Re: Schlenker et al.: Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy. (Ophthalmology. 2017;124:1579-1588)
We read with interest the paper by Schlenker et al.1 The authors state that the results with the Xen implant (Allergan, Parsippany-Troy Hills, NJ) with mitomycin C (MMC) are very similar to those of trabeculectomy with MMC in terms of both safety and efficacy. Based on these data, they suggest that the Xen implant is a reasonable alternative to trabeculectomy. When comparing the 2 groups in this paper, this finding does indeed seem to be the case. However, we think it is reasonable to point out that results from the trabeculectomy group are considerably worse than those from other real-world studies. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: James Kirwan, Alastair Lockwood, Peter Shah, David Broadway, Andrew McNaught, Anthony King Tags: Correspondence Source Type: research
Establishing a Vision and Eye Health Surveillance System for the Nation: A Status Update on the Vision and Eye Health Surveillance System
Vision loss and eye disorders cost the US health care system $65.1 billion in 2013, the fifth leading cause of medical expenditures.1 Americans fear losing vision as much as or more than memory, hearing, or speech, and consider blindness among the top 4 worst things that could happen to them.2 It is estimated that as much as 98% of visual impairment and blindness, much of it consisting of uncorrected refractive error and untreated cataracts, in the United States can be prevented through timely diagnosis and early treatment. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: David B. Rein, John S. Wittenborn, Emily A. Phillips, Jinan B. Saaddine, Vision and Eye Health Surveillance System Study Group Tags: Editorial Source Type: research
Reply
We thank Dr Kirwan for his interest and comments on our article. Dr Kirwan asserts that an ab interno gelatin microstent is a reasonable alternative to trabeculectomy “where the trabeculectomy results are suboptimal.” In our earlier correspondence, we have shown that our trabeculectomy results are very much in keeping with the modern trabeculectomy literature, and elaborated on the “difficulties” Dr Kirwan alludes to but does not address in comparing resu lts across studies. For instance, the retrospective 2015 study by Kirwan et al compared with this one has differences in baseline characteristics (e.g., 3% vs. (...
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Matthew B. Schlenker, Husayn Gulamhusein, Ina Conrad-Hengerer, Alix Somers, Markus Lenzhofer, Ingeborg Stalmans, Herbert Reitsamer, Fritz H. Hengerer, Iqbal Ike K. Ahmed Tags: Correspondence Source Type: research
Re: Francis et al.: Clinical and morphologic characteristics of MEK inhibitor-associated retinopathy: differences from central serous chorioretinopathy (Ophthalmology. 2017;124:1788-1798)
We read with interest the work by Francis et al,1 describing the clinical characteristics and OCT findings of a novel pathologic condition named mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy (MEKAR). They explained that the toxicity profile of a novel class of chemotherapeutics that specifically blocks the mitogen-a ctivated protein kinase pathway includes the acute accumulation (within approximately 2 weeks from the first intake) of focal or multifocal, self-limited (approximately 32 days), nongravitational, subretinal fluid (SRF) pockets, distributed through the entire macula in one or both ey...
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Raul Velez-Montoya, Daniel Rangel-O ’Shea, Scott C. Oliver Tags: Correspondence Source Type: research
Re: Reddy et al.: Vitrectomy and vitrector port needle biopsy of choroidal melanoma for gene expression profile testing immediately before brachytherapy. (Ophthalmology. 2017;124:1377-1382)
We read with interest the article by Reddy et al,1 which advocates combined 25-gauge pars plana vitrectomy, transvitrectomy port fine-needle aspiration biopsy of choroidal melanoma with subsequent endolaser photocoagulation and suturing of the sclerotomies to prevent scleral tumor seeding. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Armin R. Afshar, Bertil E. Damato, Jay M. Stewart, Heinrich Heimann, Sarah E. Coupland Tags: Correspondence Source Type: research
Reply
Thank you for the opportunity to respond to the critiques of Afshar et al. We also thank Afshar et al for their interest in our manuscript. In their letter, the authors are critical of several aspects of our retrospective case series as well as our actual technique of vitrectomy and transvitrector port needle biopsy of choroidal melanoma. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Deepthi Reddy Rao, Lauren Mason, John Mason, Jason Crosson, Jacob Yunker Tags: Correspondence Source Type: research
Reply
The authors thank Velez-Montoya et al for their comments on our publication.1 We are humbly grateful for their compliments on our study, which provides a morphologic description of mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy (MEKAR) and discusses the features that make it distinct from central serous cho rioretinopathy (CSC). We are delighted the authors concur with our findings, description, and interpretation. We agree the inferior tracking of fluid and retinal pigment epithelial changes are more common in chronic CSC and, therefore, that its absence in MEKAR may be more reflective of the sh...
