Fifteen years follow-up of photorefractive keratectomy up to 10 D of myopia: outcomes and analysis of the refractive regression

PURPOSE: To evaluate outcomes of photorefractive keratectomy up to -10.00 D of myopia and -4.50 of astigmatism and to develop a predictive model for the refractive changes in the long term. SETTING: Vissum Corporation and Miguel Hernandez University (Alicante, Spain). DESIGN: Retrospective-prospective observational series of cases. METHODS: This study included 33 eyes of 33 patients aged 46.79±7.04 years (range 40-57) operated with the VISX 20/20 excimer laser with optical zones of 6 mm. No mitomycin C was used in any of these cases. The minimum follow-up was 15 years. The main outcome measures were: uncorrected and corrected distance visual acuity, manifest refraction and corneal topography. Linear regression models were developed from the observed refractive changes over time. RESULTS: Safety and efficacy indexes at 15 years were 1.18 and 0.83, respectively. No statistically significant differences were detected for any keratometric variable during the follow-up (p≥0.103). 15 years after the surgery 54.55% of the eyes were within ±1.00 D of spherical equivalent and 84.85% within ±2.00 D. The uncorrected distance visual acuity at 15 years was 20/25 or better in 60.6% of the eyes and 20/40 or better in 72.73% of the eyes. The correlation between the attempted and the achieved refractions was r=0.948 (p<0.001) at 1 year, and r=0.821 (p<0.001) at 15 years. No corneal ectasia was detected in any case during the follow-up. CONCLUSIONS: Photorefractive keratectomy is a safe refractive procedure in the long term within the range of myopia currently considered suitable for its use, although its efficacy decreases with time, especially, in high myopia. The model developed predicts a myopic regression of 2.00 D at 15 years for an ablation depth of 130 µm

Follow-up study of over three years of patients with uveitis after cataract phacoemulsification: outcomes and complications

Purpose: To evaluate the rate and onset of intraoperative and postoperative complications post-phacoemulsification. Methods: One hundred sixty-two eyes of 145 patients with uveitis who underwent phacoemulsification between 2006 and 2009 were identified through surgical record review. Fifty-nine eyes of 46 patients met the inclusion criteria. Hazard ratio (HR) and Kaplan-Meier survival probability were calculated for each class of uveitis. Results: Macular edema (ME) resulted to be associated to chronic postoperative inflammation (r = 0.6; p = 0.00) and mostly related to patients who presented more than one postoperative relapse/year (r = 0.2; p = 0.02). Fuchs uveitis resulted to be a risk factor for posterior capsule opacification (PCO) (HR 3.36 IC95%1.0-10.5; p = 0.03). Hypotony and elevated intraocular pressure (IOP) were detected in the anterior uveitis group (0.02 EY). Conclusion: The HR to develop ME was significantly related to chronic anterior uveitis. PCO and elevated IOP are

biological agents in the treatment of uveitis

Inflammatory uveitis is a difficult condition to treat. Recently, a new class of drugs obtained by a biological process and therefore defined as "biologics" has been successfully used in the treatment of immunemediated rheumatic diseases. These drugs target different pro-inflammatory cytokines including tumor necrosis factor-α, interleukin-1 and interleukin-6, or immune effector cells including B and T lymphocytes. Their use has been then extended to different forms of uveitis resistant to standard therapy in small uncontrolled trials, with general and unexpected efficacy. The present review analyzes the literature on treatment of uveitis with the biologics currently available for the treatment of inflammatory rheumatic diseases. We used PubMed search engine as the main source of information. Among the papers included in the reference list, a particular emphasis was given on articles published during the last 5 years

REP1 deficiency causes systemic dysfunction of lipid metabolism and oxidative stress in choroideremia

Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations in CHM, encoding for Rab escort protein 1 (REP1). Loss of functional REP1 leads to the accumulation of unprenylated Rab proteins and defective intracellular protein trafficking, the putative cause for photoreceptor, retinal pigment epithelium (RPE), and choroidal degeneration. CHM is ubiquitously expressed, but adequate prenylation is considered to be achieved, outside the retina, through the isoform REP2. Recently, the possibility of systemic features in CHM has been debated; therefore, in this study, whole metabolomic analysis of plasma samples from 25 CHM patients versus age- and sex-matched controls was performed. Results showed plasma alterations in oxidative stress-related metabolites, coupled with alterations in tryptophan metabolism, leading to significantly raised serotonin levels. Lipid metabolism was disrupted with decreased branched fatty acids and acylcarnitines, suggestive of dysfunctional lipid oxidation, as well as imbalances of several sphingolipids and glycerophospholipids. Targeted lipidomics of the chmru848 zebrafish provided further evidence for dysfunction, with the use of fenofibrate over simvastatin circumventing the prenylation pathway to improve the lipid profile and increase survival. This study provides strong evidence for systemic manifestations of CHM and proposes potentially novel pathomechanisms and targets for therapeutic consideration

Update on Gene Therapy Clinical Trials for Choroideremia and Potential Experimental Therapies

