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:
This study aims to evaluate the therapeutic effect of intravitreal aflibercept injection for polypoidal choroidal vasculopathy (PCV).
Eighteen eyes of 17 consecutive patients with PCV received three consecutive monthly intravitreal injections of aflibercept and one additional injection 2 months later (four injections totally). All patients underwent eye examinations, which included best-corrected visual acuity (BCVA), fluorescein angiography, indocyanine green angiography, and optical coherence tomography. The primary endpoint of the study was the regression of polypoidal lesions. The secondary endpoints were BCVA, central retinal thickness (CRT) and changes in retinal exudation.
Six months after the first aflibercept injection, the polypoidal lesions were completely resolved in 14 eyes (77.7%) and partially resolved in 4 eyes (22.2%). Although branching choroidal vascular networks were still present in all eyes, retinal exudative changes had completely resolved in 17 eyes (94.4%), and the mean CRT decreased significantly from 407.2±100.1 µm to 229.1±57.2 µm (p<0.0001). BCVA (logarithm of the minimal angle of resolution, logMAR) improved significantly from 0.414±0.384 at baseline to 0.297±0.334 after 6 months (p=0.016).
At 6 months, aflibercept monotherapy effectively reduced polyps, retinal exudation and CRT in patients with PCV.
This question was posed by an elderly patient with severe glaucoma who recently adopted an adorable kitten. To my cat-loving patient's dismay, the headline of an article in The Telegraph admonished: ‘why owning a cat could lead to blindness’; while another online commentary advised: ‘keep your dog, get rid of your cat’. In view of her advanced glaucoma, should her kitty make way for a little pooch?
This uproar can be traced to a recent study by Tseng et al.
We report the results and clinical effectiveness of transcanalicular diode laser-assisted revision surgery for failed endoscopic endonasal dacryocystorhinostomy (EDCR).
We reviewed electronic charts of 53 eyes in 51 revision surgery patients, with anatomical failure after primary EDCR.
The major cause of failed EDCR was membranous obstruction of the rhinostomy site (36/53 eyes, 67.9%). The second most common cause of failure was granulomatous obstruction (13/53 eyes, 24.5%). The overall success rate of the first revision surgery was 83.0% (44/53 eyes). Revision surgery for membranous obstruction (36 eyes) showed a 100% success rate, while a 50% success rate was achieved in granulomatous obstruction (13 eyes). 2 patients with synechial obstruction also showed good results (100%). Sump syndrome (two eyes) showed a 100% failure rate after revision surgery. When granuloma was the main cause of obstruction (13 eyes), the size of the granuloma was correlated with the success of revision surgery. Granuloma size was larger in failed revision surgery (p=0.002).
A diode laser can achieve effective tissue dissection with minimal damage and is a good alternative technique for patients with membranous obstruction who had a failed EDCR. However, it may not be appropriate for large granulomatous obstruction and sump syndrome.
To assess the association between visual impairment (VI) and subsequent presence of depressive symptoms among older persons.
Of the 3654 baseline participants (aged over 49 years) of the Blue Mountains Eye Study, 2334, 1952 and 1149 were re-examined after 5, 10 and 15 years, respectively. VI was defined as best-corrected visual acuity <6/12 in either or both eyes. Presence of depressive symptoms was defined if mental health index (MHI) scores <59 or incident use of antidepressant medications. Persons with VI detected at the 5-year or 10-year follow-up visits were assessed for depressive symptoms in 5 years. Persons with VI detected at baseline or the 5-year follow-up were assessed for depressive symptoms over 10 years. Controls were persons without VI over the corresponding period. Discrete logistic regression models with time-dependent study and outcome variables were used, adjusting for potential confounders.
Of 1568 participants who had the MHI assessed at two consecutive visits, 226 had bilateral or unilateral VI detected 5 years earlier and 120 had VI detected over 10 years earlier. Depressive symptoms were reported in 27% and 31.6% of cases with VI detected 5 and over 10 years earlier, respectively, compared with 10.8%–11.5% of controls. There was a significantly greater odds of presenting depressive symptoms among VI cases detected 5 years earlier (OR, 3.06, 95% CI 1.72 to 5.44), but this was non-significant for cases detected over 10 years earlier (OR 1.29, 95% CI 0.84 to 1.98).
VI was associated with subsequently presenting depressive symptoms over 5 years among older persons.
To investigate whether there is an association between penetrating eye injuries and attention deficit hyperactivity disorder (ADHD) symptoms in children.
45 children aged 3–18 years who were treated due to penetrating ocular injuries (patient group) and 75 control subjects (control group) were enrolled in the study. The symptoms of ADHD were evaluated by the Turkish adapted and validated form of the Conner Parent Rating Scale (CPRS).
The mean age was 8.9±4.1 years in the patient group and 9.7±3.7 years in the control group. All subscale scores of CPRS were higher in the patient group compared with the control group (all p<0.05). Gender-specific analyses showed that the boys of the patient group had significantly higher mean scores of all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder, compared with the boys of the control group (all p<0.05). However, the girls of the patient group had higher mean scores of only the conduct disorder subscale (p<0.05) compared with the girls of the control group. Three of 45 patients (6.6%) and 0 of 75 control subjects (0%) had a history of previous ocular trauma (p<0.05).
There was an association between penetrating eye injuries and inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder in boys, and conduct disorder in girls. An appropriate evaluation of ADHD symptoms may prevent vision loss due to penetrating eye injuries in children. In addition, evaluation by a child psychiatrist of children presenting with penetrating eye injuries may prevent repetition of injuries.
