Anterior segment optical coherence tomography for identifying muscle status in strabismus surgery

Anterior segment optical coherence tomography （AS-OCT） finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles （EOM） and thus proved instrumental in planning and management.

质子束放射治疗脉络膜转移癌

Objective: To describe the clinical outcomes of patients treated by proton beam irradiation for choroidal metastatic tumors. Design: Noncomparative case series. Participants: A retrospective chart review was performed on a series of 63 patients (76 eyes) with choroidal metastases treated with proton beam therapy between December 1989 and September 2000. Methods:Patients were treated with 2 fractions of 14 cobalt gray equivalents (CGEs) (CGE=proton Gy x relative biological effectiveness 1.1), each using a nonoperative “ light- field” technique. Ophthalmologic follow- up was available for 46 patients (55 eyes), with a mean follow- up time of 10 months. The medical record or the Social Security Death Index was used to obtain survival status, which was available in 94% of cases. Main Outcome Measures: Tumor regression, recurrence, treatment associated complications, and visual acuity were evaluated by ophthalmologic examination and ultrasonography. Eye retention and length of survival also were assessed. Results: At the time of ocular diagnosis,49 patients reported a history of a primary cancer. Median survival time after ocular diagnosis was 16 months through May 2003. Most choroidal metastases were dome shaped (62% ) and located at the posterior pole (95% ). Mean tumor height was approximately 3.5 mm, and serous retinal detachment was seen in 63% of cases. Eighty- four percent of treated tumors regressed completely with in 5 months of treatment, and none of these recurred. Retinal detachment resolved in 82% of patients within 3.8 months after treatment, and visual acuity was preserved or improved in 47% of the patients. Complications occurred in 56% of cases and included madarosis, keratitis, dry eye syndrome, cataract, neovascular glaucoma, chorioretinal atrophy, radiation papillopathy, and radiation maculopathy. None of the treated eyes required enucleation. Conclusions: Proton beam irradiation is a useful therapeutic approach for choroidal metastases; it allows retention of the globe, achieves a high probability of local tumor control, and helps to avoid pain and visual loss. Although complications occur in most cases, many of these are minor and are not associated with a change in function. This modality is accurate and efficient, because it only entails 2 treatment fractions and does not require surgery for tumor localization.

The effect of transcorneal electrical stimulation in visual acuity: Retinitis pigmentosa

Transcorneal Electrical Stimulation (TES) was applied to a group of volunteer patients suffering from Retinitis Pigmentosa (RP), in order to investigate the effect of TES in Visual Acuity (VA). 28 partial blind patients with diagnosis of classic RP, Usher syndrome I and/or II were stimulated transcornealy, during a period of 52 weeks using a non conventional waveform, only in the lowest visually capable eye. The proposed waveform has been modeled from the natural response of human retina and delivered by means of an adaptive generator designed and built for tissue stimulation. Statistical results show the improvement of average VA or at least the contention of the disease natural progress. Categorized analysis of results indicates the same effect that if the age of patients, time since diagnosis and genetic disorder variation (classic RP, Usher syndrome I and/or II) are considered, in this case clinical and electrophysiological follow-up parameters were statistically analyzed in order to know the effect of TES. General results yield an improvement of 48.15% in the average of VA for stimulated eyes against an average degreasing of -8.06% in the same scale, with respect to their basal condition before the start of the experiment.

The Effect of Anterior Corneal Astigmatism Orientation on Toric Intraocular Lens Outcomes

Background: It is unclear whether post-operative errors after toric intraocular lens implantation would be more amenable to pre-operative correction with a fixed adjustment or a correction ratio that scales with the magnitude of pre-operative astigmatism. Purpose: To investigate the effect of pre-operative anterior corneal astigmatism orientation on outcomes of toric intraocular lens implantation in a large population. Methods: A retrospective cohort study of 625 patients undergoing refractive lens exchange through a superior clear corneal incision with Oculentis M-Plus toric intraocular lens implantation at an Optical Express, Inc. located in the United Kingdom and Ireland. Patients were stratified by axis of astigmatism on automated keratometry as with-the-rule, against-the-rule, or oblique. Analysis of visual acuity and refractive outcomes was performed using American National Standards Institute (ANSI) guidelines on astigmatic corrections with non-vector as well as vector analyses. Analysis was limited to one eye per patient. Results: Patients who had with-the-rule (WTR) astigmatism, compared with oblique and against-the-rule (ATR), had higher vector magnitudes of surgically induced refractive correction (2.89D, 2.55D, 2.42D;p Conclusions: Refractive lens exchange surgery using toric intraocular lenses overcorrected patients who had with-the-rule astigmatism. Degree of overcorrection did not vary with severity of pre-operative astigmatism. Incorporation of axis of astigmatism in lens selection and reduction of astigmatic correction among with-the-rule patients by an absolute value of 0.25D - 0.35D, rather than proportional adjustments, may reduce cylindrical over-correction.

