Showing papers in "Eye in 2005"
TL;DR: A strong association between current smoking and AMD was confirmed, which fulfilled established causality criteria and Cigarette smoking is likely to have toxic effects on the retina.
Abstract: Age-related macular degeneration (AMD) is the leading cause of severe and irreversible vision loss in the Western world. As there is no effective treatment for all types of AMD, identifying modifiable risk factors is of great importance. This review evaluates the epidemiological evidence associating smoking with AMD. Systematic review of published epidemiological studies evaluated against established criteria for evidence of a causal relationship. In total, 17 studies (cross-sectional studies, prospective cohort studies, and case–control studies) were included in the review. A total of 13 studies found a statistically significant association between smoking and AMD with increased risk of AMD of two- to three-fold in current-smokers compared with never-smokers. Five studies found no association between smoking and AMD. There was also evidence of dose-response, a temporal relationship and reversibility of effect. The literature review confirmed a strong association between current smoking and AMD, which fulfilled established causality criteria. Cigarette smoking is likely to have toxic effects on the retina. In spite of the strength of this evidence, there appears to be a lack of awareness about the risks of developing eye disease from smoking among both healthcare professionals and the general public.
497 citations
TL;DR: It would appear that the global Vision 2020 initiative is having an impact to reduce avoidable blindness particularly from ocular infections, but more needs to be done to address cataract, glaucoma, and diabetic retinopathy.
Abstract: INTRODUCTION: Recent data suggest that there are 37 million blind people and 124 million with low vision, excluding those with uncorrected refractive errors. The main causes of global blindness are cataract, glaucoma, corneal scarring (from a variety of causes), age-related macular degeneration, and diabetic retinopathy. CONCLUSION: It would appear that the global Vision 2020 initiative is having an impact to reduce avoidable blindness particularly from ocular infections, but more needs to be done to address cataract, glaucoma, and diabetic retinopathy.
318 citations
TL;DR: This study confirms capillary alteration to be the cause of increase in foveal avascular zone size in diabetics and presents an alternative evaluation method of the FAZ to FAZ size measurement.
Abstract: To describe the relations between foveal avascular zone (FAZ) size and outline in patients presenting diabetic retinopathy. 110 high-quality fluorescein angiograms from 110 diabetics were chosen from our digital retinal image databank. Patients with significant media opacities, macular scars, macular hard exsudates, high ametropia, and associated macular pathology were excluded. Both FAZ perimeter and surface area were measured with image analysis software. FAZ outline was graded according to ETDRS report Number 11 (from 0=normal to 4=capillary outline completely destroyed). Data were compared to that of 31 healthy controls. FAZ surface in diabetics was compared to that of controls and FAZ surface was compared to FAZ grade, FAZ perimeter and retinopathy stage in diabetics. Quantitative variables were compared using the U-test of Mann–Whitney or Kruskal–Wallis test and correlations between quantitative variables were estimated with the Spearmann coefficient. All patients presented diabetic retinopathy (54 BDR, 30 PPDR, 26 PDR). FAZ size was larger in diabetics than controls (P<0.001). In diabetics, FAZ size increased with FAZ grade (P
214 citations
TL;DR: Age and heredity are the most important risk factors associated with the different types of cataract, and increasing age serves as a surrogate for a number of potential external risk factors, the effect of which is cumulative.
Abstract: To provide an update on the risk factors for cataract development. Review of the literature. Age and heredity are the most important risk factors associated with the different types of cataract. While the hereditary component is self-explanatory, increasing age serves as a surrogate for a number of potential external risk factors, the effect of which is cumulative. Identification of the risk factors that have a causal effect on cataract development may provide means for cataract prevention. There are only a few risk factors that satisfy the criteria for causal effect: smoking, which results in the increased risk of nuclear cataract, excessive UV-B exposure and diabetes that increase the risk of cortical cataract, and steroidal treatment, diabetes and ionising radiation that lead to the formation of posterior subcapsular opacity. The effect of medications on cataract development requires further study, since the effect of the diseases should be distinguished from that of treatment. ‘Stop Smoking’ and ‘UV-B protection’ campaigns are gaining momentum as preventative measures, while the attempts to actively prevent cataract with antioxidants have not been successful. Cataract research has been facilitated lately by improvements of precision and standardisation in measuring lens opacities. However, measurement precision on its own cannot give us a solution to this problem. The major studies repeatedly measure the exposure to the traditional health hazards, while the missing parts in the equation are those risk factors that we do not know about and therefore do not measure. New approaches and new hypotheses are needed.
193 citations
TL;DR: The male gender, larger BMI, and longer axial length are associated with a significantly thicker central retina and these parameters should be considered for assessing retinal thickening and baseline comparisons in future studies.
