Monday, January 07, 2013 | | 1 Comments
Post-keratoplasty astigmatismremains a challenge for corneorefractive surgeons.While maintaining a healthy graft is the most crucial issue in keratoplasty procedures, astigmatismis a limiting factor in the visual rehabilitation of otherwise successful corneal grafts. The management of post-keratoplasty astigmatism takes place at 2 stages: when sutures are still present at the graft–host junction and when all sutures have been removed. Excessive suture-in post-keratoplasty astigmatism is usually managed by selective suture manipulation, ie, suture adjustment and/or suture removal along the steep meridian of astigmatism. A small amount of suture-out post-keratoplasty astigmatism can be managed by spectacles. Higher magnitudes of astigmatism can be addressed by contact lenses or surgical intervention, such as relaxing and compressing procedures. Laser lamellar refractive surgery can also be used to manage post-keratoplasty astigmatism, and toric phakic intraocular lenses have recently been recommended. In this review, we discuss the etiology and management of post-keratoplasty astigmatism and provide recommendations and tips to minimize it.
Comparison of Limbus-Based and Fornix-Based Trabeculectomy: Success, Bleb-Related Complications and Bleb Morphology
Design: Retrospective case series with some prospective data collection.
Main Outcome Measures: (1) Success rate of trabeculectomy, as determined by the achievement of each of our different IOP goals, with or without IOP-lowering medications; and (2) incidence of surgical complications.
Results: During the 4 years after surgery, the success rates of limbus-based and fornix-based trabeculectomy were not statistically different for any of our IOP criteria. Blebs after limbus-based surgery were more likely to be graded as higher and to be avascular (GEE model, both P 0.0001). Four percent of eyes experienced late-onset bleb leaks within 4 years after both limbus- and fornix-based operations; however, limbus-based cases developed bleb leaks significantly later than did fornix-based cases (2.1 vs. 1.0 years; P 0.002, GEE model). Late bleb-associated infection during the first 4 years after surgery occurred more often in limbus-based operations, although statistical significance was borderline (P 0.054, Cox model). Symptomatic hypotony during all available follow-up was more common with fornix-based operations (P 0.01, GEE model). Eyes undergoing the fornix-based operation had a greater risk of cataract surgery in the 4-year period after surgery (P 0.02, Cox model), and fornix-based cases requiring cataract surgery had the operation earlier than limbus-based cases(P 0.002, GEE model).
Conclusions: Success rates are similar between limbus-based and fornix-based trabeculectomy. Limbus-based procedures produce higher, more avascular blebs, with a greater risk of infection. Fornix-based procedures have more symptomatic hypotony and more and earlier cataract development.
Comparison of a new-generation sectorial addition multifocal IOL and a diffractive apodized multifocal IOL
METHODS: Refractive and visual outcomes at near and distance, patient satisfaction, and dysphotopsia scores were recorded 3, 6, and 12 months postoperatively.
CONCLUSIONS: The new sectorial addition multifocal IOL performed comparably to the diffractive apodized multifocal IOL in terms of UDVA and the presence of dysphotopsia. The diffractive apodized multifocal IOL performed better at 30 cm and 40 cm reading distances and had higher patient satisfaction.
DESIGN: Prospective nonrandomized noncomparative cohort study.
METHODS: The corneal inlay was implanted in the nondominant eye of naturally emmetropic presbyopic patients. Refraction, uncorrected near (UNVA), intermediate (UIVA), and distance (UDVA) visual acuities; corrected distance visual acuity(CDVA); contrast sensitivity; visual fields; subjective patient satisfaction and symptoms; and operative and postoperative adverse events and complications were evaluated.
RESULTS: The study enrolled 32 patients. The mean UNVA improved from Jaeger (J) 6 preoperatively to J1 at 3 years and the mean UIVA, from 20/40 to 20/25, respectively. At 3 years, 97% of eyes had a UNVA of J3 or better and 91% had a UIVA of 20/32 or better. The mean UDVA was 20/20, with all eyes achieving 20/32 or better. Nine eyes (28.3%) lost 1 line of CDVA, 1 eye (3.1%) lost more than 2 lines (3.8 lines), and 3 eyes (9.3%) gained 1 line. No inlay was explanted, and no inflammatory
reactions were observed. At 3 years, 15.6% of patients reported severe night-vision problems and 6.3% (versus 87.5% preoperatively) reported being dependent on reading glasses.
CONCLUSIONS: These 3-year results support the safety and efficacy of the corneal inlay to correct presbyopia in naturally emmetropic presbyopic patients. However, despite a significant gain in UNVA and UIVA, 28.3% of patients lost 1 line of CDVA.
Design: Prospective, consecutive, interventional series.
