Ophthalmology (OPHTHALMOLOGY)

Publications in this journal

• Article: A Phenotype-Genotype Correlation Study of X-Linked Retinoschisis

  Ajoy Vincent, Anthony G Robson, magella m neveu, genevieve a wright, anthony t moore, andrew r webster, graham e holder
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  ABSTRACT: PURPOSE: To compare the clinical phenotype and detailed electroretinographic parameters in X-linked retinoschisis (XLRS). DESIGN: Retrospective, comparative study. PARTICIPANTS: Fifty-seven patients (aged 1-67 years) with molecularly confirmed XLRS were clinically ascertained. METHODS: Pattern electroretinography (PERG) and full-field electroretinography (ERG), incorporating international standard recordings, were performed in 44 cases. Thirteen patients, mostly pediatric, were tested using a simplified ERG protocol. On-Off and S-cone ERGs were performed in most adults. Fundus autofluorescence (FAF) imaging and optical coherence tomography (OCT) were available in 17 and 21 cases, respectively. MAIN OUTCOME MEASURES: The clinical and electrophysiologic data associated with different types of mutation in the RS1 gene. RESULTS: Forty-three patients had missense changes (group A), and 14 patients had nonsense, splice-site, or frame-shifting mutations in the RS1 gene (group B). The mean best-corrected visual acuity was better in group A than in group B (0.34 and 0.21, respectively). Fundus examination revealed foveal schisis in approximately half of both groups. The bright-flash dark-adapted (DA) ERG (11.0 candela.sec.m-2) waveform was electronegative in 62% of group A eyes and 100% of group B eyes. The photopic 30-Hz flicker ERG was delayed in all group B eyes and all except 6 group A eyes. On-Off ERG b-waves were subnormal in 39% of group A and 89% of group B eyes; d-waves were delayed in 14 eyes (group A = 10, group B = 4). S-cone ERGs were abnormal in 50% of both groups. The PERG was abnormal in 88% of group A and 100% of group B eyes. A spoke-wheel pattern of high and low intensity was the most common FAF abnormality observed. The OCT showed intraretinal schitic cavities in the majority of eyes. CONCLUSIONS: There is profound phenotypic variability in patients with XLRS. Most patients have DA bright-flash ERGs with a low b:a ratio in keeping with inner retinal dysfunction. Generalized cone system dysfunction is common and associated with an abnormal On-response and less frequent additional Off-response involvement. Nonsense, splice-site, or frame-shifting mutations in RS1 consistently caused electronegative bright-flash ERG, delayed flicker response, and abnormal PERG; missense mutations result in a wider range of ERG abnormalities. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
  Ophthalmology 02/2013;
• Article: Endocanalicular laser dacryocystorhinostomy analysis of 118 consecutive surgeries. Hong JE, Hatton MP, Leib ML, Fay AM. Ophthalmology. 2005 Sep;112(9):1629-33.

  Hong JE, Hatton MP, Leib ML, Fay AM
  Ophthalmology 02/2013; 112(9):1629-33.
• Article: Increased Expression of CD200 on Circulating CD11b+ Monocytes in Patients with Neovascular Age-related Macular Degeneration

