Doheny Eye Institute Research Articles

Type 3 Macular Neovascularization in Age-related Macular Degeneration: Baseline Predictors of 3-Year Macular Atrophy Development

PurposeTo identify baseline optical coherence tomography (OCT) predictors of the 3-year macular atrophy (MA) development for type 3 macular neovascularization (MNV) secondary to neovascular age-related macular degeneration (nAMD) treated by anti-VEGF therapy. DesignMulticenter, retrospective, longitudinal study. ParticipantsWe included patients with treatment-naïve type 3 MNV secondary to nAMD at baseline, treated with anti-VEGF during a 3-year follow-up. MethodsPatients were identified from six retinal referral institutions: 1) San Raffaele University, Milan, Italy 2) University of Genova, Genova, Italy; 3) Doheny Eye Institute, Los Angeles, USA; 4) Stein Eye Institute, Los Angeles, USA; 5) University of Paris Est, Creteil, France; 6) IRCCS Bietti Foundation, Rome, Italy. Several baseline predictors of 3-year MA area were analyzed based on structural OCT and demographics. Main Outcome MeasuresMultivariate analysis in order to identify baseline independent predictors of the 3-year MA development for type 3 MNV secondary to nAMD treated by anti-VEGF therapy. ResultsWe included 131 eyes of 131 patients (mean age 80±6-year-old, 81% females). Best-corrected visual acuity was 0.49±0.40 LogMAR at the baseline and significantly decreased to 0.59±0.43 LogMAR at the end of 3-year follow-up (p<0.001). Patients were treated with 11±6 anti-VEGF injections and developed atrophy in 75% of cases (from 18% at the baseline). Eyes that developed 3-year MA were treated with a significantly lower number of injections compared to eyes without MA (9.9±5.5 vs 14.7±7.2 injections, p<0.001). The most relevant independent predictors at baseline of MA area at 3-year follow-up were: area of MA at baseline (p<0.001), AMD phenotype (presence of reticular pseudodrusen) (p=0.017), baseline presence of nascent geographic atrophy (p=0.008), and the baseline presence of subretinal hyper-reflective material (p=0.002). ConclusionsMacular atrophy development is a frequent complication of type 3 MNV treated with anti-VEGF injections. Several factors could be considered as baseline predictors of atrophy development during the anti-VEGF treatment.

Reply to: Socioeconomic Factors May Affect Diversity in Neuro-Ophthalmology.

Department of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California; and Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California The authors report no conflicts of interest.

Real-World Visual Outcomes of Laser and Anti-VEGF Treatments for Retinopathy of Prematurity

To characterize visual outcomes in children screened for retinopathy of prematurity (ROP). Retrospective, interventional case series. Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye examinations at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles, California) were included. Data were collected on birth characteristics, worst type of ROP, and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging, and optic atrophy. Snellen visual acuity was reported for children 4 years and older. A total of 175 infants (350 eyes) were included for analysis (mean gestational age=28.2 weeks and birth weight=1059 g) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a 9-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, whereas 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared with primary laser treatment, was associated with a decreased incidence of amblyopia (adjusted odds ratio [aOR]=0.6-0.86, P < .0001) after controlling for gestational age and birth weight. The rates of optic atrophy (P=.79), strabismus (P=.98), and myopia (P=.93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser-treated infants (P=.041). Infants receiving laser therapy were more likely to have severe myopia (aOR=1.02-1.3, P=.023), amblyopia (aOR=1.12-1.61, P=.002), and optic atrophy (aOR=1.01-1.32, P=.045) than infants not treated. These findings add to the advantages of anti-VEGF treatment compared with primary laser treatment, particularly in posterior ROP.

Effect of Age and Myopia on Retinal Microvasculature.

