The article "Oral rifampin utilisation for the treatment of chronic
multifocal central serous retinopathy(CSR)"1 by Steinle NC et al is very
informative. However a few points require further elaboration. We were
told that patient is an African -American but for how long he stayed in
Africa and how frequently he or any of his close family members visit any
tuberculosis (TB) endemic area? As both CSR and ocular TB are poor...
The article "Oral rifampin utilisation for the treatment of chronic
multifocal central serous retinopathy(CSR)"1 by Steinle NC et al is very
informative. However a few points require further elaboration. We were
told that patient is an African -American but for how long he stayed in
Africa and how frequently he or any of his close family members visit any
tuberculosis (TB) endemic area? As both CSR and ocular TB are poorly
understood diseases, there is a possibility that these were confused with
each other or TB was the underlying pathology in this condition which
resembled CSR. Furthermore Rifampin did not cure the disease and its
discontinuation led to recurrence which is also true in incomplete TB
treatment. Recommendations in this case include an appropriate test like
QuantiFERON-TB Gold2 or polymerase chain reactions (PCR) of vitreous, to
rule out TB and a full six month course of anti TB3 to avoid recurrences.
References:
1. Steinle NC, Gupta N, Yuan A, Singh RP. Oral rifampin utilisation for
the treatment of chronic multifocal central serous retinopathy. Br J
Ophthalmol. 2012 Jan;96(1):10-3.
2. Gineys R, Bodaghi B, Carcelain G, Cassoux N, Boutin le TH, Amoura Z,
Lehoang P, Trad S. QuantiFERON-TB gold cut-off value: implications for the
management of tuberculosis-related ocular inflammation. Am J Ophthalmol.
2011 Sep;152(3):433-440.e1
3. Sanghvi C, Bell C, Woodhead M, Hardy C, Jones N. Presumed tuberculous
uveitis: diagnosis, management, and outcome. Eye (Lond). 2011
Apr;25(4):475-80.
I wish to thank Ganesh et al for confirming (p <0.001) the marked
and obvious difference between the age distribution of retinal and
subdural haemorrhages in America and Japan. Finding this difference "not
surprising" neither negates nor explains it. More sophisticated child
abuse teams could not discover cases in Japan months before they occur.
Variations in incidence of osteogenesis imperfecta wou...
I wish to thank Ganesh et al for confirming (p <0.001) the marked
and obvious difference between the age distribution of retinal and
subdural haemorrhages in America and Japan. Finding this difference "not
surprising" neither negates nor explains it. More sophisticated child
abuse teams could not discover cases in Japan months before they occur.
Variations in incidence of osteogenesis imperfecta would not either. While
in America apparently people "lose it" and shake kids 4-6 weeks after they
cry (the "lag time" between the crying and SBS incidence curves), it is
unlikely the Japanese wait several months more. The traditional
explanations of differences in relative head size and strength of neck
muscles and vitreo-retinal adherence also fail to explain it. Thus, my
suggestion of an inquiry into this difference remains unaddressed.
The results presented here have a very important impact on the understanding
of
retinopathy of prematurity and its prevention. It also has several
implications for glaucoma treatment. Several drugs have been trying to
show a beneficial effect on ocular blood flow, but there are several
limitations to the methods used. Dorzolamide is thought to have a potential
benneficial effect on optic nerve head circulati...
The results presented here have a very important impact on the understanding
of
retinopathy of prematurity and its prevention. It also has several
implications for glaucoma treatment. Several drugs have been trying to
show a beneficial effect on ocular blood flow, but there are several
limitations to the methods used. Dorzolamide is thought to have a potential
benneficial effect on optic nerve head circulation by inducing a localised
acidosis by blocking
carbonic anhydrase. The results suggest that this effect, if present,
might not be reflected on any method which studies retinal circulation.
Pulsatile ocular blood flow measurements suggest that choroidal
circulation is increased by this drug. Also endothelin mediated retinal
vasoconstriction should be enhanced by other drugs said to affect
vasoregulation, such as unoprostone.
