Evaluation of the Efficacy of Various Topical Fluorides on Enamel Demineralization Adjacent to Orthodontic Brackets: An In Vitro Study.

AIM: White spot lesions (WSLs) occur frequently after fixed orthodontic treatment. This in vitro study was undertaken to compare the efficacy of 2.26% fluoride varnish, 1.23% APF gel, 0.21% fluoride toothpaste and 0.04% sodium fluoride mouthwashes in preventing enamel demineralization around orthodontic brackets in extracted premolars. MATERIALS AND METHODS: The sample for this study included 100 premolars free of caries and enamel cracks. They were divided into five groups of 20 samples each. Group 1 (FV): light-curable Fluoride varnish (Clinpro™ XT 3M ESPE, Pymble, New South Wales, Australia), group 2 (FG): 1.23% APF gel (Patterson NE. International, USA), group 3 (FTP): 0.21% w/w sodium fluoride toothpaste with tri-calcium phosphate (Clinpro™ Tooth Crème, 3M ESPE, Australia), group 4 (FMW): sodium fluoride 0.044% (w/v) mouthwash (Colgate® Phos-Flur® Ortho Defense Rinse, Colgate-Palmolive, NY) and group 5 (C): control. The samples were subjected to laboratory pH cycling. The demineralization changes in the enamel were assessed before the start of the experiment and after 14 days. RESULTS: There was a significant change in the mean Diagnodent score value (p <0.001) in all groups from day 1-day 14. The mean values were significantly different among groups at day 1 (p = 0.002), day 14 (p = 0.001) and also the change from Day 1 to Day 14 was significantly different among Groups (p = 0.001). The least change in the mean value from baseline to 14 days was seen in group 1 (FV) followed by group 3 (FTP), group 2 (FG), and group 4 (FMW) and then the group 5 (C). CONCLUSION: All the topical fluorides tested were able to reduce the demineralization when compared to the control group under similar testing conditions, but to varying degrees. light-curable fluoride varnish outperformed all the topical fluorides followed by 0.21% w/w dodium fluoride toothpaste with tri-calcium phosphate, 1.23% Acidulated phosphate fluoride gel and sodium fluoride 0.044% (w/v) mouthwash. The control group where no topical fluoride was applied showed the least resistance to demineralization. CLINICAL SIGNIFICANCE: Within the limitations of this study, routine application of light cured fluoride varnish (Clinpro) can be recommended to prevent enamel demineralization to prevent white spot lesions in patients receiving orthodontic treatment.

Variation in optic nerve and macular structure with age and race with spectral-domain optical coherence tomography.

PURPOSE: To evaluate the effects of age and race on optic disc, retinal nerve fiber layer (RNFL), and macular measurements with spectral-domain optical coherence tomography (SD OCT). DESIGN: Cross-sectional observational study. PARTICIPANTS: Three hundred fifty adult subjects without ocular disease. METHODS: Data from SD OCT imaging of the optic nerve head, peripapillary RNFL, and macula of 632 eyes from 350 subjects without ocular disease were imaged with SD OCT. Multivariate models were used to determine the effect of age and race on quantitative measurements of optic disc, RNFL, and macula. MAIN OUTCOME MEASURES: Optic nerve, RNFL, and macular measurements with SD OCT across racial strata and age. RESULTS: For optic nerve parameters, participants of European descent had significantly smaller optic disc area than other groups (P<0.0001), and Indian participants had significantly smaller rim area than other groups (P<0.0001). Indian and Hispanic participants had thicker global RNFL measurements than other groups (P<0.0001). Participants of African descent were associated with thinner inner retinal thickness in the macula (P<0.0001). Age was associated with several parameters, with rim area reducing by 0.005 mm(2)/year, RNFL thickness reducing by 0.18 µm/year, and inner retinal thickness reducing by 0.1 µm/year (P<0.0001 for all age associations). CONCLUSIONS: Optic nerve, RNFL, and macular measurements with SD OCT all varied across racial groups and with age. These differences are important in defining the range of normal variation in differing populations and should be considered in the use of these instruments in the detection of optic nerve and macular disease across these population groups. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Orbital cysticercosis: clinical manifestations, diagnosis, management, and outcome.

