Yuval Yassur

Replacing the Amsler grid: a new method for monitoring patients with age-related macular degeneration.

PURPOSEnTo investigate a method that uses hyperacuity, the Macular Computerized Psychophysical Test (MCPT), to evaluate the central macular visual field in patients with age-related macular degeneration (AMD).nnnDESIGNnProspective case-control study of a diagnostic test.nnnPARTICIPANTS AND CONTROLSnOne hundred eight eyes of 108 Patients with AMD and 51 eyes of 51 age-matched patients with no retinal disease. Patients with AMD included 32 (30%) patients with choroidal neovascularization (CNV), 23 (21%) with geographic atrophy (GA), 35 (32%) with AMD with high-risk characteristics (HRC), and 18 (17%) with early AMD with non-HRC.nnnTESTINGnEach subject underwent the MCPT, in which a virtual line composed of dots (white dots on a black background, maximal contrast) is flashed across different macular loci to a perifoveal radius of 7 degrees. Patients responses were recorded and automatically analyzed using a specific algorithm developed before the onset of the study. All patients also underwent a supervised Amsler grid examination on the encounter before or after the MCPT in random order.nnnMAIN OUTCOME MEASURESnDistortion, scotoma, or blurring perceived by the patient after a swift change of fixation was considered positive on the MCPT. Any perception of distortion, scotoma, or blurring was considered positive on the Amsler grid.nnnRESULTSnOf the 32 patients with CNV, 30 (94%) were found positive on the MCPT and 11 (34%) were found positive on the Amsler grid. Of the 23 GA patients, 21 (91%) were found positive on the MCPT and 7 (30%) were found positive on the Amsler grid. Of the 35 HRC patients, 28 (80%) were found positive on the MCPT and 3 (9%) were found positive on the Amsler grid, and of the 18 early AMD with non-HRC patients, 8 (44%) were found positive on the MCPT and 3 (17%) were found positive on the Amsler grid. Of the 51 controls, 3 (6%) were positive on the MCPT and 1 (2%) was positive on the Amsler grid.nnnCONCLUSIONSnThe MCPT was superior to the Amsler grid in detecting AMD-related lesions in this cohort. Studies are underway to determine whether the MCPT is feasible for home monitoring to provide early detection of progression to CNV.

Diabetic Retinopathy during Pregnancy

PURPOSEnThe purpose of the study is to evaluate the incidence, prevalence, progression, and risk factors of diabetic retinopathy during pregnancy.nnnMETHODSnSixty-five patients who were pregnant and had insulin-dependent diabetes mellitus were evaluated before pregnancy, in every trimester during the pregnancy, and 12 months postpartum. The medical data included age, diabetes duration, glycohemoglobin, fructosamine, hemoglobin, creatinine, uric acid, and systolic and diastolic blood pressure.nnnRESULTSnProgression of the retinopathy occurred in 77.5% of the patients who presented with diabetic retinopathy at conception; proliferative diabetic retinopathy occurred in 22.5%. Only 26% of the patients who started the pregnancy without diabetic retinopathy had some progression of the retinopathy. Duration of the diabetes was longer in the progressive group compared with the nonprogressive group (P = 0.007). The glycohemoglobin was higher in the progressive group than in the nonprogressive group at each time point, but only in the third trimester was the difference statistically significant (P = 0.04). The hemoglobin level was lower in the progressive group than in the nonprogressive group (P < 0.01). The systolic blood pressure was higher in the progressive group (P < 0.005).nnnCONCLUSIONnUnderstanding the risk factors contributing to the aggravation of diabetic retinopathy during pregnancy is helpful in designing criteria for the team management of pregnant patients with diabetes.

