Macular Degeneration: Thorne JE

Sabet-Peyman EJ, Heussen FM, Thorne JE, Casparis H, Patel SJ, Do DV. · Retina Division, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. · Ophthalmic Surg Lasers Imaging. · Pubmed #19485300 No free full text.

Abstract: A 37-year-old woman with bilateral obliterative retinal vasculitis and macular ischemia received intravitreal bevacizumab for rapidly progressive neovascularization of the optic disc and vitreous hemorrhage in the left eye. One week after treatment, she presented with central scotoma and fluorescein angiography revealed increased parafoveal capillary dropout and progressive macular ischemia in the treated eye.

Bélair ML, Kim SJ, Thorne JE, Dunn JP, Kedhar SR, Brown DM, Jabs DA. · Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Am J Ophthalmol. · Pubmed #19403110 No free full text.

Abstract: PURPOSE: To determine the incidence of cystoid macular edema (CME) after cataract surgery among eyes with and without uveitis using optical coherence tomography (OCT) and to determine risk factors for postoperative CME among eyes with uveitis. DESIGN: Prospective, comparative cohort study. METHODS: Single-center, academic practice. Forty-one eyes with uveitis and 52 eyes without uveitis underwent clinical examination and OCT testing within 4 weeks before cataract surgery and at 1-month and 3-month postoperative visits. The main outcome measure was incidence of CME at 1 and 3 months after surgery. RESULTS: Both uveitic and control eyes gained approximately 3 lines of vision (P = .6). Incidence of CME at 1 month was 12% (5 eyes) for uveitis and 4% (2 eyes) for controls (P = .2). Incidence of CME at 3 months was 8% (3 eyes) for uveitis and 0% for eyes without uveitis (P = .08). Eyes with uveitis treated with perioperative oral corticosteroids had a 7-fold reduction in postoperative CME (relative risk [RR], 0.14; P = .05). In uveitic eyes, active inflammation within 3 months before surgery increased the risk of CME when compared with eyes without inflammation (RR, 6.19; P = .04). CME was significantly associated with poorer vision (P = .01). CONCLUSIONS: Eyes with well-controlled uveitis may obtain similar outcomes to control eyes after cataract surgery (up to 3 months). Use of perioperative oral corticosteroids and control of uveitis for more than 3 months before surgery seemed to decrease the risk of postoperative CME among uveitic eyes in this study.

Lim LL, Scarborough JD, Thorne JE, Graham E, Kempen JH, Mackensen F, Nguyen QD, Prabriputaloong T, Read RW, Suhler EB, Schwartz JM, Smith JR. · Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA. · Am J Ophthalmol. · Pubmed #19166713 No free full text.

Abstract: PURPOSE: To report seven cases of uveitis occurring in patients with autoimmune hepatitis (AIH), raising the possibility that uveitis may be an extrahepatic feature of AIH. DESIGN: Multicenter, retrospective, observational case series of patients with AIH and uveitis. METHODS: One index case was identified at Oregon Health & Science University. Further cases were identified by a web-based survey of members of the American Uveitis Society, the International Uveitis Study Group, the Proctor Foundation mailing list server, and the First SUN International Workshop. Respondents were asked to provide clinical information about uveitis phenotype, AIH features, and treatment. RESULTS: Clinical information was obtained for seven individuals (four females and three males; age range, seven to 67 years) who suffered from AIH and uveitis. Average duration of follow-up was 5.5 years. All patients had chronic, persistent bilateral uveitis that was anterior (n = 3), intermediate (n = 1), or pan (n = 3) in location. Every patient had complications arising from his or her uveitis, including cataract (n = 5), glaucoma (n = 3), cystoid macular edema (n = 3), and posterior synechiae (n = 3). Final visual acuities ranged from 20/16 to hand movements. To treat the uveitis and/or AIH, the majority of patients required oral prednisone and all seven patients were treated with systemic immunosuppression. CONCLUSION: Despite the small size of this study, our findings suggest an association between AIH and uveitis. The uveitis is chronic, bilateral, and associated with sight-threatening complications, necessitating systemic immunosuppression in some individuals.

Kim SJ, Belair ML, Bressler NM, Dunn JP, Thorne JE, Kedhar SR, Jabs DA. · Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA. · Retina. · Pubmed #18536605 No free full text.