The model presented here, using the same method or any others that combine
doppler and
diameter analysis, should become a very important investigation tool to
evaluate the effect of this and other drugs on retinal circulation and
reversal of hyperoxia-induced vasoconstriction.
As cataract surgeons move toward toward less invasive procedures
including topical anesthesia, Friedman et al.[1] have done a research on
the patient's perspective.
Their results surprisingly showed that
patients preferred retrobulbar blockade anaesthesia over topical
anaesthesia in preparing for cataract surgery, raising the question
whether ophthalmologists are moving in the proper dir...
As cataract surgeons move toward toward less invasive procedures
including topical anesthesia, Friedman et al.[1] have done a research on
the patient's perspective.
Their results surprisingly showed that
patients preferred retrobulbar blockade anaesthesia over topical
anaesthesia in preparing for cataract surgery, raising the question
whether ophthalmologists are moving in the proper direction. However,
for informed consent patients need to be told not only the risks and
benefits of the cataract surgery itself but also the risk and benefits
of the alternative anesthesia modalities.[2] While rare, complications
of retrobulbar anesthesia injection can be devastating; for example,
inadvertent globe perforation,[3] blindness from the injection into the
optic nerve,[4] or apnea resulting from subarachnoid injection of the
anaesthetic agent.[5-6] Had the patients been informed of these uncommon
but serious complications, their preferences might have been altered and
the study results might have been different.
I appreciate the editorial, “Cataract surgery programmes in Africa”
in response to our paper “Increasing cataract surgery to meet VISION
2020 targets; experience from two rural programmes in East Africa.” I
agree with the need to generate evidence for the effectiveness of public
health interventions and thank you for drawing attention to this. As
pointed out, public health interventions are multifacete...
I appreciate the editorial, “Cataract surgery programmes in Africa”
in response to our paper “Increasing cataract surgery to meet VISION
2020 targets; experience from two rural programmes in East Africa.” I
agree with the need to generate evidence for the effectiveness of public
health interventions and thank you for drawing attention to this. As
pointed out, public health interventions are multifaceted and complex.
Such complexity requires the use of both quantitative and qualitative
methods to describe and understand. Within the space limits of our
paper, we could not provide more detail of either qualitative or
quantitative information we have generated on making changes at the
hospital in order to provide more service. However, this information is
provided in a booklet called “Karibuni Macho: transforming the Eye
Department of KCMC to reach VISION 2020 goals,” which may be downloaded
free at http://www.kcco.net (click Reports) or http://www.iefusa.org.
We read with great interest the study" Recovery of photoreceptor
inner and outer segment layer thickness after reattachment of
rhegmatogenous retinal detachment" by Terauchi G, et al.[1] Authors
concluded that thickness of inner segment layer (20.4 +/- 5.0 microns) at
one month after surgery was significantly less than fellow eye (28.9 =/-
2.9 microns). However, we know that the axial resolution of Spectral
Domain(SD)...
We read with great interest the study" Recovery of photoreceptor
inner and outer segment layer thickness after reattachment of
rhegmatogenous retinal detachment" by Terauchi G, et al.[1] Authors
concluded that thickness of inner segment layer (20.4 +/- 5.0 microns) at
one month after surgery was significantly less than fellow eye (28.9 =/-
2.9 microns). However, we know that the axial resolution of Spectral
Domain(SD)-OCT is approximately 5 microns i.e. one pixel on the scan image
would represent for 5 microns. This would lead to a difference between the
outer segment measurements in operated eye and fellow eye in the range of
1-2 pixels, leaving very little room for error. Although, coefficient of
repeatability for total macular thickness in Diabetic Macular Edema was
found as high as 9 micron.[2] The measurement error and coefficient of
repeatability of outer segment and inner segment measurements using SD-OCT
is still not known. Keeping this in account, would the results still
remain statistically significant? Hence, if measurements were taken by
Adaptive optics-OCT with axial resolution of 3micron[3]there would be
greater reliability of measurements and results compared to SD-OCT
especially considering smaller measurements like outer and inner segment
layer thickness.