Indocyanine green angiographic findings in nonproliferative diabetic retinopathy

PURPOSEnTo report angiographic findings of nonproliferative diabetic retinopathy patients by means of indocyanine green angiography.nnnMETHODSnForty-two eyes (42 patients) with nonproliferative diabetic retinopathy were evaluated by indocyanine green angiography in addition to fluorescein angiography. Angiographic findings with the two imaging techniques were compared with the red-free fundus appearance.nnnRESULTSnAmong the 42 eyes, five (12%) had the appearance on indocyanine green angiography of lobular spotty hyperfluorescent and hypofluorescent areas (salt and pepper appearance) in the very late phase. Twenty eyes (48%) presented with diffuse late-phase hyperfluorescence on indocyanine green angiography, corresponding to areas of retinal capillary nonperfusion on fluorescein angiography, and retinal edema. A total of 3,564 microaneurysms were divided into three types: 58 (1.6%) appeared mainly on the fluorescein angiography and very faintly on the indocyanine green angiography, 3,029 (85%) appeared on the fluorescein angiography and the indocyanine green angiography, and 477 (13.4%) were uniquely hyperfluorescent on the indocyanine green angiography.nnnCONCLUSIONSnIndocyanine green angiography in patients with nonproliferative diabetic retinopathy disclosed microvascular findings that were in addition to those shown on fluorescein angiography. These angiographic changes were not observed on fluorescein angiography because of imaging limitations. Indocyanine green angiography may be a useful adjunct to fluorescein angiography in the evaluation of chorioretinal vascular changes in nonproliferative diabetic retinopathy.

Ultrasound biomicroscopic detection of anterior ocular segment foreign body after trauma

PURPOSEnTo describe the role of ultrasound biomicroscopy in the detection and localization of foreign bodies in anterior ocular segment foreign body after trauma.nnnMETHODSnIn a prospective study, ultrasound biomicroscopy was performed in five eyes of five consecutive patients with suspected anterior ocular segment foreign body.nnnRESULTSnIn all five eyes, ultrasound biomicroscopy detected and precisely localized small foreign bodies (metallic in two eyes, stone in one eye, plastic in one eye, and ceramic in one eye) in the cornea (one eye), superficial sclera (one eye), and anterior ocular segment (three eyes). Operative procedures to remove the intraocular foreign bodies (three cases) were guided by the ultrasound biomicroscopy information.nnnCONCLUSIONSnUltrasound biomicroscopy is a noninvasive method for detecting anterior segment intraocular foreign bodies after perforating trauma. It can be used to accurately diagnose foreign bodies and assist in surgical management, particularly when direct visualization is obscured because of the trauma. In eyes with partial-thickness corneoscleral lacerations or sealed full-thickness corneoscleral laceration and suspected anterior ocular segment foreign body, ultrasound biomicroscopy is a safe and effective method for detecting and localizing foreign bodies in the anterior ocular segment.

Three-dimensional Measurements of Idiopathic Macular Holes Using a Scanning Laser Tomograph

PURPOSEnThe diagnosis of macular holes is difficult. Confocal laser tomographic analysis of the retina permits the precise measurements of the macular surface. The authors used this technique to study the macular area of patients with full-thickness macular holes. The purposes of these studies is to perform three-dimensional measurements of the macular holes and their rims and to search for a correlation between these parameters.nnnMETHODSnThirty-one eyes with idiopathic full-thickness macular holes underwent scanning of their affected macular area using the Heidelberg retinal tomograph (HRT). The authors evaluated the following parameters: area of the hole and its elevated rim, the maximal depth of the hole, and the maximal elevation of the rim at 12, 3, 6, and 9 oclock.nnnRESULTSnThe average hole area was 0.33 mm2, and the rim area average was 2.99 mm2. The average area of the rim was found to be 9.06 times larger than that of the hole (P < 0.001). The depth of the hole averaged 144 microns.nnnCONCLUSIONSnThe area of the rim is usually bigger than that of the hole and in direct correlation to it. Also, the bigger the hole area, the greater its depth. The average height in each of the four quadrants (12, 3, 6, and 9 oclock) correlates to the other quadrant heights (P < 0.001).

