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BACKGROUND AND OBJECTIVE To determine the prophylactic and therapeutic value of a single subthreshold 810-nanometer laser treatment in patients with high risk drusen as a manifestation of dry age-related macular degeneration in both eyes. PATIENTS AND METHODS The Prophylactic Treatment of Age-related Macular Degeneration study enrolled 1,278 eyes of 639 participants who were 50 years or older with at least 5 drusen 63 µm or more in diameter in each eye. Treatment consisted of the placement of an annular grid of 48 extrafoveal, subthreshold 810-nm diode laser applications centered at but sparing the foveola in one eye of each participant, with the fellow eye serving as a control. Development of choroidal neovascularization and change in best-corrected visual acuity were compared between treated and untreated eyes. RESULTS Subthreshold laser treatment did not decrease the incidence of choroidal neovascularization in treated versus untreated eyes. A modest visual acuity benefit in treated eyes was found at 24 months (1.5 letter difference; P = .04) and in the treated eyes of participants with a baseline visual acuity between 20/32 and 20/63 (4.0 letter difference; P = .0034). However, this treatment effect was not sustained at 3 years. CONCLUSION A single subthreshold 810-nanometer laser treatment to eyes of participants with bilateral high risk drusen is not an effective prophylactic strategy against choroidal neovascularization. [Ophthalmic Surg Lasers Imaging 2009;40:530-538.] AUTHORS From the UPMC Eye Center (TRF, PMB), University of Pittsburgh, Pittsburgh, Pennsylvania; the Shiley Eye Center (WRF), University of California–San Diego, La Jolla, California; and the W. K. Kellogg Eye Center (DCM), University of Michigan, Ann Arbor, Michigan. Accepted for publication December 19, 2008. Supported by Iridex Corporation, Mountain View, California, and the sources listed under the individual center descriptions found at the end of the article; the Eye and Ear Foundation of Pittsburgh, Pittsburgh, Pennsylvania; Research to Prevent Blindness, Inc., New York, New York; and unrestricted funds from several participating centers. Presented in part at the annual meeting of the American Academy of Ophthalmology, October 15-18, 2005, Chicago, Illinois, and the annual meeting of the Association for Research in Vision and Ophthalmology, April 30-May 4, 2006, Ft. Lauderdale, Florida. The authors thank photographic readers Cheryl Hiner, Columbia, MD, Rosemary J. Brothers, Madison, WI, and Linda Huang, MD, and Maria Palaiou, MS, Pittsburgh, PA; the Data and Safety Monitoring Committee voting members Donald J. D’Amico, MD, Mark W. Johnson, MD, J. Richard Landis, PhD, and nonvoting ex-officio member, Dr. Musch; and Giorgio Dorin for his contribution to the manuscript. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Thomas R. Friberg, MS, MD, UPMC Eye Center, 203 Lothrop Street, Suite 824, Pittsburgh, PA 15213. doi: 10.3928/15428877-20091030-01

The authors report a case of idiopathic polypoidal choroidal vasculopathy and sudden decrease in vision in which indocyaníne green (ICG) angiography aided in the diagnosis and treatment. ICG angiography identified choroidal-based vascular abnormalities in a patient with idiopathic polypoidal choroidal vasculopathy. One of these areas demonstrated apparent leakage and was treated with laser photocoagulation, resulting in resolution of subretinal fluid and improvement in visual acuity. ICG angiography provides a clearer visualization of the choroidal vasculature than fluorescein angiography and can aid in the diagnosis and treatment of idiopathic polypoidal choroidal vasculopathy. [Ophthalmic Surg Lasers 1996;27:467470.]

The human body is a remarkable biological machine maintained by interdependent body systems and organized biochemical reactions. Evolution has worked on humans for hundreds of thousands of years, yet the current pace of technological and social change have radically affected our life style and have exposed possible human frailties. This raises the question of whether or not nature’s work could be improved upon. We provide two-sided perspectives as a rationale for the need for the redesign of the human body. Then, we describe pedagogical strategy through which students study morphological and anatomical structures and the physiological functions of the human body systems and their respective organs and parts. The students select their own favorite system or organ to redesign in order to optimize the efficiency of the anatomical structural, physiological function, and/or the aesthetic and functional morphology; a redesign that might lead to, for example, lowering risk of diabetes, heart attack, and/or stroke. Through group work and interaction (student groups compete for a prestigious “in-house” patent award), students actively engage in the learning process in order to understand the role of design in the efficiency and functionality and vulnerability to disease of the human body system.

