Clinical presentation and outcome of retinoblastoma based on age at presentation: a review of 1450 children

To compare the clinical presentation and outcomes of retinoblastoma (RB) based on age at presentation. Retrospective comparative study of 1940 eyes of 1450 children with RB. Presentation of RB with enlarged eyeball and eyelid swelling (2% and < 1% in ≤ 1 year, 4% and 2% in > 1–2 years, 7% and 2% in > 2–3 years, and 12% and 4% in > 3 years; p < 0.0001 and p = 0.05, respectively) is more common with increasing age. Based on the 8th edition of American Joint Committee Classification, T1 is more common in children younger than 1 year (27%), while T4 is more common in children > 3 years of age (20%) (p < 0.0001). Kaplan–Meier (KM) estimate at 1 and 5 years for globe salvage was 64% and 58% in children ≤ 1 year of age versus 30% and 20% in children > 3 years, respectively [Hazard ratio (HR) = 2.48; p < 0.0001], and KM estimate at 1 and 5 years for life salvage was 99% and 97% in children ≤ 1 year of age versus 89% and 78% in children older than 3 years, respectively (HR = 7.65; p < 0.0001). Uncommon clinical features of RB including enlarged eyeball and eyelid swelling are more common with increasing age. Younger age at presentation with RB is associated with better prognosis including higher chances of life and globe salvage.     

Characteristics of dynamic processing in the visual field of patients with age-related maculopathy

Purpose To investigate the characteristics of dynamic processing in the visual field of patients with age-related maculopathy (ARM) by measuring motion sensitivity, double-pulse resolution (DPR), and critical flicker fusion. Methods Fourteen subjects with ARM (18 eyes), 14 age-matched controls (19 eyes), and 7 young controls (8 eyes) served as subjects. Motion contrast thresholds were determined by a four-alternative forced-choice (4 afc) staircase procedure with a modification by Kernbach for presenting a plaid (size = 3.8°) moving within a stationary spatial and temporal Gaussian envelope in one of four directions. Measurements were performed on the horizontal meridian at 10°, 20°, 30°, 40°, and 60° eccentricity. DPR was defined as the minimal temporal gap detectable by the subject using a 9-fold interleaved adaptive procedure, with stimuli positioned on concentric rings at 5°, 10°, and 20° eccentricity on the principal and oblique meridians. Critical flicker fusion thresholds (CFF) and the Lanthony D-15 color vision test were applied foveally, and the subjects were free to use their fovea or whatever retinal area they needed to use instead, due to their retinal lesions caused by ARM. All measurements were performed under photopic conditions. Results Motion contrast sensitivity in subjects with ARM was pronouncedly reduced (0.23–0.66 log units, p < 0.01), not only in the macula but in a region up to 20° eccentricity. In the two control groups, motion contrast sensitivity systematically declined with retinal eccentricity (0.009–0.032 log units/degree) and with age (0.01 log units/year). Double-pulse thresholds in healthy subjects were approximately constant in the central visual field and increased outside a radius of 10° (1.73 ms/degree). DPR thresholds were elevated in subjects with ARM (by 23–32 ms, p < 0.01) up to 20° eccentricity, and their foveal CFFs were increased by 5.5 Hz or 14% (p < 0.01) as compared with age-matched controls. Conclusions Dynamic processing properties in subjects with ARM are severely impaired in the central visual field up to 20° eccentricity, which is clearly beyond the borders of the macula. Presented at ARVO 2004 (#3084): Reduced motion sensitivity inside and outside the macula in age-related maculopathy.     

