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.
Ophthalmology Journal News:
To analyse long-term outcomes of ruthenium-106 (106Ru) plaque brachytherapy for the treatment of iris melanoma.
We retrospectively reviewed medical records of 19 consecutive patients with pure iris melanoma treated with 106Ru plaque brachytherapy between 1998 and 2016 at the Scottish Ophthalmic Oncology Service, Glasgow. The iris melanoma was treated with a ruthenium plaque placed on the corneal surface to deliver a surface dose of 555 Gy. We analysed vision preservation, local tumour control, radiation-related complications, eye retention rates, symptomatic metastasis and melanoma-related mortality.
The mean largest basal diameter of the lesions was 3.50±1.42 mm (range 1.6–6.5 mm), and the mean maximum height was 1.47±0.65 mm (range 0.7–2.8 mm). The tumour control and eye retention were 100% at a mean follow-up of 62 months (range 6–195 months). A 62% reduction in tumour height was observed on ultrasonography. Complications included cataract (68%), dry eye (47%), uveitis (37%) and scleral thinning (5%). At the final follow-up visit, the mean loss of Snellen visual acuity was 1.11±2.90 lines and vision of 6/9 or better was maintained in 53% of patients. None of the patients had evidence of symptomatic metastasis (non-imaged) or melanoma-related mortality.
106Ru plaque treatment for iris melanoma was highly effective a high tumour control, no tumour recurrences and a relatively a low complication rate.
To investigate the clinical findings and anatomical characteristics of patients with a thinned peripheral choroid (leptochoroid) presenting with bilateral macular geographical hyperpigmented fundus and compare with matched controls.
A retrospective, observational case series of 44 eyes (24 patients): 22 study eyes (12 study patients) with clinical findings of leptochoroid (geographical hyperpigmented fundus centred in the macula) matched with 22 control eyes (12 control patients). All eyes received enhanced depth imaging optical coherence tomography at Memorial Sloan Kettering Cancer Center. Two independent observers performed all measurements. Statistical analysis was used to correlate interobserver findings, and compare patient and eye characteristics.
Study patients had a female predominance and median age of 70 years. Iris colour and refractive error of these eyes were varied: 8 eyes were myopic (one of which was highly myopic with a refractive error of –9.00) and 14 eyes were emmetropic or hyperopic (up to+3.00). The best-corrected visual acuity was 20/40 or better in all study eyes. The geographical macular areas of relative hyperpigmentation correspond to normal choroidal thickness compared with controls (p=0.74). The relative hypopigmented surrounding fundus had significantly thinner choroid compared with controls (p value=0.0001). Choroidal thickness had a strong interobserver correlation (r=0.99, p<0.0001).
Described here is a clinical entity referred to as peripheral leptochoroid. It appears as geographical hyperpigmented fundus centred in the macula, with adjacent relative hypopigmented fundus. Compared with matched normal subjects, the hyperpigmented and hypopigmented fundus correspond with equivocal and decreased choroidal thickness, respectively.
The Rho-kinase/ROCK (Rho-associated coiled-coil-containing protein kinase) pathway is involved in the pathogenesis of multiple ocular and systemic disorders. Recently, ROCK inhibitors have been suggested as novel treatments for various ocular diseases. Several in vitro, in vivo and clinical studies have demonstrated the safety and efficacy of ROCK inhibitors in the management of ocular disorders such as corneal epithelial and endothelial damage, glaucoma, retinal and choroidal neovascularisation, diabetic macular oedema and optic nerve disorders. In this review, these studies are explored with focus on the relevant clinical investigations.
To evaluate the 6-year outcomes of anti-VEGF (vascular endothelial growth factor) monotherapy for polypoidal choroidal vasculopathy (PCV).
The charts of 66 eyes of 66 patients with newly diagnosed, symptomatic, treatment-naive PCV were reviewed retrospectively. All patients were treated with 0.5 mg intravitreal ranibizumab (IVR) injections for 3 months followed by as-needed reinjections based on monthly examinations until 3 years after the first IVR injection. Thereafter, anti-VEGF monotherapy was continued for another 3 years.
