. TAO can be divided into three subtypes: ocular myopathy, congestive myopathy and mixed congestive and myopathic ophthalmopathy. Although the precise pathophysiology of TAO remains unclear it is likely to reflect an autoimmune reaction involving sensitized T-cells and autoantibodies directed against a thyroid and orbital tissue shared antigen. One well studied candidate in this immune reaction is the thyroid-stimulating hormone receptor (TSH-r), expressed in the orbital fibroblast and pre adipocyte. In our studies of TAO, we have investigated the nature and significance of antibodies targeting other eye muscle and orbital connective tissue (OCT) antigens. Our findings suggest that autoimmunity against the eye muscle antigen calsequestrin and the OCT antigen collagen XIII plays a role in the pathogenesis of TAO. We propose that ocular myopathy and chronic eyelid retraction are due to autoimmunity against skeletal muscle calsequestrin in the extraocular and eyelid muscles, respectively. This may be initiated in the thyroid where calsequestrin expression is upregulated, possibly due to a stimulatory effect of TSH-r antibodies. We also propose that congestive ophthalmopathy results from a reaction against the TSH-r or collagen XIII in orbital fibroblast cell membranes. Further insight into the role of eye muscle and OCT antigens in the pathogenesis of TAO may allow for the development of new therapies to treat the eye disorder and reduce patient morbidity.Keywords: thyroid-associated ophthalmopathy, autoimmunity, t calsequestrin, collagen XIII Dove Press Hooshang Lahooti, Kishan R Parmar, Jack R Wall 2010-04-30 PDF http://www.dovepress.com/getfile.php?fileID=6211 http://www.dovepress.com/pathogenesis-of-thyroid-associated-ophthalmopathy-does-autoimmunity-ag-peer-reviewed-article-OPTH English

oai:dovepress.com/4350 2010-05-03 OPTH

Clinical utility of voriconazole eye drops in ophthalmic fungal keratitis Kong, David Clinical Ophthalmology Daoud Al-Badriyeh, Chin Fen Neoh, Kay Stewart, David CM KongCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, AustraliaAbstract: Fungal keratitis is one of the major causes of ophthalmic mycosis and is difficult to treat. The range of common antifungal agents available for fungal keratitis remains inadequate and is generally associated with poor clinical outcomes. Voriconazole is a new generation triazole antifungal agent. Only marketed in systemic formulation and, with broad-spectrum activity and high intraocular penetration, voriconazole has demonstrated effectiveness against fungal keratitis. Systemic voriconazole, however, is not without side effects and is costly. Voriconazole eye drops have been prepared extemporaneously and used for the treatment of ophthalmic fungal keratitis. The current article sought to review the literature for evidence related to the effectiveness and safety of topical voriconazole and its corneal penetration into the aqueous humor of the eye. The voriconazole eye drops used are typically of 1% concentration, well tolerated by the eye, and are stable. Despite existing evidence to suggest that the eye drops are effective in the treatment of fungal keratitis, more studies are needed, especially in relation to using the eye drops as first-line and stand-alone treatment, preparation of higher concentrations, and optimal dosing frequency.Keywords: voriconazole, fungal keratitis, eye drops, corneal penetration Dove Press Daoud Al-Badriyeh, Chin Fen Neoh, Kay Stewart, et al 2010-05-03 PDF http://www.dovepress.com/getfile.php?fileID=6218 http://www.dovepress.com/clinical-utility-of-voriconazole-eye-drops-in-ophthalmic-fungal-kerati-peer-reviewed-article-OPTH English

oai:dovepress.com/4351 2010-05-03 OPTH

Baerveldt implant for secondary glaucoma due to iris melanoma Tan, Clinical Ophthalmology Annelie N Tan1, Juliette GMM Hoevenaars1, Carroll AB Webers1, Bertil Damato2, Henny JM Beckers11University Eye Clinic, Maastricht, The Netherlands; 2Ocular Oncology Service Royal Liverpool University Hospital, Liverpool, United KingdomBackground: Proton beam therapy (PBT) is effective in the treatment of iris melanoma. Reported complications after PBT are radiation-induced cataract and raised intraocular pressure (IOP). Filtering glaucoma surgery has generally been avoided because of fears of seeding.Case report: A 37-year-old man presented with a self-discovered, pigmented lesion on his right iris. Four years later, the pigmented lesion was diagnosed as an iris melanoma, because of documented growth. The patient was treated with PBT but developed secondary glaucoma one month later. The IOP could not be controlled despite maximal medical therapy and selective laser trabeculoplasty (SLT). Finally, Baerveldt implant surgery was performed, resulting in an IOP lowering to 10 mmHg and stabilization of the glaucomatous visual field loss.Conclusion: Our case demonstrates that Baerveldt implant surgery is a reasonable therapy for glaucoma following successful radiotherapy of iris melanoma.Keywords: iris melanoma, proton beam therapy, secondary glaucoma, Baerveldt implant surgery Dove Press Annelie N Tan, Juliette GMM Hoevenaars, Carroll AB Webers, et al 2010-05-03 PDF http://www.dovepress.com/getfile.php?fileID=6219 http://www.dovepress.com/baerveldt-implant-for-secondary-glaucoma-due-to-iris-melanoma-peer-reviewed-article-OPTH English

oai:dovepress.com/4372 2010-05-05 OPTH

Efficacy and safety of the pars plana clip in the Ahmed valve device inserted via the pars plana in patients with refractory glaucoma Diaz-Llopis, M Clinical Ophthalmology Manuel Diaz-Llopis1,2,3, David Salom1,3, Salvador Garc&iacute;a-Delpech1,2,3, Patricia Udaondo1,3, Jose Maria Millan3,5, J Fernando Arevalo61Department of Ophthalmology, La Fe University Hospital of Valencia, Valencia, Spain; 2Department of Ophthalmology of the Valencia University, Valencia, Spain; 3Biomedical Network Research Centre on Rare Diseases (CIBERER), Valencia, Spain; 4Catholic University San Vicente Martir, Valencia, Spain; 5Department of Genetics, La Fe University Hospital of Valencia, Valencia, Spain; 6Clinica Oftalmologica Centro Caracas, Retina and VItreous Service, Caracas, DC, VenezuelaPurpose: To evaluate the efficacy and safety of the pars plana clip (PPC) in the Ahmed valve tube inserted via the pars plana in patients with secondary refractory glaucomas.Methods: Prospective and interventional case series that included 10 patients with secondary refractory glaucoma. The pars plana vitrectomy and the implant of the modified tube were performed during the same surgery. Control of intraocular pressure (IOP) and the development of intra- and postoperative complications were evaluated during the follow-up.Results: Follow-up time was twelve months in all the patients. Control of IOP was achieved in 90% of patients, and 70% needed no antiglaucoma treatment. The complications that occurred were transient hypotony in three cases, choroidal detachment in two cases, and one case of intraocular hemorrhage. No case of tube extrusion or tube kink was observed.Conclusions: Our data suggests that implantation of the Ahmed tube modified with the PPC via the pars plana is safe and effective in patients with secondary refractory glaucomas. Keywords: pars plana clip, Ahmed valve, refractory glaucoma, pars plana vitrectomy Dove Press Manuel Diaz-Llopis, David Salom, Salvador Garc&iacute;a-Delpech, et al 2010-05-05 PDF http://www.dovepress.com/getfile.php?fileID=6246 http://www.dovepress.com/efficacy-and-safety-of-the-pars-plana-clip-in-the-ahmed-valve-device-i-peer-reviewed-article-OPTH English

oai:dovepress.com/4379 2010-05-06 OPTH

Safety and efficacy of changing to the travoprost/timolol maleate fixed combination (DuoTrav) from prior mono- or adjunctive therapy Stewart, William Clinical Ophthalmology Norbert Pfeiffer1, Maria-Luise Scherzer2, Hubert Maier3, Sonja Schoelzel4, Mark C Jasek5, Jeanette A Stewart6, William C Stewart6 On behalf of the DuoTravMED study group1Johannes Gutenberg-Universit&auml;t Mainz, Mainz, Germany; 2Regenstauf, Germany; 3Gerolzhofen, Germany; 4Institutes of Molecular Medicine, University of Freiburg, Department of Surgery, Freiburg, Germany; 5Alcon Laboratories, Inc., Fort Worth, TX, USA; 6PRN Pharmaceutical Research Network, LLC, Charleston, SC, USAPurpose: To assess the safety and efficacy of changing to the travoprost/timolol fixed combination (TTFC) from other mono- or adjunctive therapies.Patients and methods: A prospective, open-label, observational cohort of primary open-angle glaucoma and ocular hypertensive patients whose intraocular pressure (IOP) was uncontrolled on prior therapy or was not on target. Patients were changed from prior mono- or adjunctive treatment at Day 0 to TTFC dosed every evening and underwent active treatment efficacy and safety evaluations at Week 12.Results: In 474/522 (91%) patients who completed this trial an IOP (mm Hg) of 21.9 &plusmn; 2.0 on prior treatment was reduced by TTFC at Month 3: from all prior treatments 5.6 &plusmn; 2.6; from monotherapy 5.9 &plusmn; 2.3; from adjunctive treatments 4.5 &plusmn; 2.9; and from several of the most frequent individual treatments: timolol 5.7 &plusmn; 2.2; latanoprost 6.3 &plusmn; 2.6; and latanoprost/timolol fixed combination 4.4 &plusmn; 1.9. Ocular hyperemia was the most frequent adverse effect (n = 21, 4%). Both patients and physicians preferred TTFC compared to all prior and common individual treatments. The solicited symptom survey showed, following a modified Bonferroni correction (&alpha;/5), a reduced incidence with TTFC of ocular pain (P = 0.01) while the prior medicine had a lower incidence of burning on instillation (P &lt; 0.001).Conclusions: Changing patients from prior mono- or adjunctive therapy to TTFC can provide on average a further reduction in IOP while demonstrating a favorable safety profile and a high patient preference.Keywords: travoprost/timolol fixed combination, primary open-angle glaucoma, ocular hypertension, safety, efficacy, intraocular pressure Dove Press Norbert Pfeiffer, Maria-Luise Scherzer, Hubert Maier, et al 2010-05-06 PDF http://www.dovepress.com/getfile.php?fileID=6253 http://www.dovepress.com/safety-and-efficacy-of-changing-to-the-travoprosttimolol-maleate-fixed-peer-reviewed-article-OPTH English

oai:dovepress.com/4380 2010-05-06 OPTH

First-year treatment costs among new initiators of topical prostaglandin analogs: pooled results Schmier, J K Clinical Ophthalmology Jordana K Schmier1, David W Covert21Managing Scientist, Exponent Inc., Alexandria, VA, USA; 2Associate Director, Health Economics, Alcon Research Ltd., Ft. Worth, TX, USAObjective: To estimate first-year treatment costs among new initiators of topical prostaglandin analogs in a managed care population.Research design and methods: A model was developed to estimate first-year medical costs. Model inputs were based on weighted results from three previous studies. Treatment patterns were derived from a claims database analysis. Published studies were used to estimate visit-related resource use. Costs were obtained from standard sources.Results: Across studies, 27,809 patients met study criteria, 44.2% of whom remained on their index therapy for 12 months. Adjunctive therapy was needed in 22.5%, 18.5%, and 11.9% of bimatoprost, latanoprost, and benzalkonium chloride (BAK)-free travoprost patients, respectively. Median days to initiating adjunctive therapy were 64, 67, and 127 for bimatoprost, latanoprost, and BAK-free travoprost patients. Estimated first-year medical costs were $1,945, $1,803, and $1,730 for patients initiating therapy with bimatoprost, latanoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis.Conclusions: A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year treatment costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit the ability to project findings to all glaucoma patients.Keywords: costs and cost analysis, drug therapy, combination, glaucoma, prostaglandin analogs Dove Press Jordana K Schmier, David W Covert 2010-05-06 PDF http://www.dovepress.com/getfile.php?fileID=6254 http://www.dovepress.com/first-year-treatment-costs-among-new-initiators-of-topical--peer-reviewed-article-OPTH English

oai:dovepress.com/4390 2010-05-10 OPTH

Diffractive multifocal intraocular lens interferes with intraoperative view Inoue, Makoto Clinical Ophthalmology Mami Yoshino1, Makoto Inoue1,2, Nae Kitamura1, Hiroko Bissen-Miyajima11Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan; 2Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, JapanAbstract: We report an unusual finding during vitreous surgery in an eye implanted with a diffractive multifocal intraocular lens (IOL). A 70-year-old woman reported gradual visual deterioration to 20/40 in the left eye two and a half years after uneventful cataract surgery with implantation of a diffractive multifocal IOL. Funduscopic examination showed an epiretinal membrane (ERM) in the left eye. Increased macular traction was believed to cause the visual deterioration. Vitreous surgery with removal of the ERM was performed and triamcinolone acetonide (TA) was injected intravitreally to visualize the residual vitreous cortex. Although the ERM was peeled successfully, the ability to focus on the vitreoretinal interface through the IOL required great effort with decreased contrast sensitivity and ghost images of the intravitreal TA crystals. The vision improved to 20/25 4 months postoperatively. Macular surgery can be performed in an eye with a diffractive multifocal IOL; however, decreased contrast sensitivity and ghost images may interfere with the intraoperative view through the diffractive IOL in complicated cases.Keywords: diffractive multifocal intraocular lens, intraoperative view Dove Press Mami Yoshino, Makoto Inoue, Nae Kitamura, et al 2010-05-10 PDF http://www.dovepress.com/getfile.php?fileID=6267 http://www.dovepress.com/diffractive-multifocal-intraocular-lens-interferes-with-intraoperative-peer-reviewed-article-OPTH English

oai:dovepress.com/4400 2010-05-10 OPTH

Hyperbaric oxygen therapy for the treatment of radiation-induced macular ischemia Haji, Shamim Clinical Ophthalmology Shamim A Haji1,2, Ronald EP Frenkel1,2,31Eye Research Foundation, Stuart, FL, USA; 2East Florida Eye Institute, Stuart, FL, USA; 3Bascom Palmer Eye Institute, Miami, FL, USAPurpose: To report a case of radiation-induced macular ischemia where vision and macular perfusion improved after hyperbaric oxygen (HBO) therapy.Methods: A 62-year-old male patient developed radiation-induced macular ischemia after he was treated with radiation for brain glioma. The patient presented with best spectacle-corrected visual acuity (BSCVA) acuity of 20/400 in his right eye. Optical coherence tomography (OCT) showed central macular thickness of 468 &mu;m. The patient received focal laser, intravitreal triamcinolone, and HBO therapy.Results: The patient&rsquo;s vision improved from 20/400 to 20/100 after focal laser and intravitreal triamcinolone. His central macular thickness improved from 468 &mu;m to 132 &mu;m. After receiving HBO therapy, his VA improved to 20/50 and fluorescein angiography showed improvement in macular perfusion.Conclusion: HBO therapy improves macular perfusion in patients with radiation-induced macular ischemia.Keywords: macular ischemia, visual acuity, hyperbaric oxygen therapy, macular perfusion Dove Press Shamim A Haji, Ronald EP Frenkel 2010-05-10 PDF http://www.dovepress.com/getfile.php?fileID=6278 http://www.dovepress.com/hyperbaric-oxygen-therapy-for-the-treatment-of-radiation-induced-macul-peer-reviewed-article-OPTH English

oai:dovepress.com/4406 2010-05-10 OPTH

Comparison of clear lens extraction and collamer lens implantation in high myopia El-Helw, Mostafa Clinical Ophthalmology Ahmed M Emarah, Mostafa A El-Helw, Hazem M YassinCairo University, Cairo, EgyptAim: To compare the outcomes of clear lens extraction and collamer lens implantation in high myopia.Patients and methods: Myopic patients younger than 40 years old with more than 12 diopters of myopia or who were not fit for laser-assisted in situ keratomileusis were included. Group 1 comprised patients undergoing clear lens extraction and Group 2 patients received the Visian implantable collamer lens. Outcome and complications were evaluated.Results: Postoperative best corrected visual acuity was -0.61 &plusmn; 0.18 in Group 1 and 0.79 &plusmn; 0.16 in Group 2. In Group 1, 71.4% achieved a postoperative uncorrected visual acuity better than the preoperative best corrected visual acuity, while only 51.8% patients achieved this in Group 2. Intraocular pressure decreased by 12.55% in Group 1, and increased by 15.11% in Group 2. Corneal endothelial cell density decreased by 4.47% in Group 1 and decreased by 5.67% in Group 2. Posterior capsule opacification occurred in Group 1. In Group 2, lens opacification occurred in 11.11%, significant pigment dispersion in 3.7%, and pupillary block glaucoma in 3.7%.Conclusion: Clear lens extraction presents less of a financial load up front, and less likelihood of the need for a secondary intervention in the future. Clear lens extraction is a more viable solution in developing countries with limited financial resources.Keywords: clear lens extraction, implantable collamer lens, myopia Dove Press Ahmed M Emarah, Mostafa A El-Helw, Hazem M Yassin 2010-05-10 PDF http://www.dovepress.com/getfile.php?fileID=6285 http://www.dovepress.com/comparison-of-clear-lens-extraction-and-collamer-lens-implantation-in--peer-reviewed-article-OPTH English

