Autologous serum eye drops in dry eye disease: Preferred practice pattern guidelines

Autologous serum eye drops provide lubrication and promote epithelial healing. They have been successfully used in the management of ocular surface disorders such as dry eye disease, persistent epithelial defects and neurotrophic keratopathy for many decades. A great deal of variation in the methods of preparation of autologous serum eye drops, the end concentration and the duration of use exists in published literature. In this review, simplified recommendations for preparation, transport, storage and use of autologous serum are described. Evidence for the use of this modality in aqueous deficient dry eye disease is summarized, along with expertise-based rationale.

Reproducibility of retinal nerve fiber layer measurements across the glaucoma spectrum using optical coherence tomography.

Purpose: The purpose was to determine intra-session and inter-session reproducibility of retinal nerve fiber layer (RNFL) thickness measurements with the spectral-domain Cirrus optical coherence tomography (OCT)® (SD-OCT) in normal and glaucomatous eyes, including a subset of advanced glaucoma. Materials and Methods: RNFL measurements of 40 eyes of 40 normal subjects and 40 eyes of 40 glaucomatous patients including 14 with advanced glaucoma were obtained on the Cirrus OCT® (Carl Zeiss Meditec, Dublin, CA, USA) five times on 1-day (intra-session) and on five separate days (inter-session). Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) values were calculated for mean and quadrant RNFL in each group separately. Reproducibility values were correlated with age and stage of glaucoma. Results: For intra-session reproducibility, the ICC, COV, and TRT values for mean RNFL thickness in normal eyes were 0.993, 1.96%, and 4.02 μm, respectively, 0.996, 2.39%, and 3.84 μm in glaucomatous eyes, and 0.996, 2.41%, and 3.70 μm in advanced glaucoma. The corresponding inter-session values in normal eyes were 0.992, 2.16%, and 4.09 μm, 0.995, 2.62%, and 3.98 μm in glaucoma and 0.990, 2.70%, and 4.16 μm in advanced glaucoma. The mean RNFL thickness measurements were the most reproducible while the temporal quadrant had the lowest reproducibility values in all groups. There was no correlation between reproducibility and age or mean deviation on visual fields. Conclusions: Peripapillary RNFL thickness measurements using Cirrus OCT® demonstrated excellent reproducibility in normal and glaucomatous eyes, including eyes with advanced glaucoma. Mean RNFL thickness measurements appear to be the most reproducible and probably represent the best parameter to use for longitudinal follow-up.

Ocular ischemic syndrome: A classical presentation of an uncommon condition.

We report a 47-year-old male who presented with acute monoocular vision loss, and had classical signs of global ocular ischemia in the right eye. Fundus fl uorescein angiography demonstrated delayed choroidal fi lling and no perfusion of retinal vasculature. Carotid Doppler and computed tomogram (CT) angiography studies revealed extensive bilateral atherosclerotic disease involving the carotid circulation. Ophthalmologists must be aware of the possibility of this potentially fatal condition, which is extremely rare. An astute clinical diagnosis, targeted workup for systemic associations and a prompt referral may turn out to be life-saving.

Optical coherence tomography findings and retinal changes after vitrectomy for optic disc pit maculopathy.

Purpose: To study the optical coherence tomography (OCT) patterns in optic disc pit maculopathy and retinal changes after vitreous surgery. Materials and Methods: Retrospective review of consecutive cases with optic disc pit maculopathy seen at two tertiary eye institutes from January 2005 to June 2009. Results: Twenty-four eyes of 23 patients are included. The presenting visual acuity ranged from 20/400 to 20/20 (median:20/80). The median age at presentation was 24 years (range, 6-57 years). Optical coherence tomography demonstrated a combination of retinoschisis and outer layer detachment (OLD) in 19 (79.17%) eyes, OLD only in 3 (12.5%) eyes and retinoschisis only in 2 (8.33%) eyes. An obvious communication (outer layer hole) between the schisis and OLD was seen in 14 (73.68%) of the 19 eyes with both features. Of the 21 eyes with retinoschisis, schisis was present in multiple layers in 15 (71.43%) and single layer in 6 (28.57%) eyes. Eleven eyes underwent pars plana vitrectomy including creation of posterior vitreous detachment (PVD), fluid-air exchange, low intensity laser photocoagulation at the temporal edge of the optic disc pit and non-expansile perfluoropropane gas (14%) injection. Five (45.45%) of 11 eyes undergoing vitrectomy had complete resolution and 4 (36.36%) eyes had partial resolution of maculopathy. Visual acuity improved in 8 (72.72%) of 11 eyes. Conclusion: Optical coherence tomography demonstrates multiple layer schisis and outer layer detachment as main features of optic disc pit maculopathy. Vitrectomy with PVD induction, laser photocoagulation and gas tamponade results in anatomical and visual improvement in most cases with optic disc pit maculopathy.

Cross-linking for microbial keratitis.

The success of collagen cross-linking as a clinical modality to modify the clinical course in keratoconus seems to have fueled the search for alternative applications for this treatment. Current clinical data on its efficacy is limited and laboratory data seems to indicate that it performs poorly against resistant strains of bacteria and against slow growing organisms. However, the biological plausibility of crosslinking and the lack of effective strategies in managing infections with these organisms continue to focus attention on this potential treatment. Well-conducted experimental and clinical studies with controls are required to answer the questions of its efficacy in future.