A single-center, prospective, case-controlled study at the Massachusetts Eye Research and Surgery Institution discovered that patients with birdshot retinochoroidopathy with active disease naïve to systemic therapy have elevated serum levels of three key immune mediators known to promote T helper 17 cells in autoimmune disease: interleukin-21, IL-23 and transforming growth factor-β1. These results suggest that IL-21, IL-23 and TBF-β1 may play an important role in the development of site-specific Th17 cell-mediated inflammation in BSRC.

The serum of 17 BSRC patients was analyzed during different phases of disease activity and therapy, with a quantitative multiplex sandwich enzyme-linked immunosorbent assay-based microarray performed to determine the levels of 20 immune mediators (T cell and proinflammatory). The serum of 12 healthy volunteers was used as controls.

Patients with BSRC and active disease naïve to systemic therapy had elevated serum levels of IL-21 (p=0.0005), IL-23 (p=0.0005) and TBF-β1 (p=0.0011) compared to that of controls. There was no significant difference in the serum levels of immune mediators between control and BRSC patients who had a current or past history of IMT or who were in remission. The levels of IL-21, IL-23 and TBF-β1 were positively correlated (IL-23/IL-21 r:0.91; TBF-β1/IL-21 r:0.97; TBF-β/IL-23 r:0.87; for all, p<0.0001).
Am J Ophthalmol 2013;156:400-406.
Yang P and Foster CS.

Brinzolamide-Brimonidine Fixed-Combination Trial Data
This Phase III
, double-masked study, set across 66 academic and private practice sites, provides evidence that the investigational non-beta-antagonist fixed combination of brinzolamide 1% and brimonidine 0.2% can safely and effectively lower intraocular pressure in patients with open-angle glaucoma or ocular hypertension. Additionally, the fixed combination shows significantly superior IOP-lowering activity compared with either brinzolamide or brimonidine monotherapy while providing a safety profile consistent with that of its individual components.

A total of 660 adults with a clinical diagnosis of open-angle glaucoma or ocular hypertension from a referred sample were enrolled. Patients were randomized 1:1:1 to treatment with fixed-combination brinzolamide 1% and brimonidine 0.2%; brinzolamide 1%; or brimonidine 0.2%, one drop a day, three times a day for three months. Mean IOP was measured during the three-month visit at four time points: 8 a.m., 10 a.m., 3 p.m. and 5 p.m.

Baseline mean IOP values were similar among treatment groups at all four time points. At three months, the mean IOP of the brinzolamide-brimonidine group (16.3 to 19.8 mmHg) was significantly lower than that of either the brinzolamide group (19.3 to 20.9 mmHg; p≤0.002) or the brimonidine group (17.9 to 22.5 mmHg; p<0.001) across all time points. One out of 10 serious adverse events (chest pain, brinzolamide group) was judged as treatment-related. A total of 129 patients experienced at least one treatment-related adverse effect (brinzolamide-brimonidine, 22.9 percent; brinzolamide, 18.6 percent; and brimonidine, 17.3 percent; p=0.31), most of which were ocular.
JAMA Ophthalmol 2013;131:6:724-730.
Katz G, DuBiner H, Samples J, Vold S, et al.

Liquid Culture Media for Diagnosing Microbial Keratitis
Researchers from the
L.V. Prasad Eye Institute in India conducted a retrospective review of the microbiology records of 114 corneal scraping samples from infectious keratitis patients and determined that liquid culture media increases the chance of isolation of bacteria in pure bacterial and/or mixed infection.
However, the role of liquid culture in isolating fungus is limited. Due to the overlap in clinical diagnosis of bacterial and fungal keratitis, the researchers recommend inclusion of both solid and liquid culture media in the laboratory diagnosis of nonviral keratitis.

Patient samples were processed by corneal smear microscopy (potassium hydroxide with calcofluor white and Gram stains) and culture examination (5% sheep blood agar, sheep blood chocolate agar, Sabouraud dextrose agar, brain heart infusion, thioglycolate broth and Robertson’s cooked meat broth). Cases where at least one liquid medium was taken were included in the study and all cases were required to have significant growth in culture as per the institutional criteria. Results of smear examination and culture growth were analyzed.

