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:

Effect of pegaptanib sodium 0.3 mg intravitreal injections (Macugen) in intraocular pressure: posthoc analysis from V.I.S.I.O.N. study
Objective

To assess the rate of pegaptanib-associated sustained intraocular pressure (IOP) elevation.

Methods

A posthoc analysis was conducted on all IOP measurements, except the immediate 30-min postinjection, from all subjects randomised to pegaptanib 0.3 mg or sham injections continuously in the first 2 years of the Vascular endothelial growth factor Inhibition Study in Ocular Neovascularisation (V.I.S.I.O.N.) study. Measurements were taken with Goldmann applanation tonometer or Tonopen, except at baseline and in cases of an IOP reading >30 mm Hg when a Goldmann applanation tonometer was mandatory.

Results

Of 221 subjects, IOP measurements ≥22 mm Hg were seen in 28/114 and 23/107 subjects of the pegaptanib and sham subgroups, respectively (p=0.6338) and measurements ≥24 mm Hg were observed in eight and eight subjects in the pegaptanib and sham groups, respectively. More than two measurements ≥22 mm Hg occurred in six and 10 subjects (p=0.3025), and more than two measurements ≥24 mm Hg were observed in one and four subjects in the pegaptanib and sham groups, respectively. One patient with sustained IOP elevation in the pegaptanib study group, and four in the sham group, had IOP lowering medication added during the course of the study. No subject required glaucoma surgery.

Conclusions

In V.I.S.I.O.N., after 2 years, there was no evidence of sustained IOP elevation associated with pegaptanib 0.3 mg use.

Trial registration number

NCT00321997.

Author: Boyer, D. S., Goldbaum, M., Leys, A. M., Starita, C., for the V.I.S.I.O.N. Study Group, Blumenkranz, Buyse, Goldberg, Gragoudas, Miller, Schwartz, Singerman, Yannuzzi, Adamis, Guyer, O'Shaughnessy, Buyse, de Gronckel, Fesneau, Quinaux, Tremolet, Wang, Brailey, Finman, Ting, Bressler, Bressler, Denblow, Schein, Seabrook, Solomon, Schachat, Philips, Altaweel, Davis, Blodi, Danis, Ip, Hiner, Elledge, Webster, Hannan, Ficken, Alexander, Neider, Wabers, Vargo, Lambert, Kastorff, Carr, Shkiele, Baliker, Guymer, Constable, Arnold, Sarks, Chang, Gillies, Mitchell, Haas, Stur, Leys, Moreira, Portella, de Avila, Taleb, Lavinsky, Lavinsky, Farah, Williams, Leonard, Garcia, Maberley, Lopez, Rodriguez, Fiser, Larsen, Korobelnik, Soubrane, Koenig, Gaudric, Dithmar, Holz, Joussen, Kirchhof, Wiedemann, Pauleikhoff, Schneider, Suveges, Gyory, Pollack, Loewenstein, Rosenblatt, Giovannini, Menchini, Brancato, Cardillo Piccolino, Grignolo, Bandello, Schlingemann, Deutman, Kaluzny, Pecold, Cunha-Vaz, da Silva, Ruiz Moreno, Mones, Figueroa, Pournaras, Zografos, Lois, Chakravarthy, Hykin, Chisholm, Johnson, Marcus, Mandava, Haller, Cangemi, Boyer, Kim, Loewenstein, Heier, Reichel, Falcone, Weissgold, Conway, Garfinkel, Glaser, Lyon, Lewis, Wells, Wilcox, Fish, Eliott, Fekrat, Taney, Eaton, Deramo, Wroblewski, Tom, Chow, Orth, Packo, Holz, Mieler, Kuppermann, Sabates, Cummings, Pendergast, Gonzales, Lim, Charles, Sanislo, Rosenfeld, Connor, Cantrill, Willson, Bailey-Freund, Rosen, Leonard, Brucker, Ho, Sneed, Friberg, Klein, Tornambe, Stoller, Capone, Bernstein, McDonald, Schatz, Johnson, Nanda, Avery, Wong, Grizzard, Higgins, Hudson, Joffe, Varenhorst, Slusher, Adamis, Betts, Cunningham, Curtiss, Guyer, Harrison, Katz, Masonson, DeMarco, O'Shaughnessy, Beals, Patel, Rodriguez, Starita
Posted: October 20, 2014, 1:06 am
Small incision iris tumour biopsy using a cavernous sampling forceps
Background

The aim of this retrospective report is to describe our experience with the Essen-23G biopsy forceps (Akgül forceps) for biopsies of pigmented iris tumours.