PURPOSE: To describe the clinical manifestations, diagnosis, management, and outcome of orbital cysticercosis in a tertiary eye care center in Southern India. DESIGN: Retrospective observational case series. PARTICIPANTS: A total of 171 patients with orbital cysticercosis. METHODS: Retrospective case series involving consecutive patients with orbital cysticercosis from March 1990 to December 2001. MAIN OUTCOME MEASURES: Clinical resolution and significant residual deficit. RESULTS: The median age at presentation was 13 years (range 2-65 years), and 93 patients (54.4%) were male. The 3 main symptoms at presentation were periocular swelling (38%), proptosis (24%), and ptosis (14%) with a median duration of 2 (range 0-24) months. The 3 main signs at presentation included ocular motility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasing order of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and the eyelid (0.6%). In all, 80.7% of patients had cysts in relation to an extraocular muscle. The superior rectus (33.3%) was the most commonly involved extraocular muscle. Contact B-scan ultrasonography was diagnostic of cysticercosis in 84.4% of patients. Orbital cysticercosis was managed medically in 158 of 166 patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patient received oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oral praziquantel. Surgery was performed in 8 patients. Clinical resolution was seen in 128 of 138 patients (92.8%) at 1 month and 81 of 85 patients (95.3%) at 3 months. A significant residual deficit was present in 29 of 138 patients (21.0%) at the final follow-up and included proptosis in 7 patients, ptosis in 6 patients, ocular motility restriction in 3 patients, diplopia in 2 patients, strabismus in 2 patients, and a combination of the above in 9 patients. CONCLUSIONS: Orbital cysticercosis is a common clinical condition in the developing world. It typically affects young individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography and computed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis with medical management, a significant proportion of patients may have residual functional deficits.

Diagnostic capability of optical coherence tomography (Stratus OCT 3) in early glaucoma.

PURPOSE: To evaluate the diagnostic capability of optical coherence tomography (Stratus OCT 3) for early glaucoma in Asian Indian eyes. DESIGN: Cross-sectional observational study. PARTICIPANTS: Two groups of patients (early glaucoma and normal) who satisfied the inclusion and exclusion criteria were included. Early glaucoma was diagnosed in presence of open angles, characteristic glaucomatous optic disc changes correlating with the visual field on automated perimetry (visual field defect fulfilling at least 2 of Anderson and Patella's 3 criteria with mean deviation > or = -6 dB). Normals had visual acuity > or =20/30, intraocular pressure <22 mmHg with normal optic disc and fields and no ocular abnormality. METHODS: All patients underwent complete ophthalmic evaluation including visual field examination (24-2/30-2 SITA standard program) and imaging with Stratus OCT 3. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values, area under the receiving operating characteristic curve and likelihood ratios were calculated for various Stratus OCT 3 parameters. RESULTS: Seventy-two eyes (72 patients) with early glaucoma and 96 eyes (96 normal subjects) were analyzed. The inferior maximum parameter had the best combination of sensitivity and specificity, 75% (95% confidence interval [CI], 70.2-79.8%) and 89.6% (95% CI, 82.6-96.6%), respectively. The 6-o'clock parameter had a sensitivity of 61.1% (95% CI, 52.3-69.9) and specificity of 99% (95% CI, 95-100); for an assumed prevalence of 5%, the positive and negative predictive values were 75% and 98%, respectively. The positive likelihood ratio for the 6-o'clock parameter (P<5%) in early glaucoma was 61. CONCLUSIONS: Optical coherence tomography has moderate sensitivity with high specificity for the diagnosis of early glaucoma and may have a potential role in screening.

Normal age-related decay of retinal nerve fiber layer thickness.

PURPOSE: To determine the normal age-related loss of retinal nerve fiber layer thickness (RNFLT) as measured on Stratus optical coherence tomography (OCT 3; Carl Zeiss Meditec, Dublin, CA) in an Asian Indian population. DESIGN: Prospective, cross-sectional, observational study. PARTICIPANTS: One hundred eighty-seven eyes of 187 normal subjects (age range, 5-75 years) who satisfied the inclusion and exclusion criteria were included. The subjects were defined as normal if they had visual acuity of 20/30 or better, intraocular pressure less than 22 mmHg with normal optic disc, and no ocular abnormality. METHODS: All patients underwent complete ophthalmic evaluation including imaging with Stratus OCT 3. Simple linear regression was performed to study the effect of age on RNFLT, with age as the independent variable and RNFLT as the dependent variable. Spearman's correlation was studied between the age and RNFLT. An analysis of variance was applied to compare RNFLT between the different age groups. The chi-square test also was used to evaluate the relationship between age and RNFLT. MAIN OUTCOME MEASURE: Effect of age on RNFLT. RESULTS: One hundred eighty-seven eyes of 187 normal subjects were analyzed. Mean age+/-standard deviation was 33.0+/-19.7 years (range, 5-75). Average RNFLT and RNFLT by quadrant demonstrated the tendency of RNFLT to decrease with increasing age, especially after age 50 years. Average RNFLT demonstrated a negative slope of 0.16 microm/year (95% confidence interval [CI], -0.1 to -0.24). By quadrant, the superior average (negative slope, -0.23 microm/year; 95% CI, -0.1 to -0.34) showed a maximum tendency to decline with age, whereas in the inferior quadrant (negative slope, -0.08 microm/year; 95% CI, 0.05 to -0.24), the age-related decay was minimal. Six clock-hour RNFLT had a least negative slope of -0.022 microm/year (95% CI, -0.08 to -0.1). Chi-square test results showed a significant inverse relationship between age and average RNFLT (P = 0.01). CONCLUSIONS: Age-related retinal nerve fiber layer (RNFL) loss is not uniform in all the quadrants, with maximum loss in the superior quadrant, and seems to reach a maximum after the age of 50 years. Furthermore, it seems that inferior quadrant RNFL is more resistant to loss.

