[Show abstract][Hide abstract] ABSTRACT: Endophthalmitis is an uncommon diagnosis but can have devastating visual outcomes. Endophthalmitis may be endogenous or exogenous. Exogenous endophthalmitis is caused by introduction of pathogens through mechanisms such as ocular surgery, open-globe trauma, and intravitreal injections. Endogenous endophthalmitis occurs as a result of hematogenous spread of bacteria or fungi into the eye. These categories of endophthalmitis have different risk factors and causative pathogens, and thus require different diagnostic, prevention, and treatment strategies. Novel diagnostic techniques such as real-time polymerase chain reaction (RT-PCR) have been reported to provide improved diagnostic results over traditional culture techniques and may have a more expanded role in the future. While the role of povidone-iodine in prophylaxis of postoperative endophthalmitis is established, there remains controversy with regard to the effectiveness of other measures, including prophylactic antibiotics. The Endophthalmitis Vitrectomy Study (EVS) has provided us with valuable treatment guidelines. However, these guidelines cannot be directly applied to all categories of endophthalmitis, highlighting the need for continued research into attaining improved treatment outcomes.
[Show abstract][Hide abstract] ABSTRACT: To the ancient Greeks, glaukos occasionally described diseased eyes, but more typically described healthy irides, which were glaucous (light blue, gray, or green). During the Hippocratic period, a pathologic glaukos pupil indicated a media opacity that was not dark. Although not emphasized by present-day ophthalmologists, the pupil in acute angle closure may appear somewhat green, as the mid-dilated pupil exposes the cataractous lens. The ancient Greeks would probably have described a (normal) green iris or (diseased) green pupil as glaukos. During the early Common Era, eye pain, a glaucous hue, pupil irregularities, and absence of light perception indicated a poor prognosis with couching. Galen associated the glaucous hue with a large, anterior, or hard crystalline lens. Medieval Arabic authors translated glaukos as zarqaa, which also commonly described light irides. Ibn Sina (otherwise known as Avicenna) wrote that the zarqaa hue could occur due to anterior prominence of the lens and could occur in an acquired manner. The disease defined by the glaucous pupil in antiquity is ultimately indeterminate, as the complete syndrome of acute angle closure was not described. Nonetheless, it is intriguing that the glaucous pupil connoted a poor prognosis, and came to be associated with a large, anterior, or hard crystalline lens.
[Show abstract][Hide abstract] ABSTRACT: We compiled uses of the word “macula” in written English by searching multiple databases, including the Early English Books Online Text Creation Partnership, America’s Historical Newspapers, the Gale Cengage Collections, and others. “Macula” has been used: as a non-medical “spot” or “stain”, literal or figurative, including in astronomy and in Shakespeare; as a medical skin lesion, occasionally with a following descriptive adjective, such as a color (macula alba); as a corneal lesion, including the earliest identified use in English, circa 1400; and to describe the center of the retina. Francesco Buzzi described a yellow color in the posterior pole (“retina tinta di un color giallo”) in 1782, but did not use the word “macula”. “Macula lutea” was published by Samuel Thomas von Sömmering by 1799, and subsequently used in 1818 by James Wardrop, which appears to be the first known use in English. The Google n-gram database shows a marked increase in the frequencies of both “macula” and “macula lutea” following the introduction of the ophthalmoscope in 1850. “Macula” has been used in multiple contexts in written English. Modern databases provide powerful tools to explore historical uses of this word, which may be underappreciated by contemporary ophthalmologists.
