American Journal of Ophthalmology - Articles in Press

Anterior Segment Complications After Diode Laser Photocoagulation for Prethreshold Retinopathy of Prematurity - Corrected Proof

Cristian M. Salgado, Yener Celik, Deborah K. Vanderveen — 2010-03-15

Purpose: To evaluate anterior segment complication rates in eyes treated for prethreshold versus threshold retinopathy of prematurity (ROP) and look for potential risk factors.Design: Retrospective, observational case series study.Methods: All patients treated with diode laser for ROP between 1995 and 2007 were identified. A total of 259 eyes of 184 patients were studied, 120 eyes in the pretheshold group and 139 eyes in the threshold group. We compare baseline characteristics, treatment parameters, ocular complications, and structural outcomes after treatment. The main outcome measured was anterior segment complication rates in eyes treated for prethreshold versus threshold ROP and we looked for potential risk factors.Results: Thirteen of 120 eyes treated at prethreshold had anterior segment complications versus 0 of 139 treated at threshold (P < .01). All eyes developed post-laser hyphema, 3 with elevated intraocular pressure. Three eyes developed cataract (2 requiring cataract extraction); 1 required treatment for band keratopathy. The mean postmenstrual age at treatment was significantly different between the prethreshold and threshold groups (36.6 vs 37.9 weeks, P = .03); eyes with anterior segment complications were treated at mean postmenstrual age of 35.7 weeks. No difference was found based on gestationtal age at birth, birth weight, zone, stage, or number of laser spots for eyes with anterior segment complications. Most anterior segment complications (77%) resolved without long-term sequelae.Conclusions: Younger postmenstrual age at laser treatment may be related to an increased risk of anterior segment complications, which should be recognized and managed appropriately.

Corneal Aberrations and Visual Acuity After Laser In Situ Keratomileusis: Femtosecond Laser Versus Mechanical Microkeratome - Corrected Proof

Ramón Calvo, Jay W. McLaren, David O. Hodge, William M. Bourne, Sanjay V. Patel — 2010-03-15

Purpose: To compare corneal high-order aberrations and visual acuity after laser in situ keratomileusis (LASIK) with the flap created by a femtosecond laser (bladeless) to LASIK with the flap created by a mechanical microkeratome.Design: Prospective, randomized, paired-eye study.Methods: Fellow eyes of 21 patients with myopia or myopic astigmatism were randomized by ocular dominance. Corneal topography and visual acuity were measured before and at 1, 3, 6, 12, and 36 months after LASIK. Wavefront errors from the anterior corneal surface were calculated from the topography data over 4- and 6-mm-diameter pupils and decomposed into Zernike polynomials to the 6th order.Results: There were no differences in corneal total high-order aberrations, spherical aberration, coma, or trefoil between methods of flap creation at any examination over 4- and 6-mm-diameter pupils. Over a 6-mm pupil, total high-order aberrations increased by 1 month after LASIK with both treatments (P ≤ .001) and remained increased through 36 months (P ≤ .001). Uncorrected and best-corrected visual acuity did not differ between methods at any examination and remained stable postoperatively through 3 years; the minimum detectable difference in visual acuity between treatments was ≤0.1 logMAR (≤1 line of vision, α = 0.05/6, β = 0.20, n = 21).Conclusions: The planar configuration of the femtosecond laser flap did not offer any advantage in corneal high-order aberrations or visual acuity through 3 years after LASIK. Corneal high-order aberrations remain stable through 3 years after LASIK.

Corneal Endothelial Cell Density and Associated Factors in a Population-Based Study in Japan: The Kumejima Study - Corrected Proof