We keenly wait authors' reply.
References
1. Terauchi, G., et al., Recovery of photoreceptor inner and outer
segment layer thickness after reattachment of rhegmatogenous retinal
detachment. Br J Ophthalmol, 2015. 99(10): p. 1323-7.
2. Sohn, E.H., et al., Reproducibility of diabetic macular edema estimates
from SD-OCT is affected by the choice of image analysis algorithm. Invest
Ophthalmol Vis Sci, 2013. 54(6): p. 4184-8.
3. Miller, D.T., et al., Adaptive optics and the eye (super resolution
OCT). Eye (Lond), 2011. 25(3): p. 321-30.
Article "Endothelial keratoplasty without Descemet's stripping in
eyes with previous penetrating corneal transplants" by Nottage JM and
Nirankari VS1, is very informative and the authors deserve appreciation
for their wonderful work. However one point requires discussion. Authors
mentioned that endothelial keratoplasty (EK) was done either for graft
rejection (n = 9) or endothelial failure (n = 24). It seems logical to...
Article "Endothelial keratoplasty without Descemet's stripping in
eyes with previous penetrating corneal transplants" by Nottage JM and
Nirankari VS1, is very informative and the authors deserve appreciation
for their wonderful work. However one point requires discussion. Authors
mentioned that endothelial keratoplasty (EK) was done either for graft
rejection (n = 9) or endothelial failure (n = 24). It seems logical to
replace endothelium in endothelium failure. The question is how new
endothelium can correct graft rejection? Authors mention "An allograft
rejection was defined as corneal clouding in association with an
epithelial or endothelial rejection line, keratic precipitates and/or
anterior chamber cells." Endothelial line reflecting endothelial rejection
can qualify as an indication for EK but the rest of the signs can be due
to rejection of the other parts of the graft. A further breakdown of the
frequency of above mentioned signs of allograft rejection would have been
useful.
Other authors have been careful not to include the generalized graft
rejection cases for EK e.g. Chen ES et al2 mentioned in their Protocal
under the heading of Methods, the inclusion criteria "after penetrating
keratoplasty (PK) and without significant stromal haze". Similarly Straiko
et al3 described inclusion criteria "for failed PK grafts from endothelial
failure with minimal stromal Opacities" and "all eyes with a prior
standard PK graft that had failed because of immunologic or nonimmunologic
endothelial failure".
Graft rejection results from host immunologic response against foreign
antigen from donor tissue. Li JY et al 4 observed that it can lead to
decreased endothelial cell survival and graft failure. They reported a
graft rejection rate of 7.3 % and that the greatest number of rejections
occurred between postoperative months 12 and 18.
An initial improvement due to healthy endothelial can be expected in all
cases of EK but antigenic stimulation will continue even after removal of
the rejected graft's endothelium. Especially for the one patient regarding
whom authors1 of the under discussion article wrote "had multiple previous
graft failure, requiring placement of an investigational ciclosporine
implant to prevent further rejection." Should we do EK or PK in PK
rejection cases? Perhaps a longer follow up will answer this question.
References:
1. Nottage JM, Nirankari VS. Endothelial keratoplasty without Descemet's
stripping in eyes with previous penetrating corneal transplants. Br J
Ophthalmol. 2012 Jan;96(1):24-7
2. Chen ES, Terry MA, Shamie N, Hoar KL, Phillips PM, Friend DJ.
Endothelial keratoplasty: vision, endothelial survival, and complications
in a comparative case series of fellows vs attending surgeons. Am J
Ophthalmol. 2009 Jul;148(1):26-31.e2. Epub 2009 Apr 17.
