Christopher I. Zoumalan

Efficacy of corticosteroids and external beam radiation in the management of moderate to severe thyroid eye disease.

Thyroid Eye Disease (TED, Graves ophthalmopathy, thyroid ophthalmopathy) is the most common cause of orbital inflammation and proptosis in adults. There is no agreement on its management although corticosteroids and external beam orbital radiation (XRT) have traditionally been believed to provide benefit in active inflammation. Our review of the published literature in English disclosed an overall corticosteroid-mediated treatment response of 66.9% in a total of 834 treated patients who had moderate or severe TED. Intravenous corticosteroids used in repeated weekly pulses were more effective (overall favorable response = 74.6%, n = 177) and had fewer side effects than daily oral corticosteroids (overall favorable response = 55.5%, n = 265). A combination of corticosteroid and radiation therapy seemed to be more effective than corticosteroids alone. Our conclusions are tempered by a notable lack of standardization within and between study designs, treatment protocols, and outcome measures. Accordingly, the North American Neuro-Ophthalmology Society (NANOS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and the Orbital Society, in conjunction with Neuro-Ophthalmology Research and Development Consortium (NORDIC), will investigate the design and funding of a multi-center controlled trial.

Visual outcomes of wavefront-guided laser in situ keratomileusis in eyes with moderate or high myopia and compound myopic astigmatism

PURPOSE: To evaluate the safety, efficacy, and clinical outcomes of wavefront‐guided laser in situ keratomileusis (LASIK) surgery for the treatment of moderate to high myopia and compound myopic astigmatism. SETTING: Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA. METHODS: This retrospective study included patients with moderate (−6.0 to −8.0 diopters [D]) and high (greater than −8.00) myopia treated with wavefront‐guided LASIK using the WaveScan linked to the CustomVue system (AMO USA, Inc.). Eyes were analyzed preoperatively and 1, 3, and 12 months postoperatively. RESULTS: The mean patient age was 38.4 years ± 7.14 (SD). Eighty‐nine eyes of 45 patients were evaluated at 3 months and 50 eyes of 25 patients at 12 months. No eye was retreated during the study. The mean manifest refraction spherical equivalent was −8.10 ± 0.98 D (range −6.00 to −10.63 D) preoperatively and −0.33 ± 0.55 D (range −1.625 to 1.375 D) 12 months postoperatively. Ninety percent of the eyes were within ±1.00 D of the intended correction and 64.0%, within ±0.50 D. For all eyes, the safety index was 1.00 and the efficacy index, 1.18. CONCLUSION: The data support the safety and efficacy of correcting moderate to high myopia and compound myopic astigmatism using wavefront‐guided LASIK.

Evaluation of intraocular and orbital pressure in the management of orbital hemorrhage: an experimental model.

OBJECTIVEnTo evaluate orbital pressure (OP), intraocular pressure (IOP), and the effectiveness of canthotomy, cantholysis, and septolysis using an experimental orbital hemorrhage model.nnnMETHODSnExpired whole blood was injected into the retrobulbar space of 10 human cadaver orbits. At 1-mL increments, OP, IOP, and globe position were documented. The mean (SD) time interval between the injections was 84 (36) seconds. Following injection of 22 mL, lateral canthotomy, cantholysis, and septolysis were performed. An additional 10 mL of blood was then injected.nnnRESULTSnAfter injecting 22 mL of whole blood, mean (SD) OP and IOP were 68.4 (32.2) and 71.5 (19.1) mm Hg, respectively. The OP and IOP correlated closely throughout the experiment, with a mean (SD) difference of 11.4 (4.9) mm Hg (Pearson coefficient, 0.97). Following canthotomy, cantholysis, and septolysis, there was a mean (SD) decrease of 48.0 (27.2) mm Hg (70%) and 50.0 (18.1) mm Hg (59%) in OP and IOP, respectively. With additional injection of 10 mL of blood, OP and IOP increased rapidly.nnnCONCLUSIONSnThe IOP and OP rose in direct proportion to the volume of whole blood injected; OP lagged behind IOP by 11 mm Hg, and surgical release of the orbit reduced OP by 70%. This effect was short-lived in the setting of continued simulated hemorrhage.

Severe surfing-related ocular injuries: the Stanford Northern Californian experience

There is a growing body of literature describing severe surfing-related ocular injuries that result in permanent vision loss. We describe three severe surfing-related ocular injuries that occurred on beaches in northern California. One particular case stresses the need to tailor treatment to the patient and injury because of the possibility of good outcomes despite severe injury. Attention should also be directed towards commercially available safety gear and providing additional safety measures to prevent other orbital and ocular injuries.

ERG evaluation of daily, high-dose sildenafil usage.

Purpose Sildenafil can cause transient, mild ERG changes in healthy individuals taking large single doses. Although the drug was originally intended for intermittent use in erectile dysfunction, it has now been approved for chronic use in subjects with pulmonary arterial hypertension (PAH). The purpose of our study is to investigate possible ERG changes in subjects using large doses of sildenafil on a chronic daily basis. Methods We examined five subjects with PAH taking sildenafil daily for 1–4xa0years. Full-field electroretinogram (ERG), multifocal ERG (mfERG), and color testing were performed. Three of the subjects returned on a later date for challenge off and on the medication. Results On chronic daily sildenafil, color vision testing was normal, and ERG and mfERG amplitudes were normal; however, cone implicit times on drug were modestly lengthened. There were no consistent full-field ERG changes when off the drug, but the mfERG showed a small amplitude increase and implicit time decrease, which returned 1xa0h after re-dosing. Conclusion There was a modest lengthening of cone implicit time on chronic daily doses of sildenafil and a hint that some of these changes may be reversible in the short term. It does not appear that chronic sildenafil usage at these dosage levels is seriously toxic or threatening to vision.

