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

George et al (see page 604)

In this population based cohort study that examined 2852 phakic participants from the Chennai Glaucoma Study, 2.17% developed incident ocular hypertension. Older participants or rural residents were at greatest risk of disease.

Harris et al (see page 609)

Structural glaucomatous progression as indicated by retinal nerve fiber layer and optic nerve head changes are associated with reductions in retrobulbar and retinal blood flow over an eighteen month period.

Crabb et al (see page 613)

Simulated visual field defects significantly impaired hazard perception on a computer-based driving test, with superior defects more impactful than inferior defects. These findings have relevance for assessing the visual field component for fitness to drive.

Lim et al (see page 618)

In 10 patients with neovascular age-related macular degeneration, a sustained delivery combination of triamcinolone and ranibizumab in a...

Author: Barton, K., Chodosh, J., Jonas, J.
Posted: April 18, 2015, 6:28 am
Changes in refractive error in patients with accommodative esotropia after being weaned from hyperopic correction
Background

To determine the long-term changes in refractive error and ocular alignment in patients with accommodative esotropia (AET) who were able to discontinue wearing hyperopic glasses because of emmetropisation.

Methods

Forty-seven patients with refractive AET who achieved emmetropisation and orthotropia without hyperopic glasses and were followed up for at least 3 years were enrolled. All of the patients had been prescribed the weakest possible glasses for best corrected vision. Refractive error and ocular alignment were analysed after the cessation of hyperopic glasses use.

Results

The mean length of follow-up was 5.7±3.21 years after successful weaning from hyperoptic glasses. The mean spherical equivalent (SE) of the refractive error was –1.01±1.53 dioptres (D), and the mean esotropia (ET) was 1.0±8.70 at the final visit. Myopia developed in 55.3% of all patients. The mean myopic progression rate per year was –0.19±0.23 D/year. Forty-one patients (87.2%) showed orthotropia; in addition, three of the patients (6.4%) developed ET, and three (6.4%) developed exotropia (XT). The six patients who had ET or XT all showed myopia. Two of the three patients who developed ET underwent surgery. Both patients initially had a low degree of hyperopia and a high ratio of accommodative convergence to accommodation (AC/A). The initial hyperopia correlated with the SE refractive error at the final follow-up (p<0.001).

Conclusions

When emmetropisation occurs early in patients with AET, it is necessary to note the development of myopia and the deterioration of ocular alignment.

Author: Cho, Y. A., Ryu, W. Y.
Posted: April 18, 2015, 6:28 am
Arthur Ferguson MacCallan: trachoma pioneer in Egypt 1903-1923

Arthur Ferguson MacCallan CBE, MD, FRCS (1872–1955) was an ophthalmic surgeon who undertook his pioneering work in Egypt between 1903 and 1923 (figure 1).i He became a world authority on trachoma; the MacCallan Classification of Trachoma, initially published in 1908, was the first grading system used to standardise the diagnosis of trachoma and was later adopted by the WHO. He also established the ophthalmic hospital infrastructure consisting of travelling and permanent hospitals, along with the training of surgeons. This fight to eliminate trachoma continues, with the WHO setting a target date for the Global Elimination of Blinding Trachoma by 2020 (‘GET 2020’). As a contribution to achieving this goal, the International Coalition for Trachoma Control (ICTC) inaugurated the ‘ICTC MacCallan Medal’ii in 2014. By naming this award after Arthur, it recognises his pioneering spirit and accomplishments which continue to resonate with the profession...

Author: MacCallan, M.
Posted: April 18, 2015, 6:28 am
Long-term efficacy and complications of black diaphragm intraocular lens implantation in patients with traumatic aniridia
Aims

To determine the efficacy and complications of long-term black diaphragm intraocular (BDI) lens implantation in patients with traumatic aniridia.

Methods

This study analysed the demographics, clinical evaluations and treatments of 95 patients with BDI lens implantation and 75 patients who wore rigid gas-permeable (RGP) contact lenses (CLs). The clinical examinations included evaluations of visual acuity (VA), best-corrected visual acuity (BCVA), intraocular pressure measurements (IOP), and corneal endothelial cell density (ECD). Ultrasound biomicroscopy (UBM) was used to observe the haptic lens positions.

Results

In the BDI group, light sensitivity dramatically decreased postoperatively in all patients, and 78 patients (82.1%) had a BCVA score >20/200. A total of 36 eyes (37.89%) developed elevated IOP after the BDI lens implantation, and 12 eyes (12.63%) underwent glaucoma laser surgery. Corneal decompensation occurred in nine eyes (9.47%), three of which developed glaucoma. Twelve patients (12.63%) experienced limbal stem cell failure, and 16 patients (16.84%) had eccentric BDI lenses. All patients in the RGP group had a BCVA score ≥20/200. Only seven eyes (9.3%) had cornea complications. There were no statistically significant differences in either the IOP or ECD after wearing the RGP CLs.

