PURPOSE: The aim of this study was to develop a predictive model based on preoperative variables for estimating postoperative intraocular pressure (IOP) of those eyes undergoing LASIK surgery,to predict the amount of ...PURPOSE: The aim of this study was to develop a predictive model based on preoperative variables for estimating postoperative intraocular pressure (IOP) of those eyes undergoing LASIK surgery,to predict the amount of underestimated IOP after LASIK for myopia and myopic astigmatism. DESIGN: Pretest-post-test longitudinal study. METHODS: Both eyes of 193 eligible subjects who underwent LASIK procedures at the Department of Ophthalmology,National Taiwan University Hospital,from July 2000 to December 2002 for myopia and myopic astigmatism were identified to build up the predictive models. IOPs were measured with noncontact air-puff tonometry. Information on age,gender,preoperative central corneal thickness (CCT),preoperative central corneal curvature (CCK),preoperative spherical equivalent refractive error,and ablation depth was collected and applied for predicting postoperative IOP after LASIK based on linear mixed model. RESULTS: Significant predictors for postoperative IOP after myopic LASIK procedures included age,gender,preoperative IOP,ablation depth,preoperativeCCT,and preoperative spherical equivalent refractive errors. The linear mixed model,taking into account these significant preoperative correlates and the correlation of IOPs between both eyes of the same patient,explained 91% of the variation of postoperative IOP. CONCLUSIONS: A statistical model was developed for predicting the amount of underestimated IOP after LASIK for myopia and myopic astigmatism,which is of clinical importance to uncover ocular hypertension among patients whose information on postoperative IOP immediately after LASIK is not available.展开更多
PURPOSE: Long-term evaluation of dihematoporphyrin ether (DHE) safety and efficacy as photodynamic therapy (PDT) for patients with corneal neovascularization (KNV). DESIGN: Prospective multi-center interventional case...PURPOSE: Long-term evaluation of dihematoporphyrin ether (DHE) safety and efficacy as photodynamic therapy (PDT) for patients with corneal neovascularization (KNV). DESIGN: Prospective multi-center interventional case series. METHODS: Seven patients were enrolled after Institutional Review Board approval and a detailed informed consent were obtained. Eligible patients presented with clinically stable KNV without active vessel progression or inflammation. All patients with severe hypertension,history of renal or hepatic disease,or sensitivity to porphyrins,and those with active keratitis or uncontrolled ocular surface disease were excluded. DHE was administered as an intravenous bolus (2 mg/kg). Seventy-two hours later,PDT was carried out using argon green laser (514 nm). The main outcome measure,extent of vascular thrombosis,was estimated during postope rative follow-up examinations performed at day 1,1 week,6 months,and up to 12 years postoperative. RESULTS: All patients obtained an immediate reduction in measurable corneal vascularization. With at least 6 months of follow-up,six of seven patients maintained a significant reduction (52.5% ± 19.6% ,P < .01) in KNV. The mean length of followup was 5.4 years (Range=6 months to 12 years) during which time there were no other ocular changes attributable to laser treatment. Three patients suffered significant systemic short-term phototoxicity reactions. CONCLUSIONS: Intravenous DHE followed by photodynamic treatment in humans is effective for the reduction of inactive,established KNV. However,the significant short-term adverse effects related to systemic administration of this drug are of particular concern and warrant further investigation.展开更多
PURPOSE: To examine the association between presence,severity,and extent of lesions of age-related macular degeneration (AMD) and optic disk and cup diameters in a general population. DESIGN: Cross-sectional study. ME...PURPOSE: To examine the association between presence,severity,and extent of lesions of age-related macular degeneration (AMD) and optic disk and cup diameters in a general population. DESIGN: Cross-sectional study. MET-HODS: setting: Population-based. study population: Adults aged 43 to 86 years participating in the Beaver Dam Eye Study. observation procedures: Fundus photographs were graded for lesions of AMD using standard protocols. The photographs were obtained during the baseline examination of the Beaver Dam Eye Study. main outcome measure: Optic disk cupping as related to presence,severity,and extent of lesions of AMD. RESULTS: There were no significant differences in the vertical optic disk and cup measurements or in the vertical cup to disk ratios by severity of lesions of AMD (P values all greater than .10). In those eyes with late lesions of AMD,there was no association of the size of the lesions or their distribution in the fundus and the extent of cupping. CONCLUSIONS: From a population perspective,there is no relationship of the presence or severity of AMD and optic disk cupping.展开更多
