Showing papers in "British Journal of Ophthalmology in 2009"
TL;DR: Many papers on retinoblastoma open with a statement that it is the most common primary intraocular cancer in children and a rare disease, but this claim is substantiated and its consequences evaluated.
Abstract: Many papers on retinoblastoma open with a statement that it is the most common primary intraocular cancer in children and a rare disease. True enough. After reflecting a little longer on the epidemiology of eye cancer, however, this statement probably should be revised to read: “retinoblastoma is the most frequent primary intraocular cancer and is gaining importance rapidly.” Let us substantiate this claim and evaluate its consequences in some detail.
First, just how frequent is retinoblastoma? Not an easy question to answer because investigators are estimating its incidence in many ways. A recent issue featured two papers on the subject from the Western hemisphere. MacCarthy and coworkers,1 who analysed data from 1601 children with retinoblastoma diagnosed in England, Scotland and Wales between 1963 and 2002, arrive at an annual incidence rate of 3.5 per million children less than 15 years of age. Broaddus and colleagues2 from the USA estimate the rate to be 11.8 per million children below 5 years of age, based on 658 entries in the Surveillance, Epidemiology, and End Results (SEER) programme database from 1975 to 2004.
MacCarthy and coworkers also provide a cumulative incidence estimate of 53 per million for the first 14 years of life, which is useful because by that age, essentially all retinoblastomas have been detected, and they report that 95% of tumours were diagnosed before the age of 5 years.1 Presuming that this percentage is constant, one can calculate the corresponding estimate to be 62 per million for the SEER study. Although they are of the same order of magnitude, the estimates, or any estimate based on the number of children of particular age, will be influenced by differences in child and adolescent mortality between countries, the more so the wider is the age cohort considered.
Because retinoblastoma is …
536 citations
TL;DR: Outdoor activity may protect against development of myopia in children, supporting recent Australian data as near work did not predict outdoor activity, and can be viewed as an independent factor and not merely the reciprocal of near work.
Abstract: Aim: To investigate the relationship of outdoor activities and myopia in Singapore teenage children. Methods: Teenage children (1249 participants), examined in the Singapore Cohort study Of Risk factors for Myopia (SCORM), during 2006 were included in analyses. Participants completed questionnaires that quantified total outdoor activity, and underwent an eye examination. Results: The mean total time spent on outdoor activity was 3.24 hours per day. Total outdoor activity (hours per day) was significantly associated with myopia, odds ratio 0.90 [95% confidence interval (CI) 0.84, 0.96] (p=0.004), after adjusting for age, gender, ethnicity, school type, books read per week, height, parental myopia, parental education and intelligence quotient. In addition, total time spent outdoors was associated with significantly less myopic refraction (regression coefficient = 0.17; CI 0.10, 0.25, p Conclusions: Participants who spent more time outdoors were less likely to be myopic. Thus, outdoor activity may protect against development of myopia in children, supporting recent Australian data. As near work did not predict outdoor activity, this can be viewed as an independent factor and not merely the reciprocal of near work.
390 citations
TL;DR: Results confirm previous reports of slowed eye growth following corneal reshaping contact lens wear, and also confirm that corneals can slow myopia progression in children.
Abstract: Background/aims: Anecdotal evidence indicates that corneal reshaping contact lenses may slow myopia progression in children. The purpose of this investigation is to determine whether corneal reshaping contact lenses slow eye growth. Methods: Forty subjects were fitted with corneal reshaping contact lenses. All subjects were 8 to 11 years and had between −0.75 D and −4.00 D myopia with less than 1.00 D astigmatism. Subjects were age-matched to a soft contact lens wearer from another myopia control study. A-scan ultrasound was performed at baseline and annually for 2 years. Results: Twenty-eight of 40 (70%) subjects wore corneal reshaping contact lenses for 2 years. The refractive error and axial length were similar between the two groups at baseline. The corneal reshaping group had an annual rate of change in axial lengths that was significantly less than the soft contact lens wearers (mean difference in annual change = 0.16 mm, p = 0.0004). Vitreous chamber depth experienced similar changes (mean difference in annual change = 0.10 mm, p = 0.006). Conclusion: Results confirm previous reports of slowed eye growth following corneal reshaping contact lens wear.
355 citations
TL;DR: The current estimate of prevalence of trachoma is lower than the previous WHO estimates and can be explained by the success in implementing control strategy, by more accurate data, as well as by socio-economic development in endemic countries.
Abstract: Objectives: Trachoma is the leading cause of infectious blindness worldwide. It is known to be highly correlated with poverty, limited access to healthcare services and water. In 2003, the WHO estimated that 84 million people were suffering from active trachoma, and 7.6 million were severely visually impaired or blind as a result of trachoma: this study provides an updated estimate of the global prevalence of trachoma based on the most recent information available. Methods: A literature search of recent published and unpublished surveys in the 57 endemic countries was carried out: the result of surveys that used the WHO trachoma grading system and additional information from regional and country experts served as a basis to determine the prevalence of trachoma in each country. Results: Population-based surveys provided recent information for 42 out of 57 endemic countries. 40.6 million people are estimated to be suffering from active trachoma, and 8.2 million are estimated to have trichiasis. Conclusions: The current estimate of prevalence of trachoma is lower than the previous WHO estimates: this can be explained by the success in implementing control strategy, by more accurate data, as well as by socio-economic development in endemic countries.
