Four-year incidence of open-angle glaucoma and ocular hypertension: the Los Angeles Latino Eye Study.

PURPOSE: To estimate the 4-year incidence of open-angle glaucoma (OAG) and ocular hypertension (OHT) among adult Latinos 40 years of age and older. DESIGN: Population-based longitudinal study. METHODS: Comprehensive ophthalmologic examinations including intraocular pressure, visual field testing, and stereoscopic fundus photography were performed at both baseline and the 4-year follow-up examination. Incident OAG at the 4-year follow-up examination was defined as the presence of an open angle and a glaucomatous visual field abnormality or evidence of glaucomatous optic disc damage, or both when not present at baseline. Incident OHT was defined as intraocular pressure of more than 21 mm Hg and the absence of optic disc damage or abnormal visual field results at the 4 year follow-up examination when not present at baseline. RESULTS: Among the 3939 participants (mean age, 54.7 ± 10.5 years) with complete data for a diagnosis of glaucoma at both baseline and follow-up examination, incident OAG at the 4-year follow-up was identified in 87 persons (4-year incidence rate, 2.3%; 95% confidence interval, 1.8% to 2.8%). Incident OHT at the 4-year follow-up was identified in 124 persons (4-year incidence rate, 3.5%; 95% confidence interval, 2.9% to 4.1%). In participants with OAG in 1 eye, the 4-year risk of OAG developing in the fellow eye was 5 times as high as the risk for those without OAG in either eye at baseline. In participants with OHT in 1 eye, the 4-year risk of OHT developing in the fellow eye was 10 times as high as the risk for those without OHT in either eye at baseline. The incidence rates of OAG and OHT were higher in older Latinos than in younger Latinos. CONCLUSIONS: Incidence of OAG in Latinos is higher than in non-Hispanic whites, but lower than in Afro-Caribbeans. The relatively high rate of incident OAG and OHT underscores the need for community screening programs in this fastest growing segment of the United States population.

Accuracy of amniotic fluid lamellar body counting for evaluating fetal lung maturity.

BACKGROUND: Respiratory distress syndrome (RDS) is one of the important causes of mortality in neonates. This study was designed to assess the role of the amniotic fluid lamellar body counting in predicting fetal lung maturity. METHOD: This study was conducted during 2010, April to 2011, February, at Isfahan University of Medical Sciences, Isfahan, Iran. One hundred and twenty eight amniotic fluid samples were obtained during normal delivery, or before rupturing the membrane in cesarean, and lamellar body was assessed by cellular counter. The respiratory statuses of neonates were determined at delivery and the optimal cut-off point was assessed by receiver operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were evaluated in optimal cut-off point. RESULTS: One hundred and twenty eight amniotic samples and 131 infants were evaluated. The means of maternal and gestational ages were 28.12 +/- 3.84 years and 32.56 +/- 2.72 weeks, respectively. The mean of lamellar body was 31266 +/- 15831 microl in matured lung infants compared to 63081 +/- 16966 microl in immature lung infants (p < 0.001). The optimal cut-off point was evaluated as 47500 microl in predicted pulmonary maturity with sensitivity of 85.1%, specificity of 91.2%, positive predictive value of 92.6% and negative predictive value of 82.5%. CONCLUSION: This study indicated that lamellar body counting test has a high positive predictive value with a good sensitivity, specificity and negative predictive value. Future studies for different cellular counters are warranted.

Blood pressure, perfusion pressure, and open-angle glaucoma: the Los Angeles Latino Eye Study.

PURPOSE: To examine the cross-sectional relationship between blood pressure, perfusion pressure, and prevalence of open angle glaucoma (OAG) in an adult Latino population. METHODS: Participants aged 40 years and older (N = 6130) from the Los Angeles Latino Eye Study (LALES), a large, population-based study of self-identified adult Latinos, underwent an interviewer-administered questionnaire and a complete ocular and clinical examination. Logistic regression was used to evaluate the covariate-adjusted association of OAG with systolic, diastolic, and mean blood pressures and perfusion pressures. Covariates included age, intraocular pressure, history of glaucoma treatment including medications and surgery, and history of blood pressure and treatment of blood pressure including use of medications. RESULTS: Low systolic (odds ratio [OR] = 2.5), diastolic (OR = 1.9), and mean (OR = 3.6) perfusion pressures and low diastolic blood pressure (OR = 1.9) were associated with a higher prevalence of OAG in LALES participants. Higher systolic blood pressure and mean arterial blood pressure were associated with a higher prevalence of OAG. There was no relationship between the prevalence of OAG and the presence of a history of cardiovascular disease. CONCLUSIONS: Low diastolic, systolic and mean perfusion pressures, low diastolic blood pressure, and high systolic and mean arterial blood pressures are associated with a higher prevalence of OAG in adult Latinos.

Comparison of pterygium recurrence rates in Hispanic and white patients after primary excision and conjunctival autograft.

