Endoscopic suturing of lacrimal sac flap to the nasal mucosa flap in
Dacryocystorhinostomy ( DCR) was described by us as early as 2004 and a
video of the procedure was published in textbook of oculoplasty (1) The
audits done showed that the short term results were excellent and the only
concern was the time taken to do the surgery. Three years later another
paper described excellent results with suturing of the flaps an...
Endoscopic suturing of lacrimal sac flap to the nasal mucosa flap in
Dacryocystorhinostomy ( DCR) was described by us as early as 2004 and a
video of the procedure was published in textbook of oculoplasty (1) The
audits done showed that the short term results were excellent and the only
concern was the time taken to do the surgery. Three years later another
paper described excellent results with suturing of the flaps and it was
reported to have a primary success rate of 96 percent and ultimate success
rate of 100 percent and the authors contemplated replacement of external
DCR with endonasal DCR (2) Traumatic Dacryocystitis has been treated
often by external DCR and some authors have suggested external DCR with
stenting in such cases (3) We have noted in our audits that doing an
endonasal DCR with suturing of the flaps and stenting both leads to 100
percent results even in cases with trauma where in there is Dacryocystitis
with coexisting orbital fracture too. The endoscopy procedure does not
disturb the lacrimal pump and the suturing of the flap causes healing by
primary intention and makes the procedure 100 percent successful
especially when combined with stents.
Reference
1) Sunil Moreker, Sneha K, Kirtane MV, Mankekar G. Endoscopic
Dacrocystorhinostomy :Recent advances. Oculoplasty and reconstructive
surgery , Jaypee publications 2010, page 286
2) Kirtane MV, Lall A, Chavan K, Satwalekar D. Endoscopic
dacryocystorhinostomy with flap suturing. Indian J Otolaryngol Head Neck
Surg. 2013 Aug;65(Suppl):236-41. doi: 10.1007/s12070-011-0354-z.
3) Rizvi SA, Sharma SC, Tripathy S, Sharma S. Management of traumatic
Dacryocystitis and failed dacryocystorhinostomy using silicone lacrimal
intubation set. Indian J Otolaryngol Head Neck Surg. 2011 Jul;63(3):264-8.
doi:10.1007/s12070-011-0230-x.
We would like to congratulate Drs Morgan and colleagues on their
recent paper “Wearing swimming goggles can elevate intraocular pressure.”
We performed a similar study and presented our data at the Association for
Research in Vision and Ophthalmology in 2007. Our findings demonstrated
that in healthy participants, IOP measurements taken during goggle wear
were significantly higher at both one and five minutes, with an av...
We would like to congratulate Drs Morgan and colleagues on their
recent paper “Wearing swimming goggles can elevate intraocular pressure.”
We performed a similar study and presented our data at the Association for
Research in Vision and Ophthalmology in 2007. Our findings demonstrated
that in healthy participants, IOP measurements taken during goggle wear
were significantly higher at both one and five minutes, with an average
increase of 12.5% or +1.5 mmHg. A small subset of eyes (10%) in our study
had an increase in IOP greater than 5 mmHg at both one and five minutes of
goggle wear. We applaud the use of a predictive model in evaluating which
goggles may be associated with IOP elevation. In our study, utilizing a
single goggle design (Speedo), the IOP did not increase significantly in
40% of subjects but increased over 5mmHg in others. In light of this
variability we have retained our prototype study goggle in order to
measure the goggle-induced IOP effect in our glaucoma patients who wish to
swim. Regularly testing these patients in the office allows us to better
inform our patients of the potential risks of goggle wear during swimming.
Indirect ophthalmoscopy has advanced since its inception. We now
recognize the importance of video imaging of the retina. Authors deviced
various slit lamp adaptors to capture retinal image(1) Many authors have
used smartphones coupled with indirect ophthalmoscopy and some even
identified an iPhone application that can control the flash and reduce the
intensity to levels that do not damage the retina.(2,3,4,5)
Indirect ophthalmoscopy has advanced since its inception. We now
recognize the importance of video imaging of the retina. Authors deviced
various slit lamp adaptors to capture retinal image(1) Many authors have
used smartphones coupled with indirect ophthalmoscopy and some even
identified an iPhone application that can control the flash and reduce the
intensity to levels that do not damage the retina.(2,3,4,5)
Some authors described a lightweight, compact, user-friendly, 3D
printed attachment which enabled high quality fundus photos achieved by
coupling smartphones to indirect ophthalmoscopy lens. (6)
In January 2013, the FDA approved the iExaminer (Welch Allyn), the
first smartphone-based imaging adaptor system that attaches an iPhone 4
(Apple Inc, Cupertino, CA) to Welch Allyn's Panoptic Ophthalmoscope to
capture images of the retina in combination with the iExaminer App.(7)
But all of the methods with adapters and iPhones are expensive or
bulky and impossible to use in ICCU setting.
