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:

Use of bioresorbable implants for orbital fracture reconstruction
Purpose

Bioresorbable implants offer several advantages over permanent implants and serve as a useful alternative in the reconstruction of orbital fractures. Our aim of the study was to evaluate the clinical effectiveness and safety of various bioresorbable implants in the repair of orbital fractures.

Methods

A retrospective review of all patients who had undergone orbital fracture repair with bioresorbable implants in a single tertiary trauma centre from January 2005 to December 2014 was performed. Main outcome measures included improvement in ocular motility, diplopia, enophthalmos and infraorbital hypoaesthesia, as well as complication rates.

Results

Our study comprised 94 patients and 98 orbits. The types of fractures included orbital floor blow-out fractures (56.1%), zygomaticomaxillary complex fractures (20.4%), combined orbital floor and medial wall fractures (15.3%) and medial wall blow-out fractures (5.1%). The implants evaluated included poly-L/DL-lactide implants (P[L/DL]LA) 85/15 (Rapidsorb), (P[L/DL]LA) 70/30 (PolyMax), polycaprolactone (Osteomesh) and (P[L/DL]LA) 70/30 (MacroPore). There was significant improvement in ocular motility, diplopia, enophthalmos and infraorbital hypoaesthesia postoperatively at week 1, 1 month and 6 months (p<0.001). Comparison of results between the various implants and types of fractures showed no significant difference in postoperative outcome and complications. Late postoperative imaging at 15–24 months showed complete resorption of implants and features of neobone formation in all patients.

Conclusion

Our experience with bioresorbable implants shows them to be safe and clinically effective in the reconstruction of orbital fractures.

Author: Young, S. M., Sundar, G., Lim, T.-C., Lang, S. S., Thomas, G., Amrith, S.
Posted: July 18, 2017, 9:30 am
Trematodal granulomatous uveitis in paediatric Egyptian patients: a case series
Purpose

To describe the clinical presentations and results of laboratory analysis of waterborne ophthalmic granulomas of the anterior chamber (AC) in Egyptian patients.

Participants

110 patients with granulomatous anterior uveitis and distinctive AC nodules.

Design

Prospective, non-comparative, case series.

Methods

Demographic data including age, gender and place of residence were recorded. A full ophthalmic examination with emphasis on the inflammatory characteristics and systemic workup was performed. The nodules were surgically removed in selected cases and molecular and histopathological analyses were performed.

Results

102 boys and 8 girls were recruited (mean age 11.5 years). All children came from villages along the basin of the River Nile in Egypt and were engaged in swimming in the local fresh water repertoires just prior to the development of the ocular lesions. 99 patients (103 eyes) showed active granulomatous anterior uveitis with distinct pearl-like white nodules in the AC measuring between 2 and 7 mm in diameter. Inactive scarred lesions were noted in 11 patients (12 eyes). Structural complications including cataract, corectopia and phthisis were documented in 29 eyes. PCR detected digenic trematode DNA in 6 out of 14 excised nodules. Histopathological examination showed aggregates of eosinophils and epithelioid cell granulomas.

Conclusions

In Egypt, a unique pattern of granulomatous anterior uveitis in rural children attributable to a waterborne helminthic infection is reported. The River Nile and its fresh water fauna are implicated in our series, and the need for an environmental investigation to further outline best management options in the given endemic areas is highlighted.

Author: Amin, R., Goweida, M., El Goweini, H., Bedda, A., Lotfy, W., Gaballah, A., Nadar, A., Radwan, A.
Posted: July 18, 2017, 9:30 am
Cataract surgery in children with retinopathy of prematurity (ROP): surgical outcomes
Purpose

To report the outcomes of cataract surgery in children with retinopathy of prematurity (ROP).

Methods

A retrospective case review of all children diagnosed with ROP from January 2001 to December 2014 was done and those who underwent cataract surgery were included in the study. Details of ROP and cataract treatment, postoperative complications and outcomes were analysed.

