- Email: [email protected]
Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C
with marked impairment in visuospatial tasks, reading, and writing but relative preservation of memory compared to AD patients. The authors conclude that PCA is distinct from typical AD and can be diagnosed with a battery of cognitive tests. PCA patients are relatively young and usually initially present with isolated impairment in reading and writing.—Valérie Biousse
*P. McMonagle, Department of Cognitive Neurology, University of Western Ontario, St. Joseph’s Hospital, London, Ontario, N6A 4V2, Canada; e-mail: [email protected]
●
Brain abnormalities in neuromyelitis optica. Weinshenker BG,* Wingerchuk DM, Vukusic S, Linbo L, Pittock SJ, Lucchinetti CF, Lennon VA. Ann Neurol 2006;59:566 – 569.
N
EUROMYELITIS OPTICA (NMO) (ALSO CALLED DEVIC’S
disease) is a severe demyelinating disease selectively affecting the optic nerves and the spinal cord. Diagnostic criteria require absence of clinical disease outside the optic nerve or spinal cord. The authors have, however, frequently encountered patients with a well-established diagnosis of NMO in whom either asymptomatic or symptomatic brain lesions develop suggesting that the diagnostic criteria for NMO should be revised. The aim of this study was to describe the magnetic resonance image (MRI) brain findings in 63 patients with NMO. MRIs were classified as normal or as abnormal with either nonspecific multiple sclerosis-like or atypical abnormalities. The authors evaluated whether brain lesions were symptomatic and analyzed the neuropathologic features of a single brain biopsy specimen. The 63 patients included 53 women (88%). Mean ⫾ SD age at onset was 37.2 ⫾ 18.4 years, and the mean ⫾SD duration of follow-up was 6.0 ⫾ 5.6 years. Neuromyelitis optica-IgG was detected in the serum of 41 patients (68%). Brain MRI lesions were detected in 36 patients (60%). Most were nonspecific, but six patients (10%) had multiple sclerosis-like lesions, usually asymptomatic. Another five patients (8%), mostly children, had diencephalic, brainstem or cerebral lesions, atypical for multiple sclerosis. When present, symptoms of brain involvement were subtle, except in one patient who was comatose and had large cerebral lesions. The authors conclude that asymptomatic brain lesions are common in NMO, and that symptomatic brain lesions do not exclude the diagnosis of NMO. They suggest a revision of diagnostic criteria for NMO to allow for brain involvement.—Valérie Biousse
*B. G. Weinshenker, Department of Neurology, Laboratory Medicine and Pathology, Radiology, and Immunology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail: weinb@ mayo.edu
VOL. 142, NO. 1
●
Treatment of traumatic optic neuropathy with highdose corticosteroid. Steinsapir KD.* J Neuroophthalmol 2006;26:65– 67.
H
IGH DOSE METHYLPREDNISOLONE IS OFTEN USED FOR
the treatment of acute traumatic optic neuropathy (TON). However, there are no prospective, randomized trials to attest to its benefit. This article (written by an expert in TON) reviews the treatment of TON. It emphasizes that the largest retrospective study showed no benefit of high-dose corticosteroid treatment of TON. Moreover, subsequent study of such treatment of acute spinal cord injury has disclosed that the clinical benefit is modest, and that treatment is actually harmful if administered more than eight hours after injury. A recently reported placebocontrolled randomized clinical trial of high-dose corticosteroids in head injury (CRASH study) was stopped prematurely because of a considerably greater mortality in the corticosteroid-treated patients. Additionally, recent experimental studies suggest that methylprednisolone may be harmful to the optic nerve. The author concludes that considering this clinical and experimental evidence, there is no basis for treating TON with high-dose corticosteroid.—Valérie Biousse
*K. D. Steinsapir, 11645 Wilshire Boulevard, Suite 750, Orbital and Ophthalmic Plastic Surgery Division, Jules Stein Eye Institute, The David Geffen School of Medicine at UCLA, Los Angeles, CA 90025; e-mail: [email protected]
●
Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C. Ralli M, NouriMahdavi K, Caprioli J.* J Glaucoma 2006;15:60 – 67.