337 citations
TL;DR: The mean age-adjusted incidence rate of retinoblastoma of 11.8 cases per million children aged 0–4 years in the USA is similar to rates reported from European countries and has remained stable for the last 30 years.
Abstract: Background: The purpose of this study was to determine the age-adjusted incidence of retinoblastoma in the USA over a 30-year period from 1975 to 2004 using a review of existing databases. Methods: Six hundred and fifty-eight patients with retinoblastoma (International Classification of Oncology (ICDO-3) codes C69.2 (retina) and C69.9 (eye, NOS)) were derived from the Surveillance, Epidemiology, and End Results (SEER) program database in the USA from 1975 to 2004. Nine historical SEER registries were utilised. The significance of trend in age-adjusted incidence rate was determined using the χ2 test, and 95% CIs were calculated. The patients were stratified according to age at diagnosis, laterality, gender and race. Results: There were a total of 658 cases of retinoblastoma, representing 6.1% of all childhood cancers under age 5 years. The mean age-adjusted incidence of retinoblastoma in the USA was 11.8 per million children aged 0–4 years (95% CI 10.9 to 12.8). There was no significant trend in age-adjusted incidence for all races/genders, nor was there any significant variation of incidence between races or between genders. The proportion of bilateral cases (26.7%) versus unilateral cases (71.9%) remained stable over the 30-year period. Conclusions: The mean age-adjusted incidence rate of retinoblastoma of 11.8 cases per million children aged 0–4 years in the USA is similar to rates reported from European countries. The age-adjusted incidence rate of retinoblastoma in the USA has remained stable for the last 30 years.
313 citations
TL;DR: The LenStar biometric measurements were found to be highly repeatable and the instrument easy to use and there were some statistical differences between ocular biometry measurements between the LenStar and current clinical instruments, but they were not clinically significant.
Abstract: Background: A new commercially available optical low coherence reflectometry device (Lenstar, Haag-Streit or Allegro Biograph, Wavelight) provides high-resolution non-contact measurements of ocular biometry. The study evaluates the validity and repeatability of these measurements compared with current clinical instrumentation. Method: Measurements were taken with the LenStar and IOLMaster on 112 patients aged 41–96 years listed for cataract surgery. A subgroup of 21 patients also had A-scan applanation ultrasonography (OcuScan) performed. Intersession repeatability of the LenStar measurements was assessed on 32 patients Results: LenStar measurements of white-to-white were similar to the IOLMaster (average difference 0.06 (SD 0.03) D; p?=?0.305); corneal curvature measurements were similar to the IOLMaster (average difference -0.04 (0.20) D; p?=?0.240); anterior chamber depth measurements were significantly longer than the IOLMaster (by 0.10 (0.40) mm) and ultrasound (by 0.32 (0.62) mm; p<0.001); crystalline lens thickness measurements were similar to ultrasound (difference 0.16 (0.83) mm, p?=?0.382); axial length measurements were significantly longer than the IOLMaster (by 0.01 (0.02) mm) but shorter than ultrasound (by 0.14 (0.15) mm; p<0.001). The LensStar was unable to take measurements due to dense media opacities in a similar number of patients to the IOLMaster (9–10%). The LenStar biometric measurements were found to be highly repeatable (variability =2% of average value). Conclusions: Although there were some statistical differences between ocular biometry measurements between the LenStar and current clinical instruments, they were not clinically significant. LenStar measurements were highly repeatable and the instrument easy to use.
273 citations
TL;DR: The results indicate that the pathogenesis of KC may involve chronic inflammatory events, and IL-6 and TNF-α are overexpressed in the tears of subclinical and KC eyes.
Abstract: Background/aims: Tissue degradation in corneal thinning disorders, such as keratoconus (KC), involves the expression of inflammatory mediators. The purpose of this study was to determine the levels of proinflammatory cytokines and matrix metalloproteinase 9 (MMP-9) in tears from both eyes of unilateral keratoconus (KC) patients. Methods: Thirty patients diagnosed as having asymmetrical KC (30 KC eyes, and 30 subclinical KC eyes) and 20 normal control subjects (one eye) were studied in a prospective, cross-sectional study. Keratoconus screening programmes were performed on these participants. Ten microlitres of tears was collected from each eye. The concentrations of cytokines (interleukin-6 (IL-6) and tumour necrosis factor α (TNF-α)) and MMP-9 were measured by ELISA. Results: Mean values for IL-6 levels were similar in KC and subclinical KC samples (5.5 (4.9 to 6.9) vs 5.7 (4.5 to 6.2) pg/ml, p = 0.131), but significantly higher in relation to the control group (2.2 (1.0 to 4.1) pg/ml, p Conclusions: IL-6 and TNF-α are overexpressed in the tears of subclinical and KC eyes. Increased MMP-9 levels were found only in the KC eye. These results indicate that the pathogenesis of KC may involve chronic inflammatory events.
246 citations
TL;DR: This review consolidates the knowledge of how IVCM has contributed significantly to greater understanding of corneal nerves in the living human cornea in health and disease.
