Rhodotorula rubra endophthalmitis in an HIV positive patient.
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
W G Hodge
Publications and source records attributed to W G Hodge.
An inventory of information on blindness and visual impairment in Canada.
BACKGROUND: Several health databases contain information on blindness and visual impairment in Canada. Such databases may permit studies of the outcomes, predictors, economic costs and meta-analysis of ocular health problems and visual disability. In this paper we summarize the existing public health information on blindness and visual impairment in Canada. METHODS: A systematic search was performed to find the information in three areas: health administrative databases, health surveys and registries. Both literature searching and Internet searching were performed. The institutions were notified by email or telephone that information pertaining to vision and blindness was desired. When necessary, we visited the institution to obtain the information. RESULTS: Health administrative databases contain information on a wide cross-section of diagnoses but are usually limited in detail and seldom provide longitudinal information. Health surveys have a limited amount of systematic information on vision-related questions and rely exclusively on self-reporting. Registries exist on a wide range of visual topics. The Canadian National Institute for the Blind (CNIB) has the most comprehensive registry. INTERPRETATION: This is the first attempt at summarizing all the public health information on blindness and visual impairment in Canada. The present population-based ocular information has numerous shortcomings. More comprehensive validation of large registries, such as that of the CNIB, is needed to provide the foundation for a longitudinal ocular surveillance system. Such a system could guide research on risk factors and the effect of treatment, economic analyses, and public policy for ocular research and service allocation.
Blindness↗
Familial occurrence of pigment dispersion syndrome.
BACKGROUND: Pigment dispersion syndrome affects up to 4% of the white population. It is characterized by the presence of transillumination defects, Krukenberg's spindle and dense trabecular meshwork pigmentation. Open-angle glaucoma will develop in as many as 50% of affected patients. In this study we describe the familial occurrence of pigment dispersion syndrome in six North American pedigrees and the phenotypic characteristics with respect to pigment dispersion syndrome and glaucoma. METHODS: Probands with pigment dispersion syndrome were identified in glaucoma clinics at university eye centres in Ottawa and Durham, NC. Families with two or more affected members were evaluated. All willing members in each family underwent a thorough clinical examination and were classified as affected with pigment dispersion syndrome, suspect or unaffected. The previous medical records were reviewed to obtain the past medical and ocular history, including risk factors for glaucoma. RESULTS: All six families are white. Three families show at least two generations of affected members. Of the 43 subjects examined 58% were women. All 14 affected members showed moderate to heavy trabecular meshwork pigmentation and either Krukenberg's spindle or transillumination defects. The affected members were also considerably more myopic (mean spherical equivalent for the right eye -4.72 dioptres) than the suspect group or the unaffected group (mean spherical equivalent -0.79 D and +1.19 D respectively) (p < or = 0.001), and the intraocular pressure was higher for the affected than the unaffected group (mean for the right eye 20 mm Hg vs. 16 mm Hg) (p = 0.004). Half of those affected also had open-angle glaucoma. INTERPRETATION: We have identified and phenotypically characterized six North American families with autosomal dominant pigment dispersion syndrome. Our ultimate goal is to identify the gene(s) that causes this disorder in order to clarify its molecular etiology and pathophysiology. This may give rise to a molecular classification of the disease as well as provide the foundation for genetic testing and new treatment approaches.
Adult↗
Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome.