Wavefront-guided laser in situ keratomileusis retreatment for consecutive hyperopia and compound hyperopic astigmatism.

PURPOSE: To evaluate the efficacy, predictability, and safety of wavefront‐guided laser in situ keratomileusis (LASIK) using the Visx CustomVue excimer laser (Advanced Medical Optics) in eyes with consecutive hyperopia and compound hyperopic astigmatism after LASIK. SETTING: Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA. METHODS: This retrospective analysis included 19 eyes of 16 patients who had wavefront‐guided LASIK for consecutive hyperopia and compound hyperopic astigmatism after initial LASIK surgery. Primary outcome variables, including uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA), higher‐order aberration (HOA) analysis, and spherical equivalence, were evaluated at 1 and 3 months. Nine eyes of 7 patients were available for all visits. RESULTS: The mean patient age was 51.7 years ± 3.77 (SD) (range 44 to 55 years). The mean preoperative manifest refractive spherical equivalent (MRSE) was 0.99 ± 0.32 diopters (D) (range 0.50 to 1.50 D) and the mean 3‐month postoperative MRSE, −0.04 ± 0.66 D (range −1.50 to 0.75 D). At 1 month, 57.9% of eyes had a UCVA of 20/20 or better and 78.9% of 20/25 or better; 84.2% were within ±1.00 D of emmetropia. At 3 months, 66.7% of eyes had a UCVA of 20/20 or better and 88.9% of 20/25 or better; 88.9% were within ±1.00 D of emmetropia. No eye lost 2 or more lines of BSCVA at 1 or 3 months. CONCLUSION: Wavefront‐guided LASIK was an effective, predictable, and safe procedure for consecutive hyperopia and compound hyperopic astigmatism after LASIK.

Orbital giant cell angiofibroma recurring as a solitary fibrous tumor.

Giant cell angiofibroma has recently been hypothesized to be a clinicopathologic variant of solitary fibrous tumor. The authors report a case of an orbital giant cell angiofibroma that recurred as a solitary fibrous tumor 4 years later. The report strongly supports the hypothesis that giant cell angiofibroma and solitary fibrous tumor are related.

Essentials in Ophthalmology: Oculoplastics and Orbit (R.F. Guthoff and J.A. Katowitz)

There have been significant advances within the subspecialty of ophthalmic plastic and reconstructive surgery over the past several decades. These advances have not only been exciting to those practicing them but also to the patients that continue to have a high level of satisfaction. Rudolf Guthoff and James Katowitz have succeeded with this book in highlighting the latest in medical and surgical advances within the field. The authors were instrumental in inviting experts to discuss a variety of topics, further making this book not only valuable for those practicing ophthalmic plastic and reconstructive surgery but also for those practicing comprehensive ophthalmology. This 282-page, hardcover book contains 18 chapters and 301 figures, most of them brilliant color photographs. Over 35 invited and notable faculty members from around the world have contributed to one or more chapters. The book captures the reader by offering different topics within each of the chapters. Such topics range from surgical orbital anatomy, eyelid reconstruction techniques, orbital disease, and cosmetic surgery. Each chapter can be read separately, depending on the interest of the reader. The purpose of each chapter’s topic is highlighted in the beginning of each chapter under “Core Messages.” Key points within each chapter allow the reader to recap the summary through “Summary for the Clinician” highlights. The color photographs used in most of the chapters are of excellent quality and, in general, are very helpful in understanding the surgical pearls. Current and key references are included at the end of each chapter. Chapters 1, 3, and 4 comprehensively discuss novel advancements and the most commonly used techniques in repairing eyelid malpositions. Chapter 4 particularly has an excellent review of literature and provides a thorough explanation in evaluating a patient with eyelid retraction. The well-thought-out differential diagnosis is helpful for readers of all ophthalmic backgrounds. These three chapters pay particular attention to the meticulous approaches in surgically repairing eyelid malpositions. Nevertheless, they are effective in stressing the importance of restoring eyelid anatomy while taking into consideration the rest of the patient’s facial aesthetics. Chapter 2 is a well-written chapter that highlights the latest update in Mohs micrographic surgery and techniques in eyelid reconstruction. The chapter includes current references describing the success Mohs surgery provides in effectively removing skin malignancies (such as basal cell and squamous cell carcinomas) while maximizing preservation of healthy tissue. The chapter also discusses the growing evidence supporting Mohs in treating periocular sebaceous carcinoma, lentigo maligna, and melanoma in situ. The authors comprehensively describe the technique of Mohs surgery in an easy-to-read fashion with excellent use of photographs and illustrations. They finally conclude the chapter by reviewing commonly employed techniques in eyelid reconstruction using an abundant number of high-quality preand post-reconstruction photos. In addition, the authors incorporate various interesting chapters discussing the latest in orbital disease research. Chapter 6 sheds new light to the clinical course of periocular hemangiomas. The chapter focuses on discussing the latest information Doppler ultrasound has provided in evaluating the growth and decay profiles of these relatively common lesions. Moreover, Chapter 7 effectively summarizes the latest in etiology and treatment modalities for a Graefes Arch Clin Exp Ophthalmol (2009) 247:1007–1008 DOI 10.1007/s00417-008-0883-7