Results

Of the 2258 children diagnosed to have ROP, 28 eyes of 22 children were included, 14 boys and 8 girls. Mean age at cataract surgery was 18.9 months (range 2 months to 12 years). Most common grade of ROP was stage 4 (13 eyes). Nineteen eyes underwent retinal surgery, scleral buckle (one eye) and laser (three eyes). Five eyes showed spontaneous regression. Mean duration for the development of cataract postretinal surgery was 7.76 months (range 2–32 months). Nine eyes did not receive a primary intraocular lens (IOL). Intraoperative posterior capsular rupture occurred in two eyes. Postoperative complications included visual axis opacification (four), secondary glaucoma (two) and IOL capture (one). Postoperative visual acuity assessment was possible in 23 eyes, 11 had better than 20/200 vision. Eleven patients had a follow-up of at least 2 years and the mean myopic shift at 2 years was –3.07 D in pseudophakes and –8.75 D in aphakes.

Conclusions

Cataracts may develop in children with ROP regardless of the modality of intervention. Postoperative complications and refractive changes are similar to those in eyes without ROP.

Author: Ezisi, C. N., Kekunnaya, R., Jalali, S., Balakrishnan, D., Kumari, P. R., Mohamed, A., Patil Chhablani, P.
Posted: July 18, 2017, 9:30 am
Vitreomacular adhesion or vitreomacular traction may affect antivascular endothelium growth factor treatment for neovascular age-related macular degeneration
Objective

The aim of this review is to determine whether vitreomacular adhesion (VMA) or vitreomacular traction (VMT) has an influence on the outcomes of antivascular endothelium growth factor (anti-VEGF) treatment neovascular age-related macular degeneration (nAMD).

Methods

A systematic literature search was performed in Pubmed.gov, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed and ClinicalTrials.gov up to 30 June 2016 to identify eligible studies.

Results

Nine studies and 2212 participants were finally identified. At month 6, the mean improvement in best-corrected visual acuity (BCVA) and mean decline in central retinal thickness (CRT) of the VMA/VMT(+) group was less than that of the VMA/VMT(-) group (95% CI –3.05 to –0.96 letters, p=0.0002; 15.53 to 32.98 μm, p<0.00001; respectively); at month 12, there was a small or only marginally significant difference (–0.01 to 2.00 letters, p=0.05; 0.17 to 23.7 μm, p=0.05; respectively) between the groups. During the 12 months, however, the VMA/VMT(+) group required more injections ((0.25 to 0.95), p=0.0008).

Conclusions

In using anti-VEGF drugs to treat nAMD, clinicians should take into account the fact that concurrent VMA or VMT might antagonise the efficacy of anti-VEGF drugs during the early stage of treatment.

Author: Xie, P., Zheng, X., Yu, Y., Ye, X., Hu, Z., Yuan, D., Liu, Q.
Posted: July 18, 2017, 9:30 am
Single-step transepithelial versus alcohol-assisted photorefractive keratectomy in the treatment of high myopia: a comparative evaluation over 12 months
Background/aims

To evaluate refractive outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) versus alcohol-assisted PRK (EtOH-PRK) for the correction of high myopia.

Methods

This was a retrospective non-randomised comparative study conducted at the American University of Beirut Medical Center, Beirut, Lebanon. Eyes with myopia (spherical equivalent (SE) larger than –6.00 D) that had undergone EtOH-PRK treatment combined with mitomycin C and TransPRK (SE: –7.53±0.90 D and –7.24±0.77 D, p=0.062), using the Schwind Amaris excimer laser, were included. 59 eyes (37 patients) that had single-step TransPRK were compared with 59 eyes (36 patients) that had EtOH-PRK. Visual and refractive outcomes, including analysis of astigmatism, and corneal higher order aberrations (HOAs) at 6.0 mm optical zone, were compared for 12 months postoperatively.

Results

Baseline characteristics were similar between the two groups (p>0.05). The SE deviation from target (SEDT) at 1 week, 1, 3, 6 and 12 months follow-up visits were similar between groups (p=0.428). At 12 months, 81.3% and 73.3% of eyes that had undergone TransPRK and EtOH-PRK, respectively, were between ±0.50 D SEDT (p=0.381). Mean cylinder power was 0.33±0.26 D versus 0.41±0.30 D at 12 months follow-up (p=0.140). The mean success index was 0.50±0.50 for the TransPRK group and 0.49±0.52 for the EtOH-PRK group (p=0.939), while the absolute mean angle of error was 7.81°±61.98° vs 13.12°±71.86° (p=0.667), respectively. The change in total, spherical and comatic corneal HOAs were similar in both groups at 12 months (p>0.05). Haze was similar between both groups; two eyes had +1 haze at 12 months in the TransPRK group versus zero eyes among the EtOH-PRK group (p=0.154).