To investigate the effect of age and refractive error on changes in the retinal microvascular network. Subjects were recruited from the Doheny Eye Institute. Refractive error and axial length were measured. High myopia was defined as refractive error greater than -6 diopters (D). Optical coherence tomography angiography (OCTA) imaging was performed and images were analyzed using fractal analysis. Primary outcomes were superficial capillary plexus (SCP) vessel density, deep capillary plexus (DCP) vessel density, and foveal avascular zone (FAZ) area. One hundred thirty-eight eyes of 69 subjects were included. Twenty-eight (41%) subjects were male and 41 (59%) subjects were female. Mean age was 42.81 years ± 19.91 years (range: 8 years to 87 years). Mean refractive error was -1.74 D ± 3.18 D (range: -15.78 D to 4.25 D), and mean axial length (AL) was 24.29 mm ± 1.35 mm (range: 21.73 mm to 28.32 mm). SCP and DCP vessel densities were negatively correlated to age (r = -0.22, P = .011; and r = -0.49, P < .001). Controlling for age, patients with high myopia and longer AL had decreased SCP density (P = .021 and P = .027, respectively), but no difference in DCP vessel density was observed (P = .065 and P = .058, respectively). FAZ area was not significantly correlated to age, gender, refraction, or AL. SCP and DCP vessel densities decreased with age. In addition, SCP density but not DCP vessel density was reduced in eyes with high myopia and longer AL. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:925-931.].

Professor Srinivas R. Sadda: unlocking the secrets of choroid

Dr. Srinivas R. Sadda (Figure 1) is Associate Professor of Ophthalmology at the Keck School of Medicine, the University of Southern California, Doheny Eye Institute. He is Director of the Medical Retina Unit, Ophthalmic Imaging Unit, Retinal Cell Replacement Laboratory, and Doheny Image Reading Center. He obtained his MD from Johns Hopkins University and a bachelor of science (Cellular and Molecular Biology) from the University of Michigan. He served as an intern at the W. Beaumont Hospital and returned to Wilmer Eye Institute for his ophthalmology residency, followed by fellowships in neuro-ophthalmology and medical retina at Wilmer.

Reversible Venting Stitch for Fenestrating Valve-less Glaucoma Shunts.

The purpose of this is to describe a venting stitch modification for valveless glaucoma aqueous shunts and characterize early postoperative intraocular pressure (IOP) and glaucoma medication use following the modification. Retrospective chart review of 61 sequential patients undergoing Baerveldt glaucoma implant (BGI)-350 implantation at the Doheny Eye Institute. Twenty-four patients received a glaucoma shunt with venting stitch modification (modified BGI) and 37 patients received an unmodified shunt (BGI-only). IOP, number of glaucoma medications, and number of hypotony cases (intraocular pressure ≤5 mm Hg) were compared between the groups. T-tests were used for statistical analysis. At postoperative-day 1, mean IOP was significantly lower compared with preoperatively in the modified BGI group (14 mm Hg; reduced by 51%; P<0.0001) but not the BGI-only group (27 mm Hg; P=0.06). IOP difference between groups persisted till immediately before tube opening (P=0.005) and fewer IOP-lowering medications needed in the modified BGI group (P<0.0001). One case (4.2%) of postoperative hypotony was encountered with BGI modification, which resolved after the stitch was removed in clinic. The venting stitch valveless shunt modification allows for effective, reliable, and safe control of early postoperative IOP.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Dean M. CestariDean M. CestariDr Cestari completed residencies in both Neurology and Ophthalmology at the Cornell University Medical College's New York Presbyterian Hospital, as well as fellowship training in neuro-ophthalmology at the Massachusetts Eye and Ear Infirmary, Harvard Medical School (HMS). He is one of approximately 10 physicians in the United States who is board certified by both the American Board of Ophthalmology and the American Board of Psychiatry & Neurology. Dr Cestari joined the full-time faculty of Mass. Eye and Ear, a primary teaching hospital for HMS, in 2006 and currently holds the rank of Assistant Professor of Ophthalmology, Harvard Medical School. He is very involved in medical education and is the Director of the Clinical Fellowship program at Mass. Eye and Ear. His efforts as a clinician-scientist focus on the evaluation and treatment of patients who present with neuro-ophthalmic disease. He is also very involved in the medical and surgical treatment of Thyroid Eye Disease with strabismus and diplopia. He just published a surgical textbook entitled, “Learning Strabismus Surgery, A Case Based Approach.” He supervises clinical fellows, second-year residents and visiting medical students and performs adult strabismus surgery and mentors second-year residents in the operating theater. Dr Cestari's translational research is focused on developing a rodent model for ischemic optic neuropathy and central retinal artery occlusion. Once this is accomplished, his team will begin to evaluate the safety and efficacy of various novel neuro-protective agents that can be used to preserve and restore vision affected by vascular occlusion. Additionally, he is working with a team of engineers from MIT and Harvard University to design and build an implantable device to restore ocular motility to denervated extra-ocular muscles from nerve palsys. Russell W. ReadRussell W. ReadDr Read graduated magna cum laude in 1994 from the University of Alabama School of Medicine in Birmingham (UAB), Alabama, USA. Dr Read completed a residency in ophthalmology at the University of Washington, Seattle, USA and dual fellowships at the Doheny Eye Institute, USA/University of Southern California, USA, in uveitis/ocular inflammatory diseases and ophthalmic pathology. Dr Read joined the faculty of the UAB Department of Ophthalmology in August 2000 where he is now Professor of Ophthalmology and Pathology. Dr Read is actively involved in the clinical care of patients with uveitis and ocular inflammatory diseases and serves as the Executive Secretary of the American Uveitis Society. He is the residency program Director for ophthalmology.

