We read with great interest Alwitry and coworkers' article[1] on
bilateral decompression retinopathy following medical treatment of an
acute primary angle closure. We would like to report the case of a 47
year
-old woman who consulted in November 2000 for a mildly painful
right eye. Pain had lasted for about three days.
Visual acuity was 20/20 OU with no optical correction. On slit-lamp
examination, b...
We read with great interest Alwitry and coworkers' article[1] on
bilateral decompression retinopathy following medical treatment of an
acute primary angle closure. We would like to report the case of a 47
year
-old woman who consulted in November 2000 for a mildly painful
right eye. Pain had lasted for about three days.
Visual acuity was 20/20 OU with no optical correction. On slit-lamp
examination, both corneas were clear, there was an anisocoria with a
round, non-reactive 7-mm right pupil. IOP was 38 mmHg OD and 14 mmHg OS.
Fundus examination was normal bilaterally, the 7-mm right mydriasis
allowing good visualization of peripheral retina OD. On gonioscopic
examination, angle was closed OD. The patient was treated topically with
timolol 0.50 bid, dorzolamide tid, pilocarpine 2% tid. Three days later,
visual acuity was still 20/20 OU. IOP had dropped to 15 mmHg OD. There
was
a reactive semi-mydriasis OD. Gonioscopy showed a Sheie III (bottom
part)/
Sheie IV (top part) angle OD. Indentation gonioscopy disclosed a plateau
iris configuration OD, the central iris being pushed back with no
further
elements disclosure. Fundus examination showed scattered blot-shaped
retinal haemorrhages with one larger white-centred (probable fibrin
plug)
temporal haemorrhage (figure 1). A week later the patient had a laser
iridotomy OD. All haemorrhages had cleared. Two weeks later, the patient
took no medication. At that time, a patent right iridotomy, a right
reactive semi-mydriasis with an IOP of 30 mmHg OD and a closed angle OD
were noted. The patient was diagnosed with a plateau iris syndrome OD.
IOP
was controlled with pilocarpine 2% bid OD.
In this case as in Alwitry and coworkers'(1), decompression retinopathy
occurred following exclusive medical treatment of acute primary angle
closure. It is remarkable that in our case IOP elevation was relatively
mild and IOP drop after treatment was only 23 mmHg. One may wonder
whether
or not the plateau iris syndrome played a role in the occurrence of
decompression retinopathy in our patient. The case we report featured
mild
decompression retinopathy and, as previously reported, outcome was
excellent.
Figure 1
Right fundus showing blot-shaped scattered haemorrhages sparring the
foveola with one larger white-centred temporal haemorrhage
References
1 Alwitry A, Khan K, Rotchford A, Zaman AG, Vernon SA. Severe
decompression retinopathy following medical treatment of acute primary
angle closure. Br J Ophthalmol 2007;91:121
I am in strong agreement with Waddell that the treatment of
conjunctival neoplasia in Africa should primarily be surgical excision
and not medical drugs.
As an ophthalmologist working in Malawi-Southern Africa where the
prevalence of HIV is very high (8.3% of whole population), conjuctival
tumours have become the dominant condition requiring surgery. In 2006
alone
a total of 467 cases of advanced con...
I am in strong agreement with Waddell that the treatment of
conjunctival neoplasia in Africa should primarily be surgical excision
and not medical drugs.
As an ophthalmologist working in Malawi-Southern Africa where the
prevalence of HIV is very high (8.3% of whole population), conjuctival
tumours have become the dominant condition requiring surgery. In 2006
alone
a total of 467 cases of advanced conjuctival neoplasia underwent
surgery (430 had surgical excisions; 37 had either enucleation or
exenteration done) at Lions Sight First Eye Hospital in Blantyre. This
represents 26% of all surgeries done at this hospital in 2006.