Performance of a new, 3D-monitor based random-dot stereotest for children under 4 years of age

Background The aim of this study was to determine the performance of a new, 3D-monitor based, objective stereotest in children under the age of four. Methods Random-dot circles (diameter 10 cm, crossed, disparity of 0.34°) randomly changing their position were presented on an 3D-monitor while eye movements were monitored by infrared photo-oculography. If ≥3 consecutive stimuli were seen, a positive response was assumed. One hundred thirty-four normal children aged 2 months to 4 years (average 17±15.3 months) were examined. Results Below the age of 12 months, we were not able to obtain a response to the 3D stimulus. For older children the following rates of positive responses were found: 12–18 months 25%, 18–24 months 10%, 24–30 months 16%, 30–36 months 57%, 36–42 months 100%, and 42–48 months 91%. Multiple linear logistic regression showed a significant influence on stimulus recognition of the explanatory variables age (p<0.00001) and child cooperation (p<0.001), but not of gender (p>0.1). Conclusions This 3D-monitor based stereotest allows an objective measurement of random-dot stereopsis in younger children. It might open new ways to screen children for visual abnormalities and to study the development of stereovision. However, the current experimental setting does not allow determining random-dot stereopsis in children younger than 12 months. This study was sponsored by OPOS-Foundation, St. Gallen. The authors have no financial interest concerning this study.     

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Background  To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO). Methods  Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later. Results  Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54 – 0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37 – 0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32 – 0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33 – 0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2 – 2.4). Median central foveal thickness (OCT-CFT) was 423 μm (KI: 378 – 456, n = 24) at baseline and decreased to 270 μm (KI: 249 – 311, n = 24) at 1 month (p < 0.0001), 265 μm (KI: 254 – 344, n = 24) at 3 months (p < 0.0001), and 266 μm (KI: 259 – 365, n = 18) at 6 months (p = 0.001). Conclusions  Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.     

A 5-year follow-up of photocoagulation in diabetic macular edema: the prognostic value of vascular leakage for visual loss

Aim  To study the long-term visual result of photocoagulation of clinically significant macular edema (CSME) in diabetic patients in relation to baseline retinal vascular leakage assessed by vitreous fluorometry. Methods  The study enrolled 36 eyes in 27 diabetic patients with CSME at baseline, all subsequently treated by photocoagulation. The diagnosis of CSME and treatment procedure followed the ETDRS criteria. The leakage through the retinal vessels was calculated as the blood–retinal barrier permeability. Five years after initial photocoagulation the patients were reexamined. Results  The mean visual acuity decreased with 16 letters at follow-up, and in 15 eyes visual loss was substantial, with a decrease of 15 letters or more, corresponding to at least 3 lines. The baseline permeability was significantly higher in eyes with substantial visual loss than in eyes with more stable vision (14.2 nm/sec and 6.3 nm/sec respectively; p = 0.006), the corresponding odds ratio was 16.1 (95% CI: 1.8–146; p = 0.014). The level of retinopathy was significantly correlated to visual loss (Fisher’s exact test < 0.02). Conclusion  Visual acuity decreased at follow-up, and a substantial visual loss of 3 or more lines in CSME was associated with higher retinal vascular leakage at baseline with an odds ratio of 16.1. For this relatively small sample, neither diabetes duration, age or HbA_1c reached statistical significance, indicating that blood-retinal barrier permability is a strong predictor of the visual outcome. The results support the investigation of triamcinolone or VEGF inhibition in patients with severe leakage, and may help to identify patients in need for intravitreal injection.     

Development of visual pursuit in the first 6 years of life

Background There are few previous investigations on the development of smooth visual pursuit in children. The aim of this study was to determine normative values for the development of horizontal and vertical smooth pursuit in a large number of normal children. Methods Eye movements of 358 healthy children aged 6 weeks through 6 years were recorded using infrared photo-oculography. Visual pursuit was elicited with colored squares of 1.2° of visual angle. The stimulus moved horizontally or vertically with constant velocities of 7.5, 15, or 30°/s. Results Attention time increased with increasing age from 0.54 to 0.77 (P<0.01) and decreased with increasing stimulus velocities (P<0.01). The ratio of time of smooth pursuit to time of smooth pursuit plus saccades increased with increasing age from 0.63 to 0.78 (P<0.01) and decreased with increasing stimulus velocities (P<0.01). For stimulus velocities of 7.5°/s, no significant difference was found between horizontal and vertical gain values. For stimulus velocities of 15°/s and 30°/s, gains for horizontal movements were larger that for vertical (P<0.05). Increasing stimulus speeds were associated with decreasing gains (P<0.05). Conclusions This study provides the following normative values for photo-oculography in healthy children aged 6 weeks through 6 years of age: attention time, smooth pursuit time, and gain for three stimulus velocities presented horizontally and vertically. This normative database should help to diagnose pathologic ophthalmological or neuropediatric conditions, to perform screening interventions, and to initiate therapies. This research followed the tenets of the Declaration of Helsinki and was approved by the Ethical Committee of Kantonsspital St Gallen. This study was supported by Swiss National Science Foundation (Bern, Switzerland) Grant 3200-052503.97/1 and the OPOS Foundation (St Gallen, Switzerland).     

