American Academy of Ophthalmology Web Site: www.aao.org
Original URL:

 
Journal Highlights
New Findings from Ophthalmology, AJO and Archives

 
 

Refractive Stability Is Maintained 12 Years After Myopic PRK

Full Involution of Laser-Treated Threshold ROP May Require More Than Two Weeks

Selective Laser Trabeculoplasty vs. Argon Laser Trabeculoplasty

How to Dance With the FDA

Cataract Patients: A Top Priority Is Quality of Vision, Irrespective of Spectacle Dependence

An Overview of Tumors Managed at an Ocular Oncology Center

Greater IOP Fluctuation and Increasing Age Are Associated With Visual Field Progression

Hypothyroidism Is Associated With an Increased Risk of Open-Angle Glaucoma

Primary Angle-Closure Glaucoma and Visual Field Loss

Managing Patients With Unilateral Posterior Vitreous Detachment—18 Critical Months

Association of Cytomegalovirus Infection With Neovascular AMD

Cytomegalovirus Retinitis in People Without HIV Infection

Hands-Free Cellular Phones and Visual Field Attention

Conjunctival Squamous Cell Carcinoma Treated With PDT

Results of Keratoplasty in Eyes With a Glaucoma Drainage Device

The Inflow of Ocular Surface Fluid Through Standard Clear Corneal Cataract Incisions

AIPL1-Related Leber’s Congenital Amaurosis—A Severe Phenotype

The Salisbury Eye Evaluation in Nursing Home Groups Study

Glaucoma: Long-Term Adjunctive Latanoprost Treatment Seems Safe

Document Use of Herbal Medicine

Respiratory Side Effects Using Beta-Antagonists for Glaucoma

Changes in Focal Macular ERGs After Macular Translocation


Previews

Refractive Stability Is Maintained 12 Years After Myopic PRK
October’s Ophthalmology

In a prospective follow-up study of myopic PRK, Rajan et al. show that refractive stability achieved at one year is maintained up to 12 years with no evidence of hyperopic shift, diurnal fluctuation or late regression.

The study followed 68 of the original 120 patients who participated in the 1990 trial, which involved use of the Summit Technology UV 200 excimer laser with a 4-millimeter ablation zone.
 
After 12 years, refractive stability was maintained with most instances of corneal haze decreasing with time and a complete recovery of BCVA. A small group of patients continued to experience nighttime glare, which the researchers attributed to the 4-mm ablation zone that was performed at the time to conserve stromal tissue.

They add that over the years, enlargement of the ablation size has not only minimized nighttime glare but also resulted in less postoperative hyperopic shift, less regression and better refractive predictability.

Full Involution of Laser-Treated Threshold ROP May RequireMore Than Two Weeks
October’s Ophthalmology

Coats et al. conducted a retrospective chart review to analyze the process of retinopathy of prematurity involution after treatment of threshold disease with transpupillary diode laser photocoagulation.

The study involved 262 eyes of 138 infants with threshold retinopathy who underwent diode laser photocoagulation of the peripheral avascular retina.

They found that approximately half of treated eyes involuted fully within two weeks of treatment, whereas the remaining eyes required at least three weeks to involute fully. Dense vitreous hemorrhage totally obscuring visualization of the retina was a bad prognostic sign, eventually followed by diagnosis of retinal detachment in more than half of the affected eyes. The retinal detachments usually were not detected until at least three weeks after treatment.

The authors conclude that because retinal detachments typically were not diagnosed in the immediate postoperative period, screening should be considered for a minimum of 10 weeks after treatment. Patients may need additional follow-up, depending on the severity of the disease.

Selective Laser Trabeculoplasty vs. Argon Laser Trabeculoplasty
October’s Ophthalmology

In patients with primary open-angle glaucoma on maximally tolerated medical therapy, selective laser trabeculoplasty was found to be as effective as argon laser trabeculoplasty in lowering IOP over a five-year period.