We used a blackberry Z 3 mobile phone to capture serial video
recordings of cases in ICCU setting in patients on ventilator support and
recorded various cases like Terson's syndrome and papillodema and other
retinal conditions that need serial follow up. The smartphone allowed us
to use 1080 p HD recording and the autofocus and ambient light sensors in
recent cameras as well as the other features allow better evaluation of
the retina.
The audio video combine recording allows for simultaneous commentary
too which is important for Medical records and to save time in ICCU
setting. The audio and video format supported are 3GP, 3GP2, M4A, M4V,
MOV, MP4, MKV, MPEG-4, AVI, ASF, WMV, WMA, MP3, MKA, AAC, AMR, F4V, WAV,
AWB, OGG, FLAC and these allow viewing in any setting,transfer over any
media and storage and editing with ease so as to create a time compressed
view of the condition for patient education and counselling.
The blackberry at a cost of Indian currency of 13,000 rupees is a
very cheap piton for such video recording of the retina. It was very easy
to train ICU residents and the ability to transfer data through encrypted
messengers like Telegram allows for excellent management of such patients
in the follow up period especially in ICCU setting in rural areas where
Superspeciality may not be available round the clock in a country like
India. The ease with which even residents and non ophthalmologists can
acquire images and transfer the images ,makes smart phones replace
indirect ophthalmoscopes in these settings. Besides the use of these
methods by those screening for diabetic retinopathy in rural outreach
settings makes it all the more exciting.The ability to see the video in
slow motion allows for better screening as well as in better assessment in
telepath alkaloid from rural areas as has been our experience.
Considering all these developments the traditional indirect
ophthalmoscope may need to be modified and made less expensive and less
bulkier and easier to use and learn even in emergency rooms and ICCU
settings to withstand the competition from smart phones.
References:-
1) Chakrabarti D. Application of mobile technology in ophthalmology to
meet the demands of low-resource settings. Journal of Mobile Technology in
Medicine 2012;1(4S):1-3.
2) Lord RK, Shah VA, San Filippo AN, Krishna R. Novel uses of smartphones
in ophthalmology. Ophthalmology 2010;117(6):1274. e3
3) Chakrabarti D. Application of mobile technology in ophthalmology to
meet the demands of low-resource settings. Journal of Mobile Technology in
Medicine 2012;1(4S):1-3.
4) Haddock LJ, Kim DY, Mukai S. Simple, Inexpensive Technique for High-
Quality Smartphone Fundus Photography in Human and Animal Eyes. Journal of
Ophthalmology 2013;2013. http://dx.doi.org/10.1155/2013/518479
5) Chhablani J, Kaja S, Shah VA. Smartphones in ophthalmology. Indian J
Ophthalmol 2012;60(2):127
6) David Myung, Alexandre Jais, Lingmin He.Mark S. Blumenkranz, Robert
T. Chang, 3D Printed Smartphone Indirect Lens Adapter for Rapid, High
Quality Retinal Imaging. Journal MTM 3:1:9-15, 2014
7) Teichman JC, Sher JH, Ahmed IIK. From iPhone to eyePhone: A technique
for photodocumentation. Canadian Journal of Ophthalmology/Journal Canadien
d'Ophtalmologie 2011;46(3):284-6.
Vision testing is a very tedious process. If a complete testing
including contrast testing,colour testing,amsler test,glare test,speed of
reading and other tests are undertaken it may take a lot of time.It is a
reality that even today visual acuity testing alone is the deciding factor
for undertaking cataract surgery. It has been noted by some authors that
lack of government-funded routine eye examinations is associated w...