oai:dovepress.com/4417 2010-05-11 OPTH

Predictability and stability of refraction with increasing optical zone diameter in hyperopic LASIK El-Helw, Mostafa Clinical Ophthalmology Mostafa A El-Helw, Ahmed M EmarahCairo University, Cairo, EgyptObjective: We undertook a prospective nonrandomized study to assess refractive outcome and patient satisfaction with hyperopic laser in situ keratomileusis (LASIK) using variable optical zone diameters in correction of hyperopia of more than 4.00 diopters.Methods: Fourteen adults (comprising 28 hyperopic eyes) underwent hyperopic LASIK correction for hyperopia of more than 4.00 diopters. The sample was divided into two groups. Group 1 included the right eyes of the 14 patients who underwent hyperopic LASIK using a 6.5 mm optical zone diameter. Group 2 comprised the left eyes of the same patients with the only difference being that the optical zone diameter was 6.0 mm.Results: The mean age of the patients was 36.42 &plusmn; 5.10 years. Group 1 eyes had a median (range) preoperative uncorrected visual acuity (UCVA) of 0.79 (0.52) and best-corrected visual acuity (BCVA) of 0.15 (0.08). Group 2 had a median preoperative UCVA of 0.79 (0.60) and BCVA of 0.15 (0.08). The median postoperative UCVA in Group 1 was 0.17 (0.21) and BCVA was 0.15 (0.13). In Group 2, the median postoperative UCVA was 0.30 (0.32) and BCVA was 0.15 (0.26). Group 1 had a median preoperative refraction of +5.37 (1.75) diopters and the median postoperative refraction at one week was &minus;0.23 (1.25) diopters, at three months was +0.75 (0.75) diopters, and at six months was +0.75 (1.00) diopters. Group 2 had a median preoperative refraction of +5.00 (1.75) diopters, and the median postoperative refraction at one week was +0.13 (1.5) diopters, at three months was +1.00 (0.75) diopters and at six months +1.25 (1.25) diopters. The difference was statistically significant between groups 1 and 2. The difference within each group was also significant. Group 1 eyes were stabilizing after the three-month period in contrast with Group 2 in which the refractive changes continued throughout the follow-up period.Conclusion: Larger optical zone diameter in correction of hyperopia of more than 4.00 diopters was more predictable, stable and safe.Keywords: hyperopia, LASIK, optical zone, refraction Dove Press Mostafa A El-Helw, Ahmed M Emarah 2010-05-11 PDF http://www.dovepress.com/getfile.php?fileID=6302 http://www.dovepress.com/predictability-and-stability-of-refraction-with-increasing-optical-zon-peer-reviewed-article-OPTH English

oai:dovepress.com/4421 2010-05-12 OPTH

Periorbital edema secondary to imatinib mesylate McClelland, Clinical Ophthalmology Collin M McClelland, George J Harocopos, Philip L CusterSchool of Medicine, Washington University, St. Louis, MO, USAAbstract: Imatinib mesylate (Gleevec&reg;) is a well-established pharmacologic treatment for all phases of chronic myeloid leukemia and for advanced gastrointestinal stromal tumors (GISTs). Edema-related side effects are relatively common in imatinib therapy with the periocular skin representing one of the most common sites for localized edema. While the adverse effect of periorbital edema with imatinib is well documented in the oncology literature, there is limited reference to this common reaction in the ophthalmology literature. We report two patients with upper eyelid edema associated with imatinib therapy who required surgical intervention to ameliorate significant visual field obstruction. We highlight the details of each case including the histopathologic findings of excised redundant skin followed by a thorough review of the literature on imatinib related periorbital edema.Keywords: imatinib mesylate, gleevec, edema, periorbital edema, tyrosine kinase inhibitor Dove Press Collin M McClelland, George J Harocopos, Philip L Custer 2010-05-12 PDF http://www.dovepress.com/getfile.php?fileID=6306 http://www.dovepress.com/periorbital-edema-secondary-to-imatinib-mesylate-peer-reviewed-article-OPTH English

oai:dovepress.com/4426 2010-05-12 OPTH

Mirtogenol&reg; potentiates latanoprost in lowering intraocular pressure and improves ocular blood flow in asymptomatic subjects Schonlau, Frank Clinical Ophthalmology Robert D Steigerwalt Jr1, Gianni Belcaro1, Paolo Morazzoni2, Ezio Bombardelli2, Carolina Burki3, Frank Sch&ouml;nlau4 1Department of Biomedical Sciences, University of Chieti-Pescara, San Valentino, Italy; 2Indena S.p.A. Scientific Department, Milan, Italy; 3Horphag Research (UK) Ltd., Geneva, Switzerland; 4Horphag Research (UK) Ltd. South Kensington, London UKPurpose: The dietary supplement Mirtogenol&reg; was previously shown to lower elevated intraocular pressure (IOP). We here present the effects of this supplement on IOP in comparison as well as in combination with latanoprost eye drops. Methods: Seventy-nine patients with asymptomatic ocular hypertension were randomly assigned to three groups receiving either the supplement, or latanoprost eye drops, or both in combination. Intraocular pressure and retinal blood flow were investigated in monthly intervals over 24 weeks.Results: Mirtogenol alone lowered IOP from baseline 38.1 to 29.0 mmHg after 16 weeks, with little further improvement during the following eight weeks. Latanoprost rapidly lowered IOP from baseline 37.7 to 27.2 mmHg within four weeks, without further effects thereafter. The combination of the supplement and latanoprost lowered IOP from 38.0 to 27.3 mmHg after four weeks, and further decreased IOP to 24.2 mmHg after six weeks. After 24 weeks IOP with the combination treatment (23.0 mmHg) was significantly lower than with latanoprost alone (27.2 mmHg). Mirtogenol and latanoprost individually showed comparable effects for gradually increasing central artery blood flow with treatment duration. Combination treatment showed higher systolic blood flow velocity throughout the trial period. The diastolic blood flow velocity gradually increased with treatment duration in all three groups. From twelve weeks onwards, the diastolic component with combination treatment was higher than with individual treatments.Conclusions: Mirtogenol lowered elevated IOP in patients almost as effectively as latanoprost, however, it takes much longer (24 vs 4 weeks). The combination of both was more effective for lowering IOP and the combination yielded better retinal blood flow. No serious side effects occurred during the study, apart from standard side effects in patients related to Latanoprost. These promising results warrant further research of Mirtogenol with a larger patient group.Keywords: intraocular pressure, latanoprost, mirtogenol, pycnogenol, nutrition Dove Press Robert D Steigerwalt Jr, Gianni Belcaro, Paolo Morazzoni, et al 2010-05-12 PDF http://www.dovepress.com/getfile.php?fileID=6311 http://www.dovepress.com/mirtogenolreg-potentiates-latanoprost-in-lowering-intraocular-pressure-peer-reviewed-article-OPTH English

oai:dovepress.com/4459 2010-05-17 OPTH

Corneal cell viability and structure after transcorneal freezing&ndash;thawing in the human cornea Oh, Joo Youn Clinical Ophthalmology Joo Youn Oh1,2, Hyun Ju Lee1,2, Sang In Khwarg1,2, Won Ryang Wee1,21Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; 2Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, KoreaPurpose: Although cryotherapy has long been used to eradicate corneal lesions, there have been no reports of adverse effects of cryotherapy on human corneas. We performed this study to evaluate and characterize ultrastructural damage to the human cornea following the transcorneal freezing-and-thawing procedure.Methods: Seven human donor corneas were randomly divided into three groups. 1, 2, and 3 repetitive freezing-and-thawing procedures were respectively applied to donor corneas in each group. A cryoprobe was cooled to -80&deg;C, and placed on the anterior surface 1.5 mm central to the limbus for 3 seconds. Samples were then allowed to spontaneously defrost. A cornea without the treatment was used as a control. Samples were evaluated through hematoxylin &amp; eosin staining, TUNEL assay, and electron microscopy.Results: After transcorneal cryoinjury, it was observed that corneal endothelial cells were lost and Descemet&rsquo;s membrane was denuded where the cryoprobe was applied. Corneal stromal cells were damaged, and the damage was more marked in the posterior stroma. The extent of damage increased with an increasing number of freezing&ndash;thawing repetitions. In contrast, corneal epithelial cells showed no cryo-induced damage, and Bowman&rsquo;s layer remained intact in all groups.Conclusions: The susceptibility to transcorneal cryo-injury differed among the corneal layers; the corneal endothelium was most susceptible, and the epithelium was least susceptible. Caution would thus be advised in regard to the potential damage in corneal endothelium when treating patients with corneal lesions using transcorneal cryotherapy.Keywords: apoptosis, cryotherapy, endothelium, keratocyte Dove Press Joo Youn Oh, Hyun Ju Lee, Sang In Khwarg, et al 2010-05-17 PDF http://www.dovepress.com/getfile.php?fileID=6350 http://www.dovepress.com/corneal-cell-viability-and-structure-after-transcorneal-freezingndasht-peer-reviewed-article-OPTH English

oai:dovepress.com/4460 2010-05-17 OPTH

A case of iridoschisis associated with lens displacement into the vitreous cavity Mutoh, Tetsuya Clinical Ophthalmology Tetsuya Mutoh1, Yukihiro Matsumoto1, Makoto Chikuda11Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanAbstract: We report the case of a 67-year-old woman with a lens that was displaced into the vitreous cavity in one eye and ipsilateral iridoschisis. She was free from a history of ocular trauma or of heritable ocular disease. Her best-corrected visual acuity was 1.2 bilaterally and right eye showed signs of iridoschisis. The corneal endothelial cell density decreased to 1,263 cells/mm2 in the right eye preoperatively. We speculated that iris tissue flowing in the anterior chamber might have intermittently touched the corneal endothelium. 25-gauge pars plana vitrectomy and lens removal were performed immediately. Free-floating iris tissue was cut during surgery with care not to injure the corneal endothelial cells. The postoperative progress was satisfactory and scleral fixation of an intraocular lens is planned. Iridoschisis is an uncommon cause of lens displacement into the vitreous cavity.Keywords: lens displacement, vitreous cavity, iridoschisis, corneal endothelial cell density, free-floating iris tissue Dove Press Tetsuya Mutoh, Yukihiro Matsumoto, Makoto Chikuda 2010-05-17 PDF http://www.dovepress.com/getfile.php?fileID=6351 http://www.dovepress.com/a-case-of-iridoschisis-associated-with-lens-displacement-into-the-vitr-peer-reviewed-article-OPTH English

oai:dovepress.com/4461 2010-05-17 OPTH

Influence of container structures and content solutions on dispensing time of ophthalmic solutions Yoshikawa, Keiji Clinical Ophthalmology Keiji Yoshikawa1, Hiroshi Yamada21Yoshikawa Eye Clinic, Tokyo, Japan; 2Santen Pharmaceutical Co., Ltd., Osaka, JapanPurpose: To investigate the influence of container structures and content solutions on the time of dispensing from eye dropper bottles.Methods: Eye dropper bottle models, solution models (filtrate water/surfactant solution) and a dispensing time measuring apparatus were prepared to measure the dispensing time.Results: With filtrate water and pressure thrust load of 0.3 MPa, the dispensing time significantly increased from 1.1 &plusmn; 0.5 seconds to 4.6 &plusmn; 1.1 seconds depending on the decrease of inner aperture diameters from 0.4 mm to 0.2 mm (P &lt; 0.0001). When using the bottle models with inner aperture diameters of 0.4 mm or larger, the dispensing time became constant. The dispensing time using surfactant solution showed the same tendency as above. When pressure thrust load was large (0.07 MPa), the solution flew out continuously with inner aperture diameters of 0.4 mm or larger and the dispensing time could not be measured. The inner aperture diameter most strongly explained the variation of the dispensing time in both the content solutions in the multiple linear regression analysis (filtrate water: 46%, R2 = 0.462, surfactant solution: 56%, R2 = 0.563).Conclusions: Among content solutions and container structures, the dispensing time was mostly influenced by the diameter of the inner aperture of bottles.Keywords: dispensing time, model eye dropper bottle, model ophthalmic solution, nozzle internal space volume, nozzle inner aperture diameter Dove Press Keiji Yoshikawa, Hiroshi Yamada 2010-05-17 PDF http://www.dovepress.com/getfile.php?fileID=6352 http://www.dovepress.com/influence-of-container-structures-and-content-solutions-on-dispensing--peer-reviewed-article-OPTH English

oai:dovepress.com/4463 2010-05-17 OPTH

Intravitreal injection analysis at the Bascom Palmer Eye Institute: evaluation of clinical indications for the treatment and incidence rates of endophthalmitis Cavalcante, Clinical Ophthalmology Ludimila L Cavalcante, Milena L Cavalcante, Timothy G Murray, Michael M Vigoda, Yolanda Pi&ntilde;a, Christina L Decatur, R Prince Davis, Lisa C Olmos, Amy C Schefler, Michael B Parrott, Kyle J Alliman, Harry W Flynn, Andrew A MoshfeghiBascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USAObjective: To report the incidence of endophthalmitis, in addition to its clinical and microbiological aspects, after intravitreal injection of vascular-targeting agents.Methods: A retrospective review of a consecutive series of 10,142 intravitreal injections of vascular targeting agents (bevacizumab, ranibizumab, triamcinolone acetonide, and preservative-free triamcinolone acetonide) between June 1, 2007 and January 31, 2010, performed by a single service (TGM) at the Bascom Palmer Eye Institute.Results: One case of clinically-suspected endophthalmitis was identified out of a total of 10,142 injections (0.009%), presenting within three days of injection of bevacizumab. The case was culture-positive for Staphylococcus epidermidis. Final visual acuity was 20/40 after pars plana vitrectomy surgery.Conclusions: In this series, the incidence of culture-positive endophthalmitis after intravitreal injection of vascular agents in an outpatient setting was very low. We believe that following a standardized injection protocol, adherence to sterile techniques and proper patient follow-up are determining factors for low incidence rates.Keywords: endophthalmitis, intravitreal injections, vascular targeting agents&nbsp; Dove Press Ludimila L Cavalcante, Milena L Cavalcante, Timothy G Murray, et al 2010-05-17 PDF http://www.dovepress.com/getfile.php?fileID=6356 http://www.dovepress.com/intravitreal-injection-analysis-at-the-bascom-palmer-eye-institute-eva-peer-reviewed-article-OPTH English

oai:dovepress.com/4492 2010-05-24 OPTH

Use of antivascular endothelial growth factor for diabetic macular edema Karim, R Clinical Ophthalmology Rushmia Karim, Benjamin TangUniversity of Sydney School of Public Health, Concord Repatriation General Hospital, Concord, NSW, AustraliaBackground: Diabetic macular edema (DME) is one of the manifestations of diabetic retinopathy leading to loss of central vision and visual acuity. It manifests itself with swelling around the central part of the retina, the area responsible for sharp vision. Current treatment includes laser therapy and intravitreal steroids with preventative measures including diabetes control. No one treatment has guaranteed control of diabetic macular edema which leads to deteriorating visual acuity, function and quality of life in patients. Vascular endothelial growth factor (VEGF) has been shown to be a critical stimulus in the pathogenesis of macular edema secondary to diabetes.1 Antiangiogenic therapy encompassed treatment with anti-VEGF which inhibits VEGF-driven neovascularization hence macular edema leading to decreased visual acuity.Objective: For this review, we evaluated the effectiveness of intravitreal anti-VEGF in treating DME.Data sources: We identified five trials (n = 525) using electronic databases (Cochrane Central Register of Controlled Trials [Central], Medline&reg;, and Excerpta Medica Database [EMBASE&reg;]) in October 2008, supplemented by hand searching of reference lists, review articles, and conference abstracts.Methods: We included all randomized clinical trials (RCTs) evaluating any form of intravitreal anti-VEGF for treating DME. The main outcome factor was change in best-corrected visual acuity and central macular thickness. One author assessed eligibility, methodological quality, and extracted data. Meta analysis was performed when appropriate.Results: We included three trials of adequate methodological quality in our metaanalysis. Patients treated with anti-VEGF showed improvement in visual acuity of -0.17 (95% confidence interval [CI]: -0.23, -0.10) and central macular thickness -84.69 (95% CI: -117.09, -52.30). Patients treated with combined anti-VEGF and intravitreal triamcinolone showed improvement of visual acuity of -0.19 (95% CI: -0.27, -0.11) and central macular thickness mean change being &ndash;111.20 (95% CI: -148.13, -74.28).Conclusions: Anti-VEGF has been associated with an improvement in visual acuity and central macular thickness in the analysis, however trial analysis was of a short duration and further research is needed to determine long-term benefits.Keywords: anti-VEGF, diabetic macular edema, ranizubimab, Avastin&reg;, pegaptanib Dove Press Rushmia Karim, Benjamin Tang 2010-05-24 PDF http://www.dovepress.com/getfile.php?fileID=6393 http://www.dovepress.com/use-of-antivascular-endothelial-growth-factor-for-diabetic-macular-ede-peer-reviewed-article-OPTH English