In this retrospective chart review by Juzych et al., 154 eyes of patients with uncontrolled POAG underwent ALT and 41 eyes underwent SLT.

SLT delivers less than 1 percent of the energy of ALT by using a nanosecond pulse duration and selectively targeting the pigmented trabecular meshwork cells, thus minimizing coagulation and collateral damage to the nonpigmented cells or adjacent structures.

While SLT was as effective as ALT in lowering IOP, long-term data indicated that many of the patients treated with SLT and ALT required further glaucoma medical or surgical intervention. Also, it is unclear whether SLT has better long-term success than ALT in repeat laser trabeculoplasty. The authors call for a long-term prospective trial.

How to Dance With the FDA
October’s Ophthalmology

While clinical trials that incorporate randomized, well-controlled and masked designs have generated a tremendous amount of meaningful data over the past few decades, the actual process of what it takes to conduct a clinical trial remains a mystery to many clinicians. According to Feinsod and Chambers, there exists no formal training in this subject and many clinicians lack even a basic understanding of the procedures required by the Federal Food, Drug and Cosmetic Act.

To address this information void, the authors have created a user-friendly “road map” to help physicians navigate through the process. The paper provides a brief overview of the FDA, discusses filing an Investigational New Drug application, explains the emergency IND application and reviews how INDs are processed and approved—including how “no news is good news.”

The authors hope this review of the workings behind the FDA will make the clinician-investigator’s next trip through the “regulatory dance” more tolerable.

Cataract Patients: A Top Priority Is Quality of Vision, Irrespective of Spectacle Dependence
October’s Ophthalmology

Nijkamp et al. conducted a randomized controlled trial to evaluate the effectiveness of multifocal IOLs to correct presbyopia after cataract surgery.

The researchers implanted monofocal IOLs in the eyes of 75 cataract patients and multifocal IOLs in the eyes of 78 patients. Sociodemographics, eagerness for spectacle independence and neuroticism (a neurotic character, condition or trait) were tested as predictors of satisfaction. Overall patient satisfaction did not differ between the groups of patients implanted with mono- and multifocal IOLs. Independent of scores for neuroticism or scores for eagerness for spectacle independence, the success of both IOLs depended on preop expectations and postop quality of aided near vision.

In light of their findings that patients seem to believe it is more important to achieve a good quality of vision irrespective of spectacle dependence, the authors conclude the quality of aided near vision should be optimal to assure patient satisfaction after cataract surgery—regardless of which IOLs are used. They also encourage clinicians to help patients set realistic postoperative expectations.

Reviews

An Overview of Tumors Managed at an Ocular Oncology Center
Ophthalmology
2004;111(9):1747-1754

Shields et al. provide a broad perspective of an ocular tumor practice spanning nearly three decades in which patients were referred with lesions, many of which proved to be malignancies.

The authors reported their series of 1,643 patients—53 percent with tumors of melanocytic origin and 47 percent of nonmelanocytic origin. In this series, the most common tumor categories were melanocytic (53 percent), premalignant and malignant epithelial (11 percent) and lymphoid (8 percent).

The 872 melanocytic tumors included nevus (52 percent), melanoma (25 percent), primary acquired melanosis (21 percent) and racial melanosis (3 percent).

The 181 epithelial malignancies included squamous cell carcinoma (60 percent), intraepithelial neoplasia (39 percent) and basal cell carcinoma (1 percent).

The 128 lymphoid tumors included malignant lymphoma (77 percent), benign reactive lymphoid hyperplasia (22 percent) and plasmacytoma (1 percent).

African-American patients represented only 7 percent of epithelial tumors, less than 1 percent of melanomas and 8 percent of lymphoid tumors.

The authors conclude that this report provides an instructional overview of the clinical spectrum of conjunctival lesions managed at an ocular oncology center.

Greater IOP Fluctuation and Increasing Age Are Associated With Visual Field Progression
Ophthalmology
2004;111(9):1627-1635

Using relevant pointwise linear regression criteria for evaluation of visual function outcomes in the Advanced Glaucoma Intervention Study, Nouri-Mahdavi et al. found two parameters consistently associated with visual field progression: greater IOP fluctuation and older age at first glaucoma intervention.

