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.
Ophthalmology Journal News:
Few longitudinal studies have evaluated the relationship between cigarette smoking and risk of neovascular age-related macular degeneration (AMD) among Asian populations. This study aimed to prospectively evaluate the association between cigarette smoking and risk of neovascular AMD among Korean men.
Men between the ages of 45 and 79 years included in the Korea National Health Insurance Service database from 2002 through 2013. We compared hazard ratios (HR) for neovascular AMD between 64 560 past/current and 64 560 never smokers by 1:1 propensity-matched analysis and 85 267 past/current and 72 347 never smokers by unmatched cohort and propensity-adjusted analysis.
The risk of neovascular AMD among past/current smokers was 50% higher than that among never smokers (propensity-adjusted whole cohort analysis: HR, 1.48; 95% CI 1.22 to 1.79; propensity-matched analysis: HR, 1.50; 95% CI 1.22 to 1.84), with the risk more pronounced among current than past smokers (current vs past smokers: propensity-adjusted whole cohort analysis, HR, 1.66; 95% CI 1.35 to 2.04 vs HR, 1.15, 95% CI 0.87 to 1.52; propensity-matched analysis, HR, 1.65; 95% CI 1.32 to 2.05 vs HR, 1.21; 95% CI 0.90 to 1.63). Duration of smoking and daily cigarette consumption was associated with the incidence of neovascular AMD in a dose-dependent manner (p<0.001 for trend).
Cigarette smoking is associated with a strong risk of neovascular AMD among Korean men. These data highlight the public health impact of smoking on blindness in Asia.
To investigate the long-term safety of intravitreal ziv-aflibercept in eyes receiving six or more intravitreal injections of ziv-aflibercept, an off-label substitute to the approved aflibercept.
Consecutive patients with retinal disease receiving six or more of intravitreal 0.05 mL ziv-aflibercept (1.25 mg) injections were followed monthly in three centres. Outcome measures were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution (logMar)) and central macular thickness (CMT) on spectral domain optical coherence tomography and monitoring for ocular inflammation, progression of lens opacities and intraocular pressure rise. Paired comparison was done using Wilcoxon signed-rank test calculator.
Sixty-five eyes of 60 consecutive patients received a mean of 8.4 (6–17) intravitreal injections with a baseline mean logMAR BCVA of 0.98±0.56 and CMT 432.7±163.0 μm and followed for a mean of 9.2 months (range 6–18 months). After the sixth injection, mean BCVA improved to 0.57±0.36 (p=0.001) and CMT decreased to 274.8±117.8 μm (p=0.0001). At the 9-month follow-up, mean BCVA improved to 0.62±0.37 (p=0.0004) and mean CMT decreased to 292.0±160.9 μm (p<0.01) in 19 eyes. At 1 year, mean BCVA was 0.73±0.52 and CMT 311.6±232.5 μm in seven eyes. Intraocular pressures did not increase after injections. One subject developed transient mild iritis at the fourth injection but not on subsequent injections. No lens opacity progression or endophthalmitis was noted. Systemic adverse effects were not registered.
Repeated intravitreal injections of ziv-aflibercept appear tolerable, safe and efficacious in the therapy of retinal disease.
To develop algorithms for preoperative estimation of the true postoperative intraocular lens (IOL) position to be used for IOL power calculation.
Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Fifty patients were implanted randomly with a 3-piece IOL model in one eye and a 1-piece model in the other eye. Preoperatively, the IOLMaster was used to determine axial length, anterior chamber depth and mean corneal radius. Lens thickness and corneal width were measured with the ACMaster. Postoperative IOL position was measured with the ACMaster. Partial least squares (PLS) regression analysis of IOL position in terms of preoperative parameters was performed with a commercially available software package.
The PLS regression analysis showed that age, refraction, corneal width, lens thickness and corneal radius are not significant predictors of postoperative position of the anterior IOL surface, while axial length and in particular anterior chamber depth are. Regression relationships in terms of the above-mentioned predictors were determined for the two models implanted. Surprisingly, it turned out that the position of the posterior IOL surface could be described by a single regression relationship valid for both models. The residual SD for prediction of IOL position was about 0.17 mm for all relationships.
Accurate relationships to determine the true postoperative IOL position were obtained. In addition to axial length and corneal radius, which are required for the IOL power calculation as such, they require measurement of preoperative anterior chamber depth only.
To study the demographic profile, clinical features, treatment outcome and ocular morbidity of smear-positive microsporidial keratoconjunctivitis.
