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:

Radius of curvature changes in spontaneous improvement of foveoschisis in highly myopic eyes
Background

Myopic foveoschisis is the splitting of retinal layers overlying staphyloma in highly myopic patients that can lead to vision loss. We assess possible contributing mechanisms to the formation of foveoschisis by examining two cases of spontaneous improvement of myopic foveoschisis and employ a radius of curvature (ROC) measure to track posterior scleral curvature over time.

Methods

A retrospective, non-comparative case series was performed and optical coherence tomography images were analysed. Retinal pigment epithelial layer ROC was calculated from manually segmented images through the posterior scleral curvature apex.

Results

Two cases of myopic foveoschisis with foveal detachments in the left eye (OS) were studied. Both patients had high myopia (either <–10 D or >30 mm in axial length). One case occurred in a treatment-naive patient who improved after 4 months of observation. On initial presentation, OS posterior scleral ROC was 12.35 mm and decreased to 12.15 mm at the time of resolution. The other case occurred in a patient who was followed for 7 years, had previously underwent pars plana vitrectomy and removal of epiretinal membrane, experienced recurrence of foveoschisis and then spontaneously improved without further posterior segment surgery. There was an uncomplicated cataract extraction in the interim. Posterior scleral ROC was 4.05 mm on presentation, 4.10 during recurrence, 3.55 mm after cataract extraction and 3.75 mm at resolution.

Conclusions

Spontaneous improvement of myopic foveoschisis may be due to changes in tractional forces from the internal limiting membrane, cortical vitreous or staphyloma or, alternatively, from a delayed or fluctuant recovery course after intervention.

Author: Hoang, Q. V., Chen, C.-L., Garcia-Arumi, J., Sherwood, P. R., Chang, S.
Posted: January 21, 2016, 8:05 am
Corneal inlay implantation complicated by infectious keratitis
Background/aims

To report five cases of infectious keratitis following corneal inlay implantation for the surgical correction of presbyopia.

Methods

This was a retrospective, observational case series. Five eyes of five patients were identified consecutively in two emergency departments during a 1-year period, from November 2013 to November 2014. Patients’ demographics, clinical features, treatment and outcomes are described.

Results

There were four female patients and one male, aged 52–64 years. Three patients had the KAMRA inlay (AcuFocus) and two had the Flexivue Microlens inlay (Presbia Coöperatief U.A.) inserted for the treatment of presbyopia and they presented from 6 days to 4 months postoperatively. Presenting uncorrected vision ranged from 6/38 to counting fingers. One patient's corneal scrapings were positive for a putatively causative organism, Corynebacterium pseudodiphtheriticum, and all patients responded to broad-spectrum fortified topical antibiotics. All patients lost vision with final uncorrected visual acuity ranging from 6/12 to 6/60 and best-corrected vision ranging from 6/7.5 to 6/12. Two patients’ corneal inlays were explanted and three remained in situ at last follow-up.

Conclusions

Infectious keratitis can occur at an early or late stage following corneal inlay implantation. Final visual acuity can be limited by stromal scarring; in the cases where the infiltrate was small and off the visual axis at the time of presentation, the final visual acuity was better than those patients who presented with larger lesions affecting the visual axis. Though infection may necessitate removal of the inlay, early positive response to treatment may enable the inlay to be left in situ.

Author: Duignan, E. S., Farrell, S., Treacy, M. P., Fulcher, T., O'Brien, P., Power, W., Murphy, C. C.
Posted: January 21, 2016, 8:05 am
Systematic screening for diabetic retinopathy (DR) in Hong Kong: prevalence of DR and visual impairment among diabetic population
Purpose

To determine the prevalence of diabetic retinopathy (DR), sight threatening DR (STDR), visual impairment and other eye diseases in a systematic DR screening programme among primary care Chinese patients with diabetes mellitus (DM) in Hong Kong.

Methods

Screening for DR was provided to all subjects with DM in public primary care using digital fundus photography according to the English national screening programme. STDR was defined as preproliferative DR (R2), proliferative DR (R3) and/or maculopathy (M1). The presence of other eye diseases was noted. Visual impairment was classified as none (visual acuity in the better eye of 6/18 or better), mild (6/18 to >6/60) and severe (6/60 or worse).

Results

Of 174 532 subjects screened, most had never been screened before. The prevalence of DR was 39.0% (95% CI 38.8% to 39.2%) and STDR 9.8% (95% CI 9.7% to 9.9%). The most common DR status was R1 (35.7%), followed by M1 (8.6%), R2 (3.0%) and R3 (0.3%). The prevalence of mild and severe visual impairment was 4.2% and 1.3%, respectively. Subjects with STDR had a higher prevalence (9.8%) of visual impairment than those without (3.5%).

Conclusions

DR was prevalent in this population and one in 10 had STDR. This suggests the need for systematic screening to ensure timely referral to an ophthalmologist for monitoring and/or treatment.