The investigators studied 509 eyes of 401 patients from the multicenter, randomized study with a baseline visual function score of no more than 16, at least seven visual function examinations and a follow-up period of no less than three years. Worsening of a test location of pointwise linear regression analysis was defined as a change of threshold sensitivity of at least one decibel a year, with visual function progression identified as worsening of at least two test locations within a Glaucoma Hermifield Test cluster with pointwise linear regression analysis.

Results indicated that both increasing age (for each five-year increment) and greater IOP fluctuation (1-mmHg increase) increased the odds of visual function progression by 30 percent. Other risk factors for worsening of visual function included longer follow-up and a higher number of glaucoma interventions.

Hypothyroidism Is Associated With an Increased Risk of Open-Angle Glaucoma
Ophthalmology
2004;111(9):1649-1652

Girkin et al. have found a strong association between a pre-existing diagnosis of hypothyroidism and an increased risk of open-angle glaucoma in a large male population being treated in a Veterans Affairs medical facility.

The nested case-control study involved 590 patients with newly diagnosed glaucoma between 1997 and 2001. They were age-matched and compared with 5,897 males who did not have glaucoma. The mean age of both groups was 69 years.

Following adjustment for diabetes, lipid metabolism disorders, hypertension, cardiovascular disease, cerebrovascular disease, arterial disease and migraines, those with glaucoma were significantly more likely to have pre-existing hypothyroidism (6.44 percent) compared with the control group (3.97 percent).

The authors conclude these findings are noteworthy given the high prevalence of hypothyroidism in the general population. They call for additional studies to determine if treatment of this condition is associated with a reduction in the incidence of glaucoma.

Primary Angle-Closure Glaucoma and Visual Field Loss
Ophthalmology
2004;111(9):1636-1640

In a hospital-based study, Ang et al. document that individuals with asymptomatic primary angle-closure glaucoma present with more severe visual field loss than those with symptomatic disease.

In this observational case series, 76 consecutive patients who presented at a Singapore hospital were evaluated. More than half of patients with asymptomatic primary angle-closure glaucoma (52.8 percent) had visual fields with Advanced Glaucoma Intervention Study scores of 18 to 20, which corresponds to end-stage visual field loss. In contrast, the majority of those with symptomatic disease only had mild or moderate visual field defects. The visual field loss in all three regions—upper, lower and nasal—was also greater in patients with asymptomatic disease. Cup-to-disc ratio was a significant predictor for visual field loss, but age, gender and level of presenting IOP were not correlated with visual field outcome.

The authors call for greater efforts toward early detection and treatment of asymptomatic primary angle-closure glaucoma, especially in Asia, where millions are afflicted with this condition.

Managing Patients With Unilateral Posterior Vitreous Detachment—18 Critical Months
Ophthalmology
2004;111(9):1705–1707

Hikichi and Yoshida have found that posterior vitreous detachment frequently develops in the fellow eye from six months to two years after PVD in the first eye.

The study involved 51 patients with acute unilateral PVD who underwent a comprehensive ocular examination every three months at least until PVD developed in the fellow eye.

PVD developed in 8 percent of eyes within six months, 24 percent within one year, 47 percent within 18 months, 65 percent within two years and 90 percent within three years. In 10 percent of these eyes, PVD did not develop after more than three years. In symptomatic PVD in this study, the most frequent symptom was floaters alone.

Based on these findings, the authors conclude that the period from six months to two years after PVD in the first eye is critical in the development of retinal breaks and subsequent retinal detachment—information that is useful for managing patients with unilateral PVD.

Association of Cytomegalovirus Infection With Neovascular AMD
American Journal of Ophthalmology
September issue

Miller et al. tried to determine if prior exposure to pathogens previously associated with vascular disease correlates with neovascular AMD.

