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Endophthalmitis Prophylaxis for Cataract Surgery Are Intracameral Antibiotics Necessary?

from ArchOpht - 01 Nov 14

Endophthalmitis prophylaxis for elective cataract surgery is a subject of considerable debate. The use of perioperative povidone-iodine and an eyelid speculum and drape with isolation of eyelids and eyelashes as well as meticulous sterile preparation and procedures are effective in limiting the incidence of endophthalmitis after cataract surgery. The rapid evolution of cataract surgical techniques, including clear-corneal incision, small-incision surgery, and femtosecond lasers, makes it difficu



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Proteomic Landscape of the Human Choroid–Retinal Pigment Epithelial Complex

from ArchOpht - 01 Nov 14

ImportanceDifferences in geographical protein expression in the human choroid–retinal pigment epithelial (RPE) complex may explain molecular predisposition of regions to ophthalmic diseases such as age-related macular degeneration.ObjectiveTo characterize the proteome of the human choroid-RPE complex and to identify differentially expressed proteins in specific anatomic regions.Design, Setting, and ParticipantsExperimental study of choroid-RPE tissue from 3 nondiseased eyes. The choroid-RPE comp



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A Cost-Minimization Analysis Comparing Immediate Sequential Cataract Surgery and Delayed Sequential Cataract Surgery From the Payer, Patient, and Societal Perspectives in the United States

from ArchOpht - 01 Nov 14

ImportanceThe cost difference is evaluated between delayed sequential cataract surgery (DSCS) and immediate sequential cataract surgery (ISCS) in the United States for patients covered by Medicare.ObjectiveTo perform a cost-minimization analysis comparing ISCS with DSCS in the United States from the payer, patient, and societal perspectives for the West Tennessee region and nationally.Design, Setting, and ParticipantsA cost-minimization analysis using cataract surgery volume and eligibility esti



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Restoration of Corneal Sensation With Regional Nerve Transfers and Nerve Grafts A New Approach to a Difficult Problem

from ArchOpht - 01 Nov 14

ImportanceCorneal anesthesia is recalcitrant to conventional treatment and can lead to permanent visual loss.ObjectiveTo assess the outcomes of a novel sensory reconstructive technique for the treatment of corneal anesthesia.Design, Setting, and ParticipantsThis prospective study evaluating a new technique was conducted at a tertiary referral center. Four eyes in 3 patients with corneal anesthesia underwent nerve transfers with nerve grafting to restore corneal sensation. Corneal sensory reconst



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Effect of Cataract Extraction on the Visual Field Decay Rate in Patients With Glaucoma

from ArchOpht - 01 Nov 14

ImportanceA visual field parameter that is resistant to cataract formation and extraction would help monitor glaucomatous visual field progression in patients with coexisting glaucoma and cataract.ObjectiveTo evaluate the effect of cataract surgery on the slow and fast components of visual field decay in a group of patients with glaucoma.Design, Setting, and ParticipantsRetrospective, interventional, longitudinal study. Eighty-five eyes of 68 patients with open-angle glaucoma who had cataract ex



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Retinal Metastasis From Systemic Cancer in 8 Cases

from ArchOpht - 01 Nov 14

ImportanceMetastatic tumors of the retina are rare, simulate retinitis, and are associated with poor patient survival.ObjectiveTo describe the clinical features and outcomes of patients with retinal metastasis from systemic cancer.Design, Setting, and ParticipantsRetrospective case series of 8 patients with retinal metastasis from cutaneous melanoma (n?=?4), breast cancer (n?=?2), esophageal cancer (n?=?1), and lung cancer (n?=?1). At presentation, the mean patient age was 62 years and all were



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Disorganization of the Retinal Inner Layers as a Predictor of Visual Acuity in Eyes With Center-Involved Diabetic Macular Edema

from ArchOpht - 01 Nov 14

ImportanceBiomarkers that predict future visual acuity (VA) in eyes with baseline diabetic macular edema (DME) would substantively improve risk assessment, management decisions, and selection of eyes for clinical studies targeting DME.ObjectiveTo determine whether baseline or early change in the novel spectral domain–optical coherence tomography (SD-OCT) parameter disorganization of the retinal inner layers (DRIL) is predictive of VA in eyes with center-involved DME.Design, Setting, and Particip



