- Email: [email protected]
Improvement of best spectacle-corrected visual acuity after LASIK in highly myopic eyes with reduced preoperative best spectacle-corrected visual acuity
ABSTRACTS EDITED BY HANS E. GROSSNIKLAUS
●
Special Report: Utilization, appropriate care, and quality of life for cataract patients. Obstbaum SA.* J Cataract Refract Surg 2006;32:1748 –1752.
*S. A. Obstbaum, Department of Ophthalmology, Lenox Hill Hospital, New York, NY 10021.
T
●
HE VOLUME OF CATARACT SURGERY PER 1,000 MEDI-
care beneficiaries has remained relatively flat in the past few years, compared with the overall trend of rapid growth and intense growth of physicians’ services. When assessed across populations residing in different states and metropolitan areas, there is some variation in the rate of cataract surgery, but it is relatively low compared with geographic variations observed for other surgical procedures. Based on the American Academy of Ophthalmology preferred practice pattern recommendation of the indications for cataract surgery, only 2% of cataract surgeries performed in 10 academic medical centers were classified as inappropriate. The range of inappropriateness ranged from 1.7% reported by the Inspector General to the 2.5% reported by the General Accounting Office. Of all 30 acute and chronic conditions studied by the RAND Corporation, patients with cataracts received the highest level of recommended care (79% of the time). Cataract surgery has been demonstrated to have excellent outcomes, not only in terms of visual acuity and low complications, but in terms of reduced functional impairment and improved quality of life. Multiple studies confirmed that visual acuity of 20/40 or better is obtained in ⬎90% of all cases and ⬎95% of cases without ocular comorbidity. In well designed observational studies, cataract surgery has consistently been shown to have a significant impact on quality of life, with up to 90% of patients undergoing first-eye cataract surgery noting improvement in visual function, as well as in physical function, particularly in terms of mobility, independence in activities of daily living, and decreased risk of fall-related injuries. Studies of qualityadjusted life year (QALY) in the United States found that the costs per QALY gained were $2,023 for cataract surgery in the first eye (calculated in 2002) and $2,727 for surgery in the second eye (calculated in 2003). This compared very favorably for those reported for other medical procedures (e.g., $7,000 for coronary artery bypass, $58,000 for treatment of systemic arterial blood pressure, and $90,000 for ambulatory peritoneal dialysis). The authors conclude that cataract surgery is a cost-effective procedure that is associated with improved quality of life for its beneficiaries and that the benefits of expanded cataract treatment will well exceed the costs.—Michael D. Wagoner 730
©
2007 BY
ALL
Effect of sublingual application of cannabinoids on intraocular pressure: A pilot study. Tomida I, AzuaraBlanco A,* House H, Flint M, Pertwee RG, Robson PJ. J Glaucoma 2006;15:349 –353.
T
HIS
PROSPECTIVE,
RANDOMIZED,
PLACEBO-CON-
trolled, four-way crossover clinical trial was undertaken in order to assess the effect of oromucosal administration of a low dose ⌬-9-tetrahydrocannabinol (⌬-9-THC) and cannabidiol (CBD) on intraocular pressure (IOP). Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM of 5 mg ⌬-9-THC, 20 mg CBD, 40 mg CBD, or placebo. Two hours after administration of 5 mg ⌬-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs 27.3 mm Hg, P ⫽ .026). The IOP returned to baseline after the four-hour IOP measurement. CBD administration did not reduce the IOP at any time. The higher dose did, however, result in a transient significant increase in IOP four hours after administration from 23.2 to 25.9 mm Hg (P ⫽ .028). Vital signs and visual acuity were not affected significantly changed in any group. One patient experienced a transient and mild panic like reaction after ⌬-9-THC administration. The authors conclude that low dose ⌬-9-THC provides a temporary reduction in IOP and is well tolerated by most patients.— Michael D. Wagoner *A. Azuara-Blanco, Department of Ophthalmology, Aberdeen Royal Infirmary, Abderdeen, AB25 22N, United Kingdom; e-mail: [email protected]
●
Improvement of best spectacle-corrected visual acuity after LASIK in highly myopic eyes with reduced preoperative best spectacle-corrected visual acuity. He R,* Qu Min, Yu Shun. J Refract Surg 2006;22:S1053–S1055.
