Konstantopoulos et al investigated the intraocular pressure lowering mechanisms of deep sclerectomy (DS) with anterior segment optical coherence tomography (AS-OCT) in a prospective cross-sectional study. AS-OCT parameters were compared between 18 DS (15 patients), 17 trabeculectomy (16 patients) and 15 controls (15 patients). Trans-conjunctival aqueous percolation was identified as a novel DS drainage route. DS had a fluid reservoir below the scleral flap, the intrascleral lake, analogous to the trabeculectomy bleb cavity. A postoperative tall intrascleral lake and a thick conjunctival/Tenon's layer were associated with good outcome.
Uemoto et al evaluated the intraoperative applicability and safety of a mixture of brilliant blue G and sodium hyaluronate (visco-BBG) for staining the inner limiting membrane (ILM). A retrospective consecutive case series of 74 eyes that had undergone ILM peeling were studied (visco-BBG...]]>
The femtosecond laser (FSL) is a focusable infrared laser that delivers ultrashort pulses in the femtosecond duration range. Contiguous pulses are placed at a definite depth within the cornea, thus resecting only targeted tissue. This surgical device allows cutting of corneal tissue in a number of reproducible, customised transplant designs, and allows the use of sagittal plane trephination profiles, such as zigzag, top-hat, Christmas tree and mushroom shapes to improve wound stability and, probably, postoperative astigmatism.
Helmholtz's assertion about the optics of the eye was quantified about a century later by Smirnov
Today is the Yesterday of Tomorrow. What is today ‘state of the art’ may tomorrow be relegated to the dustbin of history—hsd
Bloodletting had its day, based largely on the concept of ‘evil humours’ that accumulated in the body and caused disease, when it was widely practised in the early years of organised medicine. Ancient medicine is rife with examples of bloodletting as a means of ‘curing’ a number of conditions including those associated with excessive loss of blood such as nose-bleeds and menorrhagia!! As bloodletting was a ‘surgical’ procedure it was devolved to the barbers who performed this and other interventions. The barber's pole, painted with red and white spiralling stripes, is a relic from the past when it was a symbol of the medical procedures performed by barbers, the red and white stripes representing the bloodied and clean bandages.
The early history of ophthalmology documents...]]>
To identify and compare the profile of retinopathy of prematurity (ROP) in premature babies in urban and semiurban neonatal intensive care units (NICUs).
A prospective study of babies admitted to NICUs of two urban and seven semiurban centres. They were <36 weeks of gestational age and were subjected to fundus photography with a RetCam shuttle camera. Photos and NICU details were uploaded on a secure website. Photographs were read by a single observer. Infants were followed till retinal vascularisation was complete, or 45 weeks post conceptional age. Babies developing severe ROP were lasered.
500 babies were screened (243, urban group; 257, semiurban group). Incidence of ROP in the urban and semiurban groups was 16.5% (40) and 14.8% (38) respectively. Mean gestational age was 30.90 weeks and 31.53 weeks respectively. Mean birth weight was 1344 g and 1375 g respectively. 28 babies were lasered, 15 and 13 from each group respectively. There was no statistically significant difference between any of the parameters compared. Level of significance was fixed at 0.05.
The magnitude of the burden of ROP is comparable between urban and semiurban NICUs stressing the need for effective screening strategies in semiurban and rural areas as well.
To evaluate the intraoperative applicability and safety of a mixture of brilliant blue G and sodium hyaluronate (visco-BBG) for staining the inner limiting membrane (ILM).
A retrospective consecutive case series. Seventy-four eyes that had undergone ILM peeling were studied. During vitrectomy, ILM peeling with visco-BBG (visco-BBG group) was performed on 40 eyes; 12 with a macular hole (MH), 26 with an epimacular membrane (ERM) and 2 with a retinal detachment due to a MH (MHRD). ILM peeling with BBG dissolved in balanced salt solution (BSS-BBG group) was performed on 34 eyes; 9 with a MH, 23 with an ERM and 2 with a MHRD. The main outcome measures were the distribution of the dye within the vitreous cavity and the retinal sensitivity in the MH patients of the two groups by microperimetry.