Abstract: The exponential evolution of in vivo confocal microscopy (IVCM) has led to a significant enhancement in our knowledge of the living cornea in both its physiological and pathological states. Studies using white light and coherent light-based IVCM have enabled detailed quantitative analysis of sub-basal nerve parameters, and have also resulted in the elucidation of the two-dimensional architecture of the normal corneal sub-basal nerve plexus. However, accurate and repeatable methods for quantitative analysis of stromal nerves imaged by IVCM remain to be developed. The effect of corneal surgery on central corneal nerves has been well documented in many IVCM studies, and these studies provide an indication of the regenerative capacity of corneal nerves. IVCM has also clearly demonstrated the involvement of corneal nerves in diseases such as keratoconus, although it remains unclear whether these alterations are a cause of, or occur secondary to, the disease process. IVCM has also been proposed as non-invasive method of accurately diagnosing and assessing the progression of diabetic neuropathy, highlighting the potential application of this technique as an indicator of systemic disease. This review consolidates our knowledge of how IVCM has contributed significantly to our greater understanding of corneal nerves in the living human cornea in health and disease.
234 citations
TL;DR: Intravitreal therapy using bevacizumab appears to be a safe and effective treatment in patients with macular oedema secondary to retinal vein occlusion, however, the main limitations of this treatment modality are its short-term effectiveness and high recurrence rate.
Abstract: Aims: The aim of the study was to evaluate functional and anatomical changes after intravitreal bevacizumab (Avastin®) in eyes with persistent macular oedema secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Methods: Twenty-nine consecutive eyes with macular oedema secondary to BRVO (21 eyes) or CRVO (eight eyes) were included in a prospective clinical trial. Eyes were treated with three initial intravitreal bevacizumab injections of 1 mg at a monthly interval. Retreatment was based on central retinal thickness (CRT) based on optical coherence tomography. If continuous injections were indicated up to month 6, the dose was increased to 2.5 mg. Results: After 12 months of follow-up, mean visual acuity increased from 50 letters (20/100) at baseline to 66 letters (20/50 +1 ; +16 letters; p Conclusions: Intravitreal therapy using bevacizumab appears to be a safe and effective treatment in patients with macular oedema secondary to retinal vein occlusion. However, the main limitations of this treatment modality are its short-term effectiveness and high recurrence rate.
217 citations
TL;DR: In vivo MRI evidence of LGN degeneration in human glaucoma is consistent with ex vivo primate and human neuropathological studies, suggesting that LGN atrophy may be a relevant biomarker of visual system injury and/or progression in some glAUcoma patients.
Abstract: Aim: To determine in vivo whether the lateral geniculate nucleus (LGN) undergoes atrophy in patients with glaucoma and vision loss compared with normal subjects. Methods: Following institutional St Michael’s Hospital Research Ethics Board approval, a prospective and masked neuroimaging study was conducted on glaucoma patients with visual-field defects affecting both eyes (n = 10) and age-matched controls (n = 8). Following informed consent, all subjects underwent 1.5-Tesla MRI. Coronal proton density magnetic resonance images of both LGNs were obtained, and LGN height measurements were measured by consensus by three neuroradiologists masked to the diagnosis. Glaucoma and control groups were compared using the t test. Results: Both LGNs were identified and visualised by 1.5-Tesla MRI for every subject. Compared with controls, the mean LGN heights in glaucoma were decreased in right (4.09 (0.89) mm vs 4.74 (0.54) mm, p>0.05) and left LGNs (3.98 (0.57) mm vs 4.83 (0.95) mm; p = 0.033). The combined right and left LGN height in glaucoma was significantly decreased compared with controls (8.07 (1.06) mm vs 9.56 (0.86) mm; p = 0.005). Conclusion: In vivo MRI evidence of LGN degeneration in human glaucoma is consistent with ex vivo primate and human neuropathological studies. LGN atrophy may be a relevant biomarker of visual system injury and/or progression in some glaucoma patients.
199 citations
TL;DR: Although the agreement between instruments was good, TD-OCT provided thicker RNFL measurements than SD-O CT, and Measurements with these instruments should not be considered interchangeable.
Abstract: Background/aims: To evaluate spectral-domain (SD) optical coherence tomography (OCT) reproducibility and assess the agreement between SD-OCT and Time-Domain (TD) OCT retinal nerve fibre layer (RNFL) measurements. Methods: Three Cirrus-SD-OCT scans and one Stratus-TD-OCT scan were obtained from Diagnostic Innovations in Glaucoma Study (DIGS) healthy participants and glaucoma patients on the same day. Repeatability was evaluated using Sw (within-subject standard deviation), CV (coefficient of variation) and ICC (intraclass correlation coefficient). Agreement was assessed using correlation and Bland–Altman plots. Results: 16 healthy participants (32 eyes) and 39 patients (78 eyes) were included. SD-OCT reproducibility was excellent in both groups. The CV and ICC for Average RNFL thickness were 1.5% and 0.96, respectively, in healthy eyes and 1.6% and 0.98, respectively, in patient eyes. Correlations between RNFL parameters were strong, particularly for average RNFL thickness (R 2 = 0.92 in patient eyes). Bland–Altman plots showed good agreement between instruments, with better agreement for average RNFL thickness than for sectoral RNFL parameters (for example, at 90 µm average RNFL thickness, 95% limits of agreement were −13.1 to 0.9 for healthy eyes and −16.2 to −0.3 µm for patient eyes). Conclusions: SD-OCT measurements were highly repeatable in healthy and patient eyes. Although the agreement between instruments was good, TD-OCT provided thicker RNFL measurements than SD-OCT. Measurements with these instruments should not be considered interchangeable.
TL;DR: The presence of a normal IS/OS junction was associated with good visual acuity after ERM surgery, which probably indicates morphological and functional recovery of the photoreceptors.