Author: Lian, J. X., Gangwani, R. A., McGhee, S. M., Chan, C. K. W., Lam, C. L. K., Primary Health Care Group,, Wong, D. S. H., Wong, Wong, Chu, Tsui, Kwong, Li, Chao, Chan, Lai, Yiu, Luk, Fu, Hui, Liang, Chan
Posted: January 21, 2016, 8:05 am
The Royal College of Ophthalmologists National Ophthalmology Database Study of vitreoretinal surgery: report 5, anaesthetic techniques
Aims

To explore trends over time and variation in the use of anaesthetic techniques for vitreoretinal (VR) surgery in the UK.

Methods

Prospectively collected data from 13 centres contributing >50 VR operations, including either pars plana vitrectomy (PPV) or scleral buckle (SB), between May 2000 and November 2010 were retrospectively analysed. Anaesthesia was categorised as general anaesthesia (GA) or local anaesthesia (LA) and results were reported by year, centre, grade of surgeon and type of operation.

Results

160 surgeons performed 12 124 operations on 10 405 eyes (9935 patients); 6054 (49.9%) under GA and 6070 (50.1%) under LA. The percentage performed under GA decreased from 95.3% in 2001 to 40.9% in 2010. Within LA techniques, peribulbar or retrobulbar injection was used in 2783 (45.8%) operations and sub-Tenon's cannula in 3287 (54.2%). The proportions of operations performed under GA or LA were similar for consultants and trainees. Primary SB, primary combined PPV and SB for retinal detachment (RD), repeat RD surgery and complex vitrectomy surgery were more commonly performed under GA (85.8%, 67.0%, 63.5% and 69.4%, respectively), while primary PPV for RD, simple vitrectomy surgery and macular surgery were more commonly performed under LA (58.1%, 53.7% and 58.2%, respectively). Marked intercentre variation existed with the extremes being one centre with 100% of operations performed under GA and one centre with 98.3% under LA.

Conclusions

LA for VR surgery has steadily increased over the last decade in the UK but marked intercentre variation exists.

Author: Sallam, A. A. B., Donachie, P. H. J., Williamson, T. H., Sparrow, J. M., Johnston, R. L.
Posted: January 21, 2016, 8:05 am
Surrogate scleral rim with fibrin glue: a novel technique to expand the pool of donor tissues for Descemet stripping automated endothelial keratoplasty

Descemet stripping automated endothelial keratoplasty is being performed in increasing number of cases each year. An adequate scleral rim on all sides is mandatory for the donor cornea to be mounted on the artificial anterior chamber for microkeratome-assisted dissection. Occasionally, the scleral rim may however be inadequate. The primary cause of inadequate scleral rim is poorly trained technicians in in-situ excision technique. Hence, we devised a novel technique for performing successful microkeratome-assisted dissection in donor corneas with inadequate scleral rim. A surrogate scleral rim was obtained from the donor tissue not fit for optical keratoplasty. It was then glued to the optical grade donor cornea that had an inadequate scleral rim either focally or circumferentially. The combination was then used for a successful microkeratome-assisted dissection followed by endothelial keratoplasty.

Author: Sharma, N., Arora, T., Kaur, M., Titiyal, J. S., Agarwal, T.
Posted: January 21, 2016, 8:05 am
Highlights from this issue

Berk et al (see page 166)

The frequency of significant visual impairment was found to be 5.9% in patients attending a paediatric ophthalmology and strabismus tertiary referral unit. Cerebral visual cortex, retina, crystalline lens and optic nerve were the most frequently involved anatomic sites for childhood blindness.

Chawla et al (see page 172)

In a retrospective review of 600 children in India newly diagnosed with retinoblastoma, delayed presentation was a major concern, with a survival probability of 83% and 65% at 1 and 5 years, respectively. Extra-ocular invasion was predictive of poor survival.

Gil et al (see page 179)

In a study of 37 orbits of 20 embalmed cadavers, the apex of the lacrimal caruncle proved an easily identifiable and reliable landmark for prediction of the inferior oblique muscle origin.

Yoon et al (see page 184)

Orbital and sinus fungal...

Author: Barton, K., Chodosh, J., Jonas, J.
Posted: January 21, 2016, 8:05 am
Assessing interventions to increase compliance to patching treatment in children with amblyopia: a systematic review and meta-analysis
Background/Aims

Amblyopia is the most common condition affecting visual acuity in childhood. Left untreated it will not resolve itself, leading to increased risk of blindness. Occluding the good eye with a patch is a highly effective treatment if carried out before age 7 years but compliance is a major problem. This systematic review addresses the question: How effective are existing interventions at increasing compliance to patching treatment in children with amblyopia?

Methods

Electronic searches were carried out in June 2014 and updated in April 2015 to identify studies reporting primary data on interventions to increase patching compliance. Data screening, extraction and quality ratings were performed independently by two researchers.

Results

Nine papers were included. Interventions including an educational element (5 studies) significantly increased patching compliance and had higher quality ratings than interventions that changed aspects of the patching regime (3 studies) or involved supervised occlusion (1 study). Meta-analysis was conducted on four studies and indicated that overall interventions involving an educational element have a significant small effect r=0.249, p<0.001.