  Singh A, Falk MK, Hviid TVF, Sørensen TL
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  ABSTRACT: Objective Dysregulation of retinal microglial activity has been implicated in the pathogenesis of neovascular age-related macular degeneration. Microglia activity can be regulated through the membrane protein CD200 and its corresponding receptor, the CD200 receptor (CD200R). Because both the ligand and the receptor are expressed on a broad spectrum of cell types, we set out to study the expression of CD200 and CD200R on CD11b+ monocytes, granulocytes, and subsets of T lymphocytes. Design Prospective, case-control study. Participants The study population consisted of 62 patients with neovascular age-related macular degeneration (AMD) and 44 age-matched controls without AMD. Methods The participants were aged 60 years or older, had no history of immune dysfunction or cancer, and were not receiving immune-modulating therapy. All participants were subjected to a structured interview, and detailed retinal imaging was performed: fundus autofluorescence imaging, digital color fundoscopy, and spectral-domain optical coherence tomography. Fluorescein and indocyanine green angiography were performed in patients with suspected neovascular AMD. Visual acuity was measured in both eyes. Fresh venous blood was obtained and stained with monoclonal antibodies and analyzed using flow cytometry within 6 hours of phlebotomy. Main Outcome Measures The percentage of CD11b+ monocytes, granulocytes, and CD4+/CD8+ T lymphocytes positive for CD200 or CD200R in patients and controls, respectively. Results Patients with neovascular AMD had a higher percentage of CD11b+CD200+ monocytes and CD200+ monocytes compared with controls. Multiple regression analysis revealed that the intergroup differences observed were independent of age. Moreover, an age-related increment in CD200 expression on monocytes was observed in controls with healthy eyes, but not in patients with neovascular AMD. We did not find any differences in CD200 and CD200R expression between patients with subretinal fibrosis and patients without subretinal fibrosis. Conclusions The surface expression of CD200 on circulating CD11b+ monocytes was found to be increased in patients with neovascular AMD compared with controls with healthy eyes. This novel finding supports the notion that altered regulation of the inflammatory response plays an integral role in the pathogenesis of AMD.
  Ophthalmology 02/2013;
• Article: Prevalence and 5- to 6-Year Incidence and Progression of Myopia and Hyperopia in Australian Schoolchildren

  A. N. French, I. G. Morgan, G. Burlutsky, P. Mitchell, K. A. Rose
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  ABSTRACT: PURPOSE: We sought to determine the prevalence, incidence, and change in refractive errors for Australian schoolchildren and examine the impact of ethnicity and sex. DESIGN: Population-based cohort study. PARTICIPANTS: The Sydney Adolescent Vascular and Eye Study, a 5- to 6-year follow-up of the Sydney Myopia Study, examined 2760 children in 2 age cohorts, 12 and 17 years. Longitudinal data were available for 870 and 1202 children in the younger and older cohorts, respectively. METHODS: Children completed a comprehensive examination, including cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1). Myopia was defined as </=-0.50 diopters (D) and hyperopia as >/=+2.00 D right eye spherical equivalent refraction. MAIN OUTCOME MEASURES: Baseline and follow-up refraction. RESULTS: Prevalence of myopia increased between baseline and follow-up for both the younger (1.4%-14.4%; P<0.0001) and older cohorts (13.0%-29.6%; P<0.0001). The annual incidence of myopia was 2.2% in the younger cohort and 4.1% in the older. Children of East Asian ethnicity had a higher annual incidence of myopia (younger 6.9%, older 7.3%) than European Caucasian children (younger 1.3%, older 2.9%; all P<0.0001). The prevalence of myopia in European Caucasian children almost doubled between the older (4.4%; 95% confidence interval [CI], 3.0-5.8) and younger samples (8.6%; 95% CI, 6.7-10.6) when both were aged 12 years. Children with ametropia at baseline were more likely to have a significant shift in refraction (hyperopia: odds ratio [OR], 3.4 [95% CI, 1.2-9.8]; myopia: OR, 6.3 [95% CI, 3.7-10.8]) compared with children with no refractive error. There was no significant difference in myopia progression between children of European Caucasian and East Asian ethnicity (P = 0.7). CONCLUSIONS: In Sydney, myopia prevalence (14.4%, 29.6%) and incidence (2.2%, 4.1%) was low for both age cohorts, compared with other locations. However, in European Caucasian children at age 12, the significantly higher prevalence of myopia in the younger sample suggests a rise in prevalence, consistent with international trends. Progression of myopia was similar for children of East Asian and European Caucasian ethnicity, but lower than reported in children of East Asian ethnicity in East Asia, suggesting that environmental differences may have some impact on progression. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
  Ophthalmology 01/2013;
• Article: Association of Retinal Sensitivity to Integrity of Photoreceptor Inner/Outer Segment Junction in Patients with Diabetic Macular Edema

