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:

Cupping of the optic disk after methanol poisoning
Purpose

To assess the frequency and significance of optic disk cupping after methanol poisoning.

Methods

We retrospectively reviewed the medical records of 50 consecutive patients with methanol poisoning, including visual acuity, pupillary reaction, and optic disk features such as the presence and degree of cupping. All patients were examined in the chronic phase after optic nerve damage.

Results

Optic disk cupping ≥0.8 c/d was present in at least one eye of 22 of these 50 patients (43/100 eyes). Severity of cupping was statistically symmetric in the two eyes, and increasing severity of cupping was correlated with worse visual acuity (p=0.007) and increasing visual field loss. Degree of cupping was significantly correlated with increasing patient age but not with putaminal necrosis.

Conclusions

Optic disk cupping after methanol poisoning may be more common than previously recognised. Cupping in this setting may reflect toxicity of methanol metabolites to axons and glial cells in the prelaminar, laminar and retrolaminar regions, and seems to be important as a marker for worse optic nerve damage.

Author: Galvez-Ruiz, A., Elkhamary, S. M., Asghar, N., Bosley, T. M.
Posted: August 20, 2015, 7:31 am
Combining measurements from three anatomical areas for glaucoma diagnosis using Fourier-domain optical coherence tomography
Aims

To improve the diagnostic power for glaucoma by combining measurements of peripapillary nerve fibre layer (NFL), macular ganglion cell complex (GCC) and disc variables obtained with Fourier-domain optical coherence tomography (FD-OCT) into the glaucoma structural diagnostic index (GSDI).

Methods

In this observational, cross-sectional study of subjects from the Advanced Imaging of Glaucoma Study, GCC and NFL of healthy and perimetrical glaucoma subjects from four major academic referral centres of the Advanced Imaging of Glaucoma Study were mapped with the RTVue FD-OCT. Global loss volume and focal loss volume parameters were defined using NFL and GCC normative reference maps. Optimal weights for NFL, GCC and disc variables were combined using multivariate logistic regression to build the GSDI. Glaucoma severity was classified using the Enhanced Glaucoma Staging System (GSS2). Diagnostic accuracy was assessed by sensitivity, specificity and the area under the receiver operator characteristic curve (AUC).

Results

We analysed 118 normal eyes of 60 subjects, 236 matched eyes of 166 subjects with perimetrical glaucoma, and 105 eyes from a healthy reference group of 61 subjects. The GSDI included composite overall thickness and focal loss volume with weighted NFL and GCC components, as well as the vertical cup-to-disc ratio. The AUC of 0.922 from leave-one-out cross validation was better than the best component variable alone (p=0.047). The partial AUC in the high specificity region was also better (p=0.01), with a sensitivity of 69% at 99% specificity, and a sensitivity of 80.3% at 95% specificity. For GSS2 stages 3–5 the sensitivity was 98% at 99% specificity, and 100% at 95% specificity.

Conclusions

Combining structural measurements of GCC, NFL and disc variables from FD-OCT created a GSDI that improved the accuracy for glaucoma diagnosis.

Trial registration number

NCT01314326.

Author: Loewen, N. A., Zhang, X., Tan, O., Francis, B. A., Greenfield, D. S., Schuman, J. S., Varma, R., Huang, D., for the Advanced Imaging for Glaucoma Study Group
Posted: August 20, 2015, 7:31 am
The association between toll-like receptor 4 polymorphisms and diabetic retinopathy in Chinese patients with type 2 diabetes
Purpose

Diabetic retinopathy (DR) is one of the secondary microvascular complications of type 2 diabetes mellitus. Persistent inflammation and impaired neovascularisation may be important contributors to the development of DR. A recent study showed that toll-like receptor 4 (TLR4) polymorphisms were associated with DR. The present study was designed to determine whether single-nucleotide polymorphisms (SNPs) in the TLR4 gene were associated with DR in a Chinese Han population.

Materials and methods

Three SNPs (rs10759931, rs1927911 and rs1927914) in the TLR4 gene were chosen as candidate SNPs. Genomic DNA from type 2 diabetes patients and healthy controls were genotyped for the above-mentioned genetic variations through the use of PCR restriction fragment length polymorphism assay. Data were analysed by 2 analysis.