Professor Srinivas R. Sadda: unlocking the secrets of choroid

Dr. Srinivas R. Sadda (Figure 1) is Associate Professor of Ophthalmology at the Keck School of Medicine, the University of Southern California, Doheny Eye Institute. He is Director of the Medical Retina Unit, Ophthalmic Imaging Unit, Retinal Cell Replacement Laboratory, and Doheny Image Reading Center. He obtained his MD from Johns Hopkins University and a bachelor of science (Cellular and Molecular Biology) from the University of Michigan. He served as an intern at the W. Beaumont Hospital and returned to Wilmer Eye Institute for his ophthalmology residency, followed by fellowships in neuro-ophthalmology and medical retina at Wilmer.

Validity of Forced Eyelid Closure Test: A Novel Clinical Screening Test for Ocular Myasthenia Gravis

Forced eyelid closure test (FECT) is a clinical screening test developed from the original Cogan lid twitch (CLT) sign to assist in the diagnosis of ocular myasthenia gravis (OMG), We evaluated the sensitivity and specificity of FECT compared with CLT and benchmarked to standard diagnostic tests. This study was a retrospective chart review of 48 patients using electronic medical records of those that presented with ptosis and/or diplopia at Doheny Eye Institute, University of California, Los Angeles between February 2015 and April 2016. Patients without FECT testing were excluded. FECT and CLT results, and final diagnosis were recorded. To perform FECT, the patient was asked to squeeze his or her eyelids shut for 5-10 seconds then open quickly and fixate in primary position. The excessive upward overshoot of eyelids movement indicated a positive FECT. The test was performed by a neuro-ophthalmologist before establishing the diagnosis. Patients who had equivocal test results and/or inconclusive final diagnosis were excluded. Of the 48 patients studied, 18 patients (37.5%) had positive FECT; 15 of whom had a final diagnosis of OMG (83.3%). Of the 30 patients with negative FECT, 1 had OMG (3.3%). Of the 48 patients, 35 patients also had a documented CLT result (72.9%). CLT was positive in 11 of these 35 patients (31.4%), and 9 of these 11 had OMG (81.8%). Of the 24 patients with negative CLT, 2 of them had OMG (8.3%). Sensitivity and specificity of FECT were 94% and 91% (joint 95% confidence region: sensitivity × specificity = [0.70, 1] × [0.75, 1]). The relative true-positive fraction (rTPF) between FECT and CLT was 1.15; the relative false-positive fraction was 1.31. FECT is a simple clinical screening test with good sensitivity and specificity for OMG.

