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:

The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group, Report 1: baseline characteristics and visual acuity outcomes in eyes treated with intravitreal injections of ranibizumab for diabetic macular oedema
Aims

To describe baseline characteristics and visual outcome for eyes treated with ranibizumab for diabetic macular oedema (DMO) from a multicentre database.

Methods

Structured clinical data were anonymised and extracted from an electronic medical record from 19 participating UK centres: age at first injection, ETDRS visual acuity (VA), number of injections, ETDRS diabetic retinopathy (DR) and maculopathy grade at baseline and visits. The main outcomes were change in mean VA from baseline, number of injections and clinic visits and characteristics affecting VA change and DR grade.

Results

Data from 12 989 clinic visits was collated from baseline and follow-up for 3103 eyes. Mean age at first treatment was 66 years. Mean VA (letters) for eyes followed at least 2 years was 51.1 (SD=19.3) at baseline, 54.2 (SD: 18.6) and 52.5 (SD: 19.4) at 1 and 2 years, respectively. Mean visual gain was five letters. The proportion of eyes with VA of 72 letters or better was 25% (baseline) and 33% (1 year) for treatment naïve eyes. Eyes followed for at least 6 months received a mean of 3.3 injections over a mean of 6.9 outpatient visits in 1 year.

Conclusions

In a large cohort of eyes with DMO treated with ranibizumab injections in the UK, 33% of patients achieved better than or equal to 6/12 in the treated eye at 12 months compared with 25% at baseline. The mean visual gain was five letters. Eyes with excellent VA at baseline maintain good vision at 18 months.

Author: Egan, C., Zhu, H., Lee, A., Sim, D., Mitry, D., Bailey, C., Johnston, R., Chakravarthy, U., Denniston, A., Tufail, A., Khan, R., Mahmood, S., Menon, G., Akerele, T., Downey, L., McKibbin, M., Varma, A., Lobo, A., Wilkinson, E., Fitt, A., Brand, C., Tsaloumas, M., Mandal, K., Kumar, V., Natha, S., Crabb, D., on behalf of the UK AMD and DR EMR Users Group, Ong, Al-Husainy
Posted: December 14, 2016, 12:01 pm
Comparison of OCT angiography and indocyanine green angiographic findings with subtypes of polypoidal choroidal vasculopathy
Purpose

To compare the findings of optical coherence tomography angiography (OCTA) with indocyanine green angiography (ICGA) in polypoidal choroidal vasculopathy (PCV) that was divided into two types: polypoidal choroidal neovascularisation (CNV) and typical PCV (type 2 PCV).

Methods

We studied a retrospective case series of 32 patients with treatment-naïve PCV (24 men, eight women; mean age 65.4 years). PCV was categorised into polypoidal CNV (type 1 PCV) and type 2 PCV based on ICGA findings. OCTA was performed using the RTVue XR Avanti. Macular cubes (3x3 or 6x6 mm) were acquired. To evaluate the locations of polyps and branched vessel networks (BVNs), we used B-mode scan.

Results

OCTA clearly depicted only 17% of the type 1 PCV polyps and 46% of the type 2 PCV polyps which were detectable by ICGA. All type 1 PCV polyps detectable by OCTA were located just beneath the retinal pigment epithelium (RPE). On the other hand, type 2 PCV polyps were detected in various locations. All BVNs of type 1 PCV were located between the RPE and Bruch's membrane on OCTA images. However, the BVNs in type 2 PCV were located mainly under the RPE, though some were located in the choroid.

Conclusions

Polyps of type 1 PCV were more difficult to detect with OCTA than those of type 2 PCV. Polyps of type 1 PCV were located just beneath the RPE. The BVNs of type 1 PCV were located between the RPE and Bruch's membrane.

Author: Tanaka, K., Mori, R., Kawamura, A., Nakashizuka, H., Wakatsuki, Y., Yuzawa, M.
Posted: December 14, 2016, 12:01 pm
Ageing and ocular surface immunity

The prevalence of ocular surface immunopathologies is enhanced in the elderly. This increased prevalence has been attributed to age-related dysregulation of innate and adaptive immune system responses. Age-related changes in ocular surface immunity have similar and distinct characteristics to those changes seen in other mucosal tissues. This mini review provides a brief outline of key findings in the field of ocular ageing, draws comparisons with other mucosal tissues and, finally, discusses age-related changes in the context of immunopathogenesis of infectious keratitis and dry eye disease, two of the most common inflammatory disorders of the ocular surface.