oai:dovepress.com/4533 2010-05-31 OPTH

Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks Pece, Alfredo Clinical Ophthalmology Alfredo Pece1, Gaetano Russo2, Federico Ricci3, Vincenzo Isola1, Ugo Introini4, Giuseppe Querques51Department of Ophthalmology, Melegnano Hospital, Milan, Italy; 2Fondazione Evangelica Betania, Napoli, Italy; 3University of Tor Vergata, Rome, Italy; 5University, Paris XII, France; 4San Raffaele University Hospital, Milan, ItalyPurpose: To report the visual outcome of photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA) for choroidal neovascularization (CNV) secondary to angioid streaks (AS).Methods: Five eyes of five consecutive patients (mean age 45 &plusmn; 10 years) with CNV secondary to AS were treated by combination of PDT and IVTA. TA (4 mg/0.1 mL) was injected 7 days before PDT.Results: All patients completed the 12-month follow-up. CNV was subfoveal in three cases and extrafoveal in two. Median best-corrected visual acuity (BCVA) was 0.3 LogMAR (70 letters) at baseline (range 1.3&ndash;0.1), and 0.5 LogMAR (60 letters) at the final examination (range 1.0&ndash;0.1). At 12 months, one patient had severe visual deterioration, with a loss of seven lines of VA; Two patients lost up to three lines. One patient had no change in BCVA and the fifth gained nine lines of VA. Two patients received one further combination of PDT and IVTA after the first combination treatment. All eyes showed the CNV closure at the 12-month follow-up visit.Conclusions: Combination of PDT and IVTA may reduce the need for retreatment and could be potentially useful for preserving vision in some patients with CNV due to AS. Keywords: ocular corticosteroids Dove Press Alfredo Pece, Gaetano Russo, Federico Ricci, et al 2010-05-31 PDF http://www.dovepress.com/getfile.php?fileID=6437 http://www.dovepress.com/verteporfin-photodynamic-therapy-combined-with-intravitreal-triamcinol-peer-reviewed-article-OPTH English

oai:dovepress.com/4574 2010-06-09 OPTH

Perioperative visual loss in ocular and nonocular surgery Lee, Michael S. Clinical Ophthalmology Kathleen T Berg, Andrew R Harrison, Michael S LeeDepartment of Ophthalmology, University of Minnesota, Minneapolis, MN, USAAbstract: Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period.Keywords: perioperative, postoperative, vision loss, ocular surgery, nonocular surgery Dove Press Kathleen T Berg, Andrew R Harrison, Michael S Lee 2010-06-09 PDF http://www.dovepress.com/getfile.php?fileID=6498 http://www.dovepress.com/perioperative-visual-loss-in-ocular-and-nonocular-surgery-peer-reviewed-article-OPTH English

oai:dovepress.com/4588 2010-06-15 OPTH

Low levels of plasma endothelin-1 in patients with retinitis pigmentosa Ohguro, Hiroshi Clinical Ophthalmology Hiroshi Ohguro1, Yukihiko Mashima2, Mitsuru Nakazawa31Department of Ophthalmology, Sapporo Medical University School of Medicine, 2Department of Ophthalmology, Keio University School of Medicine, 3Department of Ophthalmology, Hirosaki University School of Medicine, JapanPurpose: The aim of this study was to elucidate the role of endothelin-1 (ET-1) in the pathophysiology of retinitis pigmentosa (RP).Methods: Plasma ET-1 levels and ophthalmic features in 50 RP patients were compared with those in 20 healthy-eye control subjects. Plasma ET-1 concentrations were determined using a commercially available enzyme-linked immunosorbent assay kit.Results: Mean plasma ET-1 levels of RP patients (1.88 &plusmn; 0.56 pg/mL) were significantly lower than those of control subjects (2.30 &plusmn; 0.30 pg/mL, Mann-Whitney&rsquo;s U test; P &lt; 0.01). However, ET-1 concentrations varied markedly in each patient. Among RP patients, a significant correlation of ET-1 concentrations was not observed in terms of its hereditary forms or other clinical factors.Conclusion: ET-1 may be important in the pathogenesis of RP, and measurement of its plasma concentrations may also contribute to additional insights into the retinal hemodynamics of RP.Keywords: endothelin-1, retinitis pigmentosa, retinal hemodynamics Dove Press Hiroshi Ohguro, Yukihiko Mashima, Mitsuru Nakazawa 2010-06-15 PDF http://www.dovepress.com/getfile.php?fileID=6517 http://www.dovepress.com/low-levels-of-plasma-endothelin-1-in-patients-with-retinitis-pigmentos-peer-reviewed-article-OPTH English

oai:dovepress.com/4596 2010-06-15 OPTH

Tolerability and effectiveness of preservative-free dorzolamide&ndash;timolol (preservative-free Cosopt&reg;) in patients with open-angle glaucoma or ocular hypertension Hutnik, Cindy Clinical Ophthalmology Cindy Hutnik1, David Neima2, Fahim Ibrahim3, Robert Scott4, Julie Vaillancourt5, Denis Haine5, John S Sampalis5, Natacha Bastien6, Sylvain Foucart61Ivey Eye Institute, St Joseph Healthcare, London, Ontario, Canada; 2New Westminster, British Columbia, Canada; 3Point Edward, Ontario, Canada; 4Kentville, Nova Scotia, Canada; 5JSS Medical Research, Westmount, Quebec, Canada; 6Merck Frosst Canada Ltd, Kirkland, Quebec, CanadaPurpose: To assess the effect of preservative-free dorzolamide&ndash;timolol on nonvisual symptoms and intraocular pressure (IOP) in newly diagnosed and untreated patients with open-angle glaucoma or ocular hypertension.Methods: This was a prospective, 8-week, open-label, Canadian multicenter study. All patients were treated with preservative-free dorzolamide&ndash;timolol formulation. The primary outcome was the change in the nonvisual symptom score of the Glaucoma Symptom Scale (GSS-SYMP-6) from baseline to 8 weeks. Secondary effectiveness outcome measures were absolute and percent changes in IOP from baseline to 4 and 8 weeks.Results: One hundred and seventy-eight patients were enrolled. Mean (SD) age was 65.6 (12.1) years and 90 (50.6%) were females. There were 92 patients diagnosed with open-angle glaucoma, 62 with ocular hypertension, and 23 with both diseases (diagnosis was missing for one patient). The mean (SD) GSS-SYMP-6 score increased from 73.6 (21.8) at baseline to 76.1 (20.7) at 8 weeks (P = 0.097). Mean (SD) IOP significantly decreased by 11.7 (5.1) mmHg at 4 weeks (P &lt; 0.001) and by 11.5 (5.3) mmHg at 8 weeks (P &lt; 0.001), representing reductions of -38.5% (P &lt; 0.001) and -38.0% (P &lt; 0.001), respectively.Conclusion: Preservative-free dorzolamide&ndash;timolol does not increase eye discomfort while significantly reducing IOP in patients with open-angle glaucoma or ocular-hypertension. Keywords: open-angle glaucoma, ocular hypertension, GSS-SYMP-6, intraocular pressure, dorzolamide&ndash;timolol, preservative-free Dove Press Cindy Hutnik, David Neima, Fahim Ibrahim, et al 2010-06-15 PDF http://www.dovepress.com/getfile.php?fileID=6528 http://www.dovepress.com/tolerability-and-effectiveness-of-preservative-free-dorzolamidendashti-peer-reviewed-article-OPTH English

oai:dovepress.com/4600 2010-06-15 OPTH

A modified deep sclerectomy with or without external trabeculectomy: a comparative study Kitsos, George Clinical Ophthalmology George Kitsos1, Miltiades Aspiotis1, Yannis Alamanos2, Konstantinos Psilas11Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece; 2Department of Hygiene and Epidemiology, Medical School, University of Patras, Patras, GreecePurpose: To determine whether the removal of the inner wall of Schlemm&rsquo;s canal (external trabeculectomy) improves the effectiveness of a modified method of deep sclerectomy (DS), which we will call &ldquo;reversed&rdquo; deep sclerectomy (RDS).Materials and method: We conducted a prospective study of two groups of patients. Group A included 22 eyes of 18 patients with open angle glaucoma (OAG) under maximum medical treatment, which underwent RDS &ndash; a modified method of performing DS &ndash; with the removal of the inner wall of Schlemm&rsquo;s canal (external trabeculectomy) and without using any implant. Group B included 20 eyes of 17 patients which had undergone RDS alone. Demographic and tonometric data of patients of Group A revealed no significant difference from data of patients in Group B. A mean follow up period for Group A was 22.8 months and for Group B was 23.4 months. The outcome of the operations was termed a total success when intraocular pressure (IOP) was &lt;21 mmHg postoperatively, without additional treatment, relative success when IOP was &lt;21 mmHg with additional treatment and a total failure when IOP &gt; 21 mmHg with medical treatment.Results: Total success was achieved in 18/22 eyes (81.8%) for Group A and in 8/20 eyes (40%) for Group B (P &lt; 0.05). Relative success was achieved in 22/22 (100%) for Group A and in 17/20 eyes (85%) in Group B (P = NS). Total failure occurred in 0/22 eyes (0%) in Group A and in 3/20 (15%) eyes in Group B (P = NS). The mean postoperative IOP in Group A was 13.5 &plusmn; 2.8 mmHg with a reduction of 12.4 &plusmn; 4.6 mmHg (48.1%) and in Group B mean postoperative IOP was 18 &plusmn; 4.3 mmHg with a reduction of 6.2 &plusmn; 6.9 (25.6%) (P &lt; 0.001). Mean drug reduction postoperatively was 3.2 &plusmn; 0.9 drugs in Group A and 1.7 &plusmn; 1.2 in Group B (P &lt; 0.001).Conclusion: In the follow up time during which the two groups were under study (12&ndash;36 months), the removal of the inner wall of Schlemm&rsquo;s canal while performing RDS proves an important factor in improving its effectiveness.Keywords: modified deep sclerectomy, external trabeculectomy Dove Press George Kitsos, Miltiades Aspiotis, Yannis Alamanos, et al 2010-06-15 PDF http://www.dovepress.com/getfile.php?fileID=6535 http://www.dovepress.com/a-modified-deep-sclerectomy-with-or-without-external-trabeculectomy-a--peer-reviewed-article-OPTH English

oai:dovepress.com/4617 2010-06-18 OPTH

New approach for the glaucoma detection with pupil perimetry Asakawa, Ken Clinical Ophthalmology Ken Asakawa1, Nobuyuki Shoji1,2, Hitoshi Ishikawa1,2, Kimiya Shimizu31Department of Ophthalmology and Visual Science, Kitasato University Graduate School, Doctors Program of Medical Science, 2Department of Orthoptics and Visual Science, Kitasato University, School of Allied Health Science, 3Department of Ophthalmology, Kitasato University, School of MedicineObjective: To calculate the pattern deviation for identifying abnormal points of pupil perimetry, and also to evaluate the grayscale display for distinguishing glaucomatous pupil field loss (abnormal test points) from normal pupil field (normal test points).Methods: Fourteen patients ranging in age from 51 to 80 years, who had normal-tension glaucoma (6 eyes) and primary open-angle glaucoma (8 eyes) were tested. Pupil perimetry (Kowa &amp; Hamamatsu, Japan) was used to objectively measure the visual field. Also, to obtain a subjective visual field, the analysis was performed with a Humphrey Field Analyzer (30-2, Full threshold program, Carl Zeiss Meditec, Dublin). Of the 76 test points, the 22 surrounding points and the 3 points corresponding to the blind spot are excluded; and among the remaining 51 points, the 85th percentile value of pupil perimetry was calculated. The abnormal and normal test points were recorded, and the amount of positive or negative deviation of each test point from the normal median value for the corresponding test points was determined. We also used this technique to identify the value for distinguishing glaucomatous pupil field loss from the normal pupil field. Results: This study could be improved by calculating the sensitivity and specificity of a certain cut-off value between the normative data and the glaucoma patients. The value for identifying both abnormal and normal test points was a negative deviation of &ndash;4. Based on these results, pupil perimetry gray scales were determined: white (&lt; &ndash;3), 25% gray (from &ndash;4 to &ndash;8), 50% gray (from &ndash;9 to &ndash;13), 75% gray (from &ndash;14 to &ndash;18) and black (&gt; &ndash;19). Glaucomatous pupil field losses were generally distinguished from the normal pupil field by use of a gray scale.Conclusion: Our studies demonstrated that, when a deviation of &gt; &ndash;4 was regarded as an abnormal value, the detection of pupil perimetry exhibited improvement in glaucoma patients.Keywords: pupil perimetry, percentage pupil constriction, glaucoma, pattern deviation, gray scale Dove Press Ken Asakawa, Nobuyuki Shoji, Hitoshi Ishikawa, et al 2010-06-18 PDF http://www.dovepress.com/getfile.php?fileID=6553 http://www.dovepress.com/new-approach-for-the-glaucoma-detection-with-pupil-perimetry-peer-reviewed-article-OPTH English

oai:dovepress.com/4620 2010-06-18 OPTH

Clinical distinction between nasal optic disc hypoplasia (NOH) and glaucoma with NOH-like temporal visual field defects Ohguro, Hiroshi Clinical Ophthalmology Hiroshi Ohguro, Ikuyo Ohguro, Midori Tsuruta, Maki Katai, Sachie TanakaDepartment of Ophthalmology, Sapporo Medical University School of Medicine, JapanPurpose: To report on the clinically important differences between nasal optic hypoplasia (NOH) and glaucoma with NOH-like temporal visual field defect (VFD).Method: Five NOH (four bilateral and one unilateral) patients, three unilateral NOH patients with glaucoma, and two glaucoma patients with NOH-like temporal VFD were clinically characterized. Superior segmental optic nerve hypoplasia was also associated with glaucoma in one eye of a bilateral NOH case and the NOH eye of a unilateral NOH patient. Ocular manifestations including refractive errors, size, and appearances of the optic discs, retinal nerve fiber thickness (NFLT) ascertained by optical coherence tomography (OCT), and VFD were examined.Results: Ophthalmic examinations revealing NOH showed high myopia at more than -5.0D, a small disc with nasal double-ring appearance, significantly decreased NFLT by OCT, and retinal nerve fiber layer defect in the corresponding nasal sector. Stationary temporal VFD varied from a slight depression of the peripheral isopters to wide sector defects. In contrast, two glaucoma patients with NOH-like temporal VFD showed several different clinical features, including mild myopia less than -5D, a normal size with glaucomatous disc cupping; a slight decrease in nasal NFLT and progression of temporal and other glaucomatous VFD.Conclusion: Careful evaluation of optic disc appearance and measurement of NFLT using OCT may help to distinguish between NOH and glaucoma with NOH-like temporal VFD.Keywords: nasal optic disc hypoplasia, glaucoma, temporal visual field defects, optical coherence tomography, superior segmental optic nerve hypoplasia Dove Press Hiroshi Ohguro, Ikuyo Ohguro, Midori Tsuruta, et al 2010-06-18 PDF http://www.dovepress.com/getfile.php?fileID=6556 http://www.dovepress.com/clinical-distinction-between-nasal-optic-disc-hypoplasia-noh-and-glauc-peer-reviewed-article-OPTH English