Abstract: OBJECTIVE: To validate a method of reporting postcataract macular edema (ME) using optical coherence tomography (OCT). METHODS:: Data were analyzed for 130 eyes followed prospectively for ME after uncomplicated cataract surgery. Each eye underwent OCT within 4 weeks before surgery and at 1 month and 3 months after surgery. ME was defined by observation of cystoid changes by OCT. RESULTS: Incidence of ME was 14% (95% confidence interval, 8-20). Average increase in baseline center point thickness (CPT) +/- SD at 1 month for eyes with and without ME was 202 +/- 113 microm and 8 +/- 19 microm, respectively (P < 0.001), which resulted in a 1-letter loss (-0.02 logMAR [logarithm of the minimum angle of resolution]) and a 3-line gain (0.29 logMAR) in vision, respectively (P < 0.001). Percent change in baseline CPT +/- SD for eyes with and without ME was 115 +/- 67% and 6 +/- 11%, respectively (P < 0.001). A > or =40% increase in baseline CPT accurately determined 100% of eyes with ME and 99% of eyes without ME. CONCLUSIONS: A > or =40% increase in baseline CPT, determined by OCT, offers a valid and objective method of reporting clinically relevant postcataract ME. Standardized reporting of postcataract ME would allow objective assessment and comparison of treatment outcomes among clinical studies.

Thorne JE, Daniel E, Jabs DA, Kedhar SR, Peters GB, Dunn JP. · Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. · Am J Ophthalmol. · Pubmed #18321467 links to  free full text

Abstract: PURPOSE: To describe risk factors for the presence of cystoid macular edema (CME) among patients presenting with intermediate uveitis. DESIGN: Cross-sectional study. METHODS: SETTINGS: Single-center, academic practice. STUDY POPULATION: Two hundred and eight patients with intermediate uveitis evaluated from July 1, 1984 through September 30, 2006. PROCEDURES: Clinical and demographic data were entered retrospectively into a database and analyzed. OUTCOME MEASURES: Presence of CME at presentation to our clinic; risk factors for presenting with CME. RESULTS: Of the 208 patients, 74% had bilateral intermediate uveitis, yielding 363 affected eyes. Eighty-nine patients (43%) had CME in at least one eye at the time of presentation to our clinic. After controlling for potentially confounding variables including demographics, duration of disease, active intraocular inflammation, history of diabetes mellitus or hypertension, and presence of epiretinal membrane, actively smoking at presentation was associated with a four-fold increased risk of CME at presentation vs never smoking (odds ratio (OR), 3.90; 95% confidence interval (CI), 1.43, 10.66; P = .008). Former smoking also appeared to increase the risk of CME at presentation in the multivariate analysis, but the result was of borderline statistical significance (OR, 1.97; 95% CI, 0.99, 3.94; P = .055). After adjusting for confounding, there was a 4% increased risk of CME at presentation for each cigarette smoked per day (OR, 1.04; 95% CI, 1.01, 1.7; P = .005). CONCLUSIONS: CME was a common structural ocular complication observed in our cohort. Current smoking was associated with a dose-dependent increased risk of having CME at the time of presentation to our clinic.

Kedhar SR, Thorne JE, Wittenberg S, Dunn JP, Jabs DA. · Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Retina. · Pubmed #18046221 No free full text.

Abstract: PURPOSE: To compare the clinical characteristics at presentation of multifocal choroiditis with panuveitis (MFCPU) and punctate inner choroidopathy (PIC). METHODS: A cross-sectional study of 66 patients (122 eyes) with MFCPU and 13 patients (22 eyes) with PIC was carried out. Diagnosis was based solely on retinal morphology. Demographic information, visual acuity at presentation, and presence of intraocular inflammation, choroidal neovascularization (CNV), and structural complications of intraocular inflammation (including cataract, cystoid macular edema [CME], and epiretinal membrane [ERM]) were compared for the two groups. RESULTS: The median ages at presentation of patients with MFCPU and PIC were 45 years and 29 years, respectively (P = 0.007). At presentation, patients with MFCPU had a higher frequency of structural complications, such as cataract (31.6%), CME (13.6%), and ERM (4.6%). Patients with PIC had none of these complications. Although CNV occurred more frequently in patients with PIC (PIC, 76.9%; MFCPU, 27.7%; P = 0.002), those with MFCPU were more likely to have bilateral visual impairment of 20/50 or worse (MFCPU, 20%; PIC, 0; P = 0.03). CONCLUSION: PIC and MFCPU appeared to have different clinical characteristics at presentation. Patients with PIC had a higher frequency of CNV at presentation but lower frequencies of structural complications from intraocular inflammation and a lower frequency of visual impairment at presentation.

