23 eyes of 17 consecutive patients suffering from LSCD were included in this study. A detailed examination by IVCM was performed in addition to a routine slit-lamp biomicroscopy. Size and density of corneal epithelial and conjunctival epithelial cells on cornea were measured and statistically analysed using SPSS version 8.0 software. Results were compared with histology in select cases.

Anatomical and morphological differences were observed between normal corneal cells and conjunctival epithelial cells on cornea. Size and density differences reached statistically significant levels between the normal corneal cells and the conjunctival epithelial cells on cornea (p<0.01). Goblet cells were visible throughout the conjunctivalised corneal epithelium in eight eyes. Several IVCM features could be correlated with histology in six of our patients.

A number of features were demonstrated by laser IVCM in patients presenting clinically with LSCD. Some of these features were corroborated with features observed on histological examination of tissue samples.

Seventy-nine consecutive subjects with manifest glaucomatous optic neuropathy at least in one eye were enrolled in this retrospective study. RAPD was assessed with the swinging flashlight test and quantified with a neutral density filter. Perimetry was performed using the fast thresholding strategy German Adaptive Threshold Estimation. The values of the central differential luminance sensitivity (DLS), of the MD (mean defect) and of the ‘loss volume’ (LVOL) based on the individually modelled 3D hill of vision—the latter two within the eccentricities of 10°, 20° and 30°, respectively—were entered into a linear regression model without intercept as a function of RAPD.

An absolute value of RAPD of 0.3 log₁₀ units or more was present in 20 out of 79 glaucoma subjects (25%). The magnitude of RAPD was most closely associated with LVOL-30° (R²=0.77), followed by MD-30° (R²=0.73), MD-20° (R²=0.71), LVOL-20° (R²=0.67), MD-10° (R²=0.58), LVOL-10° (R²=0.54) and central DLS (R²=0.04).

The prevalence of RAPD in glaucoma patients is comparatively small (25%). The magnitude of RAPD in glaucoma subjects is associated most closely with the LVOL within 30° eccentricity (which is the maximum visual field region tested in this study) and most loosely with central DLS, underscoring the impact of the entire (30°) visual field area on the afferent pupillary system.

46 eyes of 29 consecutive volunteers were recruited in this observational study. A detailed examination by IVCM was performed in addition to a routine slit-lamp biomicroscopy. Size and density of corneal and limbal epithelial cells were measured and statistically analysed using SPSS version 8.0 software.

Anatomical and morphological features were noted between corneal and limbal cells. Size and density differences reached to significant levels (p<0.05). Different shapes of palisades of Vogt have been described clearly by confocal microscope. Cell-like structures were observed in the peripheral end of the palisades which might represent limbal stem cell crypts.

Laser IVCM can be used to establish the features of the normal limbus. The identified features demonstrate quantitative changes in the basal epithelium between the limbus and the central cornea and morphological differences between pigmented or non-pigmented studied subjects. Further studies should be performed to correlate with histology the possible crypts which were observed in this study.

Medical notes of the 525 patients of the Jules-Gonin Eye Hospital Retinoblastoma Clinic between 1964 and 2008 were reviewed and the charts of 36 patients with retinocytomas and/or phthisis bulbi were selected.

The proportion of patients with retinocytomas and/or phthisis bulbi was 3.2%. The mean age at diagnosis was 28.7±17 years. Five tumours presented a cystic pattern (5.8%). Evidence of aggressive exophytic disease prior to spontaneous regression was documented in two eyes, and of invasive endophytic disease (regressed vitreous seeding or internal limiting membrane disruption) in three eyes. Twenty patients were followed with a mean follow-up of 44±60 months. Tumour growth was observed in 16% cases, benign cystic enlargement in 4% and malignant transformation in 12%.

This large study of retinocytomas substantially expands the published features of retinocytoma by describing the cystic nature of some retinocytomas as well as clinical characteristics of the endophytic and exophytic preregression growth patterns. The authors report two different patterns of reactivation: benign cystic enlargement and malignant transformation with or without cystic growth. Higher than previously reported frequency of growth and possible life-threatening complications impose close lifetime follow-up of retinocytoma patients.

102 periocular injections of 2 cc (10 mg of carboplatin/1 cc) were given every 4–6 weeks in 33 eyes of 29 patients. Patient's data were reviewed retrospectively.

Thirty-three eyes were followed for 7–148 months following initiation of periocular injections, and 13 (39%) have avoided enucleation. There were two cases of second malignancy resulting in one death and one survivor, two survivors of metastatic disease, and two survivors of orbital recurrence. Twenty eyes were enucleated for disease progression at a mean time of 15 months postinitiation of periocular carboplatin (POC). The Kaplan–Meier estimate of eye survival at 36 months is 36%. Eleven of the 13 salvaged eyes received concurrent treatment with chemotherapy (n=4, 30%), external beam radiation and chemotherapy in (n=6, 46%), or brachytherapy (n=1, 8%). Two of the salvaged eyes (16%) were treated with POC alone. Orbital swelling occurred in 14/33 (42%) eyes. There were no symptomatic motility disorders. One severe toxicity reaction resulted in acute loss of vision, down to light perception, which failed to recover and one eye had progression of optic nerve pallor.

This paper demonstrates that POC has limited short-term and long-term systemic toxicity and most of the ocular complications were acute, not delayed. Only two select cases showed long-term complete responses to POC alone and the data do not support the use as monotherapy, although where it was used in combination with other modalities, 39% of the eyes were saved.

15 eyes of 15 patients with iERM who underwent vitrectomy with indocyanine green-assisted membrane peeling were included in this study. The authors analysed the intraoperative fundus images and preoperative Cirrus HD-OCT to detect the shape and the size of the iERM as well as the shape and the size of each thickness-indicating colour (white, red, orange and yellow) on the RTM, respectively. The correlation of areas and morphologic characteristics between both groups was explored.

Analysis of iERM morphologic characteristics (shape) showed a similarity between the iERM contour and the corresponding RTM in 13 cases (86.6%). Furthermore, retinal folds were found in six iERMs and in their corresponding RTMs. Analysis of iERM size (area) revealed a positive correlation between the iERM area and each studied coloured area in RTM. The most significant correlation was between iERM and the red area (440–480 μm; r=0.87, p<0.0001).

The iERM-related retinal folds are clearly distinguishable on the HD-OCT. The red area in RTM representing the 440–480 μm retinal thickness can be a reliable predictor of the extent and the shape of the iERM.

Retrospective cross-sectional study.

23 patients taking HCQ were consecutively evaluated for retinal toxicity and divided into those without (HCQ-non-toxic group) and with documented visual field loss (HCQ-toxic group). A control patient group without retinal disease and not on HCQ was used for comparison. 103-hexagon P₁ mfERG amplitude response densities were analysed by averaging the 103 responses into six (age-corrected) concentric rings (R₁–R₆), calculating standard ring ratios (R₁:R₂–R₁:R₆) and R₅ ring ratios (R₅:R₁–R₅:R₆). Receiver operating characteristic curves were used to compare these tests for detecting toxicity.

Relative to HCQ-non-toxic and control groups, the HCQ-toxic group showed generalised reduction of the 103-hexagon mfERG absolute responses most prominent in the foveal/pericentral regions. R₅ ring ratios were superior to standard ring ratios in discriminating the HCQ-toxic from the HCQ-non-toxic and control groups and were approximately equivalent to pericentral absolute ring responses in detecting HCQ retinal toxicity by receiver operating characteristic criteria, with R₅:R₄ and R₅:R₃ ratios performing best. However, R₅ ring ratios revealed improved sensitivity over absolute ring responses (89% vs 73%) at a 95% specificity threshold.

Ring ratio analysis using the R₅ ring response as the ‘internal reference ring’ appeared equivalent to pericentral absolute ring responses in detecting HCQ retinal toxicity, and possibly superior at clinically desirable specificity thresholds. R₅ ring ratios did not require age correction, a potential clinical advantage over absolute ring responses.

The authors performed a cross-sectional study examining RNFL and optic nerve head (ONH) properties in 358 children aged between 6 and 13 years with no ocular disease. All children underwent an ophthalmic examination that included visual acuity (logMAR), stereopsis assessment (TNO) and optical coherence tomography (Cirrus OCT Zeiss, ‘Optic Disc Cube 200x200’ protocol). One eye from each subject selected at random was finally analysed. The authors evaluated the influence of height, gender and age on measurements.

High-quality scan data were obtained from 357 children and 344 were finally included. The mean age (SD) was 9.16 (1.7) years and the mean (SD) RNFL average thickness was 98.46 (10.79) μm. The temporal quadrant showed the thinnest RNFL (69.35±11.28 μm), followed by the nasal (71.30±13.45 μm), superior (123.65±19.49 μm) and inferior (130.18±18.13 μm) quadrants. The mean rim area (SD) and disc area (SD) were 1.59 (0.33) and 2.05 (0.39) mm², respectively. The average cup to disc (C:D) ratio (SD) was 0.43 (0.19). The authors found no differences in any of the parameters with regard to weight, height and gender.

This study demonstrates normative values of RNFL thickness and ONH parameters in a sample of Caucasian children from the general population.

As part of a population-based cross-sectional study, 913 consecutive Chinese subjects aged 40 years and older underwent HRT-3 and HD–OCT imaging of the ONH after pupillary dilation. Limits of agreement (LOA) derived from Bland–Altman analysis were calculated for ONH measurements.

The mean age (±SD) of study participants was 54.2±7.2 years and 52.0% were men. The two instruments showed no difference in mean optic disc area measurements (1.98±0.37 for HD–OCT vs 1.98±0.39 mm for HRT-3, p=0.95). HD–OCT showed smaller rim area (1.29±0.24 vs 1.46±0.27 mm, p<0.001), but bigger cup-related parameters (p<0.001 for all) than HRT-3. The highest correlations between the instruments were observed for cup volume (r²=0.74, p<0.001) and disc area (r²=0.62, p<0.001). The correlations for cup-to-disc ratio (CDR), vertical CDR and rim area were lower (r²=0.59, 0.48 and 0.24, respectively, p<0.001 for all). The Bland–Altman plots demonstrated significant proportional bias for differences in all ONH parameters (p<0.01 for all), with LOA greater for disc-related parameters (0.98–1.0) than cup-related parameters (0.26–0.50).

There are substantial disagreements between HRT-3 and HD–OCT in ONH measurements. Although optic disc area measurements were similar, HD–OCT underestimates the rim area and overestimates cup parameters compared with HRT-3.

Data were extracted from population-based prevalence surveys measuring presenting visual acuity (PVA). Results from 11 surveys performed in 10 countries in SSA, encompassing 39 458 people aged ≥40 years and older, are presented.

The prevalence of blindness (PVA<3/60 in better eye) ranged from 1.1% in an urban district of Cameroon to 7.9% in a rural district in Ethiopia. More than half of studies (6/11) reported no blindness due to URE. The proportion of moderate visual impairment (PVA ≤6/60 and >6/18) due to URE ranged from 12.3% to 57.1%. Excluding two studies that included uncorrected aphakia as part of URE, the highest proportion of blindness and severe visual impairment due to uncorrected aphakia was found in Gambia (15.2%) and Nigeria (15.8%), respectively.

Although URE is a leading cause of visual impairment, it does not represent a major cause of blindness in SSA.

Randot stereoacuity (graded-circles) and logMAR visual acuity measures were gathered in an unselected sample of 139 children (aged 4–12, mean 8.1±2.1 years) in two schools. Randot testing was repeated on two occasions (average interval between successive tests 8 days, range: 1–21 days). Three Randot scores were obtained in 97.8% of children.

