1. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01278-6. doi:
10.1016/j.ophtha.2015.10.055. [Epub ahead of print]

Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern(®) Guidelines.

Prum BE Jr(1), Lim MC(2), Mansberger SL(3), Stein JD(4), Moroi SE(4), Gedde
SJ(5), Herndon LW Jr(6), Rosenberg LF(7), Williams RD(8).

Author information: 
(1)Department of Ophthalmology, University of Virginia Health System,
Charlottesville, Virginia. (2)UC Davis Eye Center, University of California,
Davis, Sacramento, California. (3)Legacy Devers Eye Institute, Portland, Oregon. 
(4)W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences,
University of Michigan, Ann Arbor, Michigan. (5)Bascom Palmer Eye Institute,
University of Miami, Miami, Florida. (6)Duke Eye Center, Duke University Medical 
Center, Durham, North Carolina. (7)Department of Ophthalmology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois. (8)Wheaton Eye Clinic,
Wheaton, Illinois.

PMID: 26581560   [PubMed - as supplied by publisher]


2. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01267-1. doi:
10.1016/j.ophtha.2015.10.045. [Epub ahead of print]

Retinal Vein Occlusions Preferred Practice Pattern(®) Guidelines.

Pulido JS(1), Flaxel CJ(2), Adelman RA(3), Hyman L(4), Folk JC(5), Olsen TW(6).

Author information: 
(1)Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. (2)Casey Eye
Institute, Oregon Health & Science University, Portland, Oregon. (3)Department of
Ophthalmology and Visual Science, Yale School of Medicine, New Haven,
Connecticut. (4)Division of Epidemiology, Department of Family, Population and
Preventive Medicine, School of Medicine, Stony Brook University, Stony Brook, New
York. (5)Department of Ophthalmology and Visual Sciences, University of Iowa
Hospitals & Clinics, Iowa City, Iowa. (6)Emory Eye Center, Emory University,
Atlanta, Georgia.

PMID: 26581559   [PubMed - as supplied by publisher]


3. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01269-5. doi:
10.1016/j.ophtha.2015.10.047. [Epub ahead of print]

Comprehensive Adult Medical Eye Evaluation Preferred Practice Pattern(®)
Guidelines.

Feder RS(1), Olsen TW(2), Prum BE Jr(3), Summers CG(4), Olson RJ(5), Williams
RD(6), Musch DC(7).

Author information: 
(1)Northwestern Medicine, Chicago, Illinois. (2)Emory Eye Center, Emory
University, Atlanta, Georgia. (3)Department of Ophthalmology, University of
Virginia Health System, Charlottesville, Virginia. (4)Department of Ophthalmology
and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.
(5)Moran Eye Center, University of Utah Health Care, Salt Lake City, Utah.
(6)Wheaton Eye Clinic, Wheaton, Illinois. (7)W.K. Kellogg Eye Center, Department 
of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor,
Michigan.

PMID: 26581558   [PubMed - as supplied by publisher]


4. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01271-3. doi:
10.1016/j.ophtha.2015.10.049. [Epub ahead of print]

Primary Angle Closure Preferred Practice Pattern(®) Guidelines.

Prum BE Jr(1), Herndon LW Jr(2), Moroi SE(3), Mansberger SL(4), Stein JD(3), Lim 
MC(5), Rosenberg LF(6), Gedde SJ(7), Williams RD(8).

Author information: 
(1)Department of Ophthalmology, University of Virginia Health System,
Charlottesville, Virginia. (2)Duke Eye Center, Duke University Medical Center,
Durham, North Carolina. (3)W.K. Kellogg Eye Center, Department of Ophthalmology
and Visual Sciences, University of Michigan, Ann Arbor, Michigan. (4)Legacy
Devers Eye Institute, Portland, Oregon. (5)UC Davis Eye Center, University of
California, Davis, Sacramento, California. (6)Department of Ophthalmology,
Northwestern University Feinberg School of Medicine, Chicago, Illinois. (7)Bascom
Palmer Eye Institute, University of Miami, Miami, Florida. (8)Wheaton Eye Clinic,
Wheaton, Illinois.

PMID: 26581557   [PubMed - as supplied by publisher]


5. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01276-2. doi:
10.1016/j.ophtha.2015.10.053. [Epub ahead of print]

Primary Open-Angle Glaucoma Preferred Practice Pattern(®) Guidelines.

Prum BE Jr(1), Rosenberg LF(2), Gedde SJ(3), Mansberger SL(4), Stein JD(5), Moroi
SE(5), Herndon LW Jr(6), Lim MC(7), Williams RD(8).

Author information: 
(1)Department of Ophthalmology, University of Virginia Health System,
Charlottesville, Virginia. (2)Department of Ophthalmology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois. (3)Bascom Palmer Eye
Institute, University of Miami, Miami, Florida. (4)Legacy Devers Eye Institute,
Portland, Oregon. (5)W.K. Kellogg Eye Center, Department of Ophthalmology and
Visual Sciences, University of Michigan, Ann Arbor, Michigan. (6)Duke Eye Center,
Duke University Medical Center, Durham, North Carolina. (7)UC Davis Eye Center,
University of California, Davis, Sacramento, California. (8)Wheaton Eye Clinic,
Wheaton, Illinois.

PMID: 26581556   [PubMed - as supplied by publisher]


6. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01192-6. doi:
10.1016/j.ophtha.2015.10.015. [Epub ahead of print]

Subepidermal Calcified Nodule in the Periocular Region: A Report of 6 Cases.

Shields CL(1), Marous MR(2), Casey MG(2), Douglass AM(2), Khoo CT(2), Bilyk
JR(3), Shields JA(2), Eagle RC Jr(4).

Author information: 
(1)Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania. Electronic address: carolshields@gmail.com. (2)Ocular
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, 
Pennsylvania. (3)Skull Base Division, Neuro-Ophthalmology Service, Wills Eye
Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. (4)Department 
of Ophthalmic Pathology, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania.

PMID: 26581555   [PubMed - as supplied by publisher]


7. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01149-5. doi:
10.1016/j.ophtha.2015.10.003. [Epub ahead of print]

Automated Perimetry and Visual Dysfunction in Blast-Related Traumatic Brain
Injury.

Lemke S(1), Cockerham GC(2), Glynn-Milley C(3), Lin R(4), Cockerham KP(5).

Author information: 
(1)Program Evaluation & Resource Center, Veterans Administration Palo Alto Health
Care System, Palo Alto, California. (2)Ophthalmology, Veterans Administration
Palo Alto Health Care System, Palo Alto, California; Ophthalmology, Stanford
University School of Medicine, Stanford, California. Electronic address:
glenn.cockerham@va.gov. (3)Ophthalmology, Veterans Administration Palo Alto
Health Care System, Palo Alto, California. (4)Ophthalmology, Scripps Clinic
Medical Group, La Jolla, California. (5)Ophthalmology, Veterans Administration
Palo Alto Health Care System, Palo Alto, California; Ophthalmology, Stanford
University School of Medicine, Stanford, California.

PURPOSE: To evaluate feasibility and results of automated perimetry in veterans
with combat blast neurotrauma.
DESIGN: Prospective, longitudinal, observational case series.
PARTICIPANTS: Sixty-one patients in a Veterans Affairs Polytrauma Center
diagnosed with traumatic brain injury (TBI) from combat blast exposure.
METHODS: Study participants underwent automated perimetry at baseline (median
interval, 2 months after injury) (Humphrey Field Analyzer, Carl Zeiss Meditec,
Dublin, CA, Swedish Interactive Threshold Algorithm 30-2 Standard or Fast), and
36 of them were followed up (median interval, 10 months after baseline). Presence
of significant mean deviation and pattern standard deviation were determined for 
testing with reliability indices ≤20% for fixation loss, 15% for false-positives,
and 33% for false-negatives. Test-retest stability of global visual field indices
was assessed for tests with these cutoffs or with elevated fixation loss.
Associations between global visual field defects and predictors were examined.
MAIN OUTCOME MEASURES: Global visual field indices (mean deviation and pattern
standard deviation).
RESULTS: Among 61 study participants (109 study eyes) with baseline testing, a
field that met reliability cutoffs was obtained for 48 participants (79%) and 78 
eyes (72%). Fixation loss was found in 29% of eyes in initial testing. Nine study
participants (15%) demonstrated hemianopia or quadrantanopia, and an additional
36% had an abnormal global visual field index. Global indices were relatively
stable at follow-up testing for tests meeting fixation-loss cutoffs and tests
that did not. Visual scotomas due to post-chiasmal lesions were associated with
moderate to severe TBI or penetrating head injury, but other visual field
deficits were prevalent across the range of mild to severe TBI. Ocular injury to 
the retina or choroid, poorer visual acuity, and pupillary defect were associated
with visual field defects. Participants with depressed visual field sensitivity
reported lower visual quality of life.
CONCLUSIONS: Reliable automated perimetry can be accomplished in most patients
with TBI from combat blast exposure and reveals high rates of visual field
deficits, indicating that blast forces may significantly affect the eye and
visual pathways.