Abstract: Aims: To investigate the relationship between the presence of the photoreceptor inner and outer segment (IS/OS) junction and visual acuity after epiretinal membrane (ERM) surgery. Methods: Seventy eyes of 70 consecutive patients who had undergone vitrectomy for idiopathic ERM were examined by optical coherence tomography before and 3 and 6 months after surgery. The IS/OS junction was graded into three grades. The time course of recovery of the IS/OS junction, central foveal thickness (CFT) and best corrected visual acuity (BCVA) during the postoperative period was studied. Results: A normal IS/OS junction was detected in 47.1% of the eyes before surgery and in 65.7% at 3 months and 75.7% at 6 months after. There was a significant correlation between the IS/OS grade and BCVA before and at 3 and 6 months after the operation (p = 0.0001, p Conclusions: The presence of a normal IS/OS junction was associated with good visual acuity after ERM surgery. A normal IS/OS junction probably indicates morphological and functional recovery of the photoreceptors.
TL;DR: The new biometer provided results that correlated very well with those of the IOLMaster, and is a precise device containing additional features that will be helpful tools for any cataract or refractive surgeon.
Abstract: Aims: Precise biometry is an essential preoperative measurement for refractive surgery as well as cataract surgery. A new device based on partial coherence interferometry technology was tested and evaluated for accuracy of measurements. Methods: In a prospective study 200 eyes of 100 healthy phakic volunteers were examined with a functional prototype of the new ALLEGRO BioGraph (Wavelight AG)/LENSTAR LS 900 (Haag Streit AG) biometer and with the IOLMaster V.5 (Carl Zeiss Meditec AG). As recommended by the manufacturers, repeated measurements were performed with both devices and the results compared using Spearman correlation calculations (WinSTAT). Results: Spearman correlation showed high correlations for axial length and keratometry measurements between the two devices tested. Anterior chamber depth, however, had a lower correlation between the two biometry devices. In addition, the mean values of the anterior chamber depth differed (IOLMaster 3.48 (SD 0.42) mm versus BioGraph/LENSTAR 3.64 (SD 0.26) mm); however, this difference was not statistically different (p>0.05, t test). Conclusion: The new biometer provided results that correlated very well with those of the IOLMaster. The ALLEGRO BioGraph/LENSTAR LS 900 is a precise device containing additional features that will be helpful tools for any cataract or refractive surgeon.
TL;DR: Sub-threshold micropulse diode laser photocoagulation is equally as effective as CGL treatment for CSMO, and it is found that laser scarring was much more apparent with CGL than with the sub-th threshold approach (MPDL).
Abstract: Aim: The study was a prospective randomised controlled double-masked trial performed in two centres to compare sub-threshold micropulse diode laser photocoagulation (MPDL) with conventional green laser photocoagulation (CGL) in the treatment of clinically significant diabetic macular oedema (CSMO). Methods: Fifty-three patients (84 eyes) with diabetic CSMO were randomly assigned to MPDL (n = 44) or CGL (n = 40) according to the modified Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Treatments were performed after baseline and re-treatments were allowed at or after the 4 month visit if necessary. Parameters noted included the best corrected visual acuity (BCVA), colour fundus photographs, central retinal thickness using optical coherence tomography (OCT), vision contrast sensitivity with Pelli–Robson charts and presence of visible laser scars at baseline and at 4 and 12 months. The primary outcome was BCVA at 12 months. Results: All patients completed 12 months of follow-up after treatment at baseline. There were no statistically significant differences in BCVA, contrast sensitivity and retinal thickness between the two laser modalities at 0, 4 and 12 months. We found that laser scarring was much more apparent with CGL than with the sub-threshold approach (MPDL). Laser scars were identified at the 12 month visits in 13.9% of the MPDL-treated eyes compared with 59.0% of the CGL-treated eyes (p Conclusion: Sub-threshold micropulse diode laser photocoagulation is equally as effective as CGL treatment for CSMO. Trial registration number: ISTRN 90646644.
TL;DR: There has been a gradual improvement in 5-year survival of children with retinoblastoma in the USA over the last 30 years, and differences evaluated with logrank and Wilcoxon tests were significant.
Abstract: Background: The purpose of this study was to determine the survival of retinoblastoma in the USA over a 30-year period from 1975 to 2004 using a systematic review of existing databases. Methods: Nine hundred and ninety-two cases of retinoblastoma (International Classification of Oncology (ICDO-3) codes C69.2 (retina) and C69.9 (eye, NOS)) were derived from the Surveillance, Epidemiology and End Results (SEER) program database in the USA from 1975 to 2004. All 17 current SEER registries were utilised to allow for optimal patient volume for statistical analysis. Survival rates were calculated by the Kaplan–Meier method and differences evaluated with logrank and Wilcoxon tests. Cause of death was obtained and reviewed for all deceased patients. All retinoblastoma patient records were reviewed for treatments given and occurrence of second malignant neoplasms. Results: There were a total of 990 distinct patients with retinoblastoma. Almost all cases (99.1%) were reported by the hospitals, and histopathological confirmation was available in 87.7% of cases. Over the period of 30 years (1975–2004), the 5-year observed actuarial survival rate increased from 92.3% (1975–84) to 93.9% (1985–94) to 96.5% (1995–2004). The difference in rates was statistically significant (Wilcoxon = 6.2393, p = 0.0442). The proportion of cases treated with radiotherapy first increased from 20.5% in 1975–9 to 34.6% in 1985–9 and then sharply decreased to 6.5% in 2000–4. Conclusions: Over the last 30 years, there has been a gradual improvement in 5-year survival of children with retinoblastoma in the USA.