Efficacy and safety of latanoprost for glaucoma treatment: a three-month multicentric study in India.

PURPOSE: To evaluate the short-term efficacy and safety of 0.005% topical latanoprost in Indian eyes. DESIGN: Prospective non-randomised open-label multicentric trial. METHODS: One hundred and fifty patients with ocular hypertension (OHT), primary open-angle, pseudoexfoliation or pigmentary glaucoma were enrolled at four centers. Each center contributed at least 20 patients. Following baseline measurements, 0.005% latanoprost was applied topically once daily in the evening for three months. Patients were examined at 2, 6 and 12 weeks. The primary outcome measure was mean intraocular pressure (IOP) reduction. The mean diurnal variation of IOP (difference between highest and lowest IOP) at baseline and at 12-weeks was compared. RESULTS: One hundred and thirty of 150 enrolled patients completed the study. One randomly selected eye of each patient was included for analysis. At three months, latanoprost reduced the mean IOP from 24.9 (+/- 3.16) mmHg at baseline to 16.10 (+/- 2.7) mmHg, a reduction of 35.25%. 83% had a reduction in IOP of > 25%. The IOP reduction was maintained throughout the study period, and was not affected by gender or age of the patient. One eye did not show any response to the drug. Daytime diurnal variation of IOP was reduced from 4.5 to 2.9 mmHg. 20 patients had conjunctival hyperemia. Six patients had side effects requiring withdrawal from the study. CONCLUSIONS: In this short-term multicentric study, latanoprost effectively reduced IOP and stabilised the diurnal curve in Indian eyes. There were no clinically significant ocular or systemic adverse effects.

Optic disc imaging by Heidelberg retinal tomogram in congenital optic disc anomaly.

We evaluated two cases of congenital optic disc anomaly with the Heidelberg Retinal Tomograph (HRT) that could be mistaken for glaucomatous optic disc. One was an optic disc coloboma with a visual field defect and the other had an optic disc pit without a visual field defect. HRT was abnormal only in the eye with optic disc pit with normal fields. While HRT can be a valuable adjunct to disc evaluation and follow-up, it cannot be used in isolation in the differentiation of abnormal from normal optic discs.

Interpretation of computed tomography imaging of the eye and orbit. A systematic approach.

Computed tomography (CT) has revolutionised the diagnosis and management of ocular and orbital diseases. The use of thin sections with multiplanar scanning (axial, coronal and sagittal planes) and the possibility of three-dimensional reconstruction permits thorough evaluation. To make the most of this technique, users must familiarize themselves with the pertinent CT principles and terminology. The diagnostic yield is optimal when the ophthalmologist and radiologist collaborate in the radiodiagnostic workup. In this article we describe a systematic approach to the interpretation of ocular and orbital CT scans.

Primary angle closure glaucoma: a developing world perspective.

Primary angle closure glaucoma (PACG) is estimated to affect a significant proportion of the population worldwide. Of those affected, the majority reside in developing countries. In the developing world, more than 80% of the people afflicted with glaucoma are unaware that they have the disease, and visual impairment from PACG is more severe than from primary open-angle glaucoma. Considering the paucity of resources and competing opportunity costs, it is imperative that the developing world extrapolates current literature and exiting data sensibly, and develops cost-effective strategies for the detection and management of angle closure glaucoma. The number needed to treat (NNT) was used to extrapolate the trials for an individual patient. To extrapolate to the overall population (where applicable) the authors used the population attributable risk percentage (PAR%). For individual patient care, treatment of a primary angle closure suspect (PACS) has an NNT of 6 over 5 years to prevent one patient progressing to primary angle closure (PAC). The NNT for PAC to prevent PACG over 5 years is 5. The 'effective' PAR% for PACS is 56.4% and the 'effective' PAR% for PAC is 65%. This suggests both PACS and PAC are important health burdens but because of the absence of a good screening test and the opportunity costs involved, population-based screening will probably be unfeasible in developing countries.