The visco-BBG was injected over the retina where the ILM was intended to be peeled, and it stained the ILM in all cases. It did not disperse throughout the vitreous cavity or into the subretinal space. The BSS-BBG dispersed throughout the vitreous cavity, and its distribution was difficult to control. The two solutions did not stain the epiretinal membranes or any residual posterior hyaloid membrane. The difference in the retinal sensitivity between the two patients with MH of two groups was not significant. No complications were found in the visco-BBG group, although an accidental retinal perforation was found in one eye of the BSS-BBG group. Transmission electron microscopy confirmed that the membrane peeled was the ILM.
Visco-BBG can be a useful method to assist macular surgery and can overcome some of the disadvantages of conventional BBG solutions dissolved in BSS.
To evaluate the efficiency of multimicroporous expanded polytetrafluoroethylene (e-PTFE) insertion in complicated multirecurrent pterygia.
A total of 62 eyes from 62 patients with a multirecurrent pterygium associated with symblepharon or motility restriction-related binocular diplopia were recruited. All eyes underwent pterygia excision followed by application of 0.033% mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft. Multimicroporous e-PTFE was then inserted intraoperatively in 30 eyes between the transplanted amniotic membrane and the conjunctiva (group A), but not inserted in the other 32 eyes (group B). The main outcome measures were symblepharon formation, motility restriction, binocular diplopia, subjective score of conjunctival hyperaemia and postoperative pterygium recurrence.
In the mean follow-up period of 17.2±2.3 months, symblepharon formation, motility restriction, diplopia and conjunctival hyperaemia were significantly improved after surgery in group A patients (p=0.000, 0.000, 0.008 and 0.000, respectively). Postoperative symblepharon formation, motility restriction and conjunctival hyperaemia were significantly less in group A compared to group B (p=0.024, 0.027 and 0.000, respectively). After surgery, corneal recurrence developed in one eye (3.3%) from group A, which was significantly lower than the eight eyes (25%) from group B (p=0.027).
Multimicroporous e-PTFE insertion may provide a novel approach for treating intractable complicated multirecurrent pterygia.
To describe clinically, a case series of central toxic keratopathy (CTK), and contribute with one possible aetiology of this entity.
A retrospective observational case series, which included 12 eyes diagnosed with CTK after undergoing laser refractive surgery in situ keratomileusis (LASIK).
From a total of 28 eyes that underwent LASIK in the same week, 12 develop CTK. The mean time of the diagnostic was 4 days after surgery. The resolution time had an interval between 1, 3 and 9 months, and an average of 4.6 months. The occurrence of CTK cases coincided with the change of the brand of surgical gloves, and no further cases were found after their replacement.
The CTK clinical findings are well described, but with a yet unknown origin. It seems clear that it does not require specific treatment. It is possible that there might be a relationship between a substance of the gloves and CTK. Further studies are needed to know all the details of this process.
To investigate if the single nucleotide polymorphisms rs3753841, rs1015213 and rs11024102, recently implicated in the development of acute primary angle closure or primary angle closure glaucoma, are associated with ocular biometric characteristics of British adults in the European Prospective Investigation of Cancer-Norfolk eye study.
Genotyping data on rs1015213 (between PCMTD1 and ST18), rs11024102 (at PLEKHA7) and rs3753841 (at COL11A1) were available on 3268 participants. Direct genotypic data was available for rs1015213 and rs3753841. Data was imputed for rs11024102. Ocular biometric data was available on 1137 participants who attended the third European Prospective Investigation of Cancer health examination and 988 (87%) of these participants had no previous cataract surgery either eye. Axial length (AL), anterior chamber depth (ACD) and corneal keratometry were measured by using the Zeiss IOLMaster.
Presence of at least one A allele (AG or AA genotype) for rs1015213 was associated with a shallower ACD (–0.07 mm, 95% CI –0.01 to –0.14 mm, p=0.028) after adjusting for age and sex (both p≤0.001). There was no association with AL or corneal keratometry for rs1015213 genotypes. AL, ACD and keratometry were not associated with rs3753841 or rs11024102 genotypes including after adjusting for age and sex.