PURPOSE: To determine the intraocular pressure (IOP) response to phacoemulsification cataract extraction with posterior chamber intraocular lens (PC IOL) implantation in patients with pseudoexfoliation syndrome. SETTING: Eye clinics at the University of Ottawa Eye Institute, Ottawa, Ontario, Canada. METHODS: A retrospective cohort study design assigned patients to 1 of 3 subgroups: pseudoexfoliation syndrome (PEX) (n = 21), primary open-angle glaucoma (POAG) control (n = 23), and cataract control (n = 23). Inclusion criteria consisted of age older than 50 years, open angle by gonioscopy, and a cataract requiring phacoemulsification. The IOP response was determined at intervals up to 18 months. RESULTS: Postoperative IOP changes from baseline in the PEX group were -1.81, -4.52, and -2.31 mm Hg at 3, 6, and 12 months, respectively. The changes in the POAG control group were -2.22, -2.32, and -1.88 mm Hg, respectively, and in the cataract control group, -2.49, +0.45, and +0.28 mm Hg. Patients in the PEX group had a reduction in IOP from baseline at all postoperative measurements. That reduction was significantly greater than in the POAG and cataract control groups at 6 months (P =.012 and P =.002, respectively) and 12 months (P =.001 and P =.050, respectively). CONCLUSIONS: Patients with pseudoexfoliation syndrome had a postoperative IOP reduction from baseline at all measurements and a significantly greater reduction than patients in the POAG and cataract control groups at 6 and 12 months. Phacoemulsification cataract surgery with PC IOL implantation may be effective in managing patients with pseudoexfoliation syndrome who have elevated IOP and visually significant cataract but no advanced optic nerve damage.
Aged↗
Changes in measured intraocular pressure after hyperopic photorefractive keratectomy.
PURPOSE: To investigate the effect of hyperopic photorefractive keratectomy (PRK) on intraocular pressure (IOP) measurements. SETTING: University of Ottawa Eye Institute, Ottawa Hospital, Ottawa, Canada. METHODS: In this retrospective cohort study, IOP and central corneal thickness (CCT) were measured preoperatively and at 1, 2, 3, 6, 12, 18, and 24 months in 191 eyes that had hyperopic PRK with the VISX Star excimer laser. All corrections applied were between +1.00 and +6.50 diopters (D) of sphere and less than 3.75 D of cylinder. RESULTS: At all postoperative examinations, the mean IOP in the hyperopic PRK group was 1.0 to 1.8 mm Hg lower than the preoperative IOP (P <.001). A large range of IOP changes was found across the population; eg, at 6 months, 49% of the eyes had a change in IOP from baseline of at least +/-3 mm Hg. A mean reduction of 19 microm of CCT was found with pachymetry after surgery (P < .001). The change in IOP readings postoperatively was not correlated with age, sex, keratometric readings, or applied correction. Changes in IOP were strongly correlated with preoperative IOP at all time points and with preoperative CCT at 18 and 24 months (P < .001). After hyperopic PRK, the measured IOP was more likely to increase in patients with preoperative IOPs less than 14.5 mm Hg and more likely to decrease in patients with preoperative IOPs above 14.5 mm Hg. CONCLUSION: Changes in IOP after hyperopic PRK were similar to changes after myopic PRK, despite only minimal changes in the CCT. This suggests that hyperopic PRK results in biomechanical effects that modify the elastic properties of the cornea beyond the changes in rigidity expected from central corneal thinning. There was a strong negative correlation between the measured preoperative IOP and the change in IOP postoperatively that was likely the result of regression of the mean effect.
Cohort Studies↗
Prevalence of factor V Leiden and activated protein C resistance in central retinal vein occlusion.
PURPOSE: Factor V Leiden is a common inherited mutation that is a significant risk factor for deep vein thrombosis. It results in resistance to activated protein C (APC). The association between factor V Leiden and central retinal vein occlusion (CRVO) remains controversial. This study was designed to determine the prevalence of APC resistance and the factor V Leiden mutation in patients with CRVO in a controlled study. METHODS: The study was designed as a case control study conducted in a tertiary care retina practice. The prevalence of APC resistance and factor V Leiden was determined by genetic testing of blood samples obtained from patients with CRVO and clinic control patients. RESULTS: Factor V Leiden was identified in 2.3% of patients with CRVO and 3.5% of clinic control patients. There was no significant association between the presence of factor V Leiden and CRVO (odds ratio, 1.13; 95% confidence interval, 0.65-1.98; P = 0.66). CONCLUSION: Factor V Leiden does not appear to be associated with CRVO. Routine screening of patients with CRVO does not appear to be warranted.
Activated Protein C Resistance↗
Pseudoexfoliation syndrome in Icelandic families.
