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Biomedical subjects

Ingrid U Scott

Publications and source records attributed to Ingrid U Scott.

At least 73 records · Page 4Linked to original sources
PubMed2002

Hemiretinal vein occlusion associated with membranous glomerulonephritis.

PURPOSE: To report a patient in whom the finding of hemiretinal vein occlusion led to the diagnosis of membranous glomerulonephritis. DESIGN: Interventional case report. METHODS: A 44-year-old tennis instructor presented with a 1-week history of blurred vision in the left eye. Examination of the left eye demonstrated a best-corrected visual acuity of 20/40 and an inferior hemiretinal vein occlusion. RESULTS: Blood pressure was normal, and the patient was referred for a medical examination, which revealed membranous glomerulonephritis. The patient was treated with oral prednisone and cyclosporine. Four months after presentation, the left eye demonstrated resolution of the vascular abnormalities and had a best-corrected visual acuity of 20/20. CONCLUSION: Retinal vein occlusion may be associated with membranous glomerulonephritis. Treatment of the systemic disease may be associated with regression of the retinal vascular abnormalities.

Adult↗
PubMed2002

Impact of visual function on computer task accuracy and reaction time in a cohort of patients with age-related macular degeneration.

PURPOSE: To investigate the impact of visual function parameters on computer task performance in patients with age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: Eighteen patients with visual impairment due to age-related macular degeneration underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed 125 computer icon identification tasks. Relationships between computer task performance (accuracy and speed) and visual function parameters (visual acuity, contrast sensitivity, visual field, and color vision) were analyzed. RESULTS: Visual acuity and contrast sensitivity in the better eye, weighted average contrast sensitivity, and color vision defects are significantly associated with computer task accuracy. Visual acuity in the better eye, weighted average visual acuity, and color vision defects are significantly associated with performance speed. Visual function parameters and clinical features significantly associated with computer task accuracy in a multiple regression model include weighted average contrast sensitivity (P = 0.001), protan color vision defect (P = 0.002), cataract severity in the better-seeing eye (P = 0.036), and geographic atrophy outside the central macula (P = 0.046). Visual function parameters and clinical features significantly associated with computer task speed in a multiple regression model include color vision defects (deutan, P < 0.001; protan, P < 0.001) and gender (P = 0.05). CONCLUSIONS: Among this cohort of patients with AMD, visual acuity, contrast sensitivity, and color vision defects are significant predictors of computer task performance. Visual function parameters of the better eye played a more significant role than parameters of the worse eye, and contrast sensitivity is the most significant predictor of computer task accuracy.

Activities of Daily Living↗
PubMed2002

Acute zonal occult outer retinopathy: a long-term follow-up study.

PURPOSE: To report the long-term follow-up of patients with acute zonal occult outer retinopathy (AZOOR). DESIGN: Observational consecutive case series. METHODS: Prospective and retrospective review of medical records of patients with AZOOR. RESULTS: Fifty-one patients (37 women and 14 men) with a median age of 33 years (mean, age 36 years; range, 13-63 years) were followed for a median of 96 months (mean 100 months; range, 36-420 months). At presentation, AZOOR was present in one eye of 31 patients (61%) and both eyes in 20 patients (39%). All patients presented with an acute loss of one or more zones of visual field, and 45 (88%) patients presented with photopsia. Corrected visual acuity was 20/40 or better in 68 (76%) of 90 affected eyes. Funduscopic examination was normal in 82 eyes and revealed signs of AZOOR in 8 eyes. Electroretinographic amplitudes were depressed in all affected eyes. The median delay in diagnosis of AZOOR was 17 months. During follow-up, AZOOR developed in 19 fellow eyes. At final follow-up AZOOR was present in one eye of 12 (24%) patients and both eyes of 39 (76%) patients. Sixteen patients had 23 recurrences of AZOOR. Visual field loss stabilized within 6 months in 37 patients (72%), progressed stepwise in 2 patients (4%), and partly improved in 12 patients (24%). Fourteen patients (28%) had autoimmune diseases, including Hashimoto's thyroiditis in 6 patients and relapsing transverse myelopathy in 4 patients. At last follow-up all patients had residual visual field defects. Final visual acuity was 20/40 or better in 61 (68%) affected eyes. Nine patients (18%) were legally blind. The fundi of 90 affected eyes revealed no changes of AZOOR in 47 eyes (52%) and changes in the pigment epithelium and retina caused by AZOOR in 43 eyes (48%). CONCLUSIONS: Visual loss in AZOOR is characterized by one or more episodes of acute dysfunction, and in some cases, death of retinal receptor cells in one or more zones of one or both eyes. Central vision is often spared, but recovery of visual field occurs infrequently. The etiology of AZOOR is unknown. Electroretinography is essential for early diagnosis. The value of treatment is uncertain.