The mean best-corrected visual acuity (BCVA) improved significantly (p=0.001) 3 months after the first IVR injection (0.24±0.30 logarithm of the minimum angle of resolution (logMAR) VA; 20/35 Snellen VA) compared with the baseline BCVA (0.34±0.37 logMAR VA; 20/44 Snellen VA). However, the improved VA returned to 0.32±0.39 logMAR unit (20/42 Snellen VA), which was not significantly different at 3 years. This level was maintained to the end of 6 years (0.36±0.37 logMAR unit; 20/46 Snellen VA). The mean numbers of anti-VEGF injections administered annually during 6 years were 5.6±2.4 (including the initial three monthly injections), 3.3±2.2, 3.3±2.9, 3.6±3.2, 3.5±2.9 and 3.3±2.7, respectively. The mean total number of injections during 6 years was 21.5±10.1.
The results emphasised the efficacy of anti-VEGF therapy for preserving vision and the limitations of anti-VEGF therapy in that continuous treatment is required over an extended follow-up period.
Currently, the detection of pathogens or mutations associated with intraocular lymphomas heavily relies on prespecified, directed PCRs. With metagenomic deep sequencing (MDS), an unbiased high-throughput sequencing approach, all pathogens as well as all mutations present in the host’s genome can be detected in the same small amount of ocular fluid.
In this cross-sectional case series, aqueous fluid samples from two patients were submitted to MDS to identify pathogens as well as common and rare cancer mutations.
MDS of aqueous fluid from the first patient with vitreal lymphoma revealed the presence of both Epstein-Barr virus (HHV-4/EBV) and human herpes virus 8 (HHV-8) RNA. Aqueous fluid from the second patient with intraocular B-cell lymphoma demonstrated a less common mutation in the MYD88 gene associated with B-cell lymphoma.
MDS detects pathogens that, in some instances, may drive the development of intraocular lymphomas. Moreover, MDS is able to identify both common and rare mutations associated with lymphomas.
To determine the minimum inhibitory concentrations (MICs) of voriconazole and natamycin, alone and in combination, against the clinical isolates of Fungus and to evaluate the synergy between the drugs in an experimental in vitro study.
In an experimental in vitro study, clinical isolates of Fusarium, Aspergillus, Candida and Curvularia spp were maintained on Sabouraud Dextrose Agar and used for the study. The MICs of natamycin and voriconazole, used alone and in combination, were evaluated by checkerboard microdilution technique based on the standard protocol proposed by the Clinical Laboratory Standards Institute. The interactions were assessed using the fractional inhibitory concentration (FIC) Index model.
Tested with all the clinical isolates, the MICs ranged between 0.125 and 8 µg/mL both for natamycin and voriconazole. In descending order, maximum synergism (FIC ≤0.5) was observed in Candida spp (33.3%) followed by Curvularia spp and Fusarium spp (23.1%). Synergism was least for Aspergillus spp (22.2%). However, at 61.5% (8/13), maximum additive effect (>0.5–1) was observed in Aspergillus spp and minimum (33.3%, 2/6) in Candida spp. Indifference (FIC value >1 and≤4) was observed in 22.2% (2/9) of Aspergillus spp, 15.4% (2/13) of Fusarium spp, 33.3% (2/6) of Candida spp and 23.1% (3/13) of Curvularia spp. No cases of antagonism (FIC >4) were observed.
Natamycin and voriconazole in combination demonstrated more effective antifungal activity than single-use in vitro treatment in all species tested, which implies that these combinations may be helpful in treating fungal keratitis. There was no antagonism between these two drugs.
To ascertain which countries in the world have retinopathy of prematurity (ROP) screening programmes and guidelines and how these were developed.
An email database was created and requests were sent to ophthalmologists in 141 nations to complete an online survey on ROP screening in their country.
Representatives from 92/141 (65%) countries responded. 78/92 (85%) have existing ROP screening programmes, and 68/78 (88%) have defined screening criteria. Some countries have limited screening and those areas which have no screening or for which there is inadequate knowledge are mainly Southeast Asia, Africa and some former Soviet states.
With the increasing survival of premature babies in lower-middle-income and low-income countries, it is important to ensure that adequate ROP screening and treatment is in place. This information will help organisations focus their resources on those areas most in need.
To report on progression of lamellar hole-associated epiretinal proliferation (LHEP) in eyes with lamellar macular holes (LMH) using spectral-domain optical coherence tomography (SD-OCT), and to correlate with intraretinal changes and visual function.