Published by Elsevier Inc.

PMID: 26581554   [PubMed - as supplied by publisher]


8. Ophthalmology. 2015 Nov 11. pii: S0161-6420(15)01038-6. doi:
10.1016/j.ophtha.2015.09.016. [Epub ahead of print]

Drusen Volume and Retinal Pigment Epithelium Abnormal Thinning Volume Predict
2-Year Progression of Age-Related Macular Degeneration.

Folgar FA(1), Yuan EL(1), Sevilla MB(1), Chiu SJ(2), Farsiu S(2), Chew EY(3),
Toth CA(4); Age Related Eye Disease Study 2 Ancillary Spectral-Domain Optical
Coherence Tomography Study Group.

Author information: 
(1)Department of Ophthalmology, Duke University Medical Center, Durham, North
Carolina. (2)Department of Ophthalmology, Duke University Medical Center, Durham,
North Carolina; Department of Biomedical Engineering, Duke University, Durham,
North Carolina. (3)National Eye Institute, National Institutes of Health,
Bethesda, Maryland. (4)Department of Ophthalmology, Duke University Medical
Center, Durham, North Carolina; Department of Biomedical Engineering, Duke
University, Durham, North Carolina. Electronic address: cynthia.toth@dm.duke.edu.

PURPOSE: To analyze the value of novel measures of retinal pigment
epithelium-drusen complex (RPEDC) volume to predict 2-year disease progression of
intermediate age-related macular degeneration (AMD).
DESIGN: Prospective, observational study.
PARTICIPANTS: Three hundred forty-five AMD and 122 non-AMD participants enrolled 
in the Age Related Eye Disease Study 2 Ancillary Spectral-Domain (SD) Optical
Coherence Tomography (OCT) study.
METHODS: High-density SD OCT macular volumes were obtained at yearly study
visits. The RPEDC abnormal thickening (henceforth, OCT drusen) and RPEDC abnormal
thinning (RAT) volumes were generated by semiautomated segmentation of total
RPEDC within a 5-mm-diameter macular field.
MAIN OUTCOME MEASURES: Volume change and odds ratio (OR) with 95% confidence
intervals (CI) for progression to advanced AMD with choroidal neovascularization 
(CNV) or central geographic atrophy (GA).
RESULTS: Complete volumes were obtained in 265 and 266 AMD eyes and in 115 and 97
control eyes at baseline and at year 2, respectively. In AMD eyes, mean (standard
deviation) OCT drusen volume increased from 0.08 mm(3) (0.16 mm(3)) to 0.10 mm(3)
(0.23 mm(3); P < 0.001), and RAT volume increased from 8.3 × 10(-4) mm(3) (20.8 ×
10(-4) mm(3)) to 18.4 × 10(-4) mm(3) (46.6 × 10(-4) mm(3); P < 0.001). Greater
baseline OCT drusen volume was associated with 2-year progression to CNV (P =
0.002). Odds of developing CNV increased by 31% for every 0.1-mm(3) increase in
baseline OCT drusen volume (OR, 1.31; 95% CI, 1.06-1.63; P = 0.013). Greater
baseline RAT volume was associated with significant 2-year increase in RAT volume
(P < 0.001), noncentral GA (P < 0.001), and progression to central GA (P <
0.001). Odds of developing central GA increased by 32% for every 0.001-mm(3)
increase in baseline RAT volume (OR, 1.32; 95% CI, 1.14-1.53; P < 0.001). In
non-AMD eyes, all volumes were significantly lower than AMD eyes and showed no
significant 2-year change.
CONCLUSIONS: Macular OCT drusen and RAT volumes increased significantly in AMD
eyes over 2 years. These quantitative SD OCT biomarkers predict 2-year AMD
progression and may serve as useful biomarkers for future clinical trials.

Copyright © 2015 American Academy of Ophthalmology. All rights reserved.

PMID: 26578448   [PubMed - as supplied by publisher]


9. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01155-0. doi:
10.1016/j.ophtha.2015.10.008. [Epub ahead of print]

Precision Pulse Capsulotomy: Preclinical Safety and Performance of a New
Capsulotomy Technology.

Chang DF(1), Mamalis N(2), Werner L(2).

Author information: 
(1)Altos Eye Physicians, Los Altos, California. Electronic address:
dceye@earthlink.net. (2)John A. Moran Eye Center, University of Utah, Salt Lake
City, Utah.

PURPOSE: To assess the preclinical safety and performance of a new precision
pulse capsulotomy (PPC) method.
DESIGN: Human cadaver eye studies and surgical, slit-lamp, and histopathologic
evaluation in a consecutive series of 20 live rabbits.
PARTICIPANTS: Human cadaver eyes and New Zealand white rabbits.
METHODS: Precision pulse capsulotomy uses a highly focused, fast, multipulse,
low-energy discharge to produce a perfectly round anterior capsulotomy
instantaneously and simultaneously along all 360°. Capsulotomies are performed
using a disposable handpiece with a soft collapsible tip and circular nitinol
cutting element. Miyake-Apple imaging and scanning electron microscopy (SEM) of
PPC were conducted in human cadaver eyes. Surgical, postoperative slit-lamp, and 
histopathologic assessments of PPC were performed in 20 live rabbits and were
compared with manual continuous curvilinear capsulorrhexis (CCC) in the fellow
eye. Anterior chamber (AC) thermocouple temperature measurements were evaluated
in a subset of rabbit eyes.
MAIN OUTCOME MEASURES: Capsulotomy edge circularity, SEM morphologic features and
zonular movement with PPC in human cadaver eyes. Anterior chamber temperature
during PPC and grading of ocular inflammation, corneal endothelial damage,
anterior capsular opacification (ACO), and posterior capsular opacification
(PCO).
RESULTS: Miyake-Apple imaging showed minimal zonular stress, and thermocouple
measurements demonstrated negligible AC temperature changes during PPC. Precision
pulse capsulotomy produced round, complete capsulotomies in all 20 rabbit eyes,
leading to successful in-the-bag intraocular lens (IOL) implantation. Slit-lamp
examinations at 3 days and 1, 2, and 4 weeks after surgery showed no significant 
differences between PPC and CCC in corneal edema, AC inflammatory reaction,
capsular fibrosis, ACO, and PCO. Postmortem studies showed no difference in the
corneal endothelium between PPC and CCC eyes. All IOLs were well centered in PPC 
eyes, and histopathologic analysis showed no greater inflammatory infiltrates.
CONCLUSIONS: Precision pulse capsulotomy is a new method to automate consistent
creation of a perfectly circular anterior capsulotomy with a disposable handheld 
instrument that can be used in the normal phacoemulsification surgical sequence. 
Compared with CCC in fellow rabbit eyes, PPC was equally safe and showed no
greater zonular stress compared with CCC in human cadaver eyes. Human cadaver eye
SEM showed a much smoother capsulotomy edge compared to those produced by
femtosecond laser.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26578447   [PubMed - as supplied by publisher]


10. Ophthalmology. 2015 Nov 11. pii: S0161-6420(15)01117-3. doi:
10.1016/j.ophtha.2015.09.039. [Epub ahead of print]

First-Year Visual Acuity Outcomes in the United Kingdom of Providing Aflibercept 
According to the VIEW Study Protocol for Age-Related Macular Degeneration.

Talks JS(1), Lotery AJ(2), Ghanchi F(3), Sivaprasad S(4), Johnston RL(5), Patel
N(6), McKibbin M(7), Bailey C(8), Mahmood S(9); United Kingdom Aflibercept Users 
Group.

Collaborators: Lobo A, Paul B, Kashif Q, Santiago C, Walters G, Tahir M, Mushtaq 
B.