3. Straiko MD, Terry MA, Shamie N. Descemet stripping automated
endothelial keratoplasty under failed penetrating keratoplasty: a surgical
strategy to minimize complications. Am J Ophthalmol. 2011 Feb;151(2):233-
7.e2. Epub 2010 Dec 3.
4. Li JY, Terry MA, Goshe J, Shamie N, Davis-Boozer D. Graft rejection
after descemet's stripping automated endothelial keratoplasty graft
survival and endothelial cell loss. Ophthalmology. 2012 Jan;119(1):90-4.
Epub 2011 Nov 23.
We were interested to read the letter by Patel et al. reporting the
unusual and striking fundus appearance of retinal arteriolar calcification
in association with chronic renal failure.[1] However, we feel that two
important conditions have been omitted from the comment, which merit
further discussion.
First, Monckeberg’s sclerosis, which in its classic form is
characterised by ‘pipe-stem’...
We were interested to read the letter by Patel et al. reporting the
unusual and striking fundus appearance of retinal arteriolar calcification
in association with chronic renal failure.[1] However, we feel that two
important conditions have been omitted from the comment, which merit
further discussion.
First, Monckeberg’s sclerosis, which in its classic form is
characterised by ‘pipe-stem’ calcific deposition in the medial coat of
muscular arteries in middle-aged and elderly individuals,[2] and is
described with widespread systemic distribution.[3,4] Interestingly
though, a juvenile form is seen, particularly in association with chronic
renal failure and diabetes.[5] The pathological mechanism of Monckeberg’s
sclerosis is uncertain, but is thought to encompass elements both of
dystrophic and metastatic calcification.[6] In the reported case, it
would be of interest to know if there was any evidence of vascular
calcification elsewhere in this individual, or whether it was localised to
the retinal arterioles only.
Secondly, Senior-Loken syndrome (renal-retinal syndrome,
nephronophthisis associated with retinitis pigmentosa or retinal aplasia)
is also germane to this discussion.[7] Nephronophthisis is a major cause
of progressive medullary cystic renal disease leading to chronic renal
failure in adolescents.[8] It is associated with a variable retinal
phenotype, a reflection of both clinical and genetic heterogeneity. When
associated with retinitis pigmentosa, there is an absence of the classic
bone spicule pigmentation, but optic nerve head pallor and attenuation of
the blood vessels is seen. Also, electroretinographic alterations have
been reported in nephronophthisis despite normal a normal fundus
examination.[9] In view of the phenotypic overlap seen with the reported
case, results of electroretinography would be pertinent to the discussion.
We would also advocate a molecular genetic analysis at the known loci
associated with Senior-Loken syndrome, which could potentially reveal an
interesting new allelic variant.
Finally, whilst the fundus photograph elegantly demonstrates the
stark changes seen in the retinal vasculature, this evidence could be
further augmented with the addition of an ultrasound B-scan image
demonstrating the pathognomonic echogenic features of intra-ocular
calcification.
Moin Mohamed
Vision Research Group
Molecular Medicine Unit
University of Leeds
Martin McKibbin
Eye Clinic
St James’s University Hospital
Beckett Street
Leeds
References
(1) Patel DV, Snead MP, and Satchi K. Retinal arteriolar calcification in a patient with chronic renal failure. Br J Ophthalmol 2002;86:1063
(2) Juergens JL et al. Peripheral vascular diseases. 5th edition. Philadelphia: W Saunders. 1980. pp.238-240.
(3) Lachman AS, Spray TL, Kerwin DM, Shugoll GI, Roberts WC. Medial
calcinosis of Monckeberg. A review of the problem and a description of a
patient with involvement of peripheral, visceral and coronary arteries. Am
J Med 1977 Oct;63(4):615-22.
(3) Castillo BV Jr, Torczynski E, Edward DP. Monckeberg's sclerosis in
temporal artery biopsy specimens. Br J Ophthalmol 1999 Sep;83(9):1091-2.