  J. Yohannan, M. Bittencourt, Y. J. Sepah, E. Hatef, R. Sophie, A. Moradi, H. Liu, M. Ibrahim, D. V. Do, E. Coulantuoni, Q. D. Nguyen
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  ABSTRACT: PURPOSE: To evaluate the relationship between retinal sensitivity and the photoreceptor inner segment/outer segment (IS/OS) layer status in patients with diabetic macular edema (DME). DESIGN: Cross-sectional study. PARTICIPANTS: Twenty-five adult patients (37 eyes) diagnosed with DME and managed at the Wilmer Eye Institute, Johns Hopkins University (Baltimore, MD). METHODS: We obtained simultaneous fundus microperimetry (MP) and optical coherence tomography (OCT) of patients with DME using a combined MP/OCT system. The device recorded retinal sensitivity and retinal thickness on a 3-dimensional tomography map, and we performed a point-by-point analysis of the IS/OS layer integrity at every MP point. We also reviewed OCT scans to determine the type of DME, cystoid macular edema, or diffuse macular edema (absence of any cysts). In addition, fixation stability and fixation location were analyzed. MAIN OUTCOME MEASURES: Retinal point sensitivity measured by MP. RESULTS: Twenty-five patients (37 eyes: 29 male and 8 female; mean age, 64.16 years) with DME were enrolled. Fixation was centric in 30 eyes (81%), paracentric in 3 eyes (8%), and eccentric in 4 eyes (11%). Twenty-seven eyes had cystoid macular edema, and 10 eyes had diffuse macular edema. Mean central subfield thickness was 325 mum. We analyzed a total of 1036 individual MP points. Mean point sensitivity was 10.51 dB. A total of 793 points (76.5%) had IS/OS layer present, and 243 points (23.5%) had IS/OS layer disrupted. A mixed linear model, constructed to adjust for potential confounders and account for dependence between retinal points, revealed that the absence of the IS/OS junction was significantly associated with a 3.28-dB decrease in retinal point sensitivity (P<0.001). CONCLUSIONS: This novel index study demonstrates that disruption of the IS/OS junction is correlated with a significant decrease in point sensitivity in eyes with DME. Further studies are indicated to confirm and validate this relationship. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
  Ophthalmology 01/2013;
• Article: Author Reply

  Ajit Babu Majji, Muralidhar Ramappa, Somasheila Murthy, Praveen Balne, Suma Nalamada, Chandrashekar Garudadri, Annie Mathai, Usha Gopinathan, Prashant Garg
  Ophthalmology 11/2012; 119(11):2418.
• Article: 2: Ramappa M, Majji AB, Murthy SI, Balne PK, Nalamada S, Garudadri C, Mathai A, Gopinathan U, Garg P. Author reply. Ophthalmology. 2012 Sep; 119(9): 1940-1. PubMed PMID: 22944501.

  Ramappa M, Majji AB, Murthy SI, Balne PK, Nalamada S, Garudadri C, Mathai A, Gopinathan U
  Ophthalmology 09/2012; 119(9):1940-1.
• Article: Corneal thickness in keratoconus: Comparing Optical, Ultrasound and Optical coherence tomography pachymetry

  Debarun Datta, Pravin K Vadavalli, Harsha B L, Uday Addepalli
  Ophthalmology 08/2012;
• Article: Cat scratch disease

  C. L. Fraser, S. Sanchez, N. J. Newman, V. Biousse
  Ophthalmology 01/2012; 119(7):1502-3; author reply1503.
• Article: An Outbreak of post-cataract surgery endophthalmitis caused by Pseudomonas aeruginosa

