Ophthalmology News

Postoperative Visual Acuity in Patients With Fuchs Dystrophy Undergoing Descemet Membrane–Stripping Automated Endothelial Keratoplasty
Methods  In a retrospective study design, we created a histologic grading system based on common characteristics observed histologically among 92 DSAEK specimens sent to the University of Wisconsin Eye Pathology Laboratory with a clinical diagnosis of Fuchs dystrophy from 3 separate corneal surgeons. Cases were graded as mild, moderate, or severe on the basis of guttae dispersion, presence of a laminated Descemet membrane, presence of embedded guttae, and density of guttae. Regression models were built to study the relationship among preoperative VA, histologic findings, and best-corrected VA 6 months and 1 and 2 years after DSAEK.

Myopia as a Risk Factor for Open-Angle Glaucoma
This article sought to determine the association between myopia and open-angle glaucoma through a Systematic review and meta-analysis of observational studies of Thirteen studies involving 48 161 individuals. Data from 11 population-based cross-sectional studies were included in the main analyses. The pooled OR of the association between myopia and glaucoma based on 11 risk estimates was 1.92. On the basis of 7 risk estimates, the pooled ORs of the associations between low myopia (myopia up to −3 D) and glaucoma and between high myopia (≤−3 D myopic) and glaucoma were 1.65 (1.26–2.17) and 2.46 (1.93–3.15), respectively. Overall it can be concluded that individuals with myopia have an increased risk of developing open-angle glaucoma.

A Randomized Comparison of Pupil-Centered Versus Vertex-Centered Ablation in LASIK Correction of Hyperopia
This article compared visual and optical outcomes of pupil-centered vs vertex-centered ablation in patients undergoing laser-assisted in situ keratomileusis (LASIK) for hyperopia. Overall LASIK is an effective procedure for treatment of hyperopia. Pupil-centered and vertex-centered treatments provide similar visual and optical outcomes. However, in eyes showing large temporal pupil decentration, pupil-centered ablation seemed to produce a lower amount of coma and, as a consequence, a reduced loss of BCVA compared with vertex-centered patients.

Pulse-Dosed Difluprednate 0.05% Versus Prednisolone Acetate 1% in Cataract Surgery
This article compared the effects of 2 corticosteroids on corneal thickness and visual acuity after cataract surgery. In this high-dose pulsed-therapy regimen, difluprednate reduced inflammation more effectively than prednisolone acetate, resulting in more rapid return of vision. Difluprednate was superior at protecting the cornea and reducing macular thickening after cataract surgery.

Blockade of Prolymphangiogenic Vascular Endothelial Growth Factor C in Dry Eye Disease
The authors of this article sought to determine whether blocking prolymphangiogenic factors such as vascular endothelial growth factor C (VEGF-C) would suppress alloimmunity in dry eye disease using a murine model. The effects of intraperitoneal injections of 400 µg of anti–VEGF-C antibody (treated group) and intraperitoneal normal saline (untreated group) were studied in murine dry eyes induced by exposing mice to high-flow desiccated air in a controlled-environment chamber. Overall it was found that treatment with anti–VEGF-C led to significant improvement in dry eye disease, reflected by a decrease in inflammation at the clinical, molecular, and cellular levels.

Age-Related Macular Degeneration and the Risk of Stroke
Age-related macular degeneration (AMD) and stroke are both frequent diseases in the elderly. A link between AMD and stroke has been suggested, because both disorders have many risk factors in common. The aim of this study was to investigate the association between AMD and stroke and the subtypes cerebral infarction and intracerebral hemorrhage in the general elderly population. This study was part of the population-based Rotterdam Study and included 6207 participants aged ≥55 years who were stroke-free at baseline (1990 to 1993). During a median follow-up of 13.6 years, 726 participants developed a stroke (397 cerebral infarction, 59 intracerebral hemorrhage, 270 unspecified). Late AMD was associated with an increased risk of any stroke due to a strong association with intracerebral hemorrhage. In contrast, late AMD was not associated with cerebral infarction. Earlier AMD stages were not associated with risk of stroke or any of its subtypes.After data analysis it was found that late AMD is strongly associated with intracerebral hemorrhage, but not with cerebral infarction, in the general elderly population.

