4087 articles - 08.09.10
1: Br J Ophthalmol. 2010 Sep;94(9):1118-26.
Foster WJ, Tufail W, Issa AM.
Program in Personalized Medicine & Targeted Therapeutics, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, 1441 Moursund Street, Houston, TX 77030, USA; aissa@uh.edu.
Aim To appraise the quality of published pharmacoeconomic studies of therapeutic interventions for age-related macular degeneration (AMD). Methods Systematic review of the literature and evaluation of study quality using the Quality of Health Economic Studies instrument. A systematic search of the English-language literature for economic studies of therapeutic interventions for AMD from 1990 to March 2008 was performed. Results A total of 3637 articles were initially identified. Only 24 met eligibility criteria and were rated using the Quality of Health Economic Studies. The mean quality overall rating was 61.6, with quality scores ranging from 18 to 92. There was a higher mean quality score in the studies designed as clinical trials versus observational type designed studies (mean=74.7(11.4), 52.6 (16.5) respectively, p=0.002) and studies in which the statistical analyses were clearly presented versus studies in which the statistical analyses were not so clear (mean=74.3 (12.3), 53.1 (16.1) respectively, p=0.004). Interestingly, government funded studies exhibited a similar mean quality score to studies that were funded by industry (mean=71.0 (15.1), 61.7 (18.5) respectively, p=0.25). A general linear model was fitted using those independent variables which were significantly associated with quality score. The variables 'study design' and 'statistics presented clearly' were found to be jointly significant and explained nearly 70% of the variation in the dependent variable (R(2)=0.68). Conclusions Our analysis reveals that the methodological quality of the health economic analysis of AMD therapeutic interventions in the literature is suboptimal. There is considerable variation in methodological rigour between the articles, and we have identified several attributes that are predictive of study quality.
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PMID: 20813751 [PubMed - in process]2: Br J Ophthalmol. 2010 Aug 30; [Epub ahead of print]
Gupta N, Kalaivani M, Tandon R.
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Aim To compare the predictive outcome of ocular burns using two different prognostic classification systems, that is, Dua and Roper Hall classification. Patients and methods In a prospective, randomised, controlled clinical trial, the extent of acute ocular burns in 100 patients was graded by Roper Hall and Dua classifications. Patients were randomised in two groups of 50 each to receive conventional medical therapy alone or additional amniotic membrane transplantation (AMT). Moderate burns were graded similarly (grade II and III) under both systems, while severe burns were classified differently and compared further. Baseline parameters (size of epithelial defect, corneal haze, limbal ischaemia, conjunctival involvement and visual acuity) and outcome variables (healing of epithelial defect, corneal clarity, corneal vascularisation, visual outcome and symblepharon) after 1 year were noted and compared. Results There was no difference in terms of time taken and rate of healing of epithelial defect, but there was a significant difference in extent of corneal vascularisation between grades IV, V and VI (p<0.05). In patients who received AMT in addition to medical therapy, the degree of corneal clarity achieved was significantly better in patients with grade IV burns than either grade V (p=0.045) or grade VI (p=0.024) burns, and final visual acuity was significantly better in these patients (p=0.043). On comparison of patients with grade IV burns (with and without AMT), the outcome in terms of extent of corneal vascularisation was significantly better (p=0.0124) in patients who received AMT. Conclusions Dua classification by providing further subclassification of grade IV ocular burns by Roper Hall into three separate grades has a superior prognostic predictive value in severe ocular burns.
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PMID: 20805137 [PubMed - as supplied by publisher]3: Ophthalmology. 2010 Aug 27; [Epub ahead of print]
Ying GS, Maguire MG; Complications of Age-related Macular Degeneration Prevention Trial Research Group.
OBJECTIVE:: To develop a risk score for developing geographic atrophy (GA) involving easily obtainable information among patients with bilateral large drusen. DESIGN:: Cohort study within a multicenter randomized clinical trial. PARTICIPANTS:: We included 1052 participants with >/=10 large (>125 mum) drusen and visual acuity >/=20/40 in each eye. METHODS:: In the Complications of Age-related Macular Degeneration (AMD) Prevention Trial (CAPT), 1 eye of each participant was randomly assigned to laser treatment and the contralateral eye was assigned to observation to evaluate whether laser treatment of drusen could prevent vision loss. Gradings by a reading center were used to identify: CAPT end point GA (total area of GA [>250 mum] > 1 disc area), GA (>175 mum) involving the foveal center (CGA), and GA of any size and location (any GA). Established risk factors (age, smoking status, hypertension, Age-related Eye Disease Study simple severity scale score), both with and without a novel risk factor (night vision score), were used in assigning risk points. The risk scores were evaluated for the ability to discriminate and calibrate GA risk. MAIN OUTCOME MEASURES:: Development of end point GA, CGA, and any GA. RESULTS:: Among 942 CAPT participants who completed 5 years of follow-up and did not have any GA at baseline, 6.8% participants developed CAPT end point GA, 9.6% developed CGA, and 34.4% developed any GA. The 5-year incidence of end point GA in 1 or both eyes of a participant increased with the 15-point GA risk score, from 0.6% for <7 points to 15% for >/=12 points. The 5-factor risk score predicted development of GA moderately well with the area under the receiver operating characteristic curve (AUC) 0.76 (95% confidence interval [CI], 0.71-0.81) for end point GA; 0.76 (95% CI, 0.71-0.80) for CGA, and 0.68 (95% CI, 0.65-0.72) for any GA. Prediction from the risk score without the night vision score had lower AUCs (range, 0.67-0.72). CONCLUSIONS:: If validated in other patients, the GA risk score will be useful for identifying high-risk patients for clinical trials of prevention of GA and for clinical assessment of GA risk in early AMD patients. FINANCIAL DISCLOSURES:: The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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PMID: 20801521 [PubMed - as supplied by publisher]4: Ophthalmology. 2010 Aug 27; [Epub ahead of print]
Liu L, Ong EL, Crowston J.
Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Victoria, Australia; Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia; Preston Eye Clinic, Preston, Victoria, Australia.
OBJECTIVE: To visualize the changes of the iris contour in patients with pigment dispersion syndrome after blinking, accommodation, and pharmacologic miosis using anterior segment optical coherence tomography. DESIGN: Observational case series. PARTICIPANTS: A total of 33 eyes of 20 patients with pigment dispersion syndrome. METHODS: Each eye was imaged along the horizontal 0- to 180-degree meridian using the Visante Anterior Segment Imaging System (Carl Zeiss Meditec, Dublin, CA). Scans were performed at baseline and after focusing on an internal fixation target for 5 minutes, forced blinking, accommodation, and pharmacologic miosis with pilocarpine 2%. MAIN OUTCOME MEASURES: Quantitative analysis of the changes in the iris configuration. RESULTS: After 5 minutes of continual fixation, the iris became planar with the mean +/- standard deviation curvature decreasing from 214+/-74 mum to 67+/-76 mum (P<0.05). The iris remained planar in all patients with pigment dispersion syndrome after forced blinking, but the iris concavity recovered to 227+/-113 mum (P = 0.34) and 238+/-119 mum (P = 0.19) with the -3.0 and -6.0 diopter lenses, respectively. Pilocarpine-induced miosis caused the iris to assume a planar configuration in all subjects. CONCLUSIONS: This study shows that the iris in pigment dispersion syndrome assumes a planar configuration when fixating and that the concavity of the iris surface is not restored by blinking. Accommodation restored the iris concavity, suggesting that the posterior curvature of the iris in pigment dispersion syndrome is induced and probably maintained, at least in part, by accommodation. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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PMID: 20801519 [PubMed - as supplied by publisher]5: Ophthalmology. 2010 Aug 27; [Epub ahead of print]
Vaddavalli PK, Garg P, Sharma S, Sangwan VS, Rao GN, Thomas R.
Cornea and Anterior Segment Service, L V Prasad Eye Institute, Hyderabad, India.
PURPOSE: To investigate the role of confocal microscopy as a diagnostic modality in microbial keratitis and to determine inter- and intraobserver variation in the analysis and interpretation of confocal microscopy findings. DESIGN: Prospective, double masked, nonrandomized, observational clinical trial. PARTICIPANTS: We included 146 consecutive patients with clinically suspected microbial keratitis. METHODS: Confocal microscopy and microbiology evaluation of study participants. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of confocal microscopy in diagnosing fungal and Acanthamoeba keratitis compared with microbiologic evaluation, as well as the intra- and interobserver variation in interpretation of confocal scans. RESULTS: We included 148 cases of infiltrative keratitis. Of the 103 microbiologically proven cases of Acanthamoeba or fungal keratitis, the confocal microscope was able to identify fungal filaments or Acanthamoeba cysts in 91 cases with either fungal or Acanthamoeba keratitis with a sensitivity of 88.3% (95% confidence interval [CI], 82.2-94.5) and a specificity of 91.1% (95% CI, 82.8-99.4). The interobserver agreement in interpreting the scans was good (kappa = 0.6; phi = 0.617). The intraobserver agreement was kappa = 0.795 and phi = 0.807. CONCLUSIONS: The confocal microscope seems to be an accurate and reliable diagnostic modality in the etiologic diagnosis of fungal and Acanthamoeba keratitis. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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PMID: 20801515 [PubMed - as supplied by publisher]6: Eye (Lond). 2010 Aug 20; [Epub ahead of print]
Rosentreter A, Schild AM, Jordan JF, Krieglstein GK, Dietlein TS.
Department of Ophthalmology, University of Cologne, Koln, Germany.
