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:

Highlights from this issue

Mudhar et al (see page 736)

A retrospective study of 90 biopsies received by a national reference laboratory in patients with the diagnosis of cicatricial conjunctivitis reports a marked inconsistency in sampling method that should be addressed by consensus guidelines.

Galor et al (see page 745)

In a cross-sectional study of 118 individuals using artificial tears to treat dry-eye associated pain, the authors report a differential subjective response to artificial tear preparations.

Chaurasia et al (see page 750)

Assessment of corneal endothelium, using specular microscopy, in Xeroderma pigmentosum revealed morphological changes suggestive of an accelerated endothelial cell loss. Blindness could be prevented by emphasizing proper ocular protection from ultraviolet radiation.

Ramappa et al (see page 754)

In pseudophakic corneal edema, functional success and graft survival following endothelial keratoplasty without stripping Descemet's membrane are comparable to Descemet's stripping keratoplasty, the advantages being...

Author: Barton, K., Chodosh, J., Jonas, J.
Posted: May 20, 2016, 10:20 am
Retinopathy of prematurity in Korean infants with birthweight greater than 1500 g
Objective

To determine the incidence and clinical features of, and risk factors for, retinopathy of prematurity (ROP) in Korean infants with birthweight (BW) >1500 g.

Methods

A total of 201 consecutive infants with BW >1500 g from January 2009 to December 2013 were included. The location and maximal stage of retinopathy observed were recorded for each infant. The associated systemic and maternal risk factors in infants with mild or absent ROP were compared with those in infants with treatment-requiring ROP.

Results

The total incidence of ROP was 11.94% and that of treatment-requiring ROP was 3.98%. Two patients with gestational age (GA) >32 weeks and BW >1500 g had treatment-requiring ROP. 15 eyes from eight infants with type I ROP required laser photocoagulation. The mean BWs and GAs in the treatment-requiring ROP group were significantly lower than those in the no or mild ROP group. Total duration of oxygen supplementation, surfactant usage, respiratory distress syndrome, bronchopulmonary dysplasia, antibiotic use for more than 14 days and the number of ROP-associated risk factors significantly increased the likelihood of treatment-requiring ROP (p=0.002, p=0.008, p=0.008, p=0.000, p=0.015, and p=0.004, respectively).

Conclusion

Our study confirmed that treatment-requiring ROP does occur in infants with BW >1500 g. To avoid overlooking infants with vision-threatening ROP, an evaluation of the data from larger BW preterm infants is advisable so that screening guidelines in neonatal care units may be refined.

Author: Park, S. H., Yum, H. R., Kim, S., Lee, Y. C.
Posted: May 20, 2016, 10:20 am
A novel use of reticulated hyaluronic acid (Healaflow) for hypotony eyes in patients with uveitis

Persistent ocular hypotony is a complex and ongoing challenge faced in ophthalmology. It can result in early ocular phthisis and associated visual decline, pain and deformity. We present the first case series, in which repeated intracameral injections of highly reticulated hyaluronic acid (Healaflow) have successfully prevented the complications of ocular hypotony in the long term. We believe it is a viable management option that can bring about a significant improvement to the quality of life in this subgroup of patients while avoiding frequent intervention.

Author: Stead, R. E., Juma, Z., Turner, S., Jones, L. D., Sung, V. C. T.
Posted: May 20, 2016, 10:20 am
Diabetes and diabetic retinopathy in people aged 50 years and older in the Republic of Suriname
Background/Aims

Population-based surveys on diabetes and diabetic retinopathy (DR) are necessary to increase awareness and develop screening and therapeutic programmes. The aim was to estimate the prevalence of DR in older adults of different ethnic backgrounds in Suriname.

Methods

Fifty clusters of 60 people aged ≥50 years were randomly selected with a probability proportional to the size of the population unit. Eligible people were randomly selected through compact segment sampling and examined using the Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy (RAAB + DR) protocol. Participants were classified as having diabetes if they: were previously diagnosed with diabetes; were receiving treatment for glucose control; had a random blood glucose level >200 mg/dL. These participants were dilated for funduscopy, assessed for DR following the Scottish DR grading protocol and evaluated for ethnicity and DR ophthalmic screening frequencies.

Results

A total of 2806 individuals was examined (response 93.6%). The prevalence of diabetes was 24.6%. In these patients any type of DR and/or maculopathy occurred in 21.6% and sight-threatening DR in 8.0%. Of the known diabetics, 34.2% never had an eye examination for DR and in 13.0% the last examination was >24 months ago. The prevalence of diabetes was significantly higher in Hindustani people compared with other major ethnic groups.

Conclusions

The prevalence of diabetes and diabetics without regular DR control in people aged ≥50 years in Suriname was higher than expected. The uptake for special services for DR has to be expanded to decrease patient delay and DR-induced blindness.