(4) Monckeberg's sclerosis: an
unusual presentation. Top C, Cankir Z, Silit E, Yildirim S, Danaci M. Angiology 2002 Jul-Aug;53(4):483-6.
(5) Byts' IuV, Holdobina OV, Dosenko VIe, Dudko MO, Larionova NA. The
current concepts of the pathogenesis of Monckeberg-type arteriosclerosis.
Fiziol Zh 2000;46(2):64-72.
(7) Gusmano R, Ghiggeri GM, Caridi G. Nephronophthisis-medullary cystic disease: clinical and genetic aspects. J Nephrol 1998 Sep-Oct;11(5):224-8.
(8) Orssaud C, Kleinknecht C, Habib R, Broyer M. Hereditary chorioretinal
degeneration and nephronophthisis. The role of Senior-Loken syndrome.
Ophtalmologie 1989 Sep-Dec;3(4):270-2.
The authors would like to thank Dr. J.J. Wang for her constructive
comments about the statistical analysis of the data obtained in the
Beijing Eye Study.[1] As already pointed out in another recent reply to a
letter by Dr. Wang, the authors became aware of the limitations in their
statistical analysis of the data of the Beijing Eye Study.[2] The authors
are grateful to Dr. Wang for clarifying these wea...
The authors would like to thank Dr. J.J. Wang for her constructive
comments about the statistical analysis of the data obtained in the
Beijing Eye Study.[1] As already pointed out in another recent reply to a
letter by Dr. Wang, the authors became aware of the limitations in their
statistical analysis of the data of the Beijing Eye Study.[2] The authors
are grateful to Dr. Wang for clarifying these weaknesses so that these
weaknesses may be avoided in future statistical analyses of the data of
the Beijing Eye Study. In the article on the associated factors for age-related maculopathy in the adult population in China,[1] the figures in
the brackets of the Table generally give the 95% confidence intervals of
the odds ratios. The use of the abbreviation ”ARD” for “age-related
maculopathy” was a typographical error, instead of using “ARM” as
explained in the first paragraph of the Abstract. The association
estimates presented in the Table are crude (unadjusted).
Although Dr. Wang´s letter is rather critical about the statistical
analysis of the Beijing Eye Study, the authors are grateful to her for
showing up limitations in the statistical analysis, weaknesses that may be
avoided in future statistical analyses of the data of the Beijing Eye
Study.
References
1. Xu L, Li Y, Zheng Y, Jonas JB. Associated factors for age-related
maculopathy in the adult population in China. The Beijing Eye Study. Br J
Ophthalmol 2006; 90:1087-90.
2. Jonas JB, Xu L. Reply to the Letter-to-the-Editor, written by Wang JJ,
concerning the Beijing Eye Study. Am J Ophthalmol 2007; In Press.
The importance of standardizing postoperative corneal thickness
measurements is important for many reasons. At what juncture post
operatively did the authors sample postoperative pachymetric measurements?[1]
The OrbScan utilizes scanning slit technology that is unpredictably
influenced by optically sensitive interface changes in the early
postoperative healing phase in some lasik patients. In th...
The importance of standardizing postoperative corneal thickness
measurements is important for many reasons. At what juncture post
operatively did the authors sample postoperative pachymetric measurements?[1]
The OrbScan utilizes scanning slit technology that is unpredictably
influenced by optically sensitive interface changes in the early
postoperative healing phase in some lasik patients. In these postoperative
patients (with normal slit lamp biomicroscopy), there is light scatter
from the cornea causing a falsely evaluated posterior float and
concomitant falsely thin pachymetric reading. The ultrasound pachymetric
reading however show a significantly different picture and is in line with
the performed treatment parameters. These initial OrbScan errors may be
linked with the patients’ early perception of haze. Repeat OrbScan
measurements months post operatively in these corneas show resolution of
the thinning/posterior float artifact, which may be commensurate with
histo pathologic healing process. Concomitancy some patients may have a
decreased perception of haze over this juncture. Perhaps what in reality
was post lasik cornea scatter resolution, has been mislabeled as “cortical
adaptation.”