Argon green laser photoepilation in the treatment of trachomatous trichiasis

Summary We describe the treatment of focal trachomatous trichiasis with argon green laser. We treated 70 eyelashes in 17 patients with 80% success and found this treatment modality convenient both for the patient and the practitioner.

A Comparative Study of Two Dose Regimens of Latanoprost in Patients with Elevated Intraocular Pressure

OBJECTIVEnThe purpose of the study was to determine whether latanoprost (13,14-dihydro-17-phenyl-18,19,20-trinor PGF2a-isopropyl ester), a new prostaglandin analogue that has been found effective in reducing intraocular pressure (IOP) in humans, is equally effective at lower concentrations than those currently employed.nnnDESIGN AND PARTICIPANTSnFifty patients with glaucoma or ocular hypertension were treated in a randomized, crossover, double-masked fashion with 1 drop of latanoprost (50 microg/ml once daily and 15 microg/ml twice daily) in the affected eye(s) for 3 weeks on each concentration. Tonometry was obtained at 8:00, 13:00, and 17:00 hours at baseline (untreated) and after 3 weeks on each concentration. Placebo (a buffer solution of latanoprost eye drop) was administered for complete masking of the study.nnnRESULTSnMean baseline (untreated) diurnal IOP for the entire sample was 24.7 mmHg. Intraocular pressure was reduced by 6.1 mmHg with latanoprost 15 microg/ml twice daily, and by 7.5 mmHg with 50 microg/ml once daily. Results with both regimens were significant (P < 0.001 each, Students t-test). However, the 50 microg/ml dose was significantly more effective than the 15 microg/ml dose, with a difference of 1.4 mmHg (P < 0.001, ANOVA). Both dose regimens were well tolerated, with little, predominantly mild, ocular discomfort. The higher dose did not cause more hyperemia at 3 weeks than the lower one, i.e., the lower dose yielded a slightly higher score (1.8 mm) on the visual analogue scale (P < 0.29, ANOVA).nnnCONCLUSIONSnLatanoprost administered at a concentration of 50 microg/ml once daily effectively reduces IOP in patients with elevated IOP. Administration of a lower concentration (15 microg/ml) twice daily is less effective, but still significant.

Rhabdomyosarcoma: Invading the Orbit in an Adult

Sites in the head and neck region are among the most frequent locations of rhabdomyosarcoma (RMS) in patients younger than 15 years. However, comparable neoplasms in adults are very uncommon. We present a case report of a 27-year-old man who was diagnosed as having RMS. RMS rarely presents in the head and neck of adults, but should be considered in the differential diagnosis of a small cell neoplasm in patients during the third and fourth decades of life.

Reading-evoked Visual Dimming

PURPOSEnTo carry out a neuroradiologic investigation in a monocular 49-year-old patient who during the past five years described symptoms of dimming of central vision in his left eye, which was provoked only by reading.nnnMETHODSnComputed tomography and magnetic resonance imaging were performed.nnnRESULTSnAn orbital apex intraconal tumor situated laterally to and above the optic nerve was found.nnnCONCLUSIONSnReading-evoked visual dimming can be a variant of gaze-evoked amaurosis. The optic nerve displaced laterally and superiorly, and stretched by the act of reading, may be compressed between the tumor above and the contracted inferior rectus muscle inferiorly.

Extracapsular cataract extraction and intraocular lens implantation in eyes filled with silicone oil

Abstract Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed in five phakic eyes filled with silicone oil following vitreoretinal surgery. Silicone oil migration was prevented during surgery using an anterior chamber maintaining system and a self‐sealed comeoscleral tunnel incision. The posterior capsule opacified within 3 months in all patients, and neodymium:YAG capsulotomy or surgical discission was performed in a diamond‐shaped pattern. No silicone‐related complications were found, including silicone oil migration into the anterior chamber. There were no difficulties visualizing the peripheral retina during funduscopy.