Maria A. Woodward

Rapamycin slows aging in mice

Rapamycin increases lifespan in mice, but whether this represents merely inhibition of lethal neoplastic diseases, or an overall slowing in multiple aspects of aging is currently unclear. We report here that many forms of age‐dependent change, including alterations in heart, liver, adrenal glands, endometrium, and tendon, as well as age‐dependent decline in spontaneous activity, occur more slowly in rapamycin‐treated mice, suggesting strongly that rapamycin retards multiple aspects of aging in mice, in addition to any beneficial effects it may have on neoplastic disease. We also note, however, that mice treated with rapamycin starting at 9 months of age have significantly higher incidence of testicular degeneration and cataracts; harmful effects of this kind will guide further studies on timing, dosage, and tissue‐specific actions of rapamycin relevant to the development of clinically useful inhibitors of TOR action.

The Empirical Evidence for the Telemedicine Intervention in Diabetes Management

OBJECTIVE The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications. MATERIALS AND METHODS A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.) RESULTS Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicines potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated. CONCLUSIONS Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.

Relationship of visual acuity and lamellar thickness in descemet stripping automated endothelial keratoplasty

Objectives: To assess the relationship of graft thickness (GT) with visual acuity in patients who have undergone Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: We performed a retrospective chart review of all DSAEK patients who had anterior segment optical coherence tomography imaging. Donor tissue characteristics and clinical information were obtained from the eye bank and from the medical record, respectively. Patients with graft failure or with visually significant comorbidities were excluded for statistical analyses of the visual acuity. Results: Sixty-four eyes of 52 patients with a mean follow-up of 27 ± 16 months were included in the study. The mean preoperative GT of 199 ± 45 &mgr;m (range, 106–303 &mgr;m) was higher than the postoperative GT of 165 ± 53 &mgr;m (range, 88–335&mgr;m) (P < 0.0001). There was a moderate correlation of preoperative GT with postoperative GT (r = 0.41; P =0.0009). Mean Snellen visual acuity was 20/28 at 1 year and 20/29 at the final visit (r = 0.80; P < 0.0001). There was a poor correlation of best-corrected visual acuity at the final visit with preoperative GT (r = 0.11; P = 0.57) or with postoperative GT (r = 0.26; P = 0.16). Multivariate linear regression analysis indicates no association of either postoperative GT or best-corrected visual acuity at the final visit with donor tissue endothelial cell density, death-to-preservation time, death-to-surgery time, donor age, patient age, or length of postoperative follow-up. Conclusion: GT decreased after transplantation; however, there was a poor correlation of visual acuity with preoperative or postoperative DSAEK GT.

The Association Between Sociodemographic Factors, Common Systemic Diseases, and Keratoconus: An Analysis of a Nationwide Heath Care Claims Database

PURPOSE The purpose of this study was to determine whether an association exists between common systemic diseases, sociodemographic factors, and keratoconus (KCN) among a large, diverse group of insured individuals in the United States. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS Sixteen thousand fifty-three patients with KCN were matched 1:1 with persons without KCN. METHODS Persons with KCN were identified using billing codes and matched by age, gender, and overall health with a control group with no record of KCN. Multivariable logistic regression assessed whether sociodemographic factors and certain systemic diseases affected the odds of KCN. MAIN OUTCOME MEASURES Odds ratios (ORs) with 95% confidence intervals (CIs) of receiving a KCN diagnosis. RESULTS After adjustment for confounders, black persons had 57% higher odds (adjusted OR, 1.57; 95% CI, 1.38-1.79; P < 0.001) and Latino persons had 43% higher odds (adjusted OR, 1.43; 95% CI, 1.26-1.62; P < 0.001) of being diagnosed with KCN compared with whites. Asians had 39% reduced odds (adjusted OR, 0.61; 95% CI, 0.50-0.75; P < 0.001) of being diagnosed with KCN compared with whites. Patients with uncomplicated diabetes mellitus (DM) had 20% lower odds of KCN (adjusted OR, 0.80; 95% CI, 0.71-0.90; P = 0.002), and patients with DM complicated by end-organ damage had 52% lower odds of having KCN (adjusted OR, 0.48; 95% CI, 0.40-0.58; P < 0.001) compared with those without DM. Persons with collagen vascular disease had 35% lower odds of KCN (adjusted OR, 0.65; 95% CI, 0.47-0.91; P = 0.01). Other conditions found to have increased odds of KCN included sleep apnea (adjusted OR, 1.13; 95% CI, 1.00-1.27; P = 0.05), asthma (adjusted OR, 1.31; 95% CI, 1.17-1.47; P < 0.001), and Down syndrome (adjusted OR, 6.22; 95% CI, 2.08-18.66; P < 0.001). There was no association between KCN and allergic rhinitis, mitral valve disorder, aortic aneurysm, or depression (P > 0.1 for all comparisons). CONCLUSIONS Clinicians caring for persons with KCN should inquire about breathing or sleeping and, when appropriate, refer patients for evaluation for sleep apnea or asthma. Patients with DM have lower risk of KCN, potentially because of corneal glycosylation.