References
1. K Kawana, T Tokunaga, K Miyata, F Okamoto, T Kiuchi, and T Oshika. Comparison of corneal thickness measurements using Orbscan II, non-contact specular microscopy, and ultrasonic pachymetry in eyes after laser in situ keratomileusis. Br J Ophthalmol 2004; 88: 466-468.
The article "Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopathy(CSR)"1 by Steinle NC et al is very informative. However a few points require further elaboration. We were told that patient is an African -American but for how long he stayed in Africa and how frequently he or any of his close family members visit any tuberculosis (TB) endemic area? As both CSR and ocular TB are poor...
Dear Editor
I wish to thank Ganesh et al for confirming (p <0.001) the marked and obvious difference between the age distribution of retinal and subdural haemorrhages in America and Japan. Finding this difference "not surprising" neither negates nor explains it. More sophisticated child abuse teams could not discover cases in Japan months before they occur. Variations in incidence of osteogenesis imperfecta wou...
Dear Editor
The results presented here have a very important impact on the understanding of retinopathy of prematurity and its prevention. It also has several implications for glaucoma treatment. Several drugs have been trying to show a beneficial effect on ocular blood flow, but there are several limitations to the methods used. Dorzolamide is thought to have a potential benneficial effect on optic nerve head circulati...
Dear Editor
As cataract surgeons move toward toward less invasive procedures including topical anesthesia, Friedman et al.[1] have done a research on the patient's perspective.
Their results surprisingly showed that patients preferred retrobulbar blockade anaesthesia over topical anaesthesia in preparing for cataract surgery, raising the question whether ophthalmologists are moving in the proper dir...
Dear Editor,
I appreciate the editorial, “Cataract surgery programmes in Africa” in response to our paper “Increasing cataract surgery to meet VISION 2020 targets; experience from two rural programmes in East Africa.” I agree with the need to generate evidence for the effectiveness of public health interventions and thank you for drawing attention to this. As pointed out, public health interventions are multifacete...
We read with great interest the study" Recovery of photoreceptor inner and outer segment layer thickness after reattachment of rhegmatogenous retinal detachment" by Terauchi G, et al.[1] Authors concluded that thickness of inner segment layer (20.4 +/- 5.0 microns) at one month after surgery was significantly less than fellow eye (28.9 =/- 2.9 microns). However, we know that the axial resolution of Spectral Domain(SD)...
Article "Endothelial keratoplasty without Descemet's stripping in eyes with previous penetrating corneal transplants" by Nottage JM and Nirankari VS1, is very informative and the authors deserve appreciation for their wonderful work. However one point requires discussion. Authors mentioned that endothelial keratoplasty (EK) was done either for graft rejection (n = 9) or endothelial failure (n = 24). It seems logical to...
Dear Editor
We were interested to read the letter by Patel et al. reporting the unusual and striking fundus appearance of retinal arteriolar calcification in association with chronic renal failure.[1] However, we feel that two important conditions have been omitted from the comment, which merit further discussion.
First, Monckeberg’s sclerosis, which in its classic form is characterised by ‘pipe-stem’...
Dear Editor
The authors would like to thank Dr. J.J. Wang for her constructive comments about the statistical analysis of the data obtained in the Beijing Eye Study.[1] As already pointed out in another recent reply to a letter by Dr. Wang, the authors became aware of the limitations in their statistical analysis of the data of the Beijing Eye Study.[2] The authors are grateful to Dr. Wang for clarifying these wea...
Dear Editor
The importance of standardizing postoperative corneal thickness measurements is important for many reasons. At what juncture post operatively did the authors sample postoperative pachymetric measurements?[1]
The OrbScan utilizes scanning slit technology that is unpredictably influenced by optically sensitive interface changes in the early postoperative healing phase in some lasik patients. In th...
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