AIM: To examine the distribution and clinical ophthalmic characteristics of pseudoexfoliation syndrome (pseudoexfoliation) and glaucoma in Icelandic families. METHODS: Icelandic families containing three or more members aged 70 or older with at least one member with pseudoexfoliation were identified. All family members over age 45 were invited to participate. Visual acuity, Goldmann applanation tonometry, gonioscopy, slit lamp examination before and after dilatation, and dilated fundus examination were performed on all available family members. Pertinent data were obtained from medical records, including ophthalmic history and a medical history of cardiovascular disease, cerebrovascular disease, systemic hypertension, and diabetes mellitus. Participants were classified according to affected status for pseudoexfoliation, glaucoma, and age related macular degeneration. RESULTS: Six families were identified who met the criteria for entry into the study. Of 94 family members who were invited to participate 82 were enrolled (87%). Of these 25 (30%) had pseudoexfoliation syndrome, 51 (62%) were unaffected, and six (7%) were suspects. At least one individual with pseudoexfoliation was identified in the second generation of every family. A parent with pseudoexfoliation was identified in all cases either by examination (4/6) or a review of ophthalmic records (2/6). In all cases the mother was the affected parent. The prevalence of glaucoma was significantly greater in the group with pseudoexfoliation (p <0.0001). Although the presence of age related macular degeneration (ARMD) was highly associated with the presence of pseudoexfoliation, the significance was lost after correction for age (p = 0.69). Although the sample size was small, no association between pseudoexfoliation affected status and cardiovascular disease, cerebrovascular disease, systemic hypertension, or diabetes mellitus was found. CONCLUSIONS: Multiple Icelandic families with pseudoexfoliation in two generations were identified. In all cases where determination was possible, transmission to the second generation was through an affected parent. In each case the affected parent was the mother. Pseudoexfoliation was strongly associated with the presence of glaucoma, but was not associated with either ARMD or systemic disease in this study. These data clearly indicate that pseudoexfoliation is a familial condition and although not conclusive, supports the hypothesis that pseudoexfoliation syndrome is genetically inherited.
Aged↗
Nd:YAG laser corneal disruption as adjuvant treatment for infectious crystalline keratopathy.
PURPOSE: To report on the use of the Nd:YAG laser corneal disruption in the treatment of infectious crystalline keratopathy. METHOD: Case report. A 52-year-old woman with infectious crystalline keratopathy unresponsive to topical antibiotics was treated with an Nd:YAG laser to the intrastromal crystals. RESULTS: After Nd:YAG laser treatment, the infiltrate completely cleared within 4 weeks. CONCLUSIONS: Nd:YAG laser treatment may be effective in disrupting the protective glycocalyx matrix within the intrastromal crystals, rendering the bacteria susceptible to topical antibiotics. This treatment should be considered for patients with infectious crystalline keratopathy clinically resistant to topical antibiotics.
Biofilms↗
Atopy and keratoconus: a multivariate analysis.
BACKGROUND/AIMS: The primary goal of this study was to determine if atopy is a risk factor for keratoconus. Other potential risk factors were also studied and included age, sex, race, eye rubbing, mitral valve prolapse, handedness, collagen vascular disease, ocular trauma, pigmentary retinopathy, Marfan's syndrome, Down's syndrome, and a history of contact lens wear. METHODS: A case-control study was designed (n=120) with incident cases assembled from the years 1985-99. Controls were chosen from the same person-time experience as cases and were picked from a source population with multiple outcomes ensuring that none was knowingly related to any of the potential exposures being studied. Atopy was defined based on the UK working group 1994 definition (at least 4/6 criteria = complete, 3/6 criteria = incomplete, and at least 1/6 criteria = partial). Keratoconus was defined based on clinical criteria and previously published I-S values. Multiple logistic regression was used in the analysis to obtain the odds ratios as the measure of association. RESULTS: In the univariate associations, there was an association between keratoconus and atopy as well as eye rubbing and family history of keratoconus. However, in the multivariate analysis, only eye rubbing was still a significant predictor of keratoconus (odds ratio = 6.31 p = 0.001). CONCLUSIONS: This study supports the hypothesis that the most significant cause of keratoconus is eye rubbing. Atopy may contribute to keratoconus but most probably via eye rubbing associated with the itch of atopy. No other variable measured was significantly associated with the aetiology of keratoconus.
