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    American Journal of Ophthalmology

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    Morphologic and Functional Changes in Chronic CSC

    April AJO 

    In a study performed in Italy, Eandi et al. searched for a correlation between the morphologic macular changes revealed by fundus autofluorescence (FAF) and the functional parameters such as visual acuity and retinal sensitivity in patients with chronic central serous chorioretinopathy (CSC). They found that the morphologic aspects of FAF were correlated with the functional data provided by visual acuity and microperimetry (MP).

    In this prospective cross-sectional study, 46 eyes (39 consecutive patients) with chronic CSC were evaluated with FAF and MP. Retinal sensitivity value maps were exactly superimposed over FAF images. Mean best-corrected visual acuity was 20/32 (median 20/25) and was significantly correlated with FAF findings. A positive concordance between FAF and MP evaluation was also found. The hypoautofluorescent areas showed decreased retinal sensitivity, while adjacent areas of increased autofluorescence could be associated with both normal and decreased retinal sensitivity. Absolute scotoma corresponded to absence of autofluorescence.

    Altered FAF in chronic CSC patients has a functional correlation that can be quantified by MP. This study confirms the impact of FAF changes on retinal sensitivity and their value in reflecting visual impairment in chronic CSC.

    Outcomes After Secondary IOL Implantation in Children

    April AJO

    Shenoy et al. evaluated the safety and visual outcomes in surgically aphakic children undergoing secondary intraocular lens (IOL) implantation in a retrospective, consecutive, interventional case series conducted in India. Eyes of children who received sulcus-fixated secondary IOL implantation for aphakia after congenital cataract surgery showed significant improvement in best-corrected visual acuity (BCVA), with 35 percent attaining a final BCVA of 0.3 logMAR (20/40) or better at the last follow-up.

    There was a minimum of three months of follow-up (mean, 25.7 ± 24.9 months) in 174 eyes of 104 children (70 bilateral, 34 unilateral cases) who underwent secondary IOL implantation. Eyes with aphakia after surgery for traumatic cataracts and other associated ocular comorbidities were excluded. Mean age at secondary IOL implantation was 6.08 ± 3.75 years. Mean BCVA improved from 1.08 ± 0.65 logMAR in aphakic children to 0.55 ± 0.51 logMAR in pseudophakic children at last follow-up. Of the overall group of 144 eyes for which complete refractive data were available, 51 eyes (35 percent) attained a final BCVA of 0.3 logMAR or better; however, among the 23 children who had unilateral aphakia, only two eyes (8.7 percent) attained a final BCVA of 0.3 logMAR or better.

    The most common postoperative complications were secondary membrane formation (9.8 percent), optic capture (8.6 percent), IOL decentration (5.2 percent), and secondary glaucoma (5 percent). Secondary sulcus IOL implantation in children is a relatively safe procedure and leads to favorable visual postoperative outcomes.

    Association Between Statin Use and Uveitis

    April AJO

    Borkar et al. used the results from the Pacific Ocular Inflammation Study to assess whether there is a protective association between statin use and uveitis diagnosis. Using a retrospective, population-based case-control study from Kaiser Permanente Hawaii, the authors found a protective association between statin use and development of uveitis. Specifically, the odds of developing uveitis were 48 percent less in statin users than in non–statin users drawn from the general Kaiser Hawaii population, who constituted a control group.

    Medical records of all patients in the Kaiser Permanente Hawaii health plan between Jan. 1, 2006, and Dec. 31, 2007 (n = 217,061), were searched electronically for ICD diagnosis codes related to uveitis. Chart review was done to confirm incident uveitis diagnosis during the study period. Two control groups were each randomly selected at a 5:1 ratio to uveitis cases, and each of the controls was assigned an index date to match the diagnosis date of their respective case. One control group was selected from the general Kaiser Permanente Hawaii population that had at least one health care visit during the study period. Another control group was selected from the population of Kaiser Permanente Hawaii members who had at least one ophthalmology clinic visit during that period. Statin use was defined as filling a prescription for statin medication in the year prior to the diagnosis or index date, as recorded in the Kaiser Permanente Hawaii pharmacy database.

    The medical record search identified 108 incident cases of uveitis. Nineteen percent of uveitis patients had used statin medication in the year prior to diagnosis, compared with 30 percent of patients in the general Kaiser population control group and 38 percent of patients in the ophthalmology clinic control group. Using the general Kaiser population to control and adjusting for age, sex, race, and autoimmune diseases, the researchers found that the odds of a statin user developing uveitis were almost 50 percent less than those of individuals not taking this class of drugs. When the same adjustments were applied and comparisons were made against the ophthalmology clinic control group, the odds of developing uveitis were 33 percent less for statin users than for nonusers.

    The authors hypothesize that several anti-inflammatory and immunomodulatory mechanisms may explain this protective association.

    Outcomes After Femtosecond Laser Cataract Surgery

    April AJO

    Chee et al. analyzed the visual outcomes of 1,105 femtosecond laser–assisted cataract surgery cases by means of a nonrandomized treatment comparison with matched historical controls. The control group consisted of a randomly selected sample of manual cataract surgery cases that were similar to the laser group in age, axial length, and preoperative cylinder. After excluding complicated cataracts, the unaided visual outcome and mean refractive spherical equivalent appeared better in the laser group than in the control group. Refractive predictability was equivalent.

    Outcomes and intraoperative events were audited for all laser cataract surgeries (performed with 5.0- to 5.5-mm laser capsulotomies and nuclear fragmentation) at the Singapore National Eye Centre from May 2012 to Dec. 2013. Eighteen surgeons performed laser cataract surgery on 803 patients (1,105 eyes). The majority of patients were female (57 percent) and Chinese (91 percent), and the mean age was 66.1 ± 11.0 years.

    Intraoperative complications in the laser group were mild subconjunctival hemorrhage (26.2 percent), anterior capsular tear (0.81 percent), posterior capsular rupture (0.27 percent), suction loss (0.45 percent), iris hemorrhage (0.09 percent), and endothelial incision (0.09 percent). There were no cases of dropped nucleus. Capsulotomy completeness (91.2 percent were complete) was improved by increasing the volume of saline in the suction cup.

    Visual outcomes of 794 laser surgeries by surgeons who had performed more than 50 laser cases were compared against results from 420 controls. The six-week follow-up measures included postoperative unaided visual acuities (UAVA), mean absolute error (MAE), mean square error (MSE), and manifest refraction spherical equivalent (MRSE). The percentage of patients achieving UAVA of 20/25 or better was higher in the laser cases compared with the controls (68.6 percent vs. 56.3 percent, respectively), and the MRSE comparison was significant. However, there were no significant differences in MAE and MSE.

    The researchers concluded that femtosecond laser cataract surgery provided good visual results and had an acceptable complication rate in a public institution where a wide variety of challenging cataract cases of varying densities were treated.

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    American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD.

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