Opthamologists and opometrists

Ophthalmology Journal News

Welcome to the Ophthalmology Journal News page! This page will showcase the latest news from the world of Ophthalmology, as published by The British Journal of Ophthalmology (BMJ).

For the British Ophthalmology Journal Archives, please visit http://bjo.bmj.com/ .

These news items are mainly specific study results that are relevant to the layman.

We have also added another news page with more ‘general’ Opthalmogy news here: Opthamologist News.

Furthermore, we have added a page with general news articles about Eye Health here:  Eye Problems Articles  , which is a good read for both patients and Ophthalmologists alike.

Enjoy!

Ophthalmology Journal News:

On the origin of 'guttae'
Introduction

The initial description of Fuchs’ endothelial corneal dystrophy (FECD) in 19101 was made without a slit-lamp biomicroscope and, thus, did not include ‘drop-like’ excrescences beneath the endothelium observed by Vogt in 1921 who is credited with coining the term ‘guttae’ (Latin for drops).2 The origin of gutta has remained obscure. Possible explanations could be that they arise as cellular secretions3 or as extrusions from weak areas in Descemet membrane (DM).4

Limited reports describe morphologies of guttae in FECD. Laing et al described five stages distinguished by size, abnormalities of cells, coalescence of multiple guttae, and contour. They observed several stages in the same cornea.3 Gottsch et al suggest distinct guttae morphologies arise from specific genetic causes of FECD.4

Our studies of a transgenic mouse model of early onset FECD5 suggest novel insights into...

Author: Son, H.-S., Villarreal, G., Meng, H., Eberhart, C. G., Jun, A. S.
Posted: August 18, 2014, 7:50 am
Morphologic alterations on posterior iris-claw intraocular lenses after traumatic disenclavation
Aims

To analyse morphologic alterations on posterior iris-claw intraocular lenses (IOL) after dislocation due to traumatic disenclavation.

Methods

Seven dislocated iris-claw IOLs were included in this observational study. Five posterior iris-claw IOLs were explanted after traumatic disenclavation and compared to two iris-claw IOLs with a history of spontaneous disenclavation. One original aphakic iris-claw IOL served as control. All IOLs underwent standardised examinations using light microscopy.

Results

All traumatically disenclaved iris-claw haptics presented decentred and twisted fixation arms. The average decentration on iris-claw haptics measured 23±11 µm in the surface plane and 103±43 µm on the edge profile; the axial twist of the fixation arms measured five angular degrees. Traumatically affected haptics were tilted (3/5) or did not provide an adequate closure (2/5), so that a reliable fixation on the iris stroma was not ensured. Morphologic alterations were significantly different after traumatic and spontaneous disenclavation. Spontaneously disenclaved IOLs and the original IOL demonstrated symmetric haptics with centred iris-claws and a sufficient closure.

Conclusions

Traumatically dislocated iris-claw IOLs presented considerable alterations on the affected haptics, which might not guarantee a reliable re-enclavation. Therefore, we suggest an IOL replacement, instead of reenclavation, in cases of traumatic iris-claw disenclavation.

Author: Brockmann, T., Gonnermann, J., Brockmann, C., Torun, N., Joussen, A. M., Bertelmann, E.
Posted: August 18, 2014, 7:50 am
Quantitative assessment of central retinal thickness in recurrent neovascular age-related macular degeneration

We read with interest the article by Reznicek et al,1 which evaluated the fulfilment of retreatment criteria for recurrent neovascular age-related macular degeneration (AMD). We support the notion of qualitative optical coherence tomography (OCT) assessment of the retina. However, we will like to point out some factors that might have affected their conclusion that quantitative OCT-based retreatment criteria appeared not sensitive enough in a clinical setting.

Reznicek et al1 mentioned that Stratus-OCT was used in the initial assessment of AMD; subsequently upon retreatment, the macula was assessed with spectral domain OCT (SD-OCT). There are differences between the older time-domain (TD-OCT) and newer SD-OCT. Of note, SD-OCT enables faster image acquisition speed and higher image resolution.2 The TD-OCT identifies the outer boundary of the retina more internally at the interface between the inner and the outer segment of the photoreceptors.2 Previous...

Author: Chee Yee, C., Papakostas, T. D., Vavvas, D. G.
Posted: August 18, 2014, 7:50 am
Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty
Purpose

To evaluate clinical outcomes and complications after Descemet membrane endothelial keratoplasty (DMEK) and posterior iris-claw aphakic intraocular lens (IOL) implantation.

Methods

This prospective cohort study comprised seven consecutive eyes (seven patients) without adequate capsular support and bullous keratopathy undergoing posterior iris-claw aphakic IOL implantation and DMEK. Corneal transparency, central corneal thickness, endothelial cell density, visual outcomes and complication rates were measured during the follow-up.

Results

The iris-claw IOLs were inserted during an IOL exchange in three eyes, and as a secondary IOL implantation in one aphakic eye during DMEK procedure. Three eyes had IOL exchange prior to secondary DMEK. Mean follow-up was 7 months (range 3–14 months). The final best spectacle-corrected visual acuity improved significantly (0.33±0.31 logMAR) compared with the preoperative best spectacle-corrected visual acuity (1.84±0.90 logMAR). The mean endothelial cell loss was 24.8% over the follow-up. Complications included graft dislocation in four eyes; which could be easily reattached with a rebubbling procedure. No graft failures, no cases of pupillary block glaucoma and no IOL dislocations were encountered.