Author: Mashaghi, A., Hong, J., Chauhan, S. K., Dana, R.
Posted: December 14, 2016, 12:01 pm
Metastatic disease from uveal melanoma: treatment options and future prospects

Uveal melanoma represents ~85% of all ocular melanomas and up to 50% of patients develop metastatic disease. Metastases are most frequently localised to the liver and, as few patients are candidates for potentially curative surgery, this is associated with a poor prognosis. There is currently little published evidence for the optimal management and treatment of metastatic uveal melanoma and the lack of effective therapies in this setting has led to the widespread use of systemic treatments for patients with cutaneous melanoma. Uveal and cutaneous melanomas are intrinsically different diseases and so dedicated management strategies and therapies for uveal melanoma are much needed. This review explores the biology of uveal melanoma and how this relates to ongoing trials of targeted therapies in the metastatic disease setting. In addition, we consider the options to optimise patient management and care.

Author: Carvajal, R. D., Schwartz, G. K., Tezel, T., Marr, B., Francis, J. H., Nathan, P. D.
Posted: December 14, 2016, 12:01 pm
Controversies in ocular tuberculosis

Ocular tuberculosis still remains a presumptive, clinical diagnosis in the presence of supportive clinical signs and investigations, while in the absence of other possible causes of uveitis. The purpose of this review is to discuss three controversies of ocular tuberculosis today. First, it is unclear from many reports on how the diagnosis of ocular tuberculosis was defined, and if they included ‘probable’ or ‘possible’ diagnoses. Thus, there is a need to standardise the terminology used for ocular tuberculosis to allow for comparisons among studies. Second, the investigative approach is heterogeneous worldwide and there is currently no agreement on the pathogenesis of ocular tuberculosis. A suggested clinical approach involves first identifying supportive ocular signs, followed by a step-ladder approach of using various investigations such as nucleic acid amplification tests and interferon- release assays, before confirming a ‘definite’ case of ocular tuberculosis. Third, there are currently no guidelines for the commencement or duration of antitubercular therapy in patients with ocular tuberculosis. The current review highlights the need for a collaboration from ophthalmologists around the world to establish a consensus on the terminology, guidelines on first-line investigations to use and guidance on antitubercular and corticosteroid therapy for ocular tuberculosis.

Author: Ang, M., Chee, S.-P.
Posted: December 14, 2016, 12:01 pm
Comparison of diabetic retinopathy classification using fluorescein angiography and optical coherence tomography angiography
Purpose

To analyse and compare the classification of eyes with diabetic retinopathy using fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) performed either with AngioPlex or AngioVue.

Methods

This was an observational cross-sectional study of 50 eyes from 26 diabetic subjects. Two independent graders classified the FA angiograms, to assess the presence and severity of several characteristics according to the ETDRS Report 11, and a similar evaluation was performed for each 3x3 mm OCTA image from the superficial retinal layer and for the full retina slab.

Results

Percentages of non-gradable images for the outline of foveal avascular zone (FAZ) in the central subfield (CSF) were 29.0% for FA, 12.0% for AngioVue and 3.0% for AngioPlex. For capillary loss, percentages of non-gradable images in the CSF were 25.0% for FA, 11% for AngioVue and 0.0% for AngioPlex. For the inner ring (IR), percentages of non-gradable images were 12.5% for FA, 11.5% for AngioVue and 0.5% for AngioPlex. Agreement between graders was substantial for outline of FAZ. For capillary loss, the agreement was fair for the CSF, and moderate for the IR.

Conclusions

The OCTA allows better discrimination of the CSF and parafoveal macular microvasculature than FA, especially for FAZ disruption and capillary dropout, without the need of an intravenous injection of fluorescein. In addition, FA had also a higher number of non-gradable images. The OCTA can replace with advantage the FA, as a non-invasive and more sensitive procedure for detailed morphological evaluation of central macular vascular changes.

Trial registration number

NCT02391558, Pre-results.

Author: Soares, M., Neves, C., Marques, I. P., Pires, I., Schwartz, C., Costa, M. A., Santos, T., Durbin, M., Cunha-Vaz, J.
Posted: December 14, 2016, 12:01 pm
Gelatinous drop-like corneal dystrophy: a review

Gelatinous drop-like corneal dystrophy (GDLD) is a rare autosomal recessive form of corneal dystrophy characterised by subepithelial and stromal amyloid deposits. It is relatively common in Japan. It usually presents in the first two decades of life with subepithelial nodular lesions that later coalesce to form mulberry-like opacities. Although various surgical modalities have been attempted, recurrence remains a major challenge.