Adult↗
The prevalence of herpes family virus DNA in the conjunctiva of patients positive and negative for human immunodeficiency virus using the polymerase chain reaction.
OBJECTIVE: To help understand the pathogenesis of herpes family virus ocular infection among patients positive for HIV, the authors compared the rates of detection of herpes family virus DNA from the conjunctiva of patients who are positive and negative for human immunodeficiency virus (HIV) using the polymerase chain reaction (PCR). DESIGN: Cross-sectional study. PARTICIPANTS: The conjunctival scrapings of 30 patients positive for HIV and 30 patients negative for HIV were examined. INTERVENTION: PCR was used to assay for the presence of herpes simplex virus type 1 (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) DNA (n = 240 samples). MAIN OUTCOME MEASURE: The rate of detection of virus DNA in the two groups, controlling for age, gender, and race, was measured. RESULTS: HSV and VZV DNA were not detected in any of the HIV-positive or HIV-negative samples. CMV DNA was detected in 20% (6 of 30) of patients positive for HIV and was undetected in control subjects negative for HIV (P = 0.01). EBV DNA was detected in 40% (12 of 30) of patients positive for HIV and in 47% (14 of 30) of control subjects negative for HIV (P = 0.58). CONCLUSIONS: There was no difference in the frequency of detection of HSV, VZV, or EBV DNA from the conjunctiva of patients positive or negative for HIV. Only CMV DNA was detected at a significantly higher rate in the conjunctiva of patients positive for HIV compared with control subjects negative for HIV. These different rates of peripheral virus shedding may be one possible explanation for the different rates of clinical infection among the herpes family viruses among patients positive for HIV.
Adult↗
Investigating a viral etiology for keratoconjunctivitis sicca among patients who are positive for human immunodeficiency virus.
PURPOSE: Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratoconjunctivitis sicca in patients who were positive for human immunodeficiency virus (HIV). METHODS: In this cross-sectional study, we recorded the Schirmer tests and tear break-up times (TBUTs) among 30 patients who were positive for HIV. Dry-eye state was defined as a Schirmer test of <10 mm of wetting at 5 min or a TBUT of <10 s. The polymerase chain reaction assay (PCR) for herpes family viruses [Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella-zoster virus (VZV)] was performed on the conjunctival and tear specimens of the 30 HIV-positive patients by using virus-specific single primers. We compared the rates of virus DNA detection among dry-eye and non-dry-eye patients by calculating the odds ratio of detection for each virus. RESULTS: The odds ratio of viral DNA detection was adjusted for age, gender, race, CD4 count, and duration of HIV positivity. The adjusted odds ratios of EBV DNA detection among dry-eye to non-dry-eye patients were 1.30 (p = 0.79) and 0.97 (p = 0.98) by using Schirmer tests and TBUTs, respectively. For CMV, the adjusted odds ratios among dry-eye to non-dry-eye patients were 1.94 (p = 0.58) with Schirmer tests and 1.02 (p = 0.99) with TBUTs. HSV and VZV DNA were not detected in any samples. CONCLUSION: Our study does not support the role of herpesvirus infection of the lacrimal gland as a causative factor in the pathogenesis of dry eyes in patients positive for HIV.
Adult↗
A new clinical perspective of corneal dystrophies through molecular genetics.
In the past 2 years, significant advances have been made in the genetics of corneal dystrophies. Genetic heterogeneity (one disease condition caused by single mutations in any one of multiple genes) and phenotypic diversity (many disease conditions caused by mutations in a single gene) are common emerging themes. Genetic heterogeneity in Meesmann corneal dystrophy was established with the identification of two causative genes, keratins 3 and 12, that encode cytoskeletal proteins. Conversely, mutations in a single gene, keratoepithelin, were found to cause several distinct corneal dystrophies affecting the Bowman layer and the stroma. We present a novel preliminary classification of corneal dystrophies based on molecular etiology. This classification may be useful in understanding the pathogenesis of corneal dystrophies and in developing new strategies to treat these dystrophies.