PurposeThe aim of this study is to assess the efficacy and complications of trabeculectomy with a biodegradable implant (ologen implant) vstrabeculectomy using mitomycin C (MMC) in patients with medically uncontrolled open-angle glaucoma in a prospective randomised clinical trial.MethodsIn the MMC group (10 patients), trabeculectomy was performed according to standard protocols. In the ologen group (10 patients) after standard trabeculectomy the implant was positioned on top of the scleral flap and no MMC was applied. Follow-up was continued for 12 months after surgery and included testing of intraocular pressure (IOP), visual acuity, visual field, ultrasound biomicroscopy, and filtering bleb score.ResultsThe mean preoperative IOP was 24.8+/-8.9 mm Hg for all patients enrolled. At 1 year after surgery, the mean IOP was 15.6+/-2.4 mm Hg in the ologen group (P<0.01, 43% reduction) and 11.5+/-4.1 mm Hg in the MMC group (P<0.01, 50% reduction). No anti-glaucomatous medication was necessary in the MMC group in the first year of follow-up, whereas five patients in the ologen group required topical treatment. The absolute success rate was 100% in the MMC group and 50% in the ologen group (P=0.01). After 1 year, filtering blebs developed significantly more avascular areas in the MMC group (score=1.4) than in the ologen group (score=2.8; P<0.01).ConclusionThe complete success rate using trabeculectomy with the ologen implant is lower than that achieved by trabeculectomy with MMC. However, the bleb morphology caused more problems in the MMC group (avascularity score).Eye advance online publication, 20 August 2010; doi:10.1038/eye.2010.106.
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PMID: 20733558 [PubMed - as supplied by publisher]7: Br J Ophthalmol. 2010 Aug 23; [Epub ahead of print]
Liu MM, Tuo J, Chan CC.
Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
The eye is an easily accessible, highly compartmentalised and immune-privileged organ that offers unique advantages as a gene therapy target. Significant advancements have been made in understanding the genetic pathogenesis of ocular diseases, and gene replacement and gene silencing have been implicated as potentially efficacious therapies. Recent improvements have been made in the safety and specificity of vector-based ocular gene transfer methods. Proof-of-concept for vector-based gene therapies has also been established in several experimental models of human ocular diseases. After nearly two decades of ocular gene therapy research, preliminary successes are now being reported in phase 1 clinical trials for the treatment of Leber congenital amaurosis. This review describes current developments and future prospects for ocular gene therapy. Novel methods are being developed to enhance the performance and regulation of recombinant adeno-associated virus- and lentivirus-mediated ocular gene transfer. Gene therapy prospects have advanced for a variety of retinal disorders, including retinitis pigmentosa, retinoschisis, Stargardt disease and age-related macular degeneration. Advances have also been made using experimental models for non-retinal diseases, such as uveitis and glaucoma. These methodological advancements are critical for the implementation of additional gene-based therapies for human ocular diseases in the near future.
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PMID: 20733027 [PubMed - as supplied by publisher]8: Br J Ophthalmol. 2010 Aug 23; [Epub ahead of print]
Canturk S, Qaddoumi I, Khetan V, Ma Z, Furmanchuk A, Antoneli CB, Sultan I, Kebudi R, Sharma T, Rodriguez-Galindo C, Abramson DH, Chantada GL.
Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Background The survival of retinoblastoma in less-developed countries (LDCs) and the impact of socioeconomic variables on survival are not widely available in the literature. Methods A systematic review of publications from LDCs was performed. Articles were from multiple databases and written in seven languages. Results were correlated with socioeconomic indicators. Lower-income countries (LICs) and middle-income countries (MICs) were included in our analyses. Results An analysis of 164 publications including 14 800 patients from 48 LDCs was performed. Twenty-six per cent of the papers were written in languages other than English. Estimated survival in LICs was 40% (range, 23-70%); in lower MICs, 77% (range, 60-92%) and in upper MICs, 79% (range, 54-93%; p=0.001).Significant differences were also found in the occurrence of metastasis: in LICs, 32% (range, 12-45); in lower MICs, 12% (range, 3-31) and in upper MICs, 9.5% (range, 3-24; p=0.04). On multivariate analysis, physician density and human development index were significantly associated with survival and metastasis. Maternal mortality rate and per capita health expenditure were significantly associated with treatment refusal. Conclusions Important information from LDCs is not always available in English or in major databases. Indicators of socioeconomic development and maternal and infant health were related with outcome.
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PMID: 20733021 [PubMed - as supplied by publisher]9: Ophthalmology. 2010 Aug 21; [Epub ahead of print]
Rao HL, Kumar AU, Babu JG, Senthil S, Garudadri CS.
LV Prasad Eye Institute, Banjara Hills, Hyderabad, India.