Author: Minderhoud, J., Pawiroredjo, J. C., Bueno de Mesquita-Voigt, A.-M. T., Themen, H. C., Siban, M. R., Forster-Pawiroredjo, C. M., Limburg, H., van Nispen, R. M., Mans, D. R., Moll, A. C.
Posted: May 20, 2016, 10:20 am
Corticosteroids as a therapy for bacterial keratitis: an evidence-based review of 'who, when and why

Corticosteroids have been proposed as an adjunct to antibiotics for the treatment of bacterial keratitis, with significant controversy regarding the appropriate use of this therapy. Recent prospective randomised controlled trials have provided additional evidence to guide clinical decision-making. A review of the epidemiology and mechanisms of pathogenesis, preliminary animal studies, retrospective human studies and prospective randomised clinical trials that address the potential risks and benefits of corticosteroids in patients with bacterial keratitis was performed. Four prospective randomised controlled trials were identified. Three small studies found no benefit of topical corticosteroids, but were underpowered to evaluate adverse events. The Steroids for Corneal Ulcers Trial (SCUT) study and subgroup analyses provide evidence for a relative gain of one line of best spectacle-corrected visual acuity in patients with non-Nocardia bacterial keratitis, especially when corticosteroids were initiated within 3 days of presentation; no increase in adverse events was noted. No evidence was found to support the concern for corneal thinning attributable to corticosteroids in the absence of an inadequately treated infectious process. In patients with culture-proven non-Nocardia bacterial keratitis, corticosteroids provide one line of vision improvement over antimicrobials alone, with no increase in adverse events. This benefit should not be extrapolated to patients with other aetiologies of keratitis, such as fungus, herpes viruses, acanthamoeba or atypical mycobacteria, and these entities should be excluded before considering adjunctive steroid therapy.

Author: Tallab, R. T., Stone, D. U.
Posted: May 20, 2016, 10:20 am
Interobserver agreement using Goldmann applanation tonometry and dynamic contour tonometry: comparing ophthalmologists, nurses and technicians
Purpose

To compare agreement between ophthalmologists and non-ophthalmologists (nurses and ophthalmic technicians) when measuring the intraocular pressure (IOP) using Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT).

Methods

Patients attending for their routine glaucoma outpatient appointment were invited to participate. IOP was measured in one eye by either two ophthalmologists (observer group 1), two non-ophthalmologists (observer group 2) or one ophthalmologist and one non-ophthalmologist (observer group 3). All were experienced in using GAT and some experienced in using the DCT. The order of tonometer and staff was randomised. Agreement was calculated by Bland–Altman analysis, with the mean difference and 95% limits of agreement (LoA) of measurements calculated for each observer group.

Results

One hundred eyes were measured within each observer group. The mean difference (95% LoA) in IOP measurements were GAT: group 1=–0.20 (4.9) mm Hg, group 2=0.6 (5.4) mm Hg and group 3=0.0 (3.7) mm Hg; DCT: group 1=0.8 (7.7) mm Hg, group 2=0.3 (4.2) and group 3=0.0 (5.2) mm Hg. The DCT consistently over-read the GAT for all observer groups.

Discussion/conclusions

Ophthalmologists show good levels of agreement with each other when using GAT, while technicians/nursing staff show better agreement when using the DCT. The DCT may be a better tonometer to use if permanently delegating IOP measurements to non-ophthalmologists, but measurements cannot be interchanged with the GAT.

Author: Kotecha, A., Elkarmouty, A., Ajtony, C., Barton, K.
Posted: May 20, 2016, 10:20 am
Biopsies of cicatricial conjunctivitis cases reveal highly variable sampling practice among ophthalmologists: time for national and international standardisation
Background

There has been no in-depth study examining the preanalytical direct immunofluorescence (DIF) biopsy phase for patients with cicatricial conjunctivitis.

Methods

90 patients with cicatricial conjunctivitis had biopsies taken for DIF. The study examined the following biopsy and clinical parameters: Age and sex of patient, unilateral or bilateral involvement, unilateral or bilateral biopsy, site of biopsy, nature of biopsy site (normal or diseased), number of biopsies per eye, size of biopsy, medium in which biopsy sent, whether buccal mucosa biopsied, whether tissue biopsied for histology (fixed in formalin) DIF results for conjunctival and buccal biopsies and final clinicopathological diagnosis.

Results

Most cases had unilateral sampling despite many cases showing bilateral disease. 15/90 cases had buccal biopsies. The conjunctival site for biopsy was not consistent from case to case. The mean maximum biopsy size was 3.3 mm length, 1 mm depth. No case was inadequate for DIF. Biopsies were obtained from conjunctiva with varying disease activity. 80/90 cases were sent in an appropriate medium permitting DIF. DIF+ biopsy rates were not affected by biopsy site disease activity. Five cases of bilateral involvement and bilateral biopsies showed only unilateral DIF+. In five cases, the conjunctival biopsies were DIF+ and the buccal biopsy was DIF–. Five cases showed in situ and invasive carcinoma seen on the accompanying formalin-fixed biopsy.