  Antonio Pinna, Donatella Usai, Leonardo Antonio Sechi, Stefania Anna Lucia Zanetti, Nelson C A Jesudasan, Philip A Thomas, Jayaraman Kaliamurthy
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  ABSTRACT: Objective . Infectious endophthalmitis is among the most serious complications of cataract surgery. Gram-negative bacteria, including Pseudomonas aeruginosa , are responsible for less than 30% of cases; however, their rapidity of infection and virulence often results in poor visual outcome despite prompt antibiotic treatment. The purpose of this study was to investigate an outbreak of post-cataract surgery P. aeruginosa endophthalmitis in India. Design . Hospital-based case series. Participants . Twenty patients with acute postoperative endophthalmitis who underwent cataract surgery at one of the peripheral centers of Joseph Eye Hospital, Tiruchirapalli, Tamil Nadu, India, from February 23 to April 2, 2008. Interventions . Vitreous aspirates and environmental surveillance specimens were inoculated for culture. Antibiotic susceptibility testing was performed by agar diffusion method. Polymerase chain reaction (PCR) with enterobacterial repetitive intergenic consensus (ERIC) primers (ERIC-PCR) was used to establish the clonal relationship between clinical and environmental isolates. Main Outcome Measures . Post-cataract surgery P. aeruginosa endophthalmitis. Results . Pseudomonas aeruginosa was isolated from 20 eyes with postoperative endophthalmitis, the phacoemulsifier's internal tubes, the povidone-iodine solution, and the operating theater air-conditioning system. All strains were multidrug-resistant to cefazolin, chloramphenicol, tetracycline, aminoglycosides, and fluoroquinolones; conversely, most of them were susceptible to polymyxin B. Polymerase chain reaction with enterobacterial repetitive intergenic consensus primers disclosed 2 major clusters: six genetically identical clinical isolates shared 94% of similarity with the air-conditioning isolate; 11 other clinical isolates had 88% of similarity with the former strain. Despite the prompt use of intravitreal antibiotics, 10 patients had evisceration or phthisis of the affected eye. Conclusions . The outcome of cataract surgery-related P. aeruginosa endophthalmitis is poor. The detection of multidrug-resistant isolates is a serious problem, jeopardizing an appropriate choice of treatment. Polymerase chain reaction with enterobacterial repetitive intergenic consensus results strongly suggest that the main source of infection in this outbreak was the contaminated air-conditioning system. Polymerase chain reaction with enterobacterial repetitive intergenic consensus is an inexpensive, fast, reproducible, and discriminatory DNA typing tool for effective epidemiologic surveillance of clinical and environmental isolates of P. aeruginosa .
  Ophthalmology 03/2009; 116(12):2321-2326.
• Article: One-year outcomes with new-generation multifocal intraocular lenses.

  Cillino S, Casuccio A, Di Pace F, Morreale R, Pillitteri F, Cillino G, Lodato G
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  ABSTRACT: PURPOSE: To compare new-generation multifocal intraocular lenses (IOLs) with monofocal IOLs. DESIGN: Randomized prospective clinical trial. PARTICIPANTS: Sixty-two consecutive patients with cataract, seen between January of 2005 and January of 2006 at the Department of Ophthalmology of Palermo University Hospital in Italy, were bilaterally implanted with monofocal (AR 40, Advanced Medical Optics [AMO], Santa Ana, CA; 15 patients), multifocal refractive (Array SA40N, AMO; 16 patients), multifocal refractive (ReZoom, AMO; 15 patients), or multifocal diffractive pupil-independent (Tecnis ZM900, AMO; 16 patients) IOLs. INTERVENTION: Bimanual phacoemulsification. MAIN OUTCOME MEASURES: Primary outcomes were far, near, and intermediate visual acuity of the 4 IOL-implanted groups. Secondary outcomes were defocusing curves, contrast sensitivity, patients' quality of life (7-item visual function questionnaire [VF-7], halos and glare presence, overall satisfaction), and spectacle independence. Snellen visual acuity was measured as uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), uncorrected near visual acuity (UCNVA), best distance corrected near visual acuity (BDCNVA), best corrected near visual acuity (BCNVA), uncorrected intermediate visual acuity (UCIVA), and best distance corrected intermediate visual acuity (BDCIVA). RESULTS: UCNVA was 20/50 in the monofocal IOL group, compared with 20/32 or better in the multifocal IOL groups (P<0.0005). The monofocal IOL group exhibited a lower BDCNVA than the multifocal IOL groups (P<0.0005). The diffractive multifocal IOL group performed better than either refractive group (P = 0.007). UCIVA was significantly different (P = 0.001) among the groups: monofocal (AR 40) 20/32; multifocal refractive (Array SA40N) 20/30; multifocal refractive (ReZoom) 20/25; and multifocal diffractive (Tecnis ZM900) 20/30. Defocusing curves with -3.00 diopter lens exhibited a better trend in the diffractive group. The refractive multifocal IOL groups exhibited lower contrast sensitivities at 3 cycles/degree (P = 0.038). The VF-7 mean score was significantly lower in the monofocal than the multifocal IOL groups (P = 0.002). Night halos were more common in the refractive groups (P<0.01). Spectacle independence was 20% in the monofocal IOL group, 43.7% and 53.3% in the refractive multifocal IOL groups, and 87.5% in the diffractive multifocal IOL group (P<0.05). CONCLUSIONS: Multifocal IOLs provide a greater depth of focus and higher patient satisfaction, and make intermediate and near visual tasks easier than do monofocal lenses. New-generation, diffractive, pupil-independent multifocal IOLs provide better near vision, equivalent intermediate vision, less unwanted photic phenomena, and greater spectacle independence than either monofocal or refractive multifocal IOLs.
  Ophthalmology 09/2008;
• Article: Detection of virulence factors in a corneal isolate of Klebsiella pneumoniae