oai:dovepress.com/4634 2010-06-21 OPTH

Displacement of submacular hemorrhage associated with age-related macular degeneration using vitrectomy and submacular tPA injection followed by intravitreal ranibizumab Steel, DHW Clinical Ophthalmology Sukhpal Singh Sandhu1,2, Sridhar Manvikar1, David Henry William Steel11Sunderland Eye Infirmary, Sunderland, United Kingdom; 2Centre for Eye Research Australia, Melbourne, AustraliaBackground/aims: To evaluate retrospectively the clinical outcomes of patients presenting with submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD), treated by vitrectomy, submacular tissue plasminogen activator (tPA) injection and pneumatic displacement of SMH with air followed by postoperative intravitreal ranibizumab (RZB).Methods: Patients with SMH and nAMD had 25-guage vitrectomy and subretinal tPA (12.5 micrograms/0.1 mL) with fluid/air exchange. Intravitreal RZB was administered postoperatively to patients eligible for National Health Service (NHS) funded treatment.Results: Of the total of 16 patients, 11 (68.7%) had complete displacement of SMH. The remaining five had residual SMH, mainly subretinal pigment epithelium in location. Three of the four patients who previously had a failed expansile gas pneumatic displacement were successfully displaced with vitrectomy surgery. At presentation 5/16 (31.3%) patients were eligible for NHS funded intravitreal RZB. This increased to 12 patients after the vitrectomy procedure (75.0%). At 6 months postoperatively all improved by $1 line. Ten of the 16 patients (63%) improved by &ge;2 lines, with 10 of the 12 patients (83%) treated with RZB improving by &ge;2 lines.Conclusion: Vitrectomy/subretinal tPA/air to displace SMH followed by intravitreal RZB injection can stabilize/improve vision in patients with nAMD. This technique displaces hemorrhage not displaced by attempted expansile gas techniques.Keywords: submacular hemorrhage, neovascular age-related macular degeneration, vitrectomy, tissue plasminogen activator, ranibizumab Dove Press Sukhpal Singh Sandhu, Sridhar Manvikar, David Henry William Steel 2010-06-21 PDF http://www.dovepress.com/getfile.php?fileID=6570 http://www.dovepress.com/displacement-of-submacular-hemorrhage-associated-with-age-related-macu-peer-reviewed-article-OPTH English

oai:dovepress.com/4635 2010-06-21 OPTH

In vivo comparative study of ocular vasodilation, a relative indicator of hyperemia, in guinea pigs following treatment with bimatoprost ophthalmic solutions 0.01% and 0.03% Ogundele, Abayomi Clinical Ophthalmology Abayomi B Ogundele, David Earnest, Marsha A McLaughlinAlcon Research, Limited, Fort Worth, TX, USAObjective: The objective of this in vivo study was to compare the incidence of vasodilation in guinea pigs following topical administration of bimatoprost ophthalmic solutions 0.01% and 0.03%.Methods: The study comprised 20 guinea pigs assigned to 2 treatment groups (10 per treatment group) to receive either bimatoprost 0.01% or bimatoprost 0.03%. Animals were hand-held under 2.75 &times; magnification to score ocular vasodilation (a measure of hyperemia), using a scoring system developed at Alcon Research, Ltd. Following baseline ocular scoring, each animal received a 30 &mu;L dose to the left eye of either bimatoprost 0.01% (3 &mu;g) or bimatoprost 0.03% (9 &mu;g). Vasodilation was again scored at 1, 2, 3, 4, 5 and 6 hours after dosing. Incidence of vasodilation was calculated as the percent of total eyes in each 2-hour time interval with scores &ge;2.Results: The incidence of vasodilation was higher in the bimatoprost 0.01% treatment group (range, 45.0% to 60.0%) than the bimatoprost 0.03% treatment group (range, 30.0% to 52.2%) at all post-dosing time points.Conclusion: The 2 bimatoprost formulations elicited ocular vasodilation of long duration (&gt;6 hours) in the guinea pig model, with the bimatoprost 0.01% treatment group showing a higher incidence of ocular vasodilation than the bimatoprost 0.03% treatment group. Further clinical studies would be needed to determine whether the higher incidence of vasodilation may also be attributed to the increased BAK concentration in the bimatoprost 0.01% formulation.Keywords: bitamoprost, ocular vasodilation, hyperemia Dove Press Abayomi B Ogundele, David Earnest, Marsha A McLaughlin 2010-06-21 PDF http://www.dovepress.com/getfile.php?fileID=6571 http://www.dovepress.com/in-vivo-comparative-study-of-ocular-vasodilation-a-relative-indicator--peer-reviewed-article-OPTH English

oai:dovepress.com/4636 2010-06-21 OPTH

Free radicals in the aqueous humor of patients with glaucoma Oshida, Eiki Clinical Ophthalmology Eiki Oshida, Yukihiro Matsumoto, Kiyomi Arai1Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, JapanPurpose: To clarify the presence of oxidative stress in glaucoma and discuss whether free radicals contribute to neovascular glaucoma (NVG) and non-NVG.Methods: Two patient groups were formed: the NVG group (n = 10) and the non-NVG group (n = 17). Free radicals in aqueous humor were detected by measuring the electron spin resonance (ESR). To identify free radical species, either superoxide dismutase (SOD) or catalase was added to the aqueous humor and compared with aqueous humor in which SOD or catalase was not added.Results: In the NVG group, free radical waveforms were detected that differed from ascorbate-free radical (AFR) in all cases. Under SOD was added, the characteristic waveforms disappeared and the AFR of a specific waveform appeared. After catalase was added, the waveforms were unchanged. In the non-NVG group, the AFR of specific waveforms were detected in all cases. In 4 cases, the waveforms detected the presence of a trace of superoxide.Conclusions: In the NVG group, superoxides were detected, suggesting that superoxide scavenging activity was decreased markedly. L-ascorbic acid likely has an antioxidative function in the non-NVG group, suggesting that the aqueous humor in the NVG group was under higher oxidative stress compared with the non-NVG group.Keywords: oxidative stress, free radicals, glaucoma, ascorbate Dove Press Eiki Oshida, Yukihiro Matsumoto, Kiyomi Arai 2010-06-21 PDF http://www.dovepress.com/getfile.php?fileID=6572 http://www.dovepress.com/free-radicals-in-the-aqueous-humor-of-patients-with-glaucoma-peer-reviewed-article-OPTH English

oai:dovepress.com/4663 2010-06-24 OPTH

Blindness and visual impairment in retinitis pigmentosa: a Cameroonian hospital-based study Omgbwa Eballe, André Clinical Ophthalmology Andr&eacute; Omgbwa Eballe1, Godefroy Koki2, Claude Bernard Emche2, Lucienne Assumpta Bella2, Jeanne Mayouego Kouam2, Justin Melong31Faculty of Medicine and Pharmaceutical Sciences, University of Douala; 2Faculty of Medicine and Biomedical Sciences, University of Yaound&eacute;; 3Translation Unit, Ministry of Public Health, Yaound&eacute;, CameroonAim: We performed a retrospective, analytical study in February 2010 on all retinitis pigmentosa cases seen during ophthalmologic consultation at the Gyneco-Obstetrics and Pediatric Hospital of Yaounde between March 2002 and December 2009 (82 months). The aim of this research was to determine the significance of blindness and visual impairment associated with retinitis pigmentosa in Cameroon.Results: Forty cases were reported, corresponding to a hospital prevalence of 1.6/1000 (21 men and 19 women). The average age of the patients was 43.3 &plusmn; 18 years, ranging between 6 and 74 years. Bilateral blindness and low vision was noted in 30% and 27.5% of patients, respectively. The average age of patients with low vision was 40.38 &plusmn; 16.27 years and the average age of those with bilateral blindness was 51.08 &plusmn; 15.79 years. Retinitis pigmentosa was bilateral in all cases and isolated (without any eye or general additional disease) in 67.5% of cases.Conclusion: Visual impairment is common and becomes even more severe with aging. Patients should be screened to enable them to benefit from management focusing on both appropriate treatment and genetic counseling.Keywords: retinitis pigmentosa, Cameroon, blindness, Yaound&eacute; Dove Press Andr&eacute; Omgbwa Eballe, Godefroy Koki, Claude Bernard Emche, et al 2010-06-24 PDF http://www.dovepress.com/getfile.php?fileID=6610 http://www.dovepress.com/blindness-and-visual-impairment-in-retinitis-pigmentosa-a-cameroonian--peer-reviewed-article-OPTH English

oai:dovepress.com/4672 2010-06-28 OPTH

Azithromycin in DuraSite&reg; for the treatment of blepharitis Luchs, Jodi Clinical Ophthalmology Jodi LuchsDepartment of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, NY, USAAbstract: Blepharitis is a common inflammatory disease of the eyelid. Posterior blepharitis affects the posterior lamella of the eyelid and involves inflammation of the meibomian glands, whereas anterior blepharitis affects the anterior lamella of the eyelid and the eyelashes; either version can be inflammatory or infectious in nature. Each of these conditions can incite or propagate the other; anterior blepharitis, if not treated, can lead to meibomian gland disease, and vice versa. Blepharitis is typically chronic, and can be associated with a variety of systemic diseases such as dermatitis, as well as ocular diseases such as dry eye, conjunctivitis, or keratitis. The standard treatment regimen historically consists of lid hygiene with warm compresses and eyelid scrubs, although these treatment modalities may have limited efficacy for many patients, especially those with more severe disease. Adjunctive treatment includes systemic and topical antibiotics, topical corticosteroids, and tear replacement therapy. Topical antibiotics are recommended to decrease the bacterial load, and topical corticosteroids may help in cases of severe inflammation. Azithromycin ophthalmic solution 1% in DuraSite&reg; (AzaSite&reg;; Inspire Pharmaceuticals, Durham, North Carolina, USA) has been proposed as a novel treatment for posterior blepharitis, based on its well-known anti-infective profile, its antiinflammatory properties, its excellent tissue penetration, and its regulatory approval for the treatment of bacterial conjunctivitis. This review focuses on an off-label indication for topical azithromycin 1% in DuraSite for the treatment of blepharitis.Keywords: lid margin disease, meibomian gland disease Dove Press Jodi Luchs 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6620 http://www.dovepress.com/azithromycin-in-durasitereg-for-the-treatment-of-blepharitis-peer-reviewed-article-OPTH English

oai:dovepress.com/4674 2010-06-28 OPTH

Regression of macular edema secondary to branch retinal vein occlusion during anti-TNF-&alpha; therapy for rheumatoid arthritis Kachi, Shu Clinical Ophthalmology Shu Kachi, Kenshin Kobayashi, Hiroaki Ushida, Yasuki Ito, Mineo Kondo, HirokoTerasakiDepartment of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, JapanAbstract: A patient with macular edema secondary to a branch retinal vein occlusion (BRVO) was treated with intravenous injections of infliximab, an antitumor necrosis factor (TNF)-&alpha; antibody, for her rheumatoid arthritis (RA). Before the injection, the thickness of the right fovea, determined by optical coherent tomography, was 629 &mu;m and the best-corrected visual acuity (BCVA) was 20/50. After eight injections of infliximab and 10 months after the first injection, her foveal thickness was decreased to 293 &mu;m and the visual acuity improved to 20/20. There was no recurrence of macular edema during the infliximab injections. However, the infliximab injection was stopped because the patient developed pneumonia. Eight months after stopping the infliximab injection, her foveal thickness increased to 494 &mu;m. To treat the RA, her orthopedists began weekly subcutaneous injections of etanercept, a fusion protein of a section of the TNF receptor and immunoglobulin. Five months later, the foveal thickness had decreased to 260 &mu;m, and the visual acuity remained at 20/25+. Because TNF-&alpha; is known to break down the blood&ndash;retinal barrier, the improvements in our case suggest that TNF-&alpha; plays a role in the pathogenesis of macular edema in some patients with BRVO.Keywords: branch retinal vein occlusion, macular edema, tissue necrosis factor-alpha, rheumatoid arthritis, infliximab, etanercept, foveal thickness Dove Press Shu Kachi, Kenshin Kobayashi, Hiroaki Ushida, et al 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6622 http://www.dovepress.com/regression-of-macular-edema-secondary-to-branch-retinal-vein-occlusion-peer-reviewed-article-OPTH English

oai:dovepress.com/4676 2010-06-28 OPTH

Measuring accurate IOPs: Does correction factor help or hurt? Davey, Pinakin-Gunvant Clinical Ophthalmology Pinakin Gunvant1, Robert D Newcomb2, Elliot M Kirstein3, Victor E Malinovsky4, Richard J Madonna5, Richard E Meetz 41Southern College of Optometry, Memphis, Tennessee, USA; 2The Ohio State University College of Optometry, Columbus, Ohio, USA; 3The Glaucoma and Diabetes Eye Institute, Cincinnati, Ohio, USA; 4Indiana University School of Optometry, Bloomington, Indiana, USA; 5State University of New York College of Optometry, New York, USAPurpose: To evaluate if using the Ehlers correction factor on the intraocular pressure (IOP) measured using the Goldmann applanation tonometer (GAT) improves its agreement with the PASCAL dynamic contour tonometer (DCT).Patients and methods: A total of 120 eyes of 120 individuals were examined. Participants underwent IOP measurement with both the DCT and the GAT and central corneal thickness measurement. The Ehlers correction factor was applied on the GAT IOP measurements to calculate Ehlers-corrected GAT IOP. The agreement between the DCT and GAT, and DCT and Ehlers-corrected GAT IOP was analyzed. The analyses were repeated by stratifying the data by race.Results: The mean IOP of the GAT, DCT, and the Ehlers-corrected GAT was 15.30, 16.78, and 14.68 mmHg, respectively. The agreement as assessed by Bland&ndash;Altman plot for the GAT with the DCT and DCT and Ehlers-corrected GAT IOP was +4.1 to &minus;6.9 and +4.15 to &minus;8.25 mmHg, respectively. The results were similar even when stratifying the data by race.Conclusion: Using Ehlers correction factor to account for the effect of corneal parameters on the IOP measured by the GAT worsens the agreement with the DCT. This effect remains even when stratifying the data by race.Keywords: dynamic contour tonometer, Goldmann applanation tonometer, tonometric correction factors, central corneal thickness, intraocular pressure Dove Press Pinakin Gunvant, Robert D Newcomb, Elliot M Kirstein, et al 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6625 http://www.dovepress.com/measuring-accurate-iops-does-correction-factor-help-or-hurt-peer-reviewed-article-OPTH English

oai:dovepress.com/4677 2010-06-28 OPTH

DHA supplementation for late onset Stargardt disease: NAT-3 study Querques, G Clinical Ophthalmology Giuseppe Querques1, Pascale Benlian1, Bernard Chanu2, Nicolas Leveziel1, Gabriel Coscas1, Gisele Soubrane1, Eric H Souied11Department of Ophthalmology, University of Paris XII, Centre Hospitalier Intercommunal de Creteil, 2Department of Nutrition, University of Paris XII, Hopital Henry Mondor, Creteil, FranceBackground: We analyzed the effects of a docosahexaenoic acid (DHA) supplementation in patients affected with late onset Stargardt disease (STGD).Methods: DHA (840 mg/day) was given to 20 STGD patients for six months. A complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG), was performed at inclusion day 0 (D0) and at month 6 (M6).Results: Overall, no statistical differences have been observed at M6 vs D0 as regards BCVA and mfERG (P &gt; 0.05). Mild Improvement of BCVA and improvement of mfERG was noted in seven/40 eyes of four/20 patients. In the first patient, the peak of the a wave increased from 66 nV/deg&sup2; to 75.4 nV/deg&sup2; in the right eye (RE) and 24.5 nV/deg&sup2; to 49.1 nV/deg&sup2; in the left eye (LE). The peak of the b wave improved from 122 nV/deg&sup2; to 157 nV/deg&sup2; in the RE, and 102 nV/deg&sup2; to 149 nV/deg&sup2; in the LE. In the second patient peaks of the a and b waves respectively increased from 11.8 nV/deg&sup2; to 72.1 nV/deg&sup2; and 53 nV/deg&sup2; to 185 nV/deg&sup2; in the RE. In the third patient the peak of the a wave increased from 37 nV/deg&sup2; to 43 nV/deg&sup2; in the RE, and from 31 nV/deg&sup2; to 45 nV/deg&sup2; in the LE; the peak of the b wave improved from 70 nV/deg&sup2; to 89 nV/deg&sup2; in the RE, and from 101 nV/deg&sup2; to 108 nV/deg&sup2; in the LE. In the fourth patient, the peak of the a wave increased from 39 nV/deg&sup2; to 42 nV/deg&sup2; in the RE, and from 40 nV/deg&sup2; to 43 nV/deg&sup2; in the LE; the peak of the b wave improved from 86 nV/deg&sup2; to 94 nV/deg&sup2; in the RE, and from 87 nV/deg&sup2; to 107 nV/deg&sup2; in the LE.Conclusion: DHA seems to influence some functional parameters in patients affected with STGD. However, no short-term benefit should be expected from DHA supplementation. Keywords: docosahexaenoic acid (DHA), multifocal electroretinogram, omega-3, polyunsaturated fatty acid, retinal dystrophy, Stargardt disease Dove Press Giuseppe Querques, Pascale Benlian, Bernard Chanu, et al 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6626 http://www.dovepress.com/dha-supplementation-for-late-onset-stargardt-disease-nat-3-study-peer-reviewed-article-OPTH English