Randot stereoacuity improved by an average of one plate (ie, one test level) on repeat testing but was little changed when tested on the third occasion. Within-subject variability was up to three test levels on repeat testing. When stereoacuity was categorised as ‘fine’, ‘intermediate’ or ‘coarse’, the greatest variability was found among younger children who exhibited ‘intermediate’ or ‘coarse’/nil stereopsis on initial testing. Whereas 90.8% of children with ‘fine’ stereopsis (≤50 arc-seconds) on the first test exhibited ‘fine’ stereopsis on both subsequent tests, only ~16% of children with ‘intermediate’ (>50 but ≤140 arc-seconds) or ‘coarse’/nil (≥200 arc-seconds) stereoacuity on initial testing exhibited stable test results on repeat testing.

Children exhibiting abnormal stereoacuity on initial testing are very likely to exhibit a normal result when retested. The value of a single, abnormal Randot graded-circles stereoacuity measure from school screening is therefore questionable.

Homozygosity mapping and candidate gene analysis.

The authors have identified four novel mutations, all recessive, in a number of families with a typical RP phenotype.

The distribution of these novel and previously reported RP1 mutations makes it challenging to describe a unifying mutational mechanism for dominant versus recessive RP1-related RP.

236 visually impaired patients referred to vision rehabilitation centres were administered the 33-item IND–VFQ. Rasch analysis was used to investigate the scales for the following properties: precision by person separation (ie, discrimination between strata of patient ability, recommended minimum value 2.0), unidimensionality (ie, measurement of a single construct) and targeting (ie, matching of item difficulty to patient ability).

Only the general functioning scale possessed adequate measurement precision (person separation 3.49). However, it lacked unidimensionality as some items did not contribute towards the measurement of a single construct indicating a secondary dimension. This comprised seven mobility items, which formed a separate valid subscale with good targeting (–0.57 logits). Deleting these items restored unidimensionality but a misfitting item required removal. Following this the 13 items fit and were visual functioning related. However, targeting was suboptimal (–1.13 logits).

The general functioning scale of the IND–VFQ consists of two separate unidimensional constructs: visual functioning and mobility. Both these Rasch scaled versions with good psychometric properties are effective tools for the assessment of visually impaired patients in India.

A cost-effectiveness analysis was performed alongside a randomised controlled trial. 141 participants were randomly allocated to receive macular-hole surgery, with either ILM peeling or no peeling. Health-service resource use, costs and quality of life were calculated for each participant. The incremental cost per quality-adjusted life year (QALY) gained was calculated at 6 months.

At 6 months, the total costs were on average higher (£424, 95% CI –182 to 1045) in the No Peel arm, primarily owing to the higher reoperation rate in the No Peel arm. The mean additional QALYs from ILM peel at 6 months were 0.002 (95% CI 0.01 to 0.013), adjusting for baseline EQ-5D and other minimisation factors. A mean incremental cost per QALY was not computed, as Peeling was on average less costly and slightly more effective. A stochastic analysis suggested that there was more than a 90% probability that Peeling would be cost-effective at a willingness-to-pay threshold of £20 000 per QALY.

Although there is no evidence of a statistically significant difference in either costs or QALYs between macular hole surgery with or without ILM peeling, the balance of probabilities is that ILM Peeling is likely to be a cost-effective option for the treatment of macular holes. Further long-term follow-up data are needed to confirm these findings.

Thirty consecutive patients with glaucoma were enrolled. Canaloplasty was considered successful if the preoperative intraocular pressure (IOP) was reduced by one-third. The conjunctiva was examined using confocal laser-scanning microscopy 1 week before (baseline) and 12 weeks after surgery. The mean density (MMD, cysts/mm²) and mean area (MMA, μm²) of conjunctival microcysts and IOP were measured. Anterior segment optical coherence tomography was performed to evaluate post-operative trabecular distension and scleral modifications at the surgery site.

Twelve weeks after surgery, canaloplasty was successful in 23 patients (group 1) but unsuccessful in 7 (group 2). At baseline, IOP was 28.1±2.98 and 28.3±2.81 mm Hg, MMD was 10.61±4.31 and 11.35±5.6 and MMA was 2845.02±411.85 and 2700.56±518.85 in groups 1 and 2, respectively (p>0.05). Twelve weeks after canaloplasty, mean IOP was 13.2±4.48 (p<0.05) and 24.6±3.48 mm Hg in groups 1 and 2, respectively. In group 1, MMD and MMA were 37.86±21.4 and 11997.84±8630.35, respectively, a fourfold increase compared to baseline (p<0.001); no significant differences were found in group 2. Conjunctival bleb was not documented in any case.

Conjunctival microcysts were evident in all glaucomatous eyes prior to surgery, and tended to increase in density and surface area after successful canaloplasty. These findings indicated enhanced aqueous humour filtration across the sclera and conjunctiva after canaloplasty.

CTGF and VEGF levels were measured by ELISA in 52 vitreous samples of PDR patients, of which 24 patients had received intravitreal bevacizumab 1 week to 3 months before vitrectomy, and were correlated with the degree of vitreoretinal fibrosis as determined clinically and intra-operatively.

CTGF correlated positively, and VEGF correlated negatively with the degree of fibrosis. The CTGF/VEGF ratio was the strongest predictor of fibrosis. Clinically, increased fibrosis was observed after intravitreal bevacizumab.

These results confirm that the CTGF/VEGF ratio is a strong predictor of vitreoretinal fibrosis in PDR, and show that intravitreal anti-VEGF treatment causes increased fibrosis in PDR patients. These findings provide strong support for the model that the balance of CTGF and VEGF determines the angiofibrotic switch, and identify CTGF as a possible therapeutic target in the clinical management of PDR.

Retinal images from a cohort of full term infants admitted to a tertiary perinatal centre were obtained using a retinal camera. Optic disc size was measured by carefully delineating the outline with a cursor using image analysis software. MEDLINE was then systematically searched to compare the data with other published articles.

35 images of left and right eyes from 35 infants were assessed. An image from one eye per patient was then chosen for analysis. The following results were found: mean birth weight 3050±706 g; mean gestation 38.9±1.4 weeks. Mean optic disc area was 1.26±0.23 mm²; mean vertical diameter was 1.37±0.15 mm; and mean horizontal diameter was 1.14±0.12 mm. The vertical diameter of the optic disc was significantly longer than the horizontal diameter (p<0.0001).

Birth weight and sex did not influence the size of the optic disc in term infants. There were no differences in optic disc measurements between male and female infants and between low birth weight and normal birth weight infants.

CRMM-1 and CRMM-2 were exposed to cisplatin, mitomycin C (MMC), all-trans-retinoic-acid (ATRA), fotemustine or imatinib for 24 h. Sulforhodamine-B assays were used to assess the IC₅₀. Isobolograms were performed to test possible synergism and antagonism with ATRA or imatinib.

Cisplatin and MMC were efficient to inhibit the growth of CRMM-1 and CRMM-2. Combination of imatinib with MMC showed additive antitumoral effect on both cell lines. Combined treatment of imatinib with fotemustine or cisplatin resulted in antagonism. Strong antagonisms were also obtained with ATRA and fotemustine or cisplatin in both cell lines. A synergism was found for ATRA and mitomycin or imatinib in CRMM-2, in contrast to CRMM-1, where antagonism was obtained.

Cisplatin and MMC inhibit cell growth in conjunctival melanoma cell lines. The potential of ATRA was evident only in combination with MMC or imatinib in CRMM-2 cells. Imatinib and mitomycin increased their efficiency under combination therapy.

Prospective, non-comparative, uncontrolled, non-randomised, interventional case series study. Subjects older than 18 years with coexistent uncontrolled mild or moderate open-angle glaucoma (including pseudoexfoliative and pigmentary) and cataract underwent phacoemulsification and intraocular lens implantation along with ab-interno gonioscopically guided implantation of one Glaukos iStent. The variables recorded during a minimum of 3 years of follow-up were: intraocular pressure (IOP), number of antiglaucoma medications and best-corrected visual acuity.

The 19 patients enrolled were 58–88 years old (mean age 74.6±8.44 years). Mean follow-up was 53.68±9.26 months. Mean IOP was reduced from 19.42±1.89 mm Hg to 16.26±4.23 mm Hg (p=0.002) at the end of follow up, indicating a 16.33% decrease in IOP. The mean number of pressure-lowering medications used by the patients fell from 1.32±0.48 to 0.84±0.89 (p=0.046). In 42% of patients, no antiglaucoma medications were used at the end of follow-up. Mean best-corrected visual acuity significantly improved from 0.29±0.13 to 0.62±0.3 (p<0.001). No complications of surgery were observed.

Combined cataract surgery and Glaukos iStent implantation seems to be an effective and safe procedure to treat coexistent open-angle glaucoma and cataract.

Thirty eyes of 30 patients with AKC and 10 eyes of 10 healthy control subjects were examined in this prospective study. All subjects underwent fluorescein staining, conjunctival injection, conjunctival oedema and papillary formation grading. Tear and serum IgE and ECP levels were measured, and correlations between them investigated with reference to the ocular surface clinical parameters.

The mean fluorescein scores, conjunctival injection, oedema scores and papillary formation were significantly higher in AKC patients compared to controls (p<0.05). Higher total IgE and ECP levels were detected in AKC tears compared with the control group. Tear ECP levels showed a significant correlation with fluorescein staining, conjunctival injection and oedema scores (r=0.70, 0.62 and 0.62, respectively). Tear IgE had no correlation with clinical signs. Serum IgE and ECP levels were elevated in AKC patients but did not show any correlation with clinical signs.

This study suggests the presence of an eosinophilic response in AKC disease independent of IgE sensitisation. Tear ECP was a useful marker delineating the severity of ocular surface disease in AKC.

Ophthalmic examination, homozygosity mapping in a consanguineous family and candidate gene analysis.

All 16 children (4–16 years old, mean 9 years; seven girls and nine boys from 10 families) had bilateral central nuclear dust-like lenticular opacities. Two patients (one family) had cortical riders and six had associated strabismus. Cycloplegic retinoscopy was usually hyperopic (13/16; right eye spherical equivalent +0.50 to +6.25 dioptres, mean +3.50) but was sometimes myopic (3/16; right eye spherical equivalent –0.50 to –11.75, mean –6.50). In children with amblyopia (5/16), the cause was significant uncorrected ametropias rather than the lens opacities. Three patients had uncomplicated unilateral cataract surgery suggested by an outside second opinion that did not improve best-corrected visual acuity. Homozygosity mapping for one consanguineous family suggested the candidate gene CRYBB1. Sequencing of this gene revealed a homozygous c.171del mutation (p.N58Tfs*107) with a shared haplotype in all 16 children. In asymptomatic carrier parents from five of the six families available for careful slit-lamp examination, occasional central dot lenticular opacities were documented.

Central pulverulent cataract in this consanguineous population does not significantly impact visual acuity during early childhood, can be associated with significant ametropias (with amblyopia and/or strabismus) and is specific for a homozygous CRYBB1 founder mutation. Primary management in children is typically spectacle correction based on cycloplegic retinoscopy to treat significant refractive error rather than paediatric cataract surgery.

Over 2 years, all incident cases of RRD in Scotland were approached for recruitment. Early postoperative success was defined as an attached retina following one procedure with a minimum follow-up of 6–8 weeks. Using a regression model, the influence of clinical factors on the failure risk was estimated and the sensitivity and specificity of the Royal College of Ophthalmologists (RCOphth) grading for RRD and the vitrectomy in retinal detachment stratification risk formula (VR-SRF) in predicting operative failure were assessed.

Primary outcome data were available for 86.2% (975/1130) of patients. The overall primary success rate was 80.8% (95% CI 78.1 to 83.3%). The presence of preoperative proliferative vitreoretinopathy of any degree and each additional clock hour of detachment increased the risk of failure by an OR of 2.4 and 1.13 respectively (p<0.05). A specificity of >95% in predicting early surgical failure was noted for highly complex RRDs according to the VR-SRF formula and the RCOphth classification.