This study suggests that primary angle closure glaucoma susceptibility at the PCMTD1-ST18 locus may be partly explained by an association between rs1015213 and ACD in European populations. This effect is equivalent to almost 20% of the SD of the mean ACD of phakic individuals in this cohort. We were not able to identify any association between rs3753841 or rs11024102 and ocular biometry.
To investigate the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy (DS) with anterior segment optical coherence tomography (AS-OCT).
In a prospective cross-sectional study, AS-OCT parameters were compared between DS, trabeculectomy and control cases. Association with IOP and success (IOP≤16 mm Hg without medication) was investigated.
18 DS (15 patients), 17 trabeculectomy (16 patients) and 15 controls (15 patients) were examined. Successful had a taller intrascleral lake (IL) and thicker conjunctival/Tenon's layer (CTL) than non-successful cases (513.3 vs 361.1 µm, p=0.027 and 586.7 vs 251.1 µm, p<0.001, respectively). CTL thickness correlated with IOP (r=–0.6407, p=0.004). CTL thickness was significantly different between controls, DS and trabeculectomy (mean (SD): 203.3 (62.6) vs 418.9 (261.9) vs 604.1 (220.7) µm, p<0.0001). Successful trabeculectomy cases had a taller bleb cavity (BC) than non-successful cases (607.5 vs 176.7 µm, p=0.041). CTL microcysts were detected in 50% of DS and 52.9% of trabeculectomy cases (p=1).
Trans-conjunctival aqueous percolation was identified as a novel DS drainage route. DS had a fluid reservoir below the scleral flap, the IL, in analogy to the trabeculectomy BC. A postoperative tall IL and a thick CTL were associated with good outcome.
To investigate whether previous cyclodestructive (eg, cyclophotocoagulation and cyclocryodestruction) procedures have any influence on the general outcome and pressure level after glaucoma drainage device (GDD) surgery.
Retrospective analysis of 110 consecutive patients who had undergone GDD (Baerveldt 250 mm2 and 350 mm2 implant, AMO, USA) surgery with a minimum follow-up of 3 months. The patients were divided into patients with previous cyclodestructive surgery before GDD surgery (I; 47 patients) and patients without previous cyclodestructive surgery (II; 63 patients). Intraocular pressure (IOP), medication score, best-corrected visual acuity and surgical treatments were recorded before and after drainage device implantation.
Patients of group I had a mean preoperative IOP of 32.1 mm Hg and a mean medication score of 4.8; patients of group II had a mean preoperative IOP of 29.2 mm Hg (p=0.18) and a mean medication score of 4.9 (p=0.84). All patients who developed suprachoroidal haemorrhage (six cases) belonged to group I (6/47=12.8%), no patient of group II (0/63=0%) developed suprachoroidal haemorrhage (Fisher's test: p=0.01). Twelve patients developed late-onset (>6 weeks after GDD surgery) hypotony, nine of them belonging to group I (9/47=19.1%) and three of them to group II (3/63=4.8%) (Fisher's test: p=0.03).
While taking potential bias arising from the retrospective nature of the study into consideration, a history of previous cyclodestructive procedures before GDD surgery seems to be a major risk factor for suprachoroidal haemorrhage and for late-onset postoperative hypotony.
To report the complete lifetime direct healthcare costs of glaucoma treatment in a database of 1136 patients attending the Glaucoma Clinic at Glasgow Royal Infirmary, Glasgow, UK.
The database was interrogated to identify all patients who had initiated treatment at the Glaucoma Clinic at Glasgow Royal Infirmary, and who had subsequently died of natural causes. The healthcare resource use based cost assessment was based on two aspects of the direct National Health Service cost: drug costs (prescribed medications) and non-drug costs (inpatient or outpatient/and surgical or procedure costs).
106 patients (53 men, 53 women) were identified for whom there were lifetime treatment data. The mean lifespan of the patients was 80.5 years, and the mean number of years attending the glaucoma clinic was 7.05 years (range 1–22 years). The mean cost of glaucoma treatment over the lifetime of the patients was £3001, with an annual mean cost per patient of £475. Non-drug and drug costs made up 66% and 34% respectively, of the lifetime costs.
