- Email: [email protected]
Laser in situ keratomileusis for hyperopia and hyperopic and mixed astigmatism with LADARVision using 7 to 10 mm ablation zones
A
● Laser in situ keratomileusis for hyperopia and hyperopic and mixed astigmatism with LADARVision using 7 to 10 mm ablation zones. Carones F,* Vigo L, Scandola E. J Refract Surg 2003;19:548 –554.
PROSPECTIVE COHORT STUDY WAS CONDUCTED TO
determine whether culture confirmation affects the relative treatment in randomized clinical trials of bacterial keratitis. The influence of a positive bacterial culture on the rates of antimicrobial improvement and cure was estimated by proportional hazards regression among 608 patients with ulcerative keratitis treated with ciprofloxacin monotherapy. The interaction of culture confirmation on the relative cure rates of 735 patients enrolled in 4 clinical trials comparing fluoroquinolone Monotherapy to combined cephalosporin and aminoglycoside therapy were evaluated by metaregression. Bacterial keratitis that was culture positive and longer than 4 mm in diameter had a 37% (95% confidence interval, 20%, 51%) and a 56% (95% confidence interval, 41%, 67%) slower cure rate during ciprofloxacin therapy. Among randomized clinical trials, the culture result did not modify the relative effect of treatments having similar 1-week cure rates. Culture confirmation affects the antibacterial therapeutic response rate of ulcerative keratitis but does not modify the comparative effect of equivalent antibacterial treatments.—Michael D. Wagoner
T
HIS RETROSPECTIVE REVIEW EXAMINED THE RESULTS
of laser in situ keratomileusis (LASIK) performed to correct hyperopia, and hyperopic and mixed astigmatism using wider ablation diameters (optical zone diameter and overall ablation diameter) than those commonly used with the same and other lasers. The results in 53 eyes of 33 consecutive patients who underwent LASIK (Alcon LADARVision 4000) using a 7-mm optical zone diameter and a 3-mm transition zone for an overall 10-0 mm total ablation diameter were included in the analysis. The mean spheroequivalent attempted correction was ⫹2.34 ⫾ 2.09D. Six months after surgery, the mean spherical equivalent refractive error was ⫺ 0.22D ⫾ 0.41D. Fortytwo (79.2%) eyes were within ⫾ 0.50D and 52 (98.1%) were within ⫾ 1.0D of intended correction. Uncorrected visual acuity of 20/40 or better was achieved in 50 (94.3%) eyes, including 28(53%) eyes with 20/20 or better. No significant subjective nighttime symptoms, such as haloes or glare, were reported. The conclusion is that large ablation zones for hyperopia and hyperopic and mixed astigmatism are associated good visual outcomes and refractive predictability.—Michael D. Wagoner
*K. R. Wilhelmus, MD, Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin Street, Suite NC205, Houston, TX 77030 e-mail: [email protected]
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*F. Carones, MD, Carones Ophthalmology Center, Via Pietro Mascagni 20, 20122 Milan, Italy; email: [email protected]
T
● Dissection of genomewide-scan data in extended families reveals a major locus and oligogenic susceptibility for age-related macular degeneration. Iyengar SK,* Song D, Klein BE, Klein R, Schick JH, Humphrey J, Millard C, Liptak R, Russo K, Jun G, Lee KE, Fijal B, Elston RC. Am J Hum Genet 2004;74:20 –39.
Histopathologic analysis of 232 eyes with retinoblastoma conducted in an Indian tertiary-care ophthalmic center. Biswas J,* Das D, Krishnakumar S, Shanmugam M. J Pediatr Ophthalmol Strabismus 2003;40:265–267. HE AUTHORS RETROSPECTIVELY REVIEWED THE HIS-
topathological features of 232 eyes enucleated for retinoblastoma at a tertiary-care eye institute in India between 1982 and 2001. The endophytic growth pattern was present in 118 (51%) of the eyes. Vitreous seeds were present in 109 (47%) of the tumors, 23 (10%) of the tumors had subretinal seeds, and 14 (6%) of the tumors had both. Poorly differentiated tumors were present in 134 (58%) eyes. Choroidal invasion was present in 78 (34%) eyes, among which 51 eyes had full thickness involvement. Optic nerve invasion was observed in 75 (32%) of the eyes, of which postlaminar involvement occurred in 22 eyes. The authors conclude that a higher incidence of choroidal and optic nerve involvement was present in Asian Indian children in this series than among that reported among children from the West. The authors hypothesize that delays in diagnosis, different biological behavior of the tumors, or both, could account for these differences.—Michael D. Wagoner
E
*J. Biswas, MD, Medical and Vision Research Foundations, Sankara Nethralaya, 18 College Road, Chennai-600 006, India
790
AMERICAN JOURNAL
XCESSIVE FAMILIAL CLUSTERING OF AGE RELATED MAC-
ular degeneration (ARMD) has established the importance genetic factors in the etiology of ARMD. The aim of this study was to examine the genetic basis of ARMD. The authors conducted a genomewide scan in 34 extended families (297 individuals, 349 sib pairs) ascertained through index cases with neovascular disease or geographic atrophy. Family and medical history was obtained from index cases and family members. Fundus photographs were taken of all participating family members, and these were graded for severity by use of a quantitative scale. Modelfree linkage analysis was performed, and tests of heterogeneity and epistasis were conducted. The authors found evidence of a major locus on chromosome 15q. This locus was present as a weak linkage signal in their previous genome scan for ARMD, in the Beaver Dam Eye Study sample, but is otherwise novel. In this genome scan, they
OF
OPHTHALMOLOGY
APRIL 2004
● Laser in situ keratomileusis for hyperopia and hyperopic and mixed astigmatism with LADARVision using 7 to 10 mm ablation zones. Carones F,* Vigo L, Scandola E. J Refract Surg 2003;19:548 –554.