Acute Disease↗
PubMed2002

Local anesthesia with intravenous sedation for surgical repair of selected open globe injuries.

PURPOSE: To report factors associated with the use of local anesthesia with intravenous sedation (local anesthesia/sedation) rather than general anesthesia for surgery for open globe injuries in adult reparable eyes. DESIGN: Retrospective, nonrandomized, comparative case series. METHODS: Medical records were reviewed of all patients with open globe injuries repaired at Bascom Palmer Eye Institute between 1995 and 1999. "Adult reparable eyes" (eyes in patients >/=18 years of age, not treated with primary enucleation or evisceration, followed up >/=2 months) were included. RESULTS: In all, 220 eyes of 218 patients met inclusion criteria. General anesthesia was employed in 80 of 200 (36%) and local anesthesia/sedation in 140 of 220 (64%). Patients who had local anesthesia/sedation were significantly more likely to have an intraocular foreign body (31% vs 14%; P =.010, chi-square test), better presenting visual acuity (1.8 logMAR [logarithm of the minimum angle of resolution] units vs 2.5 logMAR units; P <.001, t test), more anterior wound location (75% corneal/limbal vs 65%; P =.003, chi-square), shorter wound length (6.3mm vs 10.8mm; P <.001, t test), and dehiscence of previous surgical wound (26% vs 12%; P =.021, chi-square) and were significantly less likely to have an afferent pupillary defect (22% vs 51%; P <.001, chi-square). There was no anesthesia-related complication in either group. The local anesthesia/sedation group had a shorter mean operating time than did the general anesthesia group (78 minutes vs 117 minutes; P <.001, t test). The general anesthesia group had a longer mean follow-up than the local anesthesia/sedation group (20.2 months vs 13.9 months, respectively; P =.002, t test). Change in visual acuity between the presenting and final examinations was similar for open globe injuries repaired with general anesthesia compared with local anesthesia/sedation (0.94 vs 0.72 logMAR units of visual acuity, respectively; P =.16, t test). CONCLUSIONS: Local anesthesia/sedation is a reasonable alternative to general anesthesia for selected patients with open globe injuries.

Adolescent↗
PubMed2002

Impact of graphical user interface screen features on computer task accuracy and speed in a cohort of patients with age-related macular degeneration.

PURPOSE: To investigate the impact of graphical user interface screen features on computer task performance in patients with age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: Eighteen patients with visual impairment due to AMD were recruited from the Bascom Palmer Eye Institute Low Vision Clinic. Each patient underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed computer icon identification tasks while the following screen features of the graphical user interface were varied: size of icons displayed, icon set size (number of icons displayed), and background color. Each patient performed all 125 computer tasks with each of five icon sizes (9.2 mm, 14.6 mm, 23.2 mm, 36.8 mm, 58.3 mm), each of five icon set sizes (2, 3, 4, 5, 6), and each of five different background colors (black, white, red, green, blue) in a randomly ordered fashion. Relationships between computer task performance (accuracy and speed) and graphical user interface screen features were studied. RESULTS: Icon size and icon set size are significantly associated with computer task accuracy (P <.001), whereas background color is not a significant predictor of task accuracy (P =.63). The impact of icon size on accuracy is nonlinear, with the data indicating that no additional improvement in accuracy is associated with increasing the icon size beyond 23.2 mm. The impact of icon set size on accuracy is linear, with a smaller icon set size significantly associated with greater computer accuracy. A larger icon size is significantly associated with a shorter time to task completion (P =.001); this relationship is largely linearly related to icon size. There was no significant impact of background color (P =.11) or set size (P =.37) on time to task completion. CONCLUSIONS: Modifications of graphical user interface design may permit improved computer task performance among patients with visual impairment due to AMD.

Adult↗
PubMed2002

Human papillomavirus 16 and 18 expression in conjunctival intraepithelial neoplasia.