oai:dovepress.com/4683 2010-06-28 OPTH

Concurrent central retinal artery occlusion and branch retinal vein occlusion in giant cell arteritis Chu, Edward Clinical Ophthalmology Edward R Chu, Celia S ChenDepartment of Ophthalmology, Flinders Medical Centre and Flinders University, Bedford Park, SA, AustraliaAbstract: Ophthalmic involvement in giant cell arteritis can manifest in a number of ways. Central retinal artery occlusion is one of the common causes of visual loss in giant cell arteritis. On the contrary, branch retinal vein occlusion is rarely associated with the latter. We report an 89-year-old lady with acute left central retinal artery occlusion on a background of progressive decline in vision over a 6-month period with a concurrent right branch retinal vein occlusion. Subsequent investigation confirmed giant cell arteritis on temporal artery biopsy. This is the first reported case of a concurrent central retinal artery occlusion and branch retinal vein occlusion in giant cell arteritis, and highlights the various ocular presentations that can occur in giant cell arteritis.Keywords: giant cell arteritis, retinal artery occlusion, retinal vein occlusion Dove Press Edward R Chu, Celia S Chen 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6632 http://www.dovepress.com/concurrent-central-retinal-artery-occlusion-and-branch-retinal-vein-oc-peer-reviewed-article-OPTH English

oai:dovepress.com/4692 2010-06-28 OPTH

Results of a modified non-penetrating deep sclerectomy in the treatment of open angle glaucoma with or without cataract Kitsos, George Clinical Ophthalmology George Kitsos1, Miltiades Aspiotis1, Yannis Alamanos2, Konstantinos Psilas11Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece; 2Department of Hygiene and Epidemiology, Medical School, University of Patras, Patras, GreecePurpose: To present the technique of a modified deep sclerectomy, which we will call &ldquo;reversed&rdquo; deep sclerectomy (RDS) and the results and our observations of its use in patients with open angle glaucoma (OAG) and with or without cataract extraction (phacoemulsification).Materials and methods: This prospective study included 132 eyes which underwent RDS: 37 eyes (group A) with uncontrolled OAG and 95 eyes (group B) with OAG and visually significant cataract. Mean pressure preoperatively for group A was 24.48 &plusmn; 4.92 mmHg and for group B was 22.99 &plusmn; 3.00. The mean number of antiglaucoma drugs received was 2.97 &plusmn; 0.69 and 2.56 &plusmn; 0.73 for groups A and B respectively. The RDS was performed where the deep scleral stroma is prepared in 2 parts, folded and inserted under the lateral sides of the sclerectomy, and the Schlemm&rsquo;s canal is opened prior to deep scleral stroma preparation. Cataract was extracted by phacoemulsification through the same scleral opening. The follow-up for group A was 22.23 &plusmn; 10.18 months and for group B, 25.36 &plusmn; 10.12 months. Results: Postoperative intraocular pressure (IOP) &le; 21 mmHg was achieved for group A in 40.5% without antiglaucoma drugs and 94.6% with antiglaucoma drugs, and for group B in 66.3% and in 94.7% respectively. Mean IOP reduction was 7.02 &plusmn; 6.35 mmHg (28.67%, P &lt; 0.05) for group A and 5.26 &plusmn; 3.72 mmHg (25.06%, P &le; 0.05) for group B, while mean drug reduction was 1.97 &plusmn; 1.09 (P &lt; 0.01) and 2.14 &plusmn; 0.95 (P &le; 0.01) respectively. 5-Fluorouracil was used in 8 eyes of group A and in 5 eyes of group B.Conclusion: In the follow-up time during which the two groups were under study, the RDS was effective with a few complications, similar to the classic deep sclerectomy using implants or not, with the advantage, in our opinion, of a short learning curve.Keywords: modified deep sclerectomy, cataract Dove Press George Kitsos, Miltiades Aspiotis, Yannis Alamanos, et al 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6641 http://www.dovepress.com/results-of-a-modified-non-penetrating-deep-sclerectomy-in-the-treatmen-peer-reviewed-article-OPTH English

oai:dovepress.com/4693 2010-06-28 OPTH

Concomitant bilateral intravitreal anti-VEGF injections for the treatment of exudative age-related macular degeneration Murray, Timothy Clinical Ophthalmology R Prince Davis, Amy C Schefler, Timothy G MurrayBascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USAPurpose: To report the outcomes of same-day, bilateral intravitreal anti-vascular endothelial growth factor (VEGF) therapy for a consecutive series of patients treated for exudative age-related macular degeneration (ARMD).Methods: A consecutive series of 254 eyes of 127 patients received bilateral, same-day anti-VEGF injections of either bevacizumab or ranibizumab between January 1, 2007 and July 1, 2008 and the outcomes were assessed. Approval was obtained from the Institutional Review Board at the University of Miami Miller School of Medicine.Results: Bilateral, same-day anti-VEGF injections were well tolerated in all patients receiving the therapy. Indication for injection was exudative macular degeneration in all patients. The incidence of adverse effects was low, with only four events reported, none of which were serious. Conclusions: In this study, bilateral anti-VEGF injections performed on the same day were preferred over staggered injections and were well tolerated by patients. No major systemic or ocular adverse events were noted, despite the presence of risk factors in a subset of patients. Given that there are serious, albeit rare, complications following anti-VEGF injection, further study with a larger number of patients will be necessary to definitively prove the safety of this treatment modality.Keywords: visual acuity, same-day treatment, bevacizumab, ranibizumab Dove Press R Prince Davis, Amy C Schefler, Timothy G Murray 2010-06-28 PDF http://www.dovepress.com/getfile.php?fileID=6642 http://www.dovepress.com/concomitant-bilateral-intravitreal-anti-vegf-injections-for-the-treatm-peer-reviewed-article-OPTH English

oai:dovepress.com/4699 2010-06-29 OPTH

Topical administration of adrenergic receptor pharmaceutics and nerve growth factor Steinle, Jena Clinical Ophthalmology Jena J SteinleDepartments of Ophthalmology and Anatomy and Neurobiology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN 38163, USAAbstract: Topical application of nerve growth factor (NGF) and adrenergic receptor pharmaceutics are currently in use for corneal ulcers and glaucoma. A recent interest in the neuroprotective abilities of NGF has led to a renewed interest in NGF as a therapeutic for retinal and choroidal diseases. NGF can promote cell proliferation through actions of the TrkA receptor or promote apoptosis through receptor p75NTR. This understanding has led to novel interest in the role of NGF for diseases of the posterior eye. The role of &beta;-adrenergic receptor agonists and antagonists for treatments of glaucoma, diabetic retinopathy, and their potential mechanisms of action, are still under investigation. This review discusses the current knowledge and applications of topical NGF and adrenergic receptor drugs for ocular disease.Keywords: NGF, &beta;-adrenergic receptor agents, &alpha;-adrenergic receptor agents, retina, cornea, glaucoma Dove Press Jena J Steinle 2010-06-29 PDF http://www.dovepress.com/getfile.php?fileID=6649 http://www.dovepress.com/topical-administration-of-adrenergic-receptor-pharmaceutics-and-nerve--peer-reviewed-article-OPTH English

oai:dovepress.com/4700 2010-06-29 OPTH

Minocycline is cytoprotective in human trabecular meshwork cells and optic nerve head astrocytes by increasing expression of XIAP, survivin, and Bcl-2 Kernt, Marcus Clinical Ophthalmology Marcus Kernt, Aljoscha S Neubauer, Kirsten H Eibl, Armin Wolf, Michael W Ulbig, Anselm Kampik, Cristoph HirneissDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, GermanyIntroduction: Primary open-angle glaucoma (POAG) is one of the leading causes of blindness. Activation of optic nerve head astrocytes (ONHA) and loss of trabecular meshwork cells (TMC) are pathognomonic for this neurodegenerative disease. Oxidative stress and elevated levels of transforming growth factor beta (TGF&beta;) play an important role in the pathogenesis of POAG. This study investigates the possible antiapoptotic and cytoprotective effects of minocycline on TMC and ONHA under oxidative stress and increased TGF&beta; levels.Methods: TMC and ONHA were treated with minocycline 1&ndash;150 &mu;M. Possible toxic effects and IC50 were evaluated after 48 hours. Cell proliferation and viability were examined in order to assess the protective effects of minocycline on TMC and ONHA. Expression of Bcl-2, XIAP, and survivin, as well as their mRNA expression, were assessed by real time polymerase chain reaction (RT-PCR) and Western Blot analysis 48 hours after treatment with minocycline alone and additional incubation with TGF&beta;-2 or oxidative stress.Results: Minocycline 1&ndash;75 &mu;M showed no toxic effects on TMC and ONHA. Under conditions of oxidative stress, both TMC and ONHA showed an increase in viability and an ability to proliferate when treated with minocycline 20&ndash;40 &mu;M. RT-PCR and Western blotting yielded an overexpression of Bcl-2, XIAP, and survivin when TMC or ONHA were treated with minocycline 20&ndash;40 &mu;M under conditions of oxidative stress and when additionally incubated with TGF&beta;-2.Conclusion: Minocycline up to 75 &mu;M does not have toxic effects on TMC and ONHA. Treatment with minocycline 20&ndash;40 &mu;M led to increased viability and proliferation under oxidative stress and TGF&beta;-2, as well as overexpression of Bcl-2, XIAP, and survivin. This protective pathway may help to prevent apoptotic cell death of TMC and ONHA and therefore be a promising approach to avoidance of progression of glaucomatous degeneration.Keywords: glaucoma, apoptosis, minocycline, trabecular meshwork, optic nerve head astrocytes Dove Press Marcus Kernt, Aljoscha S Neubauer, Kirsten H Eibl, et al 2010-06-29 PDF http://www.dovepress.com/getfile.php?fileID=6650 http://www.dovepress.com/minocycline-is-cytoprotective-in-human-trabecular-meshwork-cells-and-o-peer-reviewed-article-OPTH English

oai:dovepress.com/4701 2010-06-29 OPTH

Combined 20-gauge and 23-gauge pars plana vitrectomy for the management of posteriorly dislocated lens: a case series Kongsap, Pipat Clinical Ophthalmology Pipat KongsapDepartment of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Affiliated with the Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandObjective: To present a new surgical approach for the management of posteriorly dislocated lens by using a combination of 20-gauge (20G) and 23-gauge (23G) pars plana vitrectomy.Design: An interventional case seriesMethods: This technique was performed on six patients (five men, one woman; mean age, 66.67 years; range, 66&ndash;72 years). Two 23G trans-conjunctival sclerotomy ports were created for infusion and illumination along with a 20G sclerotomy port for introducing the vitrectomy probe or fragmatome.Results: This procedure was successfully performed on six eyes. On postoperative day one, the media were clear and the retina could be seen by indirect ophthalmoscopy. Hyphema developed in one eye and resolved within a week. There were no observed cases of retinal tear, wound leakage, hypotony, or endophthalmitis. The post-operative follow-up period ranged from three to twelve months (mean, 8.1 months). By the final visit, two patients had achieved a visual acuity of 20/40 or better, three patients, 20/70, and one patient, 20/200.Conclusion: The combination of 20G and 23G pars plana vitrectomy is an efficacious and safe procedure for management of posteriorly dislocated lens.Keywords: lensectomy, fragmatome, sutureless vitrectomy Dove Press Pipat Kongsap 2010-06-29 PDF http://www.dovepress.com/getfile.php?fileID=6651 http://www.dovepress.com/combined-20-gauge-and-23-gauge-pars-plana-vitrectomy-for-the-managemen-peer-reviewed-article-OPTH English

oai:dovepress.com/4723 2010-06-30 OPTH

Correlation between peripapillary macular fiber layer thickness and visual acuity in patients with open-angle glaucoma Nakazawa, Toru Clinical Ophthalmology Kazuko Omodaka, Toru Nakazawa, Yu Yokoyama, Hiroshi Doi, Nobuo Fuse, Kohji NishidaDepartment of Ophthalmology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, JapanPurpose: To determine whether the best-corrected visual acuity (BCVA) is significantly correlated with the retinal nerve fiber layer thickness (RNFLT) in the different peripapillary areas in eyes with open-angle glaucoma (OAG).Patients and methods: Two hundred twenty-nine eyes of 159 patients with OAG were studied. The overall RNFLT and the RNFLT in the superior (S), temporal (T), inferior (I), and nasal (N) quadrants were measured by Stratus optical coherence tomography (OCT). In addition, the temporal RNFLT was measured for three 30&deg; sectors with the mid-temporal (mT) sector at the three or nine o&rsquo;clock position. The Spearman coefficient of correlation was calculated to determine whether a significant correlation existed between the RNFLT and the BCVA. Eyes with a BCVA &lt; 20/20 were classified as having decreased BCVA. Results: There were significant correlations between the BCVA and the overall RNFLT, and&nbsp;also between the BCVA and the RNFLT in the T, I, and S quadrants. The coefficient correlation between the BCVA and RNFLT was the highest in the mT sector (r = &minus;0.40, P &lt; 0.0001). Forty-eight eyes (21.1%) were classified as having decreased BCVA. The cut-off value of the mT sector for eyes with decreased VA was 39.0 &mu;m.Conclusion: The highest correlation between the BCVA and the RNFLT in the mT sector was most likely due to the location of the maculopapillary bundle in this region of the optic disc. Our findings indicate that when the RNFLT in the mT sector is reduced to 40 &mu;m, glaucoma treatment should be reconsidered.Keywords: retinal nerve fiber layer, low vision, peripapillary macular bundle Dove Press Kazuko Omodaka, Toru Nakazawa, Yu Yokoyama, et al 2010-06-30 PDF http://www.dovepress.com/getfile.php?fileID=6674 http://www.dovepress.com/correlation-between-peripapillary-macular-fiber-layer-thickness-and-vi-peer-reviewed-article-OPTH English

oai:dovepress.com/4727 2010-07-01 OPTH

Oculocutaneous anthrax: detection and treatment Peter, John Victor Clinical Ophthalmology Sarada David1, Jayanthi Peter1, Renu Raju2, P Padmaja2, Promila Mohanraj21Department of Ophthalmology, Schell Eye Hospital, Christian Medical College Hospital, Vellore, India; 2Department of Microbiology, Christian Medical College Hospital, Vellore, IndiaAbstract: Anthrax, a zoonotic disease that primarily affects herbivores, has received recent attention as a potential agent of bioterrorism. We report a patient who presented with a 4-day history of pain, watering and difficulty in opening the left upper and lower eyelids, and fever. Clinical examination revealed brawny nonpitting edema with serosanguinous discharge. The history of the death of his sheep 1 week prior to the illness provided the clue to the diagnosis. Although standard cultures of the blood and the serous fluid from the lesion were negative, probably as a result of prior treatment, the diagnosis of cutaneous anthrax was made by a polymerase chain reaction (PCR) test of the serous fluid. Serial photographs demonstrating resolution of the lesion with appropriate antibiotic therapy are presented.Keywords: anthrax, polymerase chain reaction, treatment Dove Press Sarada David, Jayanthi Peter, Renu Raju, et al 2010-07-01 PDF http://www.dovepress.com/getfile.php?fileID=6682 http://www.dovepress.com/oculocutaneous-anthrax-detection-and-treatment-peer-reviewed-article-OPTH English