Author: Kaza, H., Barik, M. R., Reddy, M. M., Mittal, R., Das, S.
Posted: December 14, 2016, 12:01 pm
Highlights from this issue

Bailey et al (see page 45)

OCTA has the potential to improve visualisation of CNV cases ill-defined with dye-based angiography.

Mori et al (see page 51)

Comparison of optic coherence tomography angiography and indocyanine green angiography findings revealed polypoidal choroidal neovascularization and typical polypoidal choroidal vasculopathy to have characteristics in common.

Mitamura et al (see page 56)

We report that binarisation of enhanced depth imaging optical coherence tomographic images can be used to quantify the activity of polypoidal choroidal vasculopathy and predict the effect of intravitreal aflibercept injections.

Soares et al (see page 62)

OCTA images can be used as an important tool for assessing microvasculature abnormalities in the central subfield and parafoveal macular region. Moreover, this is non-invasive and allows qualitative grading.

Uji et al (see page 69)

AOSLO facilitated direct and noninvasive arterial wall visualisation in patients...

Author: Barton, K., Chodosh, J., Jonas, J.
Posted: December 14, 2016, 12:01 pm
Optical coherence tomography angiography: an overview of the technology and an assessment of applications for clinical research

In recent years, ophthalmology has experienced significant developments with respect to imaging modalities. Optical coherence tomography angiography is one such technology that seeks to improve diagnostics for retinal diseases. Using standard structural ocular coherence tomography hardware, optical coherence tomography angiography demonstrates the ability to non-invasively visualise the vasculature in the retina and the choroid with high resolution, allowing greater insight into retinal vascular pathologies. In addition, retinal and choroidal vessel density and blood flow can be quantified, offering potential to assist in the diagnosis of a variety of retinal diseases. To date, numerous retinal diseases, such as open-angle glaucoma, have been found to possess a vascular component. Specifically, ischaemia of the optic nerve head and lamina cribrosa has been theorised as a causative factor in ganglion cell death; however, confirmation of this mechanism has been prohibited by the limitations of currently existing imaging modalities. Optical coherence tomography angiography provides clear imaging of these regions and the possibility to elucidate further understanding of vascular factors that contribute to glaucoma development and progression. Furthermore, this imaging modality may provide insight to neural pathologies with vascular components such as Alzheimer's disease. Herein, the authors discuss the theory of operation for optical coherence tomography angiography and the current findings from pilot studies with a focus on open-angle glaucoma. In addition, speculation is offered for future applications of the technology to study other diseases with microvascular contributions.

Author: Koustenis, A., Harris, A., Gross, J., Januleviciene, I., Shah, A., Siesky, B.
Posted: December 14, 2016, 12:01 pm
Optical coherence tomographic angiography of choroidal neovascularization ill-defined with fluorescein angiography
Purpose

To evaluate the morphological structure of ill-defined choroidal neovascularisation (CNV) with traditional fluorescein angiography (FA) compared with optical coherence tomographic angiography (OCTA).

Methods

A retrospective case series study of 11 eyes with ill-defined CNV on FA was performed. Eyes were scanned with commercially available spectral-domain optical coherence tomography (OCT) (70 000 A-scans/s). The split-spectrum amplitude-decorrelation angiography (SSADA) algorithm was used to distinguish blood flow from static tissue. En face OCT angiograms were compared with FA.

Results

Eleven cases of ill-defined CNV on FA were identified from 10 study participants. Mean age of the participants was 74.5±6.8 years. Six cases had late leakage from undetermined source (LLUS) and five had fibrovascular pigment epithelial detachment (FVPED). Combining cross-sectional structural OCT with OCT angiograms, all cases were found to have type 1 CNV that corresponded to occult CNV with FA. In all cases of occult CNV on FA, distinct vascular structures were visible with OCTA in the outer retinal/retinal pigment epithelium slab. The mean CNV vessel area was 2.61±3.65 mm2. The mean CNV vessel area in cases with FVPED was larger than that in cases with LLUS (4.69±4.72 mm2 compared with 0.85±0.90 mm2, Mann-Whitney p value=0.04).

Conclusions

Although the sample size is small to draw conclusions and the nature of work is retrospective and descriptive, OCTA has the potential to improve visualisation of ill-defined CNV with dye-based angiography, including occult CNV.

Author: Malihi, M., Jia, Y., Gao, S. S., Flaxel, C., Lauer, A. K., Hwang, T., Wilson, D. J., Huang, D., Bailey, S. T.
Posted: December 14, 2016, 12:01 pm

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