The distribution of visual field defects per quadrant in standard automated perimetry as compared to frequency doubling technology perimetry.

To test the ability of frequency doubling technology (FDT) perimetry to reveal defects in the same field quadrants as detected by standard automated perimetry (SAP). Ninety-two eyes with open-angle glaucoma and documented visual field defects by threshold SAP (Octopus Dynamic strategy) also underwent threshold FDT testing after successfully passing the FDT screening test. All eyes revealed varying stages of SAP defects while only 80 revealed FDT damage: 31:21 eyes in the early field loss stage, 36:35 in the moderate field loss stage, and 25:24 in the severe field loss stage in SAP versus FDT, respectively. SAP was able to detect abnormalities in 74 and 79% of the superotemporal, and inferotemporal quadrants, respectively, while the corresponding FDT figures were 70 and 69% for the same quadrants (P < 0.05 each). With regards to the nasal hemifield, SAP detected defects in 73 and 81% of the superonasal and inferonasal quadrants, respectively, compared to 69 and 66% for FDT (P < 0.001 each). The test duration per individual eye was significantly shorter with FDT than with SAP (P < 0.05). As well as the already established lower sensitivity of FDT compared to SAP, this study also demonstrated the significantly poorer ability of FDT in detecting the same field quadrant defects, especially in the early stages of glaucomatous damage.

Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: the second year of a prospective study.

PURPOSE: To demonstrate the efficacy of intravitreal bevacizumab for treatment of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, nonrandomized clinical study. METHODS: Fifty-one patients (51 eyes) with subfoveal choroidal neovascularization (CNV) resulting from AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. These patients had already completed 12 months of follow-up. The criteria for reinjection were presence of fluid in the macula, increased central retinal thickness (CRT) of at least 100 microm, loss of at least 5 letters of vision associated with increased fluid in the macula, new classic CNV, or new macular hemorrhage. The main outcome measure was the proportion of eyes losing fewer than 15 letters of vision after 12 months. RESULTS: Fifty-one patients (51 eyes) completed the additional 12 months. Mean visual acuity improved from 45.7 letters at baseline to 54.3 letters at 24 months (P = .001), and 47 eyes (92.2%) lost fewer than 15 letters. Mean CRT decreased from 327.4 microm at baseline to 246.6 mum at 24 months (P < .001). A mean of 1.5 injections were administered over the course of the second year. No serious ocular or systemic side effects were noted. CONCLUSIONS: Eyes with neovascular AMD treated with intravitreal bevacizumab over 2 years had significant anatomic and functional improvement compared with baseline. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.

Intravitreal triamcinolone acetonide: Pattern of secondary intraocular pressure rise and possible risk factors.

PURPOSE: To determine the pattern of increase in intraocular pressure (IOP) following intravitreal triamcinolone acetonide (IVTA) and identify possible risk factors associated with this rise in IOP. METHODS: We carried out a retrospective review of records for 185 patients (226 eyes) who received 4 mg of IVTA at the American University of Beirut Medical Center and Hotel Dieu de France eye clinics between 2003 and 2005 RESULTS: Mean follow-up was 8.17 months (range 6 to 24 months). The mean number of IVTA injections per eye was 1.31 +/- 0.69. The mean IOP increased after the first IVTA injection from 15.04 +/- 3.18 mmHg at baseline to a mean maximum of 17.20 +/- 5.75 mmHg (p < 0.0001, paired t-test) at month 3 of follow-up with a return to mean baseline IOP (15.49 +/- 4.79 mmHg) at month 12. Fifty nine of 226 eyes showed IOP higher than 21 mmHg during follow-up. Nine eyes started to have IOP greater than 21 mmHg, 6 to 12 months after a single injection. Intraocular pressure lowering medications were started when IOP exceeded 25 mmHg in 15 of the 226 eyes studied. No risk factors have been found to predict this IOP rise CONCLUSIONS: IOP elevation can occur in a significant number of eyes receiving 4 mg of IVTA. This phenomenon seems to be transient and a small number of eyes required treatment during this period. Eyes that received IVTA need to be monitored for IOP changes especially during the first 3 months, but the IOP may still rise 6 months and even 12 months after a single injection. This study did not show any risk factor that may predict this IOP rise.

Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: a one-year prospective study.

