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The US Food and Drug Administration’s Efforts to Support Ophthalmology Clinical Trials

from ArchOpht - 01 Dec 14

The role of the US Food and Drug Administration (FDA) is to protect public health—keeping unsafe medical devices off the market, exposing potentially dangerous devices that carry fraudulent claims to cure or treat disease, and investigating potential and emerging health and safety issues related to medical devices in the United States. However, while protecting public health is critical to our mission, promoting public health is just as important. Part of promoting public health is facilitating



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Phenotypic Overlap Between Familial Exudative Vitreoretinopathy and Microcephaly, Lymphedema, and Chorioretinal Dysplasia Caused by KIF11 Mutations

from ArchOpht - 01 Dec 14

ImportanceRetinal detachment with avascularity of the peripheral retina, typically associated with familial exudative vitreoretinopathy (FEVR), can result from mutations in KIF11, a gene recently identified to cause microcephaly, lymphedema, and chorioretinal dysplasia (MLCRD) as well as chorioretinal dysplasia, microcephaly, and mental retardation (CDMMR). Ophthalmologists should be aware of the range of presentations for mutations in KIF11 because the phenotypic distinction between FEVR and ML



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Longitudinal Relationships Among Visual Acuity, Daily Functional Status, and Mortality The Salisbury Eye Evaluation Study

from ArchOpht - 01 Dec 14

ImportanceDetermination of the mechanisms by which visual loss increases mortality risk is important for developing interventional strategies.ObjectiveTo evaluate the direct and indirect effects of loss of visual acuity (VA) on mortality risk through functional status changes among aging adults.Design, Setting, and ParticipantsProspective longitudinal study of a population-based sample of 2520 noninstitutionalized adults aged 65 to 84 years from September 16, 1993, through July 26, 2003, in the



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Novel Screening Method for Glaucomatous Eyes With Myopic Tilted Discs The Crescent Moon Sign

from ArchOpht - 01 Dec 14

ImportanceTo our knowledge, there is no reliable screening method for glaucomatous eyes with myopic tilted discs.ObjectiveTo evaluate the diagnostic ability of a novel screening modality, the crescent moon (CM) sign, defined as the discontinuity between the superior or inferior optic rim margin and the temporal optic rim margin, for the detection of glaucomatous eyes with myopic tilted discs.Design, Setting, and ParticipantsThe study was cross-sectional and conducted in a hospital setting from N



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Association Between Serum Ferritin and Glaucoma in the South Korean Population

from ArchOpht - 01 Dec 14

ImportanceEvidence suggests that altered iron metabolism may be associated with oxidative damage to several organ systems, including the eye. Supplementary iron consumption is also associated with greater odds of self-reported glaucoma. ObjectiveTo investigate the association between serum ferritin level and the likelihood of a glaucoma diagnosis in a cross-sectional, population-based study.Design, Setting, and ParticipantsData were collected from 17?476 participants in the first and second year



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Uveitis in Patients With Late-Stage Cutaneous Melanoma Treated With Vemurafenib

from ArchOpht - 01 Dec 14

ImportanceThis case series highlights the risk of uveitis in patients treated with vemurafenib for unresectable or metastatic cutaneous melanoma.ObjectiveTo assess the occurrence and severity of uveitis as an adverse effect of vemurafenib therapy.Design, Setting, and PatientsIn this observational small case series, data were collected successively from May 1, 2012, through February 31, 2013, from patients with clinical signs of ocular inflammation treated with vemurafenib at the Department of Op



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Increased Corneal Hysteresis After Corneal Collagen Crosslinking A Study Based on Applanation Resonance Technology

from ArchOpht - 01 Dec 14

ImportanceA reliable tool for quantification of the biomechanical status of the cornea in conjunction with corneal collagen crosslinking (CXL) treatment is needed.ObjectiveTo quantify the biomechanical effects of CXL in vivo.Design, Setting, and ParticipantsA prospective, open, case-control study was conducted at the Department of Ophthalmology, Umeå University, Umeå, Sweden. Participants included 28 patients (29 eyes) aged 18 to 28 years with progressive keratoconus and corresponding age- and s