Background and objectives: Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations involving the CHM gene. Gene therapy has entered late-phase clinical trials, although there have been variable results. This review gives a summary on the outcomes of phase I/II CHM gene therapy trials and describes other potential experimental therapies. Materials and Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search was performed to identify all articles describing gene therapy treatments available for CHM. Results: Five phase I/II clinical trials that reported subretinal injection of adeno-associated virus Rab escort protein 1 (AAV2.REP1) vector in CHM patients were included. The Oxford study (NCT01461213) included 14 patients; a median gain of 5.5 &plusmn; 6.8 SD (&minus;6 min, 18 max) early treatment diabetic retinopathy study (ETDRS) letters was reported. The Tubingen study (NCT02671539) included six patients; only one patient had an improvement of 17 ETDRS letters. The Alberta study (NCT02077361) enrolled six patients, and it reported a minimal vision change, except for one patient who gained 15 ETDRS letters. Six patients were enrolled in the Miami trial (NCT02553135), which reported a median gain of 2 &plusmn; 4 SD (&minus;1 min, 10 max) ETDRS letters. The Philadelphia study (NCT02341807) included 10 patients; best corrected visual acuity (BCVA) returned to baseline in all by one-year follow-up, but one patient had &minus;17 ETDRS letters from baseline. Overall, 40 patients were enrolled in trials, and 34 had 2 years of follow-up, with a median gain of 1.5 &plusmn; 7.2 SD (&minus;14 min, 18 max) in ETDRS letters. Conclusions: The primary endpoint, BCVA following gene therapy in CHM, showed a marginal improvement with variability between trials. Optimizing surgical technique and pre-, peri-, and post-operative management with immunosuppressants to minimize any adverse ocular inflammatory events could lead to reduced incidence of complications. The ideal therapeutic window needs to be addressed to ensure that the necessary cell types are adequately transduced, minimizing viral toxicity, to prolong long-term transgenic potential. Long-term efficacy will be addressed by ongoing studies

A mild Grave's ophthalmopathy during pregnancy

Introduction: Thyroid ophthalmopathy is a complication most commonly associated with Grave’s disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment. Methods: A complete ophthalmic examination in a 35-year-old secundigravida to 14 weeks of gestation presented to the hospital for a routine ophthalmological examination with eyelid retraction in the right eye was made. We studied the course of ocular disease through the gestation with orbit ecography and a 3T MRI. Results: A diagnosis of Grave’s Ophthalmopathy was made. Conclusion: This case presents an unusual course of the GD during pregnancy and a normal post-partum relapse, according to the Th1/Th2 balance. The frequent follow-up and the use of MRI allowed a prompt identification and complete control of the disease

infectious keratitis following CXL. A systematic review of reported cases; management visual outcommes and treatment proposed

Abstract Aim: To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed. Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication. Results: A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectiv

An innovative intrastromal keratoprosthesis surgery assisted by femtosecond laser.

Purpose: To demonstrate the surgical application of a new model of epidescemetic keratoprosthesis. Methods: A 53-year-old man was referred to our center with severe alkali burns in both eyes and was treated by a combined corneal graft associated with KeraKlear implantation assisted by femtosecond laser and cataract surgery with implantation of an intraocular lens. Results: After 1 month, visual acuity was 0.6 logMAR in both eyes with −2 sphere correction. Slitlamp examination and anterior segment optical coherence tomography revealed that the device was centered in the pupil area with no infection. No sign of extrusion was detected. Conclusions: The advantage of this device is that it involves nonperforating surgery, thus reducing the postoperative risk of infection and necrosis of tissue around the prosthesis. Large-scale studies with a long follow-up period are required to evaluate the outcome of use of this device

Delayed Onset of Bilateral Acute Retinal Necrosis Syndrome: A 46-Year Interval.

Background: Acute retinal necrosis (ARN) syndrome is an uncommon, severe form of retinitis that is caused by the herpes virus family. Bilateral acute retinal necrosis (BARN) at delayed onset is rare. Methods: A retrospective, interventional case is described in a 64-year-old man complaining of blurred vision in the left eye. The patient had a history of presumed ARN in the right eye at the age of 18 years. Results: The reduced visual acuity and the ocular fundus signs lead us to the diagnosis of delayed-onset BARN. Intravenous and intravitreal antiviral therapy, corticosteroid and antiplatelet treatment were administered until recovering final visual acuity. Conclusions: This report represents the longest reported interval of ARN quiescence with eventual bilateral involvement and illustrates the importance of long-term patient follow-up in immunocompetent patients. Abstract Background: Acute retinal necrosis (ARN) syndrome is an uncommon, severe form of retinitis that is caused by the herpes virus family. Bilateral acute retinal necrosis (BARN) at delayed onset is rare. Methods: A retrospective, interventional case is described in a 64-year-old man complaining of blurred vision in the left eye. The patient had a history of presumed ARN in the right eye at the age of 18 years. Results: The reduced visual acuity and the ocular fundus signs lead us to the diagnosis of delayed-onset BARN. Intravenous and intravitreal antiviral therapy, corticosteroid and antiplatelet treatment were administered until recovering final visual acuity. Conclusions: This report represents the longest reported interval of ARN quiescence with eventual bilateral involvement and illustrates the importance of long-term patient follow-up in immunocompetent patients

Anterior segment optical coherence tomography in evaluation of severe fungal keratitis infections treated by corneal crosslinking

Purpose: Anterior segment optical coherence tomography (OCT) is a relevant diagnostic tool in the evaluation of corneal changes following corneal crosslinking (CXL) treatment in patients infected by a severe fungal corneal infection. Methods: Two patients with severe fungal keratitis that was unresponsive to medical treatment were treated with CXL. Corneal melting was present in all cases. Anterior segment OCT showed the preoperative depth and extension of the infiltrate and the modification during the follow-up. Results: Blockage of the melting was achieved in one patient and one patient developed a corneal perforation. Anterior segment OCT allowed control of the evolution of fungal infection and evaluation of the corneal tissue response to the CXL. It is also able to identify the extent and depth of the inflammation. This parameter seems more important than corneal pachymetry to ensure the safety of CXL procedures in infectious keratitis. Conclusions: The different behavior of infla