T
HIS WAS A HISTORICAL COHORT STUDY OF 205 CON-
secutive patients who underwent initial trabeculectomy with adjunctive mitomycin C in 241 phakic eyes between October 1997 and November 2003. The purpose of the study was to evaluate and compare outcomes of those who underwent laser suture lysis (LSL) with those who did not require such intervention. Laser suture lysis was performed in 95 eyes (84 patients) whereas 146 eyes (121 patients) did not require it. The intraocular pressure (IOP) was significantly higher at 12 months after LSL compared with non-LSL eyes (12.9 ⫾ 5.2 mm Hg vs 11.0 ⫾ 4.1 mm Hg; P ⫽ .04). After LSL, only 54 eyes (57%) had IOP reduction to ⬍15 mm Hg with ⱖ30% reduction of IOP, compared to 107 eyes (73%) non-LSL eyes (P ⫽ .005). However, only late LSL (last LSL session ⬎10 days after trabeculectomy) was associated with a worse outcome by this criteria in Cox’s proportional hazards model using these criteria (HR ⫽ 2.26; P ⫽ .004). Late hypotony occurred in 1% and 4% of LSL and non-LSL eyes. The authors conclude that late LSL is associated with poorer long-term IOP control than eyes not requiring laser
ABSTRACTS
203
suture lysis or eyes undergoing LSL ⬍10 days after surgery.—Michael D. Wagoner
tonometry, and to evaluate the influence of central corneal thickness (CCT) and corneal curvature. A clear correlation between dynamic contour tonometry and Goldmann applanation tonometry was found (r ⫽ 0.693, P ⬍ .001). Dynamic contour tonometry generally resulted in higher IOP measurement (mean difference ⫹ 1.8 mm Hg, mean difference ⫹ 2.34 mm Hg). Unlike dynamic contour tonometry, Goldmann applanation tonometry was remarkably affected by central corneal thickness, which partially explained the disagreement in IOP measurements by the two techniques. Neither method was significantly influenced by corneal curvature. The authors conclude that dynamic contour tonometry is a reliable method for IOP measurement, which unlike Goldmann applanation tonometry is not influenced by corneal thickness. In clinical practice, advantages from dynamic contour tonometry can be expected for cooperative patients, outpatients, and patients with sufficient bilateral ocular fixation, whereas Goldmann applanation tonometry measurements are more reliable in cases of patients with inadequate cooperation, poor vision, or nystagmus.—Michael D. Wagoner
*J. Caprioli, Glaucoma Division, Jules Stein Eye Institute, University of California at Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095; e-mail: [email protected]
●
Microbial keratitis at extremes of age. Parmar P,* Salman A, Kalavathy CM, Kaliamurthy J, Thomas PA, Jesudasan AN. Cornea 2006;25:153–158.
T
HE AUTHORS CONDUCTED A PROSPECTIVE, NONRAN-
domized, analytical clinical study of all patients presenting with microbial keratitis and undergoing microbiological workup. The patients were evaluated using a dedicated corneal ulcer protocol. They performed a comparative analysis of the microbiological profile, predisposing factors, clinical presentation, response to treatment, and final visual outcome in (1) a pediatric group of patients 16 years of age or younger (26 eyes); (2) an elderly group of patients 65 years of age or older (55 eyes); and (3) a control group between 17 and 64 years of age (188 eyes). The elderly and control groups had a similar incidence of bacterial and fungal keratitis, but the pediatric group had a significantly lower incidence of fungal keratitis (P ⫽ .001). Trauma was the most common predisposing factor in all three groups. Elderly patients tended to present with a higher incidence of central ulcers (P ⫽ .04), severe ulcers (P ⫽ .04), and poor visual acuity (P ⫽ .003) compared to the control group. The percentage of ulcers healing with medications alone was significantly more in the pediatric group (P ⫽ .004), while the incidence of poor visual outcome was greater in the elderly group (P ⫽ .006) compared to the control group. The authors conclude that pediatric patients have a better chance for resolution of microbial keratitis with medical therapy alone compared to the general population, while elderly patients with microbial keratitis tend to present with severe, central corneal ulcers that have a poor visual outcome.—Michael D. Wagoner
*E. Schneider, Department of Ophthalmology, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany; e-mail: evelin. [email protected]
●
Retinal detachment in myopic eyes after phakic intraocular lens implantation. Ruiz-Moreno J, Montero J, de la Vega C, Alio JL, Zapater P. J Refract Surg 2006;22: 247–252.