Conjuctival
tumours were the most frequent conditions requiring admissions out of
all
the out-patients seen. We do not advocate medical treatment as it would
be
very costly in our set-up; followup of patients is difficult and most
of
the cases that we see are already at an advanced stage at presentation
and
would not respond to medical therapy alone. The suggestion by authors
to do further larger studies of this condition can easily be done at our
hospital where at least 3-5 outpatient cases of conjuctival carcinoma
are
seen on a daily basis. We would be more than willing to assist anyone
interested in doing such studies at our eye hospital.
We read with great interest the study published by Srinivasan et al [1]. It sheds light over the primary management of an endemic problem,
corneal ulceration, at the village level. We have a few comments to make.
The study suggests that there is no statistically significant
difference in the rates of fungal corneal ulceration in patients with
corneal abrasions with antifungal prophylaxis or wi...
We read with great interest the study published by Srinivasan et al [1]. It sheds light over the primary management of an endemic problem,
corneal ulceration, at the village level. We have a few comments to make.
The study suggests that there is no statistically significant
difference in the rates of fungal corneal ulceration in patients with
corneal abrasions with antifungal prophylaxis or with placebo. The role of
prophylactic antibiotics for the prevention of bacterial corneal ulcers is
yet unclear, even though a few studies have indicated a positive role [2]. We
would like to note that in a rural and largely illiterate population like
India, the mass prescription of an antibiotic drug is certain to lead to
its improper use. Patients may resort to applying the medication for
unrelated eye problems, encouraging complications and antibiotic
resistance. Whether proper counseling can be done at the village health
worker level remains to be seen.
Also, in the study, only 30% of patients with ocular injury had
corneal abrasions. This protocol may lead to the under diagnosis of other
findings not picked up fluorescein-blue light examination, retinal
dialysis or angle recession to name a few. And the process of examination
may instill a false sense of security in the rural patients, preventing
them from seeking ophthalmologic care. The study provided for referral
center evaluation, but it was not clear whether the authors recommend this
as a part of the screening model.
The authors suggest that a rapid epithelialisation and a modest
antifungal effect from the ointment base itself may be the reason for the
reduced incidence of ulceration in their population. A true control
population without any topical medications may have greatly facilitated in
reaching a firm conclusion. However, to the best of our knowledge, the
antifungal effect 1% chloramphenicol base has not been reported. And if
the hypothesis were true, there remains no need to prescribe a blanket
treatment for all corneal erosions, as rapid epithelialisation will
prevent the development of corneal ulcer. An important fact, which cannot
be sidelined, is that severe side effects like aplastic anemia and even
death have been reported on topical application of chloramphenicol
eyedrops [3-5].
In view of the above observations, we would advise all patients with
ocular trauma to undergo an ophthalmologists’ detailed examination.
Patients detected to have corneal abrasions may start antibiotic
prophylaxis in the interim. However, an ophthalmologist’s evaluation must
be the emphatic general policy. As the authors conclude, the unanswered
questions may be solved by future studies.
References
1. Srinivasan M, Upadhyay MP, Priyadarsini B, Mahalakshmi R, Whitcher
JP. Corneal ulceration in southeast Asia III: prevention of fungal
keratitis at the village level in south India using topical antibiotics.
Br J Ophthalmol. 2006 Dec;90(12):1472-5.
2. Maung N, Thant CC, Srinivasan M, Upadhyay MP, Priyadarsini B,
Mahalakshmi R,Whitcher JP. Corneal ulceration in South East Asia. II: a
strategy for the prevention of fungal keratitis at the village level in
Burma.Br J Ophthalmol. 2006 Aug;90(8):968-70.
3. Brodsky E, Biger Y, Zeidan Z, Schneider M.Topical application of
chloramphenicol eye ointment followed by fatal bone marrow aplasia.Isr J
Med Sci. 1989 Jan;25(1):54.
4. Abrams SM, Degnan TJ, Vinciguerra V.Marrow aplasia following
topical application of chloramphenicol eye ointment. Arch Intern Med. 1980
Apr;140(4):576-7.