T
HE AUTHORS PERFORMED A RETROSPECTIVE STUDY TO
evaluate changes in best spectacle- corrected visual acuity (BSCVA) after LASIK in patients with high myopia and reduced preoperative BSCVA, presumably attributable to amblyopia. The mean preoperative spherical error in 97 consecutive eyes of 57 patients who underwent LASIK was -11.77⫾ 3.61 diopters (D) and the mean astigmatic error was -1.54 ⫾ 1.06 D. The mean preoperaRIGHTS RESERVED.
0002-9394/07/$32.00 doi:10.1016/j.ajo.2007.02.003
tive BSCVA was 0.54 ⫾ 0.07 (range, 0.30 to 0.60). Postoperatively, there was a statistically significant improvement in the mean BSCVA to 0.75 ⫾ 0.16 (range, 0.50 to 1.20) (t ⫽ 12.78; P ⬍ .01). The postoperative BSCVA and preoperative BSCVA were the same in 19 eyes (19.6%), in improved in 78 eyes (80.4%). The postoperative BSCVA was better than 1.0 in 14 eyes (14.4%). No eyes experienced a loss of BSCVA. The authors concluded that LASIK resulted in an improvement in postoperative BSCVA in highly myopic eyes with reduced preoperative BSCVA.—Michael D. Wagoner *R. He, Shansi Eye Hospital, 030002 Taiyauan, China; e-mail: [email protected]
●
Intrastromal ring segment insertion using a femtosecond laser to correct pellucid marginal degeneration. Ertan A,* Bahadir M. J Cataract Refract Surg 2006;32:1710 – 1716.
T
HIS RETROSPECTIVE, NONCOMPARATIVE CASE SERIES
assessed the outcomes of intrastromal ring segment (Intacs, Addition Technology) implantation using a femtosecond laser in patients with pellucid marginal corneal degeneration. After successful Intacs implantation in nine eyes of six patients, mean uncorrected visual acuity improved significantly from 0.18 ⫾ 0.24 preoperatively to 0.53 ⫾ 0.23 after six months postoperatively (P ⫽ .08). Mean best-spectacle corrected visual acuity also improved significantly during the same interval from 0.63 ⫾ 0.26 to 0.85 ⫾ 0.18 (P ⫽ .11). The mean difference preoperative and postoperative spherical refraction decreased significantly from ⫺3.86 ⫾ 2.91 diopters (D) to ⫺2.77 ⫾ 1.43 D (P ⫽ .91) and the mean cylindrical cylinder from ⫺2.41 ⫾ 2.27 D to ⫺0.94 ⫾ 1.07 D (P ⫽ .46). The mean central corneal curvature decreased significantly from 48.20 ⫾ 4.19 preoperatively to 46.90 ⫾ 5.00 (P ⫽.08) and the mean posterior elevation form 53.88 ⫾ 2.72 m to 32.55 ⫾ 11.23 m (P ⫽ .08). The authors conclude that Intacs insertion using a femtosecond laser is effective in the correction of pellucid marginal degeneration.—Michael D. Wagoner *A. Ertan, Kudner Eye Hospital, Ankara, Turkey; e-mail: ertanaylin@ hotmail.com
●
Histologic parameters helpful to recognize steroidtreated temporal arteritis: An analysis of thirty-five cases. Font RL,* Prabhakaran VC. Br J Ophthalmol 2007;91:204 –209.