The Bionic Eye: A Quarter Century of Retinal Prosthesis Research and Development

This article describes the history of visual prostheses, with emphasis on the development of the Argus II retinal prosthesis system (Second Sight Medical Products, Inc., Sylmar, CA). A brief overview of cortical electrical stimulation in the blind is provided, followed by an account of the design and development of retinal stimulation equipment at the Duke Eye Center in the late 1980s; the first human intraoperative tests there and the subsequent 8 years of tests at the Wilmer Eye Institute; the transfer of the project to the Doheny Eye Institute at the University of Southern California and the founding of Second Sight Medical Products; and the development and clinical trials of the Argus I and Argus II systems. In a series of vignettes, we pay tribute to the many colleagues and patient volunteers without whose help the work would not have been possible.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine, USA, and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of Refractive Surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a University of California, Berkeley, USA, trained engineer, graduated from the Columbia University College of Physicians and Surgeons, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Jimmy K. LeeJimmy K. LeeJimmy K. Lee, M.D. is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the Cornea, Refractive Surgery, and External Diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, USA, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the Residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute, USA, and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the medical director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the Association of University Professors of Ophthalmology (AUPO). Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Microbial Keratitis in Los Angeles: The Doheny Eye Institute and the Los Angeles County Hospital Experience

To evaluate the spectrum and antibiotic susceptibility panel of infectious keratitis at a major tertiary care referral eye center and a major county hospital in Southern California. Retrospective case series. All cultured infectious keratitis cases from July 1, 2008, through December 31, 2012, from the Doheny Eye Institute (DEI) and the Los Angeles County + University of Southern California Medical Center (LAC+USC) were evaluated. Microbiology records were reviewed retrospectively. Microbial isolates as well as antibiotic susceptibility patterns were analyzed. One hundred eighty-four (63%) of 290 cases showed positive culture results at DEI and 152 (82%) of 186 cases showed positive culture results at LAC+USC. Gram-positive pathogens were found to be the most common at both DEI (70%) and LAC+USC (68%), with coagulase-negative Staphylococcus being the most common gram-positive organism (58% at DEI and 44% at LAC+USC). Pseudomonas aeruginosa was the most common gram-negative organism (57% at DEI and 43% at LAC+USC). Ciprofloxacin and levofloxacin susceptibility for all tested pathogens was 73% at DEI and 81% at LAC+USC (P = 0.16). Oxacillin-resistant Staphylococcus aureus (ORSA) was found in 42% of cases at DEI and in 45% of cases at LAC+USC (P = 1.00). There is no significant difference in the spectrum of pathogens or antibiotic susceptibility of pathogens at DEI versus LAC+USC, and ORSA was found in approximately half of all S. aureus samples.

Refractory Open-Angle Glaucoma After Neodymium–Yttrium-Aluminum-Garnet Laser Lysis of Vitreous Floaters

