Moshe Snir

Lovastatin Therapy in Hypercholesterolemia: Effect on Fibrinogen, Hemorrheologic Parameters, Platelet Activity, and Red Blood Cell Morphology

The effect of lovastatin therapy on blood rheology was investigated in 26 hypercholesterolemia patients. Treatment with lovastatin was associated with a significant improvement in whole blood filtration time and a tendency toward normalization in red blood cell morphology. A significant increase was observed in fibrinogen level, in ADP‐induced platelet aggregation, in the percentage of “big” platelets, and in platelet count. The viscosity of whole blood and plasma and the percentage of aggregated platelets did not change significantly. The cause for these hemorrheologic changes and their role in influencing the coronary risk of lovastatin‐treated hypercholesterolemia patients should be further investigated.

Diode laser treatment of posterior retinopathy of prematurity

AIMS To study the efficacy of infrared diode laser for the treatment of posterior retinopathy of prematurity (ROP). METHODS 48 eyes of 25 premature babies (mean birth weight 779 (SD 127.7) g; mean gestational age 25.5 (SD 1.47) weeks) with threshold ROP in zone I and posterior zone II were treated by the indirect infrared (810 nm) diode laser. Confluent burns were applied to the avascular retina. In 18 eyes, an additional row of laser burns was added posterior to the ridge. RESULTS Favourable anatomical results were noted in 41 eyes (85.4%). ROP stage 5 developed in two eyes, ROP stage 4A developed in four eyes, and ROP stage 4B in one eye. Three of the eyes with stage 4A eyes were successfully buckled; the fourth was not operated on and remained demarcated by laser scars. No complications were noted. CONCLUSION In this series, the diode laser was found to be a safe and effective treatment for posterior ROP.

Diode laser treatment of retinopathy of prematurity: anatomical and refractive outcomes.

Purpose: To examine the anatomical and refractive outcomes of infrared diode laser photocoagulation (DLPC) for the treatment of threshold retinopathy of prematurity (ROP). Methods: The charts of all consecutive premature neonates with ROP treated by DLPC at our tertiary center from December 1, 1996, to December 31, 2004, were reviewed. Results: The group included 100 neonates (194 eyes) with a mean birth weight ± SD of 833.9 ± 250.3 g and a mean gestational age ± SD of 26 ± 1.9 weeks. Sixty-two percent of neonates had zone I or posterior zone II ROP. Each eye received a mean ± SD of 1,740 ± 990 laser applications, and 21% of eyes received an additional 1 to 2 rows posterior to the ridge. Neonates treated after December 2003 (cutoff date of the Early Treatment of Retinopathy of Prematurity study) underwent a significantly greater number of laser applications (mean ± SD, 2,286 ± 1,087) than did neonates treated earlier. Anatomical results of laser treatment were favorable for 179 eyes (92.3%) at a mean follow-up ± SD of 33.6 ± 27.2 months. After vitreoretinal surgery, partial or total retinal detachment was documented for 2.5% of patients who received posterior-to-the-ridge laser treatment and 3.8% of patients treated only on the avascular retina. Refractive data were available for 134 eyes: 55.2% had myopia of −5 diopters (31.3%) or greater (23.9%). Strabismus was found in 21 (28.8%) of 73 neonates tested. Gestational age was correlated with corrected age at treatment, zone of ROP, number of laser applications, and spherical equivalent. Snellen visual acuity of 6/12 or more occurred in 17 of 24 patients who complied with testing. Conclusion: DLPC is a safe and effective treatment for ROP. Neonates of lower gestational age and birth weight require earlier and more aggressive laser treatment and may have a higher refractive error.

Quantitative changes in Botulinum toxin A treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm

PURPOSE To evaluate the quantitative changes in botulinum toxin A (BTA) treatment required over time to achieve relief for 3 to 4 months in patients with essential blepharospasm (EBS) and idiopathic hemifacial spasm (IHFS). DESIGN Interventional case series. METHODS In this retrospective longitudinal study in an institutional ophthalmologic outpatient clinic, data were retrieved from patient files and a comparison between patients with EBS and IHFS was performed. The patient population consisted of 27 patients, 17 with EBS and 10 with IHFS, who were treated for the first time with BTA injections and were followed up for 4 to 6 consecutive years. All patients initially received 12 or more courses of treatment with a lower dose (<or=20 U) and were then switched to a higher dose (>20 U). The main outcome measures were the shift in the dose-response relationship between the lower and higher doses and were analyzed with respect to four variables: average number of treatments, dosage, duration of therapy, and interval of symptomatic relief. RESULTS In the EBS group the mean dose for each patient changed from 16.0 +/- 1.4 U (lower dose) to 24.2 +/- 1.4 U (higher dose). The shift occurred after a mean of 8.8 +/- 2.9 treatments per patient given for a mean of 33.5 +/- 13.3 months. The mean interval of relief was longer with the lower dose than with the higher dose (4.0 +/- 1.4 months vs 3.2 +/- 1.0 months, respectively). In the IHFS group, the mean dose / patient changed from 16.8 +/- 1.2 U to 25.0 +/- 1.8 U, and the switch occurred after a mean of 6.5 +/- 2.3 treatments given over a mean period of 23.8 +/- 6.6 months. The mean duration of treatment with the lower dose was shorter than with the higher dose. The interval of relief was similar for both dose ranges (3.8 +/- 10 months and 4.1 +/- 1.3 months, respectively). The IHFS group switched to the higher dose earlier, by both number and duration of treatments, than the EBS group. Only minor and transient side effects of treatment were observed in both groups. CONCLUSIONS Botulinum toxin A is an effective and safe treatment for EBS and IHFS. The dose in our study was increased over time by 50% to achieve 3 to 4 months of symptomatic relief with minimal complications.

Refraction and keratometry in 40 week old premature (corrected age) and term infants

Aim: To compare refraction and keratometry readings between premature and term babies at 40 weeks’ postconceptional age (PCA), and the possible effect of birth weight (BW) and gestational age (GA) on ocular parameters. Methods: 33 preterm babies hospitalised in the neonatal unit between January and March 2002 were matched with 33 term babies born within the same period and hospitalised in the same unit. The preterm group underwent funduscopy at 4–5 weeks after delivery. Ophthalmic examination at 40 weeks’ PCA included cycloplegic retinoscopy, funduscopy, and keratometric measurements. Mean and standard deviation of refraction, astigmatic power (plus cylinder), axis of astigmatism, and keratometric reading were calculated and compared between groups and correlated with BW and GA in the premature babies. Results: Retinopathy of prematurity (ROP) stage 1 or 2 was noted in 88% of the premature babies on the first funduscopy examination, but only in 36% by the corrected age of 40 weeks. Statistically significant between groups differences were found for cycloplegic refraction (p = 0.02 for both eyes) and keratometry (p = 0.001 for both eyes). GA and BW had no impact on the refractive and keratometric findings in the preterm babies. Conclusions: Babies with mild ROP at the corrected age of 40 weeks have mild hypermetropia compared to the moderate hypermetropia found in term babies (a difference of 50%), and they have higher and steeper keratometric values. The greater corneal curvature may contribute to the development of myopia. Ophthalmologists and parents need to be aware of the possibility of visual dysfunction already very early in life even in relatively older premature infants.

Keratometry measurements in preterm and full term newborn infants

Aim: To evaluate the relation between postconceptional age and birth weight with keratometric values in preterm and full term infants. Methods: A prospective cross sectional study was performed. The cohort included 99 infants (198 eyes) admitted to the Neonatal and Neonatal Intensive Care Units at Schneider Children’s Medical Center of Israel from February to September 2002. Keratometry in the horizontal and vertical meridians was performed in both eyes of each infant by two ophthalmologists using an autokeratometer. The results were evaluated according to: postconceptual age (<32 weeks, 32–36 weeks, >36 weeks) and birth weight (<1500 g, 1501–2500 g, >2501 g). Results: Corneal curvature measurements decreased progressively with both postconceptual age and birth weight. At <32 weeks, mean (standard deviation) readings were 63.3 (3.2) diopters (D) for the horizontal meridian and 57.3 (2.6) D for the vertical meridian; corresponding values at >36 weeks were 54.0 (3.0) D and 50.7 (2.4) D. In the <1500 g group, mean (SD) readings were 61.3 (3.9) D for the horizontal meridian and 56.0 (2.9) D for the vertical meridian; corresponding values in the >2501 g group were 51.3 (2.1) D and 48.6 (1.8) D. Conclusions: There is an inverse relation of horizontal and vertical keratometric values with both postconceptional age and birth weight. Highest readings were noted in the babies with the lowest birth weight and youngest postconceptional age. The decrease in corneal dioptric power to normal values is linear and is apparently part of the normal ocular maturation.