Participants: Patients with Fuchs’ endothelial dystrophy, pseudophakic bullous keratoplasty, or failed previous graft (n=136 eyes).
Intervention: The diseased central 7 mm of Descemet’s membrane (DM) was stripped from the recipient cornea and replaced with healthy DM and endothelium stripped from donor corneas through a 2.8-mm corneal incision. Descemet’s membrane endothelial keratoplasty was performed alone (n=110) or combined with either phacoemulsification and intraocular lens implantation (n=23) or pars plana vitrectomy (n =3).
Main Outcome Measures: Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density.
Results: Excluding eyes with pre-existing ocular comorbidities or those lost to follow-up, mean BSCVA at 1 year was 0.07 logarithm minimum angle of resolution (logMAR) units (20/24;range, 20/15–20/40; n=81), improving from 0.51 logMAR (20/65; range, 20/20–counting fingers); 41% of the patients achieved a BSCVA of 20/20 or better, 80% could be corrected to 20/25 or better, and 98% achieved 20/30 or better vision. A refractive hyperopic shift of +0.24+-1.01 diopters (D; range, –1.50 to 2.25 D) was found at 1 year, but it was not statistically significant (P=0.08). Also, there was no significant change in the preoperative astigmatism (P=0.17). The
endothelial cell loss at 1 year was 36+-20% (n=94; range, 13%–88%), with most of the loss being observed during the first 3 months after surgery: 31+-18% (range, 3%–77%). The DMEK graft creation could not be successfully completed in 6 cases (4.2%). All these unsuccessful attempts were among the initial 40 cases. Intracameral air was used to fix graft detachments, which usually were partial and peripheral, in 62% of the cases. Eleven grafts (8%) demonstrated primary failure and 1 eye (0.7%) had secondary failure resulting from endothelial rejection. Episodes of immunologic rejection were documented in 7 eyes (5.1%) during the first year of follow-up.
Conclusions: Descemet’s membrane endothelial keratoplasty had better visual acuity results in the first year after surgery than typically reported for other endothelial keratoplasty techniques, such as Descemet’s stripping automated endothelial keratoplasty, while having less refractive changes and similar endothelial cell counts but a higher rebubbling rate.
Most clinical trials are designated as phase I, II, III, or IV, based on the type of questions that study is seeking to answer:
These phases are defined by FDA in the Code of Federal Regulations.
Participants: A total of 4070 patients with primary uveal melanoma
Methods: The significance of trends in age-adjusted incidence, treatment, and 5-year relative survival rates were determined using chi-square testing and 95% confidence intervals (CIs).
Conclusions: The age-adjusted incidence of uveal melanoma (5.1 per million) has remained unchanged from 1973 to 2008. Despite a shift toward more conservative treatments, survival has not improved during this time period.
The Acrysof Cachet phakic lens was designed to correct moderate to high myopia
● DESIGN: Perspective.
● METHODS: Selected articles on the epidemiology, clinical and imaging features, natural history, pathophysiology, and treatment of idiopathic intracranial hypertension were reviewed and interpreted in the context of the authors’ clinical and research experience.
Wednesday, August 03, 2011 | | 0 Comments
• VA: ...................OD: HM................................ .OS:20/40
• IOP: ................ OD: 14 mmHg .................... OS:16 mmHg
Ocular examination revealed rAPD and Hertel Exophth(Base 100) measure 23 OD and 19 OS in addition to swollen optic disc OD which leak on FFA.
Go over the initial slides down to see the patient's MRI , FFA, and Histopath.
Q1 : what are the findings shown in the patient's photos, MRI and Histopath. ?
Q2 : What are your differential diagnosis and how are you going to manage such a case?
Try to answer the previous questions then go and download your powerpoint presentation of the case including differential diagnosis, management and discussion from the following link:
Design: Cross-sectional interobserver agreement study.
Participants: Photo archives from the National Eye Institute.
Methods: Three uveitis specialists from 3 different centers graded 79 randomly arranged images of the sclera with various degrees of inflammation. Grading was done using standard screen resolution (1024 768 pixels) on a 0 to 4 scale in 2 sessions: (1) without using reference photographs and (2) with reference to a set of standard photographs (proposed grading system). The graders were masked to the order of images, and the order of images was randomized. Interobserver agreement in grading the severity of inflammation with and without the use of grading system was evaluated.
Design: Systematic review and meta-analysis of the literature.
Participants: Seventeen eligible studies (17 588 eyes) examining the association between IFIS and risk factors.
Conclusions: This meta-analysis has highlighted a hierarchy concerning the role of α1-blockers in IFIS, indicating an extremely sizeable effect size of tamsulosin; this may entail important physiologic implications. Alfuzosin, terazosin, and doxazosin presented with comparable effect sizes. Hypertension, but not diabetes mellitus, emerged as a risk factor for IFIS.