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:

Anticoagulant and antiplatelet therapy during ocular surgery

We believe that some issues presented in the article by Kiire et al1 need to be corrected, and others deserve some further discussion.

Authors in the paragraph on cataract surgery pointed the increased risk of suprachoroidal haemorrhage in patients with high myopia, glaucoma, diabetes, atherosclerotic vascular disease or hypertension referencing to the interesting study,2 which was based only on intracapsular (ICCE) and extracapsular (ECCE) cataract extractions. Both techniques are much more traumatic and are supplemented usually with more invasive than topical form of anaesthesia, however, rarely used today. The dominant technique for cataract surgery is today phacoemulsification with implantation of foldable intraocular lenses (IOLs) through avascular clear corneal incisions under topical anaesthesia. This transformed the surgery into a lower risk procedure. Thus, information given on suprachoroidal haemorrhage in ECCE and ICCE seems to be irrelevant regarding the present risk of this complication during cataract surgery.

...
Author: Grzybowski, A., Packer, M.
Posted: July 18, 2014, 12:34 pm
Authors' response

We thank Grzybowski et al for their comments on our paper.1 The main contention of the authors is that patients undergoing cataract surgery with antiplatelet (Ap) and/or anticoagulant (Ac) medications should continue to receive these drugs based on evidence in the medical literature.

In our paper, we clearly acknowledge that the predominant technique for lens extraction is phacoemulsification, and that the risk of complications related to bleeding is rare. In one of the papers2 referenced by Grzybowski et al, a small, but not insignificant, risk of intraoperative haemorrhage in patients undergoing cataract surgery is mentioned, with no reported effect on visual outcome. The meta-analysis did not, however, specifically review patients with a target international normalised ratio (INR) of over 3 or those on dual therapy (ie, warfarin and aspirin). Benzimra et al3 conducted a large retrospective study using electronic patient records and once...

Author: Mukherjee, R., Kiire, C. A., Ruparelia, N., Keeling, D., Prendergast, B., Norris, J. H.
Posted: July 18, 2014, 12:34 pm
Authors' response: evaluation of choroidal thickness among patients with oculocutaneous albinism

We thank Chan et al1 for their interest in our work and their valuable comments. The authors kindly reminded that diurnal variation choroidal thickness may influence our results. We agree that diurnal variation in choroidal thickness can influence the measurements performed by enhanced depth imaging optical coherence tomography (OCT).23 Unfortunately, our study was not initially designed to eliminate the influence of diurnal variation, as those studies were not available when we started our study. We examined most of the patients during the afternoon (between 12:00 and 17:00) due to logistical availability reasons and this relative limitation of timing might have contributed to the consistency of our results. On the other hand, diurnal variation, as suggested by Chan et al, could have contributed to the difference between choroidal thickness measurements in our study and previous work,4 along with the other possible...

Author: Karabas, L., Esen, F., Celiker, H., Elcioglu, N., Cerman, E., Eraslan, M., Kazokoglu, H., Sahin, O.
Posted: July 18, 2014, 12:34 pm
Evaluation of choroidal thickness among patients with oculocutaneous albinism

We read with interest on the article by Karabas et al1, which reported statistically significant decreased subfoveal choroidal thickness in patients with oculocutaneous albinism (OCA) as compared with age-controlled normal subjects. We would like to congratulate the authors on being the first to describe this among OCA subjects. However, there are relevant factors that we will like to point out.

Karabas pointed out that their findings of choroidal thickness among the healthy control population were higher than other studies. Karabas reported subfoveal choroidal thickness of 349±70 µm and 151±31 µm in the nasal region.1 It is also important to consider the effects of diurnal variation of choroidal thickness on their reported results. Earlier studies have concluded that the choroid was typically found to be thickest at night (23:00) and thinnest at noon (12:00).2 The difference between the thickest and thinnest choroidal thickness due to diurnal...

Author: Chan, C. Y., Papakostas, T. D., Vavvas, D.
Posted: July 18, 2014, 12:34 pm
Just how old is the modern dacrocystorhinostomy?

Dacrocystorhinostomy—DCR (Gr. αo-o-o-oμα, Dakryon: Tear, Kystis: Bag, Rhis: nose, Stoma: mouth/opening) is a surgical creation of an opening between the lacrimal sac and nasal cavity, or a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function. If the procedure fails, the option is to then insert a conjunctivo-DCR tube (eg, Lester Jones tube) as a conduit between tear film and nasal passage (figure 1).

Current literature identifies Celsus and Galen as some of the earliest physicians to attempt surgical correction of epiphora by applying hot cautery on the caruncle1 (which was wrongly thought to be the lacrimal gland!). The credit for the first procedure to bear resemblance to a modern-day external DCR goes to Woolhouse12 from 18th century England who advocated the extirpation of the lacrimal sac...

Author: Giasin, O., Yeo, D. C. M., Aguirre, A.
Posted: July 18, 2014, 12:34 pm
Four haptics are better than two

Removal of the crystalline lens at the time of pars plana vitrectomy surgery is becoming an increasingly common surgical strategy in the management of vitreoretinal disease. Combined surgery provides enhanced peripheral retinal visualisation and the opportunity for a larger gaseous endotamponade and obviates the need for subsequent cataract surgery at a later date.1 These advantages only apply if there are not coexistent disadvantages. One of the reported anterior segment complications of combined surgery is pupillary capture of the lens optic, occurring in 1–2% of all cases.2 This occurs due to an induced pressure gradient between the anterior and posterior segments of the eye, which is especially pronounced in the presence of gas within the vitreous cavity. In order to quantify the incidence of pupillary capture, we performed a retrospective review of the last 698 cases of combined phacovitrectomy performed by a single surgeon. Ethical...

