The range of contact lens modalities currently available for the successful optical correction of keratoconus is greatly expanded. We review lens types currently available for the nonsurgical ...management of keratoconus, including rigid gas-permeable (GP) lenses, intralimbal lenses, corneoscleral lenses, scleral lenses, hybrid lenses, and piggyback lenses. In this review, we discuss the contemporary range of available lens types and the circumstances in which they are best used.
To evaluate retention of visual acuity and development of complications after Boston type 1 keratoprosthesis implantation over a longer follow-up period than previously reported.
Cohort study.
Forty ...eyes of 35 patients who underwent Boston type 1 keratoprosthesis surgery at the University of California, Davis, between 2004 and 2010.
Preoperative, intraoperative, and postoperative parameters were collected and analyzed.
Best-corrected visual acuity (BCVA) and postoperative complications.
Preoperative visual acuity ranged from 20/150 to light perception and was ≤20/400 in 38 eyes (95%). Preoperative diagnoses included failed corneal transplants (19 eyes, 47.5%), chemical injury (10 eyes, 25%), and aniridia (5 eyes, 12.5%). Mean follow-up duration was 33.6 months (range, 5-72 months). Of 36 eyes followed for ≥1 year, 32 eyes (89%) achieved postoperative BCVA ≥20/200. Of eyes that achieved BCVA ≥20/200, at last follow-up, 19 of 32 eyes (59%) followed for ≥1 year retained BCVA ≥20/200; 16 of 27 eyes (59%) followed for ≥2 years retained BCVA ≥20/200; 7 of 14 eyes (50%) followed for ≥3 years retained BCVA ≥20/200; and 2 of 7 eyes (29%) followed for ≥4 years retained BCVA ≥20/200. End-stage glaucoma most commonly caused vision loss (7 of 13 eyes, 54%) when BCVA ≥20/200 was not retained (follow-up ≥1 year). Glaucoma was newly diagnosed in 11 eyes (27.5%); progression was noted in 9 eyes (22.5%). Glaucoma drainage device erosion occurred in 9 eyes (22.5%). Retroprosthetic membrane formed in 22 eyes (55%), 5 eyes (12.5%) developed endophthalmitis, 6 eyes (15%) developed corneal melt, 7 eyes (17.5%) underwent keratoprosthesis replacement, and 23 eyes (57.5%) required major surgery to treat postoperative complications. The initial keratoprosthesis was retained in 32 eyes (80%).
Keratoprosthesis implantation remains a viable option for salvaging vision. A significant number of patients lost vision over the postoperative course. Glaucoma and complications related to glaucoma surgery are significant challenges to maintaining good vision after keratoprosthesis surgery. Our study highlights the need for long-term follow-up and a team approach to management, and points to a more guarded long-term visual prognosis after surgery.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
This article reviews ocular adverse events (AEs) reported in association with administration of antibody-drug conjugates (ADCs) in human clinical trials. References reporting ocular toxicity or AEs ...associated with ADCs were collected using online publication searches. Articles, abstracts, or citations were included if they cited ocular toxicities or vision-impairing AEs with a confirmed or suspected association with ADC administration. Twenty-two references were found citing ocular or vision-impairing AEs in association with ADC administration. All references reported use of ADCs in human clinical trials for treatment of various malignancies. The molecular target and cytotoxic agent varied depending on the ADC used. Ocular AEs affected a diversity of ocular tissues. The most commonly reported AEs involved the ocular surface and included blurred vision, dry eye, and corneal abnormalities (including microcystic corneal disease). Most ocular AEs were not severe (≤ grade 2) or dose limiting. Clinical outcomes were not consistently reported, but when specified, most AEs improved or resolved with cessation of treatment or with ameliorative therapy. A diverse range of ocular AEs are reported in association with administration of ADCs for the treatment of cancer. The toxicologic mechanism(s) and pathogenesis of such events are not well understood, but most are mild in severity and reversible. Drug development and medical professionals should be aware of the clinical features of these events to facilitate early recognition and intervention in the assessment of preclinical development programs and in human clinical trials.
IMPORTANCE: Low vision is irreversible in many patients and constitutes a disability. When no treatment to improve vision is available, technological developments aid these patients in their daily ...lives. OBJECTIVE: To evaluate the usefulness of a portable artificial vision device (OrCam) for patients with low vision. DESIGN, SETTING, AND PARTICIPANTS: A prospective pilot study was conducted between July 1 and September 30, 2015, in a US ophthalmology department among 12 patients with visual impairment and best-corrected visual acuity of 20/200 or worse in their better eye. INTERVENTIONS: A 10-item test simulating activities of daily living was used to evaluate patients’ functionality in 3 scenarios: using their best-corrected visual acuity with no low-vision aids, using low-vision aids if available, and using the portable artificial vision device. This 10-item test was devised for this study and is nonvalidated. The portable artificial vision device was tested at the patients’ first visit and after 1 week of use at home. MAIN OUTCOMES AND MEASURES: Scores on the 10-item daily function test. RESULTS: Among the 12 patients, scores on the 10-item test improved from a mean (SD) of 2.5 (1.6) using best-corrected visual acuity to 9.5 (0.5) using the portable artificial vision device at the first visit (mean difference, 7.0; 95% CI, 6.0-8.0; P < .001) and 9.8 (0.4) after 1 week (mean difference from the first visit, 7.3; 95% CI, 6.3-8.3; P < .001). Mean (SD) scores with the portable artificial vision device were also better in the 7 patients who used other low-vision aids (9.7 0.5 vs 6.0 2.6, respectively; mean difference, 3.7; 95% CI, 1.5-5.9; P = .01). CONCLUSIONS AND RELEVANCE: When patients used a portable artificial vision device, an increase in scores on a nonvalidated 10-item test of activities of daily living was seen. Further evaluations are warranted to determine the usefulness of this device among individuals with low vision.