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A 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome A Randomized Clinical Trial

from ArchOpht - 01 Dec 14

ImportanceProspective long-term analyses of the role of drug-induced mydriasis and laser peripheral iridotomy (LPI) are needed to identify and manage the eyes of patients with pigment dispersion syndrome (PDS) at risk for progressing to ocular hypertension.ObjectiveTo assess the 10-year incidence of increased intraocular pressure (IOP) in the 2 eyes of patients with PDS, with 1 eye that underwent LPI and the other that did not.Design, Setting, and ParticipantsIn a randomized clinical trial in th



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Solar Exposure and Residential Geographic History in Relation to Exfoliation Syndrome in the United States and Israel

from ArchOpht - 01 Dec 14

ImportanceResidential (geographic) history and extent of solar exposure may be important risk factors for exfoliation syndrome (XFS) but, to our knowledge, detailed lifetime solar exposure has not been previously evaluated in XFS.ObjectiveTo assess the relation between residential history, solar exposure, and XFS.Design, Setting, and ParticipantsThis clinic-based case-control study was conducted in the United States and Israel. It involved XFS cases and control individuals (all =60-year-old whit



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Persistence of Topical Glaucoma Medication A Nationwide Population-Based Cohort Study in Taiwan

from ArchOpht - 01 Dec 14

ImportanceMedication persistence is an important factor for treatment effect in patients with glaucoma. Evaluating risk factors for refill discontinuation might be helpful for improving persistence and preventing blindness in patients with glaucoma.ObjectivesTo estimate the persistence rate with topical glaucoma medication 2 years after diagnosis and evaluate risk factors for nonpersistence among patients in Taiwan with open-angle glaucoma and ocular hypertension.Design, Setting, and Participant



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The Risk of Toxic Retinopathy in Patients on Long-term Hydroxychloroquine Therapy

from ArchOpht - 01 Dec 14

ImportanceHydroxychloroquine sulfate is widely used for the long-term treatment of autoimmune conditions but can cause irreversible toxic retinopathy. Prior estimations of risk were low but were based largely on short-term users or severe retinal toxicity (bull’s eye maculopathy). The risk may be much higher because retinopathy can be detected earlier when using more sensitive screening techniques.ObjectivesTo reassess the prevalence of and risk factors for hydroxychloroquine retinal toxicity an



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Toric vs Aspherical Control Intraocular Lenses in Patients With Cataract and Corneal Astigmatism A Randomized Clinical Trial

from ArchOpht - 01 Dec 14

ImportanceSpectacle independence is becoming increasingly important in cataract surgery. Not correcting corneal astigmatism at the time of cataract surgery will fail to achieve spectacle independency in 20% to 30% of patients.ObjectiveTo compare bilateral aspherical toric with bilateral aspherical control intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism.Design, Setting, and ParticipantsA multicenter, hospital-based, randomized clinical trial was conducted. Th



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Hemi–Descemet Membrane Endothelial Keratoplasty Transplantation A Potential Method for Increasing the Pool of Endothelial Graft Tissue

from ArchOpht - 01 Dec 14

ImportanceThis study evaluates the technical feasibility and clinical outcomes of a Descemet membrane endothelial keratoplasty (DMEK) technique that could increase the availability of donor tissue for DMEK.ObjectiveTo evaluate the clinical outcome of using a semicircular, large-diameter Descemet membrane graft in DMEK (hemi-DMEK), potentially allowing the use of a single donor cornea for 2 DMEK procedures.Design, Setting, and ParticipantsA prospective, interventional case series was conducted at



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Angle-Closure Glaucoma on Long-Haul Flights

from ArchOpht - 01 Dec 14

ImportanceUnlike other modes of long-distance travel, long-haul flights delay urgent, specialist medical treatment until the destination is reached or the plane is diverted. Angle-closure glaucoma (ACG) occurring during those flights results in considerable morbidity and may cause permanent visual loss. It is preventable in patients with risk factors but may be an underrecognized and underreported phenomenon on long-haul flights.ObservationWe report a case series of 3 patients with ACG that deve