Survey of Ophthalmology 11/2014; · 3.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endophthalmitis remains a rare but serious cause of visual loss. Over time, changes have been noted in endophthalmitis in terms of predominant causes, infecting organisms and antibiotic susceptibilities. There is controversy regarding the use of intracameral prophylactic antimicrobials during cataract surgery. Alternatively, there appears to be increasing evidence against using routine topical antibiotics for intravitreal injections. There are also increasing reports of multidrug-resistant organisms causing endophthalmitis, but the combination of vancomycin and ceftazidime appears effective for the vast majority of cases. Future trends may involve increasing utilization of polymerase chain reaction for diagnosis, and possibly office-based pars plana vitrectomy for treatment of endophthalmitis.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Diabetic macular edema (DME) is the most common cause of visual impairment due to diabetic retinopathy. The treatment of DME has recently undergone a paradigm shift. Traditionally, photocoagulation was standard treatment, but pharmacologic therapies are becoming increasingly used for this purpose. All currently available drug therapies for DME are either anti-VEGF agents or corticosteroids.Areas covered: The pathogenesis of DME involves angiogenesis, inflammation and oxidative stress. The scientific rationale to treat DME through the pharmacologic blockade of VEGF and other pro-angiogenic factors is discussed. The fluocinolone insert is approved for the treatment of DME in several European countries, but not in the US at this time. Some medications that are already approved for other retinal diseases, most prominently aflibercept and the dexamethasone delivery system, have recently obtained approval for DME in the US. Other compounds are being studied in earlier-phase clinical trials.Expert opinion: Pharmacologic treatment of DME will likely become increasingly used, especially for patients with edema involving the fovea. At this time, the two main classes of medication for treatment of DME are anti-VEGF agents and corticosteroids. As we continue to collect clinical trials data, the precise role of individual agents, and the continuing role for photocoagulation, will become more clear.
Expert Opinion on Emerging Drugs 08/2014; · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We tried to identify the earliest cataract surgeons in the English-speaking areas of America. In 1751, couching was performed on the Caribbean island of Montserrat by John Morphy. William Stork of England, who couched cataracts, practiced in Jamaica in 1760 and then in cities from Annapolis to Boston between 1761 and 1764. Frederick William Jericho of Germany, upon completion of his training at Utrecht, published his 1767 treatise on his preferred surgical technique of extracapsular cataract extraction. Jericho had practiced in the Leeward Islands by 1776 and then in cities from Charleston to Boston between 1783 and 1785. The French surgeon Lewis Leprilete was the first to advertise cataract extraction in the United States in 1782 and probably passed on the skill to his protégé, Nathaniel Miller of Massachusetts. Leprilete was also the first to publicize Benjamin Franklin’s invention of bifocals.. These pioneers exposed American doctors and the public to cataract surgery. Shortly after their arrival, evidence emerges of other surgeons performing these procedures in America.
Survey of Ophthalmology 08/2014; · 3.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:Age-Related Macular Degeneration (AMD) is the leading cause of irreversible visual loss in developed countries. Its etiology includes genetic and environmental factors. Although VEGFA variants are associated with AMD, the joint action of variants within the VEGF pathway and their interaction with non-genetic factors has not been investigated. Methods:Affymetrix 6.0 chipsets were used to genotype 668,238 SNPs in 1,207 AMD cases and 686 controls. Environmental exposures were collected by questionnaire. A set-based test was conducted using the chi-square statistic at each SNP derived from Kraft's 2df joint test. Pathway and gene-based test statistics were calculated as the mean of all independent SNP statistics. Phenotype labels were permuted 10,000 times to generate an empirical p-value. Results: While a main effect of the VEGF pathway was not identified, the pathway was associated with neovascular AMD in women when accounting for birth control pill (BCP) use (P= 0.017). Analysis of VEGF's subpathways found that SNPs in the Proliferation subpathway were associated with neovascular AMD (P=0.029) when accounting for BCP use. Nominally significant genes within this subpathway were also observed. Stratification by BCP use revealed novel significant genetic effects in women who had taken BCPs. Conclusions: These results illustrate that some AMD genetic risk factors may only be revealed when considering complex relationships among risk factors. This shows the utility of exploring pathways of previously associated genes to find novel effects. It also demonstrates the importance of incorporating environmental exposures in tests of genetic association at the SNP, gene, or pathway level.
[Show abstract][Hide abstract] ABSTRACT: Three English ophthalmic texts of the 1580s were frequently republished: 1) Walter Bailey's A Briefe Treatise Touching the Preseruation of the Eie Sight, 2) The Method of Phisicke, an adaptation of the medieval treatise of Benevenutus Grassus, and 3) A Worthy Treatise of the Eyes, a translation of Jacques Guillemeau's treatise. Their history is intertwined through composite publications, some of which lacked clear attribution. At least 21 editions incorporated these texts. Although not previously realized, major elements of all 3 works are found in Two Treatises Concerning the Preseruation of Eie-sight, first published in 1616. To preserve eyesight, Bailey recommended eyebright (Euphrasia officinalis), fennel (Fæniculum vulgare), and a moderate lifestyle incorporating wine. In the works of Grassus and Guillemeau, cataracts were believed to lie anterior to the 'crystalline humor,' and were treated by the 'art of the needle,' or couching. Links are found between Grassus, Guillemeau, and eighteenth century glaucoma concepts. Although one of his students has traditionally received credit, it was English oculist John Thomas Woolhouse who first combined the early concepts and used the term glaucoma to describe the palpably hard eye in the early eighteenth century. The three primary ophthalmic texts of 1580s England influenced ophthalmic thought for over a century.