Use of Infliximab in the Treatment of Peripheral Ulcerative Keratitis in Crohn Disease
The authors of this article sought to test the effectiveness of infliximab in the treatment of peripheral ulcerative keratitis (PUK) associated with Crohn disease. In this small Retrospective, interventional case series Infliximab produced a rapid, dramatic, repeatable suppression of corneal inflammation, pain, and keratolysis in PUK associated with Crohn disease. Although the effect of long-term therapy with these agents is unknown, infliximab should be considered in patients with Crohn-associated PUK not amenable to traditional therapy. Larger prospective studies are needed to determine the efficacy of infliximab in this aggressive disease entity.

Nearsightedness linked to Glaucoma
People who are nearsighted may be nearly twice as likely to also develop glaucoma, a leading cause of blindness, according to a new study that summarizes earlier research. More than two million Americans over 40 have been diagnosed with the eye disease, which is becoming increasingly expensive to treat. According to one expert, the findings mean nearsighted people -- a third of all Americans -- may want to undergo regular eye screening."A conclusion might be that persons with high myopia should have regular ophthalmic examinations," Dr. Barbara Klein of the University of Wisconsin-Madison, who worked on one of the studies included in the new review, told Reuters Health.

AMD Drug Study Sparks Concerns
The study that put bevacizumab (Avastin) and ranibizumab (Lucentis) into a dead heat for treating "wet" age-related macular degeneration (AMD) did not assure that the pricier drug would be out of contention or that the lower-cost one is a winner. In fact, the American Academy of Ophthalmology (AAO) reacted cautiously to the study, which was released Thursday. Although the yearlong, head-to-head trial found that the two drugs were essentially equal in their effects on visual acuity, ranibizumab showed an advantage for one surrogate efficacy endpoint and in the rate of serious systemic adverse effects. But because bevacizumab's price tag is about 40 times lower than that of ranibizumab for intravitreal dosing, many ophthalmologists have already been recommending the less expensive drug.

Retinal Venular Diameter as an Early Indicator of Progression to Proliferative Diabetic Retinopathy
This article sought to examine the relationship between retinal arteriolar and venular diameter and the 6-year progression of diabetic retinopathy (DR) in African Americans with type 1 insulin-dependent diabetes mellitus. Overall it was found that larger retinal venular diameter is an independent and early indicator of progression to either PDR or PDR with high-risk characteristics in African Americans with type 1 diabetes mellitus.

Natural History of Visual Outcome in Central Retinal Vein Occlusion
This article investigated systematically the natural history of visual outcome in central retinal vein occlusion (CRVO). Of the eyes first seen within 3 months, visual acuity was 20/100 or better in 78% with nonischemic CRVO and in only 1% with ischemic CRVO (P<0.0001), and visual field defects were minimal or mild in 91% and 8%, respectively (P<0.0001). Final visual acuity, on resolution of macular edema, was 20/100 or better in 83% with nonischemic CRVO and in only 12% with ischemic CRVO (P<0.0001), and visual field defects were minimal or mild in 95% and 18%, respectively (P<0.0001). This artice shows a clear differentiation of CRVO into nonischemic and ischemic types, based primarily on functional criteria, is crucial and fundamental in determining visual outcome. Visual outcome is good in nonischemic CRVO and poor in ischemic CRVO.

Party 'Popper' Drugs Damage Eyes
Experimenting with "poppers" -- inhaled alkyl nitrates used as recreational drugs -- can cause lasting retinal damage, ophthalmologists warned. Four cases over a three-month period in France were reported in a letter to the editors appearing in the Oct. 14 issue of the New England Journal of Medicine. The prolonged visual loss likely resulted from damage to foveal photoreceptors by the acute, massive release of nitric oxide from the drugs, Michel Paques, MD, PhD, of the Quinze-Vingts Hospital in Paris, and colleagues wrote.

Orbital steroid injection is as effective as oral steroid therapy in management of thyroid-related ophthalmopathy
The aim of this study was to evaluate the efficacy, safety and complications of orbital steroid injection versus oral steroid therapy in the management of thyroid-related ophthalmopathy. This study showed that orbital steroid injection for thyroid-related ophthalmopathy is effective and safe. It eliminates the adverse reactions associated with oral corticosteroid use.

Hypothyroidism and the Risk of Developing Open-Angle Glaucoma
This article investigated the risk of open-angle glaucoma (OAG) after a diagnosis of hypothyroidism through a retrospective, population-based follow-up study. It was found that open-angle glaucoma developed in 7.4% of patients with hypothyroidism and 3.8% of patients in the comparison cohort during the follow-up period. Hypothyroid patients had a significantly lower 5-year OAG-free survival rate than patients in the comparison cohort. This association remained significant in untreated hypothyroidism patients and became statistically nonsignificant in patients treated with levothyroxine.