2010-03-15

Purpose: To examine the distribution of corneal endothelial cell density (ECD) and relating factors in ophthalmologically normal Japanese in a population-based setting.Design: Cross-sectional, population-based study.Methods: All residents of Kumejima Island, Japan, located in southwestern Japan (eastern longitude 126° 48′ and northern latitude 26° 20′), aged 40 years and older, were asked to undergo a comprehensive questionnaire and ocular examination, including noncontact specular microscopy of corneal endothelial cells.Results: Of the 4632 residents, 3762 (81.2%) underwent the examination. The mean ECD among all ophthalmologically normal participants (n = 2602), men (n = 1329), and women (n = 1273) was 2943 ± 387 cells/mm2, 2927 ± 385 cells/mm2, and 2959 ± 389 cells/mm2, respectively, with a significant inter-sex difference after adjusting for age (P = .001). Mean ECD was significantly lower in subgroups with a history of outdoor work compared to corresponding subgroups after adjusting for age and sex (P = .034). Linear regression analyses with an adjustment for age and/or sex showed that age was significantly negatively correlated with ECD with a slope of −7.43/mm2/year (P < .001), indicating a cell loss rate of 0.25% per year of age. Higher intraocular pressure was significantly correlated with lower ECD, with a slope of −9.87/mm2/mm Hg (P < .001).Conclusions: Mean ECD in ophthalmologically normal Japanese in Kumejima aged 40 years or older was 2943 cells/mm2. Older age, male sex, higher intraocular pressure, and history of outdoor work were also identified as factors correlating with lower ECD.

Influence of the Extent of Myopia on the Progression of Normal-Tension Glaucoma - Corrected Proof

Sae Woon Sohn, Jae Seok Song, Changwon Kee — 2010-03-15

Purpose: To evaluate the influence of the extent of myopia on the progression rate of normal-tension glaucoma (NTG).Design: Retrospective, observational case series.Methods: One hundred forty-three eyes of 143 patients with NTG who were treated from 1994 through 2006 and followed up with standard automated perimetry were evaluated in this study. The participants were divided into 4 groups: mild myopia (−0.76 to −2.99 diopters [D]), moderate myopia (−3 to −5.99 D), severe myopia (−6 D or less), and nonmyopia (emmetropia and hyperopia, −0.75 D or more) groups. The change in mean deviation, corrected pattern standard deviation, mean thresholds of 10 zones corresponding to the glaucoma hemifield test, and thresholds of 52 points of the nonmyopia group were compared with those of the other myopia groups. Additionally, we controlled each analysis for age and posttherapeutic intraocular pressure to preclude the possibility of these covariates influencing the analysis of the effect of myopia on the progression of glaucoma.Results: There was no statistically significant difference between the nonmyopia group and each of the myopia groups in terms of mean deviation, corrected pattern standard deviation, mean thresholds of 10 zones corresponding to the glaucoma hemifield test, and the thresholds of 52 point changes against refraction. Moreover, with the control of the other covariates (age and posttherapeutic intraocular pressure), no statistically significant differences were noted (multivariate analysis using mixed model, P > .1).Conclusions: Although a high incidence of open-angle glaucoma among myopic patients has been reported previously, myopia did not influence the progression rate of NTG after treatment.

A Novel Locus for Autosomal Recessive Retinitis Pigmentosa in a Consanguineous Pakistani Family Maps to Chromosome 2p - Corrected Proof

2010-03-15

Objective: To identify a disease locus for autosomal recessive retinitis pigmentosa in a consanguineous Pakistani family.Design: Prospective linkage study.Methods: Blood samples were collected and genomic DNA was extracted. A genome-wide scan was performed using 382 polymorphic microsatellite markers on genomic DNA from 4 affected and 5 unaffected family members, and logarithm of odds scores were calculated.Results: A maximum 2-point logarithm of odds score of 3.14 at θ = 0 was obtained for marker D2S165 during the genome-wide scan. Fine mapping markers identified a 20.92-cM (19.98-Mb) interval flanked by D2S149 and D2S367 that cosegregates with the disease phenotype. Haplotype analyses further refined the critical interval, distal to D2S220 in a 12.31-cM (13.35-Mb) region that does not harbor any genes that previously have been associated with retinitis pigmentosa.Conclusions: Linkage analysis identified a new locus for autosomal recessive retinitis pigmentosa that maps to chromosome 2p22.3-p24.1 in a consanguineous Pakistani family.