Author information: 
(1)Newcastle Upon Tyne Hospitals Foundation NHS Trust, Newcastle-upon-Tyne,
United Kingdom. Electronic address: james.talks@nuth.nhs.uk. (2)Faculty of
Medicine, University of Southampton, Southamptom, United Kingdom. (3)Bradford
Teaching Hospitals, Bradford, United Kingdom. (4)Kings College Hospital NHS
Foundation Trust, London, United Kingdom. (5)Gloucestershire Hospitals NHS
Foundation Trust, United Kingdom. (6)East Kent Hospitals University NHS
Foundation Trust, United Kingdom. (7)Leeds Teaching Hospitals NHS Trust, Leeds,
United Kingdom. (8)University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom. (9)Manchester Royal Eye Hospital, Central Manchester University
Hospitals NHS Foundation Trust, Manchester, United Kingdom.

PURPOSE: Aflibercept has the potential advantage of reducing capacity problems by
allowing 2 monthly visits for patients with neovascular macular degeneration
(nAMD) compared with monthly pro re nata regimens that are the most commonly used
in the United Kingdom. This study aimed to report the visual outcomes achieved in
routine clinical practice using the VEGF Trap-Eye: Investigation of Efficacy and 
Safety in Wet AMD (VIEW) protocol at 1 year and compare with trials data and
other real-world reports.
DESIGN: Retrospective data analysis from an electronic medical record.
PARTICIPANTS: Consecutive series of treatment-naïve patients initiated on
aflibercept for nAMD at least 1 year before data extraction.
METHODS: Data were anonymized and remotely extracted from 16 centers in the
United Kingdom that use the same electronic medical record (EMR) system (Medisoft
Ophthalmology; Medisoft Limited, Leeds, UK).
MAIN OUTCOME MEASURES: The minimum data set defined before first data entry and
mandated by the EMR included age, gender, visual acuity, injection episodes, and 
complications.
RESULTS: The mean age was 80.0 years (median, 81.0 years) and 63.7% were women.
During the first year of treatment with aflibercept, 1840 treatment-naïve eyes of
1682 patients received a median of 8 (mean, 7.0) injections at a median of 8
(mean, 7.3) visits. The mean baseline visual acuity was 53.7 letters, improving
to 58.8 letters (+5.1-letter gain) at 1 year. In first-treated eyes, the
respective figures were 52.7 letters at baseline and 58.2 letters at 1 year, a
gain of +5.5 letters. The proportion achieving 70 letters or more increased from 
16.4% at baseline to 33.7% at 1 year, and 92% avoided moderate visual loss at 1
year.
CONCLUSIONS: The visual acuity outcomes are comparable to randomized trials and
better than many previous real-world data collections, with a mean +5.1-letter
gain at 1 year compared with +8.4 letters in the integrated analysis of the VIEW 
1 and VIEW 2 studies. Early visual gains were maintained through the year.
Collection of outcomes beyond clinical trials can have limitations but better
reflect the full pool of patients actually treated and are important to determine
whether a particular treatment is performing as expected. Such data also have the
potential to improve services by setting up a mechanism to compare sites.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26578446   [PubMed - as supplied by publisher]


11. Ophthalmology. 2015 Nov 12. pii: S0161-6420(15)01270-1. doi:
10.1016/j.ophtha.2015.10.048. [Epub ahead of print]

Idiopathic Epiretinal Membrane and Vitreomacular Traction Preferred Practice
Pattern(®) Guidelines.

Folk JC(1), Adelman RA(2), Flaxel CJ(3), Hyman L(4), Pulido JS(5), Olsen TW(6).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals 
& Clinics, Iowa City, Iowa. (2)Department of Ophthalmology and Visual Science,
Yale School of Medicine, New Haven, Connecticut. (3)Casey Eye Institute, Oregon
Health & Science University, Portland, Oregon. (4)Division of Epidemiology,
Department of Family, Population and Preventive Medicine, School of Medicine,
Stony Brook University, Stony Brook, New York. (5)Department of Ophthalmology,
Mayo Clinic, Rochester, Minnesota. (6)Emory Eye Center, Emory University,
Atlanta, Georgia.

PMID: 26578445   [PubMed - as supplied by publisher]


12. BMC Ophthalmol. 2015 Nov 17;15(1):168.

Transient cortical visual impairment after video-assisted thoracic surgery: a
case report.

Yang HK(1), Hwang JM(2).

Author information: 
(1)Department of Ophthalmology, Seoul National University College of Medicine,
Seoul National University Bundang Hospital, 166, Gumiro, Bundang-gu, Seongnam,
Gyeonggi-do, 463-707, Korea. nan282@snu.ac.kr. (2)Department of Ophthalmology,
Seoul National University College of Medicine, Seoul National University Bundang 
Hospital, 166, Gumiro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea.
hjm@snu.ac.kr.

BACKGROUND: Visual loss associated with thoracic surgery has been reported mostly
after coronary angiography or bypass surgery. The position of video-assisted
thoracic surgery (VATS) is usually lateral, thus not compressive to the globe.
Visual loss after VATS has not been reported. Herein we report a patient without 
any cardiovascular risk factors who experienced transient cortical blindness
after an uneventful VATS.
CASE PRESENTATION: A 40-year-old man noticed a visual loss at the recovery room
after VATS. He showed normal pupillary reflex, normal optic disc appearance, and 
homonymous hemianopia respecting the vertical meridian, thus was typical for
cortical visual impairment.
CONCLUSIONS: Transient cortical visual impairment could be encountered after an
uneventful VATS in a patient without any cardiovascular risk factors.

PMCID: PMC4650142
PMID: 26577679   [PubMed - as supplied by publisher]


13. BMC Ophthalmol. 2015 Nov 16;15(1):167.

Retraction Note: Cental macular thickness in patients with type 2 diabetes
mellitus without clinical retinopathy.

Demir M(1), Oba E(2), Dirim B(2), Ozdal E(2), Can E(2).

Author information: 
(1)Sisli Etfal Training and Research Hospital, Eye Clinic, Karayolları Mah, Abdi 
ipekci bulvarı. N0:32 Avrupa tem konutları 28. Blok. Daire:14. 34250 GOP, Sisli, 
Istanbul, 34400, Turkey. drmehmetfe@hotmail.com. (2)Sisli Etfal Training and
Research Hospital, Eye Clinic, Karayolları Mah, Abdi ipekci bulvarı. N0:32 Avrupa
tem konutları 28. Blok. Daire:14. 34250 GOP, Sisli, Istanbul, 34400, Turkey.

PMCID: PMC4647828
PMID: 26572602   [PubMed - as supplied by publisher]


14. BMC Ophthalmol. 2015 Nov 12;15(1):166. doi: 10.1186/s12886-015-0151-7.

Effect of benzalkonium chloride-free travoprost on intraocular pressure and
ocular surface symptoms in patients with glaucoma previously on latanoprost: an
open-label study.

Lopes JF(1), Hubatsch DA(2), Amaris P(3).

Author information: 
(1)Clinica Oftalmológica Pasteur, Luis Pasteur 5917 - Vitacura, Santiago, Chile. 
lopesjf@gmail.com. (2)Alcon Laboratories, Inc., Fort Worth, TX, USA.
doug.hubatsch@alcon.com. (3)Clínica Oftalmológica del Caribe, Barranquilla,
Colombia. patamaris@gmail.com.

BACKGROUND: Prostaglandin analogs reduce intraocular pressure (IOP) in patients
with open-angle glaucoma or ocular hypertension; however, these medications may
affect the ocular surface and elicit ocular discomfort when preserved with
benzalkonium chloride (BAK).
METHODS: This was an open-label, single-arm study conducted in Latin America from
February 2012 to May 2013. Patients with open-angle glaucoma or ocular
hypertension who were intolerant of latanoprost 0.005 % were transitioned to
receive once-daily BAK-free travoprost 0.004 % containing polyquaternium-1
(Travatan® preserved with POLYQUAD® [PQ], Alcon Laboratories, Inc; Fort Worth,
TX) for 12 weeks. Mean change in IOP from baseline (primary efficacy endpoint)
and the percentage of patients who achieved a target IOP of ≤18 mmHg were
evaluated at all on-therapy visits. Ocular hyperemia, patient preference, and
self-projected adherence were assessed at week 12. Adverse events (AEs) were
monitored throughout the study.
RESULTS: All enrolled patients were included in the analysis (n = 191); the
majority of patients (90.6 %, n = 173/191) completed the study. Mean (SD) patient
age was 67.5 (11.3) years, and mean baseline IOP was 14.8 mmHg. Mean IOP was
reduced by 0.94 mmHg at week 6 and by 1.09 mmHg at week 12 (P < 0.001 for both). 
A greater percentage of patients achieved a target IOP of ≤18 mmHg at week 6
(93.1 %; n = 163/175) and week 12 (93.3 %; n = 166/178) compared with baseline
(89.5 %; n = 171/191). There was a 10.5 % increase in the percentage of patients 
with "none/trace" amounts of hyperemia. Most patients preferred the study
medication (81.5 %; n = 141/173) and were confident that they would adhere to
their preferred medication (90.8 %; n = 157/173). No serious AEs were reported,
and eye irritation (3.7 %; n = 7/191) was the most common treatment-related AE.
CONCLUSIONS: Transitioning from BAK-containing latanoprost 0.005 % to BAK-free
travoprost 0.004 % preserved with PQ reduced IOP in patients with open-angle
glaucoma or ocular hypertension who were intolerant of latanoprost. BAK-free
travoprost 0.004 % is a viable alternative for patients who require switching
their IOP-lowering medications because of tolerability issues.
TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01510145.