Anonymous00153, Gilson MM, Bressler NM, Jabs DA, Solomon SD, Thorne JE, Wilson DJ. · Johns Hopkins University, Baltimore, Maryland, USA. · Ophthalmology. · Pubmed #17822977 No free full text.

Abstract: PURPOSE: To evaluate fluorescein angiographic and visual acuity (VA) outcomes from patients enrolled in a trial of a single periocular corticosteroid injection immediately before photodynamic therapy (PDT) versus PDT alone for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). DESIGN: Randomized 2-center clinical trial. PARTICIPANTS: Sixty-seven subjects with AMD, subfoveal choroidal neovascularization, and best-corrected VA of 20/20 to 20/320 in the study eye who had received no more than 1 prior PDT treatment. METHODS: Subjects were randomized to receive PDT alone (no corticosteroid) or a single periocular corticosteroid injection given via the posterior superior sub-Tenon's capsule route before PDT (corticosteroid) and assessed 1, 3, and 6 months after enrollment. Best-corrected VA and intraocular pressure (IOP) measurements were taken during each examination. Color photographs and fluorescein angiograms were taken at baseline and 3 and 6 months. MAIN OUTCOME MEASURE: Presence or absence of fluorescein leakage from choroidal neovascularization 3 months after randomization. RESULTS: Between the 34 participants randomized to periocular corticosteroid and 33 to no corticosteroid, baseline features appeared balanced. Thirty-three corticosteroid participants and 30 no corticosteroid participants returned for the 3-month follow-up, at which time 56 had fluorescein leakage. Proportions of participants with leakage at 3 months for the 2 treatment groups did not statistically significantly differ; 94% of the corticosteroid group and 90% of the no corticosteroid group had fluorescein leakage at 3 months (P = 0.66). Mean VAs at 3 months after enrollment were 20/100 and 20/125 in the corticosteroid and no corticosteroid groups, respectively, decreasing on average 1.5 and 0.9 lines from baseline (P = 0.50). Adverse events included IOP > 21 mmHg in 7 corticosteroid participants (21%) and 1 (3%) no corticosteroid participant (P<0.05) and ptosis of the study eyelid in 1 (3%) corticosteroid participant. CONCLUSIONS: In contrast to previously reported uncontrolled studies and 1 controlled study, this trial did not find a reduction in the amount of fluorescein leakage 3 months after a single periocular injection of corticosteroid and PDT compared with PDT alone.

Thorne JE, Wittenberg S, Jabs DA, Peters GB, Reed TL, Kedhar SR, Dunn JP. · Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. · Ophthalmology. · Pubmed #16996607 No free full text.

Abstract: PURPOSE: To estimate the incidences of ocular complications and vision loss in patients with multifocal choroiditis with panuveitis (MFCPU) and to describe the association between therapy and the incidences thereof. DESIGN: Retrospective cohort study. PARTICIPANTS: Sixty-six patients (122 eyes) with MFCPU evaluated from January 1984 through June 2005 at a single-center academic practice. METHODS: Demographic and clinical information on patients diagnosed with MFCPU was collected and entered into a computerized database for statistical analyses. MAIN OUTCOME MEASURES: Development of ocular complications, including choroidal neovascularization, epiretinal membrane, and cystoid macular edema (CME), and loss of visual acuity (VA) to 20/50 or worse and to 20/200 or worse. RESULTS: Among affected eyes of patients with MFCPU, frequencies of VAs of 20/50 or worse and of 20/200 or worse at presentation were 55% and 38%, respectively. Choroidal neovascularization was observed in 22% of affected eyes at presentation and was the leading cause of poor VA at presentation. The incidence rates of vision loss to 20/50 or worse and to 20/200 or worse were 0.19/eye-year (EY) and 0.12/EY in affected eyes and 0.07/person-year (PY) and 0.04/PY in better-seeing eyes. Choroidal neovascularization was the most common cause of incident vision loss, with approximately 45% of incident vision loss attributed to new-onset or recurrent choroidal neovascularization. Presence of epiretinal membrane and CME also was associated with the development of vision loss during follow-up. When taken in combination, the incidence of any posterior pole complication was 0.13/EY in affected eyes. Use of immunosuppressive drug therapy (but not low-dose corticosteroid therapy) was associated with an 83% reduction in the risk of posterior pole complications (P = 0.004) and with a 92% reduction in the risk of 20/200 or worse VA in affected eyes (P = 0.05). Of the 6 eyes with recurrent choroidal neovascularization, only one recurrence was observed, in a patient receiving immunosuppressive drug therapy. CONCLUSIONS: Treatment with immunosuppressive drugs may improve VA outcomes among patients with MFCPU by reducing the risk of sight-threatening posterior pole complications, including new-onset choroidal neovascularization and recurrent choroidal neovascularization among eyes with existing choroidal neovascularization.