PURPOSE: To investigate the efficacy of intravitreal bevacizumab for treatment of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, nonrandomized clinical study. METHODS: Sixty patients (60 eyes) with subfoveal choroidal neovascular membrane (CNV) attributable to AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. All lesion types were included except for retinal angiomatous proliferation. In the initial treatment phase, intravitreal bevacizumab (2.5 mg/0.1 ml) was given at baseline, and then two additional monthly injections were given if the macula was not dry on optical coherence tomography. The criteria for re-injection after the induction phase were presence of new fluid in the macula, increased central retinal thickness (CRT) at least 100 microm, loss of at least five letters of vision with increased fluid in the macula, new classic CNV or new macular hemorrhages. Main outcome measure was the proportion of eyes losing <15 letters of vision after 12 months. RESULTS: Fifty-one patients (51 eyes) completed the 12 months. Mean visual acuity improved from 45.7 letters at baseline to 53.1 letters at 12 months (P = .004), and 47 eyes (92.2%) lost <15 letters. Mean CRT decreased from 327.4 microm at baseline to 227.8 microm at 12 months (P < .001). A mean of 3.4 injections were given over the course of the study, and no ocular or systemic side-effects were noted. CONCLUSION: Eyes with neovascular AMD treated with intravitreal bevacizumab over 12 months had significant anatomical and functional improvement. Further studies need to confirm the long-term efficacy of this treatment.

Corneal light shield as a delivery system for standardized application of mitomycin C in excimer surface ablation.

PURPOSE: To develop a simple, reproducible method of applying intraoperative mitomycin C (MMC) in excimer surface ablation surgery. METHODS: A two-part protocol was developed to study several properties of corneal light shields. Part A tested the amount of MMC (0.2 mg/mL) absorbed, expansion dimension attained, and amount released to filter paper. Part B examined in vitro release of MMC to a photorefractive keratectomy (PRK)-treated enucleated pig eye. RESULTS: Mean MMC absorbed by corneal light shields was 63.7 +/- 5.0 mg (range: 57.4 to 72.8 mg); coefficient of variability was 7.8%. Expansion diameter and thickness were constant at 9.0 mm and 1.1 mm, respectively. Mean solution released to filter paper was 55.4 +/- 3.9 mg (range: 51.3 to 63.5 mg); coefficient of variability was 7.1%. Mean solution transferred to the PRK-treated pig eye was 2.3 +/- 0.7 mg (range: 1.1 to 3.5 mg); coefficient of variability was 33%. CONCLUSIONS: Mitomycin C contact surface area, amount absorbed, and amount released by each corneal light shield were reproducible. Uniform dimensions theoretically provide uniform distribution of MMC. This method may allow standardization of intraoperative MMC application in excimer surface ablation.

Intravitreal bevacizumab vs verteporfin photodynamic therapy for neovascular age-related macular degeneration.

OBJECTIVE: To compare verteporfin photodynamic therapy (PDT) with intravitreal bevacizumab for management of choroidal neovascularization (CNV) associated with age-related macular degeneration. METHODS: Patients with predominantly classic CNV were prospectively randomized to receive standard PDT or intravitreal bevacizumab injections (2.5 mg). Best-corrected visual acuity (BCVA) measured by Snellen charts, central retinal thickness by optical coherence tomography, and greatest linear dimension of the CNV by fluorescein angiography were compared between the groups at baseline and at 3 and 6 months. Main outcome measures were stability or improvement in BCVA, decrease in central retinal thickness, and stability in greatest linear dimension. RESULTS: Mean baseline BCVA, central retinal thickness, and greatest linear dimension were not statistically different between the bevacizumab (n = 32) and PDT (n = 30) groups. Mean central retinal thickness was significantly better at 3 and 6 months in the bevacizumab group vs the PDT group (P = .04 and P = .002, respectively). At 3 months, mean BCVA and greatest linear dimension were not significantly different between the 2 groups. At 6 months, mean BCVA and greatest linear dimension were significantly better in the bevacizumab group (P < .001 and P = .02, respectively). CONCLUSION: During 6 months, intravitreal bevacizumab was superior to PDT in controlling predominantly classic CNV in age-related macular degeneration. Additional randomized clinical trials are necessary to determine if this benefit will remain with longer follow-up.

Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration.

PURPOSE: To investigate the efficacy and safety of intravitreal bevacizumab for managing choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). DESIGN: Prospective interventional case series. METHODS: Seventeen eyes of 17 patients with subfoveal CNV due to AMD participated in this study at the American University of Beirut Ophthalmology Clinics. All patients had failed, refused, or were not eligible for photodynamic therapy. All eyes received a baseline eye examination, which included best-corrected visual acuity (BCVA), dilated fundus examination, ocular coherence tomography (OCT) imaging, and fluorescein angiography. An intravitreal injection of bevacizumab (2.5 mg/0.1 ml) was given at baseline and followed by two additional injections at four-week intervals. BCVA, OCT, and fluorescein angiography were repeated four weeks after each injection. Main outcome measures were improvement in BCVA and central retinal thickness (CRT). RESULTS: Mean baseline BCVA was 20/252 (median 20/200), and baseline CRT was 362 microm (median 350 microm). Improvement in VA and CRT occurred by the fourth week. At 12 weeks, mean BCVA was 20/76 (P < .001) and median BCVA was 20/50 (P < .001). Both mean and median CRT decreased to 211 microm (P < .001). Thirteen (76%) of 17 eyes had total resolution of subretinal fluid, and four eyes (24%) had BCVA better than 20/50. No systemic or ocular side effects were noted at any time. CONCLUSION: Eyes with CNV due to AMD treated with intravitreal bevacizumab had marked anatomic and visual improvement. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.