Cornea↗
Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial.
AIMS: To compare the effectiveness of selective laser trabeculoplasty (SLT, a 532 nm Nd:YAG laser) with argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with medically uncontrolled open angle glaucoma. METHODS: A prospective randomised clinical trial was designed. Patients were randomised to treatment with either SLT or ALT and were evaluated at 1 hour, 1 week, 1, 3, and 6 months post-laser. RESULTS: There were 18 eyes in each group. Baseline characteristics were similar in both groups. In the SLT group the mean IOP at baseline, 1, 3, and 6 months was 22.8 (SD 3.0), 20.1 (4.6), 19.3 (6.0), and 17.8 (4.8) mm Hg, respectively. In the ALT group, the mean IOP at baseline, 1, 3, and 6 months was 22.5 (3.6), 19.5 (4.7), 19.6 (5.6), and 17.7 (3.3) mm Hg, respectively. There was a greater anterior chamber reaction, 1 hour after SLT v ALT (p< 0.01). Patients with previous failed ALT had a better reduction in IOP with SLT than with repeat ALT (6.8 (2. 4) v 3.6 (1.8) mm Hg; p = 0.01). CONCLUSION: SLT appears to be equivalent to ALT in lowering IOP during the first 6 months after treatment. There is a slightly greater anterior chamber reaction 1 hour after SLT. Patients with previous failed ALT had a significantly greater drop in IOP when treated with SLT v ALT. These results need to be confirmed with a larger sample size.
Adult↗
Use of topical steroid therapy in the management of nonnecrotizing anterior scleritis.
BACKGROUND: Nonnecrotizing anterior scleritis may be treated with a variety of therapies, including topical steroid therapy, systemic therapy with nonsteroidal antiinflammatory drugs (NSAIDs) and systemic steroid therapy. This study was carried out to determine the efficacy of topical steroid therapy in treating diffuse and nodular scleritis. METHODS: A phase I/II descriptive study was conducted. Thirty-two consecutive patients with nonnecrotizing anterior scleritis referred to a tertiary care ophthalmology cornea and uveitis practice in Ottawa were enrolled between September 1995 and February 1997. The patients received 1% prednisolone acetate, administered topically every 2 hours for at least 2 weeks. The drug was tapered off thereafter based on the clinical response. A successful treatment outcome was defined as resolution of scleritis without the need for systemic steroid or NSAID therapy by 2 months after initial presentation. RESULTS: The 2-month success rate was 47%. Of the 17 patients in whom treatment failed, 5 (29%) still had some evidence of scleritis at 2 months despite systemic treatment with steroids. There was no difference between the two groups in the rate of first recurrence of scleritis (log-rank test). INTERPRETATION: Although topical steroid therapy failed in over half of the patients, a significant number were spared systemic steroid therapy with its potential side effects. Despite the moderately high failure rate, topical steroid therapy could be considered as first-line treatment for nonnecrotizing anterior scleritis, especially in cases in which the likelihood of complications from systemic steroid or NSAID therapy is high.
Administration, Topical↗
Lattice corneal dystrophy type 1 in a Canadian kindred is associated with the Arg124 --> Cys mutation in the kerato-epithelin gene. sgupta@ogh.on.ca.
PURPOSE: To identify the mutation responsible for lattice corneal dystrophy type 1 in an extended Canadian kindred. METHODS: A search for a mutation in the candidate gene, kerato-epithelin, was carried out by single-strand conformation polymorphism and sequencing analyses. RESULTS: AC --> T mutation at position 417 was detected in exon 4 of the kerato-epithelin gene, which is expected to cause an Arg124 --> Cys change. This is the same nucleotide change described previously in two Swiss families with lattice corneal dystrophy type 1. CONCLUSION: Although the possibility that the three families (two previously described Swiss families and this Canadian kindred) are related has not been excluded, it appears that the unique phenotype of lattice corneal dystrophy type 1 is caused by this particular amino acid change.
Arginine↗
Ocular opportunistic infection incidences among patients who are HIV positive compared to patients who are HIV negative.