PMCID: PMC4642782
PMID: 26563363   [PubMed - in process]


15. BMC Ophthalmol. 2015 Nov 11;15(1):165. doi: 10.1186/s12886-015-0154-4.

Primary silicone oil tamponade and internal limiting membrane peeling for retinal
detachment due to macular hole in highly myopic eyes with chorioretinal atrophy.

Hong N(1), Huang BS(2), Tong JP(3).

Author information: 
(1)Department of Ophthalmology, the First Affiliated Hospital of College of
Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
drhongnan_ophthal@hotmail.com. (2)Department of Ophthalmology, the First
Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou,
Zhejiang, P. R. China. huangbaishuang@hotmail.com. (3)Department of
Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang
University, Hangzhou, Zhejiang, P. R. China. tongjp2000@hotmail.com.

BACKGROUND: Retinal detachment (RD) secondary to macular hole (MH) is a common
complication in highly myopic eyes, usually leading to a poor visual prognosis.
The purpose of this study was to evaluate the surgical outcome of silicone oil
(SO) tamponade and internal limiting membrane (ILM) peeling in the treatment of
RD caused by MH (MHRD) in highly myopic eyes with chorioretinal atrophy, and to
identify clinical factors associated with the anatomical outcomes.
METHODS: We retrospectively reviewed 21 eyes of 21 highly myopic patients
affected by RD secondary to MH and chorioretinal atrophy. All eyes were treated
with pars plana vitrectomy (PPV) with ILM peeling and SO tamponade. Anatomical
success was defined as reattachment of the retina with the closure of the MH, as 
assessed by optical coherence tomography (OCT), after SO removal. Logistic
regression was performed to determine the clinical factors influencing anatomical
success.
RESULTS: The mean patient age was 59.95 years [standard deviation (SD), 10.39;
range, 34-77 years] and the mean axial length was 30.58 mm (SD, 1.52; range,
27.99-34.51 mm). After the first surgical procedure, the anatomical success rate 
was 61.9 % (13 eyes in 21 eyes), with initial retinal attachment of16 eyes
(76.2 %). A second surgical approach was performed for the five eyes with
persistent or recurrent RD, and the final retinal reattachment rate was 100 %
(21/21). Logistic regression analysis showed that no specific factors were
significantly associated with anatomical success.
CONCLUSIONS: Primary silicone oil tamponade and ILM peeling can be a practical
treatment for repairing MHRD in highly myopic eyes with chorioretinal atrophy.

PMCID: PMC4642637
PMID: 26560878   [PubMed - in process]


16. Ophthalmology. 2015 Nov 7. pii: S0161-6420(15)01186-0. doi:
10.1016/j.ophtha.2015.10.009. [Epub ahead of print]

Incidence and Characteristics of Cystoid Macular Edema after Cataract Surgery.

Daien V(1), Papinaud L(2), Domerg C(2), Lacombe S(3), Daures JP(3), Villain M(4).

Author information: 
(1)Inserm, U1061, Montpellier, France; University of Montpellier, Montpellier,
France; Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier,
France. Electronic address: vincent.daien@gmail.com. (2)Biostatistics Department,
Echelon Régional du Service Médical du Languedoc-Roussillon, Montpellier, France.
(3)Department of Biostatistics, Epidemiology and Clinical Research EA2415,
University of Montpellier, Montpellier, France. (4)University of Montpellier,
Montpellier, France; Department of Ophthalmology, Gui De Chauliac Hospital,
Montpellier, France.

PMID: 26560833   [PubMed - as supplied by publisher]


17. Ophthalmology. 2015 Nov 7. pii: S0161-6420(15)01128-8. doi:
10.1016/j.ophtha.2015.09.045. [Epub ahead of print]

Mutations in CACNA2D4 Cause Distinctive Retinal Dysfunction in Humans.

Ba-Abbad R(1), Arno G(1), Carss K(2), Stirrups K(2), Penkett CJ(2), Moore AT(3), 
Michaelides M(1), Raymond FL(4), Webster AR(1), Holder GE(5).

Author information: 
(1)UCL Institute of Ophthalmology, University College London, London, UK;
Moorfields Eye Hospital, London, UK. (2)Department of Haematology, University of 
Cambridge and, NHS Blood and Transplant, Cambridge, UK; NIHR BioResource-Rare
Diseases, Cambridge. (3)UCL Institute of Ophthalmology, University College
London, London, UK; Moorfields Eye Hospital, London, UK; Ophthalmology
Department, UCSF School of Medicine, Koret Vision Centre, San Francisco CA.
(4)NIHR BioResource-Rare Diseases, Cambridge; Department of Medical Genetics,
Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK.
(5)UCL Institute of Ophthalmology, University College London, London, UK;
Moorfields Eye Hospital, London, UK. Electronic address:
graham.holder@moorfields.nhs.uk.

PMID: 26560832   [PubMed - as supplied by publisher]


18. BMC Ophthalmol. 2015 Nov 9;15(1):163. doi: 10.1186/s12886-015-0155-3.

Association between a vascular endothelial growth factor gene polymorphism
(rs2146323) and diabetic retinopathy: a meta-analysis.

Zeng Y(1), Dai F(2), Yang K(3), Tang Y(4), Xu M(2), Zhou Y(2).

Author information: 
(1)Department of Ophthalmology of the Shanghai Tenth People's Hospital, and
Laboratory of Clinical Visual Sciences of Tongji Eye Institute, and Department of
Regenerative Medicine, Tongji University School of Medicine, Shanghai, China.
zengying@tongji.edu.cn. (2)Department of Ophthalmology of the Shanghai Tenth
People's Hospital, and Laboratory of Clinical Visual Sciences of Tongji Eye
Institute, and Department of Regenerative Medicine, Tongji University School of
Medicine, Shanghai, China. (3)Institute of Cardiovascular Disease, Ruijin
Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
(4)Department of Development, Great China Region of Novartis, Shanghai, China.

BACKGROUND: Vascular endothelial growth factor (VEGF) is thought to play an
important role in the pathogenesis of diabetic retinopathy (DR). Previous studies
have associated the VEGF rs2146323 polymorphism with the risk of DR. However, the
results of these studies are inconsistent. A meta-analysis was performed to
evaluate the association between the VEGF rs2146323 polymorphism and the risk of 
DR.
METHODS: The PubMed, EMBASE, Web of Science and Google Scholar literature
databases until March 2015 were searched. The differences in the studies were
expressed in the form of an odds ratio (OR) and the corresponding 95 % confidence
interval (CI). Heterogeneity among the studies was tested using the I(2)
statistic based on the Q test.
RESULTS: A total of four studies (598 cases and 709 controls) were included in
the meta-analysis. A significant association was found involving the rs2146323
polymorphism in the dominant model (CA + AA VS. CC) (OR = 1.38, CI = 1.10-1.72,
P = 0.005) and the co-dominant model (CA VS. CC) (OR = 1.37, CI = 1.08-1.74,
P = 0.008).
CONCLUSIONS: Our meta-analysis confirmed the association between the VEGF
rs2146323 polymorphism and the risk of DR.

PMCID: PMC4640352
PMID: 26553067   [PubMed - in process]


19. BMC Ophthalmol. 2015 Nov 9;15(1):162. doi: 10.1186/s12886-015-0152-6.

Effects of refractive errors on visual evoked magnetic fields.

Suzuki M(1), Nagae M(2), Nagata Y(3), Kumagai N(4), Inui K(5), Kakigi R(6).