Consistent with previous series, the overall early success rate of RRD repair was 80% after one operation. The type of surgical repair did not influence overall success rates. Significant predictors of failure are the presence of preoperative proliferative vitreoretinopathy of any grade and the extent of detachment. The analytical value of current classification systems in predicting failure is most useful in complex RRDs.

IOP and resistivity index of ophthalmic artery (RI-OA) were recorded using TonoPen and ecocolor Doppler, respectively. Retinal function was assessed using photopic electroretinography. Cytokine expression and oxidative stress markers were evaluated with immunoassay techniques.

At 4 weeks post IVT treatment, TA increased IOP and RI-OA while NCX 434 did not (IOP_Vehicle=13.6±1.3, IOP_{NCX 434}=16.9±2.2, IOP_TA=20.9±1.9 mm Hg; p<0.05 vs vehicle; RI-OA_Vehicle=0.44±0.03; RI-OA_{NCX 434}=0.47±0.02; RI-OA_TA=0.60±0.04). Both NCX 434 and TA reversed ET-1 induced decrease in electroretinography amplitude to similar extents. NCX 434 attenuated ET-1 induced oxidative stress markers and nitrotyrosine in retinal tissue, and interleukin-6 and tumour necrosis factor-α in aqueous humour more effectively than TA.

NCX 434 attenuates ET-1 induced ischaemia/reperfusion damage without increasing IOP, probably due to NO release. If data are confirmed in other species and models, this compound could represent an interesting new therapeutic option for retinal and ONH diseases, including diabetic retinopathy.

This study was performed using the EYESi ophthalmic surgical simulator. Thirty junior doctors with no previous ophthalmic surgical experience were enrolled and distance visual acuity (Snellen), near visual acuity and stereoacuity (Frisby) were recorded. All participants completed a standard introductory programme on the forceps module to eliminate the learning curve. They then undertook four attempts of level 4 forceps module binocularly and another four monocularly to simulate an acute loss of stereopsis. Total score, odometer movement, corneal area injured, lens area injured and total time taken were recorded.

Mean age was 31 years (SD±9). None had amblyopia, with all demonstrating distance visual acuity of 6/6 or better and N6 for near. Mean stereopsis was 35 s of arc (SD±18). Average total score decreased from 60 while operating binocularly to 47 monocularly (p<0.05). Average corneal area injured increased from 0.95 mm² to 2.30 mm² (p<0.05), average lens area injured increased from 1.76 mm² to 3.53 mm² (p<0.05) and average time taken increased from 69.6 s to 77.4 s (p<0.05).

The importance of stereopsis for intraocular surgery is difficult to establish in a live theatre setting without compromising patient safety. Virtual reality simulators provide a safe alternative. This study demonstrates a statistically significant decrease in simulated intraocular surgical performance with acute loss of stereopsis in potential ophthalmic training applicants. Caution is recommend in using these results to advocate stereopsis testing as a screening tool in interviews because some participants performed well despite an absence of stereopsis.

1. A 64-year-old man with primary open-angle glaucoma presented with red eyes and visual halos. He had used brimonidine 0.2%, timolol 0.5% and bimatoprost 0.03% for 13 months. There was bilateral anterior chamber inflammation with diffuse pigmented and stellate keratic precipitates. His intraocular pressure was 21 mm Hg bilaterally, rising to 26 mm Hg 3 weeks later. A trabeculectomy was planned, but cessation of brimonidine resulted in resolution of uveitis and stabilisation of intraocular pressure at 14–16 mm Hg. The surgery was cancelled.

2. A 92-year-old woman with primary open angle glaucoma developed recurrent bilateral uveitis. She had used latanoprost 0.005% for 23 months, brimonidine 0.2% for 17 months and brinzolamide 1% for 7 months. Despite withdrawal of latanoprost, the uveitis flared during each of four attempts to taper topical steroids. Brimonidine...]]> 2012-01-18T00:46:59-08:00 info:doi/10.1136/bjophthalmol-2011-300872 hwp:master-id:bjophthalmol;bjophthalmol-2011-300872 BMJ Publishing Group Ltd 2012-01-18 Letters http://bjo.bmj.com/cgi/content/short/bjophthalmol-2011-300860v1?rss=1 Aims

To evaluate the efficacy of a new lacrimal bypass tube fixation technique to the conjunctiva and caruncle, preventing postoperative displacement of the tube in conjunctivodacryocystorhinostomies (CDCRs).

The authors conducted 52 CDCR procedures by a new tube fixation technique using a 6–0 prolene suture encircling the tube neck (encircling group). The suture was not removed during the follow-up period. Over the same period, the authors carried out 51 CDCRs with tube fixation using a 5–0 vicryl suture with the purse string procedure (purse string group) and 71 conventional CDCRs with tube fixation to the skin using a 6–0 nylon suture (control group). Postoperative complications, including dislodgement and tube length problems, were recorded. The three groups were statistically compared.

Among the 52 cases using the new fixation technique, tube malpositions, including extrusions, had developed in only four cases (7.7%) at 12 months after the operation. In the purse string and control groups, the same complications developed in 11 (21.6%) and 22 cases (31.0%), respectively. A statistically significant difference between these groups was detected (p=0.008). Other complications, such as conjunctival granulomas and tube obstruction, developed postoperatively in four cases (8.0%) in the encircling group, and this did not differ significantly from that in the other groups (p=0.193).

The authors believe that this encircling fixation procedure can help in CDCRs for maintaining the location and orientation of the tube during the early postoperative period.

To assess the effectiveness of mini-monoka punctocanaliculoplasty for treatment of punctal/canalicular stenosis.

A retrospective case note analysis was performed on 77 consecutive patients (123 eyes).

73% of eyes had punctal stenosis, 72% had canalicular stenosis; 46% had a combination of the above. 20% had some degree of lid laxity and 29% had nasolacrimal duct stenosis. 101 eyes (82%) had significant improvement in symptoms and were discharged without further intervention. Excluding the patients with structural comorbidity the success rate improved to 88%.

Mini-monoka punctocanaliculoplasty is an effective, safe, simple and relatively non-invasive treatment strategy for the management of epiphora secondary to punctal and/or canalicular stenosis.

99 patients with glaucoma and 21 subjects with a normal ocular examination completed a nine-item performance-based test (the Assessment of Ability Related to Vision (AARV)), received a standard ophthalmic clinical examination and answered the questions on the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ-25). All combinations of two, three or four items of the full nine-item AARV test were analysed, and their scores were compared with the full AARV scores and with clinical measures.

The correlation of four items (detecting motion, reading signs, finding objects and navigating an obstacle course) reduced test time from 60±5 min to 14±4 min and yielded results highly related to the nine-item test, including maintaining the relationship with clinical measures and with the NEI-VFQ-25.

A compressed AARV correlates highly with the full test, with a method of evaluating quality of life, and with clinical measures, yet takes on average 14 min to perform. As such, it may provide a clinically useful method of evaluating the worsening effects of illness and the benefits of treatments that affect visual loss on the ability to perform visually related activities.

Insertion locations were compared between a Taiwanese population of subjects who had received surgical treatment for strabismus and a control group who had not. Insertion locations and surgical outcomes in the strabismus group were also compared with those reported in other countries.

In Taiwanese subjects, extraocular muscle insertion locations were not significantly different between strabismus subjects and controls. However, the distances from the insertion location to the limbus of the inferior rectus, lateral rectus and superior rectus were significantly shorter in the Taiwanese subjects than in Western populations.

Extraocular muscle insertion locations for the Taiwanese population in this study significantly differed from those reported in studies of Western populations. Therefore, surgical guidelines for performing lateral rectus recession to treat exotropia in Western populations may be inappropriate for Taiwanese and other Asian populations.

A 24-month, double-masked, randomised, active-controlled clinical trial. 100 patients with primary neovascular AMD were randomly assigned (1:1) to receive intravitreal ranibizumab and sham TTT or intravitreal ranibizumab and low-dose TTT. After an initial loading phase of ranibizumab patients were assigned to receive quarterly low-dose TTT (136 mW/mm) or sham TTT for 24 months. Retreatment with ranibizumab was allowed in both treatment groups using a variable dosing regimen. The primary endpoint was the number of intravitreal injections with ranibizumab. Secondary endpoints included change in best corrected visual acuity (BCVA), central retinal thickness (CRT) and lesion area.

In the per protocol (PP) population (78 patients) the mean number of ranibizumab injections was 8.0 in the sham TTT group versus 6.3 in the TTT group (p<0.05). The mean number of injections between 0–12 months and 13–24 months was 4.8 versus 4.6 (p>0.05) and 3.2 versus 1.7 (p<0.01) in the sham TTT and TTT groups, respectively. There was no statistically significant difference in BCVA (+4.0 vs +0.9 ETDRS letters), CRT (–49.9% vs –36.4%) or lesion area (–0.3% vs –10.6%) between the treatment groups at the final examination. The results of the intent-to-treat population (92 patients) were similar to the PP population.

Treatment with low-dose TTT significantly reduced the number or intravitreal injections of ranibizumab over 24 months. The results suggest that low-dose TTT can serve as an adjuvant in combination with intravitreal ranibizumab for neovascular AMD.

The trial is registered at http://clinicaltrails.gov (no NCT00599222).

This was a longitudinal retrospective study that began in November 2007, involving eight children with disfiguring orbit and eyelid capillary haemangioma who received oral propranolol therapy. Three patients with life-threatening haemangiomas spreading to the orbit were first treated with systemic corticosteroids and beta-adrenergenic blocking agents. The remaining five patients with functional visual impairment received propranolol only. All children were given propranolol at a dose of 2 mg/kg body weight per day. The treatment was initiated between 2 and 36 months of age, with a follow-up period ranging from 6 to 30 months. Beta-blocking agents were used for 3–10 months.

We observed a successful 100% regression: that is, clinical regression by flattening 24 h after the start of treatment, regression on colour Doppler ultrasound imaging with an increase in resistance index of blood vessels, or regression seen on MRI. No re-growth was observed after the trial ended.

Despite their self-limiting course, infantile orbital and eyelid haemangiomas can cause visual impairment or disfigurement. Corticosteroids are used as first-line therapeutic agents for problematic infantile haemangiomas. Other options include interferon-α and vincristine, which present problematic side effects. In our series, propranolol was shown to inhibit haemangioma tumour growth with a better benefit/risk ratio. In the absence of any randomised study comparing the effects of systemic corticosteroids and propranolol, we propose that beta-blockers could be used as first-line therapy for severe periocular haemangiomas.

The regional degenerative process was investigated by experimentally occluding the paraoptic branches of the lateral short posterior ciliary artery, that is, the circle of Haller and Zinn, in 11 eyes. Morphological changes in nerve fibres in the lamina cribrosa were evaluated by histopathology, immunocytochemistry and angiography, and the findings were compared with those observed in an aged macaque with spontaneous glaucomatous optic neuropathy.

Retinal ganglion cell axons were grouped in bundles and traversed through pores in columns of the lamina cribrosa. The processes of astrocytes extended to the bundles, and capillaries branched in surrounding connective tissue from the circular arterioles. Experimental ischaemia induced time-dependent anoxic deterioration of phosphorylated fibres in the temporal arcuate zone, accompanied by glial proliferation. A monkey with spontaneous visual impairment had nerve fibre loss and gliosis with collagenous proliferation in the temporal hemisphere, suggesting glaucomatous neuropathy.

Circulatory interference in the circle of Haller and Zinn caused time-dependent deterioration in the area where anoxic segmental degeneration is associated with pathogenesis of open-angle glaucoma.

Prospective, double-masked, observational study of 27 patients undergoing primary (n=40 muscles) or repeat (n=10 muscles) horizontal or vertical rectus muscle surgery. EOM insertional distances were measured with SUBM, and then intraoperatively with callipers. A Bland–Altman analysis and intraclass correlation coefficient were used to compare the SUBM and surgical data.