  Antonio Pinna, Leonardo Antonio Sechi, Stefania Anna Lucia Zanetti, Francesco Carta
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  ABSTRACT: Objective . To report on the microbiological findings of a Klebsiella pneumoniae strain isolated from a patient with keratitis. Design . Interventional case report. Intervention and Testing . Conjunctival swabs and corneal scrapings from the right eye were inoculated for culture. The isolate was analyzed for the presence of the mucoid phenotype and the ability to form biofilm. We also investigated whether the formation of biofilm by the corneal Klebsiella isolate is affected by N -acetylcysteine. Main Outcome Measures . Culture results and biofilm production were analyzed. Results . K. pneumoniae was grown from the conjunctiva and cornea. The isolate showed the mucoid phenotype and strong biofilm production. N -acetylcysteine had an inhibitory effect on both biofilm formation and preformed biofilm. Conclusions . K. pneumoniae can cause severe keratitis. The presence of virulence factors, such as the mucoid phenotype and the ability to form biofilm, may be important in determining corneal infection. N -acetylcysteine is a potential candidate for use as an inhibitor of Klebsiella biofilm formation.
  Ophthalmology 01/2005; 112(5):883-887.
• Article: Lack of fundus autofluorescence to 488 nanometers from childhood on in patients with early-onset severe retinal dystrophy associated with mutations in RPE65.

  Birgit Lorenz, Bettina Wabbels, Erika Wegscheider, Christian P Hamel, Wolfgang Drexler, Markus N Preising
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  ABSTRACT: Fundus autofluorescence is due to accumulation of lipofuscin in the retinal pigment epithelium (RPE) resulting from incomplete digestion of N-retinylidene-phosphatidyl-ethanolamine from shed photoreceptor outer segment discs. Alteration in autofluorescence reflects changes in lipofuscin content of the RPE. Mutations on both alleles of RPE65 result in absent or largely decreased formation of rhodopsin, due to a defect in all-trans retinol isomerization in the RPE. Autofluorescence could therefore be altered. This study was conducted to evaluate fundus autofluorescence in patients with early-onset severe retinal dystrophy (EOSRD, or early-onset rod-cone dystrophy) associated with mutations on both alleles of RPE65. Case series. Ten 10- to 55-year-old patients with EOSRD and compound heterozygous or homozygous mutations in RPE65. For comparison, 6 heterozygous parents and 2 patients with other forms of EOSRD were examined. Participants underwent, in addition to standard clinical and electrophysiological examination, autofluorescence imaging using a confocal scanning laser ophthalmoscope. Three of the patients were also examined by optical coherence tomography (OCT) to evaluate the status of retinal degeneration. Mutations in 7 patients have been reported previously; the other patients were investigated by polymerase chain reaction-single-strand conformation polymorphism and direct sequencing for mutations in RPE65 and lecithin retinol acyltransferase (LRAT). Fundus autofluorescence and OCT. Absent or minimal autofluorescence was found in all patients with compound heterozygous or homozygous RPE65 mutations. Autofluorescence was normal in the heterozygous parents. Autofluorescence was present in 2 children with EOSRD not associated with mutations in RPE65 or LRAT, another gene involved in retinol recycling. Optical coherence tomography in younger patients revealed an intraretinal appearance similar to that of their healthy, heterozygous parents. Lack of autofluorescence in patients with EOSRD associated with mutations in RPE65 is in accordance with the biochemical defect and can be used as a clinical marker of this genotype. Optical coherence tomography results in younger patients would indicate still viable photoreceptors despite the absence of autofluorescence.
  Ophthalmology 09/2004; 111(8):1585-94.
• Article: Glucocorticoid-induced osteoporosis: considerations in ophthalmology.