5. Fraunfelder FT, Bagby GC Jr, Kelly DJ.Fatal aplastic anemia
following topical administration of ophthalmic chloramphenicol.Am J
Ophthalmol. 1982 Mar;93(3):356-60.
We thank Konstantopoulos et al. for their interest in our paper and
congratulate them for having conducted such a large study. It should be
noted, however, that we did not actually conclude that older age was not
associated with an increased risk of intraoperative complications, rather
we stated that our data suggest that age alone may not be a major risk
factor for any complication. Clearly absence of...
We thank Konstantopoulos et al. for their interest in our paper and
congratulate them for having conducted such a large study. It should be
noted, however, that we did not actually conclude that older age was not
associated with an increased risk of intraoperative complications, rather
we stated that our data suggest that age alone may not be a major risk
factor for any complication. Clearly absence of statistical evidence can
never be equated to proof of no difference and we were careful to
highlight that our numbers were small ( 9 patients older than 96, 111
greater than 88 years).
If we attempt to summarise data from our study, the Southampton Study
and that by Berler to examine whether or not age greater than 88 is a risk
factor for intra operative complications using meta analysis techniques,
we find that there is significant inconsistency between the studies (test
for heterogeneity Chi-square = 7.54, P = 0.02, I-squared = 73.5 %). It
seems likely therefore that the different findings from our work and that
of Southampton are not simply a reflection of varying study sizes but
arise from other differences between the studies - for example the
populations being operated on, or perhaps the techniques employed.
We would therefore agree with Konstantopoulos that further research
into this interesting subject is needed.
References
1. Robbie SJ, Muhtaseb M, Qureshi K, Bunce C, Xing W, Ionides A.
Introperative complications of cataract surgery in the very old. Br J
Ophthalmol 2006; 90:1516-1518.
2. Berler DK. Intraoperative complications during cataract surgery in
the very old. Trans Am Ophthalmol Soc. 2000; 98:127-30; discussion 130-2.
We read your article titled- 'Socioeconomic status, systemic blood
pressure and intraocular pressure: the Tanjong Pagar Study', with great
interest. The association of the level of education and income with
intraocular pressure in the Chinese population of Singapore has been
discussed in an interesting and detailed manner.
We do appreciate that this is the first report, to assess the
asso...
We read your article titled- 'Socioeconomic status, systemic blood
pressure and intraocular pressure: the Tanjong Pagar Study', with great
interest. The association of the level of education and income with
intraocular pressure in the Chinese population of Singapore has been
discussed in an interesting and detailed manner.
We do appreciate that this is the first report, to assess the
association. However, although the results are interesting, we feel that
caution should be exercised when drawing conclusions from this data.
Table
1 demonstrates that in those with secondary level of education, the
measured IOP was highest for age groups 50-59 years and 60-69 years, and
second highest in the above 70 years age group. Although the measured
IOP
was highest for those with secondary level of education, in 2 out of the 4 groups, and second highest in the third group, the final mean IOP was
lower in the secondary education group than those with primary or no
formal education. The reason behind this fallacy is that the number of
subjects with secondary education in the 50-59 years, 60-69 years and
the
above 70 years age group, was considerably lower than that of the
primary
and no formal education groups while that in the 40-49 years age group
was
considerably higher than the other two groups. As the measured IOP in
the
40-49 years group with secondary education was lowest among the four
groups but the number of subjects was highest, the final mean IOP in the
secondary education group was lower than that in the primary and the no
formal education group. In brief, the final mean IOP could only be
comparable if the number of subjects in all the groups considered would
have been similar. As this was not the case, there appears to be serious
doubts regarding the validity of the conclusions of this study. A more
detailed and clear explanation is warranted in this regard.
We would like to thank Kase et al for their interesting report[1] on
p27 and cyclin expression in pterygium. The authors have reported in
table
1[1] that cyclin D was up-regulated and p27 down-regulated in pterygium,
and concluded that a disorder of epithelial cell proliferation or cell
cycle was involved. However, several important issues have not been
addressed. We would like to highlight 3
points:...
