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:

Correction

Tang J, Herda AA, and Kern TS. Photobiomodulation in the treatment of patients with non-centerinvolving diabetic macular oedema. Br J Ophthalmol 2014;98:1013–5. The article states that the daily dose of light administered was 25 J/cm2; however the actual dose per treatment was 9 J/cm2.

Posted: September 16, 2014, 12:33 pm
Descemet's stripping automated endothelial keratoplasty with anterior chamber intraocular lenses

Dear Editor,

We thank Mittal and Garg for their interest in our publication. Our study analysed Descemet's stripping automated endothelial keratoplasty (DSAEK) with anterior chamber intraocular lenses (ACIOL) with regards to 3-year graft survival and endothelial cell loss as our main outcome measures, not visual outcome or complications.1 Here, we used Kaplan–Meier survival analysis that takes into account any censored data from loss to follow-up, to derive that there was a significantly poorer graft survival in the DSAEK-ACIOL group versus the DSAEK group (log-rank p=0.002). In fact, completely excluding subjects with less than 3 years of follow-up as suggested by Mittal and Garg would actually lead to a selection bias, missing 14 (out of a possible total 19) graft failures and further strengthening our study conclusions—although in an inaccurate way. We also note that even if Mittal and Garg's calculations are assumed to be acceptable, the 95% CI...

Author: Tan, D., Htoon, H. M., Ang, M.
Posted: September 16, 2014, 12:33 pm
Re: Ang et al: Descemet's stripping automated endothelial keratoplasty with anterior chamber intraocular lenses: complications and 3-year outcomes

Dear editor,

We read with interest the article titled ‘Descemet's stripping automated endothelial keratoplasty with anterior chamber intraocular lenses: complications and 3-year outcomes’ by Ang et al.1 Although the authors concluded that endothelial cell loss and graft survival in anterior chamber intraocular lens (ACIOL) group were significantly poorer compared with Descemet's stripping automated endothelial keratoplasty (DSAEK) controls at 3 years postoperatively, we would like to draw attention to following issues:

  • Though the title of the article stated that it was a ‘3-year’ outcome study, visual outcome and complications were analysed only at the end of 1 year.

  • Clinical data at 3 years were available for only eight of 18 eyes in ACIOL arm and 39 of 114 eyes in posterior chamber intraocular lens (PCIOL) arm. But the authors have calculated the graft failure rate taking 18 and 114 eyes as the denominator in ACIOL and PCIOL groups, respectively. This...

  • Author: Mittal, R., Garg, P.
    Posted: September 16, 2014, 12:33 pm
    Novel mitochondrial tRNAIle m.4282A>G gene mutation leads to chronic progressive external ophthalmoplegia plus phenotype
    Background/aim

    To investigate the underlying pathomechanism in a 33-year-old female Caucasian patient presenting with chronic progressive external ophthalmoplegia (CPEO) plus symptoms.

    Methods

    Histochemical anaylsis of skeletal muscle and biochemical measurements of individual oxidative phosphorylation (OXPHOS) complexes. Genetic analysis of mitochondrial DNA in various tissues with subsequent investigation of single muscle fibres for correlation of mutational load.

    Results

    The patient’s skeletal muscle showed 20% of cytochrome c oxidase-negative fibres and 8% ragged-red fibres. Genetic analysis of the mitochondrial DNA revealed a novel point mutation in the mitochondrial tRNAIle (MTTI) gene at position m.4282G>A. The heteroplasmy was determined in blood, buccal cells and muscle by restriction fragment length polymorphism (RFLP) combined with a last fluorescent cycle. The total mutational load was 38% in skeletal muscle, but was not detectable in blood or buccal cells of the patient. The phenotype segregated with the mutational load as determined by analysis of single cytochrome c oxidase-negative/positive fibres by laser capture microdissection and subsequent LFC-RFLP.

    Conclusions

    We describe a novel MTTI transition mutation at nucleotide position m.4282G>A associated with a CPEO plus phenotype. The novel variant at position m.4282G>A disrupts the middle bond of the D-stem of the tRNAIle and is highly conserved. The conservation and phenotype-genotype segregation strongly suggest pathogenicity and is in good agreement with the MTTI gene being frequently associated with CPEO. This novel variant broadens the spectrum of MTTI mutations causing CPEO.