PROSPECTIVE COHORT STUDY WAS CONDUCTED TO
determine whether culture confirmation affects the relative treatment in randomized clinical trials of bacterial keratitis. The influence of a positive bacterial culture on the rates of antimicrobial improvement and cure was estimated by proportional hazards regression among 608 patients with ulcerative keratitis treated with ciprofloxacin monotherapy. The interaction of culture confirmation on the relative cure rates of 735 patients enrolled in 4 clinical trials comparing fluoroquinolone Monotherapy to combined cephalosporin and aminoglycoside therapy were evaluated by metaregression. Bacterial keratitis that was culture positive and longer than 4 mm in diameter had a 37% (95% confidence interval, 20%, 51%) and a 56% (95% confidence interval, 41%, 67%) slower cure rate during ciprofloxacin therapy. Among randomized clinical trials, the culture result did not modify the relative effect of treatments having similar 1-week cure rates. Culture confirmation affects the antibacterial therapeutic response rate of ulcerative keratitis but does not modify the comparative effect of equivalent antibacterial treatments.—Michael D. Wagoner
T
HIS RETROSPECTIVE REVIEW EXAMINED THE RESULTS
of laser in situ keratomileusis (LASIK) performed to correct hyperopia, and hyperopic and mixed astigmatism using wider ablation diameters (optical zone diameter and overall ablation diameter) than those commonly used with the same and other lasers. The results in 53 eyes of 33 consecutive patients who underwent LASIK (Alcon LADARVision 4000) using a 7-mm optical zone diameter and a 3-mm transition zone for an overall 10-0 mm total ablation diameter were included in the analysis. The mean spheroequivalent attempted correction was ⫹2.34 ⫾ 2.09D. Six months after surgery, the mean spherical equivalent refractive error was ⫺ 0.22D ⫾ 0.41D. Fortytwo (79.2%) eyes were within ⫾ 0.50D and 52 (98.1%) were within ⫾ 1.0D of intended correction. Uncorrected visual acuity of 20/40 or better was achieved in 50 (94.3%) eyes, including 28(53%) eyes with 20/20 or better. No significant subjective nighttime symptoms, such as haloes or glare, were reported. The conclusion is that large ablation zones for hyperopia and hyperopic and mixed astigmatism are associated good visual outcomes and refractive predictability.—Michael D. Wagoner
*K. R. Wilhelmus, MD, Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin Street, Suite NC205, Houston, TX 77030 e-mail: [email protected]
●
*F. Carones, MD, Carones Ophthalmology Center, Via Pietro Mascagni 20, 20122 Milan, Italy; email: [email protected]
T
● Dissection of genomewide-scan data in extended families reveals a major locus and oligogenic susceptibility for age-related macular degeneration. Iyengar SK,* Song D, Klein BE, Klein R, Schick JH, Humphrey J, Millard C, Liptak R, Russo K, Jun G, Lee KE, Fijal B, Elston RC. Am J Hum Genet 2004;74:20 –39.
Histopathologic analysis of 232 eyes with retinoblastoma conducted in an Indian tertiary-care ophthalmic center. Biswas J,* Das D, Krishnakumar S, Shanmugam M. J Pediatr Ophthalmol Strabismus 2003;40:265–267. HE AUTHORS RETROSPECTIVELY REVIEWED THE HIS-
topathological features of 232 eyes enucleated for retinoblastoma at a tertiary-care eye institute in India between 1982 and 2001. The endophytic growth pattern was present in 118 (51%) of the eyes. Vitreous seeds were present in 109 (47%) of the tumors, 23 (10%) of the tumors had subretinal seeds, and 14 (6%) of the tumors had both. Poorly differentiated tumors were present in 134 (58%) eyes. Choroidal invasion was present in 78 (34%) eyes, among which 51 eyes had full thickness involvement. Optic nerve invasion was observed in 75 (32%) of the eyes, of which postlaminar involvement occurred in 22 eyes. The authors conclude that a higher incidence of choroidal and optic nerve involvement was present in Asian Indian children in this series than among that reported among children from the West. The authors hypothesize that delays in diagnosis, different biological behavior of the tumors, or both, could account for these differences.—Michael D. Wagoner
E
*J. Biswas, MD, Medical and Vision Research Foundations, Sankara Nethralaya, 18 College Road, Chennai-600 006, India
790
AMERICAN JOURNAL
XCESSIVE FAMILIAL CLUSTERING OF AGE RELATED MAC-
ular degeneration (ARMD) has established the importance genetic factors in the etiology of ARMD. The aim of this study was to examine the genetic basis of ARMD. The authors conducted a genomewide scan in 34 extended families (297 individuals, 349 sib pairs) ascertained through index cases with neovascular disease or geographic atrophy. Family and medical history was obtained from index cases and family members. Fundus photographs were taken of all participating family members, and these were graded for severity by use of a quantitative scale. Modelfree linkage analysis was performed, and tests of heterogeneity and epistasis were conducted. The authors found evidence of a major locus on chromosome 15q. This locus was present as a weak linkage signal in their previous genome scan for ARMD, in the Beaver Dam Eye Study sample, but is otherwise novel. In this genome scan, they
OF
OPHTHALMOLOGY
APRIL 2004