This is the only study to directly assess the lifetime treatment costs of glaucoma. Awareness of the costs of glaucoma treatment may be of increased importance in these financially challenging times.
To evaluate the effect of topical diquafosol in patients with meibomian gland dysfunction (MGD) using tear film parameters and quantitatively analyse the meibomian gland morphology.
The subjects were 19 eyes of 10 patients diagnosed with obstructive MGD. All subjects were given 3% diquafosol ophthalmic solution with instructions to use one drop four times a day. Ocular symptoms were scored from 0 to 14. Lid margin abnormalities were scored from 0 to 4. Changes in the meibomian glands were scored using non-contact meibography (meiboscore). Superficial punctate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3. Tear film production was evaluated by Schirmer's test. Quantitative image analysis of the meibomian glands was performed using the original software.
10 patients completed more than 4 months of therapy. Ocular symptoms, lid margin abnormalities, SPK score and meibum grade were decreased. Break-up time and tear film meniscus were increased. Mean ratio of the meibomian gland area was significantly increased after treatment (p<0.0001).
Quantitative image analysis was useful for evaluating the morphological changes of the meibomian glands. Topical diquafosol therapy was effective for patients with obstructive MGD.
To report the local control and complication rates of orthovoltage radiotherapy in the management of medial canthal basal cell carcinoma (BCC).
The medical records of all patients treated with medial canthal BCC between 1998 and 2010, with orthovoltage radiotherapy as primary treatment, adjuvant treatment after incomplete surgical excision, or for tumour recurrence following surgical excision, were retrospectively studied. The actuarial rates of tumour control and complications were calculated using Kaplan–Meier estimates. Main outcome measures were rates of tumour control and radiation complications.
90 patients were included with a median follow-up of 80 months. Tumour control rate at 10 years for the entire cohort was 94% (95% CI 84% to 98%). Tumour control rates showed no statistically significant differences among different treatment intents or treatment radiation energies. Radiation-related complication rates included loss of eyelashes in 59% (95% CI 48% to 66%), epiphora 51% (95% CI 39% to 62%), dry eye 14% (95% CI 3% to 35%) and conjunctival scarring 11% (95% CI 1% to 33%). No patient developed long-term corneal complications.
Orthovoltage radiotherapy can be a reliable therapeutic alternative for selected medial canthal BCCs, which can be contained within the prescribed radiation field, with anticipated radiation-related toxicities.
We present a series of patients with acute suppurative bacterial dacryoadenitis and review the clinical presentation, microbiology, treatment options and outcome.
A multicentre, retrospective, case series review of patients with a clinical diagnosis of acute bacterial suppurative dacryoadenitis (ASBD). Records were examined to obtain information regarding patient demographics, presenting symptoms and signs, radiology, microbiology, management, outcomes and follow-up.
11 patients (9 men, 2 women; mean age 43.9 years, range: 6–82 years) were included. Average time to presentation was 2.8 days, and predisposing conditions were found in 45% of cases. Common presenting symptoms were eyelid swelling, pain, redness and diplopia, and common signs were ptosis, discharge and restriction of eye movements. The most common causative bacteria were Staphylococcus aureus and skin flora. Lacrimal gland swelling was universally seen on CT, with globe indentation of displacement in 27% of cases. Intravenous antibiotics were used in 91% of cases, which subsequently resolved over an average period of 9.7 days. Those with abscess formation (n=2) required incision and drainage.
ASBD is a rare condition that resolves quickly if managed appropriately. Underlying anatomical, infectious or inflammatory conditions should be investigated, and skin commensals should be covered with the instigation of antibiotic therapy.
To evaluate the safety and efficacy of intralesional pingyangmycin for treatment of orbital vascular malformations.
Thirteen patients received intralesional injections of pingyangmycin at the Eye and ENT Hospital of Fudan University. CT scans of each patient were evaluated with graphic processing software to measure lesion volumes before and after treatment.