Slowing the degenerative process, long lasting effect of hyperbaric oxygen therapy in retinitis pigmentosa

Background Retinitis pigmentosa (RP) therapy is still an unsolved challenge. Recent reports have underlined that hyperbaric oxygen (HBO) therapy could play a role in slowing the retinal degenerative process. The aim of this study was to assess the efficacy of HBO therapy on visual function in RP patients. Methods We performed a single-center, comparative, longitudinal case-controlled randomized clinical trial, which lasted 10 years. We randomly divided RP patients into two groups. Group 1, the control group, consisted of 44 RP patients (21 males and 23 females; mean age 35.5) who took Vitamin A. Group 2, with 44 RP patients (21 males and 23 females; mean age 35,02), underwent HBO therapy. No statistically significant difference was found at the beginning of the study between the two groups. We compared the results concerning visual acuity, Goldmann perimetry, static perimetry Humphrey field analyzer (HFA), and electroretinogram (ERG) obtained in the two groups at 5 and 10 years follow-up. Statistical analysis was performed with Kaplan-Meier life-table with the evaluation of log-rank coefficient. Results At 5 year follow-up, 87.5% of group 2 patients preserved 80% of the initial visual acuity, while the same result was achieved in only 70.4% of group 1 patients (X² = 8.2; p < 0.01); at 10 year follow-up, 63.33% of group 2 patients preserved 80% of the initial visual acuity, while the same percentage of residual visual acuity was maintained in 40% of group 1 patients (X² = 3.22; p = 0.05). At 10 year follow-up, Goldmann perimetry (target I4e) did not change in 31.6% of group 2 and in 10.5% of group 1; evaluation of mean defect (MD) with static perimetry HFA showed that 53% of HBO patients had 80% of residual mean sensitivity compared to 23.5% of the control group patients (X² = 4.72; p = 0.035). ERG b-wave mean values at the end of the protocol were significantly higher in the HBO treated group (X² = 4.53; p = 0.013). Conclusion Our study underlines that HBO therapy can be a safe alternative approach to RP patients, contributing to the stabilization of their visual function concerning visual acuity, visual field, and ERG responses while waiting for a definite cure.     

Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation

Background  To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. Methods  This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher’s Exact test, Pearson Chi-square test, independent t-test, Mann–Whitney U-test, and a repeated ANOVA. Results  The mean age of patients was 52.7 ± 12.6 years in group 1 and 53.2 ± 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 ± 7.6 weeks in group 1 and 34.1 ± 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 ± 0.30 in group 1 and 0.72 ± 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). Conclusion  ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity. The results of this study were presented at the 8th Euretina Congress 2008, Vienna, Austria. The authors have no conflicting interests in the subject matter presented.     

Results and complications of hydrophobic acrylic vs PMMA posterior chamber lenses in children under 17 years of age