The Risk of Capsular Breakage from Phacoemulsification Needle Contact with the Lens Capsule: A Laboratory Study - Corrected Proof

Jay J. Meyer, Annie F. Kuo, Randall J. Olson — 2010-03-15

Purpose: To determine capsular breakage risk from contact by phacoemulsification needles by machine and tip type.Design: Experimental laboratory investigation.Methods: Infiniti (Alcon, Inc., Fort Worth, Texas, USA) with Intrepid cartridges and Signature (Abbott Medical Optics, Inc., Santa Ana, California, USA) phacoemulsification machines were tested using 19- and 20-gauge sharp and rounded tips. Actual and unoccluded flow vacuum were determined at 550 mm Hg, bottle height of 75 cm, and machine-indicated flow rate of 60 mL/minute. Breakage from brief tip contact with a capsular surrogate and human cadaveric lenses was calculated.Results: Nineteen-gauge tips had more flow and less unoccluded flow vacuum than 20-gauge tips for both machines, with highest unoccluded flow vacuum in the Infiniti. The 19-gauge sharp tip was more likely than the 20-gauge sharp tip to cause surrogate breakage for Signature with micropulse and Ellips (Abbott Medical Optics, Inc.) ultrasound at 100% power. For Infiniti using OZil (Alcon, Inc.) ultrasound, 20-gauge sharp tips were more likely than 19-gauge sharp tips to break the membrane. For cadaveric lenses, using rounded 20-gauge tips at 100% power, breakage rates were micropulse (2.3%), Ellips (2.3%), OZil (5.3%). Breakage rates for sharp 20-gauge Ellips tips were higher than for rounded tips.Conclusions: Factors influencing capsular breakage may include active vacuum at the tip, flow rate, needle gauge, and sharpness. Nineteen-gauge sharp tips were more likely than 20-gauge tips to cause breakage in lower vacuum methods. For higher-vacuum methods, breakage is more likely with 20-gauge than with 19-gauge tips. Rounded-edge tips are less likely than sharp-edged tips to cause breakage.

Health-Related Quality of Life and Emotional Status of Anophthalmic Patients in Korea - Corrected Proof

Ji Min Ahn, Sang Yeul Lee, Jin Sook Yoon — 2010-03-15

Purpose: To evaluate the health-related quality of life and emotional status of anophthalmic patients.Design: Prospective, cross-sectional study.Methods: The study included 134 monocular anophthalmic patients and 48 healthy volunteers who visited the department of Ophthalmology at the Yonsei University College of Medicine, Seoul, Korea, between July and December 2008. Surveys were administered to participants to evaluate their sociodemographic characteristics and disease-related factors. Data collected from the Short-Form 36-Item Health Survey (SF-36) and the Hospital Anxiety and Depression Scale survey instruments were analyzed to identify significant differences and correlations between categories.Results: Anophthalmic patients scored lower in all categories of SF-36 compared with controls. Married females and participants with children generally had lower scores on the SF-36, and some of the differences were statistically significant. There were significant negative correlations between all SF-36 scores and participant self-evaluations on whether they had negative feelings regarding their social interpersonal relationships as a result of wearing prostheses. Those who scored higher on the Hospital Anxiety and Depression Scale anxiety and depression scales tended to evade social interrelations significantly.Conclusions: Anophthalmic patients had lower health-related quality-of-life scores than healthy individuals. This finding was particularly evident in terms of the patients' own perceptions of their social relationships, which were negatively affected by their use of prosthetic eyes. Such perceptions reduced their quality of life and heightened their anxiety and depression. Therefore, it is important to evaluate both the physical and emotional well-being of anophthalmic patients to identify those patients who will need additional physical and mental support.

Thermal Comparison of Infiniti OZil and Signature Ellips Phacoemulsification Systems - Corrected Proof

Joseph S. Schmutz, Randall J. Olson — 2010-03-04

Purpose: To determine thermal characteristics of Signature Ellips (Abbott Medical Optics, Santa Ana, California, USA) and Infiniti OZil (Alcon, Inc, Fort Worth, Texas, USA) transverse ultrasound and compare both with longitudinal ultrasound in clinically relevant scenarios.Design: Laboratory investigation.Methods: Temperature increase over baseline after 60 seconds was measured in water at positions in 90-degree increments around the sleeve near the proximal needle shaft in an artificial chamber for Ellips and OZil on continuous ultrasound with aspiration blocked and unblocked. This was also done with Signature using longitudinal ultrasound, with and without micropulse (6 ms on, 12 ms off), with aspiration blocked and unblocked, and at the OZil sleeve tip on continuous transverse mode with aspiration unblocked.Results: OZil (8.1 ± 0.3 C) had greater temperature increase than Ellips (5.2 ± 0.3 C; P < .0001) with aspiration unblocked and blocked (29.3 ± 1.0 C vs 12.2 ± 0.7 C; P < .0001). OZil had uneven distribution of heat around the shaft (30.1 ± 0.5 C vs 28.5 ± 0.6 C; P < .0001), whereas Ellips did not (P = .57). OZil was cooler at the tip (6.6 ± 0.2 C; P < .0001). Friction in a cadaver eye incision only increased these numbers by 10% (OZil, irrigation blocked).Conclusions: Metal stress probably creates heat at the proximal needle junction for both transverse methods. Heat generation differences between OZil and Ellips result from the manner in which they create needle motion. Incision burns may occur, especially for OZil, under nonpulsed settings during fragment removal with occlusion when reaching across the anterior chamber such that the proximal needle shaft came near the wound.

