Volume 6, Number 10
Monday, March 13, 2006



In this issue: (click heading to view article)
Influence of Disease Severity and Optic Disc Size on Imaging Instrument Performance
UV Fluorescence Photography to Detect Early Sun Damage in Children’s Eyes
Prevalence and Treatment of H. pylori in Patients with Blepharitis
Graft Stability and Astigmatic Change Using Suture vs. Tissue Adhesive in PLK
Briefly











Influence of Disease Severity and Optic Disc Size on Imaging Instrument Performance

Researchers at the University of California, San Diego, evaluated the influence of disease severity and optic disc size on the diagnostic accuracy of three imaging technologies for structural assessment in glaucoma: confocal scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography.

A total of 105 patients with glaucoma and 61 subjects without glaucoma were recruited from the Diagnostic Innovations in Glaucoma Study. All underwent imaging with the GDx Variable Corneal and Lens Compensator (VCC; Carl Zeiss Meditec), the Heidelberg Retina Tomograph II (HRT II; Heidelberg Engineering) and the Stratus OCT (Stratus OCT; Carl-Zeiss Meditec) within a six-month period. Severity of disease was based on the Advanced Glaucoma Intervention Study (AGIS) visual field score. To evaluate the influence of severity of glaucoma and optic disc size on the diagnostic accuracy of the imaging instruments, sensitivities of the tests were fitted as a function of the AGIS score and disc area using logistic marginal regression models.

The severity of visual field loss had a significant influence on the sensitivity of all imaging instruments. More severe disease was associated with increased sensitivity. Larger optic discs were associated with decreased sensitivity for the Stratus OCT parameter Average Thickness and the GDx VCC parameter Nerve Fiber Indicator, whereas small optic discs were associated with increased sensitivity. Investigators observed an inverse effect for the HRT II parameter Moorfields regression analysis classification.

Results showed that diagnostic performances of the GDx VCC, HRT II and Stratus OCT were significantly influenced by severity of the disease and optic disc size. The authors suggest that these covariates be taken into account when comparing the performances of these tests for glaucoma diagnosis.

SOURCE: Medeiros FA, Zangwill LM, Bowd C, et al. Influence of disease severity and optic disc size on the diagnostic performance of imaging instruments in glaucoma. Invest Ophthalmol Vis Sci 2006;47(3):1008-15. 		Table of Contents











UV Fluorescence Photography to Detect Early Sun Damage in Children’s Eyes

This Australian study aimed to develop a method to detect precursors of ocular sun damage using ultraviolet fluorescence photography (UVFP).

The observational cross-sectional study included both eyes of 71 children ages three to 15 years attending preschool, primary school and high school in Sydney, Australia. Inclusion criteria were children attending the schools who gave consent. There were no exclusion criteria. Ultraviolet (UV) and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. Main outcome measures were the presence of areas of increased fluorescence detected by UVFP or presence of pinguecula detected by standard photography.

Investigators detected established pingueculae, on standard photography, in seven of 71 children (10 percent); all were 13 years or older. On UVFP, all of these pingueculae demonstrated fluorescence. In total, 23 of 71 students (32 percent) had increased fluorescence detected on UVFP, including the seven of 23 (30 percent) with pingueculae. Of the remaining 16 of 23 (70 percent), the changes were only detectable using UVFP. Fluorescence on UVFP was seen in children ages 9 years and above, with prevalence increasing with age. The presence of fluorescence (in at least one region) was 0 of 15 (0 percent) for children ages three to five years, 0 of 12 (0 percent) of children ages six to eight years, six of 23 (26 percent) for those ages nine to 11 years, and 17 of 21 (81 percent) of those ages 12 to 15 years.

The authors conclude that the areas seen to fluoresce on UVFP but not detectable on control photography represent precursors for ophthalmohelioses. They assert that their preliminary data strongly suggests that UVFP is a sensitive method for detecting early ocular sun damage occurring many years before clinical manifestations.

SOURCE: Ooi JL, Sharma NS, Papalkar D, et al. Ultraviolet fluorescence photography to detect early sun damage in the eyes of school-aged children. Am J Ophthalmol 2006;141(2):294-8.		 Table of Contents











Prevalence and Treatment of H. pylori in Patients with Blepharitis

Helicobacter pylori is a major pathogen etiologically associated with gastritis, peptic ulcer disease, gastric cancer and primary gastric lymphoma. This study by Italian researchers aimed to investigate a possible association between H. pylori infection and blepharitis.

Researchers evaluated a total of 250 consecutive patients with symptomatic blepharitis and 250 control subjects without blepharitis symptoms. After exclusions, the blepharitis group consisted of 186 patients with blepharitis and a control group of 215 patients. Blepharitis was diagnosed on the basis of findings in ophthalmic and dermatologic examinations. All patients underwent a 13C-urea breath test (UBT) to detect H. pylori infection, and impression cytology was performed before and after eradication therapy. The follow-up period was four months +/- 28 days.

The blepharitis group showed an H. pylori infection prevalence of approximately 76.3 percent (UBT-positive group with blepharitis: 142 patients), compared with 42.3 percent of the control group (UBT-positive group with blepharitis but asymptomatic: 66 patients; UBT-positive group without blepharitis: 25 patients). Investigators observed blepharitis in 30.6 percent (66 patients) of UBT-positive control subjects and 13.4 percent (29 patients) of UBT-negative control subjects. Impression cytology revealed that blepharitis was more severe in UBT-positive patients than in negative ones, and a clinical improvement in blepharitis was noted in approximately 50 percent of patients after H. pylori eradication.