Conclusions

DMEK and retropupillar iris-claw IOL implantation provide good visual outcomes with a fast visual recovery and appear to be a feasible method for the management of bullous keratopathy but with higher graft detachment rates.

Trial registration number

NCT02020044.

Author: Gonnermann, J., Maier, A.-K. B., Klamann, M. K. J., Brockmann, T., Bertelmann, E., Joussen, A. M., Torun, N.
Posted: August 18, 2014, 7:50 am
Fine needle diathermy occlusion of corneal vessels
Aims

To evaluate the efficacy of fine needle diathermy (FND) occlusion of corneal vessels in relation to defined clinical indications.

Methods

A retrospective, consecutive case series including all patients treated by FND for occlusion of corneal vessels between 2004 and 2012. Indications were lipid keratopathy, preparation for keratoplasty to reduce risk of rejection and treatment of recalcitrant corneal graft rejection associated with stromal vessels. Our outcome measures were occlusion of corneal vessels with reduced corneal vascularisation, reduction in amount of lipid deposition, and reduction of graft rejection episodes.

Results

FND effectively reduced lipid deposition associated with the treated vessels in 14 out of 17 eyes (82.3%). When used to reduce corneal vascularisation before keratoplasty and to reduce intraoperative bleeding, the 1-year survival of the high-risk grafts was (84.6%). FND prevented further rejection episodes in 3 out of 4 corneal grafts. Fourteen eyes required retreatment (2–5 times) of which 9 had lipid keratopathy and 5 were in preparation for corneal grafting.

Conclusions

FND is effective in occluding established corneal vessels. Corneal microperforation is a potentially serious adverse event, but other adverse events, such as striae, whitening and intracorneal haemorrhages are reversible. It should be considered for established corneal vessels, and can be combined with antivascular endothelial growth factors.

Author: Faraj, L. A., Elalfy, M. S., Said, D. G., Dua, H. S.
Posted: August 18, 2014, 7:50 am
A prospective study of acute corneal hydrops by in vivo confocal microscopy in a New Zealand population with keratoconus
Background/aims

To analyse the clinical and microstructural changes during the course of acute corneal hydrops in keratoconus.

Methods

A prospective study of consecutive patients presenting with acute corneal hydrops over 12 months was performed. Patients were examined with slit-lamp biomicroscopy and in vivo confocal microscopy (IVCM) at 2-weekly intervals until resolution of hydrops.

Results

10 consecutive patients (mean age 23.6±7.5 years) were recruited. All were of Maori or Pacific Island Nations origin. All affected eyes exhibited extensive grade 3 acute corneal hydrops. Mean best corrected vision in hydrops eyes was 2/60 at presentation and 6/48 at resolution. Mean time to resolution of hydrops was 9.9±4.3 weeks. On IVCM, four corneas exhibited hyper-reflective round cells in the epithelium and stroma. Elongated branching cells with small cell bodies were noted in the anterior stroma in two cases at 6 and 12 weeks, respectively. Three months after presentation, both cases also exhibited unusual stromal cells with large speckled cell bodies and elongated branching cell processes. Both cases subsequently developed corneal neovascularisation.

Conclusions

Corneal neovascularisation occurred in 20% of eyes in this pilot study and prolonged presence of presumed inflammatory cells was observed in these eyes. Further study of this potential association may enable identification of patients at risk of neovascularisation.

Author: Lockington, D., Fan Gaskin, J. C., McGhee, C. N. J., Patel, D. V.
Posted: August 18, 2014, 7:50 am
Evaluation of a new optical biometry device for measurements of ocular components and its comparison with IOLMaster
Objective

To assess the reliability of ocular component measurements with a new optical biometry device (AL-Scan; Nidek) and compare these measurements with those of the IOLMaster (Carl Zeiss Meditec) in patients with cataract.

Methods

Sixty-eight cataractous eyes of 68 patients were included in the prospective study. To assess AL-Scan repeatability and reproducibility, central corneal thickness, anterior chamber depth (ACD), keratometry (K) over 2.4 mm and 3.3 mm diameter, axial length (AL), white to white (WTW), and pupil distance (PD) values were measured by two operators. ACD, K, AL and WTW were also measured with the IOLMaster to investigate the level of agreement. Calculations of intraocular lens (IOL) power were compared between the two devices.

Results

AL-Scan measurements were highly repeatable and reproducible, except for WTW and PD. Bland–Altman analysis showed good agreement between devices for AL, ACD and most K values. Compared with the IOLMaster, AL-Scan-derived K values using a diameter of 2.4 mm showed a narrower 95% limit of agreement (LoA) than those obtained with a diameter of 3.3 mm. However, poor agreement of WTW measurements was found. The 95% LoAs between devices for IOL calculations were smaller when based on AL-Scan K measurements using a diameter of 2.4 mm rather than 3.3 mm.