For all muscles, the differences between SUBM and surgery measurements were less than 1.0 mm. The mean of the SUBM insertion distances was 6.67 mm (SD 1.65 mm) versus 6.7 mm (SD 1.6 mm) at surgery. The intraclass correlation coefficient showed ‘excellent’ correlation between the two sets of data and was higher than that reported with HUBM. The image quality with the SUBM was superior to the HUBM, and its range of field was much larger (14x18 mm vs 5x6 mm).

The SUBM with its smaller, more manoeuvrable probe handpiece and a wider scanning field was more accurate in detecting muscle insertions compared with HUBM.

Paraffin-embedded uveal (n=32) and conjunctival (n=15) melanomas were assessed by immunohistochemistry for melanocyte differentiation antigens (gp100, Melan-A/MART-1 and tyrosinase), and CT antigens (MAGE-A1, MAGE-A3/6, MAGE-A4, MAGE-C1 and NY-ESO-1).

Melanoma differentiation antigens, gp100, Melan-A/MART1 and tyrosinase, were expressed in >75% of tumour cells in all uveal and conjunctival melanomas tested. Expression of all five CT antigens tested was low in uveal melanomas, and when present, stained <25% of the tumour cells. MAGE-A1, MAGE-A4 and NY-ESO-1 were expressed in <10% of tumour cells in conjunctival melanomas, while MAGE-C1 and MAGE-A3/6 were expressed in ~20% and ~35% of tumour cells in this malignancy, respectively, with variable expression levels.

Uveal and conjunctival melanomas consistently expressed high levels of the differentiation antigens (gp100, Melan-A/MART1 and tyrosinase). However, compared with other tumours, including cutaneous melanoma, only low levels of CT antigens were found in ocular melanomas. These observations suggest that immunotherapy directly targeting the CT antigens studied may not be effective for ocular melanoma.

Patients scheduled for phacoemulsification were enrolled in this prospective observer-masked study. Central corneal thickness (CCT) was obtained with ultrasound pachymetry. Corneal biomechanical properties including corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with the ocular response analyser. Applanation intraocular pressure (IOP) (IOPappla) was measured in the supine position. Intracameral IOP (IOPintra) was measured with a pressure transducer connected to a cannula inserted into the anterior chamber.

Fifty-eight eyes of 58 patients were included. There was a significant difference between IOPappla and IOPintra (17.3±4.1 vs 13.8±4.7 mm Hg, p<0.001). CCT was significantly correlated with CH and CRF (p<0.01). Univariate regression analysis revealed IOPappla was significantly correlated with CCT and CRF (p<0.05). IOPintra had no significant association with the corneal properties (p>0.05). Multivariate regression analysis revealed IOPappla=10.43+2.69CRF–1.99CH (p<0.001) and the difference between IOPappla and IOPintra (IOP)=–1.57+0.55CRF (p=0.032).

The mean difference between IOPappla and IOPintra was 3.5 mm Hg. While IOPappla was correlated with the corneal biomechanical properties of CH and CRF, IOPintra was not. IOPappla was correlated more with the corneal biomechanical properties assessed by the ocular response analyser than with CCT alone.

A LASIK cut was performed with a prototype 200 kHz femtosecond laser in both eyes of nine patients and one eye of two patients (20 individual eyes in total). A complete ophthalmic examination was performed preoperatively and postoperatively at 1, 3, 6 and 12 months after the procedure.

In the pilot series of 20 eyes, flap creation was possible in each case. The mean preoperative manifest refractive spherical equivalent was À–4.22 D (SD±61.22 D). The postoperative spherical equivalent refraction was À–0.1 D (SD±60.26 D) at 1 month, À–0.22 D (SD±60.24 D) at 3 months and À–0.15 D (SD±60.16 D) 12 months after surgery.

Femto-LASIK with this new laser system showed high levels of safety, stability and efficacy without any enhancement.

http://www.dimdi.de. DE/CA126/AP4/3332/27/09. Bfam registration 09/03/2009, DE/CA126.

This was a retrospective case series study of six patients ascertained over a 2-year period. Ophthalmological examination, fundus photography, autofluorescence imaging, optical coherence tomography and detailed electrophysiological assessment were undertaken. Blood samples were taken for DNA extraction and mutation screening of BEST1 and PRPH2 was performed.

Six patients (3 men and 3 women) with unilateral vitelliform maculopathy were identified, ranging in age from 30 to 68 years. Vision in the affected eye ranged from 20/10 to 20/100. There was no clinical, retinal imaging or electrophysiological evidence of fellow eye involvement. Direct sequencing of BEST1 and PRPH2 did not reveal any disease-causing variants.

A case series of patients is reported with an unusual unilateral vitelliform phenotype, often associated with good visual function. The patients do not have the typical characteristics associated with age-related maculopathy or any inherited macular disorders, such as Best vitelliform macular dystrophy. Molecular screening of the candidate genes BEST1 and PRPH2 revealed no mutations.

Four international ROP readers participated. Before the grading of the photographs, the readers were informed that a high proportion of advanced ROP cases were included. In total, 243 photographs/948 quadrants were available from 136 infants. As a standard series of photographs was available, grading was performed under optimised conditions.

The four readers agreed on the quadrant scores of only 70 (7.38%) of the 948 quadrants—that is, on 1, 5, 15, 4 and 45 quadrants for scores 0, 1, 2, 3 and 4, respectively. The mean scores differed systematically between the readers (permutation test, p<0.0001). Agreement on presence of aggressive posterior ROP from all four readers was not obtained for any of the photographs. Readers scored plus disease in at least two quadrants in 95.5% of the eyes for which treatment was indicated. All four readers agreed on the scoring of indication for treatment for 195 eyes (80.2%); however, treatment was only recommended in 18 (7.4%) eyes. One reader was found to differ systematically from the others in indicating treatment (Rasch analysis; p=0.0001). Finally, a significant shift in indication for treatment occurred between birth period 2000–2002 and 2003–2006 (Mann–Whitney rank sum test, p<0.001).

Inter-reader agreement on central vascular changes is poor, especially when based on more than two rating categories. The subjective nature of diagnosing such vascular changes possibly resulted in earlier treatment of preterm infants in Denmark over the entire study period (1997–2006). The recent increased incidence of treated infants in Denmark is, at least in part, explained by a significant shift in indication for treatment.

Visual function was assessed in 18 adults with normal retinal health, 23 adults with diabetes and 35 adults with NPDR and normal visual acuity. Contrast sensitivity and frequency doubling technology (FDT) sensitivity were used to assess ganglion cell function. Acuity, dark adaptation, light-adapted visual sensitivity and dark-adapted visual sensitivity were measured to evaluate cone and rod photoreceptor visual function. The presence and severity of diabetic retinopathy was determined by grading of 7-field stereoscopic fundus photographs using the Early Treatment Diabetic Retinopathy Study grading system.

Participants with NPDR exhibited impairment of all measured visual functions in comparison with the normal participants. Inner retinal function measured by FDT perimetry was the most impaired visual function for patients with NPDR, with 83% of patients exhibiting clinically significant impairment. Rod photoreceptor function was grossly impaired, with almost half of the patients with NPDR exhibiting significantly impaired dark-adapted visual sensitivity.

Both inner retinal and outer retinal functions exhibited impairment related to NPDR. FDT perimetry and other visual function tests reveal an expanded range of diabetes induced retinal damage even in patients with good visual acuity.

Retrospective, consecutive, interventional case series of 41 eyes of 40 patients. All patients underwent pars plana vitrectomy with subretinal coapplication of rtPA and bevacizumab and intravitreal gas tamponade. Postoperatively, repeated intravitreal injections of bevacizumab or ranibizumab were applied following a flexible, predominantly visual acuity-driven re-treatment regimen.

Mean diameter of SMH was 4.5 disc diameters (range 1.5–12). Complete displacement of SMH was achieved in 35 of 41 eyes. Large and prominent SMH extending beyond the vascular arcades were completely displaced in six of eight eyes. SMH recurred in eight eyes after a mean of 9.1 months (2–19). A mean of 4.5 (2–9) intravitreal anti-vascular endothelial growth factor injections were applied during 12 months postoperatively. Short-term (3 months, n=41), mean best corrected logMAR visual acuity (BCVA) improved significantly from the preoperative value 1.7 (3.0–0.5) to 0.8 (1.6–0.2). 12 eyes had reading ability (≤logMAR 0.4) and 29 eyes had gained ambulatory visual acuity (≤logMAR 1.6). Long-term (mean 17 months (12–32), n=26) BCVA was 0.9 (1.6–0.1). Compared with short-term, BCVA had decreased in 12 of 26 eyes.

The operation effectively displaces small and large SMHs. In the long-term, a predominantly visual acuity-driven re-treatment regimen puts the initial functional improvement at risk. More sensitive re-treatment parameters may help to improve long-term functional outcome.

This is a retrospective study of 132 albino patients, ranging in age from 0.5 to 35 years. They were divided into four subtypes: OCA1A, OCA1B and OCA1C, and OCA2. Refractive errors were evaluated objectively by cycloplegic refraction and subjectively in cooperative patients. Best corrected visual acuity was assessed binocularly. Refractive errors were divided into three groups—hypermetropia, myopia and astigmatism—to avoid the use of spherical equivalent.

Refractive errors were mainly astigmatism and hypermetropia. The OCA1A group showed high hypermetropia (≥5 dioptres) in 43.4% of patients, reaching significantly higher levels than in other subgroups (p=0.007). Mean visual acuity in logMAR was: OCA1A=0.81, OCA1B=0.64, OCA1C=0.61 and OCA2=0.48. Astigmatism averaged 2.1 dioptres (consistently with-the-rule), and it was homogeneously distributed between all subgroups (53%).

The poorest visual acuity was found in those with OCA1A, which was associated with the highest rate of high hypermetropia (statistically significant different from other subgroups). Astigmatism was the most common visually significant refractive error across all subtypes of albinism. These results may help to clarify the prevalence of refractive errors in albino patients and aid the prediction of visual outcome in this heterogeneous population.

A systematic review was conducted of published and unpublished surveys from 2000 to the present. For countries without data on visual impairment, estimates were based on newly developed imputation methods that took into account country economic status as proxy.

Surveys from 39 countries satisfied the inclusion criteria for this study. Globally, the number of people of all ages visually impaired is estimated to be 285 million, of whom 39 million are blind, with uncertainties of 10–20%. People 50 years and older represent 65% and 82% of visually impaired and blind, respectively. The major causes of visual impairment are uncorrected refractive errors (43%) followed by cataract (33%); the first cause of blindness is cataract (51%).

This study indicates that visual impairment in 2010 is a major health issue that is unequally distributed among the WHO regions; the preventable causes are as high as 80% of the total global burden.

In this retrospective comparative study, 46 patients out of 52 who underwent DALK for various corneal stromal diseases such as keratoconus, stromal dystrophy or corneal scarring (caused by different conditions) were included in the analysis. BB was achieved in 25 patients and in the remaining 21 patients a BB separation of the DM was not possible necessitating manual lamellar dissection of stroma to get as close to the DM as possible.

The authors compared best-corrected visual acuity, contrast sensitivity, astigmatism, interface densitometry and Scheimpflug pachymetry in the two groups. Postoperative corneal thickness was higher in the ‘small bubbles’ group (mean 628.9 vs 564.1 μm; p<0.0005), but there was no significant difference in best-corrected visual acuity, astigmatism, contrast sensitivity and densitometry between the groups.

In DALK, manual lamellar dissection is a reasonable alternative when BB separation of the DM is not achieved.