Purpose To compare results and complications of implantation of hydrophobic acrylic foldable intraocular lenses in children with those of polymethylmethacrylate (PMMA) intraocular lenses.Methods In a retrospective study, we analyzed results of cataract surgery with posterior chamber lens implantation in 30 eyes of 30 patients aged 1–16 years. In 10 eyes, acrylic (Alcon AcrySof) intraocular lenses, and in 20 eyes, single-piece PMMA posterior chamber lenses were implanted. Indications for cataract surgery (blunt or penetrating trauma, zonular cataract, cataracta polaris posterior, posterior lenticonus) and mean age at implantation were comparable in the two groups. Mean patient age at surgery was 8.6±4.6 years (range 3–16 years) for the acrylic vs 6.3±4.3years (range 1–16 years) for the PMMA group. Mean follow-up was 1.0±0.7 years (range 0.1–2.2 years) in the acrylic group and 1.8±1.5 years (range 0.1–5.7 years) in the PMMA group. Primary anterior vitrectomy was performed in 7 eyes in the PMMA group and in 3 eyes in the acrylic group. In addition, one additional posterior capsulorhexis without anterior vitrectomy was performed in each group. Primary outcome measure was the occurrence of postoperative "complications" (fibrin, synechiae, posterior capsular opacification). For statistical evaluation, the Fisher exact test was used.Results When evaluating all complications together (at least one complication vs no complication), there were significantly less complications in the acrylic group (2 of 10 vs 15 of 20; p=0.007. For early complications (postoperative fibrin, synechiae) the difference was also significant (1 of 10 in the acrylic vs 11 of 20 in the PMMA group; p=0.02). The rate of posterior capsular opacification necessitating YAG capsulotomy was lower in the acrylic group (1 of 10 eyes) than in the PMMA group (7 of 20 eyes), but the difference did not reach statistical significance (p=0.67). The postoperative time point of YAG capsulotomy was 21 months in the acrylic group and 19±10 months (range 6–33 months) in the PMMA group. IOL dislocation was not observed in any of the patients. Postoperative visual acuity was comparable in the two groups: 0.57±0.35 (0.03–1.0) in the acrylic vs 0.39±0.34 (0.001–0.9) in the PMMA group (p=0.83).Conclusions Implantation of hydrophobic acrylic intraocular lenses in the capsular bag in children may be associated with less postoperative complications compared with implantation of PMMA lenses. This appears also to be true in children under age 6 years. The visual results seem comparable and correspond mainly to the underlying ocular pathology.     

Effect of central corneal thickness on Goldmann applanation tonometry measures—a different result with different pachymeters

Purpose To assess whether the use of Orbscan pachymetry, as an alternative to ultrasound pachymetry, had an effect on the IOP-CCT relationship for Goldmann tonometry in normal human eyes. Patients and methods The right eye of 50 healthy subjects, aged 19 to 82 years, were assessed by Orbscan (three scans), and then central corneal thickness (CCT) measured by ultrasound pachymetry (three readings) and Goldmann tonometry performed (three readings). Results Goldmann tonometry indicated average IOP values from 9.7 to 20 mm Hg (group mean 14.3 ± 2.5 mm Hg) that were highly highly correlated with ultrasound pachymetry (r = 0.608, p < 0.001). Orbscan central zone pachymetry (2-mm sample zone) yielded higher values than ultrasound, averaging 0.591 ± 0.044 mm compared to 0.523 ± 0.037 mm (p < 0.001), with the differences between the instruments being proportional to the average thickness (p < 0.001; r = 0.461). Notwithstanding, the Goldmann tonometry values were still highly correlated with the Orbscan central zone thickness data (r = 0.595, p < 0.001); but, due to the difference in the thickness data generated by the two pachymeters, the absolute slope of the IOP–CCT relationship was slightly less if Orbscan measures were used, with or without use of the acoustic factor. Conclusion Orbscan measures of the thickness of a central corneal zone can be used to assess the impact of central corneal thickness on Goldmann tonometry data. Neither of the authors has any financial interest in the production or use of any device mentioned in this article.     

Relationship between oculomotor scanning determined by the DEM test and a contextual reading test in schoolchildren with reading difficulties