tis in patients who have been treated with steroids prior to the biopsy, and to analyze the clinical features and correlate them with the histologic findings. A retrospective review of charts of 35 patients treated with steroids prior to obtaining temporal artery biopsy specimens, spanning an 11 year period from1995 to 2005. The study was conducted at the Ophthalmic Pathology Laboratory at the Cullen Eye Institute. The clinical features were evaluated and correlated with the histopathologic findings. Each case was evaluated with respect to age, gender, race, clinical findings, erythrocyte sedimentation rate, corticosteroid dosage (oral vs intravenous), and the duration of the treatment. The time interval between obtaining the biopsy specimen and the onset of steroid therapy was carefully recorded from each patient. In selected cases, histiocytic markers (CD68 and HAM-56) were performed to identify the presence of epithelioid histiocytes, which characterizes a granulomatous inflammation. Other immunohistochemical studies (CD3, CD20, CD4, CD8, CD45RO, CD45RA, and S-100 protein) were performed in selected cases to characterize the inflammatory cells. The authors believe that the three most reliable histopathologic parameters of corticosteroid-treated temporal arteritis are the following: 1) Complete or incomplete mantle of lymphocytes and epithelioid histiocytes located between the outer muscular layer and the adventitia, 2) large circumferential defects in the elastic lamina (best seen with the Movat pentachrome), and 3) absent or few small multinucleated giant cells. In some cases the main artery appears normal while the primary branches show evidence of a healing arteritis. The histologic findings vary according to the route of steroid administration (oral vs intravenous) and the duration of treatment prior to obtaining the biopsy specimen. Striking histologic differences can be recognized objectively between patients with active (untreated) giant cell arteritis (GCA) and patients who have been treated with corticosteroids. The earliest histopathologic changes were detected by the end of the first week following steroid therapy (usually after day 4 to the end of the first week). The histologic findings were more difficult to recognize after two to three months following steroid treatment. We believe ophthalmic and general pathologists should be able to recognize this entity on the basis of the histologic findings including the special stains and results of immunohistochemical markers (CD68 and HAM-56).—Hans E. Grossniklaus *R. L. Font, Ophthalmic Pathology Laboratory, Cullen Eye Institute, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; e-mail: [email protected]
●
T
HIS STUDY WAS PERFORMED IN ORDER TO ESTABLISH
the important histologic and immunohistochemical parameters that are helpful in recognizing temporal arteriVOL. 143, NO. 4
Apolipoprotein gene is associated with progression of age-related macular degeneration. Baird PN,* Richardson AJ, Robman LD, Dimitrov PN, Tikellis G, McCarty CA, Guymer RH. Hum Mutat 2006;27:337–342.
ABSTRACTS
731
●
Special Report: Utilization, appropriate care, and quality of life for cataract patients. Obstbaum SA.* J Cataract Refract Surg 2006;32:1748 –1752.
*S. A. Obstbaum, Department of Ophthalmology, Lenox Hill Hospital, New York, NY 10021.
T
●
HE VOLUME OF CATARACT SURGERY PER 1,000 MEDI-
care beneficiaries has remained relatively flat in the past few years, compared with the overall trend of rapid growth and intense growth of physicians’ services. When assessed across populations residing in different states and metropolitan areas, there is some variation in the rate of cataract surgery, but it is relatively low compared with geographic variations observed for other surgical procedures. Based on the American Academy of Ophthalmology preferred practice pattern recommendation of the indications for cataract surgery, only 2% of cataract surgeries performed in 10 academic medical centers were classified as inappropriate. The range of inappropriateness ranged from 1.7% reported by the Inspector General to the 2.5% reported by the General Accounting Office. Of all 30 acute and chronic conditions studied by the RAND Corporation, patients with cataracts received the highest level of recommended care (79% of the time). Cataract surgery has been demonstrated to have excellent outcomes, not only in terms of visual acuity and low complications, but in terms of reduced functional impairment and improved quality of life. Multiple studies confirmed that visual acuity of 20/40 or better is obtained in ⬎90% of all cases and ⬎95% of cases without ocular comorbidity. In well designed observational studies, cataract surgery has consistently been shown to have a significant impact on quality of life, with up to 90% of patients undergoing first-eye cataract surgery noting improvement in visual function, as well as in physical function, particularly in terms of mobility, independence in activities of daily living, and decreased risk of fall-related injuries. Studies of qualityadjusted life year (QALY) in the United States found that the costs per QALY gained were $2,023 for cataract surgery in the first eye (calculated in 2002) and $2,727 for surgery in the second eye (calculated in 2003). This compared very favorably for those reported for other medical procedures (e.g., $7,000 for coronary artery bypass, $58,000 for treatment of systemic arterial blood pressure, and $90,000 for ambulatory peritoneal dialysis). The authors conclude that cataract surgery is a cost-effective procedure that is associated with improved quality of life for its beneficiaries and that the benefits of expanded cataract treatment will well exceed the costs.—Michael D. Wagoner 730
©
2007 BY
ALL
Effect of sublingual application of cannabinoids on intraocular pressure: A pilot study. Tomida I, AzuaraBlanco A,* House H, Flint M, Pertwee RG, Robson PJ. J Glaucoma 2006;15:349 –353.