Author information: 
(1)R&D Department, Tokai Optical Co., Ltd, Okazaki, 444-2192, Japan.
ma-suzuki@tokaiopt.co.jp. (2)R&D Department, Tokai Optical Co., Ltd, Okazaki,
444-2192, Japan. n.mizpyon@gmail.com. (3)R&D Department, Tokai Optical Co., Ltd, 
Okazaki, 444-2192, Japan. y.nagata.chibiko@gmail.com. (4)R&D Department, Tokai
Optical Co., Ltd, Okazaki, 444-2192, Japan. n-kumagai@tokaiopt.co.jp.
(5)Department of Integrative Physiology, National Institute for Physiological
Sciences, Okazaki, 444-8585, Japan. inui@nips.ac.jp. (6)Department of Integrative
Physiology, National Institute for Physiological Sciences, Okazaki, 444-8585,
Japan. kakigi@nips.ac.jp.

BACKGROUND: The latency and amplitude of visual evoked cortical responses are
known to be affected by refractive states, suggesting that they may be used as an
objective index of refractive errors. In order to establish an easy and reliable 
method for this purpose, we herein examined the effects of refractive errors on
visual evoked magnetic fields (VEFs).
METHODS: Binocular VEFs following the presentation of a simple grating of
0.16 cd/m(2) in the lower visual field were recorded in 12 healthy volunteers and
compared among four refractive states: 0D, +1D, +2D, and +4D, by using plus
lenses.
RESULTS: The low-luminance visual stimulus evoked a main MEG response at
approximately 120 ms (M100) that reversed its polarity between the upper and
lower visual field stimulations and originated from the occipital midline area.
When refractive errors were induced by plus lenses, the latency of M100
increased, while its amplitude decreased with an increase in power of the lens.
Differences from the control condition (+0D) were significant for all three
lenses examined. The results of dipole analyses showed that evoked fields for the
control (+0D) condition were explainable by one dipole in the primary visual
cortex (V1), while other sources, presumably in V3 or V6, slightly contributed to
shape M100 for the +2D or +4D condition.
CONCLUSIONS: The present results showed that the latency and amplitude of M100
are both useful indicators for assessing refractive states. The contribution of
neural sources other than V1 to M100 was modest under the 0D and +1D conditions. 
By considering the nature of the activity of M100 including its high sensitivity 
to a spatial frequency and lower visual field dominance, a simple low-luminance
grating stimulus at an optimal spatial frequency in the lower visual field
appears appropriate for obtaining data on high S/N ratios and reducing the load
on subjects.

PMCID: PMC4640416
PMID: 26553029   [PubMed - in process]


20. BMC Ophthalmol. 2015 Nov 8;15(1):161. doi: 10.1186/s12886-015-0153-5.

Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case
report.

Li G(1), Zhang Y(2), Zhu X(3), Hou K(4).

Author information: 
(1)Department of Neurology, The First Hospital of Jilin University Changchun,
Changchun, Jilin, China. Gretchen666@yeah.net. (2)Department of Neurosurgery, The
First Hospital of Jilin University Changchun, Changchun, Jilin, 130021, China.
zhangyang_930@126.com. (3)Department of Neurosurgery, The First Hospital of Jilin
University Changchun, Changchun, Jilin, 130021, China. zhuxiaobo@126.com.
(4)Department of Neurosurgery, The First Hospital of Jilin University Changchun, 
Changchun, Jilin, 130021, China. hkyyayz@yeah.net.

BACKGROUND: Transient traumatic isolated neurogenic ptosis (TTINP) is a
sporadically reported rare entity. However, to the best of our knowledge, nearly 
all the reported cases are either secondary to direct periorbital trauma or
surgery. We would like to report on a case of TTINP with countre-coup injury of
the periorbital region.
CASE PRESENTATION: A 49-year-old female slipped and fell down while walking. She 
was hospitalized with a moderate headache and undisturbed mental state. The
patient recalled that the force bearing point was her occipital region. Physical 
examination and computed tomography (CT) on admission showed right isolated
ptosis and mild contusion and laceration in the bilateral frontal cortex. Further
radiological investigation revealed nothing remarkable except for a fracture of
the superior portion of the right medial orbital wall. She was managed
conservatively and recovered completely in two months.
CONCLUSION: TTINP might manifest as a unique entity with a relatively mild,
reversible, and non-devastating injury to the terminal branch of the oculomotor
nerve and for which perhaps no special treatment is needed. The proposed
mechanism is injury of the terminal branch of the superior division of the
oculomotor nerve.

PMCID: PMC4638091
PMID: 26549147   [PubMed - in process]


21. BMC Ophthalmol. 2015 Nov 7;15(1):160. doi: 10.1186/s12886-015-0150-8.

Evaluating vision-related quality of life in preoperative age-related cataract
patients and analyzing its influencing factors in China: a cross-sectional study.

Zhu M(1), Yu J(2), Zhang J(3), Yan Q(4), Liu Y(5).

Author information: 
(1)School of Public Health, China Medical University, Shenyang, 110122, China.
zmmin2002@126.com. (2)Department of Ophthalmology, The Fourth Affiliated Hospital
of China Medical University, Shenyang, 110001, China. cmu4h_yjm@126.com.
(3)Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical
University, Shenyang, 110001, China. 55903724@qq.com. (4)Department of
Ophthalmology, The Fourth Affiliated Hospital of China Medical University,
Shenyang, 110001, China. 121418535@qq.com. (5)School of Public Health, China
Medical University, Shenyang, 110122, China. cmu_liuyang@163.com.

BACKGROUND: To evaluate vision-related quality of life in preoperative
age-related cataract patients in China, using the Chinese version of the National
Eye Institute Visual Function Questionnaire-25 (CHI-NEI-VFQ-25), together with
analyses of its influencing factors.
METHODS: Cataract patients were interviewed using the CHI-NEI-VFQ-25, and their
demographic information was recorded. The Cronbach α coefficient was used to
determine the internal consistency of the CHI-NEI-VFQ-25. Multi-trait analyses
were used to assess construct validity, including item convergent validity and
item discriminant validity. The data were evaluated by descriptive statistical
analyses, by the Kruskal-Wallis rank sum test, and by multinomial logistic
regression.
RESULTS: The Cronbach α coefficients were all above 0.8, except for the driving
subscale. All items passed the convergent and discriminant validity tests. The
composite score was 63.0. The lowest five subscale scores were in general vision 
(40.0), mental health (37.5), role difficulty (37.5), near vision activities
(50.0), and dependence (58.3). Except for the subscale scores of general health
and ocular pain, the composite scores and subscale scores were positively
associated with the best-corrected visual acuity (BCVA) in the better eye.
Multinomial logistic regression showed that sex, age, and educational attainment 
were significantly associated with the composite score and subscale scores.
CONCLUSIONS: BCVA in the better eye was the most important determinant associated
with the decrease in vision-related quality of life. Visual impairment had more
impact on the psychosocial parameter than on the other parameters of the
patients' quality of life. Among all the demographic characteristics, including
sex, age, and educational attainment, influenced the quality of life in
age-related cataract patients.

PMCID: PMC4637140
PMID: 26547302   [PubMed - in process]


22. Ophthalmology. 2015 Nov 3. pii: S0161-6420(15)01125-2. doi:
10.1016/j.ophtha.2015.09.044. [Epub ahead of print]

Factors Associated with Patient Press Ganey Satisfaction Scores for Ophthalmology
Patients.

Long C(1), Tsay EL(2), Jacobo SA(2), Popat R(1), Singh K(3), Chang RT(4).

Author information: 
(1)Stanford University School of Medicine, Stanford, California. (2)Department of
Biology, Stanford University, Stanford, California. (3)Stanford University School
of Medicine, Stanford, California; Department of Ophthalmology, Byers Eye
Institute, Stanford University School of Medicine, Palo Alto, California.
(4)Department of Ophthalmology, Byers Eye Institute, Stanford University School
of Medicine, Palo Alto, California. Electronic address: viroptic@gmail.com.

