Ruwan A. Silva

Prospective Long-term Evaluation of the Efficacy, Safety, and Stability of the Phakic Intraocular Lens for High Myopia

OBJECTIVE To evaluate the safety, efficacy, predictability, and long-term stability of the Artisan Phakic Intraocular Lens (Ophtec BV, Groningen, the Netherlands) for the correction of high myopia. METHODS Prospective analysis of 26 eyes from 15 patients who underwent placement of the Artisan lens for the correction of high and extreme myopia. The mean (SD) preoperative spherical equivalent was - 12.30 (2.69) diopters (D) (range, - 17.25 to - 8.25 D). RESULTS At 5 years, the mean (SD) manifest refraction was - 0.37 (0.69) D, with 95% of eyes within 1 D of attempted correction and 74% of eyes within 0.5 D of the attempted correction. Ninety-five percent of eyes achieved an uncorrected visual acuity of 20/40 or better and 74% achieved an uncorrected visual acuity of 20/20 or better. No eyes experienced a loss of 1 or more lines of best-corrected visual acuity. Sixteen percent of eyes gained 2 or more lines of best-corrected visual acuity. From preoperative measurements, the mean endothelial cell density decreased by 14.05% at 5 years postoperatively. CONCLUSIONS Placement of the Artisan lens is predictable, stable, and effective at reducing high and extreme myopia 5 years after implantation. The rate of endothelial cell loss was significantly higher than has been reported in previous studies.

Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 12-month experience with telemedicine screening

Background/aims: To report the 1-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative. Methods: Forty-two consecutively enrolled infants who met ROP examination criteria were screened between 1 December 2005 through 30 November 2006 with the RetCam II and evaluated by the SUNDROP reading centre at Stanford University. Nurses obtained five images in each eye. All patients also received a dilated examination by the author within 1 week of discharge from the hospital. Outcomes included referral-warranted disease, need for treatment and anatomical outcomes. Referral-warranted disease was defined as any Early Treatment Retinopathy of Prematurity (ROP) Disease Type 2 or greater, or any plus disease. A retrospective analysis of 84 eyes, 131 unique examinations and 1315 unique images from the SUNDROP archival data is reported here. Results: In the initial 12-month period, the SUNDROP telemedicine screening initiative had not missed any referral warranted ROP. Calculated sensitivity and specificity was 100% and 95%, respectively. No patient progressed to retinal detachment or other adverse outcomes. Conclusions: The SUNDROP telemedicine screening initiative for ROP has proven to have a high degree of sensitivity and specificity for identification of referral warranted disease. These results indicate that telemedicine may improve accessibility of ROP screening.

Stanford University network for diagnosis of retinopathy of prematurity (SUNDROP): 36-month experience with telemedicine screening.

BACKGROUND AND OBJECTIVE to report the 36-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative. PATIENTS AND METHODS retrospective analysis of the SUNDROP archival data between December 1, 2005, and November 30, 2008, to evaluate this diagnostic technology for retinopathy of prematurity (ROP) screening. A total of 230 consecutively enrolled infants meeting ROP examination criteria were screened with the Ret-Cam II (Clarity Medical Systems, Pleasanton, CA) and evaluated by the SUNDROP reading center at Stanford University. Outcomes included referral-warranted ROP, treatment-warranted ROP, and anatomic outcomes. RESULTS in the initial 36-month period, the SUNDROP telemedicine initiative did not miss any treatment-warranted ROP. A total of 230 infants (460 eyes) were imaged, resulting in 1,059 examinations and 10,921 unique images. Ten infants were identified with referral-warranted ROP: nine underwent laser photocoagulation and one regressed spontaneously. The sensitivity was 100% with a specificity of 99.5%. No patient progressed to retinal detachment or other adverse outcomes. CONCLUSION the SUNDROP telemedicine screening initiative for ROP has demonstrated high reliability for identification of treatment-warranted disease. All cases of treatment-warranted disease were captured. There were no adverse outcomes.

Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 24-month experience with telemedicine screening

Purpose:  To report the 24‐month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.

Radiation treatment for age-related macular degeneration.

Age-related macular degeneration (AMD) remains a devastating cause of visual loss among elderly individuals. While considerable progress has been made towards combating the disease, most recently with intravitreal anti-VEGF agents, visual outcomes are still limited by continued retinal pigment epithelium (RPE) degeneration and subsequent neurosensory retinal atrophy. Among the promising new treatment options being explored, radiotherapy appears apt to address the multifactorial etiology of AMD. Current investigative studies underway will hopefully yield clinical efficacy to complement this theoretical suitability for arresting visual loss.