Of five men and eight women patients averaging 36 years old, six were diagnosed with venous malformations, six with cavernous haemangiomas, and one with lymphangioma. Proptosis and eyelid swelling were the most common presenting signs. The mean preoperative lesion volume was 4.4±2.3 cm3 (range, 1.6–8.8 cm3), and the average postoperative volume was 1.5±1.7 cm3 (range, 0.2–6.6 cm3) after a single pingyangmycin injection, the dose of which averaged 4.2 mg (range, 2–6 mg). The mean percentage of volume reduction was 70.0% (range, 24.5–88.3%), whereas proptosis reduction averaged 3.2 mm (range, 0–5.5 mm). The lesion volume and proptosis reductions were both statistically significant (p<0.001, and p=0.001). No adverse local or systemic side effects occurred in any of the patients during follow-up averaging 13.3 months. Histopathology of a cavernous haemangioma that underwent a second injection through a surgical incision, showed a mild chronic inflammatory response, increased numbers of myofibroblasts, loss of vascularity and fibrosis, all consistent with known effects of bleomycin treatment.
Intralesional injection of pingyangmycin for the treatment of orbital vascular malformations is an effective method that involves mild inflammation, fibrosis, and reduced vascularity of the malformation.
To study trends in rates of childhood squint surgery in England over five decades, and to study recent geographical variation in England.
Use of routine hospital statistics to analyse trends in squint surgery in the Oxford record linkage study area 1963–2010, and England 1968–2010; analysis of geographical variation in England 1999–2010. All rates, numerators and population denominators were restricted to people aged under 15 years.
The study included 519 089 admissions for operations on squint. Annual admission rates for squint surgery in England fell from 188.8 episodes per 100 000 population (95% CI 180.9 to 196.8) in 1968 to 64.1 (62.4 to 65.7) episodes per 100 000 population in 2010. A similar decline was seen in the Oxford region, from 213.2 (181.3 to 245.2) episodes per 100 000 population in 1963 to 61.3 (54.8 to 67.9) episodes in 2010. There was wide variation across local authorities in annual rates of squint surgery from 28.2 (95% CI 22.7 to 34.8) admissions per 100 000 population to 138.6 (123.0 to 155.7) admissions per 100 000, a 4.9-fold difference between areas with the highest and lowest rates.
Squint surgery rates have decreased substantially over time. The current wide geographical variation in rates raises questions about whether this scale of variation is clinically warranted, whether it reflects variation in needs for surgery and patient/parental choice, whether it is a result of inequalities in the availability of ophthalmic services, or whether it results from variation between clinicians in clinical decision making about the likely benefits of squint surgery.
To compare outcomes following contralateral lateral rectus (LR) recession and recess–resect (RR) procedures for recurrent exotropia of 20–25 prism dioptres (PD) after unilateral RR.
39 subjects were included in this retrospective study. All underwent, as a primary surgery for intermittent exotropia, unilateral RR on the non-dominant eye. They were assigned to the subsequent contralateral LR recession (LR, n=19) or RR (n=20) group for recurrent exotropia of 20–25 PD. Surgical success was defined as alignment between 5 PD esodeviation and 10 PD exodeviation.
The mean follow-up duration after the reoperation was 32.3±26.4 months in the LR group and 30.5±26.8 in the RR group (p=0.945). The mean deviation angles at postoperative 1 day were –0.7 PD (overcorrection) in the LR group and –4.3 PD in the RR group (p=0.047). The deviation angles at 3 and 6 months postoperatively were not significant (p=0.771, p=0.923). The final successful outcome was achieved in 63.2% of patients in the LR group and in 65% of patients in the RR group (p=0.905).
Contralateral LR recession was found to be a safe and effective procedure for the treatment of recurrent exotropia of 20–25 PD after unilateral RR for intermittent exotropia. With LR recession, the intentional overcorrection in the immediate postoperative period could be avoided.
As part of the UK and Ireland study of primary IOL implantation in children under 2, active surveillance has been undertaken to identify children aged <2 years undergoing surgery for cataract. Ascertainment through active surveillance has been compared to the routine NHS capture of episodes of surgery, in order to identify any weaknesses in routine data collection.
NHS information centre data on the number of children undergoing lens extraction in the first two years of life were compared to the number of cases reported through active surveillance.