Vision testing is a very tedious process. If a complete testing
including contrast testing,colour testing,amsler test,glare test,speed of
reading and other tests are undertaken it may take a lot of time.It is a
reality that even today visual acuity testing alone is the deciding factor
for undertaking cataract surgery. It has been noted by some authors that
lack of government-funded routine eye examinations is associated with a
reduced incidence of self-reported glaucoma and cataracts, probably due to
reduced detection rates (1) this only means that some method of home
testing may be essential.It is also possible that many kids would not go
blind due to amblyopia if vision was to be tested .So it may be useful to
test vision at home or school, which can be reported to the eye surgeon.
Some authors have envisaged a lay person administered vision test which
may be valid for identifying amblyopia in a controlled environment thus
making a cost-effective and easily accessible vision screening performed
by lay people a reality (2). A school vision screening program involving
only school teachers was found to have resulted in more efficient
screening than a program including professionals with the costs being a
third of what would have been spend and it was found to also improve
compliance with regards to hospital referral (3). Many authors have tried
mobile app based methods for vision and concluded that while the results
are not interchangeable with paper-based charts, mobile app tablet-based
tests of reading speed are reliable and rapid to perform, with the
potential to capture functional visual ability in research studies and
clinical practice(4). Such apps can be easily incorporated into video
glasses routinely used by children in video games.
We used a video glass available for playing video games and projected
vision charts at an appropriate distance into the glass and tested vision
at home. The fact that the glass had covers on the side, nullified the
effect of ambient light. Also some homes in India may be actually cubicles
and so may not have the requisite distance for testing and so in such
cases a mobile app based visual testing with charts projected into the
video glass helps in such situations. Following the ease of testing and
the improved ability of patients or care takers who are now being able to
test vision at home; different aspects of vision are now being tested by
patients or care takers. When this becomes more common even eye surgeons
will begin to do more tests.
References:-
1) Chan CH, Trope GE, Badley EM, Buys YM, Jin YP. The impact of lack
of government-insured routine eye examinations on the incidence of self-
reported glaucoma, cataracts, and vision loss. Invest Ophthalmol Vis Sci.
2014 Dec 9;55(12):8544-9. doi: 10.1167/iovs.14-15361.
2) Longmuir SQ, Pfeifer W, Shah SS, Olson R. Validity of a layperson-
administered Web-based vision screening test. J AAPOS. 2015 Feb;19(1):29-
32. doi:10.1016/j.jaapos.2014.10.021
3) Priya A, Veena K, Thulasiraj R, Fredrick M, Venkatesh R, Sengupta S,
BassettK. Vision screening by teachers in southern Indian schools: testing
a new "all class teacher" model. Ophthalmic Epidemiol. 2015 Feb;22(1):60-
5. doi:10.3109/09286586.2014.988877.
4) Kingsnorth A, Wolffsohn JS. Mobile app reading speed test. Br J
Ophthalmol.2014 Oct 29. pii: bjophthalmol-2014-305818.
doi:10.1136/bjophthalmol-2014-305818.
Dear Editor;
We read with great interest the article entitled "Prevalence of
canaliculitis after smartplug insertion during long-term follow-up" by
Klein-Theyer et al.(1) I would like to contribute to the article with our
clinical expeience.
Among 11 cases of canaliculitis after lacrimal plug insertion between
2007 and 2013 in a tertiary medical center, seven cases (64%) were noted
to be associated with the us...
Dear Editor;
We read with great interest the article entitled "Prevalence of
canaliculitis after smartplug insertion during long-term follow-up" by
Klein-Theyer et al.(1) I would like to contribute to the article with our
clinical expeience.
Among 11 cases of canaliculitis after lacrimal plug insertion between
2007 and 2013 in a tertiary medical center, seven cases (64%) were noted
to be associated with the use of Smartplug. All these patients were women
with a mean age of 53-year-old. This propensity could be related to
hormonal influence during menopause,(2) use of makeup,(3) or female
predominance of dry eye requiring lacrimal plug insertion. The average
time interval from plug insertion to the onset of symptoms was 4.7 years,
which is in consistent with most published studies.(1) This means that the
prevalence of lacrimal-plug canaliculitis may be underestimated if follow-
up is not really long enough. The most common isolated microorganism in
our study was Pseudomonas aeruginosa(29%), followed by Actinomyces(14%)
and Staphylococcus aureus(14%). All canaliculitis resolved after
canaliculotomy with removal of plug, and there was no recurrence was noted
during a mean post-operative follow-up period of 11 months. In the study
by Klein-Theyer and colleagues, the canaliculitis was resolved by topical
antibiotics and "repeated" lacrimal irrigations, and one of them with
persistent canaliculitis finally required canaliculotomy. Although they
did not find any plug in the lacrimal drainage system by high-resolutional
ultrasound, physicians should always keep in mind that lacrimal irrigation
may cause dislodgement of an inflamed plug into the deep lacrimal drainage
system, inciting infection or permanent blockage of the lacrimal drainage
passages.(4) Canaliculotomy with removal of plug may be an effect and safe
treatment option for these patients.