TL;DR: In this study cohort, the response to treatment of AMD with ranibizumab differed according to CFH genotype, suggesting that determining patients’ CFHgenotype may be helpful in the future in tailoring treatment for exudative AMD with intravitreal ranibIZumab.
Abstract: Aims: To determine whether complement factor H ( CFH ) genotypes have a pharmacogenetic effect on the treatment of exudative age-related macular degeneration (AMD) with ranibizumab. Methods: A retrospective study of 156 patients with exudative AMD treated with intravitreal ranibizumab monotherapy was conducted. AMD phenotypes were characterised by clinical examination, visual acuity, fundus photography, fluorescein angiography and injection timing. Patients received intravitreal ranibizumab injections as part of routine ophthalmological care and were followed for a minimum of 9 months. Each patient was genotyped for the single nucleotide polymorphism rs1061170 (Y402H) in the CFH gene. Results: Baseline lesion size and angiographic type, as well as mean visual acuities at baseline, 6 months, and 9 months were similar among the three CFH genotypes. Over 9 months, patients with both risk alleles received approximately one more injection (p = 0.09). In a recurrent event analysis, patients homozygous for the CFH Y402H risk allele had a 37% significantly higher risk of requiring additional ranibizumab injections (p = 0.04). Conclusions: In this study cohort, the response to treatment of AMD with ranibizumab differed according to CFH genotype, suggesting that determining patients’ CFH genotype may be helpful in the future in tailoring treatment for exudative AMD with intravitreal ranibizumab.
TL;DR: Dye-assisted ILM peeling was associated with significantly higher closure rates than non-peeling in both stage 2 and 3 MHS, and intraoperative ILM staining with 0.05% isotonic ICG was not associated with a significantly different visual outcome.
Abstract: Aim: To determine the effect of internal limiting membrane (ILM) peeling on anatomical and functional success rates in stage 2 and 3 idiopathic macular hole surgery (MHS). Methods: Randomised clinical trial of stage 2 and 3 idiopathic macular hole without visible epiretinal fibrosis and with less than 1 year’s duration of symptoms. Eyes were randomised to (1) vitrectomy alone without retinal surface manipulation, (2) vitrectomy plus 0.05% isotonic Indocyanine Green (ICG)-assisted ILM peeling or (3) vitrectomy plus 0.15% Trypan Blue (TB)-assisted ILM peeling. Main outcomes were hole closure after 3 and 12 months and best-corrected visual acuity after 12 months. Results: 78 eyes were enrolled. Primary closure rates were significantly higher with ILM peeling than without peeling for both stage 2 holes (ICG peeling 100%, non-peeling 55%, p = 0.014) and for stage 3 holes (ICG peeling 91%, TB peeling 89%, non-peeling 36%, p Conclusions: Dye-assisted ILM peeling was associated with significantly higher closure rates than non-peeling in both stage 2 and 3 MHS. Intraoperative ILM staining with 0.05% isotonic ICG was not associated with a significantly different visual outcome than non-peeling or TB peeling in eyes with primary hole closure. Trial registration number: NCT00302328.
TL;DR: Pre-existing glaucoma or steroid-responsive ocular hypertension and race were the two factors that independently influenced relative risk of rejection after DSEK.
Abstract: Aim: To investigate risk factors and probability of initial immunological graft rejection episodes after Descemet stripping with endothelial keratoplasty (DSEK). Methods: Outcomes of 598 DSEK cases from a single tertiary referral centre were reviewed. Risk factors and probability of rejection were assessed by multivariate Cox proportional hazards modelling. Results: Rejection episodes occurred in 54 eyes of 48 patients. Estimated probability of a rejection episode was 7.6% by 1 year and 12% by 2 years after grafting. Relative risk of rejection was five times higher for African–American patients compared with Caucasians (p = 0.0002). Eyes with pre-existing glaucoma (9%) or steroid-responsive ocular hypertension (27%) had twice the relative risk of rejection (p = 0.045) compared with eyes that did not have those problems. Patient age, sex and corneal diagnosis did not significantly influence rejection risk. Risk of rejection was not increased when fellow eyes were grafted within 1 year of the first eye (p = 0.62). Conclusions: Pre-existing glaucoma or steroid-responsive ocular hypertension and race were the two factors that independently influenced relative risk of rejection after DSEK. Rejection risk was not increased if the fellow eye was grafted within the prior year with DSEK.
TL;DR: SD-OCT 3D cube data generally showed better RNFL measurement reproducibility than TD-O CT, and two methods defining the optic nerve head (ONH) centring: Centred Each Time (CET) vs Centred Once (CO), in terms of RNFL thickness measurement variability on SD- OCT.
Abstract: Background/aims: To investigate retinal nerve fibre layer (RNFL) thickness measurement reproducibility using conventional time-domain optical coherence tomography (TD-OCT) and spectral-domain OCT (SD-OCT), and to evaluate two methods defining the optic nerve head (ONH) centring: Centred Each Time (CET) vs Centred Once (CO), in terms of RNFL thickness measurement variability on SD-OCT. Methods: Twenty-seven eyes (14 healthy subjects) had three circumpapillary scans with TD-OCT and three raster scans (three-dimensional or 3D image data) around ONH with SD-OCT. SD-OCT images were analysed in two ways: (1) CET: ONH centre was defined on each image separately and (2) CO: ONH centre was defined on one image and exported to other images after scan registration. After defining the ONH centre, a 3.4 mm diameter virtual circular OCT was resampled on SD-OCT images to mimic the conventional circumpapillary RNFL thickness measurements taken with TD-OCT. Results: CET and CO showed statistically significantly better reproducibility than TD-OCT except for 11:00 with CET. CET and CO methods showed similar reproducibility. Conclusions: SD-OCT 3D cube data generally showed better RNFL measurement reproducibility than TD-OCT. The choice of ONH centring methods did not affect RNFL measurement reproducibility.