Endophthalmitis continues to be a potentially devasting complication of ocular surgery, despite advances in microsurgical technique and infection-preventing measures. Patients with diabetes have altered immunity at various levels and may be more susceptible to infection after ocular surgery. The authors evaluate the associations between diabetes mellitus and postoperative endophthalmitis.The records of 162 consecutive patients treated over a 5-year period for endophthalmitis occurring within 2 weeks of ocular surgery were retrospectively reviewed.Twenty-one percent of this consecutive series of patients with endophthalmitis after surgery had diabetes mellitus. Both the diabetic and nondiabetic groups were similar with respect to age, type of primary surgery, duration from surgery to onset of symptoms, presenting visual acuity, and management of endophthalmitis. Seventy-nine percent of the patients with diabetes and 68% of those without diabetes had culture-proven endophthalmitis. Staphylococcus was responsible for 74% and 71% of the culture-positive cases, respectively. The patients with diabetes were more likely to have endophthalmitis secondary to a gram-negative organism (P0.001) than those without diabetes (18.5% versus 5.7%). Visual outcome was worse in the diabetic group, although this may be related to preoperative visual status.Twenty-one percent of this consecutive series of patients with endophthalmitis after surgery had diabetes mellitus. The patients with diabetes mellitus were more likely to have endophthalmitis caused by gram-negative organisms and appear to have a poorer visual prognosis after treatment for endophthalmitis.

A consecutive series of 71 cases of late onset endophthalmitis (defined as onset of symptoms at least 2 weeks after surgery) were reviewed to determine the association of this entity with glaucoma surgery filtering blebs and to identify any predisposing factors. Sixteen cases were associated with filtering blebs and two with inadvertent blebs following cataract surgery. Onset of endophthalmitis ranged from 24 days to 20 years after surgery (mean, 6.9 years). Possible contributing factors included trauma, vitreous wicks, and bleb leak. Twelve cases were culture-positive, with 5 cases of Staphylococcus epidermidis; 2, Staphylococcus aureus; 4, Streptococcus; and 1, Pseudomonas. There were no cases of Hemophilus. The more virulent organisms were generally associated with a poor visual outcome. The organisms recovered in this series were similar to those found in postoperative endophthalmitis not associated with filtering blebs.

PURPOSE To evaluate whether performing same-day pars plana vitrectomy versus delayed pars plana vitrectomy affects visual outcomes and ocular morbidity of patients with retained lens fragments after a complicated cataract surgery. METHODS Retrospective, comparative case series of 172 eyes of 171 patients with retained lens fragments undergoing 3-port pars plana vitrectomy using 20-, 23-, or 25-gauge instrumentation between 2005 and 2008. Outcome measures included best-corrected visual acuity at 6 months, final best-corrected visual acuity, and postoperative complications such as cystoid macular edema, intraocular pressure elevation, retinal detachment, vitreous hemorrhage, choroidal hemorrhage, and endophthalmitis. RESULTS The median age was 75 ± 0.8 years. The mean time to vitrectomy for the delayed group was 15 ± 2 days. The preoperative logarithm of the minimum angle of resolution best-corrected visual acuity for immediate vitrectomy was 0.73 ± 0.09 versus 0.72 ± 0.06 for delayed vitrectomy. Six-month logarithm of the minimum angle of resolution acuity was 0.44 ± 0.09 for same-day vitrectomy compared with 0.44 ± 0.05 for delayed vitrectomy (P = 0.97, 2-tailed t-test). Of 59 eyes undergoing immediate vitrectomy, 17 (29%) experienced postoperative complications, while 38 of 113 eyes (34%), experienced complications if undergoing delayed vitrectomy (Fisher exact test, P = 0.61). Overall, the most common complication was cystoid macular edema occurring in 25 of 172 eyes (15%). CONCLUSION The outcomes of same-day pars plana vitrectomy appear to be similar to non-same-day pars plana vitrectomy. The risks and benefits related to the timing of vitrectomy after a complicated cataract surgery should be carefully discussed with each patient. Further investigation is warranted to establish an optimal time for surgical planning.

This paper was prepared at the request of Capt. A. F. Lucas, Chair man ofthe Institute's Committee on Petroleum and Gas, as a preliminary discussion ofthe fuel oils which are used in the Southwest, giving their composition, uses, prices, etc. Should it afterward be found desirable, these observations may beextended over a larger area. In this connection, I suggest that samples of allkinds of fuel oils, including various tars, from all over the country, becollected and sent to some testing laboratory for examination. We would be gladto extend the facilities of the laboratory of the Bureau of Economic Geologyand Technology, at the University of Texas, for this purpose, and to do thework free of all expenses. After such examinations are made and the resultsclassified and studied, it would be possible to suggest specifications underwhich fuel oils should be purchased, and to arrive at some conclusionsrespecting the uniformity of such specifications, with due allowance forclimatic and other more or less local conditions. While such specifications donot now depart from a common standard anything like as much as specificationsfor illuminating oils do, yet there are discrepancies which should not exist.Some of these discrepancies are of lessening importance, due to the pronouncedtendency to distill every crude oil that can be distilled with profit, and tosend residues into the market for fuel oil. Residues from the refineries are ofa more uniform chemical composition and physical nature than many of the crudeoils that go direct into the fuel market. The lower flash-point oils are disappearing from the fuel trade and in place ofthem we are getting oils that do not flash below 220? F., nor burn under 320?F. In the Southwest, it has not been long since we had fuel oils that flashedas low as 110? F, and the average flash point over a considerable period was151? F. Now we are using oil that flashes at about 30? lower than the formerburning point, which was 258? F. In other words, the flash point has risen, onthe average, 100?; and the burning point about 75?. AIME 048–47