In 2009 and 2010 in the United Kingdom, 483 episodes of lens extraction in children aged <2 years with lens-related disease were reported to NHS databases, compared to 490 cases of lens extraction for congenital / infantile cataract ascertained by the BCCIG through active surveillance. There was also disparity in the coding of procedures.
There is evidence of incomplete and inaccurate reporting to NHS information centres of cataract surgery in children aged <2 years. If the accuracy of the coding could be improved then the Hospital Activity Statistics offer a reasonable approach to monitoring trends in the NHS. Nevertheless, active surveillance clinical networks remain a more robust method of case ascertainment for research.
To characterise the childhood retinal phenotype associated with recessive mutations in retinitis pigmentosa GTPase regulator interacting protein 1 (RPGRIP1), a gene that has been infrequently associated with Leber congenital amaurosis, the most severe form of childhood non-syndromic retinal dystrophy.
This was a retrospective case series analysis.
Nine children (seven families) with homozygous RPGRIP1 mutations were identified. All were noted by their families to have had shaking eyes, variable eye turn and/or poor vision at or soon after birth and to be more comfortable in darkness than daylight. At the age of examination (2–7 years of age) fixation was poor or non-existent with hemeralopia, nystagmus, variable strabismus and often an oculodigital sign (6/9). Electroretinography was non-recordable. The posterior pole was grossly normal with mild vascular attenuation, but one girl did have a subtle abnormal macular reflex associated with decreased autofluorescence. Retinal pigment epithelium changes were seen in the periphery, ranging from mottling to bone spicules, and cycloplaegic refraction was hyperopic (+3 to +10 diopters). Two children were photophobic and two were developmentally delayed. One boy had oesotropia and nystagmus that decreased when hyperopic spectacles were worn. One girl decreased her nystagmus amplitude by adopting a particular gaze preference.
Recessive RPGRIP1 mutations cause a severe cone–rod Leber congenital amaurosis phenotype, often with poor or no fixation and an oculodigital sign. In the first decade of life retinal changes are clinically most evident in the periphery. Despite the typical severity of the phenotype, fixation can improve for some affected children with wear of the associated hyperopic refraction or by a null point that dampens nystagmus. Spectacle correction of high refractive errors should be encouraged.
To report the refractive error difference (RED) between parents and their children and the estimated single generational myopic shift in an urban area in China.
395 children aged 6–17 years and their parents, who had been enrolled in the Beijing Myopia Progression Study were included. Cycloplegic and non-cycloplegic refraction of the children and parents were performed, respectively. RED was defined as the difference between the average parental spherical equivalent (SE) and the average SE of their children. Binomial fitted curves of RED were plotted as a function of the children's age. Generational myopic shift was defined as the estimated RED according to the prediction model at the age of 18 years.
395 families were enrolled. The RED was positively correlated with the children's age (rspearman=0.58, p<0.001). The RED (median (25th and 75th percentile)) was –1.88 (–3.23 to –1.00) dioptres (D) in children at 6.0–7.9 years of age, and it increased to 1.53 (–0.12 to 3.44) D in children at 16.0–17.9 years of age. The SE of the children approached the average SE of their parents at the age of 11 years. At the age of 18 years, the children's estimated myopic shift would be 1.94 D.
In this sample, children's refractive errors at the age of 11 years were already similar to their parents. Moreover, the estimated myopia in children at the age of 18 years would be up to 2.0 D higher than their parents. This remarkable single-generation myopic shift indicates that there are likely effects of environmental factors on myopia development in urban Chinese children.
Choroidal neovascularisation is often associated with pathological myopia. Bisphosphonates (BP), the preferred drug for treatment of osteoporosis, are known to have anti-angiogenic effects.
To compare the therapeutic effects of oral BP with anti-vascular endothelial growth factor therapy (anti-VEGF) and photodynamic therapy (PDT) for myopic choroidal neovascularisation (mCNV) over 2 years of follow-up.
One hundred eyes of 96 consecutive patients with mCNV who underwent oral BP treatment (alendronate 5 mg/day or 35 mg/week), anti-VEGF therapy, PDT or observation only were followed up for 2 years. The best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) in optical coherence tomography were compared among the treatment groups.