Out of 114 cases, 44 (38.59 percent) were bacterial, 62 (54.38 percent) fungal and eight (7.01 percent) were mixed bacterial and fungal infection. Thirty-eight of 44 cases of bacterial keratitis (86.36 percent) were diagnosed by solid media alone (criterion 1), while six of 44 cases (13.63 percent) required liquid media for diagnosis (p<0.001). In patients with fungal keratitis, 61 of 62 cases (98.38 percent) were diagnosed using solid media alone (criterion 1) while one case required liquid media for diagnosis. In mixed infections, none of the cases required liquid media for diagnosis of the fungal component; however, all eight cases required liquid media for establishing a bacterial component.
Am J Ophthalmol 2013; 10.1016/j.ajo.2013.05.035.
Bhadange Y, Sharma S, Das S, Sahu S.

Fellow Eye Comparison of PK And DSEK in Fuchs Patients
Researchers at the
Wills Eye Institute in Philadelphia undertook a retrospective review of patients with Fuchs endothelial dystrophy who had undergone penetrating keratoplasty in one eye and Descemet stripping endothelial keratoplasty in the fellow eye, determining that final visual outcomes were not statistically significant between the two procedures. However, DSEK had early visual stabilization while PK had a more complicated course, with more astigmatism, rejections, suture-related infections and graft failures.

Over an 18-year period, 15 patients with Fuchs underwent PK in one eye and DSEK in the fellow eye. Mean postoperative best-corrected visual acuity in the PK (0.39 ±0.39 logMAR) and DSEK groups (0.23 ±0.12) was statistically significantly better than the mean preoperative BCVA (0.83 ±0.36 and 0.76 ±0.34 logMAR, respectively; p<0.025 and p<0.001). Mean manifest refraction cylinder was higher in the PK eyes than the DSEK eyes at one year (3.58 ±1.82 D vs. 1.23 ±1.63 D) as well as at two years of follow-up (3.57 ±1.82 D vs. 1.05 ±1.18 D; p<0.001) but was not statistically different at the last visit (3.18 ±2.67 D vs. 1.5 ±1.66 D; p=0.052). Mean postoperative follow-up was 101.9 ±39.5 months after PK and 29.9 ±19.9 months after DSEK.

The most common complications after PK were high astigmatism in 15 eyes, monocular diplopia in seven eyes, posterior capsule opacity in six eyes and secondary glaucoma and graft rejection in five eyes each. After DSEK, secondary glaucoma in three eyes and graft rejection in two eyes were the most common complications.
Cornea 2013;32:1083-1088.
Kosker M, Suri K, Duman F, Hammersmith K, et al.

Orbital Fractures: National Trends and Complications
Using the Nationwide
Inpatient Sample (2002 to 2008) database, researchers determined that the number of orbital fractures and associated cost has dramatically increased over the past decade. Acute repair of orbital fractures is common and associated with a longer hospital course, increased cost and a higher rate of complications.

Researchers searched the database for the discharges classified with ICD-9 diagnosis codes of orbital fractures, orbital fracture repair and associated diagnoses. There was a nearly 50-percent increase in the annual number of orbital fracture admissions from 2002 to 2008. Demographics for patients with orbital fractures showed that 68 percent were male, most commonly between 18 and 44 years of age, with 69 percent of the cases at large teaching hospitals. Associated ocular diagnoses included eyelid laceration, commotion retinae and globe rupture.

Approximately 25 percent of patients underwent surgical repair. Surgical patients were younger than nonsurgical patients by approximately 10 years. There was an overall complication rate of 15.8 percent, including: pulmonary complications; diplopia; renal impairment; venous thromboembolism; and wound complications. Orbital fracture repair was associated with approximately one extra day of hospitalization and $22,000 in-hospital charges. The rates of pulmonary, wound and ocular motility complications were significantly higher in patients undergoing orbital fracture repair (p<0.05).
Ophthal Plast Reconstr Surg 2013;29:298-303.
Ko M, Morris C, Kim J, Lad S, et al.