Patient acceptability of the Tecnis multifocal intraocular lens.

Cataract surgery has evolved. The goal of the surgeon includes both restoration of vision and refinement of vision. Patients’ desire for spectacle independence has driven the market for presbyopia-correcting cataract surgery and development of novel intraocular lens (IOL) designs. The Tecnis® Multifocal Intraocular Lens incorporates an aspheric, modified anterior prolate IOL with a diffractive multifocal lens design. The design aims to minimize spherical aberration and improve range of focus. The purpose of this review is to assess patient acceptability of the Tecnis® multifocal intraocular lens.

Eye-bank preparation of endothelial tissue

Purpose of review Eye-bank preparation of endothelial tissue for keratoplasty continues to evolve. Although eye-bank personnel have become comfortable and competent at Descemets stripping automated endothelial keratoplasty (DSAEK), tissue preparation and tissue transport, optimization of preparation methods continues. Surgeons and eye-bank personnel should be up to date on the research in the field. As surgeons transit to Descemets membrane endothelial keratoplasty (DMEK), eye banks have risen to the challenge of preparing tissue. Eye banks are refining their DMEK preparation and transport techniques. Recent findings This article covers refinements to DSAEK tissue preparation, innovations to prepare DMEK tissue, and nuances to improve donor cornea tissue quality. Summary As eye bank-supplied corneal tissue is the main source of tissue for many corneal surgeons, it is critical to stay informed about tissue handling and preparation. Ultimately, the surgeon is responsible for the transplantation, so involvement of clinicians in eye-banking practices and advocacy for pursuing meaningful research in this area will benefit clinical patient outcomes.

Treatment of microsporidia keratitis with topical voriconazole monotherapy

Microsporidia are obligate intracellular eukaryotic pathogens known to cause superficial punctate keratitis and stromal keratitis in both immunocompromised and immuno-competent individuals. Traditionally, microsporidia were classified as primitive eukaryotes; however, recent genomic evidence supports their reclassification as fungi.1 Definitive treatment for micro-sporidial keratitis has not been established. Based on the classification of microsporidia as fungi, use of topical antifungal agents may be beneficial as monotherapy. Voriconazole is available through compounding pharmacies in topical form and is effective against several fungal pathogens.2 Herein, we report 2 cases of microsporidial superficial punctate keratitis that were responsive to treatment with topical voriconazole. To our knowledge, this is the first case series of the successful treatment of microsporidial superficial punctate keratitis with topical voriconazole.

Sutureless Intrascleral Fixation of Secondary Intraocular Lens Using 27-Gauge Vitrectomy System

Transconjunctival sutureless intrascleral fixation is an important surgical option for secondary intraocular lens (IOL) implantation. In this report, the authors describe the technique of using a 27-gauge platform to perform pars plana vitrectomy, lensectomy, and sutureless scleral IOL fixation in a patient with crystalline lens dislocation secondary to Marfans syndrome. Case report and detailed description of the surgical technique are discussed.

Influence of preoperative donor tissue characteristics on graft dislocation rate after Descemet stripping automated endothelial keratoplasty.

Purpose: To determine the influence of preoperative donor tissue characteristics on the graft dislocation rate after performing a Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: We retrospectively analyzed the associations between donor tissue characteristics and graft dislocation rates for consecutive DSAEK surgeries performed in a 4-year period at a single institution. Results: From June 2007 to June 2011, 64 (18%) of 355 eyes underwent a procedure for graft dislocation. There were no differences in donor age, preoperative endothelial graft thickness, preprocessing endothelial cell density, change in endothelial cell density after processing, time from death to tissue processing, or time from tissue processing to surgery between eyes that experienced dislocations and those that did not (P > 0.05 for each). The graft recipients corneal disease diagnosis, preoperative corneal thickness, preoperative visual acuity, glaucoma status, history of glaucoma surgery, and cataract surgery at the time of performing the DSAEK were not associated with an increased rate of dislocation (P > 0.05 for each). Recipients who experienced graft dislocation were significantly older (73.6 vs. 70.2 years, P = 0.03) and more likely to undergo subsequent repeat transplantation (29.7% vs. 10.7%, P < 0.0001). Conclusions: We found no correlation between any corneal donor tissue characteristic and graft dislocation after the DSAEK was performed. Graft dislocation was more common in older recipients. Patients with dislocation had a higher rate of subsequent transplantation.

Evolving Techniques in Corneal Transplantation

Corneal transplantation is one of the most common types of human transplant surgery. By removing a scarred or damaged host cornea and replacing it with a clear and healthy donor transplant, this procedure helps to restore vision in a variety of corneal diseases. The traditional technique for corneal transplantation, penetrating keratoplasty (PKP), involves transplantation of all corneal layers. Over the past decade though, there has been a trend away from PKP as surgeons have developed partial thickness transplant procedures, such as deep anterior lamellar keratoplasty and Descemet stripping automated endothelial keratoplasty. These partial thickness transplant procedures selectively replace diseased host corneal tissue, while conserving healthy and functioning tissue. This review describes current surgical techniques in the field of corneal transplantation, with special emphasis on indications for transplantation and postoperative outcomes.