T
*P. Parmar, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620 001 (Tamil Nadu), India; e-mail: [email protected]
●
Intraocular pressure measurement-comparison of dynamic contour tonometry and Golmann applanation tonometry. Schneider E,* Grehn F. J Glaucoma 2006;15: 2– 6.
A
PROSPECTIVE STUDY IN 100 PATIENTS WITHOUT
glaucoma was performed in order to compare intraocular pressure (IOP) measurement using dynamic contour tonometry (DCT, Pascal tonometer, Swiss Microtechnology AG, Port, Switzerland) and Goldmann applanation 204
AMERICAN JOURNAL
HIS RETROSPECTIVE, NONCOMPARATIVE, INTERVEN-
tional case series analyzed the risk of retinal detachment in highly myopic eyes that underwent implantation of phakic intraocular lenses (PIOLs). In a series of 522 consecutive highly myopic eyes (323 patients), with a mean age of 32.1 ⫾ 7.3 years (range, 18 to 52 years), a mean spherical refractive error of ⫺18.1 ⫾ 5.0 diopters (D) (range, ⫺7.0 to ⫺38.0 D), and a mean follow-up of 60.4 ⫾ 39.1 months (range, 12 to 145 months), 15 (2.9%) developed retinal detachment after PIOL implantation. The mean time between surgery and retinal detachment was 24.4 ⫾ 24.4 months (range, 1 to 92 months). By Kaplan-Meier analysis, the risk for retinal detachment after PIOL was 0.57% at three months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months. There was a statistically significant difference in the axial length of eyes that developed retinal detachment after PIOL and those that did not (30.65 ⫾ 1.97 vs 29.51 ⫾ 2.20, respectively; P ⫽ .028). The authors conclude that there is a greater risk of retinal detachment after PIOL in eyes with an axial length ⬎ 30.24 mm.—Michael D. Wagoner *Division de Oftalmologia, Univesidad Miguel Hernandez, Campus de San Juan, 03550 Alicante, Spain; e-mail: [email protected] OF
OPHTHALMOLOGY
JULY 2006
*P. McMonagle, Department of Cognitive Neurology, University of Western Ontario, St. Joseph’s Hospital, London, Ontario, N6A 4V2, Canada; e-mail: [email protected]
●
Brain abnormalities in neuromyelitis optica. Weinshenker BG,* Wingerchuk DM, Vukusic S, Linbo L, Pittock SJ, Lucchinetti CF, Lennon VA. Ann Neurol 2006;59:566 – 569.
N
EUROMYELITIS OPTICA (NMO) (ALSO CALLED DEVIC’S
disease) is a severe demyelinating disease selectively affecting the optic nerves and the spinal cord. Diagnostic criteria require absence of clinical disease outside the optic nerve or spinal cord. The authors have, however, frequently encountered patients with a well-established diagnosis of NMO in whom either asymptomatic or symptomatic brain lesions develop suggesting that the diagnostic criteria for NMO should be revised. The aim of this study was to describe the magnetic resonance image (MRI) brain findings in 63 patients with NMO. MRIs were classified as normal or as abnormal with either nonspecific multiple sclerosis-like or atypical abnormalities. The authors evaluated whether brain lesions were symptomatic and analyzed the neuropathologic features of a single brain biopsy specimen. The 63 patients included 53 women (88%). Mean ⫾ SD age at onset was 37.2 ⫾ 18.4 years, and the mean ⫾SD duration of follow-up was 6.0 ⫾ 5.6 years. Neuromyelitis optica-IgG was detected in the serum of 41 patients (68%). Brain MRI lesions were detected in 36 patients (60%). Most were nonspecific, but six patients (10%) had multiple sclerosis-like lesions, usually asymptomatic. Another five patients (8%), mostly children, had diencephalic, brainstem or cerebral lesions, atypical for multiple sclerosis. When present, symptoms of brain involvement were subtle, except in one patient who was comatose and had large cerebral lesions. The authors conclude that asymptomatic brain lesions are common in NMO, and that symptomatic brain lesions do not exclude the diagnosis of NMO. They suggest a revision of diagnostic criteria for NMO to allow for brain involvement.—Valérie Biousse
*B. G. Weinshenker, Department of Neurology, Laboratory Medicine and Pathology, Radiology, and Immunology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail: weinb@ mayo.edu
VOL. 142, NO. 1
●
Treatment of traumatic optic neuropathy with highdose corticosteroid. Steinsapir KD.* J Neuroophthalmol 2006;26:65– 67.