PURPOSE: To determine which metrics from the Press Ganey patient satisfaction
survey best correlate with "likelihood to recommend" among patients in an
academic tertiary medical center practice setting.
DESIGN: Cross-sectional study.
PARTICIPANTS: Over a 3-month period, patients presenting to an academic practice 
who agreed to participate were enrolled in the study if they met the following
entry criteria: (1) age ≥18 years, (2) ability to read and speak English, and (3)
followed in this practice between 4 months and 4 years. A total of 196 patients
were recruited.
METHODS: A 26-item abridged version of the Press Ganey survey typically
distributed to patients via mail or e-mail after visiting the Stanford University
Hospital was administered privately to each eligible patient of 2 different
attending clinics at the conclusion of his or her visit. The 26 survey items were
not modified for the purposes of the study and were administered such that
participants could not be individually identified. The arithmetic mean score for 
the item "Likelihood of your recommending our practice to others" was calculated 
by assigning a value (0-100) to the Likert value associated with survey responses
and correlated with the 25 other items using the differences in the mean scores.
MAIN OUTCOME MEASURES: Response to survey items graded on a 1 to 5 standard
Likert scale.
RESULTS: The weighted mean patient survey score for the "likelihood to recommend"
item for the junior faculty member was 95.9% and for the senior faculty member
was 94.5%, respectively. For the remaining 25 items, "Amount of time the care
provider spent with you" (Diff[1-2]=1.03; P < 0.0001) and "Ease of scheduling
your appointment" (Diff[1-2]=0.99; P < 0.0001) best correlated with likelihood to
recommend. In contrast, "Friendliness/courtesy of the care provider"
(Diff[1-2]=0.29; P = 0.0045) correlated least with likelihood to recommend.
Stratification based on provider did not affect the study results.
CONCLUSIONS: The perception of time spent with the practitioner and ease of
appointment scheduling are the 2 variables that best correlate with patients
recommending their ophthalmologists to other prospective patients.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26545321   [PubMed - as supplied by publisher]


23. Ophthalmology. 2015 Nov 3. pii: S0161-6420(15)01143-4. doi:
10.1016/j.ophtha.2015.09.046. [Epub ahead of print]

Association between Antiplatelet or Anticoagulant Drugs and Retinal or Subretinal
Hemorrhage in the Comparison of Age-Related Macular Degeneration Treatments
Trials.

Ying GS(1), Maguire MG(2), Daniel E(2), Grunwald JE(2), Ahmed O(3), Martin DF(4);
Comparison of Age-Related Macular Degeneration Treatments Trials Research Group.

Author information: 
(1)Department of Ophthalmology, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania. Electronic address:
gsying@mail.med.upenn.edu. (2)Department of Ophthalmology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. (3)Program in
Life Sciences and Management, The Wharton School, University of Pennsylvania,
Philadelphia, Pennsylvania. (4)Cole Eye Institute, Cleveland Clinic, Cleveland,
Ohio.

PURPOSE: To evaluate the association between use of antiplatelet or anticoagulant
drugs and retinal or subretinal hemorrhage in participants with neovascular
age-related macular degeneration (AMD) in the Comparison of AMD Treatments Trials
(CATT).
DESIGN: Cohort study within CATT.
PARTICIPANTS: Participants in CATT with untreated active neovascular AMD (n =
1185).
METHODS: Participants were interviewed for use of antiplatelet or anticoagulant
drugs. Trained readers evaluated photographs for the presence and size of retinal
or subretinal hemorrhage at baseline and years 1 and 2. Associations between use 
of antiplatelet or anticoagulant drugs and hemorrhage were evaluated among all
participants and by baseline hypertension status using multivariate logistic
regression models.
MAIN OUTCOME MEASURES: Odds ratio for association with antiplatelet or
anticoagulant use.
RESULTS: Among 1165 participants with gradable photographs, 724 (62.1%) had
retinal or subretinal hemorrhage at baseline; 84.4% of hemorrhages were 1 disc
area (DA) or less, 8.1% were 1 to 2 DA, and 7.5% were more than 2 DA. At
baseline, 608 participants (52.2%) used antiplatelet or anticoagulant drugs,
including 514 participants (44.1%) using antiplatelets only, 77 (6.6%) using
anticoagulants only, and 17 (1.5%) using both. Hemorrhage was present in 64.5% of
antiplatelet or anticoagulant users and in 59.6% of nonusers (P = 0.09; adjusted 
odds ratio [OR], 1.18; 95% confidence interval, 0.91-1.51; P = 0.21). Neither
presence nor size of baseline hemorrhage was associated with the type, dose, or
duration of antiplatelet or anticoagulant use. Forty-four of 1078 participants
(4.08%) had retinal or subretinal hemorrhage detected on 1- or 2-year
photographs; these hemorrhages were not associated with antiplatelet or
anticoagulant use at baseline (P = 0.28) or during follow-up (P = 0.64). Among
participants with hypertension (n = 807), antiplatelet or anticoagulant use was
associated with a higher rate of hemorrhage at baseline (66.8% vs. 56.4%;
adjusted OR, 1.48; P = 0.01), but not size of retinal or subretinal hemorrhage
(P = 0.41).
CONCLUSIONS: Most retinal or subretinal hemorrhages in eyes enrolled in CATT were
less than 1 DA. Among all CATT participants, antiplatelet or anticoagulant use
was not associated significantly with hemorrhage, but it was associated
significantly with hemorrhage in participants with hypertension.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26545320   [PubMed - as supplied by publisher]


24. Ophthalmology. 2015 Nov 3. pii: S0161-6420(15)01154-9. doi:
10.1016/j.ophtha.2015.10.007. [Epub ahead of print]

Longitudinal Study of Age-Related Cataract Using Dynamic Light Scattering: Loss
of α-Crystallin Leads to Nuclear Cataract Development.

Datiles MB 3rd(1), Ansari RR(2), Yoshida J(3), Brown H(4), Zambrano AI(4), Tian
J(4), Vitale S(5), Zigler JS Jr(4), Ferris FL 3rd(5), West SK(4), Stark WJ(4).

Author information: 
(1)National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Electronic address: DatilesM@NEI.NIH.GOV. (2)National Aeronautics and Space
Administration-John H. Glenn Research Center, Cleveland, Ohio. (3)The Wilmer Eye 
Institute, Johns Hopkins University Hospital, Baltimore, Maryland; Department of 
Ophthalmology, University of Tokyo, Tokyo, Japan. (4)The Wilmer Eye Institute,
Johns Hopkins University Hospital, Baltimore, Maryland. (5)National Eye
Institute, National Institutes of Health, Bethesda, Maryland.

PURPOSE: To conduct a longitudinal study on age-related nuclear cataracts using
dynamic light scattering (DLS) to determine if cataract progression is associated
with loss of the unbound form of the lens molecular chaperone protein,
α-crystallin.
DESIGN: Natural history and cohort study.
PARTICIPANTS: Patients 30 years of age or older of either gender seeking
treatment at the Wilmer Eye Institute Cornea-Cataract Department.
METHODS: All patients underwent a comprehensive dilated eye examination every 6
months, including slit-lamp grading of their lenses using the Age-Related Eye
Disease Study (AREDS) clinical lens grading system and obtaining an estimate of
unbound α-crystallin level in the nucleus, the α-crystallin index (ACI), using
the National Aeronautics and Space Administration-National Eye Institute DLS
device. We used a random effects statistical model to examine the relationship of
lens opacity changes over time with ACI changes.
MAIN OUTCOME MEASURES: α-Crystallin Index (ACI) and AREDS nuclear cataract grade.
RESULTS: Forty-five patients (66 eyes) 34 to 79 years of age with AREDS nuclear
lens grades of 0 to 3.0 were followed up every 6 months for a mean of 19 months
(range, 6-36 months). We found that lenses with the lowest baseline levels of ACI
had the most rapid progression of cataracts, whereas lenses with higher ACI at
baseline had no or slower cataract progression. Lenses that lost α-crystallin at 
the highest rates during the study also had faster progression of nuclear
cataracts than lenses with a slower rate of ACI loss. Kaplan-Meier survival
curves showed that lenses with the lowest initial ACI had the highest risk of
undergoing cataract surgery.
CONCLUSIONS: This longitudinal study corroborates our previous cross-sectional
study finding that higher levels of unbound α-crystallin as assessed by ACI are
associated with lower risk of cataract formation and that loss of ACI over time
is associated with cataract formation and progression. This study suggested that 
assessment of ACI with the DLS device could be used as a surrogate for lens
opacity risk in clinical studies, and for assessing nuclear cataract events in
studies where cataract development may be a side effect of a drug or device.

Published by Elsevier Inc.

PMID: 26545319   [PubMed - as supplied by publisher]


25. Ophthalmology. 2015 Nov 3. pii: S0161-6420(15)01106-9. doi:
10.1016/j.ophtha.2015.09.028. [Epub ahead of print]

Boston Type 1 Keratoprosthesis versus Repeat Donor Keratoplasty for Corneal
Graft Failure: A Systematic Review and Meta-Analysis.

Ahmad S(1), Mathews PM(1), Lindsley K(2), Alkharashi M(3), Hwang FS(4), Ng SM(2),
Aldave AJ(5), Akpek EK(6).