Background  The relationship between oculomotor scanning and reading in poor readers of primary school age is not well known. This study was designed to assess this relationship by determining mean Developmental Eye Movement (DEM) test times and reading speeds in a Spanish non-clinical population of children with poor reading skills but without dyslexia. Methods  We conducted a cross-sectional study on 81 poor readers (8–11 years of age) in the third to fifth grades recruited from 11 elementary schools in Madrid, Spain. In each subject with best spectacle correction, oculomotor scanning was measured using the DEM test, and reading speed (words per minute) was assessed by a standardized Spanish contextual reading test. Results  Mean horizontal DEM times were higher than normative values for children in the third, fourth and fifth grades, by 20 seconds, 12 seconds, and 3 seconds respectively. Mean reading speeds were 18 words per minute lower than the norm for the third and fourth grades respectively, and 30 words per minute lower than the norm for the fifth grade. Reading speeds were significantly related to horizontal DEM times (r = −0.53, p < 0.0001). Thus, children showing a longer, or worse, horizontal DEM time achieved lower reading speeds. Conclusions  Poor readers showed poor horizontal scanning as assessed by the DEM test that was related to a slow reading speed. This test should be used by optometric clinicians as a screening tool to help identify poor reading skills in school children at an early stage. This research was supported by a grant from Prats Optical S.A. Human subjects and informed consent  The authors declare that this research was performed following the tenets of the Declaration of Helsinki, and that informed consent was obtained from the subjects after the nature of the study had been explained to them in detail. The study protocol was approved by the Clinical Research Ethics Committee of the School of Optometry.     

Prognostic factors in Vogt-Koyanagi-Harada disease

Purpose To identify prognostic factors for final visual outcome, development of complications, and recurrent inflammation in patients with Vogt-Koyanagi-Harada (VKH) disease. Methods All patients diagnosed with acute uveitis associated with VKH disease at the King Khaled Eye Specialist Hospital and King Abdulaziz University Hospital between January 1999 and February 2004 were reviewed. Data collected included age, gender, initial and final visual acuities, clinical findings at presentation, interval between onset of disease and starting treatment, treatment received, complications, number of recurrences, extraocular manifestations, and duration of follow-up period. Results Sixty-eight patients were identified. There were 51 (75%) females and 17 (25%) males with a mean age of 25.04 ± 10.28 years (range 7–55 years). The mean follow-up period was 34.4 ± 20.1 months (range 8–62 months). The following factors were significantly associated with final visual acuity of 20/20 by univariate analysis: good initial visual acuity of better than 20/200 (p = 0.0415), absence of posterior synechiae of the iris at presentation (p = 0.0106), use of systemic corticosteroids for longer than nine months (p = 0.0479), slow tapering of systemic corticosteroids (p = 0.0024), absence of complications (p < 0.001), and absence of extraocular manifestations (p = 0.0124). Logistic regression analysis identified the use of systemic corticosteroids for longer than nine months to be associated with final visual acuity of 20/20 [odds ratio = 3.4; 95% confidence interval (CI) = 1.14–10.1]. The following factors were significantly associated with the development of complications by univariate analysis: age older than 18 years (p = 0.0161), initial visual acuity of 20/200 or worse (p = 0.0011), and presence of posterior synechiae of the iris at presentation (p = 0.0453). Factors identified after logistic regression analyses were age older than 18 years (odds ratio = 3.3; 95% CI = 1.33–8.17), and presence of posterior synechiae of the iris at presentation (odds ratio = 3.42; 9% CI = 1.38–8.47). Initial visual acuity of better than 20/200 was significantly associated with a lower risk of developing complications (odds ratio = 0.283; 95% CI = 0.129–0.629). The following factors were significantly associated with recurrent inflammation of three times or more by univariate analysis: initial visual acuity of 20/200 or worse (p = 0.0179), anterior chamber reaction of more than 2+ at presentation (p < 0.001), rapid tapering of systemic corticosteroids (p < 0.001), and development of extraocular manifestations (p = 0.0277). Conclusions Clinical findings at presentation, duration and method of tapering of systemic corticosteroids, and development of extraocular manifestations are significantly associated with final visual acuity, development of ocular complications, and recurrent inflammation. The development of ocular complications was significantly associated with a worse final visual acuity.     