H
IGH DOSE METHYLPREDNISOLONE IS OFTEN USED FOR
the treatment of acute traumatic optic neuropathy (TON). However, there are no prospective, randomized trials to attest to its benefit. This article (written by an expert in TON) reviews the treatment of TON. It emphasizes that the largest retrospective study showed no benefit of high-dose corticosteroid treatment of TON. Moreover, subsequent study of such treatment of acute spinal cord injury has disclosed that the clinical benefit is modest, and that treatment is actually harmful if administered more than eight hours after injury. A recently reported placebocontrolled randomized clinical trial of high-dose corticosteroids in head injury (CRASH study) was stopped prematurely because of a considerably greater mortality in the corticosteroid-treated patients. Additionally, recent experimental studies suggest that methylprednisolone may be harmful to the optic nerve. The author concludes that considering this clinical and experimental evidence, there is no basis for treating TON with high-dose corticosteroid.—Valérie Biousse
*K. D. Steinsapir, 11645 Wilshire Boulevard, Suite 750, Orbital and Ophthalmic Plastic Surgery Division, Jules Stein Eye Institute, The David Geffen School of Medicine at UCLA, Los Angeles, CA 90025; e-mail: [email protected]
●
Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C. Ralli M, NouriMahdavi K, Caprioli J.* J Glaucoma 2006;15:60 – 67.
T
HIS WAS A HISTORICAL COHORT STUDY OF 205 CON-
secutive patients who underwent initial trabeculectomy with adjunctive mitomycin C in 241 phakic eyes between October 1997 and November 2003. The purpose of the study was to evaluate and compare outcomes of those who underwent laser suture lysis (LSL) with those who did not require such intervention. Laser suture lysis was performed in 95 eyes (84 patients) whereas 146 eyes (121 patients) did not require it. The intraocular pressure (IOP) was significantly higher at 12 months after LSL compared with non-LSL eyes (12.9 ⫾ 5.2 mm Hg vs 11.0 ⫾ 4.1 mm Hg; P ⫽ .04). After LSL, only 54 eyes (57%) had IOP reduction to ⬍15 mm Hg with ⱖ30% reduction of IOP, compared to 107 eyes (73%) non-LSL eyes (P ⫽ .005). However, only late LSL (last LSL session ⬎10 days after trabeculectomy) was associated with a worse outcome by this criteria in Cox’s proportional hazards model using these criteria (HR ⫽ 2.26; P ⫽ .004). Late hypotony occurred in 1% and 4% of LSL and non-LSL eyes. The authors conclude that late LSL is associated with poorer long-term IOP control than eyes not requiring laser
ABSTRACTS
203
suture lysis or eyes undergoing LSL ⬍10 days after surgery.—Michael D. Wagoner
tonometry, and to evaluate the influence of central corneal thickness (CCT) and corneal curvature. A clear correlation between dynamic contour tonometry and Goldmann applanation tonometry was found (r ⫽ 0.693, P ⬍ .001). Dynamic contour tonometry generally resulted in higher IOP measurement (mean difference ⫹ 1.8 mm Hg, mean difference ⫹ 2.34 mm Hg). Unlike dynamic contour tonometry, Goldmann applanation tonometry was remarkably affected by central corneal thickness, which partially explained the disagreement in IOP measurements by the two techniques. Neither method was significantly influenced by corneal curvature. The authors conclude that dynamic contour tonometry is a reliable method for IOP measurement, which unlike Goldmann applanation tonometry is not influenced by corneal thickness. In clinical practice, advantages from dynamic contour tonometry can be expected for cooperative patients, outpatients, and patients with sufficient bilateral ocular fixation, whereas Goldmann applanation tonometry measurements are more reliable in cases of patients with inadequate cooperation, poor vision, or nystagmus.—Michael D. Wagoner
*J. Caprioli, Glaucoma Division, Jules Stein Eye Institute, University of California at Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095; e-mail: [email protected]
●
Microbial keratitis at extremes of age. Parmar P,* Salman A, Kalavathy CM, Kaliamurthy J, Thomas PA, Jesudasan AN. Cornea 2006;25:153–158.