We would like to thank Kase et al for their interesting report[1] on
p27 and cyclin expression in pterygium. The authors have reported in
table
1[1] that cyclin D was up-regulated and p27 down-regulated in pterygium,
and concluded that a disorder of epithelial cell proliferation or cell
cycle was involved. However, several important issues have not been
addressed. We would like to highlight 3
points:
1. p27 is usually regarded as an inhibitor to cyclin E/CDK2 rather
than cyclin D.[2] The down-regulation of p27 was apparently regarded by
the authors[1] to have an inhibitory role on G1-S progression, in such a
scenario, it would be important to report the expression and regulation
of
cyclin E in pterygium.
2. Studies have found that p27 (or members of KIP, CIP) may
positively regulate cyclin D/CDK[4,3] and many tumors show
co-expression
of p27 and cyclin D rather than suppression of p27.[4] Consequently, a
down-regulation of p27 as an upstream event in pterygium may be expected
to reduce cyclin D/CDK4 expression. We noted that the authors found up-regulation of cyclin D, which can easily have been due to fluctuation of
factors other than KIP, such as the INK4 family, usually regarded as the
more important regulators of cyclin D.[5] On the other hand, some tumors have shown binding of p27 to cyclin D2,[6] in such a case, the p27 may
have been sequestered and functionally inhibited, consequently
increasing
activity of cyclin E/CDK2. This illustrates that information on both
cyclin/CDK complexes is essential for a proper understanding of
proliferation-related diseases. It is also interesting that our gene
microarray expression studies (http://www.ncbi.nlm.nih.gov, GDS1758,
GSE2513 and GPL96) show that transcripts for cyclin D2 was significantly
down-regulated in pterygial tissue compared to un-involved conjunctival
tissue.
3. In their discussion, the authors[1] have omitted to cite studies
which did not support cell cycle dys-regulation in pterygium, which we
feel ought to be included for objectivity. For example, a study[7] which
showed no alteration in cell proliferation in pterygium and another[8]
that showed conjunctival and pterygial epithelial cell proliferation
were
not significantly different.
References
1. Kase S, Takahashi S, Sato I, Nakanishi K, Yoshida K, Ohno S.
Expression of p27(KIP1) and cyclin D1, and cell proliferation in human
pterygium. Br J Ophthalmol. 2006 Dec 19; [Epub ahead of print]
2. Xu X, Nakano T, Wick S, Dubay M, Brizuela L. Mechanism of
Cdk2/Cyclin E inhibition by p27 and p27 phosphorylation. Biochemistry.
1999 Jul 6;38(27):8713-22.
3. Bryja V, Pachernik J, Faldikova L, Krejci P, Pogue R, Nevriva I,
Dvorak P, Hampl A. The role of p27(Kip1) in maintaining the levels of D-type cyclins in vivo. Biochim Biophys Acta. 2004 May 3;1691(2-3):105-16.
4. Pignataro L, Sambataro G, Pagani D, Pruneri G.
Clinico-prognostic
value of D-type cyclins and p27 in laryngeal cancer patients: a review.
Acta Otorhinolaryngol Ital. 2005 Apr;25(2):75-85. Review. Erratum in:
Acta
Otorhinolaryngol Ital. 2005 Jun;25(3):following 207.
5. Hirai H, Roussel MF, Kato JY, Ashmun RA, Sherr CJ. Novel INK4
proteins, p19 and p18, are specific inhibitors of the cyclin D-dependent
kinases CDK4 and CDK6. Mol Cell Biol. 1995 May;15(5):2672-81.
6. Kukoski R, Blonigen B, Macri E, Renshaw AA, Hoffman M, Loda M,
Datta MW. p27 and cyclin E/D2 associations in testicular germ cell
tumors:
implications for tumorigenesis. Appl Immunohistochem Mol Morphol. 2003
Jun;11(2):138-43.