PURPOSE: To evaluate the impact of Hispanic and white ethnicity on the recurrence rates of pterygia after primary excision and conjunctival autograft (CAG) in a southern California population. METHODS: A retrospective case-control review comparing 15 Hispanic and 11 white patients with primary nasal pterygia was performed. All participants received pterygium excision with superior limbal CAG by 1 of 3 surgeons and postoperative topical steroids for 2 months. The main outcome measure was recurrence after surgery, defined as fibrovascular tissue over the corneoscleral limbus onto clear cornea in the area of previous pterygium excision. RESULTS: Average duration of follow-up in the Hispanic and white groups were 9.3 +/- 9.8 months and 13.0 +/- 10.7 months, respectively (P = 0.39). During this follow-up period, there was a statistically significant difference in the pterygium recurrence rate between the Hispanic patients, 6 of 15 (40%), and the white patients, 0 of 11 (0%) (P = 0.02). The average time to recurrence was 3.4 +/- 1.1 months (range, 1.9-5.0). The difference in average age, male/female composition, and follow-up time between the Hispanic and white patient groups studied was not found to be statistically significant (P > 0.05). CONCLUSION: Hispanic ethnicity is a potentially important risk factor for recurrence of primary pterygia treated with CAG.

Postoperative use of bevacizumab as an antifibrotic agent in glaucoma filtration surgery in the rabbit.

PURPOSE: To evaluate the efficacy of bevacizumab as an antifibrotic agent after trabeculectomy in rabbits. METHODS: Forty-two rabbits underwent trabeculectomy and were randomly assigned to receive a postoperative course of seven subconjunctival injections of bevacizumab (1.25 mg, 25 mg/mL), 5-fluorouracil (5-FU; 5 mg, 50 mg/mL), or balanced salt solution (BSS; 0.1 mL, control). Bleb survival and characteristics were evaluated over a 30-day period. The animals were killed on postoperative day (PD)10, PD20, and PD30. Histology and immunohistochemistry of the surgical eyes was performed to evaluate and grade the amount of scarring and fibrosis in each group. RESULTS: Bevacizumab significantly improved the outcome of filtration surgery in this model. Bevacizumab prolonged bleb survival compared with the 5-FU and control groups (16.0 +/- 1.3 days vs. 6.9 +/- 0.6 and 7.4 +/- 0.85 days, respectively; P < 0.001). Bevacizumab-treated eyes had significantly larger and higher blebs than the control and 5-FU-treated groups (P < 0.05). Histologic analysis revealed that eyes treated with bevacizumab had significantly less postoperative scarring at the microscopic level at PD10 and PD20 (P = 0.009). CONCLUSIONS: Postoperative subconjunctival injection of bevacizumab is associated with improved trabeculectomy bleb survival in the rabbit model. Bevacizumab may be a useful agent for improving success and limiting scar tissue formation after trabeculectomy.

Vitreitis and movement disorder associated with neurosyphilis and human immunodeficiency virus (HIV) infection: case report.

In this report, we describe an unusual patient with a choreiform movement disorder, misdiagnosed as Huntington disease, who later developed dense vitreitis leading to the identification of Treponema pallidum as the underlying pathogen of both abnormalities.

Vitreitis and movement disorder associated with neurosyphilis and human immunodeficiency virus (HIV) infection: case report / Vitreíte e distúrbio motor associados à neurosífilis e infecção pelo vírus da imunodeficiência humana (HIV): relato de caso

In this report, we describe an unusual patient with a choreiform movement disorder, misdiagnosed as Huntington disease, who later developed dense vitreitis leading to the identification of Treponema pallidum as the underlying pathogen of both abnormalities.

Neste relato descrevemos um caso infreqüente de um paciente com quadro de distúrbio motor coreiforme diagnosticado equivocadamente como doença de Huntington, o qual posteriormente desenvolveu quadro de intensa vitreíte, possibilitando a identificação do Treponema pallidum como o patógeno causador de ambas anormalidades.

Associations with intraocular pressure in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To evaluate the association of biologic factors with intraocular pressure (IOP) in a Latino population. DESIGN: Population-based cross-sectional study. METHODS: Latinos 40 years and older (n = 5,958) from the Los Angeles Latino Eye Study without a history of ocular hypotensive treatment underwent an interviewer-administered questionnaire and a complete ocular and clinical examination. IOP was obtained by applanation tonometry and was based on the mean of three measurements. Multivariable regression models were used to evaluate the independent association of biological factors with IOP. RESULTS: Higher systolic blood pressure, higher central corneal thickness, and diabetes mellitus were the major factors associated with elevated IOP. Other positively correlated variables included age, female gender, higher diastolic blood pressure, larger body mass index, darker colored irides, and nuclear sclerosis. Axial length and family history of glaucoma had no association with IOP. CONCLUSIONS: Several systemic and ocular characteristics are associated with elevated IOP in Latinos. By identifying and recognizing these risk factors, we can define subgroups of the population that may be most at risk of having elevated IOP.

Optical coherence tomography assessment of angle anatomy changes after cataract surgery.