大疱相关性眼内炎的临床特点和视力结果

Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecutive patients treated a t one institution for BAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitre al injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical pre sentation, treatment modality, microbiologic data, and clinical course were anal yzed. Visual outcomes were compared between vitrectomy and tap-and-inject grou ps, culture-positive and culture-negative groups, and early and late times. Ma in outcome measures Snellen visual acuities (VAs) at 3 months and 12 months afte r treatment and at most recent follow-up. Results The incidence of no light per ception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates i ncluded streptococcal species (32%of positive cultures), Staphylococcus epiderm idis (26%), Enterococcus, and Serratia (12%each). Patients with a positive vit reous culture had significantly worse VA (median, hand movements HM at 3 and 1 2 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months an d LP at 12 months) and a significantly higher rate of NLP vision than patients t reated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P=0.09). Conclusions Bleb associated endophthalmitis causes significant visual morbidity. Patients with culture-neg ative BAE and patients treated with prompt PPV may achieve better visual outcome .

光动力疗法治疗免疫抑制无效的炎性脉络膜新生血管化患者

Aim: To report on visual and angiographic outcomes of a consecutive series of patients with inflammatory choroidal neovascular membranes (CNV) unresponsive to systemic immunosuppression treated with photodynamic therapy (PDT). Methods: The medical records of six consecutive patients with inflammatory CNVs that failed to respond to systemic immunosuppression and that later underwent PDT were retrospectively reviewed. Patient demographics, visual acuity, and fluorescein angiographic findingswere evaluated. Results: There were five females and one male with a mean age of 40.8 years (range35- 58 years). Four patients had clinical features consistent with punctate inner choroidopathy and two with presumed ocular histoplasmosis. In all cases clinical signs of CNV activity, including subretinal fluid, subretinal blood, hard exudates, and/or recent decrease in visual acuity were present prior to PDT. All patients had been treated with high dose systemic immunosuppressants, which failed to induce regression of the CNV and/or to improve vision. The CNVs were subfoveal in five patients and juxtafoveal in one; all were classified as predominantly classic. Following PDT an improvement in vision occurred in all cases (median improvement of 18 letters, range3- 42 letters). At last follow up, signs of decreased activity in the CNV were detected in all cases. Patients were followed for a median of 10 months (range 9- 20 months). Conclusion: PDT appears to be a useful option in the management of patients with inflammatory CNVs unresponsive to immunosuppressive therapies.

评价采用潜在视力测定计预测脉络膜新生血管患者行光动力疗法后的视力

BACKGROUND AND OBJECTIVE: To evaluate the potential acuity meter in predicting visual acuity after photodynamic therapy of choroidal neovascular membranes caused by agerelated macular degeneration. PATIENTS AND METHODS: Retrospective study of 55 eyes in 51 patients with subfoveal predominantly classic choroidal neovascularization due to age-related macular degeneration. Pre-photodynamic therapy Snellen visual acuity minus the visual acuity with the potential acuity meter was compared with the actual improvement in visual acuity. Significant improvement in visual acuity after photodynamic therapy was defined as a gain of more than 2 lines in Snellen visual acuity (0.2 logarithm of the minimal angle of resolution units). RESULTS: Eighteen (51.4% ) of 35 eyes with a potential for improvement experienced an actual improvement in their Snellen visual acuity after photodynamic therapy (P < .001). All eyes lacking a potential for improvement failed to experience an actual improvement in visual acuity after photodynamic therapy. CONCLUSION: The eyes that demonstrated better visual acuity with the potential acuity meter in this study seemed more likely to experience an improvement in visual acuity after photodynamic therapy.