T
HIS
PROSPECTIVE,
RANDOMIZED,
PLACEBO-CON-
trolled, four-way crossover clinical trial was undertaken in order to assess the effect of oromucosal administration of a low dose ⌬-9-tetrahydrocannabinol (⌬-9-THC) and cannabidiol (CBD) on intraocular pressure (IOP). Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM of 5 mg ⌬-9-THC, 20 mg CBD, 40 mg CBD, or placebo. Two hours after administration of 5 mg ⌬-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs 27.3 mm Hg, P ⫽ .026). The IOP returned to baseline after the four-hour IOP measurement. CBD administration did not reduce the IOP at any time. The higher dose did, however, result in a transient significant increase in IOP four hours after administration from 23.2 to 25.9 mm Hg (P ⫽ .028). Vital signs and visual acuity were not affected significantly changed in any group. One patient experienced a transient and mild panic like reaction after ⌬-9-THC administration. The authors conclude that low dose ⌬-9-THC provides a temporary reduction in IOP and is well tolerated by most patients.— Michael D. Wagoner *A. Azuara-Blanco, Department of Ophthalmology, Aberdeen Royal Infirmary, Abderdeen, AB25 22N, United Kingdom; e-mail: [email protected]
●
Improvement of best spectacle-corrected visual acuity after LASIK in highly myopic eyes with reduced preoperative best spectacle-corrected visual acuity. He R,* Qu Min, Yu Shun. J Refract Surg 2006;22:S1053–S1055.
T
HE AUTHORS PERFORMED A RETROSPECTIVE STUDY TO
evaluate changes in best spectacle- corrected visual acuity (BSCVA) after LASIK in patients with high myopia and reduced preoperative BSCVA, presumably attributable to amblyopia. The mean preoperative spherical error in 97 consecutive eyes of 57 patients who underwent LASIK was -11.77⫾ 3.61 diopters (D) and the mean astigmatic error was -1.54 ⫾ 1.06 D. The mean preoperaRIGHTS RESERVED.
0002-9394/07/$32.00 doi:10.1016/j.ajo.2007.02.003
tive BSCVA was 0.54 ⫾ 0.07 (range, 0.30 to 0.60). Postoperatively, there was a statistically significant improvement in the mean BSCVA to 0.75 ⫾ 0.16 (range, 0.50 to 1.20) (t ⫽ 12.78; P ⬍ .01). The postoperative BSCVA and preoperative BSCVA were the same in 19 eyes (19.6%), in improved in 78 eyes (80.4%). The postoperative BSCVA was better than 1.0 in 14 eyes (14.4%). No eyes experienced a loss of BSCVA. The authors concluded that LASIK resulted in an improvement in postoperative BSCVA in highly myopic eyes with reduced preoperative BSCVA.—Michael D. Wagoner *R. He, Shansi Eye Hospital, 030002 Taiyauan, China; e-mail: [email protected]
●
Intrastromal ring segment insertion using a femtosecond laser to correct pellucid marginal degeneration. Ertan A,* Bahadir M. J Cataract Refract Surg 2006;32:1710 – 1716.