References
1. Klein-Theyer A, Boldin I, Rabensteiner DF, Aminfar H, Horwath-
Winter J. Prevalence of canaliculitis after smartplug insertion during
long-term follow-up. Br J Ophthalmol. 2015 Feb 26. pii: bjophthalmol-2014-
306290. doi: 10.1136/bjophthalmol-2014-306290.
2. Struck HG, H?hne C, Tost M. Diagnosis and therapy of chronic
canaliculitis. Ophthalmologe. 1992; 89: 233-236.
3. Brazier JS. Hall V. Propionibacterium propionicum and infections
of the lacrimal apparatus. Clin Infect Dis. 1993; 17: 892-893.
4. SmartPlug Study Group. Management of complications after insertion
of the SmartPlug punctal plug: a study of 28 patients. Ophthalmology. 2006
Oct;113(10):1859.e1-6.
We read with interest the results reported by Romano et al. The
authors speculated the reason for lower endothelial failure in larger
grafts (9.5mm) compared to smaller ones is due to the additional
endothelial cells being transplanted.
It has been reported that the host peripheral endothelium in Fuchs
endothelial dystrophy (FED) has some capacity towards restoring corneal
deturgescence in denuded posterior st...
We read with interest the results reported by Romano et al. The
authors speculated the reason for lower endothelial failure in larger
grafts (9.5mm) compared to smaller ones is due to the additional
endothelial cells being transplanted.
It has been reported that the host peripheral endothelium in Fuchs
endothelial dystrophy (FED) has some capacity towards restoring corneal
deturgescence in denuded posterior stroma where the Descemet membrance
endothalial keratoplasty (DMEK) did not attached.(1,2) This observation
was seen in all 7 eyes with FED that had partial graft detachment but not
in any of the 5 eyes with aphakic or pseudophakic bullous keratopathy
(PBK).(1) In an eccentrically positioned DMEK, the area between the edge
of the descemetorhexis and the edge of the graft often showed faster
clearance in a fashion that starts from the recipient endothelium edge
towards the graft.(2) In fact, this gap clears faster than the area over
the attached DMEK.(2)
The above findings suggest the peripheral endothelium in FED may have
migrated to cover the bare posterior stroma. Interestingly, the peripheral
endothelium may have regenerative capacity as the endothelium cell density
(ECD) appeared similar in the repopulated area and in eyes with completed
attached graft.(2)
To accommodate a larger endothelial graft, the surgeon is likely to
perform a larger descemetorhexis, hence removing more of the host's
peripheral endothelium. Should some of latter remains, a large graft is
likely to overlap hence damage the cells. Whether one should always aim to
insert a larger graft in eyes with FED requires more thoughts.
In their study, Romano et al mentioned that graft failure is
associated with ECD and graft size. One wonders whether there is an
association between failure with combined graft size and diagnosis
(PBK/FED).
1) Dirisamer M, Yeh RY, van Dijk K, Ham L, Dapena I, Melles GRJ.
Recipient endothelium may relate to corneal clearance in Descemet membrane
endothelial transfer. Am J Ophthalmol 2012; 154: 290-296.
2) Dirisamer M, Dapena I, Ham L, van Dijk K, Oganes O et al. Patterns of
endothelialization and corneal clearance after Descemet membrane
endothelial keratoplasty for Fuchs endothelial dystrophy. Am J Ophthalmol
2011; 152: 543-555.
We Read with great interest the article Topical bromfenac reduces the
frequency of intravitreal bevacizumab in patients with branch
retinal vein occlusion by Masahiko Shimura et al.(1)
We congratulate the authors for the concept and well conducted pilot study
. Repeated intravitreal injections are known to have various
complications(2) and it would be safer if noninvasive intervention like
topical bromfenac can help to red...