Ocular rosacea: Common and commonly missed Vieira, Ana Carolina, MD, PhD; Mannis, Mark J., MD
Journal of the American Academy of Dermatology,
12/2013, Letnik:
69, Številka:
6
Journal Article
Recenzirano
Rosacea is a prevalent disorder that may be disfiguring and cause significant ocular morbidity, if not diagnosed and managed appropriately. Ocular rosacea, in particular, is often left undiagnosed as ...no specific test is available to confirm the diagnosis. Accurate diagnosis is further complicated because symptoms of ocular rosacea are not always specific to the disorder alone. Other ophthalmic disorders may present with similar findings. Further challenges exist because the severity of ocular symptoms is often not related to the severity of cutaneous findings in rosacea. Isolating a disease marker may facilitate earlier diagnosis and treatment, and could also contribute to better understanding of disease pathogenesis. The glycomics of tear fluid and saliva in patients with rosacea shows promise as an initial step in the search for a biomarker specific to the disease. We have previously found potentially important disease biomarkers in roseatic tear and saliva samples. Further investigation should prove important in the early stages of developing a set of markers for accurate disease identification.
Keratoconus and Personality—A Review Mannis, Mark J; Ling, Jennifer J; Kyrillos, Ralph ...
Cornea,
2018-March, 2018-Mar, 2018-03-00, 20180301, Letnik:
37, Številka:
3
Journal Article
Recenzirano
PURPOSE:To assess the existing literature on the subject of keratoconus and personality and to propose a theory that might account for the perceived personality changes associated with this ...condition.
METHODS:A literature search was conducted in the PubMed database using the term “keratoconus” in combination with keywords such as personality, psychiatry, psychology, anxiety, depression, or psychosis. A total of 15 articles pertaining to personality and psychiatric disorders in keratoconus were retained and reviewed.
RESULTS:Although patients with keratoconus tend to score differently on personality scales compared with normal controls, the literature fails to substantiate the existence of a unique “keratoconic personality.” Instead, patients with keratoconus prove to have more dysfunctional coping mechanisms that specifically alter their interaction with health care providers and may account for the persistent clinical impression of less respectful, conforming, and cooperative patients.
CONCLUSIONS:We hypothesize that the stage of life at which keratoconus commonly presents plays a crucial role in personality and coping mechanism development that significantly affects behavioral patterns and the relationship with caregivers.
PURPOSE:To compare the University of California Davis experience using the Boston keratoprosthesis with the Boston Keratoprosthesis Study Groupʼs initial report.
DESIGN:Retrospective chart review.
...PARTICIPANTS:We analyzed 30 eyes of 28 patients who previously underwent Boston type 1 keratoprosthesis surgery at our institution between 2004 and 2008.
METHODS:Preoperative, intraoperative, and postoperative parameters were collected and analyzed.
MAIN OUTCOME MEASURES:Visual acuity and keratoprosthesis stability.
RESULTS:Preoperative diagnoses were failed graft (26 eyes, 87%), chemical injury (3 eyes, 10%), and Stevens-Johnson syndrome (1 eye, 3%). Twenty eyes (66%) had preoperative glaucoma. Preoperative best-corrected visual acuity ranged from 20/150 to light perception and was <20/200 in 83% of eyes. At an average follow-up of 19 months (range, 1-48; SD, 13.8; and median, 13), postoperative vision improved to ≥20/200 in 77% of eyes. Among eyes at least 1 year after the operation (16 eyes), vision was ≥20/200 in 75% of eyes and ≥20/40 in 25% of eyes. At an average follow-up of 19 months, retention of the initial keratoprosthesis was 83.3%.
CONCLUSIONS:The Boston type 1 keratoprosthesis is a viable option after multiple keratoplasty failures or in conditions with a poor prognosis for primary keratoplasty. Patients with autoimmune disease are at higher risk for complications. The University of California Davis experience seems equivalent to the initial report of the Boston Keratoprosthesis Study Group. With longer follow-up, additional surgical procedures may be required but good anatomic and functional outcomes can be maintained.
Mark J Mannis Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USAI read, with interest, the article by Moshirfar et al1 examining the shift in ...eyebanking models that is occurring in our country. While the authors maintain that their purpose is to provide a fact-based, non-biased exposition of the current issues,they fall regrettably short of this goal. Of the 11 paragraphs in this paper, 6 arededicated to outlining the advantages and contributions of the SightLife/CorneaGen, while the criticisms of this new paradigm are skimmed over withere lip service to the critics. If the authors had truly desired to providea balanced picture, they would have written a paper that more fully outlines thebjections to and concerns over the mixing of non-profit and for-profitorganizations.2There is no mention of the World Health Organization Principles ofTransplantation or the Barcelona Principles for Eye Banking, which have been endorsed by every major eye bank organization in the world including the EBAA,neither of which support a "for profit" model.In eye banking, change is both inevitable and critical. There is no doubt that theindustry has the wherewithal to facilitate true progress. However, we need to beclear about the role of for-profit institutions and their role in providing the gift ofsight. Moshirfar et al do not provide us with a balanced picture, a most unfortunateanalysis, clearly not free of bias. View the original paper byMoshirfar et al and colleagues
To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal ...treatments for LSCD, and obstacles to adoption.
A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial.
Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist.
There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.
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