There were 150 patients (47 neovascular AMD, 36 dry AMD and 67 non-AMD controls) included in this multicenter study. Exclusion criteria included HIV infection, malignancy, immunosuppressive illness or recent acute illness requiring hospitalization within six months. Serum samples were obtained for analysis of cytomegalovirus, Chlamydia pneumoniae and Helicobacter pylori immunoglobulin G antibody titers by enzyme-linked immunosorbent assay. The researchers compared the distribution of IgG titers between wet AMD patients, dry AMD patients and controls.

They found that the average CMV IgG titer was higher in wet AMD patients vs. controls and dry AMD patients. Of the wet AMD subjects, 26 of 47 (55 percent) had high CMV IgG titers compared with 14 of 36 (39 percent) dry AMD patients and 23 of 67 (34 percent) control patients. There was no major difference in the distribution of titers for C. pneumoniae IgG and H. pylori IgG in wet and dry AMD patients. Five of 47 (11 percent) wet AMD patients had high antibody titers to all three pathogens, compared with only one of 36 (3 percent) of dry AMD patients and four of 67 (6 percent) control subjects.

There was a significant association of high CMV IgG titer with neovascular AMD compared with dry AMD and control patients. Neovascular AMD was significantly associated with high titer to all three pathogens compared with dry AMD and control patients. Chronic infection with CMV may be a novel risk factor for the progression from dry to neovascular AMD. 

September’s AJO includes an accompanying editorial about this study authored by Margolis, Lietman and Strauss.

Cytomegalovirus Retinitis in People Without HIV Infection 
American Journal of Ophthalmology
September issue

Kuo et al. describe the characteristics and outcomes of patients with cytomegalovirus retinitis in the absence of human immunodeficiency virus infection in a retrospective cohort study of consecutive patients.

Demographic and clinical characteristics were noted at the time of CMV retinitis. Outcomes were determined retrospectively. The main outcome measures were rates of second eye involvement, vision loss, rhegmatogenous retinal detachment, immune recovery uveitis, progression of retinitis and mortality.

The clinical characteristics of CMV retinitis in 18 patients (30 eyes) without HIV infection diagnosed between January 1984 and April 2003 were similar to those of patients with HIV infection. The incidences of visual loss to the levels of 20/50 or worse and of 20/200 or worse were 17 percent per eye-year and 14 percent per eye-year, respectively. The observed incidence of retinal detachment was 3.7 percent per eye-year, and the mortality rate was 23 percent per person-year. Following reduction of immunosuppression, 10 patients (56 percent) who discontinued anti-CMV therapy remained free of retinitis progression. The incidence of immune recovery uveitis was 13 percent per person-year.

In this series, CMV retinitis in patients without HIV infection had a clinical course similar to that in patients with AIDS treated with highly active antiretroviral therapy, except the incidence of retinal detachment was lower for patients without AIDS. A substantial number of patients no longer required long-term anti-CMV therapy after adjustment of immunomodulatory therapy.



Hands-Free Cellular Phones and Visual Field Attention
American Journal of Ophthalmology
September issue

Barkana et al. quantified the central attention-diverting effect of hands-free cellular phone conversation on visual field awareness.

In this experimental study, 20 male and 21 female healthy participants performed pretest and baseline Esterman visual field examinations with the Humphrey Systems Visual Field Analyzer II. During a third examination, each participant engaged in a hands-free conversation using a cellular phone. The conversation was the same for all participants. Visual field performance parameters were compared between the second baseline-exam and the third test-exam for each eye.

A learning effect was observed with improved performance from the first to the second examination. During phone conversation, missed points increased from mean 1.0 ± 1.5 to 2.6 ± 3.4 (P ? 0.001) in the right eye and from 1.1 ± 1.53 to 3.0 ± 3.4 (P < 0.001) in the left eye.