oai:dovepress.com/4728 2010-07-01 OPTH

Palpation by blind examiners: A novel approach for glaucoma screening Gharebaghi, Reza Clinical Ophthalmology Fatemeh Heidary, Reza Gharebaghi, Roghayeh HeidaryMiddle East Cancer Institute, Tehran, IranAbstract: Although there are several risk factors for glaucoma, elevated intraocular pressure (IOP) remains the major risk factor. Palpation is one of the oldest, simplest, and least expensive methods for approximate IOP assessment. Researchers believe that blind individuals may possess a more acutely developed sense of touch, which has already proved to be beneficial in clinical breast examination to detect early breast cancer. Based on successful findings of a project that used blind and visually impaired individuals as breast examiners, we hypothesize that blind individuals may also serve as successful examiners for estimation of IOP using tactile palpation.Keywords: tactile palpation, visual impairment, blindness, intraocular pressure Dove Press Fatemeh Heidary, Reza Gharebaghi, Roghayeh Heidary 2010-07-01 PDF http://www.dovepress.com/getfile.php?fileID=6685 http://www.dovepress.com/palpation-by-blind-examiners-a-novel-approach-for-glaucoma-screening-peer-reviewed-article-OPTH English

oai:dovepress.com/4740 2010-07-01 OPTH

Ketamine versus propofol for strabismus surgery in children Erbagci, Ibrahim Clinical Ophthalmology Ayse Mizrak1, Ibrahim Erbagci2, Tulin Arici1, Ibrahim Ozcan1, Gurkan Tatar2, Unsal Oner11Anesthesiology and Reanimation, Gaziantep University School of Medicine, Gaziantep, Turkey; 2The Department of Ophthalmology, Gaziantep University School of Medicine, Gaziantep, TurkeyPurpose: To compare the effects of intravenous infusion of ketamine and propofol anesthesia in children undergoing strabismus surgery. Methods: Sixty pediatric patients aged 4&ndash;11 years were enrolled for the study. Patients in Group K were infused ketamine 1&ndash;3 mg/kg/hr (n = 30) and patients in Group P were infused with propofol6&ndash;9 mg/kg/hr (n = 30). After giving fentanyl 1 &micro;g/kg and rocuronium bromide 0.5 mg/kg, patients were intubated.Results: The consumption of anesthetics (P = 0.0001) and antiemetics (P = 0.004), the incidence of &shy;oculocardiac reflex (P = 0.02) in Group K were significantly lower than in Group P. The recovery time (P = 0.008), postoperative agitation score (P = 0.005), Face Pain Scale (P = 0.001), Ramsay Sedation Score (P = 0.01) during awakening and at postoperative 30th min (P = 0.02) in Group K were significantly lower than in Group P. The postoperative agitation score &shy;during awakening was significantly lower than the preoperative values in Group K (P = 0.0001).Conclusions: The infusion of ketamine is more advantageous than the infusion of propofol in children for use in strabismus surgery.Keywords: ketamine, propofol, pediatrics, strabismus, surgery Dove Press Ayse Mizrak, Ibrahim Erbagci, Tulin Arici, et al 2010-07-01 PDF http://www.dovepress.com/getfile.php?fileID=6913 http://www.dovepress.com/ketamine-versus-propofol-for-strabismus-surgery-in-children-peer-reviewed-article-OPTH English

oai:dovepress.com/4760 2010-07-05 OPTH

Central corneal thickness and intraocular pressure in the Cameroonian nonglaucomatous population Omgbwa Eballe, André Clinical Ophthalmology Andr&eacute; Omgbwa Eballe1, Godefroy Koki2, Augustin Ellong2, Didier Owono2, Emilienne Ep&eacute;e2, Lucienne Assumpta Bella2, C&ocirc;me Ebana Mvogo1, Jeanne Mayouego Kouam21Faculty of Medicine and Pharmaceuticals Sciences, University of Douala; 2Faculty of Medicine and Biomedical Sciences, University of Yaound&eacute;, CameroonAim: We performed a prospective, analytical study from 01 January to 31 March 2009 in the Ophthalmology Unit of the Gyneco-Obstetric and Pediatric Hospital of Yaounde, aiming to determine the profile of central corneal thickness (CCT) in the Cameroonian nonglaucomatous black population and its relationship with intraocular pressure (IOP).Results and discussion: Four hundred and eighty-five patients (970 eyes) meeting our &shy;inclusion criteria were selected for this study. The average CCT was 529.29 &plusmn; 35.9 &micro;m in the right eye (95% confidence interval [CI]: 526.09&ndash;532.49), 528.19 &plusmn; 35.9 &micro;m in the left eye (95% CI: 524.99&ndash;531.40) and 528.74 &plusmn; 35.89 &micro;m in both eyes (95% CI: 526.48&ndash;531.00), range 440 to 670 &micro;m. The average IOP was 13.01 &plusmn; 2.97 mmHg in both eyes (95% CI: 12.82&ndash;13.19). A rise in CCT by 100 &micro;m was followed by an increase in IOP of about 2.8 mmHg (95% CI: 2.3&ndash;3.6) for both eyes taken together. Linear regression analysis showed that corneal thickness was negatively correlated with age and IOP was positively related with age.Conclusion: CCT in the Cameroonian nonglaucomatous black population was found to be lower compared with CCT values in Caucasian and Asian populations. On the basis of reference values ranging between 527 and 560 &micro;m, an adjustment of IOP values by a correction factor is required for many Cameroonian patients. This will improve the diagnosis and follow-up of glaucoma by helping to detect true ocular hypertension.Keywords: central corneal thickness, intraocular pressure, Cameroon Dove Press Andr&eacute; Omgbwa Eballe, Godefroy Koki, Augustin Ellong, et al 2010-07-05 PDF http://www.dovepress.com/getfile.php?fileID=6747 http://www.dovepress.com/central-corneal-thickness-and-intraocular-pressure-in-the-cameroonian--peer-reviewed-article-OPTH English

oai:dovepress.com/4780 2010-07-07 OPTH

Age-related changes of ocular parameters in Korean subjects Lee, Dae Clinical Ophthalmology Dae Woong Lee1, Joon Mo Kim1, Chul Young Choi1, Donghun Shin2, Ki Ho Park3, Jung Gon Cho41Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea; 2School of Medicine, University of Queensland, Brisbane, Queensland, Australia; 3Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; 4Yebon Eye Clinic, Seoul, KoreaAims: To evaluate the age-related variations of ocular parameters in Korean subjects.Methods: We recruited 314 normal subjects who visited the department of &shy;Ophthalmology between January 2007 and October 2007. Refraction, axial length, corneal curvature, white-to-white distance, anterior chamber depth, corneal endothelial cell density, and retinal nerve fiber layer (RNFL) thickness were measured using auto-refractive keratometer, intraocular lens master, noncontact specular microscope, and optical coherence tomography.Result: In correlation analysis, from 19 to 82 years, hyperopic shift showed a strong positive statistical correlation with age (r = 0.553, P &lt; 0.001). Corneal curvatures increased (r = 0.221, P &lt; 0.001), while axial length (r = -0.506, P &lt; 0.001), anterior chamber depth (r = -0.491, P &lt; 0.001) and white-to-white distance (r = -0.205, P &lt; 0.001) decreased with age. Also, &shy;corneal endothelial cell density was lower in older patients than in younger patients (r = -0.409, P &lt; 0.001). Compared to younger patients, RNFL thickness was lower in the older patients as well, in all quadrants (superior, r = -0.283, P &lt; 0.001; inferior, r = -0.230, P &lt; 0.001; nasal, r = 0.025, P = 0.676; and temporal, r = -0.393, P &lt; 0.001). According to multiple regression analysis, out of the six parameters measured, only hyperopic shift, anterior chamber depth and corneal endothelial cell density (P &lt; 0.05) had statistically significant &shy;correlation with age.Conclusion: Some of the ocular parameters changed with aging. Hyperopic shift, shallowing anterior chamber depth, and reduction of corneal endothelial cell density were only definitely related to age.Keywords: corneal endothelial cell density, hyperopic, corneal curvatures, axial length, anterior chamber depth Dove Press Dae Woong Lee, Joon Mo Kim, Chul Young Choi, et al 2010-07-07 PDF http://www.dovepress.com/getfile.php?fileID=6791 http://www.dovepress.com/age-related-changes-of-ocular-parameters-in-korean-subjects-peer-reviewed-article-OPTH English

oai:dovepress.com/4812 2010-07-09 OPTH

Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension McCluskey, Clinical Ophthalmology Anne J Lee1,2, Peter McCluskey2,31Manchester Royal Eye Hospital, Manchester, UK; 2University of Sydney, Sydney, Australia; 3Sydney Eye Hospital, Sydney, AustraliaAbstract: Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents available for the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004% are prodrugs and analogs of prostaglandin F2a. Bimatoprost 0.03% is regarded as a prostamide, and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP by enhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation and remodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-lowering superiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine 0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOP-lowering compared with latanoprost, with weighted mean difference in IOP reduction documented in one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOP further when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprost formulated with timolol 0.5% and administered once daily are superior to monotherapy of its constituent parts. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. The adverse effects of PGA, and also those found more frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocular pigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administration and near absence of systemic side effects enhances tolerance and compliance. PGAs are often prescribed as first-line treatment for ocular hypertension and open-angle glaucoma.Keywords: prostaglandin analog, glaucoma, ocular hypertension, latanoprost, bimatoprost, travoprost Dove Press Anne J Lee, Peter McCluskey 2010-07-09 PDF http://www.dovepress.com/getfile.php?fileID=6870 http://www.dovepress.com/clinical-utility-and-differential-effects-of-prostaglandin-analogs-in--peer-reviewed-article-OPTH English

oai:dovepress.com/4824 2010-07-14 OPTH

Assessment of macular function by multifocal electroretinography following epiretinal membrane surgery with internal limiting membrane peeling Lim, JiWon Clinical Ophthalmology Ji Won Lim, Joon Hee Cho, Ha Kyoung KimDepartment of Ophthalmology, Hallym University Sacred Heart Hospital, Chuncheon, Republic of KoreaAbstract: The aim of the current study was to evaluate macular function before and after surgery for idiopathic epiretinal membranes with internal limiting membrane (ILM) peeling by means of multifocal electroretinography (ERG). Eighteen eyes of 18 patients who underwent vitrectomy with ILM removal were included. Best corrected visual acuity, optical coherence tomography (OCT), and multifocal electroretinography were assessed prior to surgery, and 3 and 12 months after surgery. All surgical samples were obtained and confirmed inclusion of an ILM by electron microscopy. Visual acuity and the central foveal thickness by OCT improved significantly 3 months postoperatively, with gradual recovery by 12 months. Preoperatively, only the P1 amplitude in rings 1 and 2 were decreased compared with the normal fellow eyes (P &lt; 0.01). Three and 12 months after surgery, the P1 amplitude in rings 1 and 2 were decreased compared with the preoperative P1 amplitudes, but without significance. The photoreceptor status by OCT was related to the N1 amplitude before and after surgery. Although visual acuity and macular edema were improved after surgery, macular function, as indicated by multifocal ERG, had limited recovery at 12 months.Keywords: epiretinal membrane, macular function, multifocal electroretinography Dove Press Ji Won Lim, Joon Hee Cho, Ha Kyoung Kim 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6894 http://www.dovepress.com/assessment-of-macular-function-by-multifocal-electroretinography-follo-peer-reviewed-article-OPTH English

oai:dovepress.com/4825 2010-07-14 OPTH

Treatment of keratoectasia after LASIK by intrastromal corneal ring segments in two patients who had no preoperative risk factors Tomita, Minoru Clinical Ophthalmology Minoru Tomita, Naoko Inoue, Tadahiko TsuruShinagawa LASIK Center, Tokyo, JapanPurpose: To report on keratoectasia after laser in situ keratomileusis (LASIK) in two eyes of two patients who had no obvious preoperative risk factors, and treatment of keratoectasia by intrastromal corneal ring segments.Method: Clinical interventional case report.Results: Two patients underwent LASIK in both eyes at Shinagawa LASIK center, Tokyo. Preoperative standard ophthalmological examinations demonstrated no specific risk factors of keratoectasia. However, each eye of the two patients developed keratoectasia as defined by corneal topography. Treatment for keratoectasia was performed by inserting intrastromal corneal ring segments (ICRS) in the affected eyes. In one eye, KeraRing (MEDIPHACOS, Ltd, Brazil) was inserted, and Intacs SK (Addition Technology Inc, USA) was inserted in the other.Conclusion: Even in eyes where no risk factors for keratoectasia were found following thorough preoperative examinations, keratoectasia could develop after LASIK. ICRS could be effective for the treatment of keratoectasia after LASIK.Keywords: keratoectasia, LASIK, intrastromal corneal ring segments Dove Press Minoru Tomita, Naoko Inoue, Tadahiko Tsuru 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6896 http://www.dovepress.com/treatment-of-keratoectasia-after-lasik-by-intrastromal-corneal-ring-se-peer-reviewed-article-OPTH English

oai:dovepress.com/4826 2010-07-14 OPTH

Monozygotic twins with polypoidal choroidal vasuculopathy Machida, Shigeki Clinical Ophthalmology Shigeki Machida1, Tomomi Takahashi1, Norimoto Gotoh2, Nagahisa Yoshimura2, Takamitsu Fujiwara1, Dajiro Kurosaka11Department of Ophthalmology, Iwate Medical University School of Medicine, 2Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of MedicinePurpose: To present the first findings in the set of monozygotic twins with polypoidal &shy;choroidopathy (PCV).Methods: Sixty two-year old monozygotic twin sisters were studied. The concordances and discordances of the clinical features of the twins were determined. Genomic DNA was extracted and genotyped for three established PCV risk-associated single nucleotide polymorphisms, viz CFH I62V, CFH Y402H, and ARMS A69S.Results: Both patients had hemorrhagic pigment epithelial detachments with orange lesions beneath the retinal pigment epithelium. Indocyanine green angiography showed pathognomonic choroidal vascular networks with polypoidal structures uniocularly in one twin and binocularly in the other twin. Both twins were treated with photodynamic therapy, retinal photocoagulation, and anti-vascular endothelial growth factor therapy, but both showed limited response to all the treatments, with recurrent exudative lesions with enlarged vascular network, and poor visual outcome. Genetic analyses showed that both sisters had homozygous risk alleles for ARMS2 A69S, and one risk allele each of CFH I62V and CFH Y402H.Conclusions: We present the first findings in a set of monozygotic twins with typical PCV under long-term observation. The concordances in disease progression and response to &shy;treatment between the twins indicate that these genetic factors most likely played important roles in determining the clinical manifestations.Keywords: polypoidal choroidal vasculopathy, PCV, CFH, ARMS2, monozygotic twins Dove Press Shigeki Machida, Tomomi Takahashi, Norimoto Gotoh, et al 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6898 http://www.dovepress.com/monozygotic-twins-with-polypoidal-choroidal-vasuculopathy-peer-reviewed-article-OPTH English

oai:dovepress.com/4828 2010-07-14 OPTH

Electroretinographic findings in transplant chorioretinopathy Lauer, Andreas Clinical Ophthalmology Brian T Chan-Kai1, Steven Yeh2, Richard G Weleber2, Peter J Francis2, Grazyna Adamus2, S Robert Witherspoon3, Andreas K Lauer11Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; 2Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; 3Retina Institute of Texas, Dallas, Texas, USAAim: Transplant chorioretinopathy is a rare complication following solid organ or bone &shy;marrow transplantation and can result in severe vision loss. This series presents electroretinogram (ERG) results in patients with this condition.Methods: Patients who presented with bilateral vision loss following bone marrow or solid organ transplantation were identified. A complete ophthalmologic examination, fundus &shy;photography, and fluorescein angiography (FA) were performed. Full-field ERG was obtained in all patients and a multifocal ERG (mfERG) was obtained in two patients.Results: Four patients were identified. All patients had bilateral vision loss and displayed a characteristic pattern of mottled hyperfluorescence on FA. Three patients developed &shy;progressive vision loss ranging from 20/60 to hand motions whereas one retained 20/40 vision. All patients exhibited moderate to severe cone dysfunction, while the degree of rod abnormalities was varied. Two patients with severe cone dysfunction showed mild clinical changes initially, but later developed progressive vision loss and chorioretinal atrophy.Conclusion: Transplant chorioretinopathy patients undergoing ERG testing show cone &shy;dysfunction with a variable degree of rod dysfunction. ERG abnormalities preceded the visual acuity and clinical changes in two patients, suggesting that ERG may be a helpful predictor of the clinical course in this rare disease.Keywords: transplant, chorioretinopathy, electroretinogram, ERG, mfERG Dove Press Brian T Chan-Kai, Steven Yeh, Richard G Weleber, et al 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6902 http://www.dovepress.com/electroretinographic-findings-in-transplant-chorioretinopathy-peer-reviewed-article-OPTH English