Binocular diplopia is a debilitating visual symptom requiring immediate intervention for symptomatic control, whether or not definitive treatment is eventually possible. Where prismatic correction is infeasible, the current standard is occlusion, either by a patch or an opaque contact lens. In eliminating one problem—diplopia—occlusive techniques invariably create another: reduced peripheral vision. Crucially, this is often unnecessary, for the reduced spatial resolution in the periphery limits its contribution to the perception of diplopia. Here, we therefore introduce a novel soft contact lens device that instead creates a monocular central scotoma inversely mirroring the physiological variation in spatial acuity across the monocular visual field, thereby suppressing the diplopia with minimal impact on the periphery. We compared the device against standard eye patching in 12 normal subjects with prism-induced binocular diplopia and 12 patients with binocular diplopia of diverse causes. Indexed by self-reported scores and binocular perimetry, the scotogenic contact lens was comparably effective in eliminating the diplopia while significantly superior in acceptability and its impact on the peripheral visual field. This simple, inexpensive, non-invasive device may thus be an effective new tool in the treatment of a familiar but still troublesome clinical problem.
Bach2 was reported to play a key role in T lymphocyte development and maturation to mediate immunological homeostasis. Several autoimmune and immune-related diseases were shown to be associated with Bach2 gene polymorphisms. The current study was designed to explore the association between Bach2 gene polymorphism with Vogt–Koyanagi–Harada (VKH) syndrome and Behcet's disease (BD) in a Chinese Han population.
–427 patients with BD, 422 patients with VKH and 623 controls were recruited for the first stage from a Chinese Han population. The second stage included another set of 388 patients with BD and 460 healthy subjects. PCR fragment length polymorphism methodology was used for genotyping. Frequencies of genotypes and alleles were measured by direct counting and compared between cases and controls by 2 test.
No difference could be detected between patients suffering from BD or VKH with healthy controls concerning allele and genotype frequencies of rs11755527, rs3757247, rs12212193 and rs2474619. Although in the first stage the frequencies of genotype CC and AC of rs2474619 showed a weak statistical difference between BD and the control group (Pc=0.02), the difference was lost after the second stage and combined stage experiment.
The investigated Bach2 gene polymorphisms (rs11755527, rs3757247, rs12212193 and rs2474619) are not related to the susceptibility to either VKH or BD in our investigated Chinese Han population.
This project was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-CCC-12002184).
The changing profile of patients undergoing ophthalmic surgery, with an increase in prevalence of antiplatelet and anticoagulant drug use, predisposes to bleeding complications. This mandates an awareness of these agents, allowing optimal patient management. We review traditional and newer agents in the context of cataract, vitreoretinal, glaucoma and oculoplastic surgery. Recommendations are given for continuation, cessation and re-commencement of these agents in order to minimise the risk of bleeding and thrombotic/thromboembolic complications.
To evaluate quantitative changes in anterior segment optical coherence tomography (AS-OCT) parameters at 4 years in subjects with open angles on gonioscopy at baseline.
339 gonioscopically open-angle subjects aged >50 years underwent AS-OCT imaging (Visante, Carl Zeiss Meditec, Dublin, California, USA) at baseline and at 4 years. Customised software was used to analyse images. Linear regression was performed to assess baseline predictors of change in mean trabecular iris space area (TISA).
Of the 339 subjects, 204 (61%) had good images for analysis. The mean age at baseline was 60 (SD 6.42) years; 55.4% were women and 87.7% were Chinese. Overall, there was a decrease in anterior chamber depth (ACD), anterior chamber area (ACA), anterior chamber volume (ACV) and angle opening distance at 500/750 µm, TISA 500/750 µm, iris thickness at 2000 µm and iris area in both nasal and temporal quadrants (p<0.05) at 4 years. There was an increase in iris curvature (ICURV) and lens vault (LV) (p<0.05). With univariate analysis, shorter axial length (AxL), shallower ACD, greater LV, smaller ACA/ACV and larger mean ICURV at baseline were associated with less change in TISA750 at follow-up. On multivariate analysis, only baseline mean ICURV and shorter AxL were predictive of less change in TISA750 at 4 years.
Angle width significantly decreased; ICURV and LV increased in subjects with gonioscopically open angles followed at 4 years. Eyes with shorter AxL and greater ICURV at baseline had lesser decrease in angle width.
There is a paucity of data in the literature on the surgical management of conjunctival dermolipoma. In this study, we report outcomes of a partial mass excision technique (excision of the portion visible when eyes open) and free conjunctival autograft.
Medical records of 13 patients with dermolipoma who had undergone partial mass excision at Seoul National University Hospital from January 1999 to May 2014 were retrospectively reviewed. After resection of the visible part of tumour, including the overlying thick surface conjunctiva, the conjunctival defects were reconstructed with free conjunctival autograft harvested from the contralateral superior bulbar area.
The median postoperative follow-up period was 5 months (range 1–84 months). The cosmetic surgical results were satisfactory in all 13 patients. Three patients showed thick texture on the grafted surgical area postoperatively, but there was no significant scar formation resulting in restrictive symblepharon or eye movement limitation. There were no other significant complications, such as blepharoptosis, diplopia or keratoconjunctivitissicca during the follow-up period.
Partial mass (visible part only) excision, including that of the overlying thick conjunctiva, and free conjunctival autograft from the opposite eye, is a relatively simple and effective technique for the surgical management of conjunctival dermolipoma.
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