TL;DR: The authors found that just over 20% of the fellow eyes progressed to clinical keratoconus with evidence of increased asymmetry, spherical equivalent and higher-order irregularities, which they documented with topographic indices and Fourier analysis.
Abstract: The detection of keratoconus is a major concern in the screening of refractive surgical patients, since it is known that its presence weakens the corneal stroma and can lead to iatrogenic ectasia. While clinical keratoconus is reliably detected with corneal topography and slit-lamp examination, means to detect the possibility of keratoconus in its earliest stages prior to the presence of slit-lamp findings have been extensively explored, and it is generally agreed that the first detectable sign of keratoconus is a localised steepening seen with Placido corneal topography. Several terms have been put forward to describe this condition including preclinical keratoconus, keratoconus suspect and forme fruste keratoconus. While these designations have been used interchangeably, doing so has led to problems in understanding the natural history of keratoconus.
Despite this short-coming, excellent longitudinal studies are being conducted and are slowly emerging in the literature. In the June issue, Shirayama-Suzuki and colleagues1 examined keratoconus progression in the fellow eye in unilateral keratoconus patients over the course of 6 years. The fellow eyes were included if they had no slit-lamp signs of keratoconus or deterioration of spectacle-corrected visual acuity. The authors found that just over 20% of the fellow eyes progressed to clinical keratoconus with evidence of increased asymmetry, spherical equivalent and higher-order irregularities, which they documented with topographic indices and Fourier analysis. As they note, keratoconus is a slowly progressing disease, and therefore it is likely that a longer follow-up would result in more of their cohort progressing to clinical keratoconus.
This study provides a …
TL;DR: In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with Graves’ orbitopathy, with the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches.
Abstract: Aim: To compare the outcome of various surgical approaches of orbital decompression in patients with Graves' orbitopathy (GO) receiving surgery for disfiguring proptosis. Method: Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres were analysed. Results: Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches. The average proptosis reduction for all decompressions was 5.0 (SD 2.1) mm. After three-wall decompression the proptosis reduction was significantly greater than after two-wall decompression. Additional fat removal resulted in greater proptosis reduction. Complications were rare, the most frequent being worsening of motility, occurring more frequently after coronal decompression. The average change in quality of life (QOL) in the appearance arm of the GO-QOL questionnaire was 20.5 (SD 24.8) points. Conclusions: In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with GO. The extent of proptosis reduction depends on the number of walls removed and whether or not fat is removed. Serious complications are infrequent. Worsening of ocular motility is still a major complication, but was rare in this series after the swinging eyelid approach.
TL;DR: Double circular scanning using Doppler FD-OCT is a rapid and reproducible method to measure total retinal blood flow in normal human eyes, and flow values are within the range previously established by laser Dopplers flowmetry.
Abstract: Aim: To measure total retinal blood flow in normal human eyes using Doppler Fourier-domain optical coherence tomography (FD-OCT). Methods: 10 normal people aged 35 to 69 years were measured for the right eye using Doppler FD-OCT. Double circular scans around the optic nerve heads were used. Four pairs of circular scans that transected all retinal branch vessels were completed in 2 s. Total retinal blood flow was obtained by summing the flows in the branch veins. Measurements from the eight scans were averaged. Veins with diameters >33 μm were taken into account. Results: Total retinal blood flow could be measured in eight of 10 subjects: mean (SD) = 45.6 (3.8) μl/min (range 40.8 to 52.9 μl/min). The coefficient of variation for repeated measurements was 10.5%. Measured vein diameters ranged from 33.3 to 155.4 μm. The averaged flow speed was 19.3 (2.9) mm/s, which did not correlate with vessel diameter. There was no significant difference between flows in the superior and inferior retinal hemispheres. Conclusions: Double circular scanning using Doppler FD-OCT is a rapid and reproducible method to measure total retinal blood flow. These flow values are within the range previously established by laser Doppler flowmetry.
TL;DR: Retinal thickness within the area covered by the macular map significantly decreases with age, and in the area examined in the papillomacular bundle, 20% of the retinal thinning is due to the RNFL, and 80% isdue to thinning of other layers of the retina.
Abstract: Background/aim: Retinal and retinal nerve fibre layer (RNFL) thinning with age have been described in histological studies. In vivo techniques like optical coherence tomography (OCT), has shown thinning of optic nerve RNFL and the retina in specific areas. One would expect thinning of the total macula, but so far, a correlation with the quantitative OCT macular map tool and age has not been found. Methods: Sixty-seven healthy individuals underwent three repeated scans in both eyes with the macular thickness map protocol in the Stratus OCT. That protocol divides the macula area in nine ETDRS fields.The RNFL was measured in one specific location close to the optic disc. Correlations between retinal, RNFL thickness, macular volume and age were determined. Results: We found a statistically significant negative relationship between retinal thickness and age for all ETDRS areas, total macular volume and RNFL thickness. Retinal thickness decreased with 0,26-0,46 µm, the macula volume 0,01 mm³ and RNFL with 0,09 µm per year. Conclusion: Retinal thickness within the area covered by the macular map significantly decreases with age. In the area examined in the papillomacular bundle, 20% of the retinal thinning is due to the RNFL and 80% due to thinning of other layers of the retina.
