No abstract

This study suggests that combined treatment with intravitreal bevacizumab and intravitreal triamcinolone improves structural outcome in patients with retinal vein occlusion. In our study, the combination of triamcinolone acetonide and bevacizumab offered no advantage over previously published results with intravitreal bevacizumab injections alone for improving vision at 6 months.

Purpose To describe the clinical presentation and management of late (>3.0 years) acute graft rejection in keratolimbal allograft (KLAL) recipients. Methods Multicenter, retrospective observational case series. 6 eyes of 6 patients with ocular surface transplant at a mean age of 36.2 years seen at 3 tertiary referral centers for acute graft rejection between 2007 and 2013. Main outcome measures included strength of systemic immunosuppression (SI) at the time of rejection, time to rejection, and clinical presentation of rejection. Results Preoperative diagnoses included total limbal stem cell deficiency (LSCD) due to aniridia (n = 2) or chemical injury (n = 4). Following an initially successful outcome, patients experienced late acute graft rejection at a mean time of 67.8 ± 24.1 months (range: 41 to 98) after KLAL while receiving suboptimal levels of SI due to medication taper (n = 5) or noncompliance (n = 1). Objective findings included an epithelial rejection line (n = 6), edema (n = 2), corneal epithelial irregularities (n = 2), and neovascularization (n = 1). Anti-rejection management consisted of topical corticosteroids (n = 6) and augmentation of SI therapy (n = 5). Conclusion These cases of late acute graft rejection in KLAL patients support the notion that allodonor cells can persist over the long run and remain at risk for immunologic rejection. It further underscores the fact that long-term success with KLAL may require extension of SI beyond the first few years, albeit at lower levels individualized to each patient.

Blood flow velocities and calculated vascular resistance of the OA, CRA, and PCAs conducted within 2 weeks in patients with OAG are repeatable. Intraobserver CDI measurements were found more reproducible than interobserver CDI analysis.

Colour Doppler imaging (CDI) is a frequently cited methodology for quantifying ocular blood flow velocities. This investigation reviews the feasibility of creating a normative database of CDI parameters in glaucoma patients and controls. A literature search was conducted for CDI studies involving glaucomatous eyes. Using data from these studies, a weighted mean was derived for the peak systolic velocity, end diastolic velocity and Pourcelot's resistive index in the ophthalmic, central retinal and posterior ciliary arteries. A multivariate analysis was performed to identify whether methodological characteristics contributed to the inter-study variance in CDI values. Data from 3061 glaucoma patients and 1072 controls were included. The mean values for glaucomatous eyes were within one standard deviation of the values for controls for most CDI parameters. Gender mix (p=0.043), intraocular pressure status (p=0.017), frequency of the ultrasound transducer (p=0.02) and whether the patients were on antihypertensive therapy (p=0.004) contributed to the variance. Methodological differences create inter-study variance in CDI values, complicating the construction of a normative database and limiting its utility. Because the mean values for glaucomatous and normal eyes have overlapping ranges, caution should be used when classifying glaucoma status based on a single CDI measurement.

No abstract

In this group of patients with OAG, there was a strong correlation between GAT and DCT measurements of IOP. IOP measured with DCT was consistently higher than IOP measured with GAT. Neither GAT nor DCT measurements were correlated with CCT. This data suggests that factors other than CCT may be involved in the tendency of DCT to produce higher measures of IOP than GAT.

Patients with homonymous hemianopia (HH) often fail to meet visual field (VF) requirements for a driver's license. We describe 2 patients with complete HH, who met the minimum VF requirements for driving using a novel, high-power, monocular sector prism system. Baseline VFs were assessed using automated and kinetic perimetry. Patients were fitted with glasses and press-on 57-PD peripheral monocular sector prisms placed on the lens ipsilateral to the VF defect above and below the visual axis with prisms oriented obliquely. Kinetic perimetry was reassessed both monocularly and binocularly, with and without prisms. The 2 patients had 95° and 82° angle of continuous, horizontal, binocular VF. With the use of the prism system, the binocular VF increased to 115° and 112° angles. Both patients reported improvement in quality of life and each holds a valid driver's license and has successfully operated a motor vehicle without any restrictions or accidents. These findings suggest that the addition of oblique 57-PD prisms to the ipsilateral spectacle lens above and below the visual axis for patients with complete HH can significantly increase horizontal VF, which may help an individual become visually qualified to obtain a driver's license.