7. Karukonda SR, Thompson HW, Beuerman RW, Lam DS, Wilson R, Chew
SJ,
Steinemann TL. Cell cycle kinetics in pterygium at three latitudes. Br J
Ophthalmol. 1995 Apr;79(4):313-7.
8. Tan DT, Liu YP, Sun L. Flow cytometry measurements of DNA
content
in primary and recurrent pterygia. Invest Ophthalmol Vis Sci. 2000
Jun;41(7):1684-6.
We read with interest the article by Robbie et al titled
‘Intraoperative complications of cataract surgery in the very old’.[1] We
agree with the authors that identification of risk factors for cataract
surgery is important, as it has implications for patient care, surgical
training, auditing and revalidation. The authors concluded that older
age was not associated with an increased risk of intraoper...
We read with interest the article by Robbie et al titled
‘Intraoperative complications of cataract surgery in the very old’.[1] We
agree with the authors that identification of risk factors for cataract
surgery is important, as it has implications for patient care, surgical
training, auditing and revalidation. The authors concluded that older
age was not associated with an increased risk of intraoperative
complications. Complication rates in patients >=88 years were not
significantly different to patients <88 (4.5% vs. 6.3%, p=0.54). In
patients >=96 years, although the complication rate was higher than in
patients <96, this was not statistically significant (11.1% vs. 6.3%,
p=0.45). However, the study included only 54 patients older than 90 years
(number of patients older than 88 not stated) and 9 patients older than 96
years.
In a similar study, we identified all phacoemulsification cataract
procedures carried out between 2001 and 2005 at the Southampton Eye Unit.
Intraoperative complications, as classified in the National Cataract
Surgery Survey,[2] were recorded on a computer database for each cataract
procedure. We analysed the same data as the above study,[1] including age
of patient, grade of surgeon and intraoperative complications (defined as
abnormality in wound closure, posterior capsule tear, zonule dehiscence,
anterior chamber haemorrhage, iris trauma or persistent iris prolapse).
Logistic regression analysis was carried out to examine whether age
>=88 and age >=96 years were associated with an increased risk of
complications. SPSS version 14 was used for statistical analysis;
p<0.05 was considered statistically significant.
We identified 9367 consecutive phacoemulsification procedures. The
mean patient age was 76.9 (SD 9.8) years. The overall complication rate
was 3.1%. No significant difference was found between grades of surgeon
and complication rates (trainee vs. consultant: 3.2% vs. 3.1%, p=0.90).
Interestingly, the complication rate in patients >=88 years (837
eyes) was 4.3% compared to 3.0% in patients <88 years (OR 1.4, 95% CI
1.005-2.049, p<0.05). In patients >=96 years (36 eyes) the
complication rate was 8.3% vs. 3.1% in patients <96 years (OR 2.8, 95%
CI 0.858-9.228, p=0.09).
Therefore, in contrast to the above study,[1] our results suggest
that older age may be a risk factor for intraoperative complications
during phacoemulsification surgery. We suggest that the rate of
complications in cataract surgery in different age groups requires further
study and that, in view of our results, experienced surgeons should
preferentially operate on patients older than age 88.
References
1. Robbie SJ, Muhtaseb M, Qureshi K, Bunce C, Xing W, Ionides A.
Introperative complications of cataract surgery in the very old. Br J
Ophthalmol 2006;90:1516-1518.
2. Desai P, Minassian DC, Reidy A. National cataract surgery survey 1997-
8: a report of the results of the clinical outcomes. Br J Ophthalmol
1999;83:1336-1340.
We appreciate the thoughtful comments of Dr Konstantopoulos and
colleagues on our recent article [1]. They raise some
interesting comments that we would like to answer point by point.
Basically, our article published on March 2006 showed a strong association
between NAION and Sleep apnoea syndrome [1]. The first point addressed by
Konstantopoulos et al. was the high prevalence rate (48%) of patients...