Results

The results showed that the three analysed polymorphisms in the TLR4 gene were in Hardy–Weinberg equilibrium, both in the patients and in the controls. In the type 2 diabetes group, a significantly higher frequency of the C allele of rs1927914 was observed in patients with type 2 diabetes than that in controls. The result showed that the frequencies of the TT genotype and the T allele of rs1927914 were significantly decreased in patients with type 2 diabetes. Significantly increased frequencies of the CC genotype and the C allele of rs1927911 were observed in patients with type 2 diabetes. In the DR group, the C allele of rs1927914 was significantly increased in the DR group compared with that of the control. The frequencies of the CC genotype and the C allele of rs1927911 tended to be higher in patients with DR than in the healthy controls. However, no difference was found when the Bonferroni correction was applied. No difference was detected between patients and controls with regard to all haplotypes.

Conclusions

This study suggested that rs1927914 and rs1927911 were associated with type 2 diabetes mellitus and that rs1927914 was associated with susceptibility to DR in a Han Chinese population.

Author: Xu, Y., Jiang, Z., Huang, J., Meng, Q., Coh, P., Tao, L.
Posted: August 20, 2015, 7:31 am
Large-diameter deep anterior lamellar keratoplasty for keratoconus: visual and refractive outcomes
Background

To investigate the difference in clinical outcomes between large-diameter deep anterior lamellar keratoplasty (L-DALK) and standard DALK (S-DALK) for the treatment of keratoconus.

Methods

132 patients (132 eyes) from the Zhongshan Ophthalmic Center with a clinical diagnosis of keratoconus were enrolled. The participants were featured by the intolerance to rigid gas-permeable contact lenses or unsuccessful fitting of contact lenses. Using stratified blocked randomisation, eligible eyes were allocated into the L-DALK group or the S-DALK group (66 eyes, respectively). Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive sphere, manifest cylinder and spherical equivalent refractive error were tested at 6, 12, 18 and 24 months after surgery.

Results

After surgery, the L-DALK group had better UCVA and BSCVA than the S-DALK group (p=0.000 and 0.021, respectively). At 24 months, mean BSCVA was 0.17±0.10 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 20/25) in the L-DALK group vs 0.22±0.10 logMAR (Snellen equivalent, 20/32) in the S-DALK group. Differences were observed between the L-DALK group and the S-DALK group in terms of refractive sphere (p=0.015), manifest cylinder (p=0.014) and spherical equivalent refractive error (p=0.034) at any time interval postoperatively. At 24 months, the mean spherical equivalent refractive error was –3.5±3.2 D and –5.2±2.6 D in the L-DALK and S-DALK groups, respectively.

Conclusions

L-DALK can reduce the degree of postoperative myopia and manifest astigmatism and improve visual acuity outcomes in keratoconus compared with S-DALK.

Trial registration number

Chinese Clinical Trial Registry (TRC-13003122).

Author: Huang, T., Hu, Y., Gui, M., Zhang, H., Wang, Y., Hou, C.
Posted: August 20, 2015, 7:31 am
Ophthalmic statistics note 5: diagnostic tests--sensitivity and specificity

This is the fifth statistics note produced by the Ophthalmic Statistics Group (OSG) which is designed to be a simple guide to ophthalmic researchers on a statistical issue with an applied ophthalmic example. The OSG is a collaborative group of statisticians who have come together with a desire to raise the statistical standards of ophthalmic researcher by increasing statistical awareness of common issues.