Conclusions

Interventions to increase patching compliance should include educational elements. High quality research is needed to further assess the effectiveness of specific elements of educational interventions and additional behaviour change techniques.

Author: Dean, S. E., Povey, R. C., Reeves, J.
Posted: January 21, 2016, 8:05 am
Measuring the precise area of peripheral retinal non-perfusion using ultra-widefield imaging and its correlation with the ischaemic index
Objective

To determine the calculated, anatomically correct, area of retinal non-perfusion and total area of visible retina on ultra-widefield fluorescein angiography (UWF FA) in retinal vein occlusion (RVO) and to compare the corrected measures of non-perfusion with the ischaemic index.

Methods

Uncorrected UWF FA images from 32 patients with RVO were graded manually for capillary non-perfusion, which was calculated as a percentage of the total visible retina (uncorrected ischaemic index). The annotated images were converted using novel stereographic projection software to calculate precise areas of non-perfusion in mm2, which was compared as a percentage of the total area of visible retina (‘corrected non-perfusion percentage’) with the ischaemic index.

Results

The precise areas of peripheral non-perfusion ranged from 0 mm2 to 365.4 mm2 (mean 95.1 mm2), while the mean total visible retinal area was 697.0 mm2. The mean corrected non-perfusion percentage was similar to the uncorrected ischaemic index (13.5% vs 14.8%, p=0.239). The corrected non-perfusion percentage correlated with uncorrected ischaemic index (R=0.978, p<0.001), but the difference in non-perfusion percentage between corrected and uncorrected metrics was as high as 14.8%.

Conclusions

Using stereographic projection software, lesion areas on UWF images can be calculated in anatomically correct physical units (mm2). Eyes with RVO show large areas of peripheral retinal non-perfusion.

Author: Tan, C. S., Chew, M. C., van Hemert, J., Singer, M. A., Bell, D., Sadda, S. R.
Posted: January 21, 2016, 8:05 am
Changing trends over the last decade in the aetiology of childhood blindness: a study from a tertiary referral centre
Aims

To discern treatable and preventable causes of childhood blindness by evaluating the aetiologic factors, and to compare the distribution of the most commonly affected anatomic sites of severe visual impairment (SVI) with our previous published data.

Methods

The charts of 11 871 patients followed between June 2002 and May 2014 were reviewed retrospectively, and 695 patients (5.9%) who had SVI or blindness in accordance with WHO criteria were enrolled. The results of ophthalmologic examinations and coexistence of any systemic disease were documented and checked against our published clinic data concerning the aetiology of childhood blindness before 2002. 2 test was used for statistics.

Results

Mean age was 47.0±51.9 months (median: 24 months). Cortical visual impairment (CVI) was present in 212 cases (30.5%) and 20.3% of those had a history of premature birth. The most common anatomic sites of SVI were retina (24.6%) and crystalline lens (17.1%). When compared with our previous data, we found a significant increase in the prevalence of CVI (p=0.046) and decrease in the frequency of SVI due to uveal disorders (p<0.001). Prevalence of blindness secondary to retinopathy of prematurity reduced by a third (p=0.280), and a significant decrease in aphakia-related SVI (p=0.028) was achieved within the last decade.

Conclusions

The prevalence of CVI was found to be relatively increased due to the significant reduction in the frequency of preventable causes of SVI. Furthermore our clinical practice for visual rehabilitation in aphakia has resulted in a considerable decrease in SVI in the last decade.

Author: Ozturk, T., Er, D., Yaman, A., Berk, A. T.
Posted: January 21, 2016, 8:05 am
Comparative evaluation of aspheric toric intraocular lens implantation and limbal relaxing incisions in eyes with cataracts and <=3 dioptres of astigmatism
Purpose

To compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism.

Methods

In this prospective study, sixty eyes of 60 patients with visually significant cataract and coexisting corneal astigmatism ≤3 dioptres (D) were randomised to undergo phacoemulsification with either aspheric toric IOL or aspheric monofocal IOL with LRI. The main outcome measures were postoperative 3-month uncorrected visual acuity (UCVA), contrast sensitivity, rotational stability of the toric IOL and spectacle independence.

Results

The postoperative UCVA, contrast sensitivity and refractive astigmatism were significantly better than the baseline measurements for both groups (p≤0.001). There was no significant difference detected for these parameters between LRI and toric IOL groups postoperatively (p≥0.119). At both postoperative month 1 and 3, the percentages of eyes in need of spectacles were lower in toric group than LRI group (p≤0.030). IOL misalignment was noted in three eyes in the toric IOL group (mean misalignment 7.67±4.04°). On vector analysis, magnitude of error (ME) was negative in the LRI group indicating undercorrection, whereas the ME was close to zero for toric group.

Conclusions

Both toric IOL implantation and LRI were effective in correcting corneal astigmatism ≤3 D during phacoemulsification, while LRI tended to undercorrect astigmatism.

Author: Lam, D. K. T., Chow, V. W. S., Ye, C., Ng, P. K.-F., Wang, Z., Jhanji, V.
Posted: January 21, 2016, 8:05 am

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