Conclusions

Single-step TransPRK for high myopia with or without astigmatism appears to yield similar visual, refractive and safety results as EtOH-PRK.

Author: Antonios, R., Abdul Fattah, M., Arba Mosquera, S., Abiad, B. H., Sleiman, K., Awwad, S. T.
Posted: July 18, 2017, 9:30 am
Rate and risk factors for the conversion of fovea-on to fovea-off rhegmatogenous retinal detachment while awaiting surgery
Background/aims

Progression of a fovea-on to a fovea-off rhegmatogenous retinal detachment (RRD) while awaiting surgery is rare.

Methods

A retrospective review of patient records to identify patients in whom a fovea-on retinal detachment at presentation was found to be fovea off at surgery.

Results

We identified 10 cases over 14 years which converted from fovea-on to fovea-off RRD while awaiting surgery. This represented 1.1% of RRDs that were fovea on at presentation (n=930). Nine out of 10 patients had superotemporal RRDs extending to at least the vascular arcade at presentation and all had superotemporal breaks within detached retina, which was significantly higher than the rate for other retinal detachments (100% vs 63%, p=0.02). There were 2.4 breaks per eye, similar to other retinal detachments. Six of the 10 patients converted to a fovea-off retinal detachment within a few hours and the rest by the following day. Visual outcomes were good, with eight patients maintaining their presenting visual acuity and two losing one Snellen line.

Conclusions

Offering same-day surgery to high-risk fovea-on RRDs may not significantly influence visual outcomes and would only prevent about half of the conversions to fovea off. Superotemporal retinal detachments extending to near the arcades are most at risk and might warrant posturing to limit spread of the detachment in the preoperative period.

Author: Kontos, A., Williamson, T. H.
Posted: July 18, 2017, 9:30 am
Highlights from this issue
Rate and risk factors for conversion of fovea on to fovea off rhegmatogenous retinal detachment while awaiting surgery (see page 1011)

The rate of conversion of fovea on to fovea off rhegmatogenous retinal detachment was observed at 1.1%. Superotemporal detachments extending to the vascular arcades were most at risk. Visual outcomes were good.

A prospective, randomized, double-masked comparison of local anesthetic agents for vitrectomy (see page 1016)

In a prospective, randomized, double-masked study 1% ropivacaine alone delivered via the peribulbar route during vitrectomy provided adequate intraoperative anesthesia as well as better postoperative analgesia and less postoperative subconjunctival hemorrhage

Incidence, mechanism and outcomes of schisis retinal detachments revealed through a prospective population-based study (see page 1022)

In a national epidemiological study the annual incidence of progressive schisis retinal detachments was found to be 0.85 per million. The findings also...

Author: Barton, K., Chodosh, J., Jonas, J. B.
Posted: July 18, 2017, 9:30 am
A prospective, randomised, double-masked comparison of local anaesthetic agents for vitrectomy
Purpose

To compare the intraoperative and postoperative clinical properties of 1% ropivacaine, 0.75% bupivacaine, 2% lidocaine and a mixture of 0.75% bupivacaine and 2% lidocaine (bupi+lido) administered for peribulbar anaesthesia during vitrectomy.

Methods

A total of 140 patients were randomly allocated to four groups. The time of onset of analgesia and akinesia was measured. The efficacy of anaesthesia, degree of postoperative pain and intraoperative and postoperative complications were recorded.

Results

The mean times of onset (±SD) of analgesia for the ropivacaine, bupivacaine, lidocaine and lido+bupi groups were 90.46±30.08, 94.83±40.72, 78.31±12.56 and 101.51±56.94 s, respectively (p=0.087). The mean times of onset (±SD) of akinesia for the ropivacaine, bupivacaine, lidocaine and lido+bupi groups were 138.89±62.65, 151.86±84.78, 122.66±49.35 and 141.54±62.69 s, respectively (p=0.323). No significant difference was observed in the number of patients who attained grade-5 anaesthesia in the four groups (p=0.966). The outcome of ordered logit analysis showed that the 1% ropivacaine resulted in a significantly lower degree of postoperative pain compared with the other three groups (p=0.017, p=0.001 and p=0.001, respectively). The incidence of postoperative subconjunctival haemorrhage was decreased in the ropivacaine group compared with the other three groups (p<0.001).