Fixation loss increased from mean 7.8 percent to 27.4 percent (P < 0.0001) and from 7.2 percent to 34.8 percent (P < 0.0001) for the right and left eyes, respectively. Test duration increased by a mean of 0.28 second (15 percent) per stimulus (P < 0.0001). Approximately half of missed points were inside the central 30 degrees. There was no significant difference in the performance of males and females.

The authors have created a model for the quantification of the attention-diverting effect of cellular phone conversation on the visual field. In the current study, cellular hands-free conversation caused some subjects to miss significantly more points, react slower to each stimulus and perform with reduced precision. The authors propose that legislative restrictions on concomitant cellular-phone conversation and driving may need to be based on individual performance rather than a general ban on cellular-phone usage.

Conjunctival Squamous Cell Carcinoma Treated With PDT
American Journal of Ophthalmology
2004;138(2):183–189

Photodynamic therapy is finding increasing application in medical fields including ophthalmology. Barbazetto et al. describe a prospective study of the clinical and angiographic response to treatment with PDT in three patients with squamous cell carcinoma.

The three patients (62 to 86 years old) with squamous cell carcinoma of the conjunctiva received one to three treatments of verteporfin (6 milligrams per meter2, body surface area, intravenously). The light dose was calculated as 50 Joules per centimeter2. All tumors were irradiated one minute after injection. The mean follow-up time was 8.6 months.

One week after treatment, angiographic occlusion of tumor vasculature and normal conjunctival vessels was observed in all patients. Tumor regression was noted in all patients one month post-treatment. Two patients—one who had one treatment and another who had two treatments in the entire follow-up time—had a complete regression (clinical and angiographic observation). One tumor involved large aspects of the conjunctiva and cornea. In this case, only the treated areas showed tumor regression. PDT caused minimal temporary local irritation in two patients, small conjunctival hemorrhages and mild transient chemosis in the three eyes directly after treatment. One patient had infusion-related back pain.

These preliminary results suggest that PDT may be a valuable addition to the treatment of patients with squamous cell carcinoma of the conjunctiva. The authors caution that longer follow-up is necessary to assess the duration and degree of tumor control.

Results of Keratoplasty in Eyes With a Glaucoma Drainage Device
American Journal of Ophthalmology
2004;138(2):200–205

Glaucoma is a major risk factor for corneal graft survival. Alvarenga et al. performed a study of the outcome of penetrating keratoplasty in eyes with a glaucoma drainage device in a retrospective, case-controlled study.

Among all patients who underwent penetrating keratoplasty from December 1986 to September 2002 at the University of California, Davis (n = 1,974), the authors identified 33 patients (40 grafts) who were treated with a glaucoma drainage device and followed for at least six months after the surgery. Graft survival and glaucoma control were compared to grafts in patients without glaucoma (n = 40) and patients with medically controlled glaucoma (n = 17). Kaplan-Meier survival analysis, Log rank test, repeated measures ANOVA, Fisher exact test and Chi-square were used in group comparisons. Multivariate analysis was performed using the Cox “proportional hazards” model.

The percentages of clear grafts in the drainage device group were 58.5 percent and 25.8 percent at one and two years, respectively. At one year, glaucoma was controlled in 74 percent of the eyes; at two years, 63.1 percent. Both medically controlled glaucoma patients and nonglaucomatous patients had higher graft survival percentages at comparable time points. The presence of a glaucoma drainage device was the single most important factor influencing graft survival (hazard ratio = 6.8).

The authors conclude that a glaucoma drainage device implant is an independent risk factor for graft failure. Although these devices are effective in controlling IOP in the majority of eyes in the presence of penetrating keratoplasty, corneal graft clarity is often compromised.

The Inflow of Ocular Surface Fluid Through Standard Clear Corneal Cataract Incisions
American Journal of Ophthalmology
2004;138(2):206–210

Clear corneal incision cataract surgery may have a higher rate of endophthalmitis.

Sarayba et al. evaluated the self-sealing properties of standard clear corneal cataract incisions in a laboratory model during the application of mechanical external pressure and during controlled fluctuation of IOP.