Structure–Function Correlations using Scanning Laser Polarimetry in Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma - Corrected Proof

2010-03-04

Purpose: To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry and visual field (VF) sensitivity in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).Design: Prospective, comparative, observational cases series.Methods: Fifty patients with POAG and 56 patients with PACG were examined using scanning laser polarimetry with variable corneal compensation (GDx VCC; Laser Diagnostic Technologies, Inc, San Diego, California, USA) and Humphrey VF analyzer (Carl Zeiss Meditec, Inc, Dublin, California, USA) between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity in both decibel and 1/Lambert scales, were estimated by the Spearman rank correlation coefficient (rs) and multivariate median regression models (pseudo R2). The correlations were determined globally and for 6 RNFL sectors and their corresponding VF regions.Results: The correlation between RNFL thickness and mean sensitivity (in decibels) was weaker in the PACG group (rs = 0.38; P = .004; pseudo R2 = 0.17) than in the POAG group (rs = 0.51; P < .001; pseudo R2 = .31), but the difference in the magnitude of correlation was not significant (P = .42). With Bonferroni correction, the structure–function correlation was significant in the superotemporal (rs = 0.62), superonasal (rs = 0.56), inferonasal (rs = 0.53), and inferotemporal (rs = 0.50) sectors in the POAG group (all P < .001), whereas it was significant only in the superotemporal (rs = 0.53) and inferotemporal (rs = 0.48) sectors in the PACG group (both P < .001). The results were similar when mean sensitivity was expressed as 1/Lambert scale.Conclusions: Both POAG and PACG eyes had moderate structure–function correlations using scanning laser polarimetry. Compared with eyes with POAG, fewer RNFL sectors have significant structure–function correlations in eyes with PACG.

Topical Mecamylamine for Diabetic Macular Edema - Corrected Proof

2010-02-26

Purpose: Stimulation of nicotinic acetylcholine (nACh) receptors on vascular endothelial cells promotes angiogenesis and vascular permeability in animal models. The safety and bioactivity of topical mecamylamine, an antagonist of nACh receptors, was tested in patients with diabetic macular edema.Design: A multicenter phase I/II clinical trial.Methods: Twenty-three patients with chronic diabetic macular edema received 1% mecamylamine topically twice daily for 12 weeks, the primary end point. Patients underwent safety assessments, measurement of best-corrected visual acuity (BCVA), and measurement of foveal thickness using optical coherence tomography at baseline, 1, 4, 8, 12, and 16 weeks.Results: Mecamylamine drops were well tolerated and there were no drug-related safety problems. Mean improvement in BCVA at 1, 4, 8, 12, and 16 weeks was 2.8, 1.9, 2.4, 0.8, and 3.1 letters, respectively. There was little change in mean excess foveal thickness. There was substantial heterogeneity in response, because 8 patients showed convincing improvement in BCVA, foveal thickness, or both, 9 patients showed equivocal or no substantial changes, and 4 patients showed worsening. Five patients showed a substantial improvement in BCVA, foveal thickness, or both between their last visit while receiving mecamylamine and 1 month after stopping mecamylamine.Conclusions: This study suggested that administration of topical mecamylamine, a nonspecific nACh receptor blocker, may have heterogeneous effects in patients with diabetic macular edema. Variable expression of nACh receptor subtypes on endothelial cells that have different effects on permeability would provide an explanation for these results and should be investigated, because more specific nACh receptor blockers may dissociate antipermeability and propermeability effects.