PURPOSE: To evaluate the relationship between severity of visual field (VF) loss at presentation and rate of VF progression in glaucoma. DESIGN: Clinic-based, retrospective study. PARTICIPANTS: We included 512 eyes of 310 primary glaucoma patients. METHODS: We analyzed the VFs of all subjects of primary glaucoma who had >5 VFs between 1989 and 2008. Based on the mean deviation (MD), we classified the VF loss as mild (MD > -6 dB), moderate (MD </= -6 to >/= -12 dB) or severe (MD < -12 dB). Guided Progression Analysis software which gives the rate of progression (ROP) of Visual Field Index per year was used to assess the ROP. MAIN OUTCOME MEASURES: Relationship between severity of VF loss at presentation and ROP. RESULTS: The median duration of follow-up was 6.8 years. The ROP increased (worsened) by 0.02% per year for every dB worsening of MD (P = 0.02) and for every year of increasing age (P = 0.001). Association between MD and ROP showed a significant positive relationship in mild (beta = 0.18; P = 0.001) and a significant negative relationship in severe (beta = -0.16; P<0.001) VF loss category. Association between MD and ROP was not significant in the moderate VF loss category (beta = -0.05; P = 0.61). CONCLUSIONS: In early stages of glaucoma, the ROP worsened as the severity increased, but, in later stages of the disease, ROP became smaller as the severity increased. There is a need for better methods to detect progression in eyes with severe glaucomatous damage. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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PMID: 20728941 [PubMed - as supplied by publisher]10: Ophthalmology. 2010 Aug 17; [Epub ahead of print]
Terry MA, Shamie N, Straiko MD, Friend DJ, Davis-Boozer D.
Devers Eye Institute, Portland, Oregon; Lions Eye Bank of Oregon Vision Research Laboratory, Portland, Oregon.
PURPOSE: To evaluate the relationship between storage time in Optisol GS (Bausch & Lomb, St. Louis, MO) and postoperative cell loss after Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery. DESIGN: Retrospective analysis of a noncomparative, interventional case series. PARTICIPANTS: Three hundred sixty-two eyes of 265 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy. METHODS: Storage times (death to surgery) of donor tissue were recorded for 362 eyes undergoing DSAEK surgery. Donor cell loss at 6, 12, and 24 months was recorded. Analysis of storage times with endothelial cell loss was performed using a Pearson correlation coefficient and an independent samples Student t test. MAIN OUTCOME MEASURES: Percentage of donor endothelial cell loss as measured by specular microscopy of central endothelial cell density (ECD). RESULTS: The mean storage time was 98.95+/-33 hours (range, 20.65-186.02 hours). The mean percent endothelial cell loss from before to after surgery was 29+/-16% at 6 months (n = 362), 31+/-16% at 12 months (n = 263), and 32+/-20% at 24 months (n = 98). Storage time did not correlate significantly with endothelial cell loss at any postoperative time point (6 months: r = -0.047, P = 0.373; 12 months: r = -0.023, P = 0.709; 24 months: r = -0.14, P = 0.169). The mean cell loss for corneas stored 0 to 4 days (n = 55) was 32+/-17% at 2 years and the mean cell loss for corneas stored for more than 4 days (n = 43) was 30+/-18% at 2 years (P = 0.57). At the extremes of storage time, 10 corneas stored for the shortest time (1.5 days) had a 1-year cell loss of 33% and 10 corneas stored for the longest time (7 days) had a 1-year cell loss of 30% (P = 0.45). CONCLUSIONS: No correlation was found between the characteristic of storage time and the decline of ECD. Surgeons should not make special requests to the eye bank for short storage times with the hope of improving donor endothelial survival. The upper limit of donor storage time as it relates to acceptable postoperative endothelial cell loss is not known. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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PMID: 20723995 [PubMed - as supplied by publisher]11: Ophthalmology. 2010 Aug 17; [Epub ahead of print]
Tanna AP, Bandi JR, Budenz DL, Feuer WJ, Feldman RM, Herndon LW, Rhee DJ, Whiteside-de Vos J.
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
PURPOSE: To determine the extent of interobserver agreement and intraobserver reproducibility of the subjective determination of visual field progression with achromatic automated static perimetry in eyes with glaucoma, and to determine the impact of access to Glaucoma Progression Analysis (GPA) data on interobserver agreement. DESIGN: Retrospective, observational case series. PARTICIPANTS: Five glaucoma subspecialists from 5 different academic medical centers. METHODS: Five visual field tests from each of 100 eyes of 83 patients being monitored for glaucoma were retrospectively identified and subjectively and independently evaluated by the 5 glaucoma subspecialists. Each set of visual fields was classified regarding progression as "none," "questionable," "probable," or "definite." More than 1 month later, the same expert observers reevaluated the same sets of visual field tests to allow determination of intraobserver reproducibility. A final subjective evaluation regarding progression was performed 3 months later, at which time the expert observers had access to the GPA printout. MAIN OUTCOME MEASURES: The level of interobserver agreement and intraobserver reproducibility was estimated using kappa statistics on the raw classification data and also on dichotomized data in which "none" and "questionable" progression were reclassified together as nonprogressed and " probable" and "definite" were reclassified as progressed. RESULTS: Intraobserver reproducibility was good to excellent (kappa = 0.62-0.78) for the raw data and moderate to good (kappa = 0.58-0.71) for the dichotomized data. Interobserver agreement was moderate (kappa = 0.45; 95% confidence interval [CI], 0.35-0.55) for the raw classification data and also for dichotomized data (kappa = 0.55; 95% CI, 0.46-0.64). Access to the GPA printout did not significantly change the level of interobserver agreement. CONCLUSIONS: Five glaucoma experts had good to excellent reproducibility of the determination of visual field progression compared with earlier evaluation of the same field sets. Agreement among the experts with each other was only moderate, and did not improve when each had access to GPA results. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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PMID: 20723992 [PubMed - as supplied by publisher]12: Am J Ophthalmol. 2010 Aug 16; [Epub ahead of print]
Oshima Y, Kadonosono K, Yamaji H, Inoue M, Yoshida M, Kimura H, Ohji M, Shiraga F, Hamasaki T; JAPAN MICROINCISION VITRECTOMY SURGERY STUDY GROUP.
Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
PURPOSE: To explore the incidence and visual outcomes of acute-onset endophthalmitis after transconjunctival microincision vitrectomy surgery (MIVS). DESIGN: Retrospective, interventional, multicenter survey with a systematic review. METHODS: A clinical database search was performed at 27 institutions involving 43 868 consecutive patients who underwent vitrectomy between November 2003 and October 2008 to identify all patients with endophthalmitis after vitrectomy. A systematic review of studies reporting the endophthalmitis rates after MIVS versus 20-gauge vitrectomy was conducted to assess the pooled incidence rates of postvitrectomy endophthalmitis. RESULTS: The endophthalmitis rates from the multicenter survey were 0.034% (10 cases per 29 030 eyes) after 20-gauge vitrectomy and 0.054% (8 cases per 14 838 eyes) after MIVS, with no significant (P = .603) differences between groups. Although the incidence in 25-gauge cases (6 per 8238 eyes; 0.073%) was greater than in 23-gauge cases (2 per 6600 eyes; 0.030%), the difference was not significant (P = 0.451). Of 8 eyes in which endophthalmitis developed after MIVS, 6 eyes (75%) had a final visual acuity of 0.5 or better, and none lost light perception. By combining the results of 7 studies, including the current multicenter survey, meta-analyses from a total of 77 956 cases at the baseline showed that the pooled endophthalmitis rates after MIVS (0.08%; 95% confidence interval, 0.030% to 0.164%) and after 20-gauge vitrectomy (0.030%; 95% confidence interval, 0.012% to 0.048%) did not differ significantly (P = .207, pooled risk difference; 0.0005 [95% confidence interval, -0.0002 to 0.0012]). CONCLUSIONS: The incidence of postvitrectomy endophthalmitis was low with no significant differences between MIVS and 20-gauge vitrectomy. Copyright (c) 2010 Elsevier Inc. All rights reserved.
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PMID: 20719299 [PubMed - as supplied by publisher]13: Am J Ophthalmol. 2010 Aug 16; [Epub ahead of print]
Cleary G, Spalton DJ, Gala KB.
Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom; Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Australia.
PURPOSE: To compare the accommodative performance of the Morcher BioComFold Type 89A bag-in-the-lens intraocular lens (IOL) with a conventional in-the-bag control IOL in presbyopic eyes. DESIGN: Prospective, randomized clinical trial with intraindividual comparison. METHODS: Setting: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. Study population: Fifty-two eyes of 26 patients with bilateral age-related cataracts. Intervention: Phacoemulsification cataract extraction with implantation of a bag-in-the-Lens and a control IOL, the Alcon AcrySof SA60AT (Alcon Laboratories, Fort Worth, Texas, USA), randomized to either eye. Main outcome measures: Axial IOL shift stimulated by physiologic (near visual effort) and pharmacologic (pilocarpine and cyclopentolate) accommodative stimulation was measured objectively with partial coherence interferometry. Other outcome measures were objective and subjective accommodation, logarithm of the minimal angle of resolution distance-corrected near visual acuity, and defocus curves. RESULTS: Three months after surgery, axial IOL shift stimulated by near visual effort measured -5.9 +/- 10.3 mum in bag-in-the-lens eyes versus -8.4 +/- 12.8 mum in control eyes (P = .37), that stimulated by pilocarpine measured 20.2 +/- 165.6 mum versus 50.4 +/- 164.4 mum (P = .36), and that stimulated by cyclopentolate measured -65.8 +/- 64.3 mum versus -54.0 +/- 37.5 mum (P = .34), respectively (n = 25). Objective accommodation measured 0.03 +/- 0.18 diopters (D) in bag-in-the-lens eyes versus 0.08 +/- 0.21 D in control eyes (P = .40), whereas subjective accommodation measured 2.48 +/- 0.72 D versus 2.45 +/- 0.80 D (P = .75), respectively. Distance-corrected near visual acuity and defocus curves showed no difference between IOLs. CONCLUSIONS: The bag-in-the-lens IOL demonstrated negligible axial shift and objective accommodation with physiologic near visual stimulation. The IOL shift demonstrated with pilocarpine also was clinically insignificant. The bag-in-the-lens IOL showed no accommodative or near visual advantage over a conventional in-the-bag IOL, despite its unique capsular fixation method. This provides further evidence that the focus-shift principle fails to produce clinically significant IOL movement. Copyright (c) 2010 Elsevier Inc. All rights reserved.