    Author: Jackson, C. B., Neuwirth, C., Hahn, D., Nuoffer, J.-M., Frank, S., Gallati, S., Schaller, A.
    Posted: September 16, 2014, 12:33 pm
    Effects of aflibercept on primary RPE cells: toxicity, wound healing, uptake and phagocytosis
    Background/aim

    Anti-VEGF treatment is the therapy of choice in age-related macular degeneration, and is also applied in diabetic macular oedema or retinal vein occlusion. Recently, the fusion protein, aflibercept, has been approved for therapeutic use. In this study, we investigate the effects of aflibercept on primary RPE cells.

    Methods

    Primary RPE cells were prepared from freshly slaughtered pigs’ eyes. The impact of aflibercept on cell viability was investigated with MTT and trypan blue exclusion assay. The influence of aflibercept on wound healing was assessed with a scratch assay. Intracellular uptake of aflibercept was investigated in immunohistochemistry and its influence on phagocytosis with a phagocytosis assay using opsonised latex beads.

    Results

    Aflibercept displays no cytotoxicity on RPE cells but impairs its wound healing ability. It is taken up into RPE cells and can be intracellularly detected for at least 7 days. Intracellular aflibercept impairs the phagocytic capacity of RPE cells.

    Conclusions

    Aflibercept interferes with the physiology of RPE cells, as it is taken up into RPE cells, which is accompanied by a reduction of the phagocytic ability. Additionally, it impairs the wound healing capacity of RPE cells. These effects on the physiology of RPE cells may indicate possible side effects.

    Author: Klettner, A., Tahmaz, N., Dithmer, M., Richert, E., Roider, J.
    Posted: September 16, 2014, 12:33 pm
    Two novel mutations including a large deletion of the SLC4A11 gene causing autosomal recessive hereditary endothelial dystrophy
    Introduction

    Congenital hereditary endothelial dystrophy (CHED) is an inherited disorder of the corneal endothelium characterised by bilateral non-inflammatory corneal clouding ranging from a diffuse haze to a ground-glass appearance. CHED can be inherited in an autosomal dominant (CHED1) or recessive (CHED2) manner. CHED2 usually presents at birth or early infancy. Bilateral corneal clouding can lead to visual impairment often accompanied by nystagmus in CHED2 patients requiring corneal transplantation.1

    Mutations in the solute carrier family 4 member 11 (SLC4A11) gene have been identified in most patients with CHED2. With PCR sequencing of the entire coding and putative promoter regions of SLC4A11, there were, however, some clinically confirmed CHED2 patients with undetected SLC4A11 mutations.2

    Case description

    Three affected siblings with CHED2 from a non-consanguineous Thai family were seen at the age of 7, 17 and 20 years, respectively. A diagnosis of CHED2 was made by...

    Author: Puangsricharern, V., Yeetong, P., Charumalai, C., Suphapeetiporn, K., Shotelersuk, V.
    Posted: September 16, 2014, 12:33 pm
    Medial lower lid epiblepharon repair solely by skin-redraping medial epicanthoplasty
    Background/aims

    To evaluate clinical efficacy of a procedure using solely skin-redraping medial epicanthoplasty without traditional epiblepharon correction methods in patients with medial lower lid epiblepharon with epicanthal fold.

    Methods

    This clinical practice study included 24 eyes of 12 patients with medial lower lid epiblepharon who underwent epiblepharon repairs from January to September 2012. The patients included were those whose cilia touch disappeared with medial epicanthal fold traction for temporary medial epicanthal fold repair during preoperative examination. The patients underwent the sole procedure of skin-redraping medial epicanthoplasty.

    Results

    The mean age was 7.50±3.23 years and the mean period of follow-up was 12.5±3.80 months. Complete correction of cilia touch was observed in all patients. Surgical complications such as canalicular injury, skin fold, severe hypertrophic scar and excessive haemorrhage were not observed in any patients. Cosmetic results of surgical intervention were considered satisfactory by all patients, including one case of mild scar formation. There was no recurrence during the follow-up period.

    Conclusions

    For patients with medial lower lid epiblepharon with epicanthal fold without excessive skin and muscle, a simple skin-redraping medial epicanthoplasty without traditional epiblepharon correction methods showed good results of epiblepharon repair.

    Author: Oh, J., Lee, K.
    Posted: September 16, 2014, 12:33 pm
    Management of congenital lacrimal (anlage) fistula
    Background/aims

    To review management choices and outcomes for congenital lacrimal (anlage duct) fistulae performed by a single ophthalmologist over a 10-year interval.