From a retrospectively reviewed series of 167 eyes with non-full-thickness macular holes, we exclusively included a subgroup of 34 eyes with LMH and LHEP by SD-OCT evaluation. In these eyes, area of LHEP, intraretinal changes of defect diameter, central retinal thickness, defects of the ellipsoid zone and occurrence of a contractive epiretinal membrane were analysed. Additionally, clinical data were documented.
Area of LHEP significantly increased during a mean follow-up period of 40.5 months (median 52 months). Analysing intraretinal changes, a significant enlargement of minimum and maximum horizontal lamellar hole diameter was found that correlated with the area of LHEP. Defects of the ellipsoid zone were seen in 65% of the eyes at baseline and in 85% at the end of follow-up. Increase of maximum horizontal hole diameter and ellipsoid zone defects correlated with a decline of visual acuity. Fifty per cent of patients with LMH and LHEP also demonstrated extrafoveal typical contractive epiretinal membranes with retinal folds.
Long-term follow-up revealed an increase of the area of LHEP in eyes with LMH that correlated with the enlargement of lamellar hole diameter and ellipsoid zone defects. Our data delineate the progression of intraretinal changes in association with a decline of visual function in this subgroup of LMH eyes.
To investigate whether neonatal hyperglycaemia in the first postnatal week is associated with treatment-demanding retinopathy of prematurity (ROP).
This is a Danish national, retrospective, case–control study of premature infants (birth period 2003–2006). Three national registers were searched, and data were linked through a unique civil registration number. The study sample consisted of 106 cases each matched with two comparison infants. Matching criteria were gestational age (GA) at birth, ROP not registered and born at the same neonatal intensive care unit. Potential ‘new’ risk factors were analysed in a multivariate logistic regression model, while adjusted for previously recognised risk factors (ie, GA at birth, small for gestational age, multiple birth and male sex).
Hospital records of 310 preterm infants (106 treated; 204 comparison infants) were available. Nutrition in terms of energy (kcal/kg/week) and protein (g/kg/week) given to the preterm infants during the first postnatal week were statistically insignificant between the study groups (Mann-Whitney U test; p=0.165/p=0.163). Early postnatal weight gain between the two study groups was borderline significant (t-test; p=0.047). Hyperglycaemic events (indexed value) were statistically significantly different between the two study groups (Mann-Whitney U test; p<0.001). Hyperglycaemia was a statistically independent risk factor (OR: 1.022; 95% CI 1.002 to 1.042; p=0.031).
An independent association was found between the occurrence of hyperglycaemic events during the first postnatal week and later development of treatment-demanding ROP, when adjusted for known risk factors.
To compare and correlate the retinal sensitivity measurements obtained with Nidek Microperimetry-3 (MP-3) and the CenterVue Macular Integrity Assessment (MAIA) microperimeters among healthy subjects.
In this prospective comparative study, 31 eyes of 23 subjects underwent complete ophthalmological examination including retinal sensitivity assessments using two microperimeters, the MP-3 (Nidek Technologies) and the MAIA (CenterVue). The mean retinal sensitivity (dB) and its corresponding luminance (asb) and contrast (log units) were analysed between the two instruments. The interdevice reproducibility and level of agreement between the sensitivity values of the devices were assessed.
The mean retinal sensitivity (dB) measured by the MP-3 (25.02±1.06 dB, range: 20.90–26.70) was significantly (p<0.0001) lower compared with the MAIA (30.68±0.74 dB, range: 28–31.84). The luminosity levels were significantly (p<0.0001) higher with the MP3 (7.75±1.31 asb, range: 6.44–9.06) compared with the MAIA (0.92±0.14 asb, range: 0.78–1.06). The contrast sensitivity was significantly higher for the MP-3 (0.94±0.33 log units, range: 0.61–1.27) compared with the MAIA (0.23±0.03 log units, range: 0.20–0.26). Despite these absolute differences, the intraclass coefficient was 0.85 (95% CI 0.70 to 0.92) between the two devices after applying a standard correction factor to each data point (MAIA sensitivity=MP-3 sensitivity+5.65) with a mean difference between MAIA and MP-3 of 0.01.
Retinal sensitivity measures higher, but luminance and contrast sensitivity measure lower for MAIA-generated values compared with the MP-3. The relationships, however, appeared fairly consistent, and application of a standard correction factor allowed the data to be inter-related, at least for normal eyes.
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