Purpose: To report a case of bilateral glaucoma related to pseudophacomorphic mechanism in one eye and pupillary block in the other eye after Visian Implantable Collamer Lens (ICL;STAAR Surgical) insertion. Methods: A...Purpose: To report a case of bilateral glaucoma related to pseudophacomorphic mechanism in one eye and pupillary block in the other eye after Visian Implantable Collamer Lens (ICL;STAAR Surgical) insertion. Methods: A 44-year-old female with high myopia underwent bilateral ICL implantation of MICL12.6 after sulcus diameter measurements were performed by Pentacam. Results: Pseudophacomorphic glaucoma-related angle closure occurred due to lens oversizing in the right eye. The mechanism was relieved via ICL explantation. In the left eye, pupillary block developed in a subacute manner after closure of the Peripheral Iridotomy (PI). The attack was ameliorated by reestablishing patency of the iridotomy. Conclusions: ICL-related glaucomatous attacks may result from improper sizing as well as from placement of a single PI. Identification of the proper mechanism is vital as treatments differ significantly. In pseudo phacomorphic glaucoma, explantation is needed. In pupillary block glaucoma, treatment involves establishment of a patent PI.展开更多
AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Departm...AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.展开更多
Cytomegalovirus(CMV)retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals.CMV retinitis previously infected one-third of AIDS patients in the p...Cytomegalovirus(CMV)retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals.CMV retinitis previously infected one-third of AIDS patients in the pre-highly active antiretroviral therapy(HAART)era,but since HAART,Western countries have seen an 80%decrease in the incidence of the disease.More recently,CMV retinitis has been reported in patients who are immunosuppressed,often due to chemotherapy or immunomodulatory medications.The diagnosis of CMV retinitis is often suspected based on clinical findings,with polymerase chain reaction for confirmation of CMV,especially in atypical cases.Highly active antiretroviral therapy and anti-CMV medications(systemic or local)remain the mainstay of treatment.However,for those who are not responsive to HAART,CMV retinitis remains a challenge,and can still lead to significant vision loss.Moreover,a regimen of anti-CMV medications can sometimes lead to viral resistance or organ toxicity.Complications such as immune recovery retinitis and rhegmatogenous retinal detachments continue to threaten the vision of patients who develop CMV retinitis.These complications can arise following initiation of treatment or if patients show disease progression.Proper vision screening for CMV retinitis in immunosuppressed patients at-risk is necessary for early detection and treatment.展开更多
PURPOSE: To report a case of chronic recurrent varicella virus epithelial kera titis in a child. DESIGN: Case report. METHODS: Clinical examination and polymer ase chain reaction analysis of corneal epithelium. RESULT...PURPOSE: To report a case of chronic recurrent varicella virus epithelial kera titis in a child. DESIGN: Case report. METHODS: Clinical examination and polymer ase chain reaction analysis of corneal epithelium. RESULTS: A 10-year-old heal thy child developed chronic recurrent varicella virus keratitis with pseudodendr ites after recovering from systemic varicella. Analysis of the debrided pseudode ndrites was repeatedly positive for VZV DNA and negative for HSV DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective in eliminatin g the pseudodendrites; however, recurrences occurred once the medications were d iscontinued. CONCLUSIONS: Varicella virus epithelial keratitis in children can b e a recurrent chronic condition requiring prolonged treatment.展开更多
Case Presentation: A nine-year-old boy presented to the general ophthalmologist with a several weeks history of redness, photophobia and intermittent foreign body sensation in the right eye. A pigmented lesion with an...Case Presentation: A nine-year-old boy presented to the general ophthalmologist with a several weeks history of redness, photophobia and intermittent foreign body sensation in the right eye. A pigmented lesion with anterior chamber inflammation was noted on examination. B-scan ultrasound was performed and revealed no foreign body. The patient was diagnosed with anterior uveitis, which did not completely respond to treatment. The differential diagnosis was expanded to include peripheral ulcerative keratitis, phlyctenulosis, pigmented neoplasm, and corneal foreign body. Upon referral to a cornea specialist, an exam under anesthesia revealed a large foreign body consistent with a rock fragment in the peripheral cornea, which was subsequently removed without complication. Conclusion: This case highlights an atypical presentation of foreign body as well as a differential diagnosis of pigmented peripheral corneal lesions. Foreign bodies represent the most common cause of urgent ophthalmic evaluation. When evaluating lesions of the cornea, it is imperative to keep an extensive differential diagnosis, giving the potential for severe and rapid development of visually threatening complications.展开更多