Conclusions

For peribulbar anaesthesia in vitrectomy, 1% ropivacaine alone provides an adequate intraoperative anaesthesia similar to that provided by the bupivacaine, lidocaine and lido+bupi solutions, as well as provides a better quality of postoperative analgesia and decreases postoperative subconjunctival haemorrhage.

Trial registration number

ChiCTR-IPR-16007876; Results.

Author: Zhou, Y.-l., Tong, Y., Wang, Y.-x., Zhao, P.-q., Wang, Z.-y.
Posted: July 18, 2017, 9:30 am
Topical 1% 5-fluoruracil as a sole treatment of corneoconjunctival ocular surface squamous neoplasia: long-term study
Aims

To report long-term clinical outcome of topical 1% 5-fluoruracil (5-FU) as a sole treatment of ocular surface squamous neoplasia (OSSN).

Methods

41 patients affected by OSSN were included. Each patient underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients were treated by topical chemotherapy with 1% 5-FU four times a day for 4 weeks. One course was defined as 4 weeks of topical chemotherapy. Adjunctive courses were administered after 1 month of chemotherapy-free interval.

Results

Mean follow-up was 105±32 months (range 60–171 months). Complete tumour regression was achieved in 34 cases (83%) after a mean of 1.5 courses (range, 1–3 courses). Univariate analysis revealed that complete response was significantly related to tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p=0.009, respectively) and the absence of multifocality (p=0.002). Histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma, p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3) (p=0.028) were also related to incomplete tumour response. In a multivariate analysis, just tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) were correlated with incomplete tumour response. Transient and reversible low-to-mild local side effects were documented in 19 (48%) eyes.

Conclusion

Topical 5-FU, as a sole therapy, is a long-term safe and effective treatment for patients affected by preinvasive OSSN and for a limited proportion (50%) of invasive OSSN.

Author: Parrozzani, R., Frizziero, L., Trainiti, S., Testi, I., Miglionico, G., Pilotto, E., Blandamura, S., Fassina, A., Midena, E.
Posted: July 18, 2017, 9:30 am
Incidence, mechanism and outcomes of schisis retinal detachments revealed through a prospective population-based study
Aim

To determine the incidence, presentation and outcomes of progressive sight-threatening retinal detachment (RD) complicating degenerative retinoschisis.

Methods

We conducted the first prospective population-based epidemiological study of progressive schisis detachment over a 1-year period (2014–2015) in the UK. Case ascertainment was via monthly British Ophthalmological Surveillance Unit reporting cards sent to all ophthalmologists in the UK. For each reported case, data were collected using incident and 6 months follow-up questionnaires gathering information including demographic, presenting symptoms, retinal findings, primary management, primary outcome, secondary management and secondary outcome.

Results

Fifty-five cases of progressive schisis RD were identified with similar age distribution to conventional rhegmatogenous RD (mean age 64.0 years, range 20–88), and male-to-female ratio of 2.3:1. The locations of schisis detachments were predominantly supratemporal (46.7%) and infratemporal (35.6%). At least 70% of schisis RD were associated with posterior vitreous detachment (PVD) at presentation and 21% with grade B-C proliferative vitreoretinopathy. Primary management consisted of pars plana vitrectomy (82%), scleral buckle (9%), observation (4%), laser (2%) and combined vitrectomy-buckle (2%). Primary reattachment rate was 70%. Final reattachment rate was 87% with mean best-corrected visual acuity of 0.49 Decimal (SD 0.34) for fovea-on and 0.42 Decimal (SD 0.29) for fovea-off schisis detachments at mean follow-up of 8.7 months (SE 1.0).

Conclusions

The estimated annual incidence of progressive schisis RD was 0.85 per million population (95% CI 0.64 to 1.11), equivalent to around 0.66% of all rhegmatogenous RD. PVD may play a key pathogenic role in the development of progressive schisis detachments. Surgical outcomes are inferior to those of conventional rhegmatogenous RD.

Author: Xue, K., Muqit, M. M. K., Ezra, E., Charles, S. J., Yorston, D., Mitra, A., Patel, C. K.
Posted: July 18, 2017, 9:30 am

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