  René A Cervantes, Leila I Kump, Robert M Neer, C Stephen Foster
  Ophthalmology 09/2004; 111(8):1437-8.
• Article: Oxybuprocaine induces a false positive.

  Eiichi Uchio, Kazuaki Kadonosono, Koki Aoki, Shigeaki Ohno
  Ophthalmology 09/2004; 111(8):1618.
• Article: The giant fornix syndrome: an unrecognized cause of chronic, relapsing, grossly purulent conjunctivitis.

  Geoffrey E Rose
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  ABSTRACT: To describe a group of elderly patients presenting with chronic, relapsing, copiously purulent conjunctivitis, in which the condition was often perpetuated by the sequestration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix. Retrospective review of a noncomparative case series, drawn from patients attending the lacrimal clinic at Moorfields Eye Hospital. Characterization of this unrecognized syndrome and its response to treatment. Twelve patients (10 female) presented between the ages of 77 and 93 years (mean, 85; median, 86) with a history of chronic relapsing bacterial conjunctivitis affecting, with 2 exceptions, just one eye. All had experienced multiple episodes of markedly purulent conjunctivitis and chronic ocular discharge for between 8 and 48 months (mean, 23.5; median, 24) before referral, and the patients had received multiple courses of treatment. Three had successful external dacryocystorhinostomy (for nasolacrimal duct occlusion) before the final diagnosis of giant fornix syndrome was made, 9 had developed corneal vascularization and scarring before referral, and 5 had suffered prior spontaneous corneal perforation or thinning. All patients had deep upper conjunctival fornices in association with the changes of age-related dehiscence of the levator muscle aponeurosis. Copious amounts of thick, purulent debris and a yellow coagulum were lodged in the depths of the upper fornix-this debris universally culturing Staphylococcus aureus. The condition settled rapidly on appropriate systemic antibiotics (ciprofloxacin or ofloxacin), intensive topical antibiotics, and high-dose, high-potency steroids; some patients required repeated treatment or needed to continue the use of a single drop of a combined steroid-antibiotic to prevent relapse. The capacious upper fornix of the elderly may harbor a coagulum colonized by S. aureus, leading to chronic conjunctivitis that may lead to severe sight impairment due to toxic keratopathy and secondary corneal vascularization.
  Ophthalmology 09/2004; 111(8):1539-45.
• Article: Acute primary angle closure: configuration of the drainage angle in the first year after laser peripheral iridotomy.

