JAMA Ophthalmology

Kavoussi, Shaheen C.; Brinton, Gregory S.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1163pmid: 26270408

This case report describes the use of optical coherence tomography to identify retinal cavernous hemangioma in an asymptomatic child.

Campbell, J. Peter; Skalet, Alison H.; Lauer, Andreas K.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1155pmid: 26270406

This case report illustrates vitreous veils associated with congenital X-linked retinoschisis in a young boy.

Khatib, Nora; Carvounis, Petros E.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1149pmid: 26270405

This case report describes chorioretinal lesions in a patient with X-linked chronic granulomatous disease.

Wagner, Lilly H.; Reich, Shani S.; Johnson, Brandon B.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1159pmid: 26270407

This case report discusses the evacuation of a frontal sinus mucocele via craniotomy in an adult man seen in the emergency department with pain over his left eye for several days.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2014.3732

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2014.3733

Eydelman, Malvina B.; Saha, Anindita; Tarver, Michelle E.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1310pmid: 25996586

This Viewpoint describes the role of the Center for Devices and Radiological Health of the Food and Drug Administration and its use of external scientific and clinical expertise.

McClellan, Scott F.; Soiberman, Uri; Gehlbach, Peter L.; Murakami, Peter N.; Stark, Walter J.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1097pmid: 25974186

ImportanceWe have developed a novel surgical technique, to our knowledge, for the management of subluxated crystalline lenses involving preplacement of an iris-sutured posterior chamber intraocular lens (PCIOL) before pars plana vitrectomy and lensectomy. ObjectiveTo investigate the outcomes of eyes with subluxated crystalline lenses, predominantly a result of Marfan syndrome (14 eyes [58%]) or trauma (5 eyes [21%]), that underwent pars plana vitrectomy and lensectomy with placement of an iris-sutured PCIOL. Design, Setting, and ParticipantsWe performed a retrospective, noncomparative case series of 24 eyes from 17 consecutive adult patients with surgically treated subluxated crystalline lenses presenting to the Wilmer Eye Institute at Johns Hopkins Hospital from October 6, 2006, through May 1, 2013. The mean (SD) postoperative follow-up was 24.4 (20.5) months for eyes with at least 6 months of follow-up (last date, October 13, 2014). We performed the analysis from January 21, 2014, through January 3, 2015. Main Outcomes and MeasuresImprovement in best-corrected visual acuity using an automated Snellen chart and induction of astigmatism for eyes with at least 6 months of follow-up (n = 18) and IOL stability during follow-up for all eyes (n = 24). ResultsThe mean (SD) age at surgery was 49.4 (10.7 [range, 29-67]) years. We found an improvement in mean (SD [95% CI]) best-corrected visual acuity from 0.66 (0.71 [0.30-1.02]) logMAR preoperatively (Snellen equivalent, approximately 20/90; range, 20/30 to hand motions) to 0.07 (0.11 [95% CI, 0.01-0.12]) logMAR postoperatively (Snellen equivalent, approximately 20/23; range, 20/15 to 20/50). We found little change in astigmatism postoperatively (mean change, −0.1 [95% CI, −0.5 to 0.13] diopters). Postoperative complications included retinal detachment (1 eye [4%]), retained cortical fragment (1 [4%]), cystoid macular edema (2 [8%]), and IOL subluxation (3 [13%]) owing to haptic slippage within 3 months of the procedure. The overall probability of successfully achieving placement of a centered iris-sutured PCIOL in patients with follow-up of longer than 6 months (n = 18) was 100% (95% CI, 81.5%-100%). Conclusions and RelevancePlacement of iris-sutured PCIOLs at the time of subluxated lens extraction with a pars plana surgical approach yields favorable results in terms of postoperative visual outcomes and surgical complications. This technique offers an effective procedure for surgeons to use when treating clinically significant subluxated crystalline lenses.

Baskaran, Mani; Foo, Reuben C.; Cheng, Ching-Yu; Narayanaswamy, Arun K.; Zheng, Ying-Feng; Wu, Renyi; Saw, Seang-Mei; Foster, Paul J.; Wong, Tien-Yin; Aung, Tin