Background: It is unclear whether post-operative errors after toric intraocular lens implantation would be more amenable to pre-operative correction with a fixed adjustment or a correction ratio that scales with the m...Background: It is unclear whether post-operative errors after toric intraocular lens implantation would be more amenable to pre-operative correction with a fixed adjustment or a correction ratio that scales with the magnitude of pre-operative astigmatism. Purpose: To investigate the effect of pre-operative anterior corneal astigmatism orientation on outcomes of toric intraocular lens implantation in a large population. Methods: A retrospective cohort study of 625 patients undergoing refractive lens exchange through a superior clear corneal incision with Oculentis M-Plus toric intraocular lens implantation at an Optical Express, Inc. located in the United Kingdom and Ireland. Patients were stratified by axis of astigmatism on automated keratometry as with-the-rule, against-the-rule, or oblique. Analysis of visual acuity and refractive outcomes was performed using American National Standards Institute (ANSI) guidelines on astigmatic corrections with non-vector as well as vector analyses. Analysis was limited to one eye per patient. Results: Patients who had with-the-rule (WTR) astigmatism, compared with oblique and against-the-rule (ATR), had higher vector magnitudes of surgically induced refractive correction (2.89D, 2.55D, 2.42D;p Conclusions: Refractive lens exchange surgery using toric intraocular lenses overcorrected patients who had with-the-rule astigmatism. Degree of overcorrection did not vary with severity of pre-operative astigmatism. Incorporation of axis of astigmatism in lens selection and reduction of astigmatic correction among with-the-rule patients by an absolute value of 0.25D - 0.35D, rather than proportional adjustments, may reduce cylindrical over-correction.展开更多
Background:As leprosy elimination becomes an increasingly realistic goal,it is essential to determine the factors that contribute to its persistence.We evaluate social and economic factors as predictors of leprosy ann...Background:As leprosy elimination becomes an increasingly realistic goal,it is essential to determine the factors that contribute to its persistence.We evaluate social and economic factors as predictors of leprosy annual new case detection rates within India,where the majority of leprosy cases occur.Methods:We used correlation and linear mixed effect regressions to assess whether poverty,illiteracy,nighttime satellite radiance(an index of development),and other covariates can explain district-wise annual new case detection rate and Grade 2 disability diagnoses.Results:We find only weak evidence of an association between poverty and annual new case detection rates at the district level,though illiteracy and satellite radiance are statistically significant predictors of leprosy at the district level.We find no evidence of rapid decline over the period 2008-2015 in either new case detection or new Grade 2 disability.Conclusions:Our findings suggest a somewhat higher rate of leprosy detection,on average,in poorer districts;the overall effect is weak.The divide between leprosy case detection and true incidence of clinical leprosy complicates these results,particularly given that the detection rate is likely disproportionately lower in impoverished settings.Additional information is needed to distinguish the determinants of leprosy case detection and transmission during the elimination epoch.展开更多
文摘Purpose: To report a case of bilateral glaucoma related to pseudophacomorphic mechanism in one eye and pupillary block in the other eye after Visian Implantable Collamer Lens (ICL;STAAR Surgical) insertion. Methods: A 44-year-old female with high myopia underwent bilateral ICL implantation of MICL12.6 after sulcus diameter measurements were performed by Pentacam. Results: Pseudophacomorphic glaucoma-related angle closure occurred due to lens oversizing in the right eye. The mechanism was relieved via ICL explantation. In the left eye, pupillary block developed in a subacute manner after closure of the Peripheral Iridotomy (PI). The attack was ameliorated by reestablishing patency of the iridotomy. Conclusions: ICL-related glaucomatous attacks may result from improper sizing as well as from placement of a single PI. Identification of the proper mechanism is vital as treatments differ significantly. In pseudo phacomorphic glaucoma, explantation is needed. In pupillary block glaucoma, treatment involves establishment of a patent PI.
基金Supported by the Core Grant for Vision Research and the Research to Prevent Blindness Unrestricted Grant to the UCSF Department of Ophthalmology(No.NIH-NEI EY002162)。
文摘AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.
基金supported by the National Eye Institute/National Institutes of Health core grant P30-EY06360(Department of Ophthalmology,Emory University School of Medicine)National Eye Institute,National Institutes of Health R01 EY029594(Yeh)and K23 EY030158(Shantha)+1 种基金Funding support was also provided via an Unrestricted Grant from Research to Prevent Blindness(Emory Eye Center,Emory University School of Medicine)Research support has also been provided by the Association for Research in Vision and Ophthalmology Mallinckrodt Award and the Stanley M.Truhlsen Family Foundation,Inc.
文摘Cytomegalovirus(CMV)retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals.CMV retinitis previously infected one-third of AIDS patients in the pre-highly active antiretroviral therapy(HAART)era,but since HAART,Western countries have seen an 80%decrease in the incidence of the disease.More recently,CMV retinitis has been reported in patients who are immunosuppressed,often due to chemotherapy or immunomodulatory medications.The diagnosis of CMV retinitis is often suspected based on clinical findings,with polymerase chain reaction for confirmation of CMV,especially in atypical cases.Highly active antiretroviral therapy and anti-CMV medications(systemic or local)remain the mainstay of treatment.However,for those who are not responsive to HAART,CMV retinitis remains a challenge,and can still lead to significant vision loss.Moreover,a regimen of anti-CMV medications can sometimes lead to viral resistance or organ toxicity.Complications such as immune recovery retinitis and rhegmatogenous retinal detachments continue to threaten the vision of patients who develop CMV retinitis.These complications can arise following initiation of treatment or if patients show disease progression.Proper vision screening for CMV retinitis in immunosuppressed patients at-risk is necessary for early detection and treatment.