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Cardiovascular Events and Bleeding Risk Associated With Intravitreal Antivascular Endothelial Growth Factor Monoclonal Antibodies Systematic Review and Meta-analysis

from ArchOpht - 01 Nov 14

ImportanceFew data exist regarding the systemic safety of intravitreal antivascular endothelial growth factor (anti-VEGF) monoclonal antibody (mAb).ObjectiveTo conduct a systematic review and meta-analysis to evaluate the risk of major cardiovascular and nonocular hemorrhagic events in patients with neovascular age-related macular degeneration (AMD), diabetes mellitus–associated macular edema (DME), or retinal vein occlusions (RVOs) who receive intravitreal anti-VEGF mAbs.Data SourcesThe MEDLINE



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Refractive Outcomes Following Bevacizumab Monotherapy Compared With Conventional Laser Treatment A Randomized Clinical Trial

from ArchOpht - 01 Nov 14

ImportanceChildren born prematurely who develop retinopathy of prematurity (ROP) often develop myopia, and those who require laser treatment may develop very high myopia, which has considerable clinical consequences.ObjectiveTo report refractive outcomes in preterm infants who developed ROP in zone I or zone II posterior as stage 3+ ROP or aggressive posterior ROP (APROP).Design, Setting, and ParticipantsAll infants received intravitreal bevacizumab or laser therapy in a prospective, stratified,



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Prevalence of and Risk Factors for Diabetic Macular Edema in the United States

from ArchOpht - 01 Nov 14

ImportanceDiabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically. ObjectivesTo estimate the prevalence of DME in the US population and to identify associated risk factors.Design, Setting, and ParticipantsA cross-sectional analysis of 1038 participan



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Clinical and Molecular Characterization of Enhanced S-Cone Syndrome in Children

from ArchOpht - 01 Nov 14

ImportanceEnhanced S-cone syndrome (ESCS) forms part of the differential diagnosis of night blindness in childhood.ObjectiveTo report in detail the clinical phenotype and molecular genetic findings in a series of children with ESCS.Design, Setting and ParticipantsNine children with ESCS from 5 families underwent full ophthalmic examination, electrophysiological testing, and retinal imaging at a genetic eye disease clinic of a tertiary referral eye hospital. Bidirectional Sanger sequencing of all



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Human Ciliary Epithelium as a Source of Synthesis and Secretion of Vascular Endothelial Growth Factor in Neovascular Glaucoma

from ArchOpht - 01 Nov 14

ImportanceRetinal ischemia–induced upregulation of vascular endothelial growth factor (VEGF) leads to endothelial proliferation of the anterior segment, resulting in neovascular glaucoma.ObjectiveTo investigate the ciliary epithelium as a possible source of VEGF in human eyes enucleated for intractable neovascular glaucoma.Design, Setting, and ParticipantsIn this proof-of-concept, laboratory-based study, 16 human enucleated eyes (8 with neovascular glaucoma and 8 as controls) were investigated.M



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In Vivo Effects of Femtosecond Laser–Assisted Keratoplasty

from ArchOpht - 01 Nov 14

ImportanceThe femtosecond laser is reported to cut lamellar surfaces with varying degrees of smoothness depending on the depth of the cut, with deeper cuts leaving less smooth surfaces. We attempted to evaluate the smoothness of the deeper lamellar surface as cut by the femtosecond laser after allowing 3 months of in vivo healing.ObservationsTwo patients underwent penetrating keratoplasty 3 months after inadequate visual rehabilitation following femtosecond laser–assisted sutureless anterior lam



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A Cost and Policy Analysis Comparing Immediate Sequential Cataract Surgery and Delayed Sequential Cataract Surgery From the Physician Perspective in the United States

from ArchOpht - 01 Nov 14

ImportanceA cost analysis was performed to evaluate the effect on physicians in the United States of a transition from delayed sequential cataract surgery to immediate sequential cataract surgery. Financial and efficiency impacts of this change were evaluated to determine whether efficiency gains could offset potential reduced revenue.ObservationsA cost analysis using Medicare cataract surgery volume estimates, Medicare 2012 physician cataract surgery reimbursement schedules, and estimates of po