CT cisternography of the brain and orbits was performed in 18 patients with NTG (7 women, 11 men; mean age 64.9±8.9 years) and in four patients without glaucoma or intracranial disease (4 women; mean age 62.8±18.4 years). The density of contrast-loaded cerebrospinal fluid (CLCSF) in the intracranial spaces and in the SAS surrounding the ONs was measured in Hounsfield units.

Unmasked, prospective series. Statistical analysis was performed using an independent two-tailed t test and the non-parametric Spearman correlation test.

The density of CLCSF in the SAS surrounding the ONs in the NTG group was significantly reduced compared with its density in the intracranial CSF spaces and in the SAS of ONs measured in the control group (p=0.006). There were no significant differences between men and women within the NTG group (p>0.35).

The finding of a difference in the concentration gradients between the CLCSF within the intracranial spaces and the SAS of the ONs in this group of NTG patients compared with control subjects supports the hypothesis of a disturbed CSF exchange between the CSF in the intracranial spaces and the CSF in the SAS surrounding the ONs. The disturbance of CSF dynamics in this specific CSF pathway can be explained by ON compartmentation. The clinical importance of this finding warrants further investigation.

Multifocal VEP recordings were performed with a four-channel electrode array using 58 stimulus fields (pattern reversal dartboard). For each field, the recording from the channel with maximal signal-to-noise ratio (SNR) was retained, resulting in an SNR optimised virtual recording. Correlation with RNFL thickness, measured with spectral domain optical coherence tomography and with standard perimetry, was performed for nerve fibre bundle related areas.

The mean amplitudes in nerve fibre related areas were smaller in glaucoma patients than in normal subjects. The differences between both groups were most significant in mid-peripheral areas. Amplitudes in these areas were significantly correlated with corresponding RNFL thickness (Spearman R=0.76) and with standard perimetry (R=0.71).

The multifocal VEP amplitude was correlated with perimetric visual field data and the RNFL thickness of the corresponding regions. This method of SNR optimisation is useful for extracting data from recordings and may be appropriate for objective assessment of visual function at different locations.

This study has been registered at http://www.clinicaltrials.gov (NCT00494923).

Adult inbred Fischer 344 rats received penetrating corneal allografts from inbred Wistar Furth donors (n=17), without lymphadenectomy. A second group (n=8) underwent bilateral removal of superficial cervical and facial lymph nodes 7 days before transplantation. A third group (n=9) underwent bilateral removal of superficial cervical, facial, internal jugular and posterior cervical nodes. Graft survival was assessed by corneal clarity and rejection was confirmed histologically.

All allografts underwent rejection. The median time to rejection for unmodified allografts was day 15, compared with day 14.5 for minimally lymphadenectomised recipients and day 18 for more extensively lymphadenectomised recipients (p>0.05, all comparisons). The median day to rejection for the combined group of lymphadenectomised rats was day 17 (p>0.05 compared with unmodified grafts). The rejection process was similar in all recipients.

Removal of multiple lymph nodes in the neck and thorax did not significantly influence the incidence, tempo or nature of the corneal allograft response. Sensitisation and clonal expansion of corneal alloantigen-reactive cells cannot occur only in superficial cervical, facial, internal jugular and posterior cervical lymph nodes in the rat.

Transillumination imaging was performed with a digital slit lamp camera (Photo-Slit Lamp BX 900; Haag-Streit, Koeniz, Switzerland) modified by releasing the distal end of the background illumination fibre cable from its holder. The patient's eye was held open, and the head was positioned on the head and chin rest of the slit lamp. Transillumination was achieved by gently pressing the tip of the light fibre cable against the globe. The camera was then fired and the flash delivered through the cable while synchronising with the camera shutter.

This technique was applied in five patients with ciliary body or anterior choroidal tumours. Photographs were of good diagnostic quality, making it possible to outline the tumour borders and evaluate any ciliary body involvement. No patient experienced discomfort or negative side effects.

We recommend this technique in all cases where transillumination and photographic documentation of intraocular tumours are considered important.

In a retrospective, consecutive and interventional case series, 102 patients underwent UMR recession and BMR recession for constant esotropia measuring 15–35 prism diopters (PD) and 30–70 PD, respectively, from 1 January 2007 to 30 September 2010. Successful alignment was defined as ±8 PD of orthophoria in primary and lateral gaze.

No significant difference was observed between: (1) the success rates of the BMR and UMR recession groups at postoperative days 1~3 (p=1.00) or at final follow-up (p=0.421); (2) the variation in the mean change in deviation from postoperative days 1~3 to the final follow-up of the UMR (p=0.58) and BMR (p=0.56) recession groups; and (3) the mean correction in PD per millimetre of muscle recession in the UMR and BMR (p=0.63) recession groups.

Graded UMR recession for 15–35 PD of esodeviation was as effective as graded BMR recession for 30–70 PD of esodeviation. There was no statistical difference in changes in deviation per millimetre of recession between equivalent amounts of unilateral and bilateral recession.

A retrospective chart review of 314 eyes from 314 patients who underwent evisceration, enucleation and secondary procedures using Medpor orbital implants was completed focusing on implant-associated complications and their corrective methods as surgical outcomes.

The mean follow-up was 50 months (range 6–107 months). The most common complication was blepharoptosis (n=33, 10.5%). Other postoperative complications were exposure (n=14, 4.5%) and implant infection (n=3, 1%). The complications were successfully managed by surgical repair and/or conservative care.

Using Medpor resulted in similar surgical outcomes, in terms of the types and frequencies of complications, as other kinds of porous orbital implants.

Retrospective chart review from January 2006 to June 2010. We reviewed the retinal drawings and Retcam images for a hybrid pattern of ROP, that is, presence of ridge tissue (characteristic of staged ROP) along with flat neovascular syncytium (characteristic of APROP) in the same eye.

28 eyes of 18 infants had hybrid characteristics. All eyes had severe plus disease, flat new vessels at the junction of the vascular and avascular retina and ridge tissue at variable locations. Three patterns were noted: I Ridge at the junction of vascular and avascular retina (14 (50%) eyes); II Ridge in the vascularised posterior retina (10 (35.71%) eyes); III Ill-defined ridge close to the optic disc, with mat-like fibrous proliferation into the vitreous (4 (14.29%) eyes). After confluent laser photocoagulation, we observed favourable outcome in 92.3% eyes with pattern I, 100% eyes with pattern II and 25% eyes with pattern III disease.

Some eyes with ROP may have abnormal neovascularisation resembling both APROP and classical staged ROP. It is difficult to characterise these eyes according to the international classification of ROP. However, the presence of plus disease should serve as guide to treatment.

26 eyelids of 18 patients (seven women, 11 men; 10 unilateral, eight bilateral) underwent this procedure. Only a small skin incision was made on the leg measuring 2 cm. A final of 3.5x0.6 cm or 5x1 cm fascia lata strip was obtained according to the ptosis laterality. The obtained fascia lata graft was then dissected by a described stripping technique for a final of one or two fascia lata strips approximately 12.5 cmx2 mm long. Functional and cosmetic results were evaluated and the advantages of this technique were stressed.

Mean age was 26.0 years (range 3–64) with a mean follow-up period of 28.8 months (range 6–52). All cases achieved good to excellent final lid positions and adequate cosmetic results with no postoperative early (haemorrhage, wound infection) or late (contour abnormality, overcorrection, muscle herniation, recurrence) complications.

This is an easily mastered, simple, safe and efficient alternative technique that offers various benefits over conventional approaches. It avoids extended blunt dissections and has fewer postoperative leg complaints with less haemorrhage–haematoma formation or muscle prolapsus. It is useful at any age, especially in small children who already have a limited amount of delicate fascia lata and may be preferred when a fasciotome or videoendoscope is not available or fails to harvest sufficient material of fascia lata.

Three independent lists of residents of Western Australia who were also legally blind were collated during the capture periods in 2008–9. The first list was obtained from the state-wide blind register. A second list comprised patients routinely attending hospital outpatient eye clinics over a 6-month period in 2008. The third list was patients attending ophthalmologists' routine clinical appointments over a 6-week period in 2009. Lists were compared to identify those individuals who were captured on each list and those who were recaptured by subsequent lists. Log-linear models were used to calculate the best fit and estimate the prevalence of blindness in the Western Australian population and extrapolated to a national prevalence of blindness in Australia.

1771 legally blind people were identified on three separate lists. The best estimate of the prevalence of blindness in Western Australia was 3384 (95% CI 2947 to 3983) or 0.15% of the population of 2.25 million. Extrapolating to the national population (21.87 million) gave a prevalence of legal blindness of approximately 32 892 or 0.15%.

Capture–recapture techniques can be used to determine the prevalence of blindness in whole populations. The calculated prevalence of blindness suggested that up to 30% of legally blind people may not be receiving available financial support and up to 60% were not accessing rehabilitation services.

The retinal oximeter is based on a fundus camera. It estimates retinal vessel oxygen saturation from light absorbance at 586 nm and 605 nm. Retinal vessel oxygen saturation was measured in one major temporal retinal arteriole and venule in healthy volunteers and in patients with diabetic retinopathy.

Oxygen saturation in the retinal arterioles of healthy volunteers was 93±4% and 58±6% in venules (mean±SD, n=31). The corresponding values for all diabetic patients (n=20) were 101±5% and 68±7%. The difference between healthy volunteers and diabetic patients was statistically significant (p<0.001 for arterioles and venules). Three subgroups of diabetic patients (background retinopathy, macular oedema and pre-proliferative/proliferative retinopathy) all had higher saturation values than the healthy volunteers (p<0.05 for arterioles and venules).

Retinal vessel oxygen saturation is higher in patients with diabetic retinopathy than in healthy controls. Possible explanations include shunting of blood through preferential channels, bypassing non-perfused capillaries in the capillary network. Parts of the retinal tissue may be hypoxic while blood in larger vessels has high oxygen saturation.

A-M Ervin, R Wojciechowski and O Schein reviewed the safety and efficacy of punctual plugs for the management of dry eye (in press). Moderate and severe cases of dry eyes may require punctual occlusion with plugs which induce a mechanical blockade of the tear punctum and canaliculi.

The authors included randomised and quasi-randomised controlled trials of collagen or silicone punctal plugs in symptomatic participants diagnosed with aqueous tear deficiency or dry eye syndrome. Seven...]]> 2011-11-10T22:12:47-08:00 info:doi/10.1136/bjophthalmol-2011-300889 hwp:master-id:bjophthalmol;bjophthalmol-2011-300889 BMJ Publishing Group Ltd 2011-11-10 Education http://bjo.bmj.com/cgi/content/short/bjophthalmol-2011-300485v1?rss=1 Aims

To describe the clinical characteristics of ocular surface squamous neoplasia (OSSN) in a sub-Saharan referral hospital setting according to histopathological diagnosis and HIV status.

All patients were enrolled who presented consecutively to the Kilimanjaro Christian Medical College eye department with lesions suspected to be OSSN from September 2005 to May 2007 and from February 2008 to September 2008. Clinical characteristics were documented on a standardised form, excision biopsies were performed and histopathological diagnosis was obtained on all cases. Data were analysed to look for associations among various factors.

150 patients were enrolled. Histopathological study showed OSSN in 88% of cases. Of these, 128 (85.6%) were under the age of 50 years and 60% were HIV positive. The median CD4 cell count was 71 cells/μl among HIV-positive cases. Independent of size, the lesions of patients who were HIV positive were more likely to be higher grade malignancy than those who were HIV negative.

In a sub-Saharan setting, OSSN occurs in persons who are younger than in industrialised countries and is often associated with HIV positivity. CD4 cell counts indicate that a majority of HIV-positive patients with OSSN are significantly immunosuppressed at presentation. Higher grade malignancy in this group could indicate a more aggressive course.

Retrospective study, approved by the institutional review board, of 76 eyes of 67 patients with retinoblastoma with subretinal and/or vitreous seeding treated with intra-arterial chemotherapy at Memorial Sloan-Kettering Cancer Center between May 2006 and August 2010.