Alcohol consumption shows association with decreased visual acuity in diabetics
This article investigated the association between alcohol consumption and diabetic retinopathy and deterioration of visual acuity in individuals with Type 2 diabetes. A cohort analysis of 1239 participants with Type 2 diabetes aged 55–81 years enrolled in the AdRem study, a sub-study of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Current and past consumption of wine, spirits and beer was measured by self-report. Moderate and heavy alcohol consumption was defined as 1–14 and > 14 drinks/week, respectively. Diabetic retinopathy, measured by mydriatic stereoscopic seven-field retinal photography, was defined by a 2-step progression in the Early Treatment of Diabetic Retinopathy Study (ETDRS) score or the presence of any retinal vascular lesions. Deterioration of visual acuity was defined by a decrease of two lines in best vision in either eye, measured corrected, or through a pinhole using a Snellen chart. This article showed that current moderate consumption of alcohol, compared with no current consumption, was not associated with presence or progression of diabetic retinopathy; however, it was associated with higher risk of deterioration of visual acuity.

Erythropoietin and soluble CD44 levels in patients with primary open-angle glaucoma
This article sought to investigate the levels of erythropoietin (EPO) and soluble CD44 (sCD44) in the aqueous and plasma of human eyes with primary open-angle glaucoma (POAG), and to correlate their concentration with severity of glaucoma. It found that increased levels of aqueous EPO and sCD44 may be associated with POAG. In addition, EPO and sCD44 may be useful proteins levels in aqueous of POAG patients as a result of glaucoma damage and not a cause. EPO and sCD44 concentrations in aqueous are a possible biomarkers for visual field loss in patients with POAG.

Levodopa-carbidopa May Improve Vision loss in Indirect Traumatic Optic Neuropathy
To compare the effect of levodopa-carbidopa on the visual outcome of patients with indirect traumatic optic neuropathy (ITON), this randomized, double-blind, placebo-controlled study was conducted on 32 patients with ITON within 6 days after trauma. In the levodopa group the visual acuity improved significantly after treatment, but not in the placebo group. In those who had visual acuity ≤ figure count, significant improvement in the visual acuity was observed in the levodopa group but not in the placebo group. However, the final visual acuity in these patients was comparable after treatment (p=0.21). Nine patients (56.2 %) in the levodopa group and 1 (10%) in the placebo group experienced improvement in visual acuity (p=0.02). The frequency of unrecordable PVEPs were comparable in both groups (p=0.09). Patients treated with levodopa within 6 days of onset of ITON were more likely to experience improvement in visual acuity than those in the placebo group.

Local Intra-arterial Fibrinolysis in Central Retinal Artery Occlusion versus Conservative Treatment Doesn't Show Benefit
The reported outcomes of central retinal artery occlusion (CRAO) with or without treatment vary considerably. Although local intra-arterial fibrinolysis (LIF) using recombinant tissue plasminogen activator (rtPA) is a promising treatment, outcomes have not been compared in randomized trials. This Prospective randomized multicenter clinical trial (the European Assessment Group for Lysis in the Eye Study) to compare treatment outcome after conservative standard treatment (CST) and LIF for acute nonarteritic CRAO. In light of these 2 therapies' similar outcomes and the higher rate of adverse reactions associated with LIF, we cannot recommend LIF for the management of acute CRAO.

Comparison of Natamycin and Voriconazole for the Treatment of Fungal Keratitis
An article out of the Archives of Ophthalmology conducted a therapeutic exploratory clinical trial comparing clinical outcomes of treatment with topical natamycin vs topical voriconazole for fungal keratitis. There were no significant differences in visual acuity, scar size, and perforations between voriconazole- and natamycin-treated patients with a trend toward scraping being associated with worse outcomes.

The Correlation Between Visual Acuity and Color Vision as an Indicator of the Cause of Visual Loss
This article explored the correlation between visual acuity (VA) and color vision and to establish a guide for the diagnosis of the cause of visual loss based on this correlation. total of 259 patients with visual impairment caused by 1 of 4 possible disease categories were included. Patients were divided into 4 groups according to the etiology of visual loss: 1) optic neuropathies, 2) macular diseases, 3) media opacities, and 4) amblyopia. This study found that diseases of the optic nerve affect color vision earlier and more profoundly than other diseases. When the cause of visual loss is uncertain, the correlation between the severity of color vision and VA loss can imply the possible etiology of the visual loss.

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