Modified Wise closure of the conjunctival fornix-based trabeculectomy flap.

We present modifications to the Wise fornix-based conjunctival trabeculectomy flap technique that have minimized early wound leakage in our experience. A retrospective chart review of 509 consecutive eyes revealed a 2.9% leak rate in the first postoperative month and 1.6% returned to the operating room to resuture a persistent leak. If meticulously performed, this modified closure technique may provide watertight closure as commonly as limbal-based techniques.

Simplified ab externo scleral fixation for late in-the-bag intraocular lens dislocation.

Many surgical techniques to repair late in-the-bag intraocular lens (IOL) dislocation have been described. We present a modification to ab externo scleral fixation of in-the-bag IOL dislocation that minimizes cumbersome intraocular manipulations. Using an iris hook for intraocular suture retrieval under direct visualization eliminates the need to mate the suture needle with a hypodermic needle, and the site through which the hook is used provides an ideal place for suture knot burial, potentially minimizing late suture erosion or exposure.

Measurement of intraocular and intracranial pressure: is there a relationship?

OBJECTIVE: To study whether noninvasive, intraocular pressure (IOP) measurements significantly correlate with standard intracranial pressure (ICP) measurements. METHODS: This prospective, blinded study enrolled 46 patients who were undergoing medically indicated lumbar puncture (LP). IOP was measured by applanation tonometry immediately prior to measuring LP opening pressure. One patient was excluded due to unsuccessful ICP measurement. RESULTS: In the 45 patients to successfully undergo IOP and ICP measurement, there was no significant relationship between ICP and average IOP for both eyes (r = -0.005). There was no significant relationship between ICP and IOP in either eye, when studied individually(r = 0.03 ocular dexter [OD], r = -0.05 ocular sinister [OS]). There was no significant relationship between ICP and IOP when the eye best correlated to the patient's ICP was chosen (r = -0.01). INTERPRETATION: No significant relationship between ICP and IOP was observed. Noninvasive IOP measurements do not predict ICP.

Is monthly retreatment with intravitreal bevacizumab (Avastin) necessary in neovascular age-related macular degeneration?

PURPOSE: To report our short-term experience with bevacizumab in neovascular age-related macular degeneration (AMD) and recommend a new treatment strategy. METHODS: Retrospective chart review of 29 consecutive patients receiving 1.25 mg of intravitreal bevacizumab for AMD and completing 12 weeks of follow up. Outcome measures were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness. Injections were repeated if no further improvement was observed. RESULTS: Twenty-nine eyes of 29 patients were included. The average BCVA improved from 20/148 at baseline to 20/106 at twelve weeks (P = 0.041). Of the 29 eyes, 25 (86.2%) had stable or improved BCVA. Average mean central macular thickness measured by OCT improved from 351 mum at baseline to 278 mum at 12 weeks (P = 0.003). Stabilization of vision and improved OCT central macular thickness were maintained for at least eight weeks following only a single injection in the majority of eyes. During the three months of follow up, only five eyes (17.2%) required repeat injections, with only three (10.3%) requiring retreatment at eight weeks and none at four weeks. No significant ocular or systemic side effects were observed. CONCLUSION: This short-term data suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD. Injections as frequent as every month do not appear to be necessary since initial treatment effect appears to be maintained for at least eight weeks in almost all of our patients.

Quantification of error in optical coherence tomography central macular thickness measurement in wet age-related macular degeneration.

PURPOSE: To assess error indicators encountered during optical coherence tomography (OCT) automated retinal thickness measurement (RTM) in neovascular age-related macular degeneration (NVAMD) before and after bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) treatment. DESIGN: Retrospective observational cross-sectional study. METHODS: Each of the 6 radial lines of a single Stratus fast macular OCT study before and 3 months following initiation of treatment in 46 eyes with NVAMD, for a total of 552 scans, was evaluated. Error frequency was analyzed relative to the presence of intraretinal, subretinal (SR), and subretinal pigment epithelial (SRPE) fluid. In scans with edge detection kernel (EDK) misplacement, manual caliper measurement of the central macular (CMT) and central foveal (CFT) thicknesses was performed and compared to the software-generated values. The frequency of the various types of error indicators, the risk factors for error, and the magnitude of automated RTM error were analyzed. RESULTS: Error indicators were found in 91.3% and 71.7% of eyes before and after treatment, respectively (P = .013). Suboptimal signal strength was the most common error indicator. EDK misplacement was the second most common type of error prior to treatment and the least common after treatment (P = .005). Eyes with SR or SRPE fluid were at the highest risk for error, particularly EDK misplacement (P = .039). There was a strong association between the software-generated and caliper-generated CMT and CFT measurements. The software overestimated measurements by up to 32% and underestimated them by up to 15% in the presence of SR and SRPE fluid, respectively. CONCLUSIONS: OCT errors are very frequent in NVAMD. SRF is associated with the highest risk and magnitude of error in automated CMT and CFT measurements. Manually adjusted measurements may be more reliable in such eyes.