The study authors believe that, although possible sources of error in defining the association of two highly prevalent conditions must be considered, their data seem to validate an association between H. pylori infection and blepharitis. However, it may not be indicative of a causal association. Eradication of H. pylori improved ocular cytology results; they suggest it is possible that chronic blepharitis is an extradigestive manifestation of H. pylori infection.

SOURCE: Sacca SC, Pascotto A, Venturino GM, et al. Prevalence and treatment of Helicobacter pylori in patients with blepharitis. Invest Ophthalmol Vis Sci 2006;47(2):501-8.		 Table of Contents











Graft Stability and Astigmatic Change Using Suture vs. Tissue Adhesive in PLK

Researchers at the Wilmer Ophthalmological Institute at Johns Hopkins University compared graft stability and astigmatic change using suture vs. tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty (PLK).

A 300-micron-thick partial flap keratectomy was performed in human donor corneoscleral rims using an artificial anterior chamber and a manual microkeratome. The flap stopped at the left central opening border, providing a wide hinge to add stability. After flap reflection, a 6.25-mm trephination was performed to obtain a disc of posterior stroma, Descemet membrane, and endothelium. The disc was positioned in a sutureless fashion and the flap secured with either five interrupted sutures or a chondroitin-sulfate-aldehyde-based adhesive. Increasing intrachamber pressures were created to detect graft stability. Videokeratographic data were recorded to evaluate astigmatic change.

The mean astigmatic change was 3.08 (0.84) diopters (D) in the sutured group and 1.13 (0.55) D in the glued group. Mean resisted pressures were 95.68 (27.38) mm Hg and 82.45 (18.40) mm Hg in the sutured and glued groups, respectively. Investigators believe that the modified technique of microkeratome-assisted PLK shows excellent graft stability in both groups. They believe that sutureless microkeratome-assisted PLK using tissue adhesive may become a new alternative in the surgical treatment of corneal endothelial disorders.

SOURCE: Pirouzmanesh A, Herretes S, Reyes JM, et al. Modified microkeratome-assisted posterior lamellar keratoplasty using a tissue adhesive. Arch Ophthalmol 2006;124(2):210-4.		 Table of Contents










BRIEFLY
  • ANTI-SDF-1 TREATMENT MAY LEAD TO NOVEL THERAPY FOR DIABETIC RETINOPATHY. An anti-SDF-1 treatment developed by RegenMed, a development-stage biotechnology company, prevents retinal neovascularization in animals, according to the company. SDF-1 (a cytokine) is expressed in response to injury, leading to a repair process that in the eye includes neovascularization, which disrupts the retina’s architecture. In RegenMed"s animal model of proliferative retinopathy, researchers injected an antibody that blocks SDF-1 activity before it causes neovascularization. The company is now focusing on preparing the antibody for human use, after which it plans to seek FDA approval to begin human clinical trials for treating diabetic retinopathy. For more information, go to www.regenmedbio.com.
  • ALCON WITHDRAWS EUROPEAN APPLICATION FOR RETAANE. Alcon, has announced the withdrawal of its European marketing authorization application for Retaane 30mg/ml (anecortave acetate suspension for depot injection) from the European Medicines Agency (EMEA) review process. The company chose to withdraw the application after being informed by EMEA that it would have to provide additional clinical data from existing and/or new clinical trials to support approval. The U.S. Food and Drug Administration (FDA) also recently advised Alcon that additional clinical data will be required for U.S. approval. Alcon is revising its clinical strategy and plans to continue developing Retaane suspension for "wet" age-related macular degeneration in the United States, Europe and key markets around the world; it aims to provide a time frame for resubmission or amendment after it finalizes the revised clinical development strategy.
  • SOFTWARE ANIMATIONS ILLUSTRATE AND EXPLAIN EYE CONDITIONS. Trevi Technology has introduced Ocutouch 360, an office education software program that illustrates optical conditions, treatment procedures and eye anatomy. It features an all-subject animation loop that allows selected animation sequences to be presented to patients in your waiting room. Topics are available as silent or narrated animations with music, text and captions in a one-hour continuous loop. Content is selectable to match clientele to increase understanding of diagnoses, explain treatment options, and reassure patients facing optical procedures. The program includes full-color detailed illustrations of healthy eyes and explanations of medical conditions including glaucoma, retinal detachment, macular degeneration, cataracts and diabetic retinopathy; it also includes sequences depicting corneal transplant, intraocular lens implantation, and refractive surgery procedures. The loop allows for a variable-length intermission and for insertion of customized practice information; it can be installed on most PCs and laptops and is available as part of the Ocutouch 360 Suite. For more information, call 888-668-7384 or go to www.trevitechnology.com.
  • EYE HEMORRHAGE MAY NOT ALWAYS SIGNAL CHILD ABUSE. Physicians have commonly viewed retinal hemorrhage in a child as potential evidence of child abuse. However, a new study suggests that this belief may be flawed. Forensic pathologist Dr. Patrick Lantz of Wake Forest University Baptist Medical Center, Winston-Salem, NC, said that the findings of his study show that retinal hemorrhages occur more often than most physicians think, but they’re associated with a wide variety of conditions. Lantz and his team found that about 16 percent of the 700 people of all ages he examined during autopsy had retinal hemorrhaging. The hemorrhages were found in people who died from ruptured aneurysms, falls, car accidents, gunshot wounds, meningitis and drug overdose. He detected retinal hemorrhaging in 30 children younger than 14, but only six of them were associated with child abuse. He suggests that pathologists, pediatricians and eyecare practitioners seek additional clinical or medical information before assuming that retinal hemorrhages in children are diagnostic of child abuse.


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