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PMID: 20719298 [PubMed - as supplied by publisher]14: Ophthalmology. 2010 Aug 13; [Epub ahead of print]
Zhao LQ, Wei RL, Cheng JW, Li Y, Cai JP, Ma XY.
Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
PURPOSE:: To examine possible differences in clinical outcomes between laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for myopia. DESIGN:: Systematic review and meta-analysis. PARTICIPANTS:: Patients from previously reported randomized controlled trials (RCTs) and comparative studies of LASEK and PRK with clinical outcomes. METHODS:: A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify RCTs and comparative studies comparing LASEK and PRK for myopia. MAIN OUTCOME MEASURES:: Primary outcome parameters included uncorrected visual acuity (UCVA) of 20/20 or better, manifest refractive spherical equivalent (SE) within +/-0.50 diopters (D), final refractive SE, and final UCVA of 20/40 or worse. Secondary outcome parameters included healing time of corneal epithelium, postoperative pain, and corneal haze. RESULTS:: Twelve studies were identified and used for comparing PRK (499 eyes) with LASEK (512 eyes) for myopia. There were no significant differences in odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) in the primary and secondary outcome measures. The final mean refractive SE (WMD, 0.00; 95% confidence interval [CI], -0.08 to 0.07; P = 0.95), manifest refractive SE within +/-0.50 D of the target (OR, 0.90; 95% CI, 0.63-1.29; P = 0.56), patients achieving UCVA of 20/20 or better (OR, 0.86; 95% CI, 0.61-1.20; P = 0.37), final UCVA of 20/40 or worse (OR, 1.26; 95% CI, 0.63-2.51; P = 0.52), re-epithelialization time (WMD, 0.08; 95% CI, -0.44 to 0.59; P = 0.77), and postoperative pain (SMD, 0.26; 95% CI, -0.20 to 0.72; P = 0.27) were analyzed. However, LASEK-treated eyes showed less corneal haze at 1 month after surgery (WMD, 0.25; 95% CI, 0.10-0.39; P = 0.0007) and 3 months after surgery (WMD, 0.14; 95% CI, 0.01-0.26; P = 0.03) compared with PRK. No statistically significant difference was observed between the 2 groups at 6 months after surgery (WMD, 0.14; 95% CI, -0.02 to 0.30; P = 0.08). CONCLUSIONS:: In this meta-analysis, LASEK-treated eyes had no significant benefits over PRK-treated ones with regard to clinical outcomes. Less corneal haze was observed in LASEK-treated eyes at 1 to 3 months after surgery. FINANCIAL DISCLOSURE(S):: The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20709406&dopt=ExternalLink
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PMID: 20709406 [PubMed - as supplied by publisher]15: Ophthalmology. 2010 Aug 13; [Epub ahead of print]
Dugel PU, Tong KB.
OBJECTIVE: Newer treatment regimens for age-related macular degeneration have significantly affected traditional and non-traditional retinal services across all types of practice settings around the country as they seek to find a balance among delivering best patient care, keeping operating costs under control, and maintaining profitability. DESIGN: A systematic retrospective review of a multi-city, multi-physician retinal practice's accounting system to obtain data on revenues, expenses, and profit. Data reviewed were from practice management systems to obtain claims level data on clinical procedures across 7 primary activity centers: non-laser surgery, laser surgery, office visits, optical coherence tomography (OCT), non-OCT diagnostics, drugs and drug injections, and research. PARTICIPANTS: All treated patients from a retina practice from January 1, 2005, to December 31, 2007. METHODS: Retrospective claims data review from a multi-physician retina practice detailing Current Procedural Terminology and Healthcare Common Procedure Coding System procedures performed and billed, submitted charges, allowed charges, and net collections. Analyses were performed by an outside firm and verified by a risk advisory firm. MAIN OUTCOME MEASURES: Identifying practice efficiencies/inefficiencies as they relate to patient care. RESULTS: An elaborate analysis using activity-based costing (ABC) showed that increased office visits and OCT and non-OCT diagnostics had a significant negative impact on the practice's profit margins, whereas surgical procedures contributed to the majority of the practice's profit margins because of the lower operating costs associated with surgery. CONCLUSIONS: The practice was able to accommodate the demand in patient volume, medical retina services, and medical imaging with the advent of anti-vascular endothelial growth factor therapy and realized a seismic shift in operating costs. The practice attempted to deliver state-of-the-art patient care in a cost-effective manner, yet underwent a significant decline in its financial health. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20709400&dopt=ExternalLink
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PMID: 20709400 [PubMed - as supplied by publisher]16: Ophthalmology. 2010 Aug 11; [Epub ahead of print]
Soheilian M, Ramezani A, Azimzadeh A, Sadoughi MM, Dehghan MH, Shahghadami R, Yaseri M, Peyman GA.
Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti Medical University, Tehran, Iran; Negah Eye Hospital, Tehran, Iran.
PURPOSE: To compare the efficacy of intravitreal injection of clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. DESIGN: Prospective, randomized single-masked clinical trial. PARTICIPANTS: A total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone (IVCD) group and 34 in the classic treatment (CT) group. INTERVENTION: The IVCD group received 1 to 3 injection(s) of 1 mg intravitreal clindamycin and 400 mug dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies (immunoglobulin [Ig] M and IgG) were measured using an enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Changes in retinochoroidal lesion size, measured by a computer program written in the MATLAB environment, 6 weeks after initiation of treatment. Visual acuity (VA) changes, vitreous inflammatory response, adverse drug reactions, and rate of recurrence were secondary outcome measures. RESULTS: The mean number of injections in the IVCD group was 1.6. The lesion size reduction was statistically significant after treatment in both IVCD and CT groups (P<0.001 and P = 0.009, respectively). However, the difference in mean percentage of reduction at 6 weeks was not significant: 57.0+/-27.8% in the IVCD group versus 58.4+/-29.3% in the CT group (P = 0.569). In relation to the baseline, VA increased by 0.44+/-0.24 and 0.29+/-0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively (P<0.001); however, the difference of VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant (P = 0.002); this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was insignificant between the groups. Within 2 years, 4 eyes (2 in each group) had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. CONCLUSIONS: Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to the classic treatment in ocular toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20708269&dopt=ExternalLink
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PMID: 20708269 [PubMed - as supplied by publisher]17: Ophthalmology. 2010 Aug 10; [Epub ahead of print]
Hillenaar T, Mooy CM, Verjans GM, Remeijer L.
Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
PURPOSE: To report the clinical and histologic findings of a new subset of idiopathic corneal edema: zipper cell endotheliopathy. DESIGN: Observational case report. PARTICIPANT: A 55-year-old woman with unilateral bullous keratopathy. METHODS: Clinical observation consisted of slit-lamp examination and in vivo confocal microscopy (IVCM). Aqueous humor samples and the excised corneal button were analyzed for the presence of herpes viruses. The excised cornea was subjected to detailed immunohistochemistry (IHC) and scanning and transmission electron microscopy. MAIN OUTCOME MEASURES: Clinical and pathologic characteristics of zipper cell endotheliopathy. RESULTS: In vivo confocal microscopy revealed unique morphologic alterations of the corneal endothelial layer. Focal areas of denudation were surrounded by endothelial cells with zipper-like cell borders and intercellular structures. Besides central corneal edema, no other signs of corneal inflammation were detected. A herpes virus origin for the bullous keratopathy was excluded. The IHC analysis disclosed positive staining for cytokeratin (CK) 7, CK8/18, and CK19, suggesting epithelial metaplasia of the endothelial cells. Ultrastructural examination confirmed the IVCM findings by showing large areas of endothelial denudation and vacuolated endothelial cells with large, broad-based extensions that partially overlapped neighboring cells. Despite extensive complementary research and review of the literature, the endothelial alterations could not be attributed to any known corneal disorder. CONCLUSIONS: To the authors' knowledge, zipper cell endotheliopathy is a new subset of idiopathic corneal edema. The case report presented illustrates the potential use of IVCM to differentiate the spectrum of corneal disorders and to discover new corneal diseases. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20705342&dopt=ExternalLink
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PMID: 20705342 [PubMed - as supplied by publisher]18: Br J Ophthalmol. 2010 Aug 7; [Epub ahead of print]
Carlton J, Kaltenthaler E.