Methods

In this retrospective study of cases between October 2012 and September 2013, patients with iris tumours and clinical signs for malignancy underwent biopsy to secure the diagnosis. The Essen-23G-forceps was used to grasp and extract tissue through a clear corneal incision. Eventual entry and bimanual manipulation with a 23G mini-scissors was achieved through a second incision. Tissue samples were fixed in a sterile tube for further histopathological and immunohistochemical evaluation.

Results

Seven eyes of seven patients underwent biopsy using the forceps. The average thickness of the iris tumours was 1.07±0.79 mm. A second corneal incision for scissoring in a bimanual technique was necessary in 5 cases (71%). In 6 cases (85%), a precise histological and immunohistochemical diagnosis was achieved. Complications were limited to minute bleeding at the biopsy site and one case of relative pupil enlargement (anisocoria) without further refractive issues.

Conclusions

Iris tumour biopsies can be successfully approached using a cavernous 23G intraocular forceps with a low risk for procedure-related complications. The conical interior design allows for removal of whole tissue pieces with minimal manipulative artefacts. An optional bimanual access through a second corneal incision and use of a 23G scissors provides better efficacy.

Author: Chronopoulos, A., Kilic, E., Joussen, A. M., Lipski, A.
Posted: October 20, 2014, 1:06 am
Treatment with immunosuppressive therapy in patients with pars planitis: experience of a reference centre in Mexico
Aim

To evaluate the clinical course of the patients with pars planitis that received immunosuppressive drugs.

Methods

We retrospectively analysed the data of 10 years from 374 patients with pars planitis in a large reference centre in Mexico City and included 49 patients (92 eyes).

Results

Median age at presentation was 8 years. 35 patients (71.4%) were male and 43 patients (87.7%) had bilateral disease. Diverse immunosuppressive medications were used, mainly methotrexate (69.4%) and azathioprine (63.3%) with 18 patients requiring more than one drug. The main indications for starting immunosuppressive therapy were lack of response to initial treatment and advance disease at presentation. The results showed good response with steroid reduction (69.3% of patients), visual acuity improvement (51% of patients) and inflammatory disease reduction (59.1% of patients). In 25 patients (51%), steroids were started previous to immunosuppressors and in 24 (49%) at the same time without significant difference in clinical improvement (p=0.210) or visual outcome (p=0.498). Thirteen patients (26.5%) presented mild adverse effects. The median of the final visual acuity was 20/40. The median follow-up time was 44 months (range 13–115 months).

Conclusions

Immunosuppressive therapy allows an adequate control of inflammatory disease in pars planitis, with clinical and visual improvement and steroid dose reduction.

Author: Serna-Ojeda, J. C., Pedroza-Seres, M.
Posted: October 20, 2014, 1:06 am
A novel classification of the vascular patterns of polypoidal choroidal vasculopathy and its relation to clinical outcomes
Purpose

To propose a novel classification system for polypoidal choroidal vasculopathy (PCV), and compare the clinical outcomes among PCV subtypes.

Methods

Consecutive treatment-naive patients with symptomatic PCV were managed over 5 years. PCV subtypes were classified based on indocyanine green angiography (ICGA) and fluorescein angiography (FA) characteristics.

Results

Among 107 patients, 3 PCV subtypes were seen: Type A (interconnecting channels on ICGA) –22.4%; Type B (branching vascular network with no leakage) –24.3%; Type C (branching vascular network with late leakage on FA) –53.3%. The proportion of patients with best-corrected visual acuity (BCVA) ≥20/40 was highest in Type A, intermediate in Type B and lowest in Type C at all time points (80% vs 66.7% vs 7.7% at 5 years, p<0.001). The highest rate of moderate visual loss (loss of ≥3 lines) occurred in Type C PCV (57.7% vs 0% for Types B and A at 5 years, p<0.001). Risk factors for poor visual outcomes were PCV subtype (OR 53.7, p<0.001 for Type C and OR 13.7, p=0.023 for Type B compared to Type A) and age (OR 1.06, 95% CI 1.002 to 1.125, p=0.044).

Conclusions

The PCV subtype seen on initial presentation affects the long-term visual outcomes over a 5-year period.

Author: Tan, C. S., Ngo, W. K., Lim, L. W., Lim, T. H.
Posted: October 20, 2014, 1:06 am
Topical antibiotics for the management of bacterial keratitis: an evidence-based review of high quality randomised controlled trials
Background

Severe bacterial keratitis (BK) typically requires intensive antimicrobial therapy. Empiric therapy is usually with a topical fluoroquinolone or fortified aminoglycoside–cephalosporin combination. Trials to date have not reached any consensus as to which antibiotic regimen most effectively treats BK.