We appreciate the thoughtful comments of Dr Konstantopoulos and
colleagues on our recent article [1]. They raise some
interesting comments that we would like to answer point by point.
Basically, our article published on March 2006 showed a strong association
between NAION and Sleep apnoea syndrome [1]. The first point addressed by
Konstantopoulos et al. was the high prevalence rate (48%) of patients
included in the study having a history of fellow eye NAION. They
suggest that this prevalence is unexpectedly high and not representative
of what is encountered in a normal clinical practice. In the Ischemic
Optic Neuropathy Decompression Trial (IONDT) [2] that recruited 418
patients, 19% had previous NAION affecting the fellow eye at baseline.
However, they found a cumulative incidence rate of 14.7% of second eye
NAION over a median patient follow up of 5.1 years. The cumulative
prevalence rate corresponding to the second eye involvement before and
during the study was 30.6%. Others studies found a cumulative prevalence
rate range from 23 to 48% which is closed to the prevalence we had in our
study [3-5]. A subsequent question
was the validity of second eye involvement diagnosis. Regarding this,
Konstantopoulos and colleagues were interested to know whether the visual
field defect was confirmed by perimetry. We can confirm that the diagnosis
of bilateral NAION was documented in all cases by an automated perimetry.
The larger question addressed by Konstantopoulos and colleagues was
whether there was a selection bias in our study. As stated in the article
[1], private practice ophthalmologists and general practitioners are
referring all incident cases of NAION for short duration hospitalization
allowing assessment of associated vascular risk factors and treatment decisions. Based on this, we strongly doubt that only atypical cases
of bilateral NAION were included in our study.
In summary, we have demonstrated a strong association between NAION
and OSA that justifies evaluation of every NAION patient with polysomnography
or at least a sleep questionnaire or other screening methods like
oximetry. OSA per se is one of the factors contributing to cardiovascular risk in the general population and in NAION patients.
For this reason also
hypertension, diabetes or hyperlipemia should be documented. Moreover, CPAP treatment,
independently of NAION improves the patient's quality of life when
suffering severe OSA. Finally, the crucial point is to accumulate in
the next years scientific data to address potential beneficial effects of
CPAP treatment on NAION time course evolution.
References
1. Palombi K, Renard E, Levy P, Chiquet C, et al. Non-arteritic
anterior ischaemic optic neuropathy is nearly systematically associated
with obstructive sleep apnoea. Br J Ophthalmol 2006;90:879-882.
2. Newman NJ, Scherer R, Langenberg P, Kelman S, et al. The fellow
eye in NAION: report from the ischemic optic neuropathy decompression
trial follow-up study. Am J Ophthalmol 2002;134:317-328.
3. Repka MX, Savino PJ, Schatz NJ, Sergott RC. Clinical profile and
long-term implications of anterior ischemic optic neuropathy. Am J
Ophthalmol. 1983;96:478-483.
4. Ellenberg C Jr, keltner JL, Burde RM. Acute optic neuropathy in
older patients. Arch Neurol 1973; 28:182-185.
In their article Pakravan et al. write on the correlation of central
corneal thickness and optic disc size.[1] The authors describe a negative
correlation (r= -0.284) which was statistically significant (p=0.036) for
the 72 eyes investigated. These 72 eyes, however, represent 53 patients.
This means that 19 patients are represented with both eyes and 34
participants with only one eye. The right and the...
In their article Pakravan et al. write on the correlation of central
corneal thickness and optic disc size.[1] The authors describe a negative
correlation (r= -0.284) which was statistically significant (p=0.036) for
the 72 eyes investigated. These 72 eyes, however, represent 53 patients.
This means that 19 patients are represented with both eyes and 34
participants with only one eye. The right and the left eye of the same
person cannot be considered independent from each other. Oppositely, the
two eyes frequently have similar characteristics for many parameters
including central cornea thickness and optic disc size. Using both eyes of
certain individuals and only one eye of others for correlation may lead to
incorrect conclusion due to increased representation of some
characteristics. It is especially important in cases like the authors’
report in which the correlation and the p-value were not extremely strong.
