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:

Secondary iris-claw anterior chamber lens implantation in patients with aphakia without capsular support
Background/aims

To evaluate the efficacy, predictability, safety and complications of secondary iris-claw intraocular lens (IOL) implantation in aphakic eyes without capsular support.

Methods

Retrospective, non-comparative, interventional case series of 128 aphakic eyes, which consecutively underwent secondary iris-claw Artisan IOL (Ophtec BV) implantation, were included. Manifest refraction, uncorrected visual acuity, best-spectacle corrected visual acuity, biomicroscopy, tonometry, funduscopy and central endothelial cell count (cECC) were evaluated before surgery, and at yearly intervals up to 5 years. Minimum follow-up time was 1 year.

Results

One hundred twenty-eight eyes were treated. Mean age was 54.55 years (range, 1–98 years). Mean follow-up was 41.8 months (SD 23.63). Mean preoperative logarithm of the minimum angle of resolution BSCVA and spherical equivalent (SE) were 0.67 ((SD) 0.53) and 9.63 D (SD 5.50), respectively. One year postoperatively, mean logarithm of the minimum angle of resolution best-spectacle corrected visual acuity improved to 0.52 (SD 0.46) (p<0.05), and remained stable up to 5 years. One year postoperatively, mean SE was –0.52 (SD 2.21) (p<0.05). Mean SE progressively decreased during the 1st year, and remained stable thereafter (p<0.05). Mean preoperative cECC was 2237.47 (SD 793.33) cells/mm2. cECC showed a slight, though statistically significant, decrease over the years (p=0.05). Main complications were: 2 pupillary block; 3 transient increase in intraocular pressure; 1 IOL replacement; 2 penetrating keratoplasty and 4 cystoid macular oedema.

Conclusions

Iris-claw IOL implantation in aphakic eyes is an effective, predictable and safe procedure in the first 5 years of follow-up. However, a longer follow-up is required to demonstrate its long-term safety.

Author: Guell, J. L., Verdaguer, P., Elies, D., Gris, O., Manero, F., Mateu-Figueras, G., Morral, M.
Posted: April 12, 2014, 12:52 pm
Ocular Trauma Scores in paediatric open globe injuries
Background/aims

To assess the predictive value and the applicability of Ocular Trauma Score (OTS) for paediatric injuries.

Methods

Retrospective case series of 71 open globe injuries in children less than 18 years of age with a minimum follow-up period of 1 year. The variables of the OTS, the Paediatric Penetrating OTS (POTS), lens injuries and anterior versus posterior segment injuries were analysed for their predictive values in terms of visual outcome. The applicability and the predictive values of OTS and POTS as a whole were then evaluated.

Results

Initial visual acuities, retinal detachments, wound locations (p<0.001 each), lens injuries (p=0.001), posterior segment injuries (p=0.002), traumatic cataracts (p=0.010), hyphaema (p=0.011) and vitreous haemorrhages (p=0.026) had significant impacts on visual outcome. The application of OTS proved difficult, as the presence of a mild degree of a relative afferent pupillary defect (RAPD) could not accurately be evaluated in all of our patients. Calculating the OTS without evaluation of RAPD renders it easily applicable for the initial examinations while remaining significantly prognostic (p<0.001). The predictions of the POTS correlated with the actual final visual acuities (p<0.001), but several POTS variables (ie, iris prolapse, age, organic injuries and delay of surgery >48 h) had only limited impacts on visual outcome.

Conclusions

The OTS has a high predictive value for visual outcome after open globe injuries in children, even without evaluation of RAPD.

Author: Schorkhuber, M. M., Wackernagel, W., Riedl, R., Schneider, M. R., Wedrich, A.
Posted: April 12, 2014, 12:52 pm
Correction

Pepple KL, Cusick M, Jaffe GJ, et al. SD-OCT and autofluorescence characteristics of autoimmune retinopathy. Br J Ophthalmol 2013;97:139–144. The fourth figure was accidentally omitted from print version of article. For the full version, please see the Online First version of the article available here: http://bjo.bmj.com/content/early/2012/12/04/bjophthalmol-2012-302524

Posted: April 12, 2014, 12:52 pm
Abnormal retinal thickening is a common feature among patients with ARSACS-related phenotypes

Autosomal-recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) was first described among French Canadian patients from Québec presenting with a stereotypical triad of early-onset cerebellar ataxia, spastic paraplegia and peripheral neuropathy. Two recurring pathogenic mutations in the SACS gene were subsequently identified in these families in keeping with a mutational founder event in a geographically isolated population.1 However, ARSACS is being increasingly recognised worldwide as an important cause of inherited ataxia.2 Interestingly, non-Québec patients can show strikingly variable features marked by a lack of spasticity, cognitive impairment and a delayed age of onset.2 Given the heterogeneous clinical picture that can be associated with SACS mutations, the identification of ancillary features linked with these genetic defects could prove particularly useful in prioritising the most appropriate lines of investigations when confronted with a suspected case of ARSACS. Although prominent retinal hypermyelination is thought to be a characteristic...

Author: Yu-Wai-Man, P., Pyle, A., Griffin, H., Santibanez-Korev, M., Horvath, R., Chinnery, P. F.
Posted: April 12, 2014, 12:52 pm
Correction

Muqit MM, Stanga PE. Fourier-domain optical coherence tomography evaluation of retinal and optic nerve head neovascularisation in proliferative diabetic retinopathy. Br J Ophthalmol 2014;98:65–72. M Muqit's affiliation for this article is incorrect. The work was undertaken at ‘Manchester Royal Eye Hospital, Manchester, UK’ and not Moorfields Eye Hospital.