Thorne JE, Jabs DA, Kempen JH, Holbrook JT, Nichols C, Meinert CL, Anonymous00254. · Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Ophthalmology. · Pubmed #16781775 No free full text.

Abstract: PURPOSE: To quantitate the frequencies of the common causes of visual acuity loss for patients with AIDS and cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART). DESIGN: Multicenter prospective observational study. PARTICIPANTS: Three hundred seventy-nine patients (494 eyes) with CMV retinitis. METHODS: Follow-up every 3 months with medical history, ophthalmologic examination, and laboratory testing. MAIN OUTCOME MEASURES: Loss of visual acuity across the 20/50 or worse and 20/200 or worse thresholds and doubling of the visual angle; frequencies of causes of such vision loss. RESULTS: Overall, involvement of the posterior pole with CMV retinitis (zone 1 retinitis) accounted for approximately one half of incident visual acuity loss of 20/50 or worse, 20/200 or worse, and of doubling of the visual angle. Cataract and retinitis-related retinal detachment were the second and third most common causes of vision loss, accounting for 22% to 33% and 13% to 20% of vision loss for the 3 outcomes, respectively. In subset analysis, cataract and cystoid macular edema (CME) accounted for approximately 50% of incident vision loss in eyes of patients with longstanding CMV retinitis and immune recovery at baseline, but these complications accounted for <10% of incident vision loss in eyes of patients with newly diagnosed CMV retinitis at baseline. Of eyes that had a vision-threatening complication of CMV retinitis, eyes that developed retinal detachment had the highest risk of vision loss, with 100% of eyes developing visual impairment (20/50 or worse vision) and 42% of eyes developing legal blindness (20/200 or worse vision) at 12 months after diagnosis of the retinal detachment. CONCLUSIONS: In the HAART era, zone 1 involvement and retinal detachment remain the most common causes of visual acuity loss among patients with CMV retinitis. Cataract and CME also are common causes of loss of visual acuity, primarily in those patients with HAART-induced immune recovery.

Thorne JE, Jabs DA, Peters GB, Hair D, Dunn JP, Kempen JH. · Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD 21250, USA. · Am J Ophthalmol. · Pubmed #16038650 No free full text.

Abstract: PURPOSE: To describe the incidence of vision loss and of ocular complications attributable to birdshot retinochoroidopathy and to describe the association between therapy and the incidence thereof. DESIGN: Retrospective cohort study. METHODS: SETTING: Single-center, academic practice. STUDY POPULATION: Forty patients with birdshot retinochoroidopathy were evaluated from January 1984 through March 2004. OBSERVATION PROCEDURE: Demographic and clinical information on patients diagnosed with birdshot retinochoroidopathy was collected. MAIN OUTCOME MEASURES: Visual acuity and visual field loss; ocular complications including cystoid macular edema (CME). RESULTS: In affected eyes, the frequencies of vision loss to 20/50 or worse and to 20/200 or worse and of CME at presentation were 33%, 13%, and 20%, respectively. Patients who presented with a duration of disease of > or = 30 months had higher frequencies of visual impairment to 20/50 or worse (68% vs 32%; P = .004) and to 20/200 or worse (32% vs 9%; P = .01), and had a higher frequency of CME (38% vs 14%; P = .02) than patients who presented with a duration of disease <30 months. The incidence rates on follow-up for vision loss to 20/50 or worse and to 20/200 or worse were 13% and 4% per eye-year (EY), respectively. The incidence of CME was 10%/EY. Use of immunosuppressive drug therapy was associated with a reduced risk of developing CME (relative risk = 0.17; 95% confidence interval: 0.05, 0.64; P = .009). CONCLUSIONS: Birdshot retinochoroidopathy is a progressive disease with the potential for visual impairment. Patients who present at a later date after the onset of disease were more likely to have vision impairment and CME. Use of long-term immunosuppressive therapy may reduce the risk of CME.