oai:dovepress.com/4829 2010-07-14 OPTH

Correlation between morphology of optic disc determined by Heidelberg Retina Tomograph II and visual function in eyes with open-angle glaucoma Nakazawa, Toru Clinical Ophthalmology Kazuko Omodaka, Toru Nakazawa, Takaaki Otomo, Masahiko Nakamura, Nobuo Fuse, Kohji NishidaDepartment of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanPatients and Methods: One hundred and three eyes of 76 patients with OAG were studied. The baseline optic disc morphology was used to classify the eyes into four types: focal ischemic type (FI), myopic glaucomatous type (MY), senile sclerotic type (SS), and generalized enlargement type (GE). The morphological parameters of the disc were determined by the Heidelberg Retina Tomograph II (HRT-II) and the visual function by the mean deviation (MD) of the Humphrey field analyzer.Results: Fourteen eyes were classified as the FI type; 52 as the MY type; 17 as the SS type; and 20 as the GE type. The highest correlation coefficients of HRT-II parameters to the MDs was the cup/disc area ratio (r&nbsp;= -0.27) for all groups, the vertical cup/disc ratio (r&nbsp;= -0.42) in the MY group, the maximum cup depth (r&nbsp;= 0.49) in the SS group, and the cup area (r&nbsp;= -0.70) in the GE group. However, none of the parameters was correlated in the FI group.Conclusions: The correlation between the HRT-II parameters and MDs was different for the four disc types. These findings suggest that a classification of optic disc morphology had a benefit for interpreting the measured values of HRT-II.Keywords: open angle glaucoma, optic disc morphology, classification, visual function Dove Press Kazuko Omodaka, Toru Nakazawa, Takaaki Otomo, et al 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6904 http://www.dovepress.com/correlation-between-morphology-of-optic-disc-determined-by-heidelberg--peer-reviewed-article-OPTH English

oai:dovepress.com/4831 2010-07-14 OPTH

Case of endophthalmitis following intravitreal injections of bevacizumab Sawada, A Clinical Ophthalmology Shinya Komori1, Akira Sawada1, Tsutomu Oguni1, Kiyofumi Mochizuki1, Kiyofumi Ohkusu21Department of Ophthalmology, 2Department of Microbiology, Gifu University Graduate School of Medicine, Gifu, JapanPurpose: We report a case of infectious endophthalmitis that developed after the third intravitreal injection of bevacizumab. The endophthalmitis was caused by Staphylococcus epidermidis.Methods: Observational case series.Results: This was a case of a 77-year-old man who had received three intravitreal injections of bevacizumab and developed infectious endophthalmitis. Polymerase chain reaction of an aqueous humor sample showed that the endophthalmitis was caused by S. epidermidis. The patient received intravitreal ceftazidime and vancomycin, and subconjunctival injection of vancomycin. After the intravitreal injections he was treated with topical levofloxacin and cefmenoxime hydrochloride, and intravenous cefpirome. Subsequently, the ocular inflammation gradually decreased and his visual acuity remained at 30/200.Conclusions: Our findings indicate that endophthalmitis can develop after intravitreal bevacizumab injections. Polymerase chain reaction is useful for differentiation from sterile endophthalmitis.Keywords: endophthalmitis, bevacizumab, Staphylococcus, antibiotics Dove Press Shinya Komori, Akira Sawada, Tsutomu Oguni, et al 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6910 http://www.dovepress.com/case-of-endophthalmitis-following-intravitreal-injections-of-bevacizum-peer-reviewed-article-OPTH English

oai:dovepress.com/4847 2010-07-14 OPTH

Crystallization after intravitreal ganciclovir injection Choopong, Pitipol Clinical Ophthalmology Pitipol Choopong, Nattaporn Tesavibul, Nattawut RodanantDepartment of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: To report crystal formation as a complication of intravitreal ganciclovir injection.Patients and methods: A 73-year-old female patient with unilateral cytomegalovirus retinitis was treated with intravitreous ganciclovir (4 mg/0.04 mL).Results: After the intravitreal injection, sudden crystallization was observed in the vitreous. The patient experienced marked reduction in visual acuity and increased intraocular pressure. Despite aqueous paracenthesis and pars plana vitrectomy, optic atrophy was observed and her visual acuity remained unimproved after 12 months.Conclusion: Crystal formation can occur as a complication of intravitreal ganciclovir injection. Associated retinal and optic nerve damage was found which results in permanent visual morbidity.Keywords: ganciclovir, intravitreal injection, intraocular, CMV, toxicity Dove Press Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant 2010-07-14 PDF http://www.dovepress.com/getfile.php?fileID=6943 http://www.dovepress.com/crystallization-after-intravitreal-ganciclovir-injection-peer-reviewed-article-OPTH English

oai:dovepress.com/4867 2010-07-16 OPTH

Retinal vein occlusion: pathophysiology and treatment options Karia, Niral Clinical Ophthalmology Niral KariaDepartment of Ophthalmology, Southend Hospital, Prittlewell Chase, Westcliff on Sea, Essex, United KingdomAbstract: This paper reviews the current thinking about retinal vein occlusion. It gives an overview of its pathophysiology and discusses the evidence behind the various established and emerging treatment paradigms.Keywords: central, hemispheric, branch, retinal vein occlusion, visual loss Dove Press Niral Karia 2010-07-16 PDF http://www.dovepress.com/getfile.php?fileID=6983 http://www.dovepress.com/retinal-vein-occlusion-pathophysiology-and-treatment-options-peer-reviewed-article-OPTH English

oai:dovepress.com/4868 2010-07-16 OPTH

5-Fluorouracil for the treatment of intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and cornea Al-Barrag, A Clinical Ophthalmology Abdulmoghni Al-Barrag1, Mutahar Al-Shaer1, Nabil Al-Matary2, Mohammed Al-Hamdani21Ophthalmic Department, Faculty of Medicine and Health Sciences, Sana&rsquo;a University, Sana&rsquo;a, Republic of Yemen; 2Ophthalmic Department, Military Hospital, Sana&rsquo;a, Republic of YemenObjective: To evaluate the efficacy and risks of complications of pulse dosing of topical 5-fluorouracil (5-FU) in the treatment of corneal intraepithelial neoplasia (CIN), and conjunctival squamous cell carcinoma (SCC). Design: Prospective, noncomparative case series. Participants: Fifteen patients with histological evidence CIN or SCC of the conjunctiva and cornea were identified by tumor biopsy. Methods: All patients clinically evident of CIN, or SCC were evaluated, with maximum 30 months of follow-up were treated with pulsed dosing of 1% 5-FU. Treatment cycles were defined as four times per day for 4 days using the medication followed by 30 days without medication. The number of initial treatment was six cycles. Results: The mean age of the 15 patients was 50.8 years (range 25&ndash;78 years). Excision biopsy proved seven cases as CIN, and eight cases as locally invasive SCC. All patients remained disease free with a mean follow-up of 14.53 months (range 6-30 months). Additional chemotherapy was given after the initial treatment cycles, only for one case. 5-FU caused mild temporary local irritation, but no long-term intraocular or extra ocular complications. Conclusions: Adjuvant 1% topical 5-FU appears to be effective in the prevention of recurrence of conjunctival or corneal CIN and SCC after excision biopsy. Our results indicate that at least six cycles of topical 1% 5-FU is required to prevent local recurrence in the long term. It is well-tolerated and an effective method of treatment. No complications that would preclude use of our dose regimen were noted.Keywords: chemotherapy, fluorouracil, neoplasia, treatment cycles Dove Press Abdulmoghni Al-Barrag, Mutahar Al-Shaer, Nabil Al-Matary, et al 2010-07-16 PDF http://www.dovepress.com/getfile.php?fileID=6985 http://www.dovepress.com/5-fluorouracil-for-the-treatment-of-intraepithelial-neoplasia-and-squa-peer-reviewed-article-OPTH English

oai:dovepress.com/4870 2010-07-16 OPTH

The significance of the determination of lymphocytes with clinical manifestation of ophthalmic zoster sine herpete Marumoto, Tatsuya Clinical Ophthalmology Tatsuya Marumoto1, Yoshimune Hiratsuka2,3, Akira Murakami21Marumoto Eye Clinic, Yokohama, Japan; 2Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan; 3Department of Management Sciences, National Institute of Public Health, Wako, JapanObjective: To examine the significance of VZV-IgG (IgG) enzyme immunoassay (EIA) and the determination of peripheral blood lymphocyte counts in the diagnosis of ophthalmic zoster sine herpete (ophthalmic ZSH).Method: Clinical case-control study with a sample of 65 patients with ophthalmic ZSH (16 males and 49 females; mean age 56 &plusmn; 18 years) in whom pressure elicited pain in tender points of Valleix (tender points of sites at which the trigeminal nerve appears subcutaneously). A total of 41 healthy controls (17 males and 24 females, mean age 48 &plusmn; 21 years) were also recruited. In each group, IgG and lymphocyte count were determined upon receiving the consent of patients. Multiple logistic regression analysis was used to evaluate the factors associated with diagnosis of ophthalmic ZSH. Odds ratios and 95% confidence intervals (CI) were determined for each variable.Results: Lymphocyte count in the patients with ophthalmic ZSH was significantly low, though there were no significant differences in age, gender, and IgG between the two groups. Multiple logistic regression analysis revealed that lymphocytes pose a significant prognostic factor, and in case of 1,800 lymphocytes/&micro;l or more, the odds ratio to less than1,800 lymphocytes/&micro;l was 0.29 (95% CI: 0.12&ndash;0.72).Conclusion: Patients with orbital pain should be suspected as having ophthalmic ZSH as this allows for the determination of lymphocyte counts after tender points were confirmed. The swift diagnosis of ophthalmic ZSH and the administration of antiviral drugs from an early stage improve the subjective symptoms of the patient and is regarded as necessary to reduce the risk of severe complications.Keywords: ophthalmic ZSH, lymphocytes count, VZV-IgG, tender points of Valleix, orbital pain, antiviral drugs Dove Press Tatsuya Marumoto, Yoshimune Hiratsuka, Akira Murakami 2010-07-16 PDF http://www.dovepress.com/getfile.php?fileID=6990 http://www.dovepress.com/the-significance-of-the-determination-of-lymphocytes-with-clinical-man-peer-reviewed-article-OPTH English

oai:dovepress.com/4874 2010-07-19 OPTH

Kyrieleis&acute; vasculitis in acute retinal necrosis Diaz-Llopis, M Clinical Ophthalmology Ester Franc&eacute;s-Mu&ntilde;oz1, Roberto Gallego-Pinazo1, Ruth L&oacute;pez-Lizcano1, Salvador Garc&iacute;a-Delpech1, J Luis Mullor3, Manuel D&iacute;az-Llopis1,21Department of Ophthalmology, Hospital La Fe, Valencia, Spain; 2University of Valencia, Valencia, Spain; 3Unit of Experimental Ophthalmology. Fundaci&oacute;n para la Investigaci&oacute;n del Hospital Universitario La Fe. Valencia, Valencia, SpainAbstract: We report the first case in the literature of Kyrieleis&acute; vasculitis related to acute retinal necrosis by Varicella zoster virus in a 76-year-old woman with bilateral involvement. In our patient the arterial lesions appeared 15 days after the initial presentation.Keywords: Kyrieleis&acute; vasculitis, retinal necrosis, herpes virus Dove Press Ester Franc&eacute;s-Mu&ntilde;oz, Roberto Gallego-Pinazo, Ruth L&oacute;pez-Lizcano, et al 2010-07-19 PDF http://www.dovepress.com/getfile.php?fileID=6999 http://www.dovepress.com/kyrieleisacute-vasculitis-in-acute-retinal-necrosis-peer-reviewed-article-OPTH English

oai:dovepress.com/4875 2010-07-20 OPTH

Correlation between the matrix metalloproteinase-9 activity and chondroitin sulfate concentrations in tear fluid after laser in situ keratomileusis Mutoh, Tetsuya Clinical Ophthalmology Tetsuya Mutoh, Masaya Nishio, Yukihiro Matsumoto, Kiyomi Arai Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, JapanAims: The aim of the present study was to evaluate the correlation between matrix &shy;metalloproteinase-9 (MMP-9) and chondroitin sulfate (CS) concentrations in human tear fluid following laser in situ keratomileusis (LASIK).Methods: Twelve eyes from six patients who had no ocular complaints except for &shy;refractive errors, and who had undergone LASIK, were enrolled in this study. We measured the &shy;concentrations of chondroitin 4 sulfate (C4S), chondroitin 6 sulfate (C6S), and MMP-9 activity with an enzyme-linked immunosorbent assay and an enzyme immunocapture activity assay preoperatively and postoperatively on days 1 and 4, week 1, and at 1 and 3 months.Results: Although the preoperative MMP-9 activity and the C4S concentration were highly correlated (r = 0.900; P &lt; 0.001), they were not postoperatively correlated at month 1. Although the preoperative MMP-9 activity and the C6S concentration were highly &shy;correlated (r = 0.885; P &lt; 0.001), they were not postoperatively correlated at either week 1 or months 1 and 3.Conclusions: The correlation appeared to be collapsed by LASIK, and it did not recover to the preoperative score at 3 months post-surgery. Our study indicates that the corneal wound healing was not terminated at 3 months following LASIK.Keywords: preoperative correlation, postoperative correlation, wound healing, refractive errors, human cornea Dove Press Tetsuya Mutoh, Masaya Nishio, Yukihiro Matsumoto, et al 2010-07-20 PDF http://www.dovepress.com/getfile.php?fileID=7001 http://www.dovepress.com/correlation-between-the-matrix-metalloproteinase-9-activity-and-chondr-peer-reviewed-article-OPTH English

oai:dovepress.com/4879 2010-07-20 OPTH

Measurement of treatment compliance using a medical device for glaucoma patients associated with intraocular pressure control: a survey Berdeaux, Gilles Clinical Ophthalmology Jean-Philippe Nordmann1, Christophe Baudouin1, Jean-Paul Renard2, Philippe Denis3, Antoine Lafuma4, Caroline Laurendeau4, Viviane Jeanbat4, Gilles Berdeaux5,61H&ocirc;pital des Quinzes-Vingt, Paris, France; 2H&ocirc;pital du Val de Gr&acirc;ce, Paris, France; 3H&ocirc;pital Edouard Herriot, Lyon, France; 4Cemka, Bourg-la-Reine, France; 5Alcon France, Rueil-Malmaison, France; 6Conservatoire National des Arts et M&eacute;tiers, Paris, FranceObjective: To identify and characterize treatment compliance profiles of glaucoma patients and evaluate the association with intraocular pressure (IOP).Methods: A computerized device (Travalert&reg;) that recorded daily instillation times and eye-drop counts was given for 3 months. Patients were declared compliant when at least 2 drops were instilled per day. Compliance rates were calculated for weekdays and weekends, separately, over 8 consecutive weeks. A principal components analysis (PCA) was followed by an ascendant hierarchical classification (AHC) to identify compliance groups.Results: 140 patients were recruited (mean age 65.5 years; 51.8% female) of whom 83.6% had primary open-angle glaucoma with mean IOP 23.9 mmHg before Travalert&reg; use. 60.7% were treated with DuoTrav&reg; (travoprost timolol fixed combination) and 39.3% with &shy;travoprost. The PCA identified two axes (compliance and treatment weeks). The AHC identified 3 &shy;compliance groups: &lsquo;high&rsquo; (56.6%, approx. 80% compliance), &lsquo;medium&rsquo; (21.2%, approx. 50% compliance), and &lsquo;low&rsquo; (22.1%, approx. 20% compliance). Demographics and glaucoma parameters did not predict low compliance. Final mean IOP was 16.1 mmHg, but higher in the low compliance group (17.7 mmHg, P = 0.02).Conclusions: Compliance measurement by a medical device showed compliance rates &lt;80% by 50% (approx.) of patients, significantly impacting IOP control. No demographic or glaucoma variable was associated with low compliance.Keywords: glaucoma, compliance, efficacy, intraocular pressure control Dove Press Jean-Philippe Nordmann, Christophe Baudouin, Jean-Paul Renard, et al 2010-07-20 PDF http://www.dovepress.com/getfile.php?fileID=7010 http://www.dovepress.com/measurement-of-treatment-compliance-using-a-medical-device-for-glaucom-peer-reviewed-article-OPTH English