Eight fresh human donor globes were prepared for Miyake video microscopy. A standard two-plane 3-millimeters clear corneal incision was created and a 3- x 3-mm sponge soaked with india ink was placed on the wound surface. One globe with a sutured corneal wound served as control. A transscleral cannula was inserted and connected to a bottle of saline. IOP was modified varying the bottle height. External pressure was applied through manual contact on different regions of cornea. Digital video images were computer-analyzed at different time points to detect intraocular ink inflow by optical density differential between pre- and postprovocative tests.

Four out of seven eyes demonstrated intraocular presence of ink, three of them after external manipulation and another after varying the IOP. Self-sealing properties of unsutured clear corneal wounds were compromised in this model.

These data may give insight into the possible mechanisms involved in the inflow of extraocular fluid into the eye through clear corneal cataract incisions.

AIPL1-Related Leber’s Congenital Amaurosis—A Severe Phenotype
Archives of Ophthalmology
2004;122(7):1029–1037

Mutations in AIPL1 encoding the aryl hydrocarbon receptor interacting protein-like 1, involved in photoreceptor differentiation and survival, account for 7 percent of Leber’s congenital amaurosis.

The phenotype of AIPL1-related LCA is relatively severe, with a maculopathy in most patients (80 percent) and keratoconus and cataract in a subset (26 percent). Rod electroretinogram abnormalities may be present in heterozygous carriers of AIPL1 mutations. Recognizing the phenotype of LCA may help in understanding the course of the disorder. Identifying the gene defect is the first step in preparation for therapy since molecular diagnosis in LCA will mandate the choice of treatment.

The researchers note that patients with AIPL1-related LCA appear to have a particularly severe phenotype, characterized by marked visual impairment, nondetectable visual fields and electroretinograms, optic disc pallor, maculopathy, peripheral retinal bone spicule-like pigmentation and a significant prevalence of keratoconus and cataract.

The Salisbury Eye Evaluation in Nursing Home Groups Study
Archives of Ophthalmology
2004;122(7):1019–1024

Among 1,307 residents of 28 nursing homes on the Eastern Shore of Maryland and Delaware in whom vision could be tested, 496 (37 percent) were found to have vision worse than 20/40 in the better-seeing eye.

Friedman et al. found that rates of low vision were similar between blacks and whites (39 percent and 38 percent respectively, age-adjusted P = 0.18). Cataract was the leading cause of low vision, responsible for 37 percent of low vision among whites and 54 percent of low vision among blacks. Macular degeneration was responsible for 29 percent of low vision among whites, but only 7 percent among blacks. Glaucoma caused low vision in 4 percent of whites and 10 percent of blacks. Refractive error was not a frequent cause of low vision in nursing home residents.

In summary, low vision and blindness are highly prevalent among residents of nursing homes with over one-third affected. Blacks have a greater burden of unoperated cataract and glaucoma, while whites have much higher prevalence rates of AMD. Cataract remains the most common cause for both racial groups, pointing to a potential benefit of intervention programs that are aimed at providing surgical services to this population.

Glaucoma: Long-Term Adjunctive Latanoprost Treatment Seems Safe
Archives of Ophthalmology
2004;122(7):957–965

Latanoprost (Xalatan) was added to previous glaucoma treatment in 380 patients who were followed for five years in order to determine the long-term safety and efficacy of adjunctive latanoprost.

Alm et al. observed increased iris pigmentation in 33.4 percent of all patients. This increased pigmentation was restricted primarily to patients with nonhomogeneous eye color.

The increased iris pigmentation developed in 74 percent of cases within 12 months, 94 percent within two years and none after three years. Progression rate decreased over time and no or little progression was observed three years after the first observed change.

Neither anterior uveitis nor cystoid macular edema was more frequent among eyes treated with latanoprost than in untreated eyes.

The overall mean IOP reduction from baseline of 25 percent was sustained with no need for change in IOP-lowering treatment in 70 percent of eyes.