T
HIS RETROSPECTIVE, NONCOMPARATIVE CASE SERIES
assessed the outcomes of intrastromal ring segment (Intacs, Addition Technology) implantation using a femtosecond laser in patients with pellucid marginal corneal degeneration. After successful Intacs implantation in nine eyes of six patients, mean uncorrected visual acuity improved significantly from 0.18 ⫾ 0.24 preoperatively to 0.53 ⫾ 0.23 after six months postoperatively (P ⫽ .08). Mean best-spectacle corrected visual acuity also improved significantly during the same interval from 0.63 ⫾ 0.26 to 0.85 ⫾ 0.18 (P ⫽ .11). The mean difference preoperative and postoperative spherical refraction decreased significantly from ⫺3.86 ⫾ 2.91 diopters (D) to ⫺2.77 ⫾ 1.43 D (P ⫽ .91) and the mean cylindrical cylinder from ⫺2.41 ⫾ 2.27 D to ⫺0.94 ⫾ 1.07 D (P ⫽ .46). The mean central corneal curvature decreased significantly from 48.20 ⫾ 4.19 preoperatively to 46.90 ⫾ 5.00 (P ⫽.08) and the mean posterior elevation form 53.88 ⫾ 2.72 m to 32.55 ⫾ 11.23 m (P ⫽ .08). The authors conclude that Intacs insertion using a femtosecond laser is effective in the correction of pellucid marginal degeneration.—Michael D. Wagoner *A. Ertan, Kudner Eye Hospital, Ankara, Turkey; e-mail: ertanaylin@ hotmail.com
●
Histologic parameters helpful to recognize steroidtreated temporal arteritis: An analysis of thirty-five cases. Font RL,* Prabhakaran VC. Br J Ophthalmol 2007;91:204 –209.
tis in patients who have been treated with steroids prior to the biopsy, and to analyze the clinical features and correlate them with the histologic findings. A retrospective review of charts of 35 patients treated with steroids prior to obtaining temporal artery biopsy specimens, spanning an 11 year period from1995 to 2005. The study was conducted at the Ophthalmic Pathology Laboratory at the Cullen Eye Institute. The clinical features were evaluated and correlated with the histopathologic findings. Each case was evaluated with respect to age, gender, race, clinical findings, erythrocyte sedimentation rate, corticosteroid dosage (oral vs intravenous), and the duration of the treatment. The time interval between obtaining the biopsy specimen and the onset of steroid therapy was carefully recorded from each patient. In selected cases, histiocytic markers (CD68 and HAM-56) were performed to identify the presence of epithelioid histiocytes, which characterizes a granulomatous inflammation. Other immunohistochemical studies (CD3, CD20, CD4, CD8, CD45RO, CD45RA, and S-100 protein) were performed in selected cases to characterize the inflammatory cells. The authors believe that the three most reliable histopathologic parameters of corticosteroid-treated temporal arteritis are the following: 1) Complete or incomplete mantle of lymphocytes and epithelioid histiocytes located between the outer muscular layer and the adventitia, 2) large circumferential defects in the elastic lamina (best seen with the Movat pentachrome), and 3) absent or few small multinucleated giant cells. In some cases the main artery appears normal while the primary branches show evidence of a healing arteritis. The histologic findings vary according to the route of steroid administration (oral vs intravenous) and the duration of treatment prior to obtaining the biopsy specimen. Striking histologic differences can be recognized objectively between patients with active (untreated) giant cell arteritis (GCA) and patients who have been treated with corticosteroids. The earliest histopathologic changes were detected by the end of the first week following steroid therapy (usually after day 4 to the end of the first week). The histologic findings were more difficult to recognize after two to three months following steroid treatment. We believe ophthalmic and general pathologists should be able to recognize this entity on the basis of the histologic findings including the special stains and results of immunohistochemical markers (CD68 and HAM-56).—Hans E. Grossniklaus *R. L. Font, Ophthalmic Pathology Laboratory, Cullen Eye Institute, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; e-mail: [email protected]
●
T
HIS STUDY WAS PERFORMED IN ORDER TO ESTABLISH
the important histologic and immunohistochemical parameters that are helpful in recognizing temporal arteriVOL. 143, NO. 4
Apolipoprotein gene is associated with progression of age-related macular degeneration. Baird PN,* Richardson AJ, Robman LD, Dimitrov PN, Tikellis G, McCarty CA, Guymer RH. Hum Mutat 2006;27:337–342.
ABSTRACTS
731