To illustrate 3 cases of chronic open-angle glaucoma secondary to the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis procedure for symptomatic vitreous floaters. Observational case series. Location of the study was the Doheny Eye Institute. Three eyes of 2 patients who developed chronic open-angle glaucoma after Nd:YAG vitreolysis for symptomatic floaters presenting with very high intraocular pressure (IOP >40 mm Hg) were selected. The time from the laser treatment to the onset of elevated pressure ranges from 1 week to 8 months. There was no associated inflammation, steroid use, or other identifiable cause of chronic IOP elevation. All eyes were treated initially with glaucoma medication, followed by selective laser trabeculoplasty (SLT) and eventually glaucoma surgery (Trabectome) in 2 eyes for disease management. In all eyes, intraocular pressures were eventually stabilized within a normal pressure range from 18 to 38 months following Nd:YAG vitreolysis. At the latest follow-up post surgery, all eyes had intraocular pressures of 22 mm Hg or less with or without medications. Secondary open-angle glaucoma is a complication of Nd:YAG vitreolysis for symptomatic floaters that may present with an increase in intraocular pressure immediately, or many months after the surgery. Furthermore this complication may be permanent and require chronic medical therapy or glaucoma surgery.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine, USA, and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of Refractive Surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a University of California, Berkeley, USA, trained engineer, graduated from the Columbia University College of Physicians and Surgeons, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Jimmy K. LeeJimmy K. LeeJimmy K. Lee, M.D. is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the Cornea, Refractive Surgery, and External Diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, USA, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the Residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute, USA, and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the medical director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the Association of University Professors of Ophthalmology Program Directors Council (AUPO). Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Role of ultra-widefield fluorescein angiography in the management of uveitis

ObjectiveTo discuss and illustrate the role of ultra-widefield fluorescein angiography (UWFFA) in the diagnosis and management of peripheral retinal vasculitis. DesignRetrospective case series. ParticipantsFour consecutive patients in whom UWFFA showed far peripheral vasculitis were included. All patients were seen between May 2011 and May 2012 at the Doheny Eye Institute. MethodsConventional fluorescein angiogram (FA) images or areas determined by the Early Treatment of Diabetic Retinopathy Study Group protocol for imaging the posterior pole and peripheral retina were superimposed on the UWFFA images. The ability to detect the extent and severity of vasculitis and vascular occlusion using both conventional FA and UWFFA was compared by 2 investigators, and any discrepancies were adjudicated by a third investigator. ResultsIn none of the cases was the full extent of vasculitis and capillary occlusion visible in the fields normally portrayed by conventional FA. In contrast, capillary nonperfusion and peripheral vasculitis were detectable by UWFFA in all cases. In 2 cases, the posterior extent of vasculitis could have been detected by conventional FA. ConclusionsDetection and depiction of the extent and severity of peripheral vascular changes are enhanced with UWFFA, aiding in the management of vasculitis in the retinal periphery.

Functional and Visual Improvement With Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lenses for Irregular Corneas