文摘PURPOSE: To report a case of chronic recurrent varicella virus epithelial kera titis in a child. DESIGN: Case report. METHODS: Clinical examination and polymer ase chain reaction analysis of corneal epithelium. RESULTS: A 10-year-old heal thy child developed chronic recurrent varicella virus keratitis with pseudodendr ites after recovering from systemic varicella. Analysis of the debrided pseudode ndrites was repeatedly positive for VZV DNA and negative for HSV DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective in eliminatin g the pseudodendrites; however, recurrences occurred once the medications were d iscontinued. CONCLUSIONS: Varicella virus epithelial keratitis in children can b e a recurrent chronic condition requiring prolonged treatment.
文摘Case Presentation: A nine-year-old boy presented to the general ophthalmologist with a several weeks history of redness, photophobia and intermittent foreign body sensation in the right eye. A pigmented lesion with anterior chamber inflammation was noted on examination. B-scan ultrasound was performed and revealed no foreign body. The patient was diagnosed with anterior uveitis, which did not completely respond to treatment. The differential diagnosis was expanded to include peripheral ulcerative keratitis, phlyctenulosis, pigmented neoplasm, and corneal foreign body. Upon referral to a cornea specialist, an exam under anesthesia revealed a large foreign body consistent with a rock fragment in the peripheral cornea, which was subsequently removed without complication. Conclusion: This case highlights an atypical presentation of foreign body as well as a differential diagnosis of pigmented peripheral corneal lesions. Foreign bodies represent the most common cause of urgent ophthalmic evaluation. When evaluating lesions of the cornea, it is imperative to keep an extensive differential diagnosis, giving the potential for severe and rapid development of visually threatening complications.
文摘Background: It is unclear whether post-operative errors after toric intraocular lens implantation would be more amenable to pre-operative correction with a fixed adjustment or a correction ratio that scales with the magnitude of pre-operative astigmatism. Purpose: To investigate the effect of pre-operative anterior corneal astigmatism orientation on outcomes of toric intraocular lens implantation in a large population. Methods: A retrospective cohort study of 625 patients undergoing refractive lens exchange through a superior clear corneal incision with Oculentis M-Plus toric intraocular lens implantation at an Optical Express, Inc. located in the United Kingdom and Ireland. Patients were stratified by axis of astigmatism on automated keratometry as with-the-rule, against-the-rule, or oblique. Analysis of visual acuity and refractive outcomes was performed using American National Standards Institute (ANSI) guidelines on astigmatic corrections with non-vector as well as vector analyses. Analysis was limited to one eye per patient. Results: Patients who had with-the-rule (WTR) astigmatism, compared with oblique and against-the-rule (ATR), had higher vector magnitudes of surgically induced refractive correction (2.89D, 2.55D, 2.42D;p Conclusions: Refractive lens exchange surgery using toric intraocular lenses overcorrected patients who had with-the-rule astigmatism. Degree of overcorrection did not vary with severity of pre-operative astigmatism. Incorporation of axis of astigmatism in lens selection and reduction of astigmatic correction among with-the-rule patients by an absolute value of 0.25D - 0.35D, rather than proportional adjustments, may reduce cylindrical over-correction.
基金KHG,WC,RKS,BG,and TCP acknowledge support from the Meaningful Modeling of Epidemiological Data(MMED)program,a NIH-funded joint initiative under the University of Florida,the South African Centre for Epidemiological Modelling and Analysis(SACEMA)the African Institute for Mathematical Sciences(AIMS)(NIH NIGMS R25GM102149 to J.R.C.Pulliam and A.Welte.).LW,TML,AG,and TCP acknowledge funding of the NTD Modelling Consortium by Novartis Foundation.The views,opinions,assumptions and conclusions or any other information set out in this article are solely those of the authors and not of Novartis Foundation.Novartis Foundation was not involved in the establishment of this article and this article should not be attributed to Novartis Foundation or any person connected with Novartis Foundation+1 种基金TCP acknowledges support from the US NIH NIGMS MIDAS program,U01-GM087728AG acknowledges support from US NIH NIGMS MIDAS award U01-GM087719.
文摘Background:As leprosy elimination becomes an increasingly realistic goal,it is essential to determine the factors that contribute to its persistence.We evaluate social and economic factors as predictors of leprosy annual new case detection rates within India,where the majority of leprosy cases occur.Methods:We used correlation and linear mixed effect regressions to assess whether poverty,illiteracy,nighttime satellite radiance(an index of development),and other covariates can explain district-wise annual new case detection rate and Grade 2 disability diagnoses.Results:We find only weak evidence of an association between poverty and annual new case detection rates at the district level,though illiteracy and satellite radiance are statistically significant predictors of leprosy at the district level.We find no evidence of rapid decline over the period 2008-2015 in either new case detection or new Grade 2 disability.Conclusions:Our findings suggest a somewhat higher rate of leprosy detection,on average,in poorer districts;the overall effect is weak.The divide between leprosy case detection and true incidence of clinical leprosy complicates these results,particularly given that the detection rate is likely disproportionately lower in impoverished settings.Additional information is needed to distinguish the determinants of leprosy case detection and transmission during the elimination epoch.