Panretinal photocoagulation and intravitreal triamcinolone acetonide for the management of proliferative diabetic retinopathy with macular edema.

PURPOSE: To investigate intravitreal triamcinolone acetonide (IVTA) as an adjunctive therapy to panretinal photocoagulation (PRP) in patients with both high-risk proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). METHODS: Thirty-five eyes diagnosed with both high-risk PDR and CSME underwent PRP and a single injection of 4 mg of IVTA (IVTA group). Visual, anatomic, and fluorescein angiographic changes were documented. Any complications resulting from the combined procedure were noted. These data were compared retrospectively to 35 eyes that underwent grid laser treatment to the macula followed 2 weeks later by PRP (laser group). Main outcome measures included change in best-corrected visual acuity, improvement in macular edema (clinical or angiographic), and control of the neovascular disease. RESULTS: Mean follow-up was 9.6 months for the IVTA group and 11.9 months for the laser group. Mean pretreatment best-corrected visual acuity was 20/286 in the IVTA group and 20/282 in the laser group (P = 0.80). After 9 months of follow-up, visual acuity was 20/80 in the IVTA group versus 20/156 in the laser group (P = 0.007). Thirty-four percent of eyes in the IVTA group had final vision of 20/40 or better versus 11% in the laser group (P = 0.044). At 9 months follow-up, 84% of IVTA eyes had complete resolution of macular edema versus 46% of laser eyes (P = 0.002). Three eyes in the IVTA group had recurrence of macular edema after 6 months and required reinjection of IVTA. Elevation in intraocular pressure occurred in eight eyes in the IVTA group and responded to topical therapy. Cataract progression was observed in nine eyes in the IVTA group. CONCLUSIONS: The addition of intravitreal triamcinolone acetonide to PRP in the management of patients with both PDR and CSME seems promising. Further study is needed to assess the effect of this combined treatment.

Plasma thymulin and nerve growth factor levels in patients with primary open angle glaucoma and elevated intraocular pressure.

BACKGROUND: The objective was to measure the plasma concentrations of thymulin and nerve growth factor (NGF) in a group of patients with primary open angle glaucoma (POAG) and compare them with age- and sex-matched normal controls. METHODS: Twenty-eight patients newly diagnosed with POAG who were not undergoing treatment were compared with the same number of age- and sex-matched healthy controls. Blood samples were drawn into heparinized tubes and plasma samples were collected for the determination of the concentrations of thymulin and NGF, using specific enzyme-linked immunosorbent assay (ELISA). The Student's t test was used to perform the necessary statistical analysis of the results. RESULTS: Seventeen women and 11 men were enrolled in each of the two groups (study and control), with a mean age of 63.7 (SD 10.3) years in the former and 63.3 (SD 9.6) years in the latter. There was a highly significant (p<0.001) elevation in the thymulin levels in POAG patients compared with the control group. However, no significant difference was observed when comparing the plasma NGF levels. CONCLUSION: This is the first report to measure plasma thymulin levels in glaucoma patients. The significant results point the possible role of this immunomodulator in the pathogenesis of primary open angle glaucoma. The potential role of NGF seems to be less likely. These findings warrant further investigation.

Intravitreal triamcinolone for the management of macular edema due to nonischemic central retinal vein occlusion.

OBJECTIVE: To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to nonischemic central retinal vein occlusion (CRVO). METHODS: Twenty consecutive patients were selected with a 3- to 4-month history of nonischemic CRVO and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide (40 mg/mL). The follow-up period ranged from 10 to 12 months. The amount of macular edema was assessed by the amount of retinal thickening on clinical examination using the Goldmann contact lens and by the area and intensity of staining on fluorescein angiography. Treated patients were compared with a retrospectively matched group of patients who were managed with observation only. MAIN OUTCOME MEASURES: Changes in visual acuity and amount of macular edema were assessed in the treated patients and compared with the observation group. RESULTS: The mean baseline visual acuity in the treatment group was 20/132 vs 20/123 for the observation group (P =.57). After 1 week, the treated group had a mean visual acuity of 20/51. At final follow-up, the treated group had a mean visual acuity of 20/37 while the observation group had a mean visual acuity of 20/110 (P =.001). Sixty percent of treated patients had a final visual acuity of 20/40 or better vs only 20% in the observation group (P =.01). Forty percent of the untreated patients had a final visual acuity worse than 20/200 while none of the treated patients did (P<.001). At final follow-up, 75% of treated patients had complete resolution of macular edema on clinical examination vs only 20% of the untreated patients (P<.001). Two of the treated patients had recurrence of macular edema at 6 months, and 3 had elevated intraocular pressure. CONCLUSION: This study shows a treatment benefit from intravitreal triamcinolone in terms of visual acuity and macular edema for nonischemic CRVO.