Conclusions

The repeatability and reproducibility of AL-Scan was excellent for all parameters, except WTW and PD. Excluding WTW, good agreement was found between the AL-Scan and IOLMaster. The 2.4-mm diameter K value may be the most reliable choice for calculation of IOL power with the AL-Scan.

Author: Huang, J., Savini, G., Li, J., Lu, W., Wu, F., Wang, J., Li, Y., Feng, Y., Wang, Q.
Posted: August 18, 2014, 7:50 am
Cataract surgery outcomes in adult patients with Down's syndrome
Purpose

To describe the outcomes of cataract surgery in adult patients with Down's syndrome at a tertiary eye hospital in Hong Kong.

Methods

Retrospective case-file analysis was performed to identify patients with Downs's syndrome who underwent cataract surgery between January 2002 and December 2012. Morphology of cataract, associated ocular features and surgical and visual outcomes were analysed.

Results

Cataract surgery was performed in 33 eyes of 20 patients (12 males, 8 females, mean age 42.9±10.6 years) over a 10-year period. Nine patients (9/20, 45.0%) had bilateral cataracts at the time of diagnosis. White cataracts were noted in 12 eyes of 10 patients (12/33, 36.3%) at the time of presentation. Associated ocular problems included myopic maculopathy (18 eyes, 54.5%), keratoconus (12 eyes, 36.3%), nystagmus (2 eyes, 6.0%), corneal scar (2 eyes, 6.0%) and glaucoma (2 eyes, 6.0%). Five eyes (15.1%) underwent extracapsular cataract extraction whereas a phacoemulsification was performed in 28 (84.9%) eyes. Intraocular lens implantation was performed in 32/33 eyes. The most common postoperative complication was posterior capsular opacification (8 eyes, 24.2%). The mean best-corrected visual acuity improved from 0.07±0.11 preoperatively to 0.17±0.19 at 3 months postoperatively (p=0.000).

Conclusions

A high incidence of bilateral cataracts as well as white cataracts was observed in patients with Down's syndrome in our study. Although the surgical outcomes of cataract surgery were good, the visual outcomes were suboptimal in our cases due to associated ocular comorbidities.

Author: Li, E. Y., Chan, T. C., Lam, N. M., Jhanji, V.
Posted: August 18, 2014, 7:50 am
When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature
Objective

To report 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis (LASIK) and discuss the continually increasing number of cases in China.

Methods

A multicentre retrospective survey of eye injuries was carried in 31 military hospitals from January 2006 to December 2011. Detailed information from the medical records of all 92 cases with a history of prior LASIK treatment were collected and summarised, with respect to visual acuity (VA), flap condition, treatment and final outcome. All Chinese publications relevant to late traumatic flap complications in Chinese patients were retrieved and summarised.

Results

92 inpatients (92 eyes) underwent LASIK surgery; 45 of these had traumatic LASIK flap complications. Flap dislocation was the commonest and most needed surgical repair. VA after treatment was good and no statistically significant difference was observed when compared with the 47 cases without flap complications. 109 articles related to late traumatic flap complications after LASIK were retrieved from four Chinese document databases. There were 550 cases of late traumatic flap complications. From 2004, case reports became more common; 10 or more cases were reported in some case series. VA of most cases was good and there was no remarkable vision loss after treatment.

Conclusions

Late traumatic flap complications after LASIK have become more frequent in China, although the prognosis of most cases is good.

Author: Xiao, J., Jiang, C., Zhang, M., Jiang, H., Li, S., Zhang, Y., Li, Zhang
Posted: August 18, 2014, 7:50 am
Cataract surgery in small adult eyes
Aim

To evaluate the clinical outcomes of phacoemulsification cataract surgery in microphthalmos.

Methods

Retrospective consecutive case series of eyes with axial length <20.9 mm, and requiring a high intraocular lens (IOL) power (≥30 or ≥35 dioptres for anterior or posterior chamber fixation, respectively), with no history of previous ocular surgery, and undergoing planned phacoemulsification cataract surgery with IOL implantation at Moorfields Eye Hospital was investigated to observe the incidence of intraoperative and postoperative complications.

Results

During a 5-year study period, 47 of 22 093 eyes were treated in two locations (0.21%). Thirty-nine eyes met the study inclusion criteria. No serious intraoperative adverse events were recorded. Severe postoperative complications (retinal detachment and chronic postoperative uveitis) occurred in two cases. The postoperative corrected distance visual acuity (CDVA) was logMAR 0.30 or better in 24 eyes (62%), and only three eyes obtained worse vision. The overall ocular comorbitidy rate was 53%; 10 microphthalmic eyes (26%) presented with associated congenital or hereditary pathology, and had worse visual outcomes (p<0.0001).

Conclusions

Microphthalmic eyes requiring high IOL power are rare, and their presence is often associated with other ocular congenital or acquired disorders. Overall, the clinical outcomes were satisfactory and the surgical procedure affected by a low complication rate.

Author: Carifi, G., Safa, F., Aiello, F., Baumann, C., Maurino, V.
Posted: August 18, 2014, 7:50 am

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