Retrospective case series of all patients with clinical features of microsporidial keratoconjunctivitis and who were smear positive for the same on Gram stain from January 2013 to December 2015. Demographic data, predisposing factors, microbiological investigations, clinical course and visual outcome were analysed.
Of the 10 655 patients with conjunctivitis, 550 (5.2%) patients were positive for microsporidia on Gram stain during this time period. The disease was prevalent throughout the year with an increased incidence from July to December. Bilateral involvement was seen in 27 (4.9%) patients. There was no predisposing risk factor in 428 (77.8%) patients. 384 (69.1%) patients had received prior treatment before presentation to us with the most common drug being antibiotic in 285 (49.4%) patients. All the patients underwent diagnostic corneal debridement and received topical 0.3% fluconazole eye drops four times a day. Of the 296 patients who followed-up, 187 (63.1%) patients had complete resolution without sequelae. 68 (22.9%) had persistent superficial punctate keratopathy, 30 (10.1%) developed subepithelial nummular keratitis. No significant change in visual acuity was seen in 255 (80.7%) eyes, two or more line improvement was seen in 48 (15.2%) eyes, while two or more line worsening was seen in 13 (4.1%) eyes.
Microsporidial keratoconjunctivitis is prevalent in South India throughout the year. The characteristic clinical signs and simple microbiological investigation help us to differentiate it from adenoviral keratoconjunctivitis. The visual prognosis is good.
Gupta P, Thakku SG, Sabanayagam C, et al. Characterisation of choroidal morphological and vascular features in diabetes and diabetic retinopathy. Br J Ophthalmol 2017;101:1038–1044.
This paper has been corrected since it first published. Author Rupesh Agrawal has been added. The new author list and affiliations are:
Preeti Gupta,1,2 Sri Gowtham Thakku,1,2 Charumathi Sabanayagam,1,2,3Gavin Tan,1,2,3 Rupesh Agrawal,1,4,5 Chui Ming Gemmy Cheung,1,2,3 Ecosse L Lamoureux,1,2,3 Tien-Yin Wong,1,2,3 Ching-Yu Cheng1,2,3
1Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
2Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
3Duke-NUS Medical School, Singapore, Singapore
4Tan Tock Seng Hospital, Singapore
5School of Material Science and Engineering, Nanyang Technological University, Singapore
Although chloral hydrate (CH) has been used as a sedative for decades, it is not widely accepted as a valid choice for ophthalmic examinations in uncooperative children. This study aimed to systematically review the literature on the drug's safety and efficacy.
We searched PubMed, EMBASE, ISI Web of Science, Scopus, CENTRAL, Google Scholar and Trip database to 1 October 2015, using the keywords ‘chloral hydrate’, ‘paediatric’ and ‘procedural sedation OR diagnostic sedation’. A meta-analysis of randomised controlled trials (RCTs) was performed.
A total of 6961 articles were screened and 104 were included in the review. Thirteen of these concerned paediatric ophthalmic examination, while 13 others were RCTs and were meta-analysed. CH was reported to have been administered in a total of 24 265 sedation episodes in children aged from <1 month to 18 years. The meta-analysis showed CH had a higher OR (2.95, 95% CI 1.09 to 7.99) for successful sedation compared to other sedatives, but significant limitations apply. The commonest reported adverse events (AE) were not serious (eg, paradoxical reaction or transient vomiting) and required no intervention. Severe AE, including two deaths, were related to comorbidity, overdose or aspiration.
Despite the paucity of high quality evidence, the existing literature suggests that the use of CH for procedural sedation in children appears to be an effective alternative to general anaesthesia, and it can be safe when administered in the hospital setting with appropriate monitoring and vigilance for intervention.
To evaluate the effects of intra-arterial chemotherapy on retrobulbar blood flow parameters in patients with retinoblastoma.
20 eyes of 10 patients with unilateral retinoblastoma that were treated with intra-arterial chemotherapy were evaluated using colour Doppler imaging. The peak systolic and end-diastolic velocities of the ophthalmic, central retinal and posterior ciliary arteries were determined. The pulsatility and resistance indices were calculated automatically. The treated eye was compared with the untreated (control) eye and with itself before and after intra-arterial chemotherapy.