T
HE AUTHORS CONDUCTED A PROSPECTIVE, NONRAN-
domized, analytical clinical study of all patients presenting with microbial keratitis and undergoing microbiological workup. The patients were evaluated using a dedicated corneal ulcer protocol. They performed a comparative analysis of the microbiological profile, predisposing factors, clinical presentation, response to treatment, and final visual outcome in (1) a pediatric group of patients 16 years of age or younger (26 eyes); (2) an elderly group of patients 65 years of age or older (55 eyes); and (3) a control group between 17 and 64 years of age (188 eyes). The elderly and control groups had a similar incidence of bacterial and fungal keratitis, but the pediatric group had a significantly lower incidence of fungal keratitis (P ⫽ .001). Trauma was the most common predisposing factor in all three groups. Elderly patients tended to present with a higher incidence of central ulcers (P ⫽ .04), severe ulcers (P ⫽ .04), and poor visual acuity (P ⫽ .003) compared to the control group. The percentage of ulcers healing with medications alone was significantly more in the pediatric group (P ⫽ .004), while the incidence of poor visual outcome was greater in the elderly group (P ⫽ .006) compared to the control group. The authors conclude that pediatric patients have a better chance for resolution of microbial keratitis with medical therapy alone compared to the general population, while elderly patients with microbial keratitis tend to present with severe, central corneal ulcers that have a poor visual outcome.—Michael D. Wagoner
*E. Schneider, Department of Ophthalmology, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany; e-mail: evelin. [email protected]
●
Retinal detachment in myopic eyes after phakic intraocular lens implantation. Ruiz-Moreno J, Montero J, de la Vega C, Alio JL, Zapater P. J Refract Surg 2006;22: 247–252.
T
*P. Parmar, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620 001 (Tamil Nadu), India; e-mail: [email protected]
●
Intraocular pressure measurement-comparison of dynamic contour tonometry and Golmann applanation tonometry. Schneider E,* Grehn F. J Glaucoma 2006;15: 2– 6.
A
PROSPECTIVE STUDY IN 100 PATIENTS WITHOUT
glaucoma was performed in order to compare intraocular pressure (IOP) measurement using dynamic contour tonometry (DCT, Pascal tonometer, Swiss Microtechnology AG, Port, Switzerland) and Goldmann applanation 204
AMERICAN JOURNAL
HIS RETROSPECTIVE, NONCOMPARATIVE, INTERVEN-
tional case series analyzed the risk of retinal detachment in highly myopic eyes that underwent implantation of phakic intraocular lenses (PIOLs). In a series of 522 consecutive highly myopic eyes (323 patients), with a mean age of 32.1 ⫾ 7.3 years (range, 18 to 52 years), a mean spherical refractive error of ⫺18.1 ⫾ 5.0 diopters (D) (range, ⫺7.0 to ⫺38.0 D), and a mean follow-up of 60.4 ⫾ 39.1 months (range, 12 to 145 months), 15 (2.9%) developed retinal detachment after PIOL implantation. The mean time between surgery and retinal detachment was 24.4 ⫾ 24.4 months (range, 1 to 92 months). By Kaplan-Meier analysis, the risk for retinal detachment after PIOL was 0.57% at three months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months. There was a statistically significant difference in the axial length of eyes that developed retinal detachment after PIOL and those that did not (30.65 ⫾ 1.97 vs 29.51 ⫾ 2.20, respectively; P ⫽ .028). The authors conclude that there is a greater risk of retinal detachment after PIOL in eyes with an axial length ⬎ 30.24 mm.—Michael D. Wagoner *Division de Oftalmologia, Univesidad Miguel Hernandez, Campus de San Juan, 03550 Alicante, Spain; e-mail: [email protected] OF
OPHTHALMOLOGY
JULY 2006