  Laurence S Lim, Tin Aung, Rahat Husain, Ying-Juan Wu, Gus Gazzard, Steve K L Seah
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  ABSTRACT: To evaluate the changes in the configuration of the drainage angle in the first year after acute primary angle closure (APAC). Prospective observational case series. Forty-four Asian subjects with APAC. Acute primary angle closure cases were treated with medical therapy followed by laser peripheral iridotomy (LPI). Static and dynamic gonioscopies were performed in APAC-affected and fellow eyes before LPI (baseline) and then at 2 weeks, 4 months, and 12 months after presentation. The angles were graded in each quadrant according to the Shaffer scheme, and the number of clock hours of peripheral anterior synechiae (PAS) was recorded. Patients who underwent intraocular surgery at any point during follow-up were excluded from the study. Intraocular pressure (IOP) and medical treatment were documented at each visit, and gonioscopic changes were correlated with the development of elevation in IOP requiring medical treatment. Average Shaffer grade and the number of clock hours of PAS. The majority of subjects were Chinese (84%) and female (64%), and the mean age was 60.2+/-10.7 years. At presentation, 73% of both affected and fellow eyes had very narrow angles (average Shaffer grade < or = 1), with affected eyes having more extensive PAS (P<0.001), a third of whom had > or =8 clock hours of PAS. In APAC eyes, there was a significant increase in angle width from baseline to 2 weeks after LPI (P = 0.045), but no change in angle width subsequently. Fellow eyes showed a widening of the angle between baseline and week 2 (P = 0.01) and from week 2 to month 4 (P = 0.001). There was no significant change in PAS in either affected or fellow eyes over the 12 months of follow-up. Of the 44 subjects, 19 (41.3%) subsequently developed IOP elevation during follow-up that required treatment. However, there was no difference in angle width or amount of PAS between eyes with and without a subsequent rise in IOP, and the angle configuration did not change significantly in either group over 1 year. In Asian eyes with APAC, the angle widened in the first 2 weeks after LPI, but did not change thereafter over 1 year, and the amount of PAS remained stable throughout. The results indicate the effectiveness of LPI in preventing progressive closure of the angle in the first year after APAC.
  Ophthalmology 09/2004; 111(8):1470-4.
• Article: Orbital irradiation for Graves' ophthalmopathy: Is it safe? A long-term follow-up study.

  Iris M M J Wakelkamp, Hendra Tan, Peerooz Saeed, Reinier O Schlingemann, Frank D Verbraak, Leo E C M Blank, Mark F Prummel, Wilmar M Wiersinga
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  ABSTRACT: We evaluated the frequency of long-term complications of orbital irradiation (radiation-induced tumors, cataract, and retinopathy) in comparison with glucocorticoids. We conducted a follow-up study in a cohort of 245 Graves' ophthalmopathy patients who had been treated with retrobulbar irradiation (20 Gy in 2 weeks) and/or oral glucocorticoids between 1982 and 1993 in our institution. Irradiated patients were compared with nonirradiated patients. Data on mortality and cause of death were obtained. Living patients were invited to participate in a follow-up study. Possible retinopathy was assessed in a masked fashion and defined as the presence of > or =1 hemorrhages and/or microaneurysms on red-free retina photographs. If >5 lesions were present, patients were categorized as suffering from definite retinopathy. Cataract was assessed using the Lens Opacity Classification System II score. Mortality, prevalence of retinopathy, prevalence of cataract, and type of cataract. Thirty-seven of the 245 patients had died, none of them from an intracranial tumor. Mortality was similar in the irradiated (27/159 [17%]) and nonirradiated patients (10/86 [12%]; P = 0.264). One hundred fifty-seven of the 208 living patients (75%) consented to participate in a follow-up ophthalmologic investigation; the mean follow-up time (+/- standard deviation) was 11+/-3 years. Possible retinopathy was present in 15% of patients, 22 of the irradiated and 1 of the nonirradiated patients (P = 0.002). In 5 patients (all had been irradiated), definite retinopathy (i.e., >5 retinal lesions) was present. Of these, 3 had diabetes mellitus, and 1 had hypertension. Diabetes was associated with both possible (P = 0.029) and definite (P = 0.005) retinopathy, with a relative risk of 21 (95% confidence interval, 3-179). The prevalence and severity of cataract were similar in the radiotherapy group (29%) and the glucocorticoid group (34%); it should be noted that 88 of 104 of the irradiated patients were also treated with oral glucocorticoids. The data suggest that orbital irradiation for Graves' ophthalmopathy is a safe treatment modality, except possibly for diabetic patients.
  Ophthalmology 09/2004; 111(8):1557-62.