Safety and efficacy of trans-scleral glued intraocular lens implantation

Background:The commonly used intraocular lens(IOL)implantation modalities when there is a rent in a posterior capsule or lack of posterior capsular support includes iris fixated IOL,anterior chamber(AC)IOL,sutured and suture less trans-scleral fixated IOL.This work was planned to evaluate the safety and efficacy of trans-scleral glued IOL implantation.Methods:Retrospective study was undertaken with 28 patients of glued IOL fixation,performed by a single surgeon over a period of 4 years.Relevant pre-operative and post-operative data including visual acuity,intraocular pressures,associated ocular conditions and complications were collected and statistically analyzed.Results:The mean age of males in our study group was 39.1±4.6 years and mean age of females were 37.9±7.5 years.Glued IOL was implanted in 13 eyes with traumatic cataract with subluxation of 46.4%.The most common associated ocular condition was found to be a penetrating ocular trauma with corneal tear in three patients(10.6%).The mean pre-operative and post-operative Log MAR acuity was found to be 1.18 and 0.55 respectively,which was found to be statically significant with P value of 0.00.Twenty five out of 28 patients(89%)of the study population had no postoperative complications.Conclusions:Glued IOL implantation technique has 89%of success rate and statistically significant improvement in visual acuity with no significant change in intraocular pressure.

对继发于年龄相关性黄斑变性的脉络膜新生血管膜中肺炎衣原体的鉴定

Age-related macular degeneration (AMD) is a leading cause of blindness in the United States, and increasing evidence suggests that, it is an inflammatory disease. The prokaryotic obligate intracellular pathogen Chlamydia pneumoniae is emerging as a novel risk factor in cardiovascular disease, and recent seroepidemiological data suggest that C. pneumoniae infection is also associated withAMD. In this study,we examined choroidal neovascularmembrane (CNV) tissue from patients with neovascular AMD for the presence of C. pneumoniae and determined whether the pathogen can dysregulate the function of key cell types in ways that can cause neovascular AMD. Nine CNV removed from patients with neovascular AMD were examined for the presence of C. pneumoniae by immunohistochemistry (IHC) and polymerase chain reaction (PCR); in addition, we performed PCR on nine non-AMD eyes, and IHC on five nonAMD CNV, seven non-AMD eyes, and one internal limiting membrane specimen. Finally, human monocyte-derived macrophages and retinal pigment epithelial (RPE) cells were exposed to C. pneumoniae and assayed in vitro for the production of pro-angiogenic immunomodulators (VEGF, IL-8, and MCP-1). C. pneumoniae was detected in four of nine AMD CNV by IHC and two of nine AMD CNV by PCR, induced VEGF production by human macrophages, and increased production of IL-8 and MCP-1 by RPE cells. In contrast, none of the 22 non-AMD specimens showed evidence for C. pneumoniae. These data indicate that a pathogen capable of inducing chronic inflammation and pro-angiogenic cytokines can be detected in some AMD CNV, and suggest that infection may contribute to the pathogenesis of AMD.

眼球挫伤继发视网膜血管阻塞

Purpose: To describe an unusual fundus abnormality in eyes after trauma and it s pathophysiologic basis. Methods: Prospective, observational case series of fiv e consecutive male patients who suffered retinal vascular occlusions after ocula r contusion. Results: We present five cases of retinal vascular occlusions follo wing ocular contusion, found on routine fluorescein angiography in otherwise hea lthy individuals. Conclusions: Different patterns of retinal vascular occlusions can occur in ocular trauma. The pathogenesis of these occlusions may be related to direct damage to the endothelium.

The retinal function imager and clinical applications

Background:The Retinal Function Imager(RFI)provides in vivo and noninvasive imaging of both the retinal structure and function.Review:The RFI can create capillary perfusion maps,measure blood flow velocity,and determine metabolic function including blood oximetry.It can aid clinical diagnosis as well as assess treatment response in several retinal vascular diseases including diabetic retinopathy.Blood flow velocity abnormalities have also been implicated in disease such as age-related macular degeneration and require further investigation.Compared with optical coherence tomography angiography,the RFI produces capillary maps of comparable image quality and wider field of view but it is unable to provide depth-resolved information and has longer image acquisition time.Currently,functional imaging using blood oximetry has limited applications and additional research is required.Conclusion:The RFI offers noninvasive,high-resolution imaging of retinal microvasculature by creating capillary perfusion maps.In addition,it is capable of measuring retinal blood velocity directly and performs functional imaging with retinal blood oximetry.Its clinical applications are broad and additional research with functional imaging may potentially lead to diagnosis of diseases and their progression before anatomic abnormalities become evident,but longer image acquisition times may limit its clinical adoption.