The authors’ are requested to repeat their calculation using one
(preferably randomly selected) eye per patient, and to present their data
(r and p-value). If the significant negative correlation presented in the
original article is reproducible, the conclusion can be maintained, but in
the opposite case revision of the conclusion is necessary.
Correspondence to: Gábor Holló, Department of Ophthalmology,
Semmelweis University, Budapest; hg@szem1.sote.hu
The author has no commercial interest in any product mentioned in the
article or the comment.
References
1. Pakravan M, Parsa A, Sanagou M, et al. Central corneal thickness
and correlation to disc size: a potential link for susceptibility to
glaucoma. Br J Ophthalmol 2007;91:26-28.
Dear Editor
We read with great interest Alwitry and coworkers' article[1] on bilateral decompression retinopathy following medical treatment of an acute primary angle closure. We would like to report the case of a 47 year -old woman who consulted in November 2000 for a mildly painful right eye. Pain had lasted for about three days. Visual acuity was 20/20 OU with no optical correction. On slit-lamp examination, b...
Dear editor
I am in strong agreement with Waddell that the treatment of conjunctival neoplasia in Africa should primarily be surgical excision and not medical drugs. As an ophthalmologist working in Malawi-Southern Africa where the prevalence of HIV is very high (8.3% of whole population), conjuctival tumours have become the dominant condition requiring surgery. In 2006 alone a total of 467 cases of advanced con...
Dear editor
We read with great interest the study published by Srinivasan et al [1]. It sheds light over the primary management of an endemic problem, corneal ulceration, at the village level. We have a few comments to make.
The study suggests that there is no statistically significant difference in the rates of fungal corneal ulceration in patients with corneal abrasions with antifungal prophylaxis or wi...
Editor
We thank Konstantopoulos et al. for their interest in our paper and congratulate them for having conducted such a large study. It should be noted, however, that we did not actually conclude that older age was not associated with an increased risk of intraoperative complications, rather we stated that our data suggest that age alone may not be a major risk factor for any complication. Clearly absence of...
Dear Editor
We read your article titled- 'Socioeconomic status, systemic blood pressure and intraocular pressure: the Tanjong Pagar Study', with great interest. The association of the level of education and income with intraocular pressure in the Chinese population of Singapore has been discussed in an interesting and detailed manner.
We do appreciate that this is the first report, to assess the asso...
Dear editor
We would like to thank Kase et al for their interesting report[1] on p27 and cyclin expression in pterygium. The authors have reported in table 1[1] that cyclin D was up-regulated and p27 down-regulated in pterygium, and concluded that a disorder of epithelial cell proliferation or cell cycle was involved. However, several important issues have not been addressed. We would like to highlight 3 points:...
Dear Editor
We read with interest the article by Robbie et al titled ‘Intraoperative complications of cataract surgery in the very old’.[1] We agree with the authors that identification of risk factors for cataract surgery is important, as it has implications for patient care, surgical training, auditing and revalidation. The authors concluded that older age was not associated with an increased risk of intraoper...
Dear Editor
We appreciate the thoughtful comments of Dr Konstantopoulos and colleagues on our recent article [1]. They raise some interesting comments that we would like to answer point by point. Basically, our article published on March 2006 showed a strong association between NAION and Sleep apnoea syndrome [1]. The first point addressed by Konstantopoulos et al. was the high prevalence rate (48%) of patients...
Dear Editor
In their article Pakravan et al. write on the correlation of central corneal thickness and optic disc size.[1] The authors describe a negative correlation (r= -0.284) which was statistically significant (p=0.036) for the 72 eyes investigated. These 72 eyes, however, represent 53 patients. This means that 19 patients are represented with both eyes and 34 participants with only one eye. The right and the...
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