Cost-effectiveness sequential modeling of ranibizumab versus usual care in age-related macular degeneration

Aims  To assess effectiveness, cost, and cost-effectiveness of ranibizumab versus the current medical practices of treating age-related macular degeneration in France. Methods  A simulation decision framework over 1 year compared ranibizumab versus the usual care using two effectiveness criteria: the “visual acuity improvement rate” (greater than 15 letters on the ETDRS scale) and the “rate of legal blindness avoided”. Two decision trees included various sequences of current treatments, with or without ranibizumab. Results  Ranibizumab appeared significantly more effective than the usual care (p < 0.001), providing greater treatment success rate of visual acuity improvement (48.8% versus 33.9%). The cost of the ranibizumab strategy was higher (9,123 euros (€) over 1 year for ranibizumab versus 7,604 € for the usual care) but the average cost-effectiveness was lower – 18,721 € /success for ranibizumab versus 22,543 €/success for usual care (p < 0.001). Considering the “legal blindness avoided” success criterion, the ranibizumab strategy appeared significantly more effective (p < 0.001), providing greater treatment success rate for of legal blindness avoided than usual care (99.7% versus 93.1%) although it was more expensive (9,196 € over 1 year for ranibizumab versus 5,713 € for the usual care). Conclusion  Ranibizumab significantly improved the rate of visual acuity improvement and reduced the rate of legal blindness. Ranibizumab appeared significantly more cost-effective than the usual treatments in terms of visual acuity improvement. Financial relationships: This study was sponsored by Novartis Pharma SAS, France. The authors have no financial interests with the sponsor and have full control of all primary data. Thomas Citterio and Ségolène Bisot-Locard are employees of Novartis, France. The authors agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review their data upon request.     

Relationship between Age and Retinal Nerve Fiber Layer Thickness in Normal Children

Purpose: To evaluate the effect of age and ocular factors on peripapillary retinal nerve fiber layer (RNFL) thickness in children. Method: A total of 198 normal subjects aged <19 years received a comprehensive ophthalmologic examination, including measurement of visual acuity, axial length, and cycloplegic refraction. Fast optical coherence tomography RNFL scans were obtained and average RNFL thickness was adjusted for ocular magnification. One eye of each subject was randomly selected as the study eye. The correlations between age and other ocular variables were examined. Results: Mean subject age was 8.61 ± 3.12 years. Average RNFL thickness and ocular magnification-corrected average RNFL thickness were 107.71 ± 11.83 and 103.03 ± 12.53 μm, respectively. There was no significant correlation between observed RNFL thickness and spherical equivalent of the refractive error (SE), axial length, or age (all P >0.05). Corrected RNFL thickness was positively correlated with age and axial length and negatively correlated with SE (P <0.01). Age was negatively correlated with the percent difference between observed and corrected RNFL thickness (P <0.001). Multivariate linear regression analysis showed that both axial length and age were correlated with corrected RNFL thickness in subjects <15 years old (P <0.05). Conclusion: The RNFL thickness is likely to be overestimated in children <15 years old. Additionally, an RNFL thickness increase was observed in children <15 years old. Thus, ocular magnification and RNFL thickness increase should be considered when assessing RNFL thickness in patients <15 years old.     

Electrophysiological Assessment of Glaucomatous Visual Dysfunction During Treatment with Cytidine-5′-diphosphocholine (citicoline): A Study of 8 years of Follow-up

In this study we assessed, by simultaneous recordings of visual evoked potentials (VEPs) and pattern-electroretinograms (PERGs), the effects cytidine-5′-diphosphocholine (citicoline) on retinal function and/or visual cortical responses in glaucoma patients. Thirty glaucoma patients were randomly divided into two age-matched groups: patients in group GC (15 patients) were treated with citicoline (1000 mg/die intramuscularly) for 2 months; patients in group GP (15 patients) were treated with placebo for 2 months. After 4 months of wash-out (month 6), GC patients underwent a further 2-month period of citicoline treatment (months 7–8) followed by another 4-month period of wash-out (months 9–12). In GP patients the wash-out was extended for a further 6 months (months 7–12). During the following 13–96 months, GC patients received additional 2-month periods of treatment with citicoline (each period followed by 4 months of wash-out) for a total of 16 periods in 8 years. GP patients were also examined at months 24, 26, 48, 60, 72, 84 and 96. In GC patients the first two treatments with citicoline induced a significant (p<0.01) improvement of VEP and PERG parameters with respect to pre-treatment conditions. VEPs and PERGs recorded in GC patients after the first wash-out revealed that, although there was a worsening trend, the electrophysiological improvement was still maintained with respect to baseline conditions. The additional periods of citicoline treatment in GC patients during the subsequent 13–96 months induced a greater (p<0.01) improvement of VEP and PERG parameters with respect to pre-treatment conditions and when compared to GP patients. Thus, we observed that citicoline significantly improves retinal and cortical bioelectrical responses in glaucoma patients, suggesting a potential use of this substance in the medical treatment of glaucoma, as a complement to hypotensive therapy. The author states that he has no proprietary interest in the development or marketing of this or a competing drug.     