We Read with great interest the article Topical bromfenac reduces the
frequency of intravitreal bevacizumab in patients with branch
retinal vein occlusion by Masahiko Shimura et al.(1)
We congratulate the authors for the concept and well conducted pilot study
. Repeated intravitreal injections are known to have various
complications(2) and it would be safer if noninvasive intervention like
topical bromfenac can help to reduce the number of intravitreal injections
.However, we would like to make an observation in the study design.
Fundus Flourescein Angiography (FFA) of the enrolled patients was not
performed at any time during the study. It is known that patients with
branch retinal vein occlusion can develop CNP areas(Capillary Nonperfusion
Areas) and the size of CNP areas is positively correlated with the amount
of (Vascular Endothelial Growth Factor)VEGF(3,4). VEGF release is one of
the important factors responsible for macular edema. Non availability of
FFA can lead to the bias between the two groups because there is a chance
of patients with larger CNP areas and thereby more VEGF at the baseline to
be present in one group.
We would like to suggest that CNP areas need to be considered while
randomising patients to remove this bias.
References
1.Shimura M, Yasuda K. Topical bromfenac reduces the frequency of
intravitreal
bevacizumab in patients with branch retinal vein occlusion. Br J
Ophthalmol. 2015 Feb;99(2):215-9.
2. Gunther JB, Altaweel MM. Bevacizumab (Avastin) for the treatment
of ocular disease. Surv Ophthalmol 2009;54:372-400.
3.Fujikawa, Masato et al. Correlation between Vascular Endothelial Growth
Factor and Nonperfused Areas in Macular Edema Secondary to Branch Retinal
Vein Occlusion. Clinical Ophthalmology (Auckland, N.Z.) 7 (2013): 1497-
1501.
4.Noma H, Funatsu H, Yamasaki M, et al. Pathogenesis of macular edema with
branch retinal vein occlusion and intraocular levels of vascular
endothelial growth factor and interleukin-6. Am J Ophthalmol. 2005;140:256
-261.
Your study actually confirms the data that we reported in the lead
article of the AJO in October 2008 showing the benefit of ketorolac in
preventing CME and retinal thickening after routine cataract surgery. To
demonstrate statistical significance for CME, it requires a sample size of
close to 400 patients per group. Your data clearly shows a trend to
decreased retinal thickening when a NSAID is used in conjunction with...
Your study actually confirms the data that we reported in the lead
article of the AJO in October 2008 showing the benefit of ketorolac in
preventing CME and retinal thickening after routine cataract surgery. To
demonstrate statistical significance for CME, it requires a sample size of
close to 400 patients per group. Your data clearly shows a trend to
decreased retinal thickening when a NSAID is used in conjunction with
steroids. You failed to reach statistical significance because you failed
to have a large enough sample size. It requires approximately 80 to 100
patients to demonstrate definite statistical advantage with an
approximately 95% chance of showing the correct result. Looking at your
graphs there is a definite trend especially for ketorolac. In fact, your
percentages for ketorolac are very similar to the percentages we reported.
Similarly, your placebo group also is not far off the percentages we
reported. However, our were statistically significant because there were
over 260 patients in each group.
We read with interest the article by Faraj et al1 proposing the
clinical characterization of corneal neovascularization (CoNV) based
entirely on slit lamp biomicroscopy and color photography. The authors
provide a useful reminder of many issues previously discussed addressed in
the 1970s.2 Their aim was to provide a nomenclature and a standardized
system for grading and characterising CoNV. We have...
We read with interest the article by Faraj et al1 proposing the
clinical characterization of corneal neovascularization (CoNV) based
entirely on slit lamp biomicroscopy and color photography. The authors
provide a useful reminder of many issues previously discussed addressed in
the 1970s.2 Their aim was to provide a nomenclature and a standardized
system for grading and characterising CoNV. We have concerns about the
"take-home" messages, which are not representative of the current standard
of care for patients with CoNV. Biomicroscopy, whilst essential, is
greatly complemented by ancillary techniques such as angiography and in
vivo confocal microscopy (IVCM). The analogy is assessing the macula and
guiding the treatment of retinal diseases such as AMD using only
biomicroscopy and colour photography, with using angiography or OCT!