Aflibercept For The Treatment Of Retinal Pigment Epithelial Detachments

Purpose: To compare anatomical and visual acuity outcomes of eyes with persistent pigment epithelial detachments (PEDs) secondary to exudative age-related macular degeneration despite ranibizumab or bevacizumab treatment. Methods: After institutional review board approval, 40 eyes with PEDs switched from ranibizumab or bevacizumab to intravitreal aflibercept were compared for logMAR visual acuity, central subfield thickness on spectral domain optical coherence tomography, and PED height. Using paired t-tests, these parameters at baseline, after 3 consecutive injections, and 1 year after the switch were compared. Results: Baseline visions of 20/61 ± 3.99 lines declined after 3 injections with aflibercept by 0.39 ± 2.43 lines (P = 0.32) and continued to fall after 1 year by 1.27 ± 3.48 lines (P = 0.03). Central subfield thickness was reduced after 3 injections (9.1 ± 52.0 &mgr;m, P = 0.27) and after 1 year (24.4 ± 55.3 &mgr;m, P = 0.01). The height of PEDs decreased by 31.7 ± 71.53 &mgr;m (P = 0.008) after 3 injections and by 47.81 ± 77.94 &mgr;m (P < 0.001) after 1 year. Conclusion: Switching to aflibercept from ranibizumab or bevacizumab resulted in a reduction in the height of PED and central subfield thickness, but a trend toward worse visual acuity 1 year after the switch.

Retinal breaks due to intravitreal ocriplasmin

Ocriplasmin represents a new treatment option for numerous vitreoretinopathies involving an abnormal vitreomacular interface. While the drug may circumvent the traditional risks of surgical treatment, pharmacologic vitreolysis is not devoid of risk itself. This report presents two cases, one of vitreomacular traction syndrome and the other of a full-thickness macular hole, both of which were treated with an intravitreal injection of ocriplasmin. Notably, in both cases, vitreomacular traction of the macula appears to have been alleviated; however, failure to completely relieve vitreoretinal traction from the peripheral retina generated retinal breaks with one patient eventually developing a macula-involving retinal detachment. Thus, even in instances of ‘successful’ pharmacologic treatment of vitreomacular traction, continued follow-up evaluation is essential.

Rifampin and linezolid in the treatment of methicillin-resistant Staphylococcus aureus preseptal cellulitis.

Methicillin-resistant Staphylococcus aureus (MRSA) preseptal cellulitis is an aggressive ophthalmic infection of increasing frequency. Previously reported cases were successfully treated with first line drugs such as vancomycin or Bactrim (trimethoprim and sulfamethoxazole); however, such drugs have limited efficacy in treating cutaneous MRSA. The authors report the first 2 known cases of MRSA-mediated preseptal cellulitis that resolved with systemic linezolid and rifampin following failed intravenous vancomycin treatment after incision and drainage of the abscess. The authors conclude that in cases of cutaneous MRSA infections that respond poorly to vancomycin, linezolid and rifampin combination therapy may provide an alternative therapeutic option.

Exudative retinal detachment following photocoagulation in older premature infants for retinopathy of prematurity: description and management.

Purpose: To describe exudative retinal detachment following laser photocoagulation after 40 weeks of postmenstrual age (PMA) for retinopathy of prematurity in premature infants, its medical management, and outcomes. Methods: Two pediatric vitreoretinal surgeons at 2 different quaternary care institutions retrospectively identified children who received laser photocoagulation after 40 weeks of PMA and subsequently developed exudative detachment. Hospital course, management, and outcomes were identified. Results: Three infants were identified that developed exudative retinal detachments following laser photocoagulation for retinopathy of prematurity after 40 weeks of PMA. The average gestational age was 25 weeks with an average birth weight of 650 g. All babies were Zone II at initial examination and developed Stage 3 with pre-plus or plus disease after 40 weeks of PMA (average 42 weeks of PMA). Therapy consisted of topical cyclogyl (0.5%) and topical prednisolone acetate (1%) to the affected eyes and intravenous dexamethasone in all cases. The exudative retinal detachments resolved by 50 weeks of PMA in all infants. Hard exudates following resolution were found in all eyes. Two eyes demonstrated temporal macular dragging. Conclusion: Premature infants who require laser photocoagulation for retinopathy of prematurity at >40 weeks of PMA may be predisposed to develop exudative retinal detachments. In the absence of identifiable traction, systemic corticosteroid use can be considered to achieve favorable anatomic outcomes.

Severe worsening of diabetic retinopathy following bariatric surgery.

Intensive glycemic control results in long-term reduction of diabetic retinopathy, although initial short-term worsening of retinopathy is not uncommon. The authors report a patient with a history of stable diabetic retinopathy who, despite achieving abrupt glycemic control following laparoscopic Roux-en-Y gastric bypass surgery, suffered rapid worsening of her retinopathy within 1 month of surgery. Hemoglobin A1c levels were 8.8 preoperatively and declined to 7.2 at 3.5 months postoperatively. Although visual function in the left eye was spared, useful visual acuity was lost in the right eye. Retinal evaluation is recommended in all patients with diabetes mellitus who are considering bariatric surgery, with close follow-up as warranted.