oai:dovepress.com/4886 2010-07-21 OPTH

Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap) Kernt, Marcus Clinical Ophthalmology Marcus Kernt, Ulrich C Schaller, Carmen Stumpf, Michael W Ulbig, Anselm Kampik, Aljoscha S NeubauerDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, GermanyPurpose: Clinical differentiation of choroidal pigmented lesions is sometimes difficult. &shy;Choroidal melanoma is the most prevalent primary neoplasia among malignant ocular tumors, and metastasis often occurs before the primary tumor is diagnosed. Therefore, early detection is essential. We investigated the imaging properties of clinically diagnosed melanocytic choroidal tumors using a nonmydriatic ultra-wide-field scanning laser ophthalmoscope (SLO) with two laser wavelengths to distinguish benign from malignant lesions. Repeated standardized ultrasound (US) evaluation provided reference standard.Methods: In a consecutive series of 49 patients with clinically diagnosed melanocytic &shy;choroidal tumors in one eye, 29 had established melanoma (defined by proven growth on repeated US follow-up) and 20 had nevi (defined by no malignancy according to clinical, US, and growth &shy;characteristics for at least 2 years). All patients underwent clinical examination, undilated Optomap? (Optos PLC, Dunfermline, Fife, Scotland, UK) imaging, standardized US &shy;examination, and standard retinal photography. Measurements of the tumor base using the Optomap software were compared with US B-scan measurements. Imaging characteristics from the SLO images were correlated with the structural findings in the two patient groups.Results: Measurements of tumor base correlated well between SLO and US with r = 0.61 (T-direction) and r = 0.51 (L-direction). On SLO imaging, typical malignant lesions appeared dark on the red laser channel and bright on the green laser channel. Based on those simple binary characteristics, a sensitivity of 76% at a specificity of 70% was obtained for a correct classification of lesions. When analogous to clinical examination lesion size, margin touching the optic disc, and existence of subretinal fluid were additionally considered, 90% sensitivity at 82% specificity was obtained.Conclusions: In this first, limited series, nonmydriatic SLO imaging with two laser wavelengths permitted to differentiate malignant ocular tumors from nonmalignant lesions with high &shy;diagnostic accuracy. Additional parameters may further enhance diagnostic properties, but larger patient series are required to validate our findings and prove the diagnostic properties.Keywords: choroidal melanoma, nevus, imaging, ultra-wide-field scanning laser ophthal&shy;moscopy Dove Press Marcus Kernt, Ulrich C Schaller, Carmen Stumpf, et al 2010-07-21 PDF http://www.dovepress.com/getfile.php?fileID=7025 http://www.dovepress.com/choroidal-pigmented-lesions-imaged-by-ultra-wide-field-scanning-laser--peer-reviewed-article-OPTH English

oai:dovepress.com/4902 2010-07-23 OPTH

Effect of travoprost on 24-hour intraocular pressure in normal tension glaucoma Nakakura, Shunsuke Clinical Ophthalmology Yuya Nomura1, Shunsuke Nakakura2, Mitsuyasu Moriwaki1, Yasuhiro Takahashi1, Kunihiko Shiraki11Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Japan; 2Department of Ophthalmology, Saiseikai Gose Hospital, JapanPurpose: The effect of travoprost 0.004% on 24-hour intraocular pressure (IOP) was examined in patients with normal tension glaucoma (NTG).Subjects and methods: This study included 17 patients with newly diagnosed unilateral NTG. IOP was measured at three-hour intervals over 24 hours by Goldman applanation tonometer in patients taking topical travoprost 0.004% and was compared retrospectively with 24-hour IOP data in untreated eyes.Results: IOP values were significantly reduced at individual time points after treatment (P &lt; 0.01). Mean 24-hour IOP, maximum 24-hour IOP, minimum 24-hour IOP, and 24-hour IOP fluctuations at baseline (mean &plusmn; SD) were 12.9 &plusmn; 2.2 mmHg, 15.4 &plusmn; 2.7 mmHg, 10.5 &plusmn; 2.2 mmHg, and 4.9 &plusmn; 1.2 mmHg, respectively, and were significantly reduced to 10.3 &plusmn; 2.0 mmHg, 12.4 &plusmn; 2.5 mmHg, 8.5 &plusmn; 1.9 mmHg (all P &lt; 0.001), and 3.9 &plusmn; 1.5 mmHg (P &lt; 0.05), respectively, after treatment. The rate of IOP reduction greater than 20% was 58.8% (10 eyes) for maximum 24-hour IOP and 53.0% (nine eyes) for mean 24-hour IOP.Conclusion: Travoprost reduced IOP throughout the 24-hour study period, with over half of the eyes examined showing IOP reduction exceeding 20%.Keywords: 24-hour intraocular pressure, fluctuation, normal tension glaucoma, travoprost, Travatan Z Dove Press Yuya Nomura, Shunsuke Nakakura, Mitsuyasu Moriwaki, et al 2010-07-23 PDF http://www.dovepress.com/getfile.php?fileID=7057 http://www.dovepress.com/effect-of-travoprost-on-24-hour-intraocular-pressure-in-normal-tension-peer-reviewed-article-OPTH English

oai:dovepress.com/4904 2010-07-23 OPTH

Efficacy of amniotic membrane-assisted bleb revision for elevated intraocular pressure after filtering surgery Kiuchi, Yoshiaki Clinical Ophthalmology Yoshiaki Kiuchi1, Masahide Yanagi1, Takao Nakamura21Department of Ophthalmology and Visual Sciences, Hiroshima University, Hiroshima, 2Department of Ophthalmology, Otemae Hospital, Osaka, JapanPurpose: To compare the effectiveness of standard revision surgery using mitomycin C (MMC) with revision using amniotic membrane transplantation and MMC for elevated intraocular pressure (IOP) after trabeculectomy.Patients and methods: A retrospective, nonrandomized comparative study of 36 eyes of 36 patients with a failed trabeculectomy. Patients were divided into two groups, ie, a nonamnion-transplanted group and an amnion-transplanted group. The amniotic membrane was placed on the scleral flap under the conjunctiva in the amnion-transplanted group. Both groups recovered filtration of aqueous humor from the surgical site with the adjunctive use of MMC. The changes in IOP and cumulative survival rate were compared for the two groups. Success was defined as a 30% reduction in IOP from the preoperative IOP and maintenance below 21 mmHg with or without the use of antiglaucomatous agents.Results: The mean preoperative IOP was not significantly different in the two groups. The mean postoperative IOP in the nonamnion group, 12.1 &plusmn; 5.5 mmHg, was significantly lower than the IOP in the amnion group, 16.0 &plusmn; 3.7 mmHg. Survival curves in the two groups did not reach significantly different levels.Conclusions: Conventional surgical bleb revision with MMC can significantly reduce the elevated IOP associated with a failed filtration bleb. The use of an amniotic membrane transplant did not improve the surgical outcome in our cases.Keywords: filtration bleb revision, amniotic membrane, mitomycin C, filtering surgery Dove Press Yoshiaki Kiuchi, Masahide Yanagi, Takao Nakamura 2010-07-23 PDF http://www.dovepress.com/getfile.php?fileID=7061 http://www.dovepress.com/efficacy-of-amniotic-membrane-assisted-bleb-revision-for-elevated-intr-peer-reviewed-article-OPTH English

oai:dovepress.com/4910 2010-07-26 OPTH

Multifocal visual evoked potentials in amblyopia due to anisometropia Moschos, Marilita Clinical Ophthalmology MM Moschos, I Margetis, S Tsapakis, G Panagakis, IK Chatzistephanou, E IliakisDepartment of Ophthalmology, University of Athens, GreecePurpose: To investigate multifocal visual evoked potentials (mfVEP) of the amblyopic and fellow eye in amblyopia due to anisometropia.Methods: We recorded mfVEP in both eyes of 15 anisometropic amblyopic patients and 15 normal control subjects. The responses from the central 7.0&deg; arc of the visual field were measured, and changes in latency and amplitude were compared between the amblyopic, fellow, and normal control eyes.Results: There was a significant difference in the latency and amplitude of mfVEP between the amblyopic and fellow eyes. The responses in the central region of the visual field (rings 1 and 2) had a longer latency and smaller amplitude in the amblyopic eye. In contrast, there was no difference in mfVEP latency or amplitude between the fellow eye and normal control eyes.Conclusion: These results suggest that mfVEP may be used as an alternative objective method for diagnosis and monitoring of anisometropic amblyopia.Keywords: amblyopia, anisometropia, multifocal visual evoked potentials Dove Press MM Moschos, I Margetis, S Tsapakis, et al 2010-07-26 PDF http://www.dovepress.com/getfile.php?fileID=7075 http://www.dovepress.com/multifocal-visual-evoked-potentials-in-amblyopia-due-to-anisometropia-peer-reviewed-article-OPTH English

oai:dovepress.com/4919 2010-07-28 OPTH

Beals&ndash;Hecht syndrome and choroidal neovascularization Diaz-Llopis, M Clinical Ophthalmology Roberto Gallego-Pinazo1, Ruth L&oacute;pez-Lizcano1, Jos&eacute; Mar&iacute;a Mill&aacute;n2,3, J Fernando Arevalo5, J Luis Mullor6, Manuel D&iacute;az-Llopis1,3,41Department of Ophthalmology, 2Department of Genetics, Unit of Experimental Opthalmology, Hospital Universitario La Fe, Valencia, Spain; 3Centro de Investigaci&oacute;n Biom&eacute;dica en Red de Enfermedades Raras (CIBERER), Valencia, Spain; 4Faculty of Medicine, University of Valencia, Valencia, Spain; 5Retina and Vitreous Service, Cl&iacute;nica Oftalmol&oacute;gica Centro Caracas, Caracas, Venezuela; 6Unit of Experimental Opthalmology, Fundaci&oacute;n Parala Investigaci&oacute;n del Hospital La Fe, Valencia, SpainPurpose: To describe a case of choroidal neovascularization (CNV) in a female diagnosed with Beals&ndash;Hecht syndrome.Methods: A retrospective, interventional case is described in a 26-year-old female complaining of metamorphopsia and visual loss in her left eye (counting fingers). The fluorescein angiogram and the optical coherence tomography supported the diagnosis of CNV. Intravitreal ranibizumab was administered.Results: After the third intravitreal ranibizumab, her visual acuity improved to 0.8 and the morphology of the macular area was restored.Conclusions: To our knowledge this is the first report of CNV in Beals&ndash;Hecht syndrome treated with ranibizumab. Self-monitoring by periodically performing Amsler grid test is strongly recommended in these patients in order to achieve an early diagnosis of eventual CNV and avoid visual acuity loss.Keywords: Beals&ndash;Hecht syndrome, connective tissue disease, choroidal neovascularization, ranibizumab Dove Press Roberto Gallego-Pinazo, Ruth L&oacute;pez-Lizcano, Jos&eacute; Mar&iacute;a Mill&aacute;n, et al 2010-07-28 PDF http://www.dovepress.com/getfile.php?fileID=7094 http://www.dovepress.com/bealsndashhecht-syndrome-and-choroidal-neovascularization-peer-reviewed-article-OPTH English

oai:dovepress.com/4932 2010-07-28 OPTH

Efficacy and patient tolerability of travoprost BAK-free solution in patients with open-angle glaucoma and ocular hypertension Mirza , Sophia Clinical Ophthalmology Sophia K Mirza, Sandra M JohnsonDepartment of Ophthalmology, University of Virginia, Charlottesville, Virginia, USAAbstract: The medical treatment of glaucoma has evolved significantly over the past several decades. The main driving forces behind this evolution are the safety profiles and efficacy of these medications. Prostaglandin (PG) analogs are shown to be superior to older drugs in both efficacy and tolerability. Though there are much fewer side effects that manifest after using PG analogs, the adherence and compliance to medication regimens are surprisingly lower than expected. A commonly sited reason is the ocular irritation and inflammation with these medications. Much of this inflammation can be attributed to the preservative, benzalkonium chloride (BAK). The chronic clinical and subclinical inflammation becomes increasingly detrimental when filtration surgery fails from bleb fibrosis secondary to this hypercellularity. A BAK-free formulation of a PG analog recently became available. BAK-free travoprost is reviewed here. It has demonstrated equal efficacy and less ocular surface toxicity than its preserved counterparts. It is expected to serve as an instrumental resource in managing ocular hypertension and glaucoma in patients who demonstrate significant sensitivity to BAK. More randomized, controlled, double-blind studies are encouraged to evaluate its improved safety and tolerability.Keywords: glaucoma, benzalkonium chloride, Travatan Z, sofZia Dove Press Sophia K Mirza, Sandra M Johnson 2010-07-28 PDF http://www.dovepress.com/getfile.php?fileID=7122 http://www.dovepress.com/efficacy-and-patient-tolerability-of-travoprost-bak-free-solution-in-p-peer-reviewed-article-OPTH English

oai:dovepress.com/4982 2010-08-05 OPTH

Low-dose aspirin as treatment for central serous chorioretinopathy Caccavale , Antonio Clinical Ophthalmology Antonio Caccavale1, Filippo Romanazzi1, Manuela Imparato1, Angelo Negri1, Anna Morano2, Fabio Ferentini11Department of Ophthalmology, Hospital C Cant&ugrave;, Abbiategrasso, Milan; 2University Eye Clinic, Foundation IRCCS San Matteo Hospital, Pavia, ItalyPurpose: To evaluate the effectiveness of low-dose aspirin for the treatment of central serous chorioretinopathy (CSCR).Patients and methods: Patients with classical or multifocal CSCR were treated with aspirin 100 mg per day orally for 1 month followed by 100 mg on alternate days for 5 months. Treated patients were compared with historic controls consisting of patients with classical or multifocal CSCR previously followed up at our institution.Results: Mean visual acuity in the group treated with aspirin started to improve after the first week of therapy and continued to improve throughout the following 3 months. Visual recovery was slower in the untreated control group than in the treated group and achieved better visual acuity between the first and third month from the onset of the disease. There were no adverse events related to the administration of aspirin.Conclusion: The results indicate that treatment with low-dose aspirin may result in more rapid visual rehabilitation with fewer recurrences in patient with CSCR compared with untreated historic controls. The effectiveness of treatment with aspirin supports our hypothesis regarding the role of impaired fibrinolysis and increased platelet aggregation in the choriocapillaris in the pathogenesis of CSCR.Keywords: central serous chorioretinopathy, aspirin, plasminogen activator inhibitor 1, macula Dove Press Antonio Caccavale, Filippo Romanazzi, Manuela Imparato, et al 2010-08-05 PDF http://www.dovepress.com/getfile.php?fileID=7231 http://www.dovepress.com/low-dose-aspirin-as-treatment-for-central-serous-chorioretinopathy-peer-reviewed-article-OPTH English

oai:dovepress.com/4934 2010-07-28 OPTH

Choroidal neovascularization due to punctate inner choroidopathy: long-term follow-up and review of literature Brouzas, D. Clinical Ophthalmology Dimitrios Brouzas, Antonios Charakidas, Tryfon Rotsos, Marilita M Moschos, Helen Loukianou, Chryssanthy Koutsandrea, Ioannis Ladas, Stefanos BaltatzisFirst Department of Ophthalmology, University of Athens Medical School, Athens, GreeceIntroduction: The aim of the article was to report on the long-term follow-up of choroidal neovascularization (CNV) cases secondary to punctate inner choroidopathy (PIC) either treated with photodynamic therapy (PDT) or followed without treatment. A comprehensive review of existing literature on the various treatment modalities is incorporated.Methods: Nine eyes of 8 female patients with CNV due to PIC were followed retrospectively for an average of 105 months (range, 36&ndash;162 months). Mean age of the patient cohort on presentation was 28 years (range, 21&ndash;39). Four eyes were treated with PDT, whereas in 4 patients, including 1 with bilateral involvement, the disease followed its natural course without treatment. Snellen visual acuity and the extent of neovascularization and subretinal fibrosis were evaluated on presentation and at the end of the follow-up period.Results: Improvement of vision was observed in 6 eyes (66.7%), including all cases treated with PDT, and in 2 of 5 eyes left untreated. The size of the neovascular lesion, including both CNV and subretinal fibrosis, increased in all cases left untreated (55.6%) and remained stable in all cases treated with PDT (44.4%).Conclusion: Without treatment, the CNV due to PIC is slowly progressive. Our short cohort appears to have benefited from PDT in terms of maintaining visual acuity and stabilizing the extent of CNV and fibrosis.Keywords: PIC natural course, PIC treatment Dove Press Dimitrios Brouzas, Antonios Charakidas, Tryfon Rotsos, et al 2010-07-28 PDF http://www.dovepress.com/getfile.php?fileID=7127 http://www.dovepress.com/choroidal-neovascularization-due-to-punctate-inner-choroidopathy-long--peer-reviewed-article-OPTH English

oai:dovepress.com/4935 2010-07-28 OPTH

Cerebral and ocular congenital toxoplasmosis c