When comparing the retinoblastoma-containing eyes with the contralateral normal eyes, the peak systolic and end-diastolic velocities of the central retinal artery were significantly higher in the tumorous eyes than in the normal eyes before intra-arterial chemotherapy. Moreover, the peak systolic and end-diastolic velocities in the posterior ciliary and central retinal arteries were significantly decreased after intra-arterial chemotherapy in the tumorous eyes (p<0.05). There were no statistically significant differences in the other parameters.
Our results suggest that intra-arterial chemotherapy has a measurable effect on the retrobulbar blood flow, which can cause a decrease in the peak systolic and end-diastolic velocities in the posterior ciliary and central retinal arteries.
Up to date, no standardised reproducible orbital volume measurement method is available. Therefore, this study aimed to investigate the accuracy of a new measurement method, which delineates the boundaries of orbital cavity three-dimensionally (3D).
In order to calculate the orbital volume from axial CT slice images of the patients, using our first described measurement method, the segmentation of the orbital cavity and the bony skull was performed using Amira 3D Analysis Software. The files were then imported into the Blender program. The stereographic skull model was aligned based on the Frankfurt horizontal plane and superposed according to defined anatomical reference points. The anterior sectional plane ran through the most posterior section of the lacrimal fossa and the farthest dorsal point of the anterior latero-orbital margin, which is positioned perpendicular to the Frankfurt horizontal plane. The volume of each orbital cavity was then determined automatically by the Blender program.
The 10 consecutive subjects (5 female, 5 male) with mean age of 50.3±21.3 years were considered for analysis in the current study. The first investigator reported a mean orbital volume of 20.24±1.01 cm3 in the first and 20.25±1.03 cm3 in the second evaluation. Furthermore, the intraclass correlation coefficient (ICC) showed an excellent intrarater agreement (ICC=0.997). Additionally, the second investigator detected a mean orbital volume of 20.20±1.08 cm3 in his assessment, in which an excellent inter-rater agreement was found in ICC (ICC=0.994).
This method provides a standardised and reproducible 3D approach to the measurement of the orbital volume.
To describe the prevalence of polypoidal choroidal vasculopathy (PCV) in a Caucasian population with neovascular age-related macular degeneration (NAMD).
All patients referred to a city AMD service over a 2-year period underwent imaging including Indocyanine Green Angiography at baseline. A panel of experts confirmed the patients with NAMD and diagnosed the lesion type including PCV. The proportion of Caucasian patients with PCV was identified. Two authors independently reviewed clinical imaging and recorded data of patients with PCV on lesion characteristics. Further information including treatments received and visual acuity at different time points was analysed.
A total of 492 patients were diagnosed with NAMD during the 2-year study period. Of these patients, 204 had occult lesions (41.5%). PCV was identified in 45 patients (22.1% of occult NAMD and 9.1% of all NAMD). 23 patients received anti-vascular endothelial growth factor (VEGF) monotherapy, 8 received verteporfin photodynamic therapy (PDT) monotherapy and the remaining 14 patients were managed with combined PDT and anti-VEGF treatment.
The prevalence of PCV in Caucasians is higher than previously reported. Indocyanine Green Angiography should be a standard investigation for all new patients with NAMD, particularly those with occult NAMD, to avoid missing this important subset.
To compare anti-vascular endothelial growth factor (VEGF) treatment outcomes for macular oedema (ME) secondary to retinal vein occlusion (RVO) based on vitreoretinal interface (VRI) status.
This retrospective case series includes treatment-naive eyes diagnosed with RVO and treated with anti-VEGF injections. Eyes were stratified based on international VRI classification schema at baseline into three groups—vitreomacular traction (group A), no posterior vitreous detachment (PVD) (group B) and PVD without vitreomacular attachment (group C). Fifty-two eyes were identified based on inclusion/exclusion criteria. The primary endpoint was change in central subfield thickness (CST) on optical coherence tomography at 6 months.
There were no statistically significant differences in baseline characteristics of patients with RVO when stratified by VRI subgroups. After 6 months of treatment, there was no statistically significant difference in the change in CST from baseline between VRI cohorts (p=0.11). There was a trend demonstrating the greatest improvement in CST in eyes in group A compared with eyes in groups B and C (–224.13 μm, –160.88 μm and –50.92 μm, respectively, p=0.11 between cohorts). Mean change in logarithm of the minimum angle of resolution visual acuity from baseline to month 6 in group A compared with groups B and C was –0.25, –0.14 and –0.13, respectively (p=0.64 between cohorts).
We did not identify an association between VRI status and treatment outcomes with anti-VEGF agents for ME secondary to RVO.
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