[Show abstract][Hide abstract] ABSTRACT: From antiquity through the Renaissance, congenital blindness was generally regarded as incurable, as noted in both medical and lay publications. The earliest reference to congenital cataract surgery that we identified, reported in 1663, referred to an 18-year-old female treated by English oculist John Stepkins (d. 1652). An examination of the literature related to the Stepkins family reveals the presence of male and female oculists during that period, including his daughter, Lady Theodosia Ivy. Eye waters attributed to Stepkins contained tutty (an oxide of zinc), roses, sugar candy, and other ingredients. Interestingly, John Thomas Woolhouse, the author of the next identified report of congenital cataract surgery in 1706, stated that he was related to Stepkins. Woolhouse reported by 1721 that he had performed 36 congenital cataract surgeries, with the youngest patient being 18 months of age.
[Show abstract][Hide abstract] ABSTRACT: Torpedo maculopathy is a congenital solitary, oval-shaped lesion typically located temporal to the center of the macula. Congenital hypertrophy of the retinal pigment epithelium (RPE), RPE lesions of Gardner syndrome, and other lesions can present with similar characteristics. Because of its unique clinical and imaging features, torpedo maculopathy generally can be differentiated from other posterior segment lesions. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:xxx-xxx.].
[Show abstract][Hide abstract] ABSTRACT: Endophthalmitis following pars plana vitrectomy is a very uncommon cause of endophthalmitis. Cases reported over the last decade show a decrease in incidence over time. To optimize visual outcome, early diagnosis and treatment are essential. In this review we report a summary of the incidence of endophthalmitis following vitrectomy, various risk factors for their occurrence, the microbiological profile and the visual outcomes post treatment.
[Show abstract][Hide abstract] ABSTRACT: A case of Staphylococcus caprae endophthalmitis in a young patient following pars plana vitrectomy for symptomatic vitreous floaters is reported here. Recent literature suggests that there is an increasing trend of performing pars plana vitrectomy for symptomatic floaters. Although rare, the potential risk of endophthalmitis should be explicitly discussed with patients considering surgical intervention for vitreous floaters.
[Show abstract][Hide abstract] ABSTRACT: With this article, we aimed to trace the evolution and impact of eye-related terms common in written English during the past 2 centuries by studying digital resources. Eye-related words and phrases (n-grams) occurring in English books at a frequency of 0.00001% for at least 25 years between 1790 and 2008 were identified from the Google n-gram database by searching for 254 strings such as eye or ophth. The first known English use of these n-grams was identified from historical articles and from multiple digital resources. Eye color was not commonly described as brown or green before 1840. Many common bigrams, such as bright eyes, suggested light emanating from the eyes, consistent with the extramission theory of vision. Based on word frequency, the impact of the revolutionary 1850 ophthalmoscope exceeded that of the stethoscope for 60 years. Glaucoma was not commonly written until the ophthalmoscope permitted visualization of the characteristic optic neuropathy. Green spectacles gave way during the early 1900s to dark glasses, subsequently renamed sunglasses. Until the mid-1900s, an eye surgeon was more often described as an oculist than an ophthalmologist, and inflamed eyes were said to experience ophthalmia more often than uveitis. Macular degeneration was rarely written about for more than a century after 1850 because it was labeled choroiditis. Of the 135 n-grams in the dictionary, an earlier written instance was identified in 92 cases (68%). Online databases of the written word reveal the origin and impact of many important vision concepts.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Currently, the standard therapy for neovascular age-related macular degeneration involves the use of anti-vascular endothelial growth factor (VEGF) drugs, which are delivered by repeated office-based intravitreal injections. This treatment is generally very effective in stabilizing or improving vision, although repeated injections create a burden for patients, family members and physicians. In addition, the cumulative risks of endophthalmitis and other complications increase with the number of injections. Areas covered: In the clinic, much attention is focused on the relative efficacies of the three major anti-VEGF medications (bevacizumab, ranibizumab and aflibercept) as well as the most popular re-injection regimens (monthly, as-needed and treat-and-extend). In theory, intravitreal anti-VEGF drug delivery with sustained-release devices would offer similar visual results with fewer required re-injections. Various approaches have been studied, including noninvasive techniques, intraocular implants and colloidal carriers, such as liposomes, microparticles and nanoparticles. Expert opinion: Despite its theoretical appeal, sustained-release drug delivery will not replace current techniques unless it offers one or more advantages in efficacy, safety, convenience or cost. Currently, many patients maintain stable vision with intravitreal injections at intervals of 2 months or longer, so sustained-release techniques will have to lengthen these intervals substantially to become widely accepted. As we continue to collect data from clinical trials, the role of sustained-release techniques will become better defined.