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Jasmine H. Francis, David H. Abramson, Larissa Habib, Lawrence A. Yannuzzi, Federica Catalanotti Tags: Correspondence Source Type: research
Oculodermal Melanocytosis, Darker Complexion, Choroidal Melanoma: A Missed Clue
A 68-year-old African-American woman with known history of an abnormally pigmented right optic nerve head was referred for a choroidal mass. Examination of the right eye demonstrated numerous pigmented scleral patches, diffuse iris thickening with mammillations, a hyperpigmented optic disc with slightly asymmetric hyperpigmentation of the choroid compared with her left eye (Fig 1A-B), and a choroidal melanoma (Fig 1C). External examination with bright illumination revealed subtly increased skin pigmentation of the right hemiface (Fig 1D). (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Meera Ramakrishnan, Robin Vora, Michael I. Seider Tags: Pictures & Perspectives Source Type: research
Re: De Moraes et al.: 24-2 Visual fields miss central defects shown on 10-2 tests in glaucoma suspects, ocular hypertensives, and early glaucoma (Ophthalmology. 2017;124:1449-1456)
We read with great interest the cross-sectional prospective study by De Moraes et al1 describing the prevalence of visual field (VF) defects in glaucomatous eyes, glaucoma suspects, and ocular hypertensives with 24-2 and 10-2 VFs. Although the findings seemed to be very promising and could potentially change our VF testing strategy for glaucoma patients, a closer look leaves a number of unanswered questions and areas of concern that may be beneficial to explain to readers of the article. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Piergiacomo Grassi, Henrietta Ho, Kin Sheng Lim Tags: Correspondence Source Type: research
Multimodal Imaging in Adult-Onset Coats' Disease
A 58-year-old man with recent vision loss to 20/200 in the left eye. Ultrawide-field color image (Fig 1A) shows myelinated retinal nerve fibers inferior to disc, macular and peripheral exudation correlating with fluorescein angiographic leakage (Fig 1B). En face swept-source OCT angiography with segmentation of the superficial capillary plexus (Fig 1C) and whole retina (Fig 1D) shows temporal telangiectasia, microaneurysms surrounding an enlarged foveal avascular zone, and a large retinal arterial macroaneurysm (yellow arrowhead). (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Yoichi Sakurada, K. Bailey Freund, Lawrence A. Yannuzzi Tags: Pictures & Perspectives Source Type: research
Clinicopathologic Correlation of Choroidal Invasion in Retinoblastoma
Although choroidal invasion in retinoblastoma eyes is commonly observed pathologically, it has rarely been identified ophthalmoscopically or with ultrasound. Over a 2-year period, a 6-year-old girl was treated for bilateral retinoblastoma with systemic chemotherapy, intrarterial chemotherapy, laser, cryotherapy, and brachytherapy. She developed a dome-shaped brown/orange fundus lesion that was speckled on its surface with overlying serous retinal detachment (Fig 1A). Ultrasound confirmed that this emanated from the choroid but did not connect to the ciliary body (Fig 1B). (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: David H. Abramson, Robert Folberg, Jasmine H. Francis Tags: Pictures & Perspectives Source Type: research
Bilateral Asymptomatic Cryptococcal Retinitis without Choroiditis or Vitritis
A visually asymptomatic 36-year-old man with HIV/AIDS (CD4: 4) was diagnosed with Cryptococcus gattii meningitis. He received 1 month of intravenous amphotericin and flucytosine followed by oral fluconazole with significant clinical improvement. Multifocal elevated circular retinal lesions without choroiditis or vitritis were evident bilaterally (Fig 1). OCT demonstrated preserved retinal architecture beyond the domed lesions with intraretinal speckled reflection. The fovea was spared bilaterally, consistent with uncorrected 20/20 vision. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: William J. Johnson, Jeffrey P. Blice, Katherine K. Lee Tags: Pictures & Perspectives Source Type: research
Reply
We thank the authors for their interest in our work and the relevant points brought up for discussion. With regard to the sequence of visual field testing, in the African Descent and Glaucoma Evaluation Study (ADAGES) visual field testing order (24-2 vs 10-2) was assigned randomly at the patient level. The median time between visual field examinations was 20 minutes (25th to 75th quartile range, 16 –28). As the authors suggested, it is therefore, possible participants were fatigued by the time they performed the second test, whether it was a 24-2 or 10-2 examination. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Carlos Gustavo De Moraes, Donald C. Hood, Robert N. Weinreb, Linda M. Zangwill, Jeffrey M. Liebmann Tags: Correspondence Source Type: research
Infraorbital Nerve Involvement on Magnetic Resonance Imaging in Igg4-Related Ophthalmic Disease: A Highly Suggestive Sign
A 47-year-old man presented to the orbital surgery department with a history of recent orbital inflammation. He presented with bilateral orbital swelling and a palpable mass above the right eye (Fig 1A, black arrow). He had no fever and laboratory tests were normal. Coronal T2 (Fig 1B) and coronal fat-saturated post-contrast T1 weighted imaging magnetic resonance imaging (Fig 1C) showed an enlargement and e nhancement of the left infra-orbital nerve (white arrow). A biopsy was performed with histological and immunohistochemical analysis (Fig 1D) revealing a lymphoplasmacytic infiltrate expressing IgG4, confirming the dia...
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Augustin Lecler, Mathieu Zmuda, Romain Deschamps Tags: Pictures & Perspectives Source Type: research
Iris-Fixated Phakic Intraocular Lenses: New Results
Phakic intraocular lens (pIOL) implantation to correct refractive error is considered most often as an alternative to laser corneal refractive surgery in the setting of relatively high refractive error when there is an opportunity to retain the patient's ability to accommodate. There are 3 main designs: angle-supported anterior chamber, iris-claw anterior chamber, and posterior chamber, with several models commercially available. Because each pIOL offers different features, clinicians must match the pIOL specification carefully against their patients' needs and desired visual outcomes. (Source: Ophthalmology)
Source: Ophthalmology - March 19, 2018 Category: Opthalmology Authors: Thomas Kohnen Tags: Commentary Source Type: research
