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Advances in cystic fibrosis management have significantly improved life expectancy in these patients. However, we are now faced with a growing number of long-term extrapulmonary consequences of this disease, including ophthalmic complications of diabetes in cystic fibrosis patients. We present a unique report that documents a case of diabetic papillopathy progressing to nonarteritic anterior ischemic optic neuropathy resulting in vision loss in a patient with CF and diabetes. It highlights the potentially devastating consequences of longstanding diabetes in CF patients.

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OBJECTIVE: To examine the issues influencing the outcome of cataract surgeries performed by visiting surgeons in a remote region of British Columbia. DESIGN: Retrospective series. PARTICIPANTS: We studied 198 patients who underwent cataract surgery in 2008 in a northern community (approximate area, 12 million hectares, population, 64,000). METHODS: We retrospectively reviewed the 236 eyes of the participants. Outcomes include pre- and postoperative best-corrected visual acuity (BCVA), complication rate, pre-existing ocular comorbidities, and follow-up rate. RESULTS: Preoperative BCVA was 20/53. The postoperative BCVA was 20/27. The complication rate, defined as postoperative BCVA less than 20/40 not explained by ocular comorbidities or needing further postoperative treatment outside of the region, was 4%. CONCLUSIONS: Issues contributing to the higher complication rate may include lower follow-up rate due to lack of accessible ophthalmologic care, late presentation, and a long surgical waiting list.

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OBJECTIVE: To evaluate the effect of intravitreal bevacizumab on visual acuity (VA) and central retinal thickness (CRT) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). DESIGN: Retrospective review. PARTICIPANTS: The study included 42 patients with ME secondary to BRVO who received intravitreal injections of bevacizumab in 2 referral-based retinal practices in Vancouver, B.C., between November 2005 and July 2006. METHODS: We performed a retrospective review of consecutive patients with ME secondary to BRVO. All of the patients in this study had nonischemic BRVOs. Patients were all treated with at least 1 bevacizumab injection and were seen at 6- to 8-week intervals for VA testing. Most of the patients also underwent optical coherence tomography (OCT) 2 months and 6 months after treatment. VA and OCT measurements at each follow-up time point were compared with the baseline values. RESULTS: A total of 42 eyes from 42 patients with ME secondary to BRVO were reviewed. The mean VA improved from 20/280 at baseline to 20/180 at first follow-up session (p < 0.04; average follow-up = 42 days) and remained at a similar level, 20/170, through the eighth follow-up session (p < 0.04; average follow-up = 356). The CRT was reduced from a mean of 451 microm (388-512 microm) at baseline to 358 microm (298-418 microm) at 2 months (p < 0.02) and to 400 microm (335-465 microm) at 6 months postinjection (p < 0.068). CONCLUSIONS: We found a significant improvement in VA and CRT in patients with ME secondary to BRVO after intravitreal bevacizumab injection(s). No complications or serious side effects were observed. Intravitreal bevacizumab appears to have an emerging role as either a primary or an adjuvant treatment modality in the setting of ME secondary to BRVO.

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PURPOSE: To review the clinical and histopathologic features of porous polyethylene (PP) orbital implants requiring explantation. DESIGN: Case series. PARTICIPANTS: Eighteen explanted PP orbital implants of 18 patients were studied. METHODS: The charts and histopathologic findings were reviewed for all patients requiring explantation of PP orbital implants between 1997 and 2006 by 2 oculoplastic surgeons at the University of British Columbia. MAIN OUTCOME MEASURES: Clinical data obtained included patient demographics, the nature of the primary surgery, and the clinical presentation leading to eventual implant removal. The histopathologic data observed included the presence of anterior exposure, area of fibrovascular ingrowth, type of inflammation, and presence and type of bacterial colonies. RESULTS: Nine (50%) of the 18 patients studied were referred from other surgeons. The balance represented 3.2% of all PP implants placed by the 2 surgeons. The procedures for the primary surgery were 12 enucleations (67%), 5 eviscerations (28%), and 1 secondary implant (5%). Clinical findings included anterior implant exposure and discharge in all cases. Histopathologic analysis was performed in all of the implants and showed less than 50% fibrovascular ingrowth in 16 implants (89%) and predominantly acute or mixed inflammation in 15 (83%). Foreign body giant cells were seen adjacent to the implant material in all cases. Bacterial colonies on gram stain were identified in 12 specimens (67%); overall, gram-positive cocci in clusters or chains were found in 10 implants (56%), and gram-negative bacteria were found in 1 (5.5%). Thirteen patients (72%) lived in locations distant from Vancouver, the surgical center. CONCLUSIONS: This article presents the largest review of explanted porous polyethylene orbital spheres. The findings suggest that anterior exposure allows bacterial colonization and the development of a heavy inflammatory infiltrate. Poor tissue ingrowth may limit the penetration of topical or systemic antibiotic therapy, leading to the necessity for explantation. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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PURPOSE: To examine the effect of lipid-lowering agents in the development of age-related macular degeneration (AMD) through the techniques of meta-analysis. METHODS: Case-control and cohort studies presenting relative risks and 95% confidence intervals were identified through a literature review. Inclusion was limited to studies where both the exposure of interest (lipid-lowering agents) and outcome (AMD) were explicitly defined. Pooled estimates were computed using the random effects model. To quantify heterogeneity we calculated the proportion of total variance of between study variance using the Ri statistic. The Q statistic for heterogeneity was also calculated. RESULTS: Eight studies were identified. The pooled relative risk (RR) for all studies was 0.74 (95% CI, 0.55-1.00). When only those studies examining the use of statins were pooled (n=7), the RR was 0.70 (95% CI, 0.48-1.03). Using the Ri statistic, the heterogeneity between studies was found to be 0.85 for all studies and 0.89 for studies examining statins. CONCLUSION: Lipid-lowering agents, including statins, do not appear to lower the risk of developing AMD, although clinically significant effects cannot be excluded. The use of these agents in the prevention of AMD cannot be recommended until well designed prospective studies with long follow up have demonstrated a benefit.

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PURPOSE: To identify possible risk factors for the development of posterior vitreous detachment (PVD). DESIGN: Retrospective case-control study. METHODS: A total of 138 cases with PVD and 114 age-matched controls were accrued from two different sites. Demographic, medical, ocular, and lifestyle data were obtained through chart review, questionnaires, and clinical examination. A 108-item semiquantitative food frequency questionnaire was also used to estimate macro- and micronutrient intake. Univariate and multivariate regression analyses were employed to identify variables significantly associated with the main outcome measure of PVD. Subgroup analysis of gender-specific variables was performed. RESULTS: Among all patients, multivariate regression analysis demonstrated female gender (odds ratio [OR] = 2.01, P = .016), myopic refraction (OR = 4.32, P < .0005), and higher intake of vitamin B6 (OR = 2.61, P = .001) to be associated with PVD after controlling for age. In the subgroup analysis of women, menopause (OR = 18.2, P < .0005), myopic refraction (OR = 3.42, P = .01), and higher intake of vitamin B6 (OR = 3.92, P = .005) were associated with PVD. Specifically, there was a significant association between vitamin B6 and PVD amongst premenopausal women but not amongst postmenopausal women. CONCLUSIONS: An association between PVD and menopause has not been documented previously. We suspect that high estrogen levels seen in premenopausal women may be protective against PVD and that hormonal changes associated with menopause may lead to changes in the vitreous, predisposing to PVD. Higher levels of intake of vitamin B6 were also associated with the development of PVD in premenopausal women possibly through an anti-estrogen effect. These findings should be investigated further with prospective studies.

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