Ophthalmology: Journal of The American Academy of Ophthalmology - Volume 116, Number 5, May 2009
Volume 116, Issue 5, Pages A1-A40, 821-1020 (May 2009)
ISSN: 0161-6420
http://www.book4doc.com/35592Ophthalmology, the official journal of the American Academy of Ophthalmology, publishes original, peer-reviewed reports of research in ophthalmology, including basic science investigations and clinical studies. Topics include new diagnostic and surgical techniques, treatment methods, instrument updates, the latest drug findings, results of clinical trials, and research findings. Ophthalmology also publishes major reviews of specific topics by acknowledged authorities.
The objective of the American Academy of Ophthalmology in publishing Ophthalmology is to provide opportunities for the free exchange of ideas and information.
This Issue at a Glance:24-Hour Assessment of Intraocular Pressure
in Glaucoma Patients
In the first study to evaluate optic disc appearance in relation to 24-hour
intraocular pressure (IOP), Deokule et al (p. 833) found that untreated
glaucoma patients with a concentric optic disc enlargement demonstrate
higher mean IOP and a greater number of IOP peaks in the nocturnal
period compared with those with non-concentric optic disc appearance.
This study involved 75 eyes of 45 patients with primary open angle
glaucoma whose IOP was assessed for 24 hours in a sleep laboratory. The
optic disc appearance for each eye was classified as either concentric or
non-concentric. The mean nocturnal IOP was significantly greater in the
concentric group (24.03.8 mmHg) compared with the non-concentric
group (21.91.9 mmHg). The majority of IOP peaks in patients with the
concentric optic disc appearance occurred overnight compared with the
diurnal period of patients with the non-concentric optic disc appearance.
The authors conclude measuring IOP only during office hours may lead
to an underestimation of IOP.
Maintaining Corneal Epithelial Homeostasis
in Absence of Limbal Epithelial Stem Cells
It is widely believed that the limbus plays a key role in maintaining
the central corneal epithelium and that damage to it results in abnormal
corneal epithelium. In this case series of 5 patients (8 eyes) with
clinically diagnosed total stem cell deficiency, where the central
corneal epithelium was preserved over a long period of time, Dua et
al (p. 856) present evidence raising questions about the role of the
limbus in normal corneal epithelial homeostasis. Patients presented
with total limbal stem cell deficiency in one or both eyes, with a
central area of normal corneal epithelial cells. Clinical slit lamp
examination and in vivo confocal microscopy over a mean of 60
months revealed the existence and survival of a healthy sheet of
corneal epithelial cells in the presence of a clinically apparent total
limbal stem cell deficiency. The authors conclude that these findings
support the hypothesis that physiological corneal epithelial homeostasis
can be maintained in the absence of clinically detectable limbal
epithelial stem cells.
Tumor-Infiltrating Lymphocyte Immunotherapy
for Recurrent, Metastatic Melanoma
Yeh et al (p. 981) describe the course of a 35-year-old Caucasian man
who, after successful eradication of metastatic melanoma with adoptive
cell transfer (ACT) therapy, developed chronic bilateral panuveitis that
was not responsive to local immunosuppressive therapy. The patient
underwent ACT of ex vivo expanded, autologous tumorreactive
tumor-infiltrating lymphocytes plus interleukin-2 therapy,
after a lymphodepleting regimen of cyclophosphamide and fludarabine,
which resulted in a complete remission. However, the patient
subsequently developed bilateral panuveitis, hearing loss, vitiligo, poliosis,
and alopecia requiring local ophthalmic immunosuppressive therapy.
Although the patient did not present with the typical features of acute
Vogt-Koyanagi-Harada (VKH) syndrome, his sunset-glow fundus resembled
the convalescent ophthalmic phase observed in patients with the
chronic form of VKH disease. The high percentage of tumor-reactive
T-cells obtained from the aqueous fluid was indicative of a breakdown of
the blood-ocular barrier, loss of immune-privilege, and T-cell homing to
melanocytes within the iris, ciliary body, and choroidal tissues. This
patients course highlights the fine balance between tumor-specific immunity
and loss of self-tolerance.
Angiotensin II Type 1 Receptor Expression in
Giant Cell Arteritis
Giant cell arteritis (GCA), a granulomatous form of vasculitis, produces
a variety of symptoms including blindness, jaw claudication, headaches,
stroke, and aortic arch syndrome. The disease is treated with corticosteroids
or immunomodulating agents. Seeking a non-corticosteroid treatment
alternative, Dimitrijevic et al (p. 990) focused this study on angiotensin
II, a vasoactive peptide involved in vessel inflammation during
atherosclerosis. Angiotensin II receptor inhibitors have proven effective
in preventing atherosclerosis. The authors conducted an immunohistochemical
study of temporal arteries using archival formalin-fixed,
paraffin-embedded tissue of 10 patients withGCAand 10 control patients
clinically suspected of having GCA but diagnosed as not having GCA.
Their results showed that angiotensin type 1 (AT1) receptors played a role
in the development of GCA. High levels of AT1 receptor expression were
found in the vascular smooth muscle cells and inflammatory cells in the
temporal arteries of patients with GCA. They conclude that inhibiting
the renin-angiotensin system may serve as a non-corticosteroid alternative
for the treatment of GCA inflammation.
FL-41 Tint Provides Benefit in Benign
Essential Blepharospasm
Blackburn et al (p. 997) found that FL-41 lenses provide a significant
benefit to patients with benign essential blepharospasm (BEB). The
FL-41 is a rose-colored tint that blocks visible light at the green-to-blue
end of the spectrum. The authors conducted 2 studies. The first study was
a randomized crossover study comparing the perceived improvement in
light sensitivity and activities of daily living provided by FL-41 lenses in
30 patients with BEB. The second study used surface electromyography
to evaluate the effects of FL-41 on blink frequency, duration, and force in
26 patients with BEB and 26 controls. Most participants observed improvement
with both FL-41 and gray-tinted lenses. However, FL-41
lenses provided superior improvement in reading, fluorescent light
sensitivity, overall light sensitivity, blepharospasm frequency, and blepharospasm
severity. In addition, FL-41 lenses reduced mean blink rate,
compared with both rose- and gray-tinted lenses, and reduced eyelid
contraction force compared with rose-tinted lenses. The authors conclude
that FL-41 tinted spectacles represent a viable option to help patients
improve BEB symptoms.
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