Anterior Segment Optical Coherence Tomography Evaluation of the Integrity of Clear Corneal Incisions: A Comparison between 2.2-mm and 2.65-mm Main Incisions - Corrected Proof

Soon-Phaik Chee, Seng-Ei Ti, L.I. Lim, Anita S.Y. Chan, Aliza Jap — 2010-02-26

Purpose: To compare wound characteristics and integrity of the 2.2-mm and 2.65-mm clear corneal incisions.Design: Prospective, randomized clinical trial.Methods: Patients undergoing phacoemulsification with lens implant were randomized to receive a 2.2-mm or 2.65-mm temporal clear corneal incision. The incisions were evaluated at 2, 24, and 96 hours for gape and wound architecture using anterior segment optical coherence tomography and for integrity using the Seidel test. Squareness of an incision was calculated (ratio of the incision length to the width).Results: There were 30 patients in each group. Both incision sizes were watertight, although a mild internal main wound gape was detected on anterior segment optical coherence tomography in 35 eyes (58.3%) at 2 hours. The smaller wound was more square (0.81; standard deviation [SD], 0.11) than the larger wound (0.62; SD, 0.08; P < .001, t test). The mean squareness of eyes without wound gape at 2 hours (0.66; SD, 0.11) was lower than those with a wound gape (0.75; SD, 0.14; P = .008). A squareness factor of 0.72 or more had a positive predictive value for presence of wound gape at 2 hours of 79.3% and a negative predictive value of 61.3%. One side port incision with squareness of 1.39 had a mild leak at 2 and 24 hours, but no gape was seen on anterior segment optical coherence tomography.Conclusions: Both the 2.2-mm and 2.65-mm clear corneal incisions clinically were competent, but the side port incision may leak. A truly square wound has a greater likelihood of being associated with internal wound gape at 2 hours after surgery, especially if the squareness factor is 0.72 or more.

Combined Fluocinolone Acetonide Intravitreal Insertion and Glaucoma Drainage Device Placement for Chronic Uveitis and Glaucoma - Corrected Proof

Paula E. Malone, Leon W. Herndon, Kelly W. Muir, Glenn J. Jaffe — 2010-02-26

Purpose: To determine whether a fluocinolone acetonide sustained-release intravitreal drug delivery system can be implanted safely at the same time that a glaucoma drainage device is placed for eyes with uveitis and elevated intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy.Design: Retrospective, observational case series.Methods: Subjects had chronic noninfectious intermediate or posterior uveitis and elevated IOP while receiving maximum tolerated medical therapy. Fluocinolone acetonide implantation and glaucoma tube shunt placement were performed in a single surgical session. The main outcome measures were inflammatory recurrences, visual acuity (VA), use of adjunctive anti-inflammatory therapy, IOP, and adverse events.Results: Seven eyes of 5 patients were studied. The average number of recurrences 12 months before implantation was 3 episodes per eye; of the 3 eyes followed up for more than 30 months, none had an inflammatory recurrence within 30 months after implantation. The mean Snellen visual acuity 12 months after the combined surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12 months after the combined surgery (P = .019).Conclusions: The favorable results observed in all eyes suggest that fluocinolone acetonide implantation can be safely combined with glaucoma tube shunt placement in a single surgical session in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering therapy. Uveitis recurrences decreased, visual acuity improved, and IOP decreased. There were no adverse events during insertion of the fluocinolone acetonide implant and placement of the glaucoma tube shunt.

Four-Year Incidence and Progression of Lens Opacities: The Los Angeles Latino Eye Study - Corrected Proof

2010-02-24

Purpose: To estimate the 4-year incidence and progression of lens opacities.Design: Population-based longitudinal study.Methods: A total of 4658 adult Latinos from Los Angeles County were examined at baseline and 4-year follow-up. Examination included assessment of lens opacities using the Lens Opacities Classification System II (LOCS II). Incidences of cortical, nuclear, and posterior subcapsular opacities (with LOCS II scores ≥2) were defined as opacity development in persons without that opacity at baseline. Single and mixed opacities were defined in persons without any opacity at baseline. Incidence of all lens changes included development of at least 1 opacity or cataract surgery among those without any opacity at baseline. Four-year progressions were defined as increase of ≥2 in LOCS II score.Results: The 4-year incidence of all lens opacities was 14.2%. Four-year incidence of cataract surgery was 1.48%. The incidences were 4.1% for cortical-only, 5.8% for nuclear-only, 0.5% for PSC-only, and 2.5% for mixed. The incidences for any opacities were 7.5% for cortical, 10.2% for nuclear, and 2.5% for PSC. Incidence increased with age (P < .0001 for all). The progressions were 8.5% for cortical, 3.7% for nuclear, and 2.9% for PSC opacities.Conclusions: Our Latino population had a higher incidence of nuclear than cortical opacities, but a greater progression of cortical than nuclear opacities. Incidence and progression of PSC was low. Additional understanding of the natural history and progression of various lens opacities will give us a better understanding of the pathogenesis and management of lens opacities.