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Small-Bubble Deep Anterior Lamellar Keratoplasty Technique

from ArchOpht - 01 Nov 14

Stromal disease (ectasia, opacities, scars, or melting) that occurs after penetrating keratoplasty (PK) can variously affect visual outcome. To date, even in the presence of healthy endothelium, this type of complication has been treated with subsequent PK. Instead, the selective replacement of the diseased stroma by means of deep anterior lamellar keratoplasty (DALK) using pneumatic dissection (big bubble) has not been attempted, mainly because of the extreme likelihood of breaking the descemet





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Stability of Melphalan Solution for Intravitreal Injection for Retinoblastoma

from ArchOpht - 01 Nov 14

Intravitreal injections for the treatment of retinoblastoma have been gaining relevance among ophthalmologists, supported by reports on outcome and improvement of the administration technique. Currently, doses up to 30 µg per injection are used according to an extensively described technique for intravitreal injection that minimizes the risk of extraocular dissemination of tumor cells.



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Atypical Lymphocytic Angiitis of the Optic Nerve and Central Nervous System

from ArchOpht - 01 Nov 14

Primary angiitis of the central nervous system (PACNS), also known as primary vasculitis of the central nervous system, is a rare, poorly understood, and often fatal disorder. Although the association of PACNS with optic neuropathy has been documented, this is the first report to our knowledge of visual loss with histopathologic involvement of the optic nerves.



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Optic Disc Pit Maculopathy Recurring in the Absence of Vitreous Gel

from ArchOpht - 01 Nov 14

Optic disc pit (ODP) is a rare congenital cavitation in the optic nerve head frequently associated with serous detachments of the macula, ODP maculopathy (ODP-M), and subsequent visual decline. Optic disc pit maculopathy is preceded by development of a schisis cavity due to accumulation of intraretinal fluid from the ODP. The source of the fluid remains controversial and 4 mechanisms have been hypothesized: (1) fluid from the vitreous cavity; (2) cerebrospinal fluid originating from the subarach



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Traumatic Prepapillary Loop Torsion and Associated Branch Retinal Artery Occlusion

from ArchOpht - 01 Nov 14

Prepapillary vascular loops are a congenital anomaly characterized as having both an ascending and a descending branch, and they are thought to be arterial in origin in 95% of cases. As such, complications that may spontaneously arise include branch retinal artery occlusion (BRAO) and, less commonly, amaurosis fugax, vitreous hemorrhage, and hyphema. We describe and videographically demonstrate the first case, to our knowledge, of trauma-induced prepapillary vascular loop torsion with associated



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Thalidomide for Recalcitrant Nodular Scleritis in Sarcoidosis

from ArchOpht - 01 Nov 14

Scleritis is an uncommon manifestation of sarcoidosis. Initial treatment for most patients is systemic corticosteroids, although immunomodulatory therapy is necessary in some patients. Biological response modifiers such as tumor necrosis factor (TNF) antagonists may be useful in patients with scleritis refractory to immunomodulatory therapy. Patients who fail therapy with TNF antagonists or experience intolerable adverse effects have limited treatment options. Herein, we describe a patient with



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Conjunctival Intralymphatic Small Cell Lymphocytostasis Associated With a Salmon Patch

from ArchOpht - 01 Nov 14

Lymphoid tumors of the conjunctiva, also referred to clinically as salmon patches, have a favorable prognosis. They are composed of reactive lymphoid hyperplasias and low-grade lymphomas. To our knowledge, associated intralymphatic lymphocytostasis has received no attention in the ophthalmic literature, and we describe it herein.



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Candida glabrata Endophthalmitis Transmitted From Graft to Host After Descemet Stripping Automated Endothelial Keratoplasty

from ArchOpht - 01 Nov 14

Fungal endophthalmitis is a recognized but uncommon complication following corneal transplantation procedures. Herein, we describe a patient with Candida glabrata endophthalmitis subsequent to Descemet stripping automated endothelial keratoplasty (DSAEK) with graft-to-host transmission. To our knowledge, this is the first report in the literature of a patient who developed C glabrata endophthalmitis after DSAEK in which the residual graft tissue had a positive culture for the causative organism.


 

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