OBJECTIVE: To evaluate conjunctival intraepithelial neoplasia (CIN) and normal conjunctiva for the presence of human papillomavirus (HPV) DNA and for expression (as detected by the presence of mRNA) of the HPV E6 region. DESIGN: Prospective, case-controlled study. PARTICIPANTS: Ten consecutive patients who underwent CIN excision by one surgeon (CLK) and five age-matched control subjects who underwent retinal detachment repair at the Bascom Palmer Eye Institute. METHODS: A reverse transcriptase in situ polymerase chain reaction (PCR) technique was used to search for the presence of HPV mRNA in CIN specimens from 10 consecutive patients who underwent CIN excision by one surgeon (CLK) at Bascom Palmer Eye Institute, as well as in clinically uninvolved conjunctival specimens from the same eyes of these patients. In addition, conjunctival specimens from five control subjects (age-matched to five of the cases), who had no clinically identifiable conjunctival disease and who underwent retinal detachment repair at the Bascom Palmer Eye Institute, were analyzed in a similar manner. The clinical diagnoses of CIN and normal conjunctiva were confirmed histopathologically in all cases by an ocular pathologist, who was masked as to the patients' clinical diagnoses, and the PCR testing was performed by an investigator (GJN) who was masked as to the clinical diagnoses. RESULTS: HPV 16 DNA and mRNA were present in five CIN specimens, and HPV 18 DNA and mRNA were present in the other five CIN specimens; neither HPV 16 or 18 DNA nor mRNA were detected in any of the control specimens or in any of the clinically uninvolved conjunctival specimens (P < 0.001). In each of the CIN specimens, 20% to 40% of the dysplastic cells expressed the HPV E6 region. CONCLUSIONS: HPV 16 or 18 DNA and mRNA corresponding to the E6 region were detected in all CIN specimens examined. HPV 16 or 18 DNA or mRNA was not present in any of the control or uninvolved conjunctival specimens. The consistency of the current findings with those reported for human cervical malignant lesions, and the fact that the protein encoded by the E6 region of HPV 16 and 18 has been shown to form a complex with the protein encoded by the host tumor suppressor gene p53, provide strong evidence for an etiologic role of HPV in the development of CIN.

Carcinoma in Situ↗
PubMed2002

Assessment of vision-related function in patients with age-related macular degeneration.

OBJECTIVE: To investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DESIGN: Prospective noncomparative observational case series. PARTICIPANTS: One hundred fifty-nine consecutive patients attending a sole practitioner's academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. MAIN OUTCOME MEASURES: Correlations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. RESULTS: There was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = -0.50), and overall quality of vision (r = -0.56). A strong correlation was noted between VF-14 score and patients' self-rating of amount of trouble with vision (r = -0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients' self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = -0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. CONCLUSIONS: The VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.

Aged↗
PubMed2002

Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes.

OBJECTIVE: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. MAIN OUTCOME MEASURES: Visual acuity outcomes and intraocular pressure control after endophthalmitis. RESULTS: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31%) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31%) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: > or = 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and < 5/200 (64% versus 31%). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11%) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. CONCLUSIONS: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

Adult↗
PubMed2002

Outcomes and complications associated with giant retinal tear management using perfluoro-n-octane.

OBJECTIVE: To report visual acuity and anatomic outcomes, as well as complications, associated with giant retinal tear management using intraoperative perfluoro-n-octane and to investigate clinical features associated with anatomic and visual acuity outcomes. DESIGN: A prospective, noncomparative, observational, multicenter study. PARTICIPANTS: Two hundred twelve patients (212 eyes) > or =15 months of age who underwent giant retinal tear management with intraoperative perfluoro-n-octane at 24 study sites between April 1994 and February 1996. Giant retinal tear was defined as a retinal tear extending > or =90 degrees. INTERVENTION: Vitrectomy with perfluoro-n-octane intraoperative retinal tamponade. MAIN OUTCOME MEASURES: Visual acuity and rates of retinal reattachment, reoperation, retained perfluoro-n-octane, corneal edema, elevated intraocular pressure (IOP > 25 mmHg), hypotony (IOP < 5 mmHg), and cataract. All outcome measures were assessed at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively and at the last examination. RESULTS: The study included 212 eyes of 212 patients followed a median of 3.5 months. Visual acuity > or =20/200 was measured in 56 (27%) patients preoperatively and 67 (47%) patients at 6 months. Postoperative visual acuity improved in 107 (59%) eyes, remained stable in 44 (24%) eyes, and worsened in 29 (16%) eyes (percentages are based on the number of patients for whom the data were available at these time points). Of the 124 patients with visual acuity < or =5/200 preoperatively, 94 (76%) had improved visual acuity at 6 months postoperatively. At 6 months, the retina was attached in 108 (76%) eyes, and retained perfluoro-n-octane was noted in 8 (6%) eyes. Throughout follow-up, 64 (30%) eyes underwent reoperation for recurrent retinal detachment. At 6 months, corneal edema, elevated IOP, and hypotony were noted in 5 (4%), 4 (3%), and 12 (9%) eyes, respectively. Of the 72 phakic eyes without cataract preoperatively, 61 (85%) had a cataract or underwent cataract extraction during study follow-up. Factors significantly (P < 0.05) associated with recurrent retinal detachment include female gender, younger age, preoperative proliferative vitreoretinopathy, prior vitrectomy, larger size of giant retinal tear, lack of scleral buckle placement, and relaxing retinotomy. Multivariate analysis demonstrated that female gender, larger size of giant retinal tear, and prior vitrectomy were significantly associated with recurrent detachment. Factors significantly associated with vision >or =20/200 include male gender, no prior vitrectomy, better preoperative vision, and no need for relaxing retinotomy. After adjusting for recurrent detachment, factors significantly associated with vision > or =20/200 include no prior vitrectomy, better preoperative vision, and no need for relaxing retinotomy. CONCLUSIONS: Retinal reattachment and preserved visual acuity were achieved in most eyes that underwent giant retinal tear management with intraoperative perfluoro-n-octane. Significant risk factors for recurrent retinal detachment include size of retinal tear, age, prior vitrectomy, and female gender. After adjusting for recurrent detachment, significant predictors of postoperative vision >or =20/200 include no prior vitrectomy, better preoperative vision, and no need for relaxing retinotomy.