Despite advanced intraocular disease with seeding, the majority (56/76) of eyes were saved; 20/76 eyes were enucleated. Among treatment-naive eyes, the 2-year probability of ocular salvage was 83% (95% CI 27% to 97%) for eyes with subretinal seeding only, 64% (95% CI 24% to 87%) for eyes with vitreous seeding only, and 80% (95% CI 40% to 95%) for eyes with both. Among eyes that received previous treatment and had progressed, the 2-year probability of ocular salvage was 50% (95% CI 15% to 78%) for eyes with only subretinal seeding, 76% (95% CI 48% to 91%) for eyes with vitreous seeding only, and 54% (95% CI 20% to 79%) for eyes with both. Nine of 29 naive eyes (31%) were cured with intra-arterial (super-selective ophthalmic artery infusion of chemotherapy) chemotherapy alone.

Unlike radiation or systemic chemotherapy, intra-arterial chemotherapy can usually prevent the need for enucleation in naive eyes with advanced intraocular retinoblastoma with seeding—especially if the seeding is subretinal. Treatment appears to be less effective in previously treated eyes when subretinal seeding is present (50% at 2 years), but may be more effective in eyes that failed to respond to previous systemic chemotherapy and have only vitreous seeding.

A retrospective review of 107 consecutive primary gold weight implants in 95 patients with lagophthalmos in a single centre over a 5-year period. Implant placement utilised a combined high pretarsal placement, levator recession and fixation. Revision surgery included repositioning, removal or exchange. Blinded assessment of eyelid parameters, including cosmesis, was performed by an independent reviewer using photographs from each revision case taken preoperatively and 6 months postoperatively.

Mean follow-up 2.5 years (range 1–5) with 15/107 (14%) eyelids revised, the majority within 12 months of the primary procedure. Five eyelids required up to 3 further revisions, giving 21 revisions in total. Indications included prominent implants in 15/21 (71%) revisions; poor eyelid contour in 14/21 (67%, 9 drooped and 5 flattened eyelids); extrusion in 2/21 (10%); persistent erythema in 8/21 (29%, 5 gold allergies and 1 extrusion). Revisions consisted of platinum chain exchange (6), replacement (3), repositioning (8) and removal (4). Following final revision, eyelid contour returned to normal and five eyelids demonstrated mild prominence.

High pretarsal placement was successful in treating lagophthalmos, with a complication rate of 1 in 6 requiring a revision procedure, the majority within 12 months. Main indications were unsatisfactory cosmesis from prominence of implant and poor eyelid contour.

University of Michigan clinics, USA.

Male patients over the age of 50 years were recruited from clinics over 3 months and divided into two groups: 18 study patients taking α₁-adrenoreceptor antagonists (Flomax, Uroxatral, Cardura and Hytrin) and 31 control patients who had never been on them. Those with conditions known to affect pupil diameter were excluded. Pre-dilation pupil diameters were recorded using a pupillometer in mesopic and scotopic conditions. Right eyes were dilated with phenylephrine and tropicamide, and the left eye served as an undilated control. Following dilation, pupil diameters were measured in both lighting conditions.

No statistically significant difference was found in pupil mydriasis of patients taking α₁-antagonists versus controls (mesopic p=0.37, scotopic p=0.67). When considering only those patients taking tamsulosin, the lack of significance remained. The duration of time on the medication did not have a statistically significant effect on pupil mydriasis. Comparison of pupil diameters of patients on tamsulosin with those on non-selective α₁-antagonists, both before and after dilation, showed no significant difference in pupil mydriasis (mesopic p=0.77, scotopic p=1.00).

The outcomes of this study present an interesting contrast to current literature. Previously, it had been hypothesised that a majority of patients taking α₁-antagonists would experience preoperative impairment of pupil dilation. The authors found no significant decrease in pupil diameters of patients on α₁-adrenoreceptor antagonists compared with controls, and no indication that duration or medication subtype had an effect.

Consecutive patients with VKC were randomised in a prospective, double-masked, clinical trial to receive either topical CsA 2% dissolved in olive oil vehicle or dexamethasone 0.1% drops for 4 weeks. Both groups then received sodium chromoglycate 2% drops for maintenance therapy for a further 4 weeks. The primary outcome was the reduction in composite score for VKC-related symptoms and signs at 4 weeks. Secondary outcomes included side effects, best-corrected visual acuity, comfort rating of the trial drops during 4 weeks' test medication and relapse rate thereafter.

The 366 participants recruited had the limbal (91.5%) or mixed form of VKC. At the end of the 4-week treatment period, the composite score had decreased significantly (p<0.001) from baseline without any significant difference between CsA and dexamethasone (p=0.20). There were no severe adverse reactions, but CsA drops caused more stinging than the oil placebo and dexamethasone (p<0.001). In both treatment groups, the visual acuity had improved at 4 weeks compared with baseline (p<0.001) with no significant difference between the treatment arms. The relapse rate following cessation of the trial treatments was similar (p=0.84) in both groups.

There is no significant difference between the efficiency of topical CsA 2% and dexamethasone 0.1% for the management of acute VKC in Central Africa, but tolerance needs to be improved.

Good-quality (global signal strength (SS)≥6; manufacturer specification) peripapillary circular OCT scans (fast retinal nerve fibre layer scan protocol; Stratus OCT; Carl Zeiss Meditec, Dublin, California, USA) were obtained from 6 healthy, 19 glaucoma-suspect and 43 glaucoma subjects. Scans were grouped based on SegE. Quality index (QI) values were computed for each A-scan using software of our own design. Logistic mixed-effects regression modelling was applied to evaluate SS, global mean and SD of QI, and the probability of SegE.

The difference between local mean QI in SegE regions and No-SegE regions was –5.06 (95% CI –6.38 to 3.734) (p<0.001). Using global mean QI, QI SD and their interaction term resulted in the model of best fit (Akaike information criterion=191.8) for predicting SegE. Global mean QI≥20 or SS≥8 shows little chance for SegE. Once mean QI<20 or SS<8, the probability of SegE increases as QI SD increases.

When combined with a signal quality parameter, the variation of signal quality between A-scans provides significant information about the quality of an OCT scan and can be used as a predictor of segmentation error.

Retrospective case series.

Nine children (seven families) initially examined from 2 to 8 years of age were identified. Three had a similar initial presentation of abnormal head position with head shaking and nystagmus, while the other six presented with either infantile nystagmus (without abnormal head position or head shaking), suspected congenital glaucoma (with associated nystagmus), intermittent exotropia, V-pattern esotropia, comitant esotropia or difficulty with near vision only (reading). Only two children had clinically evident retinal changes (macular discoloration), and only two had a myopic cycloplegic refraction (the child with infantile nystagmus and the glaucoma suspect who actually had megalocornea). In addition to cone dystrophy, ERGs showed delayed scotopic responses with supranormal (six), high normal (two) or normal (one) scotopic b-wave responses to bright flash. Only one ERG (with a supranormal response) did not show a broad a-wave trough response to scotopic flash. For all patients, KCNV2 sequencing revealed one of three homozygous recessive mutations (one previously reported (p.E143X), two novel (p.Y53X, p.E80D)). The three children who presented with an abnormal head position, head shaking and nystagmus and the child who presented with infantile nystagmus had several years' follow-up, during which these findings resolved (two) or decreased (two).

Initial clinical presentation varied, the most common presentation being abnormal head position, head shaking and nystagmus that improved with time. ERG findings are characteristic and specific for KCNV2 mutations but do not necessarily include a scotopic b-wave flash response that is supranormal under standard ERG conditions.

Computer-based models and simulations of this surgical procedure were used to investigate the relative effects of various shapes and dimensions of scleral flap and sclerostomy on the aqueous outflow.

In these computer simulations, increasing scleral flap size was found to be associated with an increase of 48.55% in aqueous egress. In addition, a square scleral flap increased the aqueous drainage by 36.26% compared with a triangular flap of equivalent flap area. Surprisingly, our simulation results showed that a smaller semicircular sclerostomy improved aqueous drainage by up to 33.00%, while a semicircular sclerostomy, compared with a circular sclerostomy, led to a further 6.16% increase in aqueous outflow. Decreasing flap thickness beyond half-thickness caused an additional increase in aqueous outflow. However, clinically the flap should not be thinner than half the thickness of the sclera as this may result in hypotony.

These simulations indicate that the optimal flow rate through operation site will be achieved in trabeculectomy using a square scleral flap with a large flap-to-sclerostomy ratio.

Hospital episode statistics were analysed for annual treatment rates of intravitreal injection between the NHS financial years of 1989/1990 and 2008/1999.

Annual injection rates increased from 0.4 episodes (95% CI 0.37 to 0.49) per 100 000 population in 1989/1990 to 10.7 (10.4–11.0) in 2006/2007. Rates then rose exponentially to 59.5 (58.8–60.2) in 2008/2009, with increasing use of multiple injections per person. The largest growth in injection rates was found in older people, and for AMD. Numbers of treatment episodes increased from 203 (1989/1990) to 30 458 (2008/2009). Geographical analysis showed a very wide variation across local authority areas in injection rates, from 0.9 (0.2–2.2) to 42.2 (38.9–45.7) people per 100 000 population in 2005–2008.

Rates of intravitreal injection increased exponentially from 2006/2007. This followed the US Food and Drug Association licensing of ranibizumab for the treatment of neovascular AMD (2006), and its recommendation by National Institute for Health and Clinical Excellence (2008). This study demonstrates some of the major issues which arise with the emergence of expensive new treatments, including speed and cost of adoption, geographical variation in access, and implications for licensing, commissioning and health financing in an ageing society.

Artificial visual techniques were used to develop the CAD in two steps: normalisation and feature vector extraction from OCT images; and training and classification by means of decision trees. Technical validation was performed by a retrospective study design based on OCT images randomly extracted from clinical charts. Images were classified as normal or abnormal to serve for screening purposes. Sensitivity, specificity, positive predictive values and negative predictive values were obtained.

The CAD was able to quantify image information by working in the perceptually uniform hue–saturation–value colour space. Particle swarm optimisation with Haar-like features is suitable to reveal structural features in normal and abnormal OCT images. Decision trees were useful to characterise normal and abnormal images using feature vectors obtained from descriptive statistics of detected structures. The sensitivity of the CAD was 96% and the specificity 92%.

This new CAD for automated analysis of OCT images offers adequate sensitivity and specificity to distinguish normal OCT images from those showing potential neovascular age-related macular degeneration. These results will enable its clinical validation and a subsequent cost-effectiveness assessment to be made before recommendations are made for population-screening purposes.

19 participants with distance exotropia were tested using a PlusoptiXSO4 photo refractor set in a remote haploscopic device that assessed simultaneous vergence and accommodation to a range of targets incorporating different combinations of blur, disparity and proximal cues at four fixation distances between 2 m and 33 cm. Responses on decompensation were compared with those from the same children when their deviation was controlled.

Manifest exotropia was more common in the more impoverished cue conditions. When decompensated for near, mean accommodation gain for the all-cue (naturalistic) target was significantly reduced (p<0.0001), with resultant mean under-accommodation of 2.33 D at 33 cm. The profile of near cues usage changed after decompensation, with blur and proximity driving residual responses, but these remaining cues did not compensate for loss of accommodation caused by the removal of disparity.

Accommodation often reduces on decompensation of distance exotropia as the drive from convergence is extinguished, providing a further reason to try to prevent decompensation for near.

The authors recruited cases with advanced AMD, spouses and siblings. All subjects were carefully phenotyped. Clinical findings in the siblings were compared with spouses. Information about family history was collected. The ORs for reported family history of AMD were calculated. Analyses were adjusted for age, smoking and genotype.

495 AMD cases, 259 spouses and 171 siblings were recruited. The OR for AMD was 27.8 (CI 3.8 to 203.0; p=0.001) with a reported family history of an affected parent and 12.0 (CI 3.7 to 38.6; p<0.0001) with a history of an affected sibling. ORs adjusted for age and smoking were higher. Examination of siblings confirmed their increased risk with 23% affected by AMD and an OR of 10.8 (4.5 to 25.8; p<0.0001). Adjusting for age increased the OR to 16.1 (6.2 to 41.8).

The risk of AMD is greatly increased by having an affected first-degree relative. Those at risk need to be made aware of this and AMD patients should advise siblings and children to seek prompt ophthalmological advice if they develop visual symptoms of distortion or reduced vision.

12 consecutive patients underwent biopsy of iris lesions at the Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK. Samples were obtained using a novel technique called trans-corneal fine cannula aspiration. This comprised a 25-gauge, Rycroft cannula aspiration technique performed by a single surgeon and samples transferred into alcohol-based tissue fixative. A specialist ophthalmic histopathologist performed a histological analysis of the samples.

On average, the size of the specimens obtained in theatre ranged from 1 mm to 1.5 mm (maximum dimensions). This sample size allowed an unequivocal histological diagnosis in all 12 cases. In this study, 10 patients were diagnosed as having iris melanoma, one patient with metastatic adenocarcinoma and one patient with pigmented adenoma.

This simple iris tumour biopsy technique provides sufficiently large sample sizes to obtain a firm histological diagnosis in 100% of cases performed so far. The sample sizes permitted not only morphological interpretation but also ancillary investigations such as immunohistochemistry.

This is a prospective study of 439 consecutive patients aged 60 years and older with exudative AMD starting intravitreal ranibizumab for exudative AMD in Iceland from March 2007 to December 2009. All patients initially received three consecutive ranibizumab injections, with regular follow-up visits and re-treatment as needed.

In total, 517 eyes from 439 patients received treatment for exudative AMD (mean age 79 years). The annual incidence of exudative AMD in the population 60 years and older is 0.29%. The incidence increased with advancing age, double for patients 85 years and older compared with those 75–79 years. Approximately 2400 ranibizumab injections per 100 000 persons aged 60 years and older were given each year for exudative AMD.

These data allow an estimation of the incidence of exudative AMD in a Caucasian population and the treatment load with ranibizumab, which may help plan anti-vascular endothelial growth factor treatment programmes and estimate costs.

Patients diagnosed with BCR (n=12), retinitis pigmentosa (RP, n=292) and cone dystrophy (n=16) were included in this study. The authors mainly examined fundus photographs and SD-OCT, infrared and fundus autofluorescence images of these patients.

Crystalline deposits were detected in portions of the retinal pigment epithelium that lacked patchy degenerated lesions. SD-OCT revealed that most of the observed crystalline deposits were located adjacent to the inner side of retinal pigment epithelium layer. The change most frequently observed was circular hyper-refractive structures in the outer nuclear layer. Although the structures were considered to be previously reported "tubular formation" or "tubular degeneration", we determined that many of these circular structures were slices of spherical structures and were typically noted in areas suspected of ongoing active degeneration.

BCR has characteristic structures in the outer nuclear layer. Although the incidence of the structure varies, it may be characteristic of retinal degeneration and can be found in many retinal degenerative diseases.

We measured visual acuity, refractive error and endothelial cell counts and recorded complications in a group of children after insertion of Artisan iris-claw implants.

Artisan implants were implanted in eight eyes of five children. Mean follow-up was 28 months (range: 4–58 months). The mean preoperative LogMAR best-corrected visual acuity was 0.21±0.2, and postoperatively, mean LogMAR uncorrected visual acuity was 0.04±0.09 (p=0.04). Mean endothelial cell count was 3312±277 cells preoperatively and 2913±268 cells postoperatively, representing a mean cell loss of 14.2% (p<0.001). Mean defocus equivalent was 11.38±1.04 preoperatively and 2.34±0.66 postoperatively. We encountered no postoperative complications in any of the eyes.

Artisan iris-claw implants are safe and effective in the correction of aphakia in children following lensectomy for ectopia lentis, enabling good spectacle-free distance vision in 75% of eyes with no postoperative complications.

This study evaluated 20 eyes of 20 patients with spherical equivalents of –7.36±2.13 D (mean±SD) who underwent Hole ICL implantation. Before surgery and at 1 week and 1, 3 and 6 months after surgery, we assessed the safety, efficacy, predictability, stability and adverse events of the surgery.

Logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity and logMAR best spectacle-corrected visual acuity were –0.20±0.12 and –0.25±0.06, respectively, 6 months after surgery. The safety and efficacy indices were 1.13±0.24 and 1.03±0.30, respectively. At 6 months, 95%, and 100% eyes were within ±0.5 and ±1.0 D of the targeted correction, respectively. Change in manifest refraction from week 1 to month 6 was 0.06±0.28 D. No significant rise in intraocular pressure (including pupillary block) or a secondary cataract occurred in any case during the period of observation.

Implantation of a newly developed Hole ICL offered good results for all measures of safety, efficacy, predictability and stability for the correction of moderate to high myopic errors, even without peripheral iridectomy, suggesting its viability as a surgical option for the treatment of such eyes.

A retrospective analysis of the histopathological diagnoses of all corneal buttons submitted to the regional Ocular Pathology Laboratory (Glasgow, UK) between January 2001 and December 2010 was performed.

Between 2001 and 2010, a total of 921 keratoplasties were performed in the West of Scotland. These included 646 (70.1%) penetrating keratoplasties and 275 (29.9%) lamellar keratoplasties (LK). Keratoconus (n=264, 28.7%) was the leading indication for keratoplasty, followed by graft failure (n=177, 19.2%), Fuch's endothelial dystrophy (n=124, 13.5%), keratitis (n=106, 11.5%), pseudophakic/aphakic bullous keratopathy (n=88, 9.6%), endothelial failure (n=67, 7.3%), non-Fuch's corneal dystrophies (n=21, 2.3%), trauma (n=19, 2.0%), autoimmune/inflammatory diseases (n=16, 1.7%) and others (n=39, 4.2%). A significant increase in the proportion of LK over penetrating keratoplasty was observed during this 10-year period: from 14.1% LK (2001–2005) to 40.4% LK (²=71.78, p value<0.001).

Keratoconus was the leading indication for keratoplasty in the West of Scotland. Both anterior LK and endothelial keratoplasty seemed to show an emerging trend as the procedures of choice for dealing with anterior and posterior corneal pathologies, respectively.

40 eyes of 21 healthy subjects were scanned on the Cirrus HD-OCT, Topcon 3D-OCT-2000 and Heidelberg Spectralis-OCT. Raw data were imported into custom grading software (3D-OCTOR). Manual segmentation was performed on every data set, and retinal thickness values in the foveal central subfield were computed.

37 eyes of 20 subjects were gradable on every machine. The average retinal thicknesses for these eyes were 236.7 μm (SD 20.1), 235.7 μm (SD 20.4) and 236.5 μm (SD 18.0) for the Cirrus, 3D-OCT-2000 and Spectralis, respectively. Comparing manual retinal thickness measurements between any two machines, the maximum difference was 18.2 μm. The mean absolute differences per eye between two machines were: 4.9 μm for Cirrus versus 3D-OCT-2000, 3.7 μm for Cirrus versus Spectralis and 4.4 μm for 3D-OCT-2000 versus Spectralis.

When a uniform position is used to locate the outer retinal boundary, the retinal thickness measurements derived from three different spectral domain optical coherence instruments devices are virtually identical. Manual correction may allow OCT-derived thickness measurements to be compared between devices in clinical trials and clinical research.

Retrospective review of all consecutive uveitis patients seen at a single, tertiary institution over 9 years with uveitis consistent with TB, positive tuberculin skin test with other causes ruled out, and a minimum of 6 months follow-up after completion of treatment. Clinical characteristics, treatment type, treatment duration and clinical response were recorded. Our main outcome measure was the effect of ATT duration on the recurrence of inflammation.

Of the 182 eligible patients, 46 received ATT of ≥6 month's duration; 18 patients defaulted and received <6 months treatment. The patients' mean age was 45.3±13.2 years and most were female (n=118, 57.6%) and of Chinese race (n=104, 50.7%). Patients who completed >9 months ATT were less likely to develop recurrence compared with those not treated with ATT (OR 0.09; 95% CI 0.01 to 0.76; p=0.027), while adjusting for potential confounders such as patient demographics, anatomical location of uveitis and corticosteroid therapy.

Patients with uveitis and latent TB treated with ATT of >9 months duration had an 11-fold reduction in the likelihood of recurrence.

We conducted ROP screening according to the German guidelines of 1999: all preterm infants with a GA of <32 weeks and/or a BW of <1501 g, or with GA ≥32 weeks and postnatal oxygen treatment for >3 days, were assigned for screening. Dense laser coagulation was performed according to the current treatment criteria.

All 767 consecutive inborn (patients born at the Department of Neonatology, University Hospital of Cologne, Germany) preterm infants of a tertiary medical centre of maximum care underwent complete screening from 2001 to 2009. The treatment incidence was 7.0%. No preterm infant developed stage 4/5 ROP. Mean GA and BW of untreated/treated preterm infants were 28.4/24.6 weeks and 1109/635 g, respectively. Increasing treatment incidence was associated with lower GA, but not with lower BW in logistic regression analysis.

In this very immature high-risk cohort, advanced stages 4 and 5 were avoided throughout 9 years of screening. We suggest three factors that contributed to this outcome: (1) strict adherence to current ROP screening and treatment guidelines; (2) prompt and very dense laser coagulation if necessary; and (3) a specialised neonatal intensive care unit with experience of very immature babies.

Forty-five eyes with exudative branching vascular networks were treated with intravitreal bevacizumab and followed for at least 24 months. Original polypoidal lesions had been treated successfully with previous photodynamic therapy in all eyes. The best-corrected visual acuity and retinal morphological changes were assessed retrospectively.

Exudative branching vascular networks were characterised as occult choroidal neovascularisation (38 eyes) or classic choroidal neovascularisation (7 eyes) on fluorescein angiography. Intravitreal bevacizumab maintained or improved vision in 38 eyes (84%) over 12 months and in 36 eyes (80%) over 24 months, although the mean visual acuity at 12 and 24 months did not differ significantly compared with baseline. Complete resolution of macular fluid was achieved continuously in 26 eyes (58%) during 24 months. Sixteen eyes (36%) responded once to treatment but became unresponsive to additional injections for recurrent exudation. Three eyes (7%) were refractory to treatment throughout follow-up. Cystoid macular oedema eventually developed in 10 eyes and was a poor prognostic sign for visual outcome.

Intravitreal bevacizumab improved the retinal morphology and maintained vision over 1 year in most eyes with recurrent fluid owing to persistent abnormal vascular networks in polypoidal choroidal vasculopathy. The therapeutic response, however, may decrease during the second year.

Retrospective, comparative case series of 218 eyes of 138 children <12 years of age undergoing cataract extraction with intraocular lens implantation. The study cohorts were grouped into two categories based on incision location: group 1 comprising 108 eyes from 65 children with scleral incision; group 2 comprising 110 eyes from 73 children with clear corneal incision. Cycloplegic refraction was performed at 1, 3 and 6 months postoperatively.

The mean age in group 1 was 61±39 months and in group 2, 51±41 months. The mean postoperative astigmatism in group 1 was 1.28±0.97 D, 1.42±1.00 D and 1.38±0.98 D at 1, 3 and 6 months respectively. The change in astigmatism between 1 and 6 months was non-significant (p=0.26). The mean astigmatism in group 2 was 1.34±1.20 D, 1.13±0.88 D and 1.03±0.89 D at 1, 3 and 6 months respectively. Astigmatism in group 2 decreased significantly with time (p<0.001). The amount of astigmatism was comparable between the two groups at 1 month postsurgery (p=0.90), while it was significantly lower in the corneal incision group at 3 (p=0.03) and 6 months (p=0.01).