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Background/aims Health-related quality of life (HRQoL) measures are used in healthcare to help inform clinical decision-making and policy-making decisions. A number of disease-specific or condition-specific measures have been developed and applied in ophthalmology; however, their use in the specific fields of amblyopia and strabismus are not as established. The purpose of this study is to identify and discuss specific HRQoL instruments that may be used in the investigation and management of patients with amblyopia and/or strabismus. Methods A systematic literature review was undertaken in November 2009. The electronic databases of AMED (Allied and Complementary Medicine: 1985 to November 2009), the British Nursing Index and Archive (1985 to October 2009), Ovid Medline In-Process and Other Non-Indexed Citations and Ovid Medline (1950 to present) and PsycINFO (1806 to November Week 1 2009) were searched. No language restrictions were applied to the search. Results Four instruments were identified: the Amblyopia and Strabismus Questionnaire (A&SQ), the Amblyopia Treatment Index (ATI), the Adult Strabismus Questionnaire (AS-20) and the Intermittent Exotropia Questionnaire (IXTQ). Conclusion The use of HRQoL measures in patients with amblyopia and/or strabismus is a developing area. Further research is necessary to determine the impact of issues such as diplopia and poor cosmesis upon patient groups, and to determine the influence of ethnicity and parental reporting in these patients.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20693563&dopt=ExternalLink
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PMID: 20693563 [PubMed - as supplied by publisher]19: Ophthalmology. 2010 Aug 4; [Epub ahead of print]
Gdih GA, Yuen D, Yan P, Sheng L, Jin YP, Buys YM.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
TOPIC: Comparison of efficacy of intraocular pressure (IOP) reduction between 1- versus 2-site phacotrabeculectomy. CLINICAL RELEVANCE: The last systematic review concluded that there was weak evidence to suggest that 2-site phacotrabeculectomy provides 1- to 2-mmHg lower IOP than 1-site surgery. Since this study, there have been further publications on this topic, stimulating this meta-analysis. METHODS/LITERATURE REVIEWED: Randomized controlled trials comparing 1- versus 2-site phacotrabeculectomy were searched through August 2009 using MEDLINE and the Cochrane Registry with the keyword phacotrabeculectomy. Inclusion criteria were prospective randomized controlled trials, a minimum of 12 months of follow-up, and English language. Quality of the trials was assessed using Cochrane collaboration's tool of assessing risk of bias. The main outcome measure was IOP, and secondary outcomes included number of glaucoma medications, visual acuity, complications, and surgical time. RESULTS: Ten articles were included. There was no statistically significant difference in the amount of IOP reduction between 1- and 2-site phacotrabeculectomy. The pooled IOP decreases from baseline (95% confidence interval) were: 7.85 mmHg (6.76-8.92 mmHg) versus 5.83 mmHg (4.72-6.94 mmHg) at 1 month; 8.03 mmHg (7.38-8.67 mmHg) versus 7.03 mmHg (6.35-7.71) at 3 months; 7.78 (7.14-8.42) versus 6.75 (6.04-7.46) at 6 months; 6.44 (5.47-7.41 mmHg) versus 6.68 mmHg (5.56-7.81 mmHg) at 12 months; 7.17 mmHg (6.45-7.89 mmHg) versus 6.56 mmHg (5.77-7.35 mmHg) at 24 months; and 7.76 mmHg (7.02-8.49 mmHg) versus 7.14 mmHg (6.36-7.92 mmHg) at 36 months for 1- versus 2-site phacotrabeculectomy, respectively. There was no significant difference in the reduction in glaucoma medications or change in visual acuity at any time point. CONCLUSIONS: There is no significant difference in IOP reduction between 1- and 2-site phacotrabeculectomy. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20691480&dopt=ExternalLink
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PMID: 20691480 [PubMed - as supplied by publisher]20: Am J Ophthalmol. 2010 Aug 4; [Epub ahead of print]
Mesci C, Erbil HH, Olgun A, Yaylali SA.
Ophthalmology Department, Goztepe Training and Research Hospital, Istanbul, Turkey.
PURPOSE: To compare the visual performance of patients with unilateral cataract following implantation of monofocal, accommodating, refractive, and diffractive multifocal intraocular lenses (IOL). DESIGN: Prospective nonrandomized clinical trial. METHODS: Eighty-seven patients with unilateral cataract were enrolled in 4 groups for phacoemulsification and IOL implantation. Twenty-four patients had monofocal (Alcon Acrysof) (group 1), 21 patients had accommodating (Human Optics 1CU) (group 2), 22 patients had diffractive multifocal (Tecnis ZM900) (group 3), and 20 patients had refractive multifocal (AMO Rezoom) (group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analyzed at the 18th postoperative month were subjective refractions, monocular and binocular distance, intermediate and near uncorrected visual acuities, monocular distance and near best-corrected visual acuities, monocular distance-corrected intermediate and near visual acuities, stereopsis, visual complaints, and spectacle dependency. RESULTS: No significant difference was observed between distance and near best-corrected visual acuities of IOL groups, and between intermediate visual acuities of groups 2, 3, and 4. Groups 3 and 4 had statistically better near vision than the other groups (P < .05). No significant difference was observed between near visual acuities of groups 3 and 4. Number of patients with better stereoscopic function, spectacle independence, and complaints of halo in groups 3 and 4 was significantly higher than in other groups (P < .05). CONCLUSIONS: Multifocal IOLs provide better stereopsis, higher spectacle independence rates, and satisfactory functional vision over a broad range of distances in presbyopic patients with unilateral cataract compared with the monofocal and accommodating IOLs. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20691422&dopt=ExternalLink
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PMID: 20691422 [PubMed - as supplied by publisher]