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We Need to Be Better Prepared for Hydroxychloroquine Retinopathy

from ArchOpht - 01 Dec 14

From the first discovery of chloroquine by Hans Andersag at Bayer in 1939 and later development of its hydroxyl and less toxic form hydroxychloroquine (HCQ), these medications have been one of the most abundantly used around the world and have been instrumental in saving countless lives from malaria. Hydroxychloroquine is currently listed in the World Health Organization Model List of Essential Medicines as a disease-modifying agent for rheumatoid arthritis. Its use is becoming ubiquitous for a



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Using Multidose Eyedrops in a Health Care Setting A Policy and Procedural Approach to Safe and Effective Treatment of Patients

from ArchOpht - 01 Dec 14

ImportanceQuality and safety of eyedrop use for patients treated in a health care setting play a vital role in the delivery of health care.ObjectiveTo describe the development of a policy and procedural approach to the use of multidose eyedrops in multiple patients, approved and accepted by The Joint Commission in compliance with preferred practice standards in ophthalmology, the safe handling and administration of multidose eyedrops, and cost benefits of a multidose eyedrop approach.Design, Set





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Cerebrospinal Fluid in the Upper Eyelid An “Abscess” of a Different Kind

from ArchOpht - 01 Dec 14

Distinguishing between a cerebrospinal fluid (CSF) collection of the upper eyelid and an abscess can be challenging, as the following case demonstrates. Each may be preceded by surgical intervention and both could present with pyrexia. Good clinical skills will assist in differentiation, but laboratory tests are required to provide the final diagnoses.



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Eye-Preserving Treatment for Invasive Conjunctival Melanoma

from ArchOpht - 01 Dec 14

Although orbital exenteration has been recommended for extensive malignant conjunctival neoplasms, including those invading the palpebral margin, fornices, or caruncle, it has not been demonstrated to improve survival of patients with melanomas greater than 2.0 mm thick. We describe a patient with extensive conjunctival melanoma (CM) managed by eye-preserving therapies.



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Choroidal Neovascularization and Chorioretinal Anastomoses Following Laser Treatment of a Secondary Vasoproliferative Tumor

from ArchOpht - 01 Dec 14

Laser photocoagulation–induced choroidal neovascularization (CNV) is an uncommon iatrogenic complication following thermal laser treatment for diabetic macular edema and proliferative diabetic retinopathy. Disruption of the retinal pigment epithelium–Bruch membrane complex due to intense laser energy presumably leads to the development of CNV. We report a dramatic case of laser-induced CNV initially associated with a chorioretinal mass lesion that displayed characteristics of an atypical seconda



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Orbicularis Oculi Weakness and Obstructive Meibomian Gland Disease

from ArchOpht - 01 Dec 14

To the Editor We read with special interest the article titled “Botulinum Toxin Type A Injection for Lateral Canthal Rhytids: Effect on Tear Film Stability and Tear Production” by Ho et al and offer additional support for the mechanism by which botulinum toxin injection may alter the functioning of the meibomian glands that was not referenced by the authors. Ho and colleagues hypothesize that injection of botulinum toxin type A at the lateral canthus may diffuse to the pretarsal orbicularis and



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Trypan Blue Vital Dye Staining vs TUNEL Technique to Detect Corneal Endothelium Toxic Effects

from ArchOpht - 01 Dec 14

To the Editor We read the article titled “Efficacy and Safety of Antifungal Additives in Optisol-GS Corneal Storage Medium” by Layer et al with interest. In their article, the authors investigated the efficacy and safety of voriconazole and amphotericin B in reducing Candida species contamination of Optisol-GS under normal storage conditions. Layer and colleagues used 0.4% trypan blue as a vital stain to evaluate corneal endothelium toxic effects.



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Trypan Blue Vital Dye Staining vs TUNEL Technique to Detect Corneal Endothelium Toxic Effects—Reply

from ArchOpht - 01 Dec 14

In Reply There is no gold standard or widely accepted staining protocol for assessing endothelial cell death in human corneas after storage. We followed the vital dye staining protocol proposed by Park et al, who validated the ability of trypan blue to detect endothelial damage by comparing corneas exposed to hydrogen peroxide with those exposed to balanced salt solution and found that the optimal dye concentration was 0.4%. The only other study, to our knowledge, of an antifungal additive in Op


 

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