Methods

A systematic review and meta-analysis using Cochrane methodology was undertaken to evaluate the effectiveness of topical antibiotics in the management of BK. Outcomes included treatment success, time to cure, serious complications of infection and adverse effects.

Results

A comprehensive search for trials resulted in 27 956 abstracts for review. This eventually resulted in 16 high quality trials involving 1823 participants included in the review. Treatment success, time to cure and serious complications of infection were comparable among all antibiotic treatments included in the review. Furthermore, there was no evidence of difference in the risk of corneal perforation with any included antibiotics or antibiotic classes. Fluoroquinolones significantly reduced risk of ocular discomfort and chemical conjunctivitis but increased the risk of white precipitate formation compared with aminoglycoside–cephalosporin. Fortified tobramycin–cefazolin was approximately three times more likely to cause ocular discomfort than other topical antibiotics.

Conclusions

Results of this review suggest no evidence of difference in comparative effectiveness between fluoroquinolones and aminoglycoside–cephalosporin treatment options in the management of BK. There were differences in safety profile, however. Fluoroquinolones decreased the risk of ocular discomfort and chemical conjunctivitis while ciprofloxacin increased the risk of white corneal precipitate compared with aminoglycoside–cephalosporin.

Author: McDonald, E. M., Ram, F. S. F., Patel, D. V., McGhee, C. N. J.
Posted: October 20, 2014, 1:06 am
Phenotype and genotype analysis in patients with macular corneal dystrophy
Aim

The aim of this study was to analyse corneal morphological organisation and identify mutations in the carbohydrate sulfotransferase 6 gene (CHST6) in patients with macular corneal dystrophy originating in a Polish population.

Methods

Macular corneal dystrophy was diagnosed in 24 patients based on the slit-lamp exam, confocal microscopy, 1310 nm time domain and 840 nm spectral domain optical coherence tomography. 10 corneal buttons obtained from penetrating keratoplasty were processed for light microscopy. Genetic analysis of the CHST6 gene was performed, followed by a study of the sequencing results.

Results

Highly reflective, diffuse corneal deposits and a general increase in reflectivity were revealed with optical coherence tomography and confocal microscopy. The deposits extended from the Bowman layer to the Descemet membrane and correlated with the Alcian blue-positive granular-filamentous material into and around the stromal keratocytes confirmed by structural analysis of the corneal buttons. The genetic analysis of the blood samples identified the following mutations and single nucleotide polymorphisms: novel P64L (heterozygous), Y110C (homozygous), R162G and L200R, and M1L (heterozygous and homozygous).

Conclusions

Genetic mutation heterogeneity was revealed. No phenotype heterogeneity was revealed among patients with in vivo corneal morphology assessment or histological analysis.

Author: Nowinska, A. K., Wylegala, E., Teper, S., Wroblewska-Czajka, E., Aragona, P., Roszkowska, A. M., Micali, A., Pisani, A., Puzzolo, D.
Posted: October 20, 2014, 1:06 am
Optical quality assessment in normal and forme fruste keratoconus eyes with a double-pass system: a comparison and variability study
Purpose

To comparatively evaluate the image quality in normal and forme fruste keratoconus patients using a double-pass system.

Methods

Fourteen normal eyes and 15 eyes with forme fruste keratoconus were included. Corneal tomographic parameters were obtained with optical coherence tomography. Image quality characteristics were determined by an optical quality analysis system (OQAS). Two readings were obtained from each eye. The following parameters were analysed: modulation transfer function cutoff frequency (MTF), Strehl ratio and OQAS values (OV) at contrasts of 100% (OV-100), 20% (OV-20) and 9% (OV-9). Repeatability coefficient (RC), coefficient of variation (CVw) and intraclass correlation coefficient (ICC) were evaluated.

Results

There were no significant differences in central corneal thickness, anterior best-fit sphere and posterior best-fit sphere in both groups. There was a significant difference between the mean MTF (p=0.001), Strehl ratio (p<0.001), OV-100 (p=0.001), OV-20 (p<0.001) and OV-9 (p<0.001) values between both groups. The coefficients of variation were 4.10 (MTF) and 13.77 (Strehl ratio) in normal eyes and 14.53 (MTF) and 14.97 (Strehl ratio) in eyes with forme fruste keratoconus. The ICC values were 0.99 and 0.95 for MTF and, 0.80 and 0.91 for Strehl ratio, in normal and forme fruste keratoconus eyes, respectively. The corresponding repeatability values were 3.53 and 6.15 for MTF and, 0.06 and 0.04 for Strehl ratio, respectively.

Conclusions

OQAS has the potential to be a useful diagnostic tool in cases with early keratoconus. The repeatability of a double-pass (DP) system was good in normal as well as forme fruste keratoconus eyes.