TL;DR: Hyalocytes might be one of the critical components of ERM mediating its contractile property through the effect of TGF-β2 in the vitreous fluid.
Abstract: Aim: To address the cellular components and the contractile mechanisms of the idiopathic epiretinal membrane (ERM). Methods: Ten surgically removed ERMs were fixed in 4% paraformaldehyde and analysed by whole-mount immunohistochemistry with anti-glial fibrillar acidic protein (GFAP) and alpha smooth-muscle actin (αSMA) antibodies. Type I collagen gel contraction assay, an established wound-healing assay in vitro, was performed using cultured bovine hyalocytes or normal human astrocytes (NHA) to evaluate the contractile property of the cells in the presence of tissue growth factor (TGF)-β2. The expression of αSMA was also analysed by western blot analysis to examine myofibroblastic transdifferentiation of the cells. Vitreous-induced collagen gel contraction was also evaluated. Results: All membranes were composed of αSMA immunopositive cells in contracted foci and GFAP immunopositive cells in the periphery. No apparent double positive cells were observed in any membranes examined. Cultured hyalocytes showed overexpression of αSMA and hypercontraction of collagen gels in response to TGF-β2, while glial cells showed marginal change. The vitreous from ERM patients also caused overexpression of αSMA and hypercontraction of the gels embedding hyalocytes, which were almost completely inhibited in the presence of anti-TGF-β2 neutralising antibody. Conclusions: Hyalocytes might be one of the critical components of ERM mediating its contractile property through the effect of TGF-β2 in the vitreous fluid.
TL;DR: It is estimated that blindness and severe visual impairment from cataract could be reduced by around 11% in the low- and middle-income countries if women were to receiveCataract surgery at the same rate as men.
Abstract: Background: Cataract remains the leading cause of global blindness. Evidence from population-based surveys, carried out up to 2000, and the launch of the VISION 2020 initiative to address avoidable blindness showed that women in low- and middle-income countries had a lower cataract surgical coverage (CSC) than men. Methods: A systematic review identified population-based surveys reporting CSC in low- and middle-income countries published since 2000. Researchers extracted data on sex-specific CSC rates and estimated the overall CSC differences using meta-analyses. Results: Among the 23 surveys selected for this review, 21 showed higher CSC among men. The Peto odds ratio revealed that men were 1.71 times (95% CI 1.48 to 1.97) more likely to have cataract surgery than women. The risk difference in the rates of surgery varied from −0.025 to 0.276, and the combined average was 0.116 (95% CI 0.082 to 0.149). Discussion: Gender inequity in use of cataract surgical services persists in the low- and middle-income countries. It is estimated in this study that blindness and severe visual impairment from cataract could be reduced by around 11% in the low- and middle-income countries if women were to receive cataract surgery at the same rate as men. Additional effort globally is needed to ensure that women receive the benefits of cataract surgery at the same rate as men.
TL;DR: Wearing contact lenses remains the most important risk factor for infectious corneal ulcers and reduction of the rate and severity of infectious keratitis requires continuous education of patients, and of professionals.
Abstract: Aim: The aim of the study was to identify the epidemiological characteristics, predisposing factors, and the clinical and microbiological diagnosis of infectious corneal ulcers in a population based in southern England. Methods: A retrospective review was undertaken of the medical records of patients presenting with infectious corneal ulcers at the eye casualty department of Queen Alexandra Hospital, Portsmouth, UK, between January 1997 and December 2003. Results: A total of 1786 patients presented with infectious corneal ulcers, with a mean age of 45 years and female predominance (54.5%). Contact lens wear was the main predisposing factor in 554 patients (31%). Corneal scrapes from 1254 patients grew positive cultures in 800 patients. Gram-positive bacteria accounted for 696 (71.1%) of the total 979 bacterial isolates, while Gram-negative bacteria accounted for 283 (28.9%) with the predominance of Pseudomonas aeruginosa. Nine out of 11 patients with Acanthamoeba keratitis were contact lens wearers. The majority of patients 1728 (96.8%) sought medical help more than once and 34 patients (1.9%) had poor visual outcome. Follow-up was completed in 1633 patients (91.4%) with an average of 11.5 days. Conclusions: Wearing contact lenses remains the most important risk factor for infectious corneal ulcers. Reduction of the rate and severity of infectious keratitis requires continuous education of patients, and of professionals.
TL;DR: Characteristic features of an inflammation induced by bevacizumab injection include an early onset with painless loss in VA mostly without conjunctival or ciliary injection and patients respond to systemic or topical cortisone treatment with slow recovery but without permanent damage.