Evaluation of macular abnormalities in Stargardt’s disease using optical coherence tomography and scanning laser ophthalmoscope microperimetry

Background  The purpose of this study is to evaluate the diagnostic value of optical coherence tomography (Stratus OCT) and scanning laser ophthalmoscope (SLO) microperimetry in patients with Stargardt’s disease (STGD), and the correlation between macular morphology and visual function in these patients. Methods  Twenty-two patients with STGD (mean age 44 years, range 11 to 71 years) and 20 age-matched healthy control subjects were included in the study. OCT imaging was performed using six radial line scans manually centered on the fovea. SLO microperimetry was used to assess central scotoma and fixation behavior in patients with STGD. Results  Mean best corrected Snellen visual acuity (BCVA) was 20/80, range 20/25 to 20/300 (log MAR 0.6, range 0.1 to 1.2) in the STGD group and 20/20 (log MAR 0.0) in the control group. Foveal thickness was significantly reduced in patients with STGD (119.0 ± 19.6 μm) compared to controls (210.7 ± 19.6 μm, P < 0.0001). A significant correlation between foveal thickness and BCVA was observed within the STGD group (R² = 0.62, P < 0.0001). Photoreceptor loss in the macular area and a corresponding central scotoma were observed in all STGD patients. Conclusions  OCT findings, particularly reduced foveomacular thickness and photoreceptor loss in the macular area may be useful in the diagnosis of STGD. Furthermore, a strong correlation between foveal thickness and visual function was observed in our patients. Assessment of central visual function using SLO microperimetry provides additional useful information, important in the management of STGD.     

Circadian changes of intraocular pressure and ocular perfusion pressure after timolol or latanoprost in Caucasians with normal-tension glaucoma

Purpose To evaluate the circadian effects on intraocular pressure (IOP) and ocular perfusion pressure (OPP) of 0.5% timolol or 0.005% latanoprost in Caucasian patients affected by normal-tension glaucoma (NTG). Patients and methods In this crossover trial, 30 consecutive NTG subjects underwent three 24-hour assessments of IOP, blood pressure (BP), heart rate (HR), and OPP [calculated according to the formula OPP = (1/3 systolic BP + 2/3 diastolic BP) x 2/3 – IOP]: at baseline, and after 1-month treatment with timolol or latanoprost. These parameters were recorded at 4 a.m., 8 a.m., noon, 4 p.m., 8 p.m., and midnight. Results Both timolol and latanoprost reduced IOP (p < 0.001), with a difference in favour of latanoprost of 1.3 mmHg (95% CI 0.9, 1.6; p < 0.001). After timolol, BP and HR decreased with respect to baseline (p < 0.001). Latanoprost increased mean OPP (3.6 mmHg, 95% CI 2.9, 4.3; p < 0.001), whereas timolol did not improve it. Conclusions Latanoprost induces an IOP reduction greater than timolol, also achieving a better circadian flattening of the IOP curve. Only latanoprost significantly increased mean 24-hour OPP. The management of Caucasian NTG patients should be critically realized, considering the 24-hour influence of each IOP-lowering drug on the ocular blood perfusion.     