The mean BCVA of the patients was maintained for up to 2 years in the BP and PDT groups. In the anti-VEGF group, the mean BCVA was significantly improved but was significantly worse in the no-treatment group. The visual outcomes were significantly better in the BP, PDT and anti-VEGF groups than the no-treatment group over 2 years of follow-up (–0.28, –0.26 and –0.39 logMAR units, p=0.032, 0.021 and 0.0004, respectively). The mean CRT was significantly decreased in all treatment groups (–84, –121 and –122 mm, p=0.0025, 0.017 and 0.000025, respectively).
Oral BP should be investigated further as possible therapeutic and preventive drugs for mCNV.
To quantitatively evaluate the time course of macular choroidal blood flow velocity in acute central serous chorioretinopathy (CSC).
This retrospective observational case series included 21 eyes of 20 patients (17 men, 3 women; mean age, 53.0 years) with treatment-naïve acute CSC. Laser speckle flowgraphy was performed to calculate macular mean blur rate (MBR), an indicator of relative blood flow velocity at the first visit, 3 and 6 months thereafter. Changes in average MBR values were compared with visual improvement at 6 months.
Subretinal fluid completely resolved in all eyes within 6 months, while best-corrected visual acuity (BCVA) significantly improved at 6 months compared to the initial BCVA. During the follow-up period, the average MBR significantly decreased to 92.8% and 82.3% at 3 and 6 months, respectively, against baseline (100%). Importantly, there was a negative correlation between the BCVA recovery and the MBR decrease, showing the possible association of MBR increase with poor visual prognosis. Multiple regression analysis demonstrated no significant correlation between MBR and ocular perfusion pressure.
These results indicate that macular choroidal blood flow velocity decreases concurrently with regression of CSC, suggesting a validity of choroidal blood flow elevation in the pathogenesis of acute CSC.
To identify the relationship of retinal arteries in a population with systemic arterial hypertension.
High resolution, dilated, digitised, fundus photographs of consecutive patients with a history of hypertension requiring pharmacologic therapy seen on the Wills Eye Hospital Retina Service were analysed. Included were photographs of the temporal retinal vascular arcades in which media clarity permitted good visualisation of third-order retinal vascular bifurcations. Each first- and second-order arteriovenous (AV) crossing was then examined to identify anatomic patterns at the sites where veins and arteries crossed. Eyes in patients without a history of hypertension were used as controls.
Among the 71 patients (134 eyes), there were 430 first-order and second-order AV crossings, in which AV nicking was present at 126 sites. A retinal artery was located anterior to the retinal vein in 122 of the 126 sites (96.8%) at which AV nicking was noted, while nicking associated with the vein located anteriorly to the artery occurred in only 4 of 126 (3.2%) of AV crossings (p<0.001). An anatomical pattern of venous arching, or cascading of a retinal vein over a retinal artery, was noted predominantly when the vein was positioned anterior to the artery in both subjects and controls. Among the 43 venous arching sites in the study group, 41 (95.3%) demonstrated the retinal vein anterior to retinal artery (p<0.001).
In patients with systemic arterial hypertension and hypertensive retinopathy, AV nicking of the retinal vein at the site of AV crossing is seen predominantly when the retinal artery lies anterior to the vein, but generally not when the vein lies anterior to the artery. The clinician should realise that when a retinal vein lies anterior to a retinal artery, the absence of AV nicking does not rule out more severe, chronic, retinopathic changes than observed with retinal arterial straightening only.
To examine the relationship between aspirin intake and early age-related macular degeneration (AMD) among an Asian population.
A population based cross sectional study of 3207 ethnic Indians aged 40 years or older residing in Singapore. AMD signs were graded from retinal images following the modified Wisconsin grading system. Information on aspirin intake was obtained from a standardised questionnaire.