Author information: 
(1)The Wilmer Eye Institute, The Johns Hopkins University School of Medicine,
Baltimore, Maryland. (2)Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland. (3)Consultant, King Saud
University, Riyadh, Saudi Arabia. (4)Cornea and External Disease, The Kresge Eye 
Institute, Wayne State University, Detroit, Michigan. (5)Cornea and Refractive
Surgery Services, The Jules Stein Eye Institute, Los Angeles, California. (6)The 
Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore,
Maryland. Electronic address: esakpek@jhmi.edu.

PURPOSE: To compare repeat penetrating keratoplasty (PK) with Boston type I
keratoprosthesis (KPro) implantation for full-thickness donor corneal graft
failure.
DESIGN: Previous donor graft failure is a common indication for both PK and KPro 
implantation. Selection of the surgical procedure is entirely dependent on the
surgeon because there are no studies available for guidance. Therefore, a
systematic review was undertaken to examine vision, device retention, graft
clarity, and postoperative glaucoma and infection outcomes after repeat PK versus
KPro implantation.
METHODS: Articles with data regarding repeat PK published between 1990 and 2014
were identified in PubMed, EMBASE, the Latin American and Caribbean Health
Sciences Literature Database, and the Cochrane Central Register of Controlled
Trials and were reviewed. Results were compared with a retrospective review of
consecutive, nonrandomized, longitudinal case series of KPro implantations
performed at 5 tertiary care centers in the United States. Visual acuity at 2
years was the primary outcome measure. The proportion of clear grafts in the
repeat PK group, device retention in the KPro group, and the development of
postoperative glaucoma and infection were secondary outcome measures.
RESULTS: The search strategy identified 17 128 articles in the PK analysis. After
screening, 26 studies (21 case series and 5 cohort studies) were included in the 
review. Pooled analysis of the 26 unique studies demonstrated a 42% (95%
confidence interval [CI], 30%-56%) likelihood of maintaining 20/200 or better at 
2 years after repeat PK, compared with an 80% (95% CI, 68%-88%) probability with 
KPro implantation. The probability of maintaining a clear graft at 5 years was
47% (95% CI, 40%-54%) after repeat PK, whereas the probability of retention of
the KPro at 5 years was 75% (95% CI, 64%-84%). The rate of progression of
glaucoma at 3 years was 25% (95% CI, 10%-44%) after repeat PK and 30% in the KPro
cohort.
CONCLUSIONS: These results demonstrate favorable outcomes of KPro surgery for
donor corneal graft failure with a greater likelihood of maintaining visual
improvement without higher risk of postoperative glaucoma compared with repeat
donor PK.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26545318   [PubMed - as supplied by publisher]


26. Ophthalmology. 2015 Nov 3. pii: S0161-6420(15)01114-8. doi:
10.1016/j.ophtha.2015.09.036. [Epub ahead of print]

Natural History of Geographic Atrophy Progression Secondary to Age-Related
Macular Degeneration (Geographic Atrophy Progression Study).

Schmitz-Valckenberg S(1), Sahel JA(2), Danis R(3), Fleckenstein M(4), Jaffe
GJ(5), Wolf S(6), Pruente C(7), Holz FG(8).

Author information: 
(1)Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading 
Center, University of Bonn, Bonn, Germany. (2)Université Pierre et Marie Curie
and Institut de la Vision, Paris, France. (3)Department of Ophthalmology and
Visual Sciences, University of Wisconsin, Madison, Wisconsin. (4)Department of
Ophthalmology, University of Bonn, Bonn, Germany. (5)Department of Ophthalmology,
Duke University, Durham, North Carolina. (6)Department of Ophthalmology,
University Hospital Bern, Inselspital, University Bern, Bern, Switzerland.
(7)Department of Ophthalmology, Kantonsspital Baselland, Liestal, Switzerland.
(8)Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading 
Center, University of Bonn, Bonn, Germany. Electronic address:
Frank.Holz@ukb.uni-bonn.de.

PURPOSE: The Geographic Atrophy Progression (GAP) study was designed to assess
the rate of geographic atrophy (GA) progression and to identify prognostic
factors by measuring the enlargement of the atrophic lesions using fundus
autofluorescence (FAF) and color fundus photography (CFP).
DESIGN: Prospective, multicenter, noninterventional natural history study.
PARTICIPANTS: A total of 603 participants were enrolled in the study; 413 of
those had gradable lesion data from FAF or CFP, and 321 had gradable lesion data 
from both FAF and CFP.
METHODS: Atrophic lesion areas were measured by FAF and CFP to assess lesion
progression over time. Lesion size assessments and best-corrected visual acuity
(BCVA) were conducted at screening/baseline (day 0) and at 3 follow-up visits:
month 6, month 12, and month 18 (or early exit).
MAIN OUTCOME MEASURES: The GA lesion progression rate in disease subgroups and
mean change from baseline visual acuity.
RESULTS: Mean (standard error) lesion size changes from baseline, determined by
FAF and CFP, respectively, were 0.88 (0.1) and 0.78 (0.1) mm(2) at 6 months, 1.85
(0.1) and 1.57 (0.1) mm(2) at 12 months, and 3.14 (0.4) and 3.17 (0.5) mm(2) at
18 months. The mean change in lesion size from baseline to month 12 was
significantly greater in participants who had eyes with multifocal atrophic spots
compared with those with unifocal spots (P < 0.001) and those with extrafoveal
lesions compared with those with foveal lesions (P = 0.001). The mean (standard
deviation) decrease in visual acuity was 6.2 ± 15.6 letters for patients with
image data available. Atrophic lesions with a diffuse (mean 0.95 mm(2)) or banded
(mean 1.01 mm(2)) FAF pattern grew more rapidly by month 6 compared with those
with the "none" (mean, 0.13 mm(2)) and focal (mean, 0.36 mm(2)) FAF patterns.
CONCLUSIONS: Although differences were observed in mean lesion size measurements 
using FAF imaging compared with CFP, the measurements were highly correlated with
one another. Significant differences were found in lesion progression rates in
participants stratified by hyperfluorescence pattern subtype. This large GA
natural history study provides a strong foundation for future clinical trials.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26545317   [PubMed - as supplied by publisher]


27. Ophthalmology. 2015 Nov 3. pii: S0161-6420(15)01109-4. doi:
10.1016/j.ophtha.2015.09.031. [Epub ahead of print]

Visual Outcomes after Proton Beam Irradiation for Choroidal Melanomas Involving
the Fovea.

Patel AV(1), Lane AM(1), Morrison MA(2), Trofimov AV(3), Shih HA(3), Gragoudas
ES(1), Kim IK(4).

Author information: 
(1)Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard
Medical School, Boston, Massachusetts. (2)Department of Ophthalmology and Visual 
Science, University of Utah, Salt Lake City, Utah. (3)Department of Radiation
Oncology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts. (4)Department of Ophthalmology, Massachusetts Eye and Ear
Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address:
ivana_kim@meei.harvard.edu.

PURPOSE: To report visual outcomes in patients undergoing proton beam irradiation
of tumors located within 1 disc diameter of the fovea.
DESIGN: Retrospective review.
PARTICIPANTS: Patients with choroidal melanoma involving the fovea treated with
proton beam therapy between 1975 and 2009.
METHODS: Three hundred fifty-one patients with choroidal melanomas located 1 disc
diameter (DD) or less from the fovea and more than 1 DD away from the optic nerve
were included in this study. In a subgroup of 203 of the patients with small and 
medium choroidal melanomas, the effect of a reduced dose of radiation, 50 Gy
(relative biological effectiveness [RBE]) versus 70 Gy (RBE), on visual outcomes 
was analyzed. The Kaplan-Meier method and Cox regression analysis were performed 
to calculate cumulative rates of vision loss and to assess risk factors for
vision loss, respectively.
MAIN OUTCOME MEASURES: Visual acuity and radiation complications, which included 
radiation maculopathy, papillopathy, retinal detachment, and rubeosis, were
assessed.
RESULTS: Three hundred fifty-one patients were included in this study with a mean
follow-up time of 68.7 months. More than one-third of patients (35.5%) retained
20/200 or better vision 5 years after proton beam irradiation. For those patients
with a baseline visual acuity of 20/40 or better, 16.2% of patients retained this
level of vision 5 years after proton beam irradiation. Tumor height less than 5
mm and baseline visual acuity 20/40 or better were associated significantly with 
a better visual outcome (P < 0.001). More than two-thirds (70.4%) of patients
receiving 50 Gy (RBE) and nearly half (45.1%) of patients receiving 70 Gy (RBE)
retained 20/200 or better vision 5 years after treatment, but this difference was
not significant. Approximately 20% of patients with these smaller macular tumors 
retained 20/40 vision or better 5 years after irradiation.
CONCLUSIONS: The results of this retrospective analysis demonstrate that despite 
receiving a full dose of radiation to the fovea, many patients with choroidal
melanoma with foveal involvement maintain useful vision. A radiation dose
reduction from 70 to 50 Gy (RBE) did not seem to increase the proportion of
patients who retain usable vision.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26545316   [PubMed - as supplied by publisher]


28. BMC Ophthalmol. 2015 Nov 4;15(1):158. doi: 10.1186/s12886-015-0139-3.

A novel characterization of posterior keratoconus using anterior segment optical 
coherence tomography in an infant: a case report.