Conclusions

Glaucoma, corneal decompensation, limbal stem cell failure, and eccentric BDI lenses appeared to be the major long-term complications in BDI lens implantation. BDI lens implantation could effectively improve postoperative outcomes by reducing glare disability, improving visual performance, and addressing cosmetic issues. Because the implantation of the BDI lens in traumatic aniridia had a high incidence of complications, this treatment should be used with caution, and the long-term complications should be seriously considered.

Author: Qiu, X., Ji, Y., Zheng, T., Lu, Y.
Posted: April 18, 2015, 6:28 am
Ophthalmic statistics note 6: effect sizes matter
Why statistical significance alone is not a sufficient basis to interpret the findings of a statistical analysis

Medical statistics plays a key role in clinical research by helping to avoid errors of interpretation due to the play of chance. It is, however, critical to understand the limits of what statistical analysis provides and interpret the findings accordingly. Statistical analysis can summarise the statistical evidence but it cannot tell us whether a difference is important per se, as clinical judgement is needed. Suppose we have a clinical trial which compares two drugs for reducing the intraocular pressure (IOP) in the eye and there is evidence of a statistically significant difference in favour of drug A. Does this mean A is superior to B? Perhaps, if the average difference is 5 mm Hg but what if it is only 0.1 mmg Hg? We would be very unlikely to conclude clinical superiority under these circumstances,...

Author: Cook, J. A., Bunce, C., Dore, C. J., Freemantle, N., on behalf of the Ophthalmic Statistics Group, Cipriani, V., Crabb, D., Cumberland, P., Czanner, G., Donachie, P., Elders, A., Finana, M. G., O'Leary, N., Nash, R., Quartilho, A., Saunders, L., Sivasubramaniam, S., Rogers, C., Skene, S., Stratton, I., Wen, X.
Posted: April 18, 2015, 6:28 am
Retinal pigment epithelial cells display specific transcriptional responses upon TNF-{alpha} stimulation
Background/aims

Tumour necrosis factor-α (TNF-α) is a key mediator of ocular inflammation and its interaction with the retinal pigment epithelium (RPE) may be a driving force in vitreoretinal disorders such as age-related macular degeneration, proliferative vitreoretinopathy (PVR) and diabetic retinopathy. Under inflammatory conditions, the ability of RPE cells to maintain the blood–retinal barrier and immune privilege may be lost and proliferation of RPE cells is facilitated. To gain insight into the effects of TNF-α on RPE cells, a gene expression study was performed.

Methods

ARPE-19 and HT-29 cells were stimulated with 50 ng/mL TNF-α for 6 h. Gene expression patterns were compared between stimulated and control cells using whole genome gene expression arrays. Data were analysed using Partek and OmniViz and validated using quantitative RT-PCR. Functional annotation analysis was performed using Ingenuity and DAVID.

Results

A total of 97 genes were uniquely modulated by TNF-α in ARPE-19 cells compared with HT-29 cells (86 upregulated and 11 downregulated). Most commonly affected biological processes were apoptosis, cell motility and cell signalling. The highest upregulated gene was EFNA1. Among the downregulated genes were transcription factors implicated in ocular development (SIX3, PAX6) and modulation of p53-mediated apoptosis (CITED2).

Conclusions

This study provides insight into the unique responses of RPE cells to TNF-α stimulation and suggests a role for genes involved in apoptosis and retinal epithelial development. These findings contribute to our understanding of the behaviour of RPE cells under inflammatory conditions and the crucial role of RPE cells in vitreoretinal diseases.

Author: Korthagen, N. M., van Bilsen, K., Swagemakers, S. M. A., van de Peppel, J., Bastiaans, J., van der Spek, P. J., van Hagen, P. M., Dik, W. A.
Posted: April 18, 2015, 6:28 am
Periocular tuberculous disease: experience from a UK eye hospital
Background/aims

To describe our experience of patients presenting to a tertiary referral adnexal department with orbital or periocular tuberculosis (TB) over a 10-year period.

Methods

We reviewed all patients with a diagnosis of orbital or periocular TB from 2001 to 2011 in Moorfields Eye Hospital.

Results

Nine patients were identified over the 10-year period. Three cases of cutaneous TB, two cases of TB dacryocystitis and four cases of diffuse orbital TB were identified. All patients lived in the UK, but were born in the African or Asian subcontinents. Three patients had known prior (and treated) pulmonary TB and all were immunocompetent.All patients presented with periocular discomfort. After tissue diagnosis, all patients were referred for triple antituberculous therapy (ATT); all patients completed their course of ATT, with resolution of all orbital and lacrimal masses. There were no recurrences at a median follow-up of 26 weeks (range 1 month–5 years). One patient, who required later evisceration, was the only case with loss of vision.

Conclusions

Orbital and periocular TB can be difficult to diagnose and lead to diagnostic delays, with emphasis on clinical suspicion rather than a positive culture result; the management of such cases is not only surgical, but also medical and social. Although surgical intervention can alleviate symptoms and prevent visual loss, the use of a complete course of ATT is paramount for disease management and the patient and their family need to be counselled about the associated public health issues.