The Effect of Octreotide Against Oxidative Damage in Photosensitized Conjunctiva and Cornea of Rabbits

The purpose of this study was to determine the protective effect of octreotide against oxidative damage in rabbit conjunctiva and cornea exposed to ultraviolet radiation. Twenty rabbits weighing 2500–3000 g were used and we divided them into 4 groups with randomly selected 5 rabbits. Rabbits were exposed to 2 J/cm²/h of ultraviolet A radiation (UVA) in the range 320–405 nm for 12 h per day for 90 days. Group 1 did not receive any treatment or UVA exposure (control group). Group 2 was only exposed to UVA radiation (UVA group). Group 3 received 8-methoxypsoralen and UVA (PUVA group). Group 4 was treated with 8-methoxypsoralen + UVA + octreotide (octreotide group). At the end of 90 days the rabbits were killed by decapitation and then eyes were enucleated. Both eyes of each rabbit were used for histopathologic evaluation. Histopathologic analysis of each group indicated that UVA group and PUVA group showed increasing edema (p<0.01), inflammation (p<0.05), fibroblast proliferation (p<0.05), dysplasia (p<0.05), hyperchromasia (p<0.01) in the conjunctiva. Octreotide group had significant protective effect in comparison with the UVA group and PUVA group. The UVA group and PUVA group showed increasing proliferation (p<0.01), dysplasia (p<0.01), hyperchromasia (p<0.01), pyknosis (p<0.001) and parakeratosis (p<0.01) in the corneal epithelium. Octreotide group showed similar results with control group. We conclude that octreotide which is considered as free radical scavenger protects the eye from the damaging effect of UV exposure.     

Central corneal thickness in adult Chinese. Association with ocular and general parameters. The Beijing Eye Study

Background To evaluate the distribution of central corneal thickness and its associations in the adult Chinese population. Methods The Beijing Eye Study 2006 is a population-based study including 3,251 (73.3%) subjects (aged 45+ years) out of 4,439 subjects who participated in the survey in 2001 and who returned for re-examination. Central corneal thickness (CCT) measurements were performed by slit lamp-based optical coherence tomography. Results Central corneal thickness measurement data were available for 3,100 (95.4%) subjects. Mean CCT was 556.2±33.1 μm (median: 553 μm; range: 429–688 μm). In multiple regression analysis, CCT was significantly associated with optic disc area (P = 0.043), urban region (P < 0.001; odds ratio (OR): 4.77; 95% confidence interval (CI): 2.37, 7.17), male gender (P < 0.001; OR: 5.64; 95%CI: 2.57, 8.71), and intraocular pressure measurements (P < 0.001). It was not significantly associated with body weight (P = 0.54) and body height (P = 0.66), age (P = 0.17), and refractive error (P = 0.43). Intraocular pressure (measured by pneumotonometry) increased for each μm central corneal thickness increase by 0.03 mmHg. Conclusions In the adult Chinese population, CCT was significantly associated optic disc area, urban region, and male gender. Intraocular pneumotonometric pressure measurements increased for each μm increase in central corneal thickness by 0.03 mmHg. CCT was not associated with age and refractive error. Supported by Beijing Natural Science Foundation No 7071003, Beijing, China.     

Kestenbaum procedure with posterior fixation suture for anomalous head posture in infantile nystagmus

Background  The purpose of this study was to report the effect of combining the Kestenbaum procedure with posterior fixation suture for infantile horizontal nystagmus with anomalous head posture (AHP) in children. Methods  Nine consecutive patients who underwent combined Kestenbaum procedure plus posterior fixation suture to the recessed muscles at the same time were retrospectively studied. All patients were orthotropic before surgery and were followed for at least 6 months. Pre- and postoperative AHP and binocular corrected visual acuity (BCVA), and ocular alignment were assessed. Results  Mean age at surgery was 4.8 ± 1.5 years. The average follow-up was 29.7 months. The average head turn preoperatively was 27.4° and postoperatively 7.2°. The average net change in AHP was 24.8° (P = 0.008). Seven of 9 patients (78%) achieved a residual head turn of 10° or less. The average Log Mar BCVA was 0.33 preoperatively and 0.31 postoperatively (P = 0.68). Only 1 patient needed additional surgery for residual horizontal AHP. No patient developed strabismus. Conclusion  Combined Kestenbaum procedure with posterior fixation suture was an effective and stable procedure in reducing AHP of the range of 20° to 35° in children with infantile nystagmus. Presented in part as a poster at the American Association for Pediatric Ophthalmology and Strabismus 32nd Annual Meeting in Keystone, Colorado, March 15-19, 2006. The authors have no proprietary interest related to this article. The authors have full control of all primary data and we agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review our data upon request.