Adolescent↗
PubMed2002

Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy.

PURPOSE: To investigate factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy (ICSC). METHODS: Retrospective consecutive case series that included patients with ICSC who were younger than 50 years of age at the time of initial examination and were followed up for > or =3 years. RESULTS: The mean follow-up for 101 involved eyes of 61 patients was 9.8 years (median, 8.0 years). Eyes were stratified into two groups based on visual acuity at the final examination: Group 1, visual acuity of 2040 or better; and Group 2, visual acuity of worse than 2040. Findings identified as potential risk factors for reduced vision at the final follow-up examinations for Group 1 versus Group 2 included the following: macular retinal pigment epithelium atrophy (90.8% versus 96.0%, respectively; P = 0.68); persistent pigment epithelial detachment or persistent subretinal fluid (5.3% versus 28.0%, respectively; P = 0.004); recurrences (39.5% versus 68.0%, respectively; P = 0.020); laser treatment (28.9% versus 32.0%, respectively; P = 0.80); and submacular choroidal neovascularization (0.0 versus 8.0%, respectively; P = 0.059). CONCLUSIONS: Factors associated with reduced visual acuity during long-term follow-up of patients with ICSC included persistent pigment epithelial detachment and/or subretinal fluid, recurrences, and submacular choroidal neovascularization.

Adult↗
PubMed2002

Retinal detachment in patients with a preexisting glaucoma drainage device: anatomic, visual acuity, and intraocular pressure outcomes.

PURPOSE: To report anatomic, visual acuity, and intraocular pressure (IOP) outcomes after retinal detachment (RD) repair in patients with a preexisting glaucoma drainage device. METHODS: Consecutive case series including patients with a preexisting glaucoma drainage device who underwent RD repair at Bascom Palmer Eye Institute between 1989 and 1999. RESULTS: Ten patients were identified with a mean follow-up of 18 months. Initial RD repair included pars plana vitrectomy (PPV) and fluid-gas exchange in four patients, scleral buckling procedure (SBP) in two, PPV and SBP in three, and pneumatic retinopexy in one. Three patients initially treated with SBP or pneumatic retinopexy developed recurrent RD secondary to proliferative vitreoretinopathy. All patients eventually underwent PPV. At 6 months, the retina was attached in eight patients, and nine patients had an IOP no greater than 21 mmHg. Although postoperative vision was stable or improved compared to preoperative levels in seven patients, visual acuity at 6 months was worse than 2/200 in only four patients, largely because of preexisting advanced glaucoma. CONCLUSIONS: In eyes with RD and a preexisting glaucoma drainage device, PPV with fluid-gas exchange was the most successful approach in achieving retinal reattachment. Although anatomic success is usually achieved and IOP is usually controlled, visual acuity outcomes are often poor, largely because of preexisting advanced glaucoma.

Adolescent↗
PubMed2002

Evaluating outpatient versus inpatient costs in endophthalmitis management.