Abstract: Background/aims: To report a series of severe intraocular inflammatory events following intravitreal injections of bevacizumab (Avastin). This procedure is performed on a rapidly increasing number worldwide, and rare complications such as intraocular inflammation, endophthalmitis or intraocular haemorrhage are gaining in importance in clinical routine. Methods: This is a single-centre retrospective interventional case series of eight patients with severe intraocular inflammation after intravitreal injection of bevacizumab at one referral centre consecutively seen out of approximately a total of 2500 injections performed in that time period. Patients who developed severe intraocular inflammation after intravitreal injection were evaluated clinically, including slit-lamp examination, best-corrected Snellen visual acuity (VA), slit-lamp photography, optical coherence tomography and fluorescein angiography prior to the event and during follow-up. Results: Patients noticed a painless drop in VA up to 2 days following the injection. All patients had a marked anterior chamber reaction with increased flare and cells, but no hypopyon. Typical posterior segment findings included vitreous cellular infiltrates of pseudogranulomatous aspect. Due to their initial clinical aspect suspicious of an endophthalmitis, three cases were treated with systemic antibiotics, but the final diagnosis was uveitis. Five cases showed a characteristic pseudogranulomatous vitreous infiltration as seen in vitritis and were treated only topically. Conclusions: Characteristic features of an inflammation induced by bevacizumab injection include an early onset with painless loss in VA mostly without conjunctival or ciliary injection. Patients respond to systemic or topical cortisone treatment with slow recovery but without permanent damage. Vitreous haemorrhage and infectious endophthalmitis might be differentiated by time course and symptoms.
TL;DR: Findings show similarities and differences across the risk factors for all, at-fault and injurious MVCs, and point to the need for verification and possible interventions.
Abstract: Aims: To identify visual and medical risk factors for motor vehicle collisions (MVCs). Methods: Data from four cohorts of older drivers from three states were pooled (n = 3158). Health information was collected at baseline, and MVC data were obtained prospectively. Cox proportional hazards regression was used to estimate rate ratios (RRs) and 95% CIs for associations between medical characteristics and MVCs. Results: A total of 363 MVCs were observed during the study period (1990-1997), of which 145 were at fault, and 62 were injurious. Falls and impaired useful field of view (UFOV) were positively associated with overall MVCs. At-fault MVCs were also positively associated with falls and UFOV impairment, and inversely with cancer. Injurious MVCs were positively associated with arthritis and neurological disease, and inversely with hypertension. Conclusions: These findings show similarities and differences across the risk factors for all, at-fault and injurious MVCs, and point to the need for verification and possible interventions.
TL;DR: The incidence of conjunctival melanoma increased in Sweden during the period 1960 to 2005 and increasingly arose from parts of the conjunctiva exposed to ultraviolet radiation.
Abstract: Purpose: To study time trends in the incidence of conjunctival melanoma in Sweden. Methods: All patients with conjunctival melanoma 1960 to 2005 in Sweden were identified through the Swedish Cancer Registry, cross-checked against hospital files and validated by histopathologic review (97.5%) or detailed hospital records (2.5%). The crude and age-standardized incidences were estimated separately for each gender and the annual change in incidence over time was estimated using a regression model with logarithmic incidence numbers. Time trends of the largest diameter, thickness and location of the tumor when diagnosed were analyzed. Results: The age-standardized incidence of conjunctival melanoma increased significantly in males (n = 89) from 0.10 cases/million to 0.74 cases/million (P = 0.001) and in females (n = 81) from 0.06 cases/million to 0.45 cases/million (P = 0.007). The annual relative change in age-standardized incidence was 16.9 % (95 % CI, 12.2 % - 21.6 %) in males and 19.5 % (95% CI, 9.3 % - 29.7 %) in females. The age-specific incidence was higher in men and women 65 years and older (1.48 and 1.39 cases/million, respectively) than in younger men and women (0.3 and 0.2 cases/million, respectively). During the period of study, tumors became smaller (P = 0.005) and thinner (P = 0.002) at the time of diagnosis and increasingly arose from parts of the conjunctiva exposed to ultraviolet radiation (P = 0.001). Conclusions: The incidence of conjunctival melanoma increased in Sweden during the period 1960 through 2005.
TL;DR: A single intravitreal injection of 4.0 mg of VEGF Trap-Eye was well tolerated and preliminary evidence of bioactivity was detected, and these findings support additional studies investigating multiple injections of V EGF trap-Eye in patients with DMO.
Abstract: Aim: The aim of the study was to assess the safety and bioactivity of a single intravitreal injection of vascular endothelial growth factor (VEGF) Trap-Eye in subjects with diabetic macular oedema (DMO). Methods: Five subjects with DMO, foveal thickness ⩾250 μm measured by optical coherence tomography (OCT), and best-corrected visual acuity (BCVA) between 20/40 and 20/320, were enrolled. Each participant received a single intravitreal injection of 4.0 mg of VEGF Trap-Eye followed by a 6-week observation period. Outcome measures included safety and biological activity, including changes in BCVA and excess retinal thickness assessed by OCT. Results: Injections of VEGF Trap-Eye were well tolerated with no ocular toxicity. One patient had an unrelated serious adverse event: hospitalisation for cellulitis of the left foot 27 days after injection of VEGF Trap-Eye. Median baseline BCVA was 36 ETDRS letters read at 4 m (not ETDRS visual acuity score; Snellen equivalent: 20/50) and median baseline excess central 1 mm foveal thickness (FTH) was 108 μm. At 4 weeks after injection, the median excess FTH was 59 μm and the median improvement in BCVA was nine letters. At 6 weeks after injection, four of the five patients showed improvement in excess FTH (median 74 μm; 31% reduction from baseline, p = 0.0625) and four of the five showed improvement in BCVA (median improvement of three letters). Conclusions: A single intravitreal injection of 4.0 mg of VEGF Trap-Eye was well tolerated and preliminary evidence of bioactivity was detected. These findings support additional studies investigating multiple injections of VEGF Trap-Eye in patients with DMO.