    Methods

    All cases of congenital lacrimal fistulae with minimum follow-up of 1 year, seen and managed by the senior author (PJD) from 2000 to 2010, were retrieved from electronic medical records. Recorded data included demographic features, associated abnormalities of the lacrimal outflow apparatus and type of surgical intervention and outcome.

    Results

    15 cases of lacrimal fistulae were identified. 67% were males, and mean age of presentation was 5 years. All presented with tearing from the eye or fistulous opening. Two patients had Down syndrome (13%). Mean follow-up was 7.3 years. While two cases required excision combined with endonasal dacryocystorhinostomy (DCR) or intubation, 9 of 11 (82%) operated cases were successfully treated with simple excision alone. Spontaneous resolution of symptoms occurred in 27% following successful treatment of concurrent nasolacrimal duct obstruction with lacrimal sac massage; in two of these cases, the fistulae were probed and found to have sealed spontaneously. The most common site of the fistula was at the inferior medial canthal area and was connected to the lacrimal sac or common canaliculus in all cases.

    Conclusions

    Congenital lacrimal fistulae may be successfully treated with simple excision alone in most cases. Adjunctive DCR or intubation can be reserved for those identified to have lacrimal outflow tract abnormalities.

    Author: Al-Salem, K., Gibson, A., Dolman, P. J.
    Posted: September 16, 2014, 12:33 pm
    Eyelash line resection for cilial entropion in patients with Down's syndrome
    Aim

    To describe a surgical procedure for excising the eyelash line to treat cilial entropion in patients with Down's syndrome.

    Methods

    24 Down's patients with cilial entropion and medial epiblepharon underwent eyelash line resection bilaterally. The area and density of fluorescein staining of the superficial punctate keratopathy (SPK; 0=none to 3=wide or severe) and the frequency of spectacle wear (0=no wear to 2=all day wear) were evaluated prospectively.

    Results

    The postoperative area and density of the SPK improved significantly in both eyes (p<0.001, p<0.001). The score of spectacle wear was 1.3±0.8 preoperatively which improved significantly to 1.7±0.5 after surgery (p=0.018). Five patients had a partial recurrence of misdirected eyelashes adjacent to the site of the excision. Two patients had extended excisions of the misdirected eyelashes 3 years after the initial surgery, and they did not have any further recurrences. Three other patients were followed without additional treatment because lacrimation and eye discharge were mild even with some eyelashes misdirected toward cornea.

    Conclusions

    Eyelash line resection is a simple and effective technique for cilial entropion and medial epiblepharon in patients with Down's syndrome. The surgery improves the SPK and frequency of spectacle wear.

    Trial registration number

    NCT01758718.

    Author: Suzuki, Y., Hama, Y., Yoshikawa-Kobayashi, I., Tomita, K., Inoue, M., Hirakata, A.
    Posted: September 16, 2014, 12:33 pm
    Clinical outcomes of sleeveless phacotip assisted levitation of dropped nucleus
    Background/aim

    To demonstrate the feasibility of a sleeveless phacotip-assisted approach to levitate dropped nucleus.

    Methods

    This single-centre, retrospective, interventional, non-comparative case series reviewed the medical records of 34 eyes of 34 patients. Corrected and uncorrected distance visual acuity (CDVA, UDVA), early and late postoperative complications and ultrasound biomicroscopic (UBM) evaluation of the sclerotomy site was analysed.

    Results

    At 18 months follow-up, the mean postoperative UDVA and CDVA in Snellen's decimal equivalent was 0.42±0.16 and 0.91±0.2, respectively. There was a significant improvement in the UDVA (p=0.001) and CDVA (p=0.002). Nucleus drop occurred following intraoperative posterior capsular rupture in 25 eyes (73.5%), zonular weakness in 5 eyes (14.8%) and post-trauma in 4 eyes (11.7%). In the early postoperative period, corneal oedema was seen in 2 eyes, pigment dispersion in 3 eyes and vitritis in 2 eyes. There was loss of CDVA in 1 (2.9%) eye due to persistent cystoid macular oedema. UBM did not reveal any vitreous incarceration into the sclerotomy site.

    Conclusion

    Dropped nucleus was successfully levitated into anterior chamber with this technique, resulting in a significant visual outcome with a favourable complication rate.

    Author: Agarwal, A., Narang, P., A Kumar, D., Agarwal, A.
    Posted: September 16, 2014, 12:33 pm

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