* Colour photography. Although the advent of digital image
documentation allows a much improved image analysis than that achieved,
for example, with hand drawings;3,4 photography is limited by inconsistent
vessel delineation and standardization.4 Indeed, this was already
recognized by Bron and Easty, who, in the 1970s, used angiography to study
CoNV in more than 250 patients. 2
* Functional staging of CoNV. Angiography using fluorescein (FA) and
indocyanine green (ICGA) allows the characterization of CoNV based on
assessment of both morphologic (diameter, length tortuosity, area etc) and
functional parameters such as flow and time to leakage, which are
indicators of vessel maturity and disease activity.3,4,5 Angiography
elucidates the anatomy of the marginal corneal and limbal vascular arcades
which are important in the development of CoNV and peripheral corneal and
limbal disorders.3 Relying only on clinical features to estimate vessel
leakage, although helpful, is as acknowledged by the authors, unreliable.
* Multidimensional characterization of CoNV. Angiography and IVCM has
been used to demonstrate acellular perfusion of ghost vessels,
intravascular cellular traffic and with digital substraction analysis, has
allowed the characterisation of lymphatic vessels, which are of great
importance but evade mere clinical observation.6
* Guiding treatment. To undertake treatment such as selective fine
needle diathermy (FND) only relying only on biomicroscopy is very
challenging even aided by the patients pulse. Spiteri et al reported that
angiography, even in the presence of exudate and scarring, allows precise
detection of the afferent stems to guide FND. 4, 5
* Terminology. The suggested abbreviation "CVas" adds to the existing
terminologic confusion rather than helping consolidate the more widely
accepted term "CoNV". CVA is a well accepted term for cerebrovascular
accident and clearly CVa is not a suitable abbrevation.
While the present study provides a useful reminder for the
biomicroscopic characterisation of CoNV, it is time to embrace new
technological advances similar to our retinal colleagues.
References
1 Faraj LA, Said DG, Al-Aqaba M, Otri AM, Dua HS. Clinical
evaluation and characterisation of corneal vascularisation. Br J
Ophthalmol 2015
2 Easty DL, Bron AJ. Fluorescein angiography of the anterior segment.
Its value in corneal disease. Br J Ophthalmol 1971; 55: 671-682
3 Anijeet DR, Zheng Y, Tey A, Hodson M, Sueke H, Kaye SB. Imaging and
evaluation of corneal vascularization using fluorescein and indocyanine
green angiography. Investigative ophthalmology & visual science 2012;
53: 650-658
4 Romano V, Spiteri N, Kaye SB. Angiographic-guided treatment of
corneal neovascularization. JAMA ophthalmology 2015; 133: e143544
5 Spiteri N, Romano V, Zheng Y, Yadav S, Dwivedi R, Chen J, Ahmad S,
Willoughby CE, Kaye SB. Corneal angiography for guiding and evaluating
fine-needle diathermy treatment of corneal neovascularization.
Ophthalmology 2015; 122: 1079-1084
6 Romano V, Steger B, Zheng Y, Ahmad S, Willoughby CE, Kaye SB:
Angiographic and in vivo confocal microscopic characterization of human
corneal blood and presumed lymphatic neovascularization: a pilot study.
Cornea 2015
We have read with interest the paper by Tzelikis et al. entitled:
"Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of
cystoid macular oedema after phacoemulsification: prospective placebo-
controlled randomised study" [Br J Ophthalmol 2015;99(5):654-658].
In order to consider as statistically similar the effects of
ketorolac 0.4%, 0.1% nepafenac and placebo, the authors really needed to
have...
We have read with interest the paper by Tzelikis et al. entitled:
"Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of
cystoid macular oedema after phacoemulsification: prospective placebo-
controlled randomised study" [Br J Ophthalmol 2015;99(5):654-658].
In order to consider as statistically similar the effects of
ketorolac 0.4%, 0.1% nepafenac and placebo, the authors really needed to
have established a margin of equivalence for the clinical effectiveness of
the two active treatments versus placebo, which would have allowed
determining the number of patients needed in each group and the associated
statistical power, in order to test a hypothesis of equivalence, as
previously suggested in a BMJ publication (1) citing Piaggio et al (2).
Although no working hypothesis is mentioned, the aim of the study
suggests that the authors actually designed the study with the intention
of demonstrating the superiority of active treatment over placebo. The
results shown in Figure 1 are of paramount importance, given the objective
of the work. The authors state that "operative check-up revealed a change
in central subfields retinal thickness of <10 microns, between 10 and
25 microns, and >25 microns compared with preoperative values in all
groups. The highest percentages of >10 microns were observed in the
group 1". We agree with this statement. On applying the Jonckheere-
Terpstra test to the data, we observed overall differences between the
three categories of retinal thickness between at least two of the groups
(p<0.001). A posteriori comparisons show that both the ketorolac group
(p=0.02 and p=0.04) and the nepafenac group (p=0.03 and p=0.04) differed
from the placebo group, for the category of <10 microns compared with
>10 microns as well as for the category of 10-25 microns, respectively.