Author: Rahman, R., Khan, K.
Posted: July 18, 2014, 12:34 pm
Patient perceptions during phacoemulsification cataract surgery: a proposal for routine preoperative patient counselling

Numerous studies have explored the visual perceptions in phacoemulsification cataract surgery.1–3 However, the patient experience is not simply limited to visual perceptions; auditory perceptions (including the phaco machine), facial touch including the flow of water down the face and the presence of a drape, in addition to others, also inevitably contribute to the overall patient experience. We devised a study to explore patient perceptions of routine phacoemulsification cataract surgery and to determine whether presurgical counselling of patients should routinely incorporate this information.

Fifty patients undergoing routine phacoemulsification cataract surgery were asked to complete a structured questionnaire immediately postoperatively. While all patients had been informed about the most serious risks relating to the surgery, there was great variability in the additional information provided. The patient perceptions of surgery were explored including parameters such as vision (brightness/colour of light and instrument/hand movement), sound (including buzzing/hissing of the...

Author: Khan, M. A., Tang, W. K. S., Tahhan, M.
Posted: July 18, 2014, 12:34 pm
Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome

We read an interesting ‘Clinical science’ article by Dotan et al1 entitled ‘Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome’. After studying the manuscript there are some issues that come to mind.

First, their prospective study was performed between May 2010 and November 2011. r-tPA was injected into patients who had undergone cataract surgery but whose condition had failed to respond to topical and subconjunctival steroid treatments. It was unclear why such a high number of patients required this treatment in a period as short as 18 months. We would like to know if they were faced with toxic anterior segment syndrome and if they investigated possible causes such as viscoelastics, irrigating solution, intraocular lens material etc.

Second, they prepared r-tPA by distributing insulin injectors stored at –80°C. Whenever necessary they used r-tPA by defrosting the same insulin injectors at 24°C. Some injections...

Author: Cakmak, H., Kocaturk, T.
Posted: July 18, 2014, 12:34 pm
The reliability of parafoveal cone density measurements
Background

Adaptive optics scanning light ophthalmoscopy (AOSLO) enables direct visualisation of the cone mosaic, with metrics such as cone density and cell spacing used to assess the integrity or health of the mosaic. Here we examined the interobserver and inter-instrument reliability of cone density measurements.

Methods

For the interobserver reliability study, 30 subjects with no vision-limiting pathology were imaged. Three image sequences were acquired at a single parafoveal location and aligned to ensure that the three images were from the same retinal location. Ten observers used a semiautomated algorithm to identify the cones in each image, and this was repeated three times for each image. To assess inter-instrument reliability, 20 subjects were imaged at eight parafoveal locations on one AOSLO, followed by the same set of locations on the second AOSLO. A single observer manually aligned the pairs of images and used the semiautomated algorithm to identify the cones in each image.

Results

Based on a factorial study design model and a variance components model, the interobserver study's largest contribution to variability was the subject (95.72%) while the observer's contribution was only 1.03%. For the inter-instrument study, an average cone density intraclass correlation coefficient (ICC) of between 0.931 and 0.975 was calculated.

Conclusions

With the AOSLOs used here, reliable cone density measurements can be obtained between observers and between instruments. Additional work is needed to determine how these results vary with differences in image quality.

Author: Liu, B. S., Tarima, S., Visotcky, A., Pechauer, A., Cooper, R. F., Landsem, L., Wilk, M. A., Godara, P., Makhijani, V., Sulai, Y. N., Syed, N., Yasumura, G., Garg, A. K., Pennesi, M. E., Lujan, B. J., Dubra, A., Duncan, J. L., Carroll, J.
Posted: July 18, 2014, 12:34 pm
DMEK lenticule preparation from donor corneas using a novel 'SubHyS' technique followed by anterior corneal dissection
Purpose

To describe a novel submerged hydro-separation (SubHyS) technique followed by anterior corneal dissection to prepare a Descemet endothelial graft (DEG) for Descemet's membrane endothelial keratoplasty from human donor corneas.

Methods

30 human donor corneas were immersed in liquid (organ culture (OC) storage medium). Using a 25-gauge needle, approximately 0.3 mL of OC was injected (SubHyS) in the posterior stroma to create a liquid bubble. The bubbled cornea was mounted onto a modified artificial chamber with the epithelial side facing the air. The endothelium was protected with a viscoelastic solution. The anterior cornea was excised with a Barron radial vacuum trephine and the residual peripheral stroma was removed manually using micro-scissors. The DEG was dismounted and washed. The endothelial cell density (ECD) and mortality of the prepared DEG was determined. All the DEGs were preserved in deturgescent medium for 7 days using a cornea claw which was fixed to the sclera. ECD and mortality were checked post preservation.

Results

Complete detachment of Descemet's membrane and stroma was achieved in all 30 cases. Bubble burst was observed in five cases (excluded from the study) due to overfilling of the liquid. The average diameter of the excised DEG was 10.96 mm. The average endothelial cell loss post preservation was 27.69%. Histological analysis confirmed elimination of the residual stroma (n=13).

Conclusions

The DEGs can be preserved in a deturgescent medium for up to 7 days. The procedure provides a standardised, pre-validated (quality assured), pre-separated, no-touch, ready-to-use tissue and also reduces the preparation time. Further, the tissues can be trephined as per the surgeon’s convenience and can either be rolled or a contact lens could be used for final delivery of the DEG using a surgical glide.

Author: Salvalaio, G., Parekh, M., Ruzza, A., Ferrari, S., Camposampiero, D., Ponzin, D.
Posted: July 18, 2014, 12:34 pm

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