The researchers conclude that latanoprost was effective, safe and well-tolerated during five years of follow-up.

Round-Up of Other Journals

Document Use of Herbal Medicine
Journal of the American College of Surgeons
2004;198:583–590

Do you know if your patient is taking herbal medicine and, if so, what kind? Findings from a self-administered patient questionnaire reveal that you should.

In a study by Adusumilli et al., 2,186 patients completed the survey. Of these, 57 percent admitted to the use of herbal medicine at some point in their life, and 38 percent had consumed herbal medicine in the two years before surgery. Perhaps most eye-opening, 16 percent continued the use of herbal medicine in the month of surgery.

These patients often consumed more than one type of product, the most common being echinacea, aloe vera, ginseng, garlic and ginko biloba. Among the 833 patients taking herbal medicine, only 7 percent volunteered their herbal medicine history to the health care staff.

Considering that the exact incidence and nature of adverse events from herbal medicine remains a mystery, this high percentage of herbal medicine usage among the surgical population should be a consideration for surgeons when an unexplained complication or interaction occurs in their patients.

The authors call for a broader, multicenter epidemiologic survey to better define the magnitude and importance of the problem. In the meantime, surgeons and their staff should make it a point to ask about and document herbal medicine use among their patients.

Respiratory Side Effects Using Beta-Antagonists for Glaucoma
British Journal of Ophthalmology
2004;88:196–198

Kirwin et al. have previously shown that topical beta-antagonists, the most commonly prescribed glaucoma drugs in the United Kingdom, are associated with an increased incidence of airways obstruction in individuals with no previous history of respiratory disease.

It is thought that selective topical beta-antagonists are considered to be less likely to cause bronchospasm. Additionally, a recent systematic review demonstrated that selective beta-antagonists were not associated with respiratory side effects when used to treat cardiovascular disease.

However, in this historical cohort study, Kirwan et al. found that selective topical beta-antagonists actually do appear to have an excess risk of airways obstruction in patients being treated for glaucoma with no previous respiratory history. Specifically, 12 of 324 patients treated with selective topical beta-antagonists developed airways obstruction, compared with 112 of 9,094 controls. Furthermore, the magnitude of risk appeared similar to that for unselective topical beta-antagonists.

They conclude that selective topical beta-antagonist prescriptions to treat glaucoma and ocular hypertension should be subject to the same caveats as all topical beta-antagonists.

Changes in Focal Macular ERGs After Macular Translocation
Investigative Ophthalmology & Visual Science
2004;45:567–573

In this retrospective study, Terasaki et al. sought to answer several questions concerning patients who underwent macular translocation with 360-degree retinotomy for choroidal neovascularization secondary to AMD (17 eyes) or polypoidal choroidal vasculopathy (two eyes). Does the newly located retina-RPE complex function as well as the original macula? In essence, are the neural components preserved or reorganized? Do they recover function after the acute retinal detachment and relocation to the new site? Is the recovered function long-lasting?

To answer these questions, the investigators recorded focal macular electroretinograms before surgery, six to 12 months after surgery and 18 to 30 months after surgery. A 15-degree stimulus was used to elicit the focal macular ERGs.

The researchers discovered significant improvements in visual acuity. Additionally, before surgery, the amplitudes of all components of the focal macular ERGs were markedly reduced in all eyes. The mean b-wave amplitude in 17 AMD eyes recorded early after surgery was significantly larger and the mean a-wave amplitude was also increased but not significantly. The mean amplitudes of the a- and b-waves in 10 AMD eyes recorded after 18 months were significantly larger than those before the surgery.

The researchers conclude that, based on these data, macular function is partially recoverable after macular translocation in some patients.

_______________________________
Ophthalmology summaries are written by Lori Baker Schena and edited by John Kerrison, MD. American Journal of Ophthalmology reviews are edited by Thomas J. Liesegang, MD. Archives summaries are edited by the lead authors. Roundup is written by Lori Baker Schena and edited by Jose S. Pulido, MD, MS, MBA.