The prevalence of early AMD was 5.6%. Aspirin use was reported by 11.4% of participants. Early AMD signs were present among 10.9% of aspirin users and 4.9% of non-aspirin users (p<0.001). After adjusting for potential confounders, including age, smoking and previous cataract surgery, aspirin use was associated with early AMD (OR 1.50; 95% CI: 1.01 to 2.22). The association weakened and was not significant after additional adjustment for cardiovascular disease (OR 1.38; 95% CI 0.89 to 2.14). In stratified analysis, aspirin use was significantly associated with early AMD in participants with (adjusted OR 2.64, 95% CI 1.31 to 5.36) but not without (OR 0.73; 95% CI 0.36 to 1.51) a history of cardiovascular disease (interaction term, p=0.011).
Aspirin intake overall was not associated with early AMD in this sample of Asian Indians, but in those with a history of cardiovascular disease the association between aspirin intake and early AMD might warrant further investigation.
To investigate the effect of a structured, supervised, cataract simulation programme on ophthalmic surgeons in their first year of training, and to evaluate the level of skill transfer.
Trainees with minimal intraocular and simulator experience in their first year of ophthalmology undertook a structured, sequential, customised, virtual reality (VR) cataract training programme developed through the International Forum of Ophthalmic Simulation. A set of one-handed, bimanual, static and dynamic tasks were evaluated before and after the course and scores obtained. Statistical significance was evaluated with the Wilcoxon sign-rank test.
The median precourse score of 101.50/400 (IQR 58.75–145.75) was significantly improved after completing the training programme ((postcourse score: 302/400, range: 266.25–343), p<0.001). While improvement was evident and found to be statistically significant in all parameters, greatest improvements were found for capsulorhexis and antitremor training ((Capsulorhexis: precourse score=0/100, range 0–4.5; postcourse score=81/100, range 13–87.75; p=0.002), (antitremor training: precourse score=0/100, range 0–0; postcourse score=80/100, range 60.25–91.50; p=0.001)).
Structured and supervised VR training can offer a significant level of skills transfer to novice ophthalmic surgeons. VR training at the earliest stage of ophthalmic surgical training may, therefore, be of benefit.
At presentation in the department of ophthalmology CSMMU Lucknow, the child had bilateral, severe, axial, non-pulsatile, almost symmetrical proptosis, along with forniceal prolapse, conjunctival chemosis and exposure keratopathy. The ocular movements were restricted in all directions in both the eyes. There was no fundal view because of the severe exposure keratopathy (
What is the differential diagnosis of severe proptosis in a neonate? What are the most relevant investigations? What are the immediate management options? What are the...]]>
We have found similar evidence of obstructive sleep apnoea syndrome (SAS) tested by overnight pulse oximetry in a cohort of 17 consecutive patients presenting to the eye clinic with non-arteritic ischaemic optic neuropathy (NAION).
Patients answered an abbreviated questionnaire of SAS and were sent for sleep studies if they had symptoms. They were tested by the sleep clinic with overnight oximetry and answered the Epworth sleepiness scale. Of the patients 64.7% were diagnosed with SAS, 55% were men, and the mean age was 79 years. The prevalence of SAS in patients with NAION has been previously found to be as high as 89%.
NAION is rare with an incidence...]]>
Latanoprost was the first prostaglandin analogue to be licensed for the treatment of primary open angle glaucoma and ocular hypertension. In 2012, the patent to manufacture branded latanoprost (Xalatan) expired, and a number of generics manufacturers created the product. This meant that since January 2012, our patients received a number of various generic versions of latanoprost with variations in bottle size and shape.
We performed a questionnaire survey of 50 consecutive patients attending our glaucoma service...]]>
We were very interested in the results of the survey by Connor and Fraser
The GENEVA trial
Medical records and optical coherence tomography (OCT) images of consecutive patients with macular oedema secondary to CRVO treated with Ozurdex between October 2010 and January 2012 in three centres in the northeast part of England were reviewed. Patients were seen at baseline and 1, 3 and 6 months after injection of Ozurdex. Treatment-naive CRVO patients with at least 6 months follow-up...]]>
We thank Dr Shoaib for the points raised
It is difficult to compare results across studies because differing success criteria are often used, an issue which we mentioned in our discussion and believe should be addressed by future studies. In particular these outcome criteria do not take into account the initial characteristics of the patients studied or assess the control of their deviations. We chose the Pineles et al