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1110pmid: 25974263

ImportanceGlaucoma represents a major public health challenge in an aging population. The Tanjong Pagar Eye Study reported the prevalence and risk factors of glaucoma in a Singapore Chinese population in 1997, which established the higher rates of blindness in this population. ObjectivesTo determine the prevalence and associated risk factors for glaucoma among Chinese adults in Singapore and to compare the results with those of the 1997 study. Design, Setting, and ParticipantsIn a population-based survey of 4605 eligible individuals, we selected 3353 Chinese adults 40 years or older from the southwestern part of Singapore. Participants underwent examination at a single tertiary care research institute from February 9, 2009, through December 19, 2011. ExposuresAll participants underwent slitlamp ophthalmic examination, applanation tonometry, measurement of central corneal thickness, gonioscopy, and a dilated fundus examination. Main Outcomes and MeasuresGlaucoma as defined by the International Society of Geographical and Epidemiological Ophthalmology guidelines and age-standardized prevalence estimates computed as per the 2010 Singapore Chinese census. Blindness was defined as logMAR visual acuity of 1.00 (Snellen equivalent, 20/200 or worse). ResultsOf the 3353 respondents, 134 (4.0%) had glaucoma, including primary open-angle glaucoma (POAG) in 57 (1.7%), primary angle-closure glaucoma (PACG) in 49 (1.5%), and secondary glaucoma in 28 (0.8%). The age-standardized prevalence (95% CI) of glaucoma was 3.2% (2.7%-3.9%); POAG, 1.4% (1.1%-1.9%); and PACG, 1.2% (0.9%-1.6%). In a multivariate model, POAG was associated with being older and male and having a higher intraocular pressure. Of the 134 participants with glaucoma, 114 (85.1%; 95% CI, 78.1%-90.1%) were not aware of their diagnosis. Prevalence (95% CI) of blindness caused by secondary glaucoma was 14.3% (5.7%-31.5%), followed by 10.2% (4.4%-21.8%) for PACG and 8.8% (3.8%-18.9%) for POAG. We could not identify a difference in the prevalence of glaucoma compared with the 3.2% reported in 1997 (difference, −0.04%; 95% CI, −1.2 to 1.2; P = .97). Conclusions and RelevanceThe prevalence of glaucoma among Singapore Chinese likely ranges from 2.7% to 3.9%, with secondary glaucoma being the most visually debilitating type. We could not identify a difference compared with previous studies approximately 12 years earlier. We report a high proportion of previously undiagnosed disease, suggesting the need to increase public awareness of this potentially blinding condition.

Gupta, Mrinali P.; Lane, Anne Marie; DeAngelis, Margaret M.; Mayne, Katie; Crabtree, Margaux; Gragoudas, Evangelos S.; Kim, Ivana K.

2015 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2015.1119pmid: 25974357

ImportanceSomatic mutations in BAP1 (BRCA1-associated protein 1 gene) are frequently identified in uveal melanoma. To date, the role of germline BAP1 mutations in uveal melanoma has not been characterized. ObjectiveTo characterize the clinical phenotype of uveal melanoma in patients with germline BAP1 mutations. Design, Setting, and ParticipantsRetrospective cohort study at an academic ophthalmology referral center among 507 patients with uveal melanoma who consented for collection of blood samples. The study dates were June 22, 1992, to December 14, 2010. Main Outcomes and MeasuresClinical characteristics of uveal melanoma and the development of metastases. BAP1 gene sequencing from blood samples of patients with uveal melanoma was correlated with clinical characteristics. ResultsOf 507 blood samples analyzed, 25 patients (4.9%) exhibited 18 BAP1 polymorphisms, of which 9 were novel. Computational analyses predicted that 8 BAP1 mutations in 8 patients (1.6%) were likely to result in damaged BAP1 protein. Five of these 8 mutations were novel. These 8 patients were compared with 482 patients in whom no BAP1 polymorphisms were identified. In univariate analyses, patients with germline BAP1 mutations exhibited larger tumor diameters (mean, 15.9 vs 12.3 mm; P = .004) and higher rates of ciliary body involvement (75.0% vs 21.6%, P = .002) and metastases (71.4% vs 18.0%, P = .003) compared with control subjects. Patients with germline BAP1 mutations exhibited increased frequency of family history of cancer (100% vs 65.9%, P = .06), particularly cutaneous melanoma (62.5% vs 9.9%, P < .001) and ocular melanoma (25.0% vs 1.9%, P = .01). No differences were identified in age at diagnosis, sex, history of other malignant neoplasm, presenting visual acuity, distance of the tumor from the optic nerve or fovea, iris involvement, extrascleral extension, or tumor pigmentation. Germline BAP1 mutations increased risk of metastasis independent of ciliary body involvement (P = .02). Germline BAP1 mutation approached significance as an independent risk factor for metastasis (P = .09). Conclusions and RelevanceThese data suggest that germline BAP1 mutations occur infrequently in uveal melanoma and are associated with larger tumors and higher rates of ciliary body involvement, 2 known risk factors for metastasis.