Glaucoma management in developing countries: medical, laser, and surgical options for glaucoma management in countries with limited resources.

PURPOSE OF REVIEW: Most people affected by glaucoma live in developing countries. Recent trials and reports provide sound evidence for management of glaucoma. This review extrapolates relevant articles to the developing world. RECENT FINDINGS: The predictive value of gonioscopy for progression of primary angle closure suspects (PACS) to primary angle closure (PAC) is only 22% (95% CI: 9.80-34.2). PACS are not uncommon; laser peripheral iridotomy (LPI) is neither indicated nor feasible for all. Twenty-eight and a half percent of PAC progress to primary angle closure glaucoma; the number needed to treat (NNT) for LPI to prevent progression is only 4. Laser peripheral iridoplasty controls acute angle closure glaucoma (AACG) faster than medical therapy alone. Primary lens extraction has also been suggested as treatment for AACG after control of the acute attack. A 5-year NNT for ocular hypertension (OH) of 20 is too high to allow treatment of all OH. High-risk OH and primary open angle glaucoma (POAG) have an NNT of 5 to 6 and merit treatment. Latanoprost and brimonidine are effective in lowering IOP in Asian eyes with POAG, but primary surgical therapy may be a more viable option. For cataract and coexistent glaucoma requiring filtration, trabeculectomy combined with the Blumenthal technique of cataract surgery may be as effective as trabeculectomy combined with phacoemulsification. SUMMARY: The principles of glaucoma management should be the same the world over. Considering the paucity of resources and competing opportunity costs, countries with limited resources have to extrapolate available information in a sensible and cost-effective manner.

Incomplete and complete plateau iris syndrome.

Plateau iris syndrome is considered to be a rare entity and has been classified into two subtypes, the complete and the incomplete forms. Herein a case is reported of plateau iris syndrome that had a postmydriatic rise in intraocular pressure (IOP) in one eye (complete syndrome) and no increase in IOP in the other (incomplete syndrome). The pre- and post-mydriasis ultrasound biomicroscopic findings were documented. These findings suggest that incomplete plateau iris syndrome may be caused by a difference in the extent of closure of the angle circumferentially over the 360 degrees of the angle.

Rapid intraoperative diagnosis of tumors of the eye and orbit by squash and imprint cytology.

PURPOSE: To evaluate the diagnostic accuracy of intraoperative squash and imprint cytologic techniques in ocular and orbital lesions. DESIGN: Observational case series. METHODS: Forty-five consecutive ocular and orbital biopsy specimens subjected to squash and imprint cytologic techniques for rapid intraoperative diagnosis were included in this study. The indications for which the surgeon requested intraoperative diagnosis included: (1) infiltrative lesions where a preoperative tissue diagnosis was not available, (2) discrepancy between preoperative and intraoperative clinical diagnosis, and (3) unusual clinical presentations with an uncertain diagnosis. Fresh unfixed tissue was used for making squash preparations and imprint smears. Alcohol-fixed smears were stained with hematoxylin and eosin, whereas air-dried smears were stained with the Giemsa stain. The residual tissue was subjected to routine processing for histopathologic examination. MAIN OUTCOME MEASURE: Correlation of intraoperative cytologic diagnosis with the final histologic diagnosis was the primary outcome measure. The correlation was considered to have complete concordance if the diagnosis matched with respect to nature of the lesion (benign vs. malignant) as well as with the further classification of the benign or the malignant lesion. Partial concordance was considered when there was agreement with respect to the nature of the lesion, but there was a mismatch in the further classification of the benign or the malignant lesion. RESULTS: Biopsies were obtained from 45 patients whose ages ranged from 1 to 79 years (median, 21 years). The sites of biopsy included eyelids (n = 4), conjunctiva (n = 6), intraocular tissue (n = 3), and orbit (n = 32). Adequate cellularity was obtained in all cases by squash and imprint techniques. A cytologic diagnosis could be made within 5 to 8 minutes after receiving the sample. Of 44 cases in which a cytologic diagnosis could be made, 21 (48%) were malignant and 23 (52%) were benign. Cytologic analysis was inconclusive in 1 case. The cytologic-histologic correlation showed complete concordance in 41 of 45 cases (91%) and partial concordance in 3 cases. Sensitivity and specificity of the squash and imprint technique in detecting malignant lesions was 100%. CONCLUSIONS: Assuming the availability of a skilled cytologist, ophthalmic pathologist, or both, squash and imprint preparations are useful for rapid and reliable intraoperative diagnosis of ocular and orbital lesions.