OBJECTIVE: The purpose of the study was to examine the incidence of ocular opportunistic infections among patients who are human immunodeficiency virus (HIV) positive compared to patients who are HIV negative. DESIGN: The study design was a retrospective cohort study. PARTICIPANTS: All patients were recruited from 1984 until 1995 at the San Francisco General Hospital. INTERVENTION: Incidences for numerous diagnoses were compared among the exposure group (HIV positive) and nonexposed control group (HIV negative). MAIN OUTCOME MEASURES: The diagnoses studied were cytomegalovirus (CMV) retinitis, herpes zoster ophthalmicus, Pneumocystis carinii choroidopathy, herpes simplex keratitis, Toxoplasma retinitis, fungal retinitis, ocular syphilis, and ocular lymphoma. RESULTS: Among the HIV-positive pool, there were 1800 patient visits with a total of 5200 person-years of follow-up. Among the HIV-negative control pool, there were 48,200 patient visits with a total of 30,100 person-years of follow-up. Incidence rates were calculated using the product-limit method, and risk ratios were calculated using the Cox proportional hazards model. Incidence rate differences were calculated using the incidence density method. Among the outcomes studied, only CMV retinitis, herpes zoster ophthalmicus, and, to a lesser extent, Toxoplasma retinitis showed both an elevated risk ratio and rate difference among patients who were HIV positive compared to patients who were HIV negative. Of the other outcomes studied, either the risk ratio, rate difference, or both were similar among patients who were HIV positive compared to patients who were HIV negative. CONCLUSIONS: Not all ocular infections seen in patients who are HIV positive should be considered opportunistic, because many occur with similar incidence among patients who are HIV negative. The biologic reasons for this will require further study.
AIDS-Related Opportunistic Infections↗
Posterior capsule opacification after cataract surgery.
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Age Factors↗
Laser vision correction for low hyperopia. An 18-month assessment of safety and efficacy.
OBJECTIVE: This study aimed to assess the efficacy and safety of hyperopic photorefractive keratectomy (PRK) and to evaluate the effect of degree of hyperopia, two epithelial removal methods, and various postoperative patient management techniques on clinical outcomes. DESIGN: Prospective, nonrandomized, open-label clinical trial. PARTICIPANTS: A total of 38 patients with mean follow-up of 13.9 months (n = 65 eyes with hyperopia from +1.00 diopter [D] to +4.00 D) participated. INTERVENTION: Hyperopic PRK with the VISX STAR Excimer Laser System was performed. MAIN OUTCOME MEASURES: Spherical equivalent (SE) including vector analysis of SE; uncorrected visual acuity (UCVA); best-spectacle corrected visual acuity (BSCVA); low-, medium- and high-contrast visual acuities; topography; keratometry; pachymetry; and intraocular pressure, haze, and all other potential complications were measured. RESULTS: A total of 80% of eyes were within +/- 0.5 D and all but 1 eye (98%) were within +/- 1.0 D of intended manifest SE at 1 year. There was no induced astigmatism at 1 year. At 12 months, 72% of eyes had UCVA of 20/25 or better and 70% had achieved preoperative BSCVA, with no eye seeing worse than 20/25. These results remained constant at 18 months. There was a tendency toward regression between months 1 and 6 with stabilization of SEs between months 6 and 12. Thereafter, up to 18 months, there was some regression with a mean of +0.31 D, but the number of patients was small. There was one mild decentration and very slight decreases in mean intraocular pressure and central corneal thickness. One patient had grade 1.0 haze develop in both eyes at 12 and 18 months; all other patients experienced trace or no haze. There were no significant complications. CONCLUSIONS: The results of this study support the hypothesis that laser vision correction is safe and effective for treating low hyperopia. The predictability of the hyperopic laser vision correction procedure used in this study was very good. Other than the slower recovery of BSCVA and UCVA seen with this procedure, as compared with myopic PRK, there were no significant complications. The trend toward some later regression needs to be further evaluated in a larger number of patients. Overall, patients were very pleased with the treatment, even in the first 6 months.
Adult↗