Slanted lateral rectus recession for exotropia with convergence weakness.

OBJECTIVE To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exotropia (XT) with convergence weakness. DESIGN Predesigned, nonrandomized, comparative trial. PARTICIPANTS Twelve study patients and six control subjects with XT greater at near than at distance by > or =10 prism diopters (PD). INTERVENTION Twelve consecutive patients underwent slanted LR recession, and six consecutive control subjects underwent standard LR recession. MAIN OUTCOME MEASURES Between-groups comparison of the postoperative ocular alignment at distance and near, and the difference between them, as well as the stereopsis. RESULTS Slanted LR recession reduced the XT to <8 PD in all patients at distance and in 11/12 patients at near. Additionally, the mean difference between the distance and near exodeviation was reduced from 14+/-4.5 PD preoperatively to 2.9+/-2.4 PD postoperatively. All patients in the control group demonstrated postoperative deviations of <8 PD at distance, but all had residual exodeviations >8 PD at near. Three of the study patients gained gross stereopsis postoperatively. CONCLUSIONS Slanted recession of the LR is superior to standard recession in reducing both distance and near XT and in collapsing the difference between them. This technique may also have a positive impact on gross stereopsis.

Lovastatin therapy in heterozygous familial hypercholesterolaemic patients: effect on blood rheology and fibrinogen levels

Abstract. Thirteen heterozygous familial hypercholesterolaemic patients were treated with lovastatin for 1 year, and were investigated for the effect on lipid profile, blood rheology and fibrinogen levels. A significant dose‐dependent reduction in serum levels of total and LDL‐cholesterol, Apo B and the ratio of total cholesterol to HDL‐cholesterol was noted. Improvement in red blood cell filterability and an increase in fibrinogen levels were also observed. We conclude that the hypocholesterolaemic effect of lovastatin in familial hypercholesterolaemia is accompanied by changes in blood rheology. While some of these haemorheological changes may be considered beneficial, others may be regarded as unfavourable. The net effect of lovastatin therapy on the coronary risk of familial hypercholesterolaemic patients warrants further investigation.

Intravitreal Bevacizumab As Supplemental Treatment Or Monotherapy For Severe Retinopathy Of Prematurity

Purpose: To investigate the benefit of intravitreal bevacizumab as supplemental or primary treatment for retinopathy of prematurity. Methods: The files of nine consecutive infants treated with intravitreal bevacizumab for bilateral severe posterior retinopathy of prematurity were reviewed. Results: Gestational age was 24 weeks to 27 weeks, and birth weight was 660 g to 1,131 g. Indications for treatment were retinopathy of prematurity progression from Stage 3 to 4A or 2 to 3 with extraretinal neovascularization despite laser treatment; active neovascular Stage 4A disease after laser and cryo-treatment; anterior segment neovascularization and bleeding after laser treatment; and aggressive posterior disease with tunica vasculosa lentis and vitreous haze, which prevented laser treatment. One patient (two eyes) underwent lens-sparing vitrectomy after bevacizumab treatment; one eye acquired macular fold. One patient underwent bilateral scleral buckle. Bevacizumab treatment was associated with subsidence of the active vascular component in all eyes. Anatomical results were favorable in 17 eyes. There were no local or systemic complications. Conclusion: Intravitreal bevacizumab may serve as a supplemental therapeutic agent for severe laser-refractory retinopathy of prematurity or as monotherapy when media opacities preclude diode laser photocoagulation or the patient is too sick for lengthy laser treatment.

Central venous stasis retinopathy following the use of tranexamic acid.

Central venous stasis retinopathy (CVSR) was observed in two young women following the administration of oral tranexamic acid (TA) for the treatment of menorrhagia. Clinical and laboratory parameters were normal. Withdrawal of the drug and treatment with systemic steroids and fibrinolytic drugs resulted in improvement of visual acuity to 6/6. The pathogenesis of the CVSR in these cases is suggested, and the rationale of systemic treatment is discussed.