Peripapillary and macular choroidal thickness in glaucoma.

PurposeTo compare choroidal thickness (CT) between individuals with and without glaucomatous damage and to explore the association of peripapillary and submacular CT with glaucoma severity using spectral domain optical coherence tomography (SD-OCT).MethodsNinety-one eyes of 20 normal subjects and 43 glaucoma patients from the UCLA SD-OCT Imaging Study were enrolled. Imaging was performed using Cirrus HD-OCT. Choroidal thickness was measured at four predetermined points in the macular and peripapillary regions, and compared between glaucoma and control groups before and after adjusting for potential confounding variables.ResultsThe average (± standard deviation) mean deviation (MD) on visual fields was -0.3 (±2.0) dB in controls and -3.5 (±3.5) dB in glaucoma patients. Age, axial length and their interaction were the most significant factors affecting CT on multivariate analysis. Adjusted average CT (corrected for age, axial length, their interaction, gender and lens status) however, was not different between glaucoma patients and the control group (P=0.083) except in the temporal parafoveal region (P=0.037); nor was choroidal thickness related to glaucoma severity (r=-0.187, P=0.176 for correlation with MD, r=-0.151, P=0.275 for correlation with average nerve fiber layer thickness).ConclusionsChoroidal thickness of the macular and peripapillary regions is not decreased in glaucoma. Anatomical measurements with SD-OCT do not support the possible influence of the choroid on the pathophysiology of glaucoma

Demographics of ocular myasthenia gra

Among patients with generalized myasthenia gravis (GMG), women are more likely than men to present during early adulthood, with men typically developing GMG after 50 years of age. We investigated the incidence of ocular myasthenia gravis (OMG) by age, race and gender

Pars Plana Anterior Vitrectomy, Hyaloido-Zonulectomy, and Iridectomy for Aqueous Humor Misdirection

PURPOSE: To report a surgical technique for aqueous misdirection refractory to medical treatment consisting of combined pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. DESIGN: Noncomparative case series. METHODS: The charts of 5 pseudophakic patients who sought treatment for aqueous humor misdirection refractory to medical treatment from May 2008 trough February 2009 were reviewed. All 5 patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy with an anterior vitrector through a pars plana incision. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination results, and fundus findings. RESULTS: Five female patients (age range, 23 to 89 years) had increased intraocular pressure and shallowing of the anterior chamber after cataract extraction or trabeculectomy, and none responded to conventional medical therapy. After surgery, prompt resolution of the aqueous misdirection was achieved in all cases. The follow-up was 7.6 months (range, 1 to 13 months). CONCLUSIONS: Aqueous misdirection refractory to medical treatment can be treated successfully with surgery consisting of partial pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. (Am J Ophthalmol 2010;150:82-87. (C) 2010 by Elsevier Inc. All rights reserved.

A Review of Mitomycin Use in Ophthalmic Surgery: Clarification of Safety Standards for Patients and Hospital Personnel

The aim of this article is to review the main indications for use of mitomycin in ophthalmology, the adverse effects after exposure, identify the mechanisms of accidental exposure to mitomycin by sanitary personnel and patients, and offer guidelines on safe handling of the drug.Various studies have revealed that repeated exposure to antineoplastic medications, such as mitomycin, can cause deleterious reproductive effects. Due to these concerns, several organizations have published official guidelines for safe handling of antineoplastic drugs, including mitomycin.Mitomycin C is a chemotherapeutic agent, used systemically for pancreatic and stomach neoplasms, that is also commonly used in ophthalmic surgery. Because of its role in operating rooms of hospitals and surgical centers around the world, the potential hazards and measures to assure safety of this chemotherapeutic drug need to be explained. All personnel that is in contact with this medicine needs to be informed of the risks of exposure and trained to prevent exposure, whether they participate in drug preparation, handling mitomycin before or during surgery, perform or assist in surgery, or manipulate the instruments and materials that have been in contact with mitomycin

Single clear corneal incision for glaucoma drainage device shortening in pediatric glaucoma

Glaucoma drainage devices are commonly used for management of glaucoma in adults and children. With time, the position of the tube can change and cause damage such as corneal scarring, iris or lens contact, and uveitis. Most of these problems can be improved with tube shortening and/or excision of adherent iris or fibrous tissue. We describe a surgical technique that uses a single clear corneal incision to externalize and trim the shunt in pediatric patients. The technique has a short surgical. We review the indications and outcomes for this procedure in 13 eyes of 12 children who required shunt revision

Quantitative efficacy of external and internal browpexy performed in conjunction with blepharoplasty

Browpexy surgery is a minimally invasive surgical adjunct to upper blepharoplasty. The traditional internal (IB) approach is well documented, while the newer external (EB) variant has only recently been described. To date, there is little quantitative data to evaluate the efficacy of either procedure, and no data to compare results between the two. We determine the efficacy of, and compare surgical results between, internal and external browpexy surgery in lifting the central and lateral brow. A 3.5-year retrospective review of patients undergoing internal and external browpexy surgery to assess the amount of central and lateral lift to the brow was performed. Patients undergoing blepharoplasty without brow lift were used as a control group. The Massachusetts Eye and Ear Infirmary FACE-gram program was used to quantify surgical outcome. Ninety-eight patients are included for review, with an average follow-up of 4-5 months. The average elevation in lateral/central brow position was 2.29 mm and 1.47 mm in the IB group, and 2.97 mm and 1.90 mm in the EB group. These were not statistically significant (p = 0.164, and p = 0.507, respectively). There was a statistically significant elevation in central and lateral brow height for both browpexy techniques and the control group (p < 0.001). External and internal browpexy surgery afford a similar, and non-statistically different, elevation of the central and lateral brow at 4-5 months. When compared to standalone blepharoplasty (control) the amount of lift for both procedures is statistically significant

Intravitreal bevacizumab (Avastin) injection as primary treatment of inflammatory choroidal neovascularization

Objective: To assess the effects of intravitreal bevacizurnab injection as primary treatment of inflammatory choroidal neovascularization (CNV). Methods: Data for nine consecutive patients with newly diagnosed inflammatory CNV who were treated with intravitreal bevacizurnab (1.25 mg) injection were reviewed retrospectively. Main outcome measures were best-corrected visual acuity, foveal thickness measured by optical coherence tomography (OCT), and complete resolution of CNV. Results: CNV resolved completely in 9 (100%) of 9 affected eyes. At the last examination, visual acuity was improved in 8 eyes (88.8%), stable in 1 (11.2%), and worse in 0. Over a mean follow-up of 7.1 months (range, 6 -10 months), 7 eyes received 1 injection, 1 eye developed CNV recurrence and required a second injection, and 1 eye required a third injection. Foveal thickness by OCT decreased significantly (P = 0.049) after treatment. Conclusion: In this small case series of eyes with limited follow-up, intravitreal bevacizumab injection for treatment of inflammatory CNV was found to be safe and was associated with favorable visual outcomes for both subfoveal and juxtafoveal or extrafoveal inflammatory CNV