We would respectfully propose different wording from "statistically
similar" macular foveal thicknesses between the active treatment and
placebo groups.
References
1. Piaggio G, Elbourne DR, Altman DG, Pocock SJ, Evans SJ. Reporting
of noninferiority and equivalence randomized trials: an extension of the
CONSORT statement. JAMA 2006;295:1152-1160.
2. Research Methods & Reporting. CONSORT 2010 Statement: updated
guidelines for reporting parallel group randomised trials. BMJ
2010;340:c332. http://www.bmj.com/content/340/bmj.c332 (accessed in July
2015)
Endoscopic suturing of lacrimal sac flap to the nasal mucosa flap in Dacryocystorhinostomy ( DCR) was described by us as early as 2004 and a video of the procedure was published in textbook of oculoplasty (1) The audits done showed that the short term results were excellent and the only concern was the time taken to do the surgery. Three years later another paper described excellent results with suturing of the flaps an...
We would like to congratulate Drs Morgan and colleagues on their recent paper “Wearing swimming goggles can elevate intraocular pressure.” We performed a similar study and presented our data at the Association for Research in Vision and Ophthalmology in 2007. Our findings demonstrated that in healthy participants, IOP measurements taken during goggle wear were significantly higher at both one and five minutes, with an av...
Indirect ophthalmoscopy has advanced since its inception. We now recognize the importance of video imaging of the retina. Authors deviced various slit lamp adaptors to capture retinal image(1) Many authors have used smartphones coupled with indirect ophthalmoscopy and some even identified an iPhone application that can control the flash and reduce the intensity to levels that do not damage the retina.(2,3,4,5)
...
Vision testing is a very tedious process. If a complete testing including contrast testing,colour testing,amsler test,glare test,speed of reading and other tests are undertaken it may take a lot of time.It is a reality that even today visual acuity testing alone is the deciding factor for undertaking cataract surgery. It has been noted by some authors that lack of government-funded routine eye examinations is associated w...
Dear Editor; We read with great interest the article entitled "Prevalence of canaliculitis after smartplug insertion during long-term follow-up" by Klein-Theyer et al.(1) I would like to contribute to the article with our clinical expeience.
Among 11 cases of canaliculitis after lacrimal plug insertion between 2007 and 2013 in a tertiary medical center, seven cases (64%) were noted to be associated with the us...
We read with interest the results reported by Romano et al. The authors speculated the reason for lower endothelial failure in larger grafts (9.5mm) compared to smaller ones is due to the additional endothelial cells being transplanted.
It has been reported that the host peripheral endothelium in Fuchs endothelial dystrophy (FED) has some capacity towards restoring corneal deturgescence in denuded posterior st...
We Read with great interest the article Topical bromfenac reduces the frequency of intravitreal bevacizumab in patients with branch retinal vein occlusion by Masahiko Shimura et al.(1) We congratulate the authors for the concept and well conducted pilot study . Repeated intravitreal injections are known to have various complications(2) and it would be safer if noninvasive intervention like topical bromfenac can help to red...
Your study actually confirms the data that we reported in the lead article of the AJO in October 2008 showing the benefit of ketorolac in preventing CME and retinal thickening after routine cataract surgery. To demonstrate statistical significance for CME, it requires a sample size of close to 400 patients per group. Your data clearly shows a trend to decreased retinal thickening when a NSAID is used in conjunction with...
Dear Editor,
We read with interest the article by Faraj et al1 proposing the clinical characterization of corneal neovascularization (CoNV) based entirely on slit lamp biomicroscopy and color photography. The authors provide a useful reminder of many issues previously discussed addressed in the 1970s.2 Their aim was to provide a nomenclature and a standardized system for grading and characterising CoNV. We have...
We have read with interest the paper by Tzelikis et al. entitled: "Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo- controlled randomised study" [Br J Ophthalmol 2015;99(5):654-658].
In order to consider as statistically similar the effects of ketorolac 0.4%, 0.1% nepafenac and placebo, the authors really needed to have...
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