Intravitreal bevacizumab (avastin) treatment of retinal angiomatous proliferation.

PURPOSE: To report our short-term experience with intravitreal bevacizumab treatment of retinal angiomatous proliferation (RAP) in neovascular age-related macular degeneration (AMD). METHODS: A retrospective, interventional case series was performed that included 13 patients who received intravitreal injection of bevacizumab (1.25 mg) for treatment of RAP and completed 12 weeks of follow-up. Ophthalmic assessment included determination of best-corrected Snellen visual acuity (BCVA), complete ocular examination, fluorescein angiography, and optical coherence tomography (OCT). Injections were repeated if no further improvement or worsening was observed after an initial favorable functional and/or anatomical response. Main outcome measures were BCVA and central macular thickness (CMT) measured by OCT. RESULTS: Twelve eyes (92.3%) had stable or improved BCVA, and 8 eyes (61.5%) had at least 2 lines of vision improvement. The average BCVA improved from 20/203 at baseline to 20/113 at 12 weeks (P = 0.001). Average CMT improved from 369 mum at baseline to 216 microm (P = 0.016) and 315 microm (P = 0.020) at 8 weeks and 12 weeks, respectively. Six eyes underwent fluorescein angiography at the 12-week follow-up visit; 3 (50%) of these eyes had decreased leakage compared with baseline. Both stabilization of vision and improved CMT were maintained for at least 8 weeks after a single injection in almost all eyes. No significant side effects were observed. CONCLUSION: These short-term data suggest that bevacizumab is a viable treatment option for RAP in AMD. The initial treatment effect appears to be maintained for at least 8 weeks.

Lens structure in MIP-deficient mice.

In this study we used correlative light, scanning, and transmission (freeze-etch) electron microscopy to characterize lens structure in normal mice and compare it with that in mice deficient in the major intrinsic protein (MIP) of fiber cells. Grossly, wild-type lenses were transparent and had typical Y sutures at all of the ages examined. These lenses had fibers of uniform shape (hexagonal in cross section) arranged in ordered concentric growth shells and radial cell columns. In addition, these fibers had normal opposite end curvature and lateral interdigitations regularly arrayed along their length. Ultrastructural evaluation of these fibers revealed anterior and posterior end segments characterized by square array membrane on low-amplitude wavy fiber membrane. Approximately 13% of the equatorial or mid segments of these same fibers were specialized as gap junctions (GJs). In contrast, heterozygote lenses, while initially transparent at birth, were translucent by 3 weeks of age, except for a peripheral transparent region that contained fibers in the early stages of elongation. This degradation in clarity was correlated with abnormal fiber structure. Specifically, although the mid segment of these fibers was essentially normal, their end segments lacked normal opposite end curvature, were larger than normal, and had a distinct non-hexagonal shape. As a result, these fibers failed to form typical Y sutures. Furthermore, the nuclear fibers of heterozygote lenses were even larger and lacked any semblance of an ordered packing arrangement. Grossly, homozygote lenses were opaque at all ages examined, except for a peripheral transparent region that contained fibers in the early stages of elongation. All fibers from homozygote lenses lacked opposite end curvature, and thus failed to form any sutures. Also, these fibers were essentially devoid of interlocking devices, and only 7% of their mid segment was specialized as GJs. The results of this study suggest that MIP has essential roles in the establishment and maintenance of uniform fiber structure, and the organization of fibers, and as such is essential for lens function.