Efficacy and Tolerability of Preservative-Free and Preserved Diclofenac and Preserved Ketorolac Eyedrops after Cataract Surgery - Corrected Proof

2010-02-11

Purpose: To compare the anti-inflammatory efficacy and subjective tolerability of preservative-free and preserved diclofenac 0.1% and preserved ketorolac 0.5% eye drops for prophylaxis and management of inflammation after cataract surgery.Design: Prospective, randomized, investigator-masked, parallel-group, comparative clinical trial.Methods: One hundred two patients who underwent small-incision phacoemulsification cataract surgery in an institutional setting were assigned randomly to receive preservative-free diclofenac sodium 0.1% (Voltaren ophtha SDU; Novartis Pharma, Vienna, Austria), preserved diclofenac sodium 0.1% (Voltaren ophtha; Novartis Pharma), or preserved ketorolac tromethamine 0.5% (Acular; Pharm Allergan, Ettlingen, Germany) eyedrops 4 times daily for 4 weeks after surgery. During the 1-month follow-up, anterior chamber flare and mean foveal thickness were evaluated for objective comparison of the anti-inflammatory effect. Ocular tolerability was assessed by observer-based grading of conjunctival hyperemia and ocular discomfort, as well as obtaining subjective ratings of ocular tolerability on a visual analog scale. Distance and near visual acuity and intraocular pressure served as safety measures.Results: All 3 formulations demonstrated equal anti-inflammatory efficacy as measured by reduction of anterior chamber flare after surgery and prevention of postoperative macular edema. Patients treated with preservative-free diclofenac eyedrops reported significantly better subjective tolerability values (P = .001), were classified as having less ocular discomfort (P < .001), and experienced earlier reduction of postoperative conjunctival hyperemia (P = .029).Conclusions: Anti-inflammatory efficacy was comparable for all 3 agents. However, preservative-free diclofenac 0.1% eyedrops exhibited a significantly better postoperative subjective and objective tolerability when compared with preserved eyedrops containing ketorolac or diclofenac.

Four-Year Incidence and Progression of Diabetic Retinopathy and Macular Edema: The Los Angeles Latino Eye Study - Corrected Proof

2010-02-10

Purpose: To estimate the 4-year incidence and progression of diabetic retinopathy, macular edema (ME) and clinically significant macular edema (CSME) among adult Latinos with diabetes mellitus.Design: A population-based, longitudinal study of 4658 self-identified Latinos (primarily Mexican Americans), residing in Los Angeles, examined at baseline (2000–2003) and at 4 years (2004–2008).Methods: Participants underwent a standardized ophthalmic examination. Diabetic retinopathy (DR) and CSME were detected by grading of stereoscopic fundus photographs using the modified Airlie House classification scheme. χ2 and trend tests were used to assess differences in incidence when stratifying by age and duration of diabetes.Results: The 4-year incidence of DR, ME, and CSME was 34.0% (182/535), 5.4% (38/699), and 7.2% (50/699) respectively. Younger persons and those with longer duration of diabetes mellitus had a higher incidence of DR compared to those who were older and had shorter duration of diabetes mellitus. A higher incidence of ME was associated with longer duration of diabetes mellitus (P = .004). Worsening/progression of any DR was found in 38.9% (126/324) and improvement occurred in 14.0% (37/265) of participants. Progression from nonproliferative DR (NPDR) to proliferative DR (PDR) and from NPDR to PDR with high-risk characteristics occurred in 5.3% and 1.9% of participants.Conclusions: The 4-year incidence and progression of DR and the incidence of ME and CSME among Latinos are high compared to non-Hispanic whites. These findings support the need to identify and modify risk factors associated with these long-term complications.