Postoperative astigmatism after paediatric cataract surgery by clear corneal incision was lower compared with scleral incision. However, the difference was small and clinically insignificant.

Retrospective analysis of eight patients with Coats' disease manifesting total or partial exudative retinal detachment where the retinal telangiectasia was treated with standard laser photocoagulation and/or cryotherapy plus additional intravitreal bevacizumab (1.25 mg/0.05 ml).

The mean patient age was 88 (range 7–240) months and 63% were male. Coats' disease was classified as stage 2 (n=1, 12%), 3a (n=3, 38%) and 3b (n=4, 50%). Features included retinal detachment (n=8, 100% with mean detachment extent involving 8 clock hours), telangiectasia (n=8, 100% with mean extent of 8 clock hours), peripheral retinal ischaemia on fluorescein angiography (n=7, 88%) and no evidence of neovascularisation. Treatment consisted of cryotherapy (n=8, 100%), laser photocoagulation (n=4, 50%) and bevacizumab intravitreal injection (n=8) with median number of one injection per eye (mean 1.75, and range 1–4 injections). After a mean follow-up of 8.5 months, resolution of retinopathy (n=8, 100%), Coats'-related subretinal fluid (n=8, 100%) and retinal exudation (n=6, 75%) was noted. However, vitreous fibrosis developed (n=4, 50%) at a mean of 5 months following a mean of 1.75 bevacizumab injections with three (38%) evolving into traction retinal detachment.

Coats' disease treated with intravitreal bevacizumab in addition to standard therapy can develop to vitreoretinal fibrosis and potentially traction retinal detachment. These tractional features are not often found in Coats' disease treated with standard measures without bevacizumab. Caution is advised in the use of bevacizumab for patients with Coats' disease.

Thirty adult patients (32 eyes) with canalicular obstruction were treated with RC-BCI from September 2005 to December 2007 at Zhongshan Ophthalmic Centre (Guangzhou, China). Silicone tubes were left in place for 2–3 months and were removed when patients had relief by tearing. Patients were evaluated postoperatively by symptoms, lacrimal irrigation and satisfaction rate.

Mean follow-up time after tube removal was 21.5 (range 6–26) months. Twenty-six eyes (81.25%) had complete epiphora relief, two eyes (6.25%) had partial relief and four eyes (12.5%) had no improvement after the removal of the tubes. One eye (3.13%) had lower punctum splitting 2 months after the surgery. The overall satisfaction rate was 93.3% in 30 patients. No other complications occurred.

Our findings demonstrated that the RC-BCI was an effective procedure for treating canalicular obstruction with few complications.

Children aged <16 years with a new diagnosis of an inherited retinal disorder made between September 2006 and February 2008 in the UK were identified through two national active surveillance schemes. Clinical and socio-demographic information was collected on each child at diagnosis and 9 months later using standardised questionnaires.

241 patients were reported with 24 distinct diagnoses. 14% had additional systemic disorders and 13% had dual sensory impairment. Annual incidence was 1.4/100 000 children (aged 0–15 years) and the cumulative incidence by age 16 years was 22.3/100 000 children. The most common mode of inheritance was autosomal recessive. A significantly higher rate was seen in males than females (relative rate (RR) 1.53), in children of Asian compared with White ethnicity (RR 7.12) and in those in the worst quintile of socio-economic deprivation compared with those in the best (RR 1.43). Parents most commonly detected a problem with their child's vision. Up to seven different health professionals were involved in a child's early management, and variations were noted in the proportion of eligible children having assessments for low vision aids, statement of educational needs and certification as sight-impaired.

These findings illustrate the highly heterogeneous nature of childhood retinal dystrophies and provide previously unavailable data on disease incidence, distributions and management, which are important for service provision and for planning future treatment programmes, particularly as novel therapies become available.

24 eyes in 24 patients with PO caused by increased intracranial pressure and 22 eyes in 22 normal subjects were studied. OCT high-quality fundus images were analysed and graded by three masked observers using the Modified Frisén Scale. Eyes with PO were divided into two subgroups: those with mild PO (n=18) and those with moderate-severe PO (n=6). Two methods of measurements were evaluated and compared: retinal nerve fibre layer (RNFL) thickness measurements using standard optic disc cube 200x200 acquisition protocol and PTR thickness measurements using the ‘macular’ cube 512x128 acquisition protocol centred on the optic disc. Thickness values were calculated globally and for each quadrant (temporal, superior, nasal, inferior) and compared among the three groups (control, mild PO, moderate-severe PO). The main outcome measures were RNFL and PTR thickness.

Average RNFL and PTR thickness in the moderate-severe PO, mild PO and control groups were 299.3±10.9, 112.4±6.3, 96±5.7 and 804.5±17, 463.1±9.8 and 332.4±8.9 μm, respectively. Moderate-severe PO differed from mild PO and control groups using both RNLF thicknesses and PTR thicknesses measurements. Mild PO did not differ from controls using RNLF thickness measurement (p=0.17), but was statistically different using PTR thickness measurement (p<0.001).

PTR thickness measurement increases the sensitivity of detection of mild PO compared with conventional RNFL measurement. This new way of using OCT may be useful for clinicians to detect mild PO.

Thirty-three eyes from 33 patients were analysed retrospectively. BCVA and MP were correlated with parameters from various functional and morphological tests. The mean MP sensitivities at fovea 2° and 4°, retinal thickness and degree of defect at the photoreceptor inner and outer segment junction (IS/OS) of the spectral domain-optical coherent tomography image, normalised coefficient of variation of grey scale at the fovea in the short wavelength and near infrared fundus autofluorescence image, P1 amplitude and latency, and N1 amplitude and latency of multifocal electroretinography at ring 1 (R1) were measured. Spearman correlations and multiple linear regression analysis were used for analysis of correlation between functional and morphological characteristics.

The mean BCVA was 0.19±0.23 (logarithm of the minimum angle of resolution (logMAR)). The mean MP at 2° was 12.79±4.47 dB. BCVA correlated with MP at 2° (=–0.491, p=0.004) and had a significant association with the IS/OS defect and centre point thickness (CPT) (BCVA=0.413+0.314xIS/OS defect–0.002xCPT; p<0.001, R=0.739, R²=0.546). Retinal sensitivity measured by MP at the fovea (2°) had a significant association with the IS/OS defect and N1 latency at R1 (MP at 2°=19.350–9.116xIS/OS defect –0.324xN1 latency at R1; p<0.001, R=0.804, R²=0.647).

The visual function of eyes with resolved central serous chorioretinopathy was suboptimal and was better explained when various parameters showing retinal status were combined and interpreted together.

To determine the value of ultrasound biomicroscopy (UBM) in the assessment of posterior chamber involvement in advanced retinoblastoma.

Retrospective review of all retinoblastoma cases enucleated at the Jules Gonin Eye Hospital from January 1996 to December 2009 for which UBM (35 MHz) evaluation was available. The patients' records were reviewed for patient and tumour features and histopathological findings. UBM findings were compared with histopathological features.

UBM documentation was available in 31 cases. Retinoblastoma was detected by UBM in the posterior chamber in 18 cases and was absent in 13 cases while histopathological analysis demonstrated its presence in the posterior chamber in 22 cases and its absence in 9 cases. Among the 18 UBM-positive cases, 7 had biomicroscopic detectable involvement of the anterior chamber. There was a significant correlation between echodensities consistent with retinoblastoma on UBM in the posterior chamber and histopathological tumorous involvement of the posterior chamber (p=0.0001). The sensitivity of UBM in the assessment of posterior chamber invasion by retinoblastoma was 81% and the specificity was 100%.

In selected cases of advanced retinoblastoma, UBM appears to represent a valuable tool in the precise evaluation of anterior extension of disease, with good sensitivity and specificity for the assessment of posterior chamber involvement. UBM may provide useful criteria governing the indication for enucleation.

Five non-contact-lens wearers were recruited to evaluate the diagnostic capability of the TearLab. Three osmolarity measurements were taken at 1 min intervals in the morning at 09:00, midday between 12:00 and 13:00 and afternoon at 16:00 for two consecutive days. Forty more osmolarity measurements were carried out at different times on one subject with low and one subject with high tear osmolarity over 4 months. The osmolarity of a standard solution, 290 mOsm/l, was measured 19 times alternatively with the TearLab by two examiners.

Consecutive tear osmolarity readings in an individual varied up to 35 mOsm/l, but an average over three readings was found to be a reliable indicator of tear osmolarity at 95% confidence level. For population studies, a power analysis based on the variability of the data showed that three repeat measurements would be required to obtain reliable data for a study with <50 subjects, whereas one measurement would suffice for 490 or more subjects. There were no interobserver or interinstrumental differences, but readings obtained for the standard solution varied up to 89 mOsm/l.

Three consecutive readings are required with the TearLab to obtain a reliable measure of tear osmolarity. The variation in recorded tear osmolarity makes it difficult to use the technique for the diagnosis of mild dry eye.

Calculation of age- and sex-specific rates from primary source clinical data, and application to the demographic structure of England to estimate the number of cases affected by DMO. A public health commissioner and provider of social care perspective was adopted in a standard cost of illness study.

The number of people with diabetes in England in 2010 was estimated at 2 342 951 of which 2 334 550 were aged ≥12 years. An estimated 166 325 (7.12%) had DMO in one or both eyes, and of these, 64 725 individuals had clinically significant DMO reducing the visual acuity to poorer than 6/6 in at least one eye. The overall health and social care costs in 2010, on the pathway from screening to rehabilitation and care in the home, are estimated at £116 296 038.

The outcomes of this study should alert public health commissioners and clinical providers to the burden of DMO. The methods employed should also encourage the use of clinical ophthalmic data at the interface between local population and hospital-based recording systems.

A patient was referred for removal of a presumed right-lower-lid papilloma. Clinically, the lesion appeared benign. A shave excision biopsy was performed, and a diagnosis of DT was made. The DT constituted the bulk of the lesional tissue. In continuity with the DT, at one edge was a minor incompletely excised basaloid component. An anterior lamellar excision with a 2 mm margin...]]> 2011-02-24T06:32:29-08:00 info:doi/10.1136/bjo.2010.187856 hwp:master-id:bjophthalmol;bjo.2010.187856 BMJ Publishing Group Ltd 2011-02-24 Education http://bjo.bmj.com/cgi/content/short/bjo.2010.201970v1?rss=1 We thank Drs Raizada and Al Sabti1 for their interest in our article ‘Enhanced internal search for iatrogenic retinal breaks in 20-gauge macular surgery’2 and for their useful comments.

We are aware that most vitreoretinal surgeons currently employ wide-field viewing systems and peripheral indentation during their search for retinal breaks at the end of surgery. The existing literature on this subject, however, often mentions indirect funduscopy or does not specify search methods. And from personal communications we still encounter practices of search using indirect ophthalmoscopy, confinement of search to sclerotomy sites or confinement of search only to cases where a posterior vitreous detachment is induced. A recent large series focusing on break incidence in 20-gauge pars plana vitrectomy also found a high number of breaks.3 We hope that all this attention will eradicate sloppy search practices by vitreoretinal surgeons.

Drs Raizada and Al...]]> 2011-02-04T02:27:57-08:00 info:doi/10.1136/bjo.2010.201970 hwp:master-id:bjophthalmol;bjo.2010.201970 BMJ Publishing Group Ltd 2011-02-04 Letters http://bjo.bmj.com/cgi/content/short/bjo.2010.199844v1?rss=1 We read with interest the article by Tan et al.1 We congratulate the authors for emphasising the need for meticulous examination of the peripheral retina to look for retinal breaks after pars plana vitrectomy (PPV). We would like to add some comments to augment this fine study.