PURPOSE: Clinical and histopathologic documentation of sympathetic ophthalmia (SO) development in eyes with postoperative bacterial endophthalmitis. DESIGN: Observational case series; retrospective clinicopathologic s...PURPOSE: Clinical and histopathologic documentation of sympathetic ophthalmia (SO) development in eyes with postoperative bacterial endophthalmitis. DESIGN: Observational case series; retrospective clinicopathologic study. METHODS: All patients who presented with a clinical diagnosis of SO during 2002 to 2004 were included in the study. The diagnosis of SO was made on the basis of history of penetrating ocular injury,followed by development of bilateral intraocular inflammation,ultrasonographic detection of bilateral diffuse thickening of the choroid,or both. Patients presenting with the additional finding of hypopyon underwent an anterior chamber tap and vitreous aspirate for microbiologic detection of bacteria and fungi. Eight exciting eyes were enucleated and submitted for histologic examination. RESULTS: Of a total of 26 patients with a clinical diagnosis of SO,four also had bacterial endophthalmitis. Of these,histologic examination of three exciting eyes revealed vitreous abscess and typical features of SO. Of the five remaining enucleated globes,histologic examination showed that two eyes had phacoanaphylactic endophthalmitis,and two others revealed features of SO; the one remaining eye had nongranulomatous diffuse choroiditis. CONCLUSIONS: Bacterial endophthalmitis cannot prevent the development of SO. Early diagnosis of coexistent mixed infectious and in-flammatory processes,and initiation of antimicrobial treatment directed at the infection followed by immunomodulatory agents to address the autoimmune component may improve the prognosis in such cases.展开更多
PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive pa...PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.展开更多
PURPOSE: To report an unusual case of multiple myeloma presenting with bilateral tearing secondary to lacrimal sac involvement. DESIGN: Observational single case report. METHODS: An 83-year-old woman presented with bi...PURPOSE: To report an unusual case of multiple myeloma presenting with bilateral tearing secondary to lacrimal sac involvement. DESIGN: Observational single case report. METHODS: An 83-year-old woman presented with bilateral tearing secondary to infiltrative lesions of the lacrimal sacs. A biopsy was performed; findings confirmed the diagnosis of multiple myeloma. RESULTS: The lacrimal sac fossa lesions responded to chemotherapy and local radiation. The patient subsequently developed multiple systemic recurrences,ultimately leading to her death. CONCLUSIONS: Multiple myeloma should be included in the differential diagnosis of lacrimal sac lesions.展开更多
PURPOSE: To observe and document the daily changes in the morphology of Elschnig pearls. DESIGN: A prospective cohort study. METHODS: Twenty-nine pseudophakic eyes with pronounced,regeneratory posterior capsule opacif...PURPOSE: To observe and document the daily changes in the morphology of Elschnig pearls. DESIGN: A prospective cohort study. METHODS: Twenty-nine pseudophakic eyes with pronounced,regeneratory posterior capsule opacification (PCO) were included in this prospective study. Retroillumination images were taken at days 0,1,2,and 14. A square grid was laid over the images. Increase,decrease,appearance,and disappearance of pearls between the follow-up images were quantified. RESULTS: A total of 1371 areas (mean: 53/eye)-of 26 eyes were analyzed between days 0 and 1 and 1 and 2,and 896 areas (50/eye) of 18 eyes between days 0 and 14. Between days 0 and 1,days 1 and 2,and days 0 and 14,we observed "no change" in pearl size in 72% ,77% ,and 32% ,a "minor increase" in 16% ,14% ,and 10% ,a "major increase" in 4% ,3% ,and 42% ,a "minor decrease" in 14% ,11% ,and 11% ,and a "major decrease" in 4% ,3% ,and 37% ,respectively. Appearance of newly formed pearls was found in 1% ,1% ,and 9% and disappearance of pearls in 1% ,1% ,and 5% ,respectively. CONCLUSIONS: Significant changes in the morphology of Elschnig pearls were observed within time intervals of only 24 hours. Appearance and disappearance of pearls,as well as progression and regression of pearls within these short intervals illustrate the dynamic behavior of regeneratory PCO. These findings may contribute to a better understanding of PCO and have implications on pharmaceutical interventions for PCO.展开更多