Conclusions

DIF biopsies for cicatricial conjunctivitis showed highly variable preanalytical phase sampling practice that requires national and international standardisation to facilitate prompt diagnosis, treatment, research and audit.

Author: Mudhar, H. S.
Posted: May 20, 2016, 10:20 am
A prospective randomised controlled clinical trial comparing a combination of repeated intravitreal Ozurdex and macular laser therapy versus macular laser only in centre-involving diabetic macular oedema (OZLASE study)
Background/aims

To evaluate the clinical efficacy and safety of combined repeated Ozurdex and macular laser therapy (MLT) compared with MLT monotherapy in participants with visual impairment due to centre-involving diabetic macular oedema (DMO).

Methods

80 patients with best corrected visual acuity (BCVA) between 54 and 78 ETDRS letters due to centre-involving DMO were randomised to combination therapy with Ozurdex and MLT or MLT only. The combination arm received mandated Ozurdex injections at baseline and 16 weeks followed by retreatment criteria-guided pro-re-nata therapy at 32 and 48 weeks. Patients randomised to MLT only were treated every 16 weeks if clinically significant macular oedema was present. The primary outcome was the mean change from baseline in BCVA between arms at 56 weeks.

Results

The mean change in BCVA at 56 weeks was –0.3 (SD 11.4) ETDRS letters in the combination arm versus +0.4 (SD 9.6) ETDRS (Early Treatment Diabetic Retinopathy study) letters in the MLT arm (effect estimate 1.15 (95% CI –3.32 to 5.61)). However, at 56 weeks, a post hoc comparison of central subfield thickness (CST) showed a decrease of –113 μm (IQR –218, –64) (combination) versus –17 μm (–128, 12) (MLT arm) (p<0.001). Elevated intraocular pressure requiring topical therapy was observed in 8 (20%) eyes in the combination versus 1 (2.5%) in the MLT arm. 33% (9/27) of phakic patients in the combination arm underwent cataract surgery.

Conclusions

Visual outcome following combination therapy did not differ from MLT alone in the centre-involving DMO despite a significant decrease in CST likely due to an entry visual acuity-related ceiling effect and cataract development.

Trial registration number

EudraCT 2011-003339-74

Author: Heng, L. Z., Sivaprasad, S., Crosby-Nwaobi, R., Saihan, Z., Karampelas, M., Bunce, C., Peto, T., Hykin, P. G.
Posted: May 20, 2016, 10:20 am
Correction: Current therapeutic developments in atrophic age-related macular degeneration

Hanus J, Zhao F, Wang S. Current therapeutic developments in atrophic age-related macular degeneration. Br J Ophthalmol 2016;100:122–7. In the first paragraph of the "Lipofuscin and visual cycle inhibitors" section of the paper (p. 124), the authors state "A2E, derived from vitamin E, is a byproduct of the visual cycle and a component of lipofuscin". This sentence should read: "A2E, derived from vitamin A, is a byproduct of the visual cycle and a component of lipofuscin".

Posted: May 20, 2016, 10:20 am
Novel morphological macular findings in juvenile CLN3 disease
Aims

Juvenile CLN3 disease, one of the most common forms of a group of lysosomal storage diseases called neuronal ceroid lipofuscinoses (NCLs), is a progressive neurodegenerative disorder with initial visual deterioration. The objective of this study was to analyse the retinal phenotype of patients with CLN3 disease with the help of recent ophthalmic imaging modalities to distinguish CLN3 disease from other inherited retinal dystrophies.

Methods

Patients underwent ophthalmic evaluations, including anterior and posterior segment examinations, optical coherence tomography, fundus autofluorescence, near infrared imaging and fundus photography. Patients were also assessed according to the Hamburg juvenile NCL (JNCL) score. Each ophthalmic finding was assessed by three independent examiners and assigned to a clinical severity score.

Results

22 eyes of 11 patients were included. The mean age at examination was 14.4 years (range 11.8–26.4 years), with an average age at initial diagnosis of 8 years (range 4.5–11 years). The mean Hamburg JNCL score was 7.3 (range 0–13). All patients showed a specific macular striation pattern on optical coherence tomography that was independent of age and progression of the disease. Other previously described retinal features of CLN3 disease were classified into four severity grades.

Conclusions

This study represents the first prospective observational case series documenting retinal abnormalities in CLN3 disease with the aid of the spectral domain optical coherence tomography. The major finding was a characteristic, striated macular pattern in all patients studied. Particularly in early disease cases, macular striae can potentially help to discriminate CLN3 disease from other inherited forms of retinitis pigmentosa.

Author: Dulz, S., Wagenfeld, L., Nickel, M., Richard, G., Schwartz, R., Bartsch, U., Kohlschu&#x0308;tter, A., Schulz, A.
Posted: May 20, 2016, 10:20 am

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