Comparison of Persistent Submacular Fluid in Vitrectomy and Scleral Buckle Surgery for Macula-Involving Retinal Detachment - Corrected Proof

Yong-Kyu Kim, Se Joon Woo, Kyu Hyung Park, Young Suk Yu, Hum Chung — 2010-02-10

Purpose: To compare the frequency of persistent submacular fluid (SMF) and sequential visual outcomes after pars plana vitrectomy (PPV) and scleral buckling (SB) in recent-onset macula-involving rhegmatogenous retinal detachment (RD), and thus to determine the role of persistent SMF on visual outcome with different surgical methods.Design: Observational case series.Methods: Sixty-one patients (61 eyes) who underwent successful PPV (16 patients) or SB (45 patients) underwent thorough ophthalmologic examinations including optical coherence tomography at 1 month after surgery, as well as every 3 months until SMF disappeared. The SB group was divided into 2 groups according to the presence (SB-SMF+) or absence (SB-SMF−) of persistent SMF at 1 month after surgery. Preoperative and postoperative best-corrected visual acuities were compared among the different surgical groups and also were analyzed depending on the RD duration (acute, symptom duration ≤ 7 days; subacute, symptom duration > 7 and ≤ 30 days).Results: Persistent SMF at 1 month after surgery was more frequent in the SB group (55.6%) than it was in the PPV group (6.25%; P = .006). The SB-SMF+ group showed worse postoperative best-corrected visual acuity than the PPV or SB-SMF− groups at 6 to 12 months after surgery, whereas there were no significant differences in the final visual acuity among the groups. This difference in visual recovery was not observed in patients with subacute RD.Conclusions: The similar visual recovery patterns seen in the PPV and SB-SMF− groups suggest that persistent SMF is a more important prognostic factor than surgical method is in the setting of acute onset and successful RD surgery.

Ocular Signs Predictive of Tubercular Uveitis - Corrected Proof

Amod Gupta, Reema Bansal, Vishali Gupta, Aman Sharma, Pradeep Bambery — 2010-02-10

Purpose: To determine ocular signs predictive of tubercular uveitis.Design: Retrospective, nonrandomized, comparative interventional case study.Methods: Three hundred eighty-six patients with active uveitis were treated at a tertiary care single-center uveitis practice. Uveitis was presumed to be tubercular in patients who showed evidence of latent or manifest tuberculosis without any other known cause and who did not show recurrence of uveitis after 12 months of antitubercular therapy. One hundred eighty-two patients who thus obtained clinical diagnoses of presumed tubercular uveitis were enrolled in group A. Two hundred four patients with uveitis resulting from a nontubercular cause were enrolled in group B. Patients were monitored for the presence of types of keratic precipitates (mutton fat or fine), posterior synechiae (broad based or filiform), iris nodules, snowballs, snow banking, vasculitis (with or without choroiditis), serpiginous-like choroiditis, and other types of posterior uveitis (choroidal abscess, retinochoroiditis, or exudative retinal detachment) which were compared between the 2 groups. Statistical analysis was carried out at a 5% level of significance. The main outcome measures were clinical signs significantly associated with tubercular uveitis.Results: Broad-based posterior synechiae, retinal vasculitis with or without choroiditis, and serpiginous-like choroiditis were seen significantly more commonly in patients with tubercular uveitis. Filiform posterior synechiae were more frequent in eyes with nontubercular uveitis.Conclusions: Broad-based posterior synechiae, retinal vasculitis with or without choroiditis, and serpiginous-like choroiditis in patients with latent or manifest tuberculosis in tuberculosis-endemic areas are suggestive of a tubercular cause of uveitis and merit specific treatment.