To evaluate the Doheny Eye Institute Experience with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lenses for the management of irregular corneas with outcomes based on visual acuity (VA) and visual function. A retrospective chart review of 58 subjects (90 eyes) with irregular corneal surfaces referred to the Doheny Eye Institute for PROSE treatment between July 2009 and December 2011 was performed. The best-corrected VA before and after PROSE fitting was recorded. A functional assessment before and after PROSE fitting was also performed using the Ocular Surface Disease Index, a 12-item questionnaire that grades the severity of ocular discomfort and vision-related function. Keratoconus (43%) represented the largest group, and post-PK astigmatism (31%) represented the second largest group of patients with irregular corneas who had completed the PROSE treatment. Patients with keratoconus had the greatest improvement in VA after PROSE fitting with an 88% improvement in the logarithm of the minimal angle of resolution vision. Patients with post-PK astigmatism had the greatest improvement in Ocular Surface Disease Index scores with a 79% improvement observed after PROSE fitting. PROSE scleral lenses offer improvements in the VA and function, and they could be an option for patients with irregular corneas who have failed conventional treatments before considering additional surgery.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Robert C. SergottRobert C. SergottRobert C. Sergott, MD, is co-Director of the neuro-ophthalmology service and Attending Surgeon at Wills Eye Hospital, Philadelphia, USA. He is also Professor of ophthalmology, neurology, and neurosurgery at Thomas Jefferson University, USA. He has authored over 200 articles in peer-reviewed journals and lectured at many national and international meetings. He has been the recipient of grant support from the National Eye Institute, National Institutes of Health, Neurology Division, and the National Multiple Sclerosis Society. In 1996, chairmen of academic ophthalmology departments in the USA elected him one of the 100 best ophthalmologists in America in a vote. He has been involved with clinical and research tele-ophthalmology for the last 10 years, concentrating on thyroid eye disease, multiple sclerosis and optic neuritis, and ischemic optic neuropathy. Russell W. ReadRussell W. ReadDr Read graduated magna cum laude in 1994 from the University of Alabama School of Medicine in Birmingham (UAB), Alabama, USA. Dr Read completed a residency in ophthalmology at the University of Washington, Seattle, USA and dual fellowships at the Doheny Eye Institute, USA/University of Southern California, USA, in Uveitis/Ocular Inflammatory Diseases and Ophthalmic Pathology. Dr Read joined the faculty of the UAB Department of Ophthalmology in August 2000 where he is now Professor of Ophthalmology and Pathology. Dr Read is actively involved in the clinical care of patients with uveitis and ocular inflammatory diseases and serves as the Executive Secretary of the American Uveitis Society. He is the residency program Director for ophthalmology.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of refractive surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a UC Berkeley trained Engineer, graduated from the Columbia University College of Physicians and Surgeons, New York, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as Faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Prabjot ChannaPrabjot ChannaDr Channa is board certified in Ophthalmology and is Assistant Professor at the Albert Einstein College of Medicine, New York, USA. She earned her medical degree from Bombay University in Goa, India, and did her ophthalmology residency at Albert Einstein College of Medicine. Dr Channa is fellowship trained in cornea, external disease & uveitis at Francis I. Proctor Foundation, University of California, USA. She has been at Montefiore Medical Center since 2002. While her practice concentrates on challenging chronic eye diseases, Dr Channa has long held a passion for helping patients with more serious eye dysfunction. Utilizing the most advanced corneal transplant and keratoprosthesis techniques, she has been able to restore sight in people who have lost virtually all vision, related to ocular surface problems. Kristin HammersmithKristin HammersmithDr Hammersmith received her medical degree in her hometown from West Virginia University, USA. She completed her ophthalmology residency at the Wilmer Ophthalmological Institute at Johns Hopkins University, USA in 2002. Following subspecialty training in cornea and external disease at Wills Eye Hospital, USA, she joined the Wills Cornea Service. She is currently an Instructor at Thomas Medical College of Thomas Jefferson University, USA. Dr Hammersmith has clinical expertise in corneal disease and surgery and cataract surgery. She has a special interest in ocular surface disorders and diseases affecting children. She is a section co-Editor for the Yearbook of Ophthalmology. She is actively involved in fellow and resident education and serves on the residency education and continuing medical education committees at Wills Eye Hospital. She is a member of the American Academy of Ophthalmology, for which she serves on the Cornea Self-Assessment Committee, and the Association for Research in Vision and Ophthalmology.

Tiny Bubbles

*Retinal Consultants of Arizona, Phoenix, Arizona †Doheny Eye Institute ‡Keck School of Medicine, University of Southern California, Los Angeles, California The author is a consultant to Alcon, Ft. Worth, Texas.

Descemet stripping with automated endothelial keratoplasty: A comparative study of outcome in patients with preexisting glaucoma

PurposeTo compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma. MethodsFor this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication (55) or with previous glaucoma surgeries (64) with a time-matched group of all other DSAEK cases (179, control). ResultsWith a mean follow-up of 1.85±1.12years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure (odds ratio OR=12.35, 95% confidence interval CI [5.46–27.90], P<0.001). Graft detachment was not associated with either history of glaucoma or glaucoma surgery (P>0.05). Glaucoma on medication had no increased risks of graft failure compared to normal eyes (P=0.38). However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries (OR=4.26, 95% CI [1.87–9.71], P<0.001). Medically managed glaucoma has increased risks of postoperative IOP elevation (OR=2.39, 95% CI [1.25–4.57], P=0.013), whereas surgically managed glaucoma has no significant elevation (P=0.23). Elevation of IOP was not significantly correlated with graft failure (P=0.21). ConclusionDSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival.