Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Endophthalmitis is a severe inflammation of the anterior or posterior (or both) chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection

High-Resolution Optical Coherence Tomography as an Adjunctive Tool in the Diagnosis of Corneal and Conjunctival Pathology

To evaluate the use of a commercially available, high-resolution, spectral-domain optical coherence tomography (HR-OCT) device in the diagnosis of corneal and conjunctival pathologies, with a focus on malignant lesions. Eighty-two eyes of 71 patients were enrolled in this prospective case series, including 10 normal eyes, 21 with ocular surface squamous neoplasia (OSSN), 24 with a pterygium or pingueculum, 3 with lymphoma, 18 with pigmented conjunctival lesions (nevus, flat melanosis, or melanoma), and 6 with Salzmann nodular degeneration. Subjects were imaged using photography and HR-OCT (RTVue, Optovue, Fremont, CA). When clinically indicated, surgery was performed and histopathologic specimens were correlated with OCT images. HR-OCT was useful in differentiating among various lesions based on optical signs. Specifically, in OSSN, HR-OCT findings included epithelial thickening and hyper-reflectivity, whereas pterygia and pinguecula showed a subepithelial mass under thinner epithelium. In lymphoma, a hypo-reflective, homogenous subepithelial mass was observed. Differentiating between pigmented lesions with HR-OCT was more difficult, but certain characteristics could be identified. Eyes with nevi and melanoma both displayed intensely hyper-reflective basal epithelial layers and discrete subepithelial lesions, but could be differentiated by the presence of cysts in nevi and intense shadowing of sublesional tissue in most melanomas. We found that a commercially available HR-OCT was a useful noninvasive adjunctive tool in the diagnosis of ocular surface lesions

Evidence for contamination with C. trachomatis in the household environment of children with active Trachoma: A cross-sectional study in Kongwa, Tanzania.

BackgroundTrachoma, a conjunctivitis caused by repeated infections with Chlamydia trachomatis, remains a significant cause of blindness worldwide. While mass treatments with azithromycin decreases disease and infection, re-emergence occurs, indicating that elimination may require other sustainable interventions. Environmental changes largely focus on facial hygiene and latrines, but further work to identify other possible transmission targets are needed. We sought to determine, in a cross-sectional survey of households of children with active trachoma, if we could detect the presence of Chlamydia trachomatis on household objects and on family members based on sleeping and caretaking patterns.MethodsIn five villages in Kongwa, Tanzania, children ResultsOf 80 visited households, 13 (16%) had at least one swab from environmental sources positive for C. trachomatis DNA. A positive environmental swab was associated with the presence of ocular infection in the index child (Odds Ratio = 22.0, p = .007), the presence of an infant ConclusionsC. trachomatis DNA is present in the environment of children with active trachoma, especially in households with an ocular infection. Specific findings also suggest that washing hands, clothing, and bedding may be important

Ability of novice clinicians to interpret high-resolution optical coherence tomography for ocular surface lesions

To assess the ability of novice clinicians to use a commercially available high-resolution anterior segment optical coherence tomography (HR-OCT) device to diagnose various lesions of the ocular surface and cornea. Cross-sectional study. Twenty-six black-and-white HR-OCT images were projected, and clinicians were asked to determine whether the lesions represented ocular surface squamous neoplasia (OSSN) or another ocular surface pathology. A 20-minute instructional lecture was given on HR-OCT interpretation, and the same 26 images were shown. The clinicians were asked to repeat their assessment of the lesions. Thirty-four novice clinicians at the Bascom Palmer Eye Institute, Miami, FL, participated. A commercially available device (RTVue, Optovue, Fremont, Calif.) was specifically chosen for this study. The mean frequency of correct identification of the 26 lesions was 70% (standard deviation [SD] 15%) before instruction; after a short lecture, the frequency of correct identification improved to 84% (SD 9%, p = 0.002). Novice clinicians were more accurate in correctly determining that a lesion was not an OSSN (ruling it out as a diagnosis) than in determining that a lesion was an OSSN (p = 0.001). Some lesions (both OSSN and not OSSN), however, were more difficult to interpret than others. This study demonstrated that all levels of novice clinicians can quickly improve diagnostic accuracy with a commercially available HR-OCT after a short training session

Functional Characterization of Pathogenic Human MSH2 Missense Mutations in Saccharomyces cerevisiae

Hereditary nonpolyposis colorectal cancer (HNPCC) is associated with defects in DNA mismatch repair. Mutations in either hMSH2 or hMLH1 underlie the majority of HNPCC cases. Approximately 25% of annotated hMSH2 disease alleles are missense mutations, resulting in a single change out of 934 amino acids. We engineered 54 missense mutations in the cognate positions in yeast MSH2 and tested for function. Of the human alleles, 55% conferred strong defects, 8% displayed intermediate defects, and 38% showed no defects in mismatch repair assays. Fifty percent of the defective alleles resulted in decreased steady-state levels of the variant Msh2 protein, and 49% of the Msh2 variants lost crucial protein–protein interactions. Finally, nine positions are predicted to influence the mismatch recognition complex ATPase activity. In summary, the missense mutations leading to loss of mismatch repair defined important structure–function relationships and the molecular analysis revealed the nature of the deficiency for Msh2 variants expressed in the tumors. Of medical relevance are 15 human alleles annotated as pathogenic in public databases that conferred no obvious defects in mismatch repair assays. This analysis underscores the importance of functional characterization of missense alleles to ensure that they are the causative factor for disease

Human Papilloma Virus Infection Does Not Predict Response to Interferon Therapy in Ocular Surface Squamous Neoplasia

PURPOSE: To identify the frequency of human papilloma virus (HPV) in ocular surface squamous neoplasia (OSSN), and evaluate differences in clinical features and treatment response of HPV positive versus negative tumors. DESIGN: Retrospective case series. PARTICIPANTS: 27 patients with OSSN METHODS: OSSN specimens were analyzed for the presence of HPV. Clinical features and response to interferon were retrospectively determined and linked to the presence (versus absence) of HPV. MAIN OUTCOME MEASURES: Clinical characteristics of OSSN by HPV status. RESULTS: Twenty one of 27 tumors (78%) were HPV positive. HPV genotypes identified included HPV 16 in 10 (48%), HPV 31 in 5, HPV 33 in 1, HPV 35 in 2, HPV 51 in 2, and a novel HPV in 3 (total 23 as one tumor had 3 genotypes identified). Tumors found in the superior limbus were more likely to be HPV positive (48% vs 0%, Fisher exact P = 0.06). HPV 16 positive tumors were larger (68mm(2) vs 34 mm(2), Mann Whitney U P = 0.08) and were more likely to have a papillomatous morphology (50% vs 12%, Fisher exact P = 0.07) compared to HPV 16 negative tumors. HPV status was not found to associate with response to interferon therapy (Fisher exact P = 1.0). Metrics found to associate with a non-favorable response to interferon were male gender and tumors located in the superior conjunctivae. CONCLUSIONS: HPV presence in OSSN appears more common in lesions located in the non-exposed, superior limbus. HPV presence does not seem to be required for a favorable response to interferon therapy

Application of Corneal Optical Coherence Tomography Angiography for Assessment of Vessel Depth in Corneal Neovascularization

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Purpose:To map and measure the depths of corneal neovascularization (NV) using 3-dimensional optical coherence tomography angiography (OCTA) at 2 different wavelengths.Methods:Corneal NV of varying severity, distribution, and underlying etiology was examined. Average NV depth and vessel density were measured using 840-nm spectral-domain OCTA and 1050-nm swept-source OCTA. The OCTA results were compared with clinical slit-lamp estimation of NV depth.Results:Twelve eyes with corneal NV from 12 patients were imaged with OCTA. Clinically "superficial," "midstromal," and "deep" cases had an average vessel depth of 23%, 39%, and 66% on 1050-nm OCTA, respectively. Average vessel depth on OCTA followed a statistically significant ordinal trend according to the clinical classification of vessel depth (Jonckheere-Terpstra test, P < 0.001). In 8 cases where both 840-nm OCTA and 1050-nm OCTA were acquired, there was excellent agreement in the mean vessel depth between the 2 systems (concordance correlation coefficient = 0.94, P < 0.001). The average vessel density measured by 840-nm OCTA was higher (average 1.6-fold) than that measured by 1050-nm OCTA.Conclusions:Corneal OCTA was able to map corneal NV in 3 dimensions and measure vessel depth and density. The depth of corneal NV varied between different pathologies in a manner consistent with previous pathologic studies. The measured vessel density appeared to be affected by the interscan time, which affects blood flow velocity sensitivity, and the wavelength, which affects the ability to penetrate through opacity. These findings suggest possible clinical applications of OCTA for the diagnosis of corneal pathology and quantitative monitoring of therapeutic response in patients with corneal NV

Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia

PURPOSE: The objective of this study was to compare the cost associated with surgical versus interferon (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN). DESIGN: A matched, case-control study. PARTICIPANTS: Ninety-eight patients with OSSN; 49 of whom were treated surgically and 49 of whom were treated medically. METHODS: Patients with OSSN treated with IFNα2b were matched to surgery patients based on age and date of treatment initiation. Financial cost to the patient was calculated using two different methods (hospital billing and Medicare allowable charges) and compared between the two groups. These fees included physician fees (clinic, pathology, anesthesia, and surgery), facility fees (clinic, pathology, and operating room), and medication costs. Time invested by patients was calculated in terms of number of visits to the hospital and compared between the two groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis. MAIN OUTCOME MEASURES: Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges. RESULTS: When considering cost in terms of time, the medical group had an average of 2 more actual and imputed number of visits over 1 year compared to the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean $17,598, SD$7,624) when compared to the IFNα2b group (mean $4,986, SD$2,040). However, cost between the two groups was comparable when calculated based on Medicare allowable charges (surgical group: mean $3,528, SD$1,610; medical group: mean $2,831, SD$1,082; P = 1.00). The highest cost category in the surgical group was the excisional biopsy (Hospital billing $17,598; Medicare allowable$3,528) while the highest cost in the medical group was interferon ($1,172 for drops, average 8.0 bottles;$370 for injections, average 5.4 injections). CONCLUSION: Our data in this group of patients previously demonstrated equal efficacy of surgical versus medical treatment. Here, for the first time, we consider costs of therapy and found that medical treatment involved slightly more office visits whereas surgical treatment could be more or equally costly depending on insurance coverage