文摘PURPOSE: The aim of this study was to develop a predictive model based on preoperative variables for estimating postoperative intraocular pressure (IOP) of those eyes undergoing LASIK surgery,to predict the amount of underestimated IOP after LASIK for myopia and myopic astigmatism. DESIGN: Pretest-post-test longitudinal study. METHODS: Both eyes of 193 eligible subjects who underwent LASIK procedures at the Department of Ophthalmology,National Taiwan University Hospital,from July 2000 to December 2002 for myopia and myopic astigmatism were identified to build up the predictive models. IOPs were measured with noncontact air-puff tonometry. Information on age,gender,preoperative central corneal thickness (CCT),preoperative central corneal curvature (CCK),preoperative spherical equivalent refractive error,and ablation depth was collected and applied for predicting postoperative IOP after LASIK based on linear mixed model. RESULTS: Significant predictors for postoperative IOP after myopic LASIK procedures included age,gender,preoperative IOP,ablation depth,preoperativeCCT,and preoperative spherical equivalent refractive errors. The linear mixed model,taking into account these significant preoperative correlates and the correlation of IOPs between both eyes of the same patient,explained 91% of the variation of postoperative IOP. CONCLUSIONS: A statistical model was developed for predicting the amount of underestimated IOP after LASIK for myopia and myopic astigmatism,which is of clinical importance to uncover ocular hypertension among patients whose information on postoperative IOP immediately after LASIK is not available.
文摘PURPOSE: Long-term evaluation of dihematoporphyrin ether (DHE) safety and efficacy as photodynamic therapy (PDT) for patients with corneal neovascularization (KNV). DESIGN: Prospective multi-center interventional case series. METHODS: Seven patients were enrolled after Institutional Review Board approval and a detailed informed consent were obtained. Eligible patients presented with clinically stable KNV without active vessel progression or inflammation. All patients with severe hypertension,history of renal or hepatic disease,or sensitivity to porphyrins,and those with active keratitis or uncontrolled ocular surface disease were excluded. DHE was administered as an intravenous bolus (2 mg/kg). Seventy-two hours later,PDT was carried out using argon green laser (514 nm). The main outcome measure,extent of vascular thrombosis,was estimated during postope rative follow-up examinations performed at day 1,1 week,6 months,and up to 12 years postoperative. RESULTS: All patients obtained an immediate reduction in measurable corneal vascularization. With at least 6 months of follow-up,six of seven patients maintained a significant reduction (52.5% ± 19.6% ,P < .01) in KNV. The mean length of followup was 5.4 years (Range=6 months to 12 years) during which time there were no other ocular changes attributable to laser treatment. Three patients suffered significant systemic short-term phototoxicity reactions. CONCLUSIONS: Intravenous DHE followed by photodynamic treatment in humans is effective for the reduction of inactive,established KNV. However,the significant short-term adverse effects related to systemic administration of this drug are of particular concern and warrant further investigation.
文摘PURPOSE: To examine the association between presence,severity,and extent of lesions of age-related macular degeneration (AMD) and optic disk and cup diameters in a general population. DESIGN: Cross-sectional study. MET-HODS: setting: Population-based. study population: Adults aged 43 to 86 years participating in the Beaver Dam Eye Study. observation procedures: Fundus photographs were graded for lesions of AMD using standard protocols. The photographs were obtained during the baseline examination of the Beaver Dam Eye Study. main outcome measure: Optic disk cupping as related to presence,severity,and extent of lesions of AMD. RESULTS: There were no significant differences in the vertical optic disk and cup measurements or in the vertical cup to disk ratios by severity of lesions of AMD (P values all greater than .10). In those eyes with late lesions of AMD,there was no association of the size of the lesions or their distribution in the fundus and the extent of cupping. CONCLUSIONS: From a population perspective,there is no relationship of the presence or severity of AMD and optic disk cupping.