Author: Salam, T., Uddin, J. M., Collin, J. R. O., Verity, D. H., Beaconsfield, M., Rose, G. E.
Posted: April 18, 2015, 6:28 am
Ophthalmic manifestations of perinatally acquired HIV in a US cohort of long-term survivors
Background/aims

To determine the ophthalmic manifestations of HIV in a cohort of long-term survivors of perinatally acquired HIV.

Methods

Twenty-two patients with perinatally acquired HIV who were aged ≥12 years were prospectively studied at a university clinic. They underwent complete ophthalmic examinations and fundus photography. Their medical histories, medications and CD4 counts were abstracted from the medical records. To evaluate for keratoconjunctivitis sicca, both HIV patients and 44 healthy controls (matched by age, gender and contact lens wear) underwent Schirmer testing and ocular surface staining.

Results

Nine male and 13 female HIV patients with mean age of 16.6 years (SD, 3.4) were examined. Of the 22 HIV patients, 21 had been treated with highly active antiretroviral therapy (HAART). Only one patient had a CD4 count nadir of <200 cells/µL. The mean visual acuity of the eyes of the HIV subjects was 20/22 (SD, 1.6 lines). No patient had cytomegalovirus retinitis. Four of the 22 (18%) HIV patients had strabismus. HIV subjects and controls had similar rates of abnormal Schirmer (9% and 14%, p=0.62) and ocular staining scores (p=0.29).

Conclusions

In the post-HAART era, long-term survivors of perinatally acquired HIV exhibited little vision-threatening disease, but had a high prevalence of strabismus.

Author: Rutar, T., Youm, J., Porco, T., Tilton, N., Muskat, M., McNamara, N., Wara, D.
Posted: April 18, 2015, 6:28 am
Spectral domain optical coherence tomography findings in eyes with acute ischaemic retinal whitening

Acute retinal ischaemia presents in various forms depending on the type and location of the associated vascular occlusion. Cotton wool spots have been considered one manifestation of ischaemia and represent swelling in the nerve fibre layer. However, clinical retinal whitening also occurs in areas not affected by cotton wool spots, and has distinguishing spectral domain optical coherence tomography (SD-OCT) features. We present SD-OCT findings of hyper-reflectivity and thickening in four eyes with representative retinal arterial or retinal venous occlusions, specifically branch retinal artery occlusion, central retinal vein occlusion, Purtscher-like retinopathy and ophthalmic artery occlusion. The spectrum of retinal ischaemia from various causes was found to manifest in inner nuclear layer hyper-reflectivity and thickening on SD-OCT. En Face OCT imaging further characterises the topographical distribution of ischaemia, and reveals patterns which provide insight into the pathological processes involved.

Author: Coady, P. A., Cunningham, E. T., Vora, R. A., McDonald, H. R., Johnson, R. N., Jumper, J. M., Fu, A. D., Haug, S. J., Williams, S. L., Lujan, B. J.
Posted: April 18, 2015, 6:28 am
Comparison of umbilical cord serum and amniotic membrane transplantation in acute ocular chemical burns
Purpose

To compare the efficacy of umbilical cord serum (UCS) with amniotic membrane transplantation (AMT) in cases of acute ocular chemical burns.

Methods

In a retrospective, interventional, comparative case series, 55 eyes with grades III, IV and V chemical burns (Dua's classification) who presented within 3 weeks of injury were evaluated. Patients were treated with conventional medical (CM group, 20 eyes) management alone or combined with either UCS (UCS group, 17 eyes) or AMT (AMT group, 18 eyes). The parameters evaluated were time to epithelialisation, epithelial defect diameter, epithelial defect area, corneal clarity, tear break-up time (TBUT), Schirmer test and best-corrected vision.

Results

UCS and AMT groups showed early epithelialisation as compared with the CM group (Kaplan–Meier analysis=0.01). Mean time for healing of epithelial defect was 57.7±29.3, 27.4±19.0, 41.1±28.9 days in the CM, UCS and AMT groups, respectively (p=0.02). Mean TBUT at the last follow-up was 8.6±0.7, 10.3±1.1, 9.4±1.2 s in the CM, UCS and AMT groups, respectively (p=0.02). The mean Schirmer value at the last follow-up was 13.7±1.0, 16.9±3.0 and 13.2±1.5 mm in the CM, UCS and AMT groups, respectively (p=0.01). The visual outcomes and the occurrence of corneal vascularisation, symblepheron, ectropion and entropion were comparable in between the groups.

Conclusions

Our study suggests that the UCS therapy may be a better alternative to AMT in acute moderate to severe (grades III, IV and V) ocular chemical burns, as it avoids surgical manoeuvre in already inflamed eyes.

Author: Sharma, N., Lathi, S. S., Sehra, S. V., Agarwal, T., Sinha, R., Titiyal, J. S., Velpandian, T., Tandon, R., Vajpayee, R. B.
Posted: April 18, 2015, 6:28 am

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