Modified technique for tube fixation in conjunctivodacryocystorhinostomy.

The standard glass tube used with a conjunctivodacryocystorhinostomy is subject to spontaneous displacement or extrusion, especially in the early postoperative period. To anchor the tube in the surrounding tissues, a suture is commonly tied around the collar of the Pyrex tube and externalized to the skin of the medial canthal area where it is fixed. The loop can become loose around the tube, and displacement or extrusion can occur. We describe an alternative method to better secure the tube in place during the early postoperative period and until the time when the tissues around the tube contract.

Anterior canthal tendon release for correction of the centurion syndrome.

PURPOSE: To investigate the effectiveness of anterior canthal tendon release in the management of centurion syndrome. METHODS: Four patients diagnosed as having the centurion syndrome were treated over a period of 3 years. They all underwent bilateral anterior canthal tendon release under local anesthesia. RESULTS: None of these patients had adequate apposition of the lower puncta after surgery. One patient had partial relief of epiphora on one side. CONCLUSIONS: Our results indicate that anterior canthal tendon release is insufficient as a sole treatment for patients with centurion syndrome.

Anticardiolipin antibodies in patients with retinal vein occlusion and no risk factors: a prospective study.

BACKGROUND: Several reports have described the association between antiphospholipid antibodies (APAs) and retinal venous occlusive (RVO) disease. The purpose of this study was to look at the prevalence of these antibodies in patients with RVO disease and no conventional risk factors. We specifically examined how APAs may affect the course of this disease. METHODS: Twenty-four patients with the diagnosis of RVO disease were screened prospectively for APAs. All were free from risk factors for retinal vein thrombosis and other immunologic conditions. Patients were observed for a period of 3 to 12 months. RESULTS: Lupus anticoagulant was negative in all 24 patients. Ten (43%) of 24 patients had anticardiolipin antibodies (ACAs). All patients with ACAs were younger than 45 years of age, with an average age of 33 years. The average age of patients with no ACAs was 66 years. Comparison of the average age of the two groups showed a statistically significant difference. There was no statistical significance between the two groups for development of neovascular disease. Seropositive patients who developed neovascularization had elevated titers for an average of 11.8 weeks versus 3.3 weeks for those who did not have neovascularization. Neovascular complications generally began several weeks after the titers became negative. CONCLUSION: There was a significant prevalence of ACAs in young patients with RVO disease and no associated systemic risk factors. Seropositive patients who developed neovascular disease had elevated titers for more than 6 weeks. However, the role of these transient ACAs in retinal vein occlusion is still not clear and merits further study.

Branch retinal artery occlusion following embolization of a maxillary sinus tumor.

Retinal vascular complications following embolization of carotid artery branches have been occasionally reported. Since the result can be catastrophic and is often irreversible, all efforts to prevent this complication should be considered prior to the intervention. We report the occurrence of a branch retinal artery occlusion following embolization of a maxillary sinus tumor. Cerebral angiography pre- and post-embolization; pathology results from the excised tumor; fundoscopic, visual field, and fluorescein angiographic findings are reported. A combination of risk stratification and preoperative evaluation methods which might help in prevention of this serious complication are discussed.

Mitomycin C as adjunct therapy in correcting punctal stenosis.

PURPOSE: To assess the efficacy of intraoperative mitomycin C in improving the success rate of the posterior punctectomy procedure. METHODS: The charts of all patients who underwent posterior punctectomy between the years 1997 and 2000 were reviewed. The procedure was done without mitomycin C (n = 26 eyes, group A) until the end of 1998 and with mitomycin C (n = 25 eyes, group B) starting in 1999. The Kaplan-Meier curve was used for statistical evaluation. RESULTS: In group A, 5 of 26 (19.2%) eyes had complete anatomic obstruction and scarring of their puncta after surgery, compared with 0 of 25 (0.0%) eyes in group B. The difference was statistically significant (P<0.02). No significant complications were observed. CONCLUSIONS: Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.