文摘PURPOSE: Clinical and histopathologic documentation of sympathetic ophthalmia (SO) development in eyes with postoperative bacterial endophthalmitis. DESIGN: Observational case series; retrospective clinicopathologic study. METHODS: All patients who presented with a clinical diagnosis of SO during 2002 to 2004 were included in the study. The diagnosis of SO was made on the basis of history of penetrating ocular injury,followed by development of bilateral intraocular inflammation,ultrasonographic detection of bilateral diffuse thickening of the choroid,or both. Patients presenting with the additional finding of hypopyon underwent an anterior chamber tap and vitreous aspirate for microbiologic detection of bacteria and fungi. Eight exciting eyes were enucleated and submitted for histologic examination. RESULTS: Of a total of 26 patients with a clinical diagnosis of SO,four also had bacterial endophthalmitis. Of these,histologic examination of three exciting eyes revealed vitreous abscess and typical features of SO. Of the five remaining enucleated globes,histologic examination showed that two eyes had phacoanaphylactic endophthalmitis,and two others revealed features of SO; the one remaining eye had nongranulomatous diffuse choroiditis. CONCLUSIONS: Bacterial endophthalmitis cannot prevent the development of SO. Early diagnosis of coexistent mixed infectious and in-flammatory processes,and initiation of antimicrobial treatment directed at the infection followed by immunomodulatory agents to address the autoimmune component may improve the prognosis in such cases.
文摘PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.
文摘PURPOSE: To report an unusual case of multiple myeloma presenting with bilateral tearing secondary to lacrimal sac involvement. DESIGN: Observational single case report. METHODS: An 83-year-old woman presented with bilateral tearing secondary to infiltrative lesions of the lacrimal sacs. A biopsy was performed; findings confirmed the diagnosis of multiple myeloma. RESULTS: The lacrimal sac fossa lesions responded to chemotherapy and local radiation. The patient subsequently developed multiple systemic recurrences,ultimately leading to her death. CONCLUSIONS: Multiple myeloma should be included in the differential diagnosis of lacrimal sac lesions.
文摘PURPOSE: To observe and document the daily changes in the morphology of Elschnig pearls. DESIGN: A prospective cohort study. METHODS: Twenty-nine pseudophakic eyes with pronounced,regeneratory posterior capsule opacification (PCO) were included in this prospective study. Retroillumination images were taken at days 0,1,2,and 14. A square grid was laid over the images. Increase,decrease,appearance,and disappearance of pearls between the follow-up images were quantified. RESULTS: A total of 1371 areas (mean: 53/eye)-of 26 eyes were analyzed between days 0 and 1 and 1 and 2,and 896 areas (50/eye) of 18 eyes between days 0 and 14. Between days 0 and 1,days 1 and 2,and days 0 and 14,we observed "no change" in pearl size in 72% ,77% ,and 32% ,a "minor increase" in 16% ,14% ,and 10% ,a "major increase" in 4% ,3% ,and 42% ,a "minor decrease" in 14% ,11% ,and 11% ,and a "major decrease" in 4% ,3% ,and 37% ,respectively. Appearance of newly formed pearls was found in 1% ,1% ,and 9% and disappearance of pearls in 1% ,1% ,and 5% ,respectively. CONCLUSIONS: Significant changes in the morphology of Elschnig pearls were observed within time intervals of only 24 hours. Appearance and disappearance of pearls,as well as progression and regression of pearls within these short intervals illustrate the dynamic behavior of regeneratory PCO. These findings may contribute to a better understanding of PCO and have implications on pharmaceutical interventions for PCO.