Garg N(1), Chang TC(2), Reiser BJ(3,)(4), Cavuoto KM(5).

Author information: 
(1)Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami 
Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA.
nisha.garg@med.miami.edu. (2)Department of Ophthalmology, Bascom Palmer Eye
Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, 
FL, 33136, USA. t.chang@med.miami.edu. (3)Children's Hospital Los Angeles, 4650
Sunset Blvd., Los Angeles, CA, 90027, USA. Bibiana.Reiser@med.usc.edu.
(4)University of Southern California Eye Institute, 1450 San Pablo Street, Los
Angeles, CA, 90033-4682, USA. Bibiana.Reiser@med.usc.edu. (5)Department of
Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of 
Medicine, 900 NW 17th St, Miami, FL, 33136, USA. kcavuoto@med.miami.edu.

BACKGROUND: Posterior keratoconus is a rare cause of a corneal opacity in an
infant. It is characterized by thinning of the posterior cornea without ectasia
of the anterior cornea. Imaging of this condition with anterior segment optical
coherence tomography (AS-OCT) has not been reported in the literature.
CASE PRESENTATION: A six week old African-American male presented with a
congenital corneal opacity of the right eye. He underwent an examination under
anesthesia in which photography and AS-OCT were performed. AS-OCT confirmed the
diagnosis of posterior keratoconus. The patient subsequently underwent an optical
iridectomy for visual development.
CONCLUSION: AS-OCT is a useful tool in cases when a child presents with a corneal
opacity of unknown or unclear etiology. In our patient, AS-OCT showed the classic
description of central corneal thinning seen in this condition. Additionally, it 
revealed an associated detached Descemet membrane, a feature which has not been
previously described in posterior keratoconus.

PMCID: PMC4634598
PMID: 26537455   [PubMed - in process]


29. BMC Ophthalmol. 2015 Nov 2;15(1):151. doi: 10.1186/s12886-015-0128-6.

Intraocular foreign bodies extracted by pars plana vitrectomy: clinical
characteristics, management, outcomes and prognostic factors.

Nicoară SD(1), Irimescu I(2), Călinici T(3), Cristian C(4).

Author information: 
(1)Department of Ophthalmology, "Iuliu Hațieganu" University of Medicine and
Pharmacy, 8, V. Babeș str, 400012, Cluj-Napoca, Romania.
simonanicoara1@gmail.com. (2)Department of Neuroscience, "Iuliu Hațieganu"
University of Medicine and Pharmacy, Cluj-Napoca, Romania. iulirimes@gmail.com.
(3)Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu"
University of Medicine and Pharmacy, Cluj-Napoca, Romania. tcalinici@umfcluj.ro. 
(4)Department of Ophthalmology, "Iuliu Hațieganu" University of Medicine and
Pharmacy, 8, V. Babeș str, 400012, Cluj-Napoca, Romania.
christinacristian@gmail.com.

BACKGROUND: Intraocular foreign bodies (IOFBs) are an important cause of visual
loss within the group of working age population. We aim to present the clinical
features and the algorithm according to which we manage the foreign bodies that
are located in the posterior segment of the eye. We define the outcomes and the
prognostic factors that influenced the final visual acuity and globe survival in 
patients with IOFBs that we extracted by pars plana vitrectomy (PPV) over a
5-year period.
METHODS: We reviewed the medical records of all the cases with IOFBs that we
removed by PPV, over 5 years (2009-2013). We extracted the following parameters: 
age, gender, wound anatomy, IOFB characteristics, ocular lesions, initial and
final visual acuities. We used the program SPSS version 20.0.0. for the
statistical analysis of our data.
RESULTS: During 5 years, we treated 21 IOFBs by PPV, representing 12.20 % of all 
the open globe injuries. All the patients were males with the median age of
36 years. The foreign body was located in the vitreous - 11 cases (52.38 %),
retina - seven cases (33.33 %) and perforating - three cases (14.28 %). Retinal
detachment (RD) at presentation was identified in eight cases (38.09 %) and
endophthalmitis, in six cases (28.57 %). The visual outcome was significantly
worse in patients with RD at presentation (p = 0.012) and with IOFBs larger than 
3 mm (p = 0.042). Endophthalmitis did not influence the visual outcome.
CONCLUSIONS: The worse prognostic factors were: RD at presentation and large
foreign body.
TRIAL REGISTRATION NUMBER: IRCT2015040418966N3 / Apr. 9/2015.

PMCID: PMC4631100
PMID: 26526732   [PubMed - in process]


30. Ophthalmology. 2015 Oct 31. pii: S0161-6420(15)01095-7. doi:
10.1016/j.ophtha.2015.09.026. [Epub ahead of print]

A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted
versus Phacoemulsification Cataract Surgery.

Ewe SY(1), Abell RG(1), Oakley CL(1), Lim CH(1), Allen PL(1), McPherson ZE(2),
Rao A(2), Davies PE(2), Vote BJ(3).

Author information: 
(1)Tasmanian Eye Institute, Launceston, Tasmania, Australia. (2)Newcastle Eye
Hospital Research Foundation, Newcastle, New South Wales, Australia. (3)Tasmanian
Eye Institute, Launceston, Tasmania, Australia. Electronic address:
eye.vote@me.com.

PURPOSE: To evaluate visual outcomes after femtosecond laser-assisted cataract
surgery (LCS) with phacoemulsification cataract surgery (PCS).
DESIGN: Prospective, multicenter, comparative case series.
PARTICIPANTS: Consecutive patients undergoing femtosecond LCS or PCS with
intraocular lens insertion.
METHODS: A total of 1876 eyes of 1238 patients (422 male and 772 female) who
underwent cataract surgery between January 2012 and June 2014 were included in
the study: 1017 eyes from center A and 859 eyes from center B. Cases underwent
clinico-socioeconomic selection. Patients with absolute LCS contraindications
were assigned to PCS; otherwise, all patients were offered LCS and elected on the
basis of their decision to pay (the out-of-pocket cost for LCS). Demographic and 
postoperative data were collected to determine differences between groups.
MAIN OUTCOME MEASURES: Six-month postoperative visual and refractive outcomes.
Masked subjective refractions were performed 2 to 6 months postoperatively.
RESULTS: There were 988 eyes in the LCS group and 888 eyes in the PCS group.
Baseline best-corrected visual acuity (BCVA) was better in LCS compared with PCS 
(20/44.0 vs. 20/51.5; P < 0.0003). Preoperative surgical refractive aim differed 
significantly between groups (LCS -0.28 vs. PCS -0.23; P < 0.0001). More patients
who received LCS had Toric lenses implanted compared with PCS (47.4% vs. 34.8%; P
< 0.0001). Postoperative BCVA was better after LCS (20/24.5 vs. 20/26.4; P =
0.0003) with a greater proportion of LCS cases achieving BCVA >20/30 (LCS 89.7%
vs. PCS 84.2%; P = 0.0006) and 20/40 (LCS 96.6% vs. PCS 93.9%; P = 0.0077).
However, PCS cases had more letters gained compared with LCS cases (13.5 vs. 12.5
letters; P = 0.0088), reflecting baseline BCVA differences. Mean absolute error
was higher in LCS compared with PCS (0.41 diopters [D] vs. 0.35 D; P < 0.0011).
The percentage of eyes within 0.5 D of error from preoperative aim refraction was
higher in the PCS group (LCS 72.2% vs. PCS 82.6%; P < 0.0001).
CONCLUSIONS: Femtosecond LCS did not demonstrate clinically meaningful
improvements in visual outcomes over conventional PCS.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.
All rights reserved.

PMID: 26526634   [PubMed - as supplied by publisher]