Expert Opinion on Drug Delivery 11/2013; · 4.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diabetic macular edema (DME) remains an important cause of visual loss worldwide. Corticosteroids have a role in the treatment of some patients with advanced or recurrent DME. The best studied steroids for this indication are triamcinolone acetonide, dexamethasone, and fluocinolone acetonide. All steroids are associated with risks of cataract and intraocular pressure elevation. In addition, intravitreal injection of any medication is associated with such risks as infectious endophthalmitis, which has led to the investigation of various extended-release steroid implants. At this time, no steroid is approved by the United States Food and Drug Administration for the treatment of DME.
[Show abstract][Hide abstract] ABSTRACT: When delivered via a single intravitreal injection, ocriplasmin can effect proteolytic resolution of symptomatic vitreomacular adhesion (VMA). The authors describe their initial clinical experience with ocriplasmin at a large academic center.
Retrospective review of all patients with symptomatic VMA treated with ocriplasmin from January 2013 through May 2013 at a single center.
Nineteen patients with symptomatic VMA received intravitreal ocriplasmin. Eight patients (42%) exhibited resolution of VMA. Macular holes in three of six patients (50%) closed after injection. A higher proportion of VMA resolution was observed in patients with the following baseline characteristics: age less than 65 years, focal adhesions less than or equal to 1,500 μm, presence of macular hole, phakic status, and absence of epiretinal membrane.
Initial clinical outcomes using ocriplasmin in this study are consistent with those reported in the phase 3 clinical trials. Improved clinical results can be achieved with careful case selection based on specific baseline characteristics. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:334-343.].
[Show abstract][Hide abstract] ABSTRACT: Patients with prominent vitreous opacities may demonstrate a characteristic shadowing on the volume-scanning protocols using spectral-domain optical coherence tomography. The authors present five cases of this characteristic shadowing artifact. This finding may be useful in objectively documenting the status of vitreous opacification and verifying the patient's complaint of symptomatic floaters, a so-called "floater scotoma." [Ophthalmic Surg Lasers Imaging Retina. 2013;44:415-418.].
[Show abstract][Hide abstract] ABSTRACT: Variations in a locus at chromosome 10q26 are strongly associated with the risk of age-related macular degeneration (AMD). The most significantly associated haplotype includes a nonsynonymous SNP rs10490924 in the exon 1 of ARMS2 and rs11200638 in the promoter region of HTRA1. It is under debate which gene(s), ARMS2, HTRA1 or some other genes are functionally responsible for the genetic association. To verify whether the associated variants correlate with a higher HTRA1 expression level as previously reported, HTRA1 mRNA and protein were measured in a larger human retina-RPE-choroid samples (n = 82). Results show there is no significant change of HTRA1 mRNA level among genotypes at rs11200638, rs10490924 or an indel variant of ARMS2. Furthermore, two AMD-associated synonymous SNPs rs1049331 and rs2293870 in HTRA1 exon 1 do not change its protein level either. These results suggest that the AMD-associated variants in the chromosome 10q26 locus do not significantly affect the expression of HTRA1.
Experimental Eye Research 05/2013; · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A patient with solitary congenital hypertrophy of the retinal pigment epithelium demonstrated a striking choroidal cavitation on spectral-domain optical coherence tomography (OCT). Although photoreceptor atrophy overlying congenital hypertrophy of the retinal pigment epithelium has been described on time-domain OCT, this patient manifested a previously unrecognized tomographic feature.[Ophthalmic Surg Lasers Imaging Retina. 2013;44:301-302.].