Author: Saunders, L. J., Zhu, H., Bunce, C., Dore, C. J., Freemantle, N., Crabb, D. P., on behalf of the Ophthalmic Statistics Group, This fifth note from the Ophthalmic Statistics Group illustrates the utility of measurements of sensitivity and specificity in assessing the usefulness of a test for predicting the presence of pathology, on behalf of the Ophthalmic Statistics Group, This fifth note from the Ophthalmic Statistics Group illustrates the utility of measurements of sensitivity and specificity in assessing the usefulness of a test for predicting the presence of pathology, Cipriani, Cook, Cumberland, Czanner, Donachie, Elders, Garcia Finana, Nash, O'Leary, Prevost, Qaurtilho, Rogers, Sivasubramaniam, Skene, Stratton, Vasconcelos, Xing
Posted: August 20, 2015, 7:31 am
Syphilitic uveitis and optic neuritis in Sydney, Australia
Aims

To describe ocular syphilis presentations to a tertiary referral eye hospital over a 5-year period and to document HIV coinfection frequency.

Methods

A retrospective chart review was conducted of consecutive ocular syphilis presentations to Sydney Eye Hospital from 2007 to 2012. Inclusion criteria were positive syphilis serology, ocular inflammation on clinical examination and appropriate syphilis treatment. Outcome measures were clinical features at presentation and best-corrected visual acuity (BCVA) at interval follow-up.

Results

Thirty-seven eyes of 25 patients were included in the series. Patients were predominantly male (92.0%, p<0.05) with mean age 43.7±14.0 years. Eight (32.0%) patients had confirmed HIV coinfection, three newly diagnosed with HIV. Twelve (32.4%) eyes demonstrated anterior segment involvement with anterior uveitis. Twenty-five (67.6%) eyes demonstrated posterior segment involvement, including panuveitis, acute syphilitic posterior placoid chorioretinitis, retinitis, necrotising retinitis, punctate retinitis and optic neuritis. There was a significant improvement in BCVA for involved eyes (p<0.05) at 1 month and 2–3 months follow-up.

Conclusions

The clinical findings of 37 eyes with ocular syphilis demonstrated a broad spectrum of clinical manifestations. Rates of HIV coinfection were high, with patients exhibiting both anterior and posterior segment inflammation. Visual outcome improved following syphilis treatment.

Author: Northey, L. C., Skalicky, S. E., Gurbaxani, A., McCluskey, P. J.
Posted: August 20, 2015, 7:31 am
Ophthalmic grading of facial paralysis: need for a closer look

Very many variations of facial grading systems have been developed, but none address the ophthalmic complications of facial nerve weakness adequately. The important priorities for ophthalmic surgeon are protecting the ocular surface, maintaining sight and peripheral vision, as well as improving the cosmesis of periocular area. The absence of a universally agreed grading system on the ophthalmic plastic complications of facial nerve paralysis is an obstacle to standardised treatment. It is time for clinicians to recognise this need.

Author: Ziahosseini, K., Nduka, C., Malhotra, R.
Posted: August 20, 2015, 7:31 am
Late in-the-bag intraocular lens dislocation in patients with uveitis
Background

Late in-the-bag intraocular lens (IOL) dislocation is an unusual complication of cataract surgery, being strongly associated with pseudoexfoliation, less so with previous vitreoretinal surgery, myopia and uveitis. We present the clinical features, management and outcomes of late spontaneous IOL dislocation in a series of patients with uveitis.

Methods

A retrospective case series of IOL dislocation affecting patients in the Manchester Uveitis Clinic, UK. The uveitis diagnosis, IOL type, presentation and management are discussed.

Results

Six patients from out of 1056 undergoing cataract surgery (0.57%) were affected. Uveitis was the only identified risk factor for IOL dislocation, which occurred a mean 10.3 years following uncomplicated cataract surgery by phakoemulsification with endocapsular IOL implantation. The dislocation was in-the-bag in all six cases. Two patients presented with the IOL in the anterior chamber, and required removal of the IOL-bag complex, and are using aphakic refractive correction. Two patients with inferior IOL subluxation have been managed conservatively. Two patients underwent pars plana vitrectomy with sutureless scleral fixation of the existing IOL in one case, and IOL exchange with a scleral sutured IOL in the other.

Conclusions

IOL dislocation is an uncommon late complication in patients with uveitis. Conservative management is appropriate in patients with tolerable symptoms, or in those with difficult uveitis. Otherwise, fixation of the existing IOL, or removal and implantation of a secondary IOL, may be necessary. Angle-supported, or iris-enclaved IOLs, are not of proven safety in this patient group; scleral-fixated posterior chamber IOLs are the favoured approach in our service.