Structural and Functional Assessment in HIV-Infected Patients Using Optical Coherence Tomography and Frequency-Doubling Technology Perimetry - Corrected Proof

2010-02-10

Purpose: To assess retinal nerve fiber layer (RNFL) and macular thickness using optical coherence tomography (OCT) on HIV-infected patients without ocular manifestations and to correlate these findings with frequency-doubling technology perimetry (FDT).Design: Cross-sectional study.Methods: setting: Single center.study population: Seventy-three patients (146 eyes) with clinically normal examination classified in 3 groups: group A, HIV-infected patients with CD4 count <100 cells/mm3 for at least 6 months; group B, HIV-infected patients with CD4 count >100 cells/mm3 since diagnosis; and group C, HIV-negative control subjects.observation procedures: Fast RNFL and fast macula scan strategies on Stratus OCT and Humphrey Matrix 24-2 full-threshold program.main outcome measures: OCT RNFL and macular thicknesses and FDT indices (mean deviation [MD], pattern standard deviation [PSD], and glaucoma hemifield test [GHT]).Results: Group A had a significantly thinner average RNFL, temporal outer macula, and inferior outer macula thicknesses when compared to groups B and C (P < .05). Statistically significant differences were observed in the FDT MD between groups A and C (P = .034) and in PSD in group A compared to groups B and C (P = .011). Eyes of HIV patients with GHT and PSD results outside normal confidence limits had thinner average RNFL thickness measures than eyes with results within normal limits in the same group of patients (P < .05).Conclusions: HIV-infected patients with low CD4 count have a significant RNFL and macular thinning. Functional loss detected by FDT is related to RNFL thinning in HIV-infected patients.

Incidence, Ocular Manifestations, and Survival in Children with Neuroblastoma: A Population-Based Study - Corrected Proof

Stephen J. Smith, Nancy N. Diehl, Brian D. Smith, Brian G. Mohney — 2010-02-10

Purpose: To determine the incidence, ophthalmic manifestations, and survival among children with neuroblastoma in a defined population.Design: Population-based retrospective cohort.Methods: The medical records of all pediatric (<19 years) residents of Olmsted County, Minnesota, diagnosed with neuroblastoma from January 1, 1969, through December 31, 2008, were retrospectively reviewed.Results: Fourteen children were diagnosed with neuroblastoma as residents of Olmstead County, Minnesota, during the 40-year period, yielding an age- and gender-adjusted incidence of 11.8 (95% confidence interval [CI]: 5.6–18.0) per million patients <15 years of age. The calculated incidence for patients presenting before the age of 5 in this cohort was 1 in 5970 children (95% CI: 3920–12 580 children). The mean age at diagnosis for the 14 study patients was 22.5 months (range, 10.4–42.6 months). Six of the 14 (43%; 95% CI: 18%–71%) had ocular manifestations, including orbital metastasis in 6 (100%), proptosis and ecchymosis in 4 (67%), ptosis in 2 (33%), and strabismus in 1 (17%). The Kaplan-Meier rate of survival for all 14 children was 57% at 1 year (95% CI: 36%–90%) and 50% at 5 years (95% CI: 30%–84%), while the 6 with eye findings had a survival rate of 17% at 9 months (95% CI: 3%–100%).Conclusions: The incidence of neuroblastoma in this population was 11.8 per million patients <15 years, with ophthalmic involvement observed in 6 of the 14 study patients (43%). Orbital metastasis in the 6 children in this cohort was associated with poor prognosis.

Preimplantation Genetic Diagnosis for Stargardt Disease - Corrected Proof

Mahsa A. Sohrab, Rando Allikmets, Michael M. Guarnaccia, R. Theodore Smith — 2010-02-10

Purpose: To report the first use of in vitro fertilization (IVF) and preimplantation genetic diagnosis to achieve an unaffected pregnancy in an autosomal-recessive retinal dystrophy.Design: Case report.Methods: An affected male with Stargardt disease and his carrier wife underwent IVF. Embryos obtained by intracytoplasmic sperm injection underwent single-cell DNA testing via polymerase chain reaction and restriction enzyme analysis to detect the presence of ABCA4 mutant alleles. Embryos were diagnosed as being either affected by or carriers for Stargardt disease. A single carrier embryo was implanted.Results: Chorionic villus sampling performed during the first trimester verified that the fetus possessed only 1 mutant paternal allele and 1 normal maternal allele, thus making her an unaffected carrier of the disease. A healthy, live-born female was delivered.Conclusion: IVF and preimplantation genetic diagnosis can assist couples with an affected spouse and a carrier spouse with recessive retinal dystrophies to have an unaffected child.

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

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

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

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

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

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

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

2010-02-08

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

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

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

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

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

2010-02-08

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

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

2010-02-08

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

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

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

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

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

2010-02-08

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

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

2010-02-08

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

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

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

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