PURPOSE: To assess the cost savings that would result from 1) implementing the treatment guidelines of the Endophthalmitis Vitrectomy Study (EVS) and 2) performing procedures on an outpatient rather than an inpatient basis, and to compare the savings to the cost of conducting the EVS. METHODS: The coding algorithms for four endophthalmitis treatment groups were obtained from Patient Financial Services at the Anne Bates Leach Eye Hospital (ABLEH) and national Medicare averages were consulted for reimbursements in 2000 dollars. The four groups were: 1) inpatient pars plana vitrectomy (PPV) with intravenous antibiotics; 2) outpatient PPV; 3) inpatient vitreous tap with intravenous antibiotics; and 4) outpatient vitreous tap. Physician reimbursements were calculated using International Classification of Diseases-9 (ICD-9) diagnoses and Current Procedural Terminology (CPT) codes. Facility reimbursements were calculated using ICD-9 diagnoses and Diagnosis-Related Group codes for inpatient procedures versus Ambulatory Payment Classification codes for outpatient procedures. The annual savings in reimbursements were estimated for a range of annual incidence rates of endophthalmitis assuming ABLEH financial data across all patients in the United States, and the savings into the future as well as the total expenses of conducting the EVS from 1989 to 1995 were summed in 2000 dollars using a net present value analysis based on the Bureau of Labor Statistics consumer price indices. RESULTS: Facility reimbursements are significantly higher for procedures performed on an inpatient compared to an outpatient basis (P < 0.001). Treating endophthalmitis according to the EVS guidelines on an outpatient basis would be associated with an estimated $1.5 to $7.8 million reduction in reimbursements per year. The cost of the EVS in 2000 dollars was $4.0 million. CONCLUSIONS: Implementing the treatment guidelines of the EVS on an outpatient basis may result in significant cost savings--savings that may cover the entire cost of the EVS in 3 years.

Ambulatory Care↗
PubMed2002

Vitreoretinal surgery for complications of branch retinal vein occlusion.

Branch retinal vein occlusion (BRVO) is second only to diabetic retinopathy as a cause of retinal vascular disease. Vision loss from BRVO may be associated with multiple causes, including macular edema, macular ischemia, foveal hemorrhage, vitreous hemorrhage, epiretinal membrane, and retinal detachment. The few published studies that report outcomes of pars plana vitrectomy for complications of BRVO consist only of case reports and small case series, limitations of which include small sample sizes and lack of comparison groups. Given the variable outcomes among patients with untreated BRVO, comparison groups are necessary for accurate evaluation of the efficacy of pars plana vitrectomy for BRVO.

Epiretinal Membrane↗
PubMed2002

Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma.

PURPOSE: To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C. MATERIALS AND METHODS: Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision. RESULTS: The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control. CONCLUSIONS: Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.

Adult↗
PubMedDate not supplied

Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study).

OBJECTIVE: To evaluate the short-term fluorescein angiographic and visual acuity effects of a single intravitreal injection of bevacizumab (Avastin) for the management of persistent new vessels (NV) associated with diabetic retinopathy. METHODS: A prospective, nonrandomized open-label study of diabetic patients with actively leaking NV refractory to laser treatment and best-corrected Early Treatment Diabetic Retinopathy Study visual acuity (BCVA) worse than 20/40. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 6, and 12 (+/-1) following intravitreal injection of 1.5 mg of bevacizumab. Main outcome measures include changes in total area of fluorescein leakage from active NV and BCVA. RESULTS: Fifteen consecutive patients (men, 9 [60%]; women, 6 [40%]) were included and all completed the 12-week follow-up period of the study. The mean +/- SD age of participants was 60.08 +/- 7.75 years (median, 59.5; range, 49-73 years). At baseline, mean +/- standard error of the mean (SEM) NV leakage area was 27.79 +/- 6.29 mm2. The mean +/- SEM area of active leaking NV decreased significantly to 5.43 +/- 2.18 mm2 and 5.50 +/- 1.24 mm2 (P < 0.05, Tukey multiple comparisons post-test) at 1 and 12 weeks postinjection, respectively; at week 6 no leakage was observed. The mean +/- SEM logMAR (Snellen equivalent) BCVA improved significantly from 0.90 (20/160) +/- 0.11 at baseline to 0.76 (20/125(+2)) +/- 0.12, 0.77 (20/125(+2)) +/- 0.11, and 0.77 (20/125(+2)) +/- 0.12 at weeks 1, 6, and 12, respectively (P < 0.05, Tukey multiple comparisons post-test). No major adverse events were observed. CONCLUSIONS: Intravitreal injection of bevacizumab achieved short-term reduction of fluorescein leakage from persistent active NV without loss of vision in patients with diabetic retinopathy. Further studies to investigate the role of anti-VEGF therapy with bevacizumab for the management of diabetic retinopathy refractory to laser treatment are warranted.

Adult↗