Posted: April 12, 2014, 12:52 pm
Focal digital pressure for the management of posterior chamber tube shunts: a novel technique
Background

Glaucoma affects 2–3 millions of Americans and is a leading cause of blindness.1 The only proven intervention to slow disease progression is to reduce the intraocular pressure which can be done with medications, lasers and surgery.1 Glaucoma drainage implants (GDI) are useful adjuncts in surgical management.2 Several types of implants are currently available and vary in surface area, shape, material composition, and presence or absence of a flow-restricting valve. GDIs may be placed in the anterior chamber, ciliary sulcus or pars plana.3 The location of the tube is determined by the surgeon and often depends on several factors. Visibility of the anterior chamber tube is one clear advantage over a posteriorly placed tube. However, tube erosion and extrusion as well as corneal decompensation are presumably less common in a sulcus and pars placed tubes, making these preferred locations for...

Author: Medina, C. A., Davis, R., Schuman, J. S.
Posted: April 12, 2014, 12:52 pm
Follicle size in trachoma: assessment of a well-known trachoma grading diagram
Introduction

Trachoma remains the world's leading infectious cause of blindness.1 Trachoma control programmes determine when to start and stop mass antibiotic treatments based on the prevalence of follicular trachoma (TF) in children aged 1–9 years, as assessed by examination of the upper tarsal conjunctiva using the WHO simplified grading system.2 According to the WHO classification, TF is defined as the presence of ≥5 follicles at least 0.5 mm in diameter. The original paper describing the WHO simplified grading system included a diagram of the everted conjunctiva with examples of follicles that were 0.5 mm in diameter.2 However, in our clinical experience, the follicles in this diagram seem to be less than 0.5 mm when considered relative to the size of the conjunctiva. In this article, we measured the size of the follicles on the WHO diagram relative to photographs of everted conjunctivae from clinical trials...

Author: Morberg, D. P., Amza, A., Gebresillasie, S., Tadesse, Z., Yu, S. N., Stoller, N. E., Emerson, P. M., Gaynor, B. D., Lietman, T. M., Keenan, J. D.
Posted: April 12, 2014, 12:52 pm
A novel RPGR mutation masquerading as Stargardt disease
Introduction

An adult male was referred for a second opinion of his retinal dystrophy. His prior genetic testing identified an ABCA4 gene variant associated with Stargardt disease. He had an affected younger brother, and the rest of his family was reported to be asymptomatic. He wanted to know if he would qualify for any Stargardt gene or stem cell therapy trials.

Case description

The adult male proband (III:A) experienced blurred central vision, nyctalopia and photophobia since childhood. His best-corrected visual acuity was 20/100 and 20/200, respectively. Fundus examination demonstrated a bull's eye maculopathy and peripapillary atrophy (figure 1). There was no intraretinal pigmentary migration, pisciform flecks, optic disc pallor or retinal vessel attenuation. Fundus autofluorescence revealed a prominent bull's eye pattern. Spectral domain optical coherence tomography showed foveal thinning (figure 2). These findings were not inconsistent with a cone dystrophy such as...

Author: Bassuk, A. G., Sujirakul, T., Tsang, S. H., Mahajan, V. B.
Posted: April 12, 2014, 12:52 pm
Random conjunctival biopsy in multiorgan disease

A previously fit and well 43-year-old woman from West Africa presented with a 9 month history of productive cough, weight loss and unsteadiness on her feet. She denied night sweats. On examination she was apyrexial. Blood cultures were negative. Full blood count was normal, serum ACE was elevated at 194, and she was hypercalcaemic with a low parathyroid hormone level. She was HIV negative. Chest X-ray and subsequent CT chest showed bilateral hilar and mediastinal lymph node enlargement. MRI brain and spine were normal. Lumbar puncture revealed no organisms, low protein and glucose.

On further questioning she gave a several months’ history of bilateral blurred vision. She was reviewed by ophthalmology and was found to have visual acuity of 6/9 and mild anterior chamber activity with mutton-fat keratic precipitates bilaterally. Dilated funduscopy revealed bilateral multiple small, rounded, white choroidal lesions. There was no vitreous activity. There were no conjunctival lesions...

Author: Silvester, A., Armstrong, S., Matthews, C., Hamid, B.
Posted: April 12, 2014, 12:52 pm
Ophthalmic statistics note 2: absence of evidence is not evidence of absence
Scenario 1

Patients undergoing vitrectomy surgery for idiopathic full-thickness macular holes used to be routinely advised to follow a strict regime of posturing face down for a variable period (up to 2 weeks) after surgery.1–3 There was a scientific rationale for this—the tractional forces of gravity would force gases against the macula allowing it to heal more readily. Patients who postured were therefore believed to be less at risk of their macular hole reopening and of the need for repeat surgery to repair the hole. Medicine has clearly changed very significantly over time with a far greater emphasis on patient based outcomes and upon the need for an evidence base to justify practice.45 A senior colleague tells me that he has run a large randomised controlled clinical trial on patients who have had vitrectomies for macular holes. He...

Author: Bunce, C., Patel, K. V., Xing, W., Freemantle, N., Dore, C. J., On behalf of the Ophthalmic Statistics Group, Cook, Crabb, Cumberland, Czanner, Donachie, Elders, Garcia-Finana, Nash, O'Leary, Prevost, Rogers, Saunders, Sivasubramanium, Stratton, Vasconcelos, Zhu
Posted: April 12, 2014, 12:52 pm

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