Author: Steeples, L. R., Jones, N. P.
Posted: August 20, 2015, 7:31 am
Comparison of central and peripheral corneal thickness measurements with scanning-slit, Scheimpflug and Fourier-domain ocular coherence tomography
Purpose

To compare central, regional and relational corneal thickness values obtained with multiple technologies in normal patients and to determine their equivalence and interchangeability.

Methods

Retrospective analysis of 100 eyes from 50 patients evaluated by ultrasound pachymetry (Pachette II), scanning-slit (Orbscan II), Scheimpflug (Pentacam HR) and spectral-domain ocular coherence tomography (OCT) (RTVue-100) obtained as average values (OCT-A) and point measurements (OCT-P). Measurements included central corneal thickness (CCT) for all technologies and thinnest corneal thickness for scanning-slit, Scheimpflug and OCT. Peripheral thickness measurements were obtained at the 3 mm radius in the superior (S), nasal (N), inferior (I) and temporal (T) regions.

Results

CCT values were: 563.9±36.1μ ultrasound, 570.9±36.1μ scanning-slit, 552.8±33.8μ Scheimpflug, 550.5±32.7μ (OCT-A), 549.4±32.7μ (OCT-P). Ultrasound and scanning-slit were significantly different from each other (p<0.0001), and both were significantly different from all other devices (p<0.0001), while Scheimpflug was similar to OCT-A and OCT-P (p=0.4). Differences between CCT and thinnest corneal thickness were significantly different from all technologies except scanning-slit and OCT-A. For peripheral values, almost all locations’ measurements were significantly different from one another (p<0.0001). Superior–inferior values and ratios were also significantly different from one another for almost all devices with no consistent patterns detectible.

Conclusions

There are significant clinically relevant differences between regional and relational thickness measurements obtained with ultrasound, scanning-slit, Scheimpflug and OCT devices. Screening metrics devised for one system do not appear directly applicable to other measurement systems.

Author: Randleman, J. B., Lynn, M. J., Perez-Straziota, C. E., Weissman, H. M., Kim, S. W.
Posted: August 20, 2015, 7:31 am
Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial
Purpose

To compare the efficacy of topical 1% voriconazole vs 5% natamycin for the treatment of fungal keratitis.

Methods

In a prospective, double-masked, randomised, controlled, registered clinical trial, 118 patients with fungal keratitis were treated using identical dosage schedule with either voriconazole (58) or natamycin (60) as inpatients for 7 days and followed up weekly. The outcome measures were percentage of patients with healed or resolving ulcer and final visual acuity at last follow-up (primary) and on day 7 (secondary) in each group.

Results

More patients (p=0.005) on natamycin (50/56, 89.2%) had healed or resolving ulcer compared with voriconazole (34/51, 66.6%) at last follow-up. The improvement in vision was marginally greater in patients in the natamycin group compared with the voriconazole group at day 7 (p=0.04) and significantly greater at final visit (p=0.01). In univariate analysis, drug, age and mean size of corneal infiltrate and epithelial defect had a significant effect on the final visual outcome. In multivariate analysis, the effect of drug (voriconazole vs natamycin, adjusted coefficient 0.27 (–0.04 to 0.57), p=0.09) was marginal while the effect of age and epithelial defect was significant (p<0.001 for both). In the group treated with natamycin, the final visual acuity was significantly better (p=0.005, Wilcoxon signed-rank test) in patients with Fusarium keratitis but not with Aspergillus keratitis (p=0.714, paired t test).

Conclusions

When compared with voriconazole, natamycin was more effective in the treatment of fungal keratitis, especially Fusarium keratitis.

Trial registration number:

Clinical Trial Registry India (2010/091/003041).

Author: Sharma, S., Das, S., Virdi, A., Fernandes, M., Sahu, S. K., Kumar Koday, N., Ali, M. H., Garg, P., Motukupally, S. R.
Posted: August 20, 2015, 7:31 am

– For more Ophthalmology news, please browse our other News pages.

 

Leave a Reply

Your email address will not be published. Required fields are marked *