Author: Ye, C., Ng, P. K.-F., Jhanji, V.
Posted: October 20, 2014, 1:06 am
Lamina cribrosa displacement after optic nerve sheath fenestration in idiopathic intracranial hypertension: a new tool for monitoring changes in intracranial pressure?
Introduction

Imaging in patients with idiopathic intracranial hypertension (IIH) is by definition normal but MRI may show dilatation of the subarachnoid space (SAS) around the optic nerve and a secondary flattening of the posterior sclera.1 Because of the existence of a trans-lamina cribrosa (LC) gradient, in patients with IIH the disc surface and thus the LC should be anteriorly displaced secondary to the raised intracranial pressure (ICP).

In patients with glaucoma, an anterior displacement of the LC after lowering intraocular pressure (IOP) using spectral domain optical coherence tomography (SD-OCT) has been recently demonstrated.2–4 However, changes in the LC position after IIH treatment have not been reported previously.

Case report

A 28-year-old woman diagnosed with IIH and treated with lumbo-peritoneal shunt presented with progressive visual loss despite well-controlled ICP. Bilateral sequential optic nerve sheath fenestration was planned and the...

Author: Perez-Lopez, M., Ting, D. S. J., Clarke, L.
Posted: October 20, 2014, 1:06 am
First clinicial results on the feasibility, quality and reproducibility of aberrometry-based intraoperative refraction during cataract surgery
Objective

To provide the first clinical data in determining the feasibility, quality and precision of intraoperative wavefront aberrometry (IWA)-based refraction in patients with cataract.

Design

IWA refraction was recorded at 7 defined measurement points during standardised cataract surgery in 74 eyes of 74 consecutive patients (mean age 69±11.3 years). Precision and measurement quality was evaluated by the 'limits of agreement’ approach, regression analysis, correlation analysis, Analysis of variance (ANOVA) and ORs for predicting measurement failure. Wavefront map (WFM) quality was objectivised and compared with the Pentacam Nuclear Staging analysis.

Results

Out of 814 IWA measurement attempts, 462 WFMs could be obtained. The most successful readings (n=63) were achieved in aphakia with viscoelastic. The highest (50.63%, SD 20.23) and lowest (29.19%, SD 13.94) quality of WFMs across all measurement points were found after clear corneal incision and in pseudophakia with viscoelastic, respectively. High consistency across repeated measures were found for mean spherical equivalent (SE) differences in aphakia with –0.01D and pseudophakia with –0.01D, but ranges were high (limits of agreement +0.69 D and –0.72 D; +1.53 D and –1.54 D, respectively). With increasing WFM quality, higher precision in measurements was observed.

Conclusions

This is the first report addressing quality and reproducibility of WA in a large sample. IWA refraction in aphakia, for instance, appears to be reliable once stable and pressurised anterior chamber conditions are achieved. More efforts are required to improve the precision and quality of measurements before IWA can be used to guide the surgical refractive plan in cataract surgery.

Author: Huelle, J. O., Katz, T., Druchkiv, V., Pahlitzsch, M., Steinberg, J., Richard, G., Linke, S. J.
Posted: October 20, 2014, 1:06 am
Changes in subfoveal choroidal thickness associated with uveitis activity in patients with Behcet's disease
Aims

To evaluate the efficacy of measuring subfoveal choroidal thickness in monitoring uveitis activity before and after treatment with infliximab in patients with Behçet's disease (BD)-associated uveitis.

Methods

Thirteen patients with BD (23 eyes) were selected for this retrospective observational case study. Subfoveal choroidal thickness was measured during active and remission phases of uveitis by enhanced depth imaging–spectral domain optical coherence tomography (EDI-OCT). In five patients (10 eyes), choroidal thickness was assessed at weeks 0, 2, 6 and 14 after the initiation of infliximab treatment.

Results

Accompanied by excessive dye leakage from choroidal vessels on indocyanine green angiography, dilation of choroidal vessels was observed in the active phase of uveitis by EDI-OCT and the choroidal thickness was significantly greater than that in the remission phase. Treatment with infliximab significantly reduced the choroidal thickness from week 2 after the first infusion, and the reduced choroidal thickness was maintained thereafter. No correlation was found between choroidal thickness and best corrected visual acuity converted to logarithm of the minimum angle of resolution, but choroidal thickness correlated significantly with anterior and posterior ocular inflammation scores.

Conclusions

This study indicates that measurement of subfoveal choroidal thickness by EDI-OCT is useful for evaluating the activity of uveitis and the therapeutic efficacy in patients with BD.

Author: Ishikawa, S., Taguchi, M., Muraoka, T., Sakurai, Y., Kanda, T., Takeuchi, M.
Posted: October 20, 2014, 1:06 am

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