PURPOSE: To evaluate changes in anterior chamber (AC) morphology induced by cataract extraction using anterior segment optical coherence tomography (OCT). DESIGN: Prospective comparative observational case series. METHODS: Thirty-two eyes of 32 patients underwent OCT imaging of the angle before and after cataract surgery. Anterior chamber depth (ACD), angle opening distance at 500 microm (AOD(500)) and trabecular-iris space at 500 microm (TISA(500)) were measured pre- and postoperatively. Preoperative lens thickness (LT) and lens position (LP) were calculated. RESULTS: ACD, AOD(500), and TISA(500) increased significantly after cataract extraction (P < .001). Preoperatively, ACD and LT highly correlated (P = .0083) as did ACD and TISA(500) (P = .0001). TISA(500) correlated with LP (P = .0001) but not with LT (P = .74). CONCLUSIONS: Changes in angle morphology after cataract surgery can be imaged and objectively quantified by anterior segment OCT. Lens position may have a greater influence on angle width than LT.

Anterior segment optical coherence tomography for imaging the anterior chamber after laser peripheral iridotomy.

PURPOSE: To evaluate changes in anterior segment morphology by anterior segment optical coherence tomography (OCT) and gonioscopy before and after laser peripheral iridotomy (LPI). DESIGN: Prospective comparative observational case series. METHODS: Ten eyes of 10 patients with narrow angles were enrolled in the study. Angles were assessed by gonioscopy and anterior segment OCT pre- and post-LPI. The angle opening distance at 500 microm, angle recess area at 500 microm and 750 microm, and trabecular-iris space area at 500 microm and 750 microm were compared pre- and post-LPI. RESULTS: The mean gonioscopy grade increased significantly from 0.56 to 2.6 (P < .001). All OCT parameters increased significantly post-LPI. CONCLUSIONS: Changes in the anterior chamber angle morphology post-LPI can be imaged and objectively quantified by anterior segment OCT.

Optical coherence tomography of the anterior segment in secondary glaucoma with corneal opacity after penetrating keratoplasty.

AIM: To evaluate secondary glaucoma after penetrating keratoplasty with anterior-segment optical coherence tomography (OCT). DESIGN: Case series. METHODS: Four eyes of four patients with corneal opacity and increased intraocular pressure (IOP) were evaluated using high-speed (2000 axial scans/s) OCT at 1.3 microm wavelength. Cross-sectional images of the anterior segment were analysed to assess the cause of increase in pressure. RESULTS: Slit-lamp evaluation of the anterior chamber in all cases was limited by corneal opacity. The OCT imaging allowed visualisation of anterior-segment structures behind the opaque corneas. Using OCT, iris-intraocular lens adhesion and pupillary block were identified as the probable reasons for the increased IOP in one case. Peripheral anterior synechiae and angle closure were identified in the three remaining cases. In two cases, we found that the tip of the aqueous drainage tube was blocked by peripheral anterior synechiae. CONCLUSIONS: OCT is similar to ultrasound in that it allows visualisation through opaque corneas. However, OCT has an advantage in that it requires neither contact nor immersion. It is a valuable tool for evaluating the depth of the anterior chamber angle and the causes of secondary angle closure.

Fornix reconstruction with conjunctival inclusion cyst marsupialization in Stevens-Johnson syndrome.

A 17-year-old boy presented with multiple, progressively enlarging cystic masses located at the junction of the lower eyelids and anterior orbit, 1 year after recovery from Stevens-Johnson syndrome. Bilaterally, symblepharon obliterated the inferior fornix and restricted supraduction. All but 1 cyst (which was sent for microscopic evaluation) was marsupialized. Cut edges of the cysts were sutured to adjacent conjunctiva and the epithelial walls were used as fornix lining. Histologically, the wall of the excised cyst consisted of conjunctiva. One year after surgery, the inferior fornices remained substantially deepened with improved ocular motility. This case demonstrated that conjunctival inclusion cysts occurring in the aftermath of Stevens-Johnson syndrome can be effectively managed with marsupialization. The epithelial lining can then be used in fornix reconstruction.

Corneal and conjunctival toxicity from hydrogen peroxide: a patient with chronic self-induced injury.

PURPOSE: To report a patient with severe corneal and conjunctival toxicity from long-term, habitual use of hydrogen peroxide as an eye wash. DESIGN: Observational case report. INTERVENTION AND TESTING: Serial examinations of the cornea, conjunctiva, and ocular adnexa were done. Penetrating keratoplasty with amniotic membrane transplantation was performed. MAIN OUTCOME MEASURES: Ocular inflammation, pain, and visual acuity outcome. RESULTS: Bilateral corneal and conjunctival inflammation and scarring mimicking ocular-cicatricial pemphigoid were noted. Formation of a descemetocele after starting treatment with low-dose topical steroids required emergent penetrating keratoplasty with amniotic membrane transplantation. CONCLUSIONS: This is the first reported case of ocular surface toxicity in a patient after deliberate chronic use of high-dose hydrogen peroxide. It highlights the value of obtaining a thorough medical and social history and the importance of direct questioning about the use of any medications or agents on the eyes before making a diagnosis or initiating therapy.