Abstract: Optical coherence tomography (OCT) acquires cross-sectional retinal images with high resolution using low-coherence interferometry. Few studies have studied the effect of demographic data and ocular parameters that may affect central retinal thickness. In this study, these factors were used as parameters to analyse if any significant relationship exists with central retinal thickness. Volunteers with a best-corrected visual acuity of 6/12 or better and no evidence of ocular abnormalities or interventions were recruited from October 2001 to March 2003. Body mass index (BMI), autorefraction, and keratometry recordings were measured, followed by applanation tonometry and A-scan ultrasonography. The central retinal thickness of the right eye was analysed using a scan length of 3 cm. Another 25 eyes were selected for interobserver reproducibility. In all, 117 normal subjects (60 male and 57 female subjects) were recruited. The mean thickness of the central retina with a diameter of 1 mm was 203±23 μm for male and 189±20 μm for female subjects. Age, intraocular pressure, and keratometric readings were not significantly correlated with central retinal thickness. Using multiple regression, gender, BMI, axial length, and signal-to-noise ratio (P<0.05) were significantly associated with the central retinal thickness. The intraclass correlation coefficient was 0.98 for interobserver reproducibility. OCT has a high interobserver reproducibility. The male gender, larger BMI, and longer axial length are associated with a significantly thicker central retina and these parameters should be considered for assessing retinal thickening and baseline comparisons in future studies.
170 citations
TL;DR: This study strongly suggests that etanercept may suppress the clinical signs in GO, but randomized controlled trials are needed to further evaluate the effect of anti-TNF treatment and to compare its side-effects with those of corticosteroids.
Abstract: To assess the effect of etanercept, an antitumour necrosis factor (anti-TNF) drug, on clinical signs in Graves' ophthalmopathy (GO). A total of 10 consecutive patients (seven female, three male) with recent-onset, active, mildly-to-moderately severe GO were treated with subcutaneous injections of 25 mg etanercept (Enbrel®) twice weekly during 12 weeks. The average age was 50 years (range: 39–59 years). The average duration of GO was 4 months (range: 2–6 months). All patients were at least 2 months euthyroid with medication. The mean pretreatment clinical activity score (CAS) was 4 (range: 3–6). The mean CAS prior to treatment was 4, at 6 weeks 2.6, and at 12 weeks 1.6. The mean ophthalmopathy index (OI) prior to treatment was 5.8, at 6 weeks 4.8, and at 12 weeks 4.4. Thus, after 12 weeks of treatment the mean CAS had decreased by 2.4±1.3 (60%), and the mean OI had decreased by 1.4±1.2 (24%). The main decrease of the CAS and OI was noted at 6 weeks of treatment. The difference was particularly evident on soft-tissue changes, including periocular chemosis and redness. The mean exophthalmometry values did not change. In all, 60% percent of patients reported moderate to marked improvement. In three patients, the GO flared up again after cessation of treatment. There were no serious adverse events or side effects during a mean follow-up time of 18 months. This study strongly suggests that etanercept may suppress the clinical signs in GO, but randomized controlled trials are needed to further evaluate the effect of anti-TNF treatment and to compare its side-effects with those of corticosteroids.
168 citations
TL;DR: Intravitreal injection of triamcinolone acetonide can increase visual acuity in patients with branch retinal vein occlusion, and this effect was significantly higher in the study group at 1 month, 2 months, and 2 months after baseline.
Abstract: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity in branch retinal vein occlusion. The prospective comparative nonrandomized clinical interventional study included 28 patients (28 eyes) with branch retinal vein occlusion. The study group consisting of 10 consecutive patients received an intravitreal injection of 20–25 mg of triamcinolone acetonide. The control group including 18 patients did not receive an intravitreal injection. The mean follow-up was 8.7±4.4 months. In the study group, mean visual acuity increased significantly (P=0.02) from 0.27±0.11 preoperatively to a best postoperative visual acuity of 0.45±0.27. Visual acuity measurements determined 1 month after the injection were significantly (P=0.027) higher than baseline values. Nine (90%) eyes gained in visual acuity, with six (60%) eyes showing an increase in visual acuity of at least two Snellen lines. In the ischaemic subgroup, visual acuity did not change significantly (0.18±0.18 to 0.13±0.04; P=0.66), while, in the nonischaemic subgroup, visual acuity increased significantly (P=0.012) from the baseline value to the best postoperative measurement (0.29±0.09 to 0.53±0.24). In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (P=0.27). Comparing the study and control groups with each other, the gain in visual acuity was significantly higher in the study group at 1 month (P=0.016) and 2 months (P=0.012) after baseline. Intravitreal injection of triamcinolone acetonide can increase visual acuity in patients with branch retinal vein occlusion.
160 citations
TL;DR: Developing corneal transplantation services need a comprehensive approach encompassing medical standards in eye banking, training of cornea specialists and eye banking personnel and exposure of ophthalmologists to care of corNEal transplants for better follow-up care.
Abstract: To analyse the role of keratoplasty in reducing world blindness due to corneal diseases. Review of published literature. We collected and analysed articles published in the English language literature related to the prevalence and causes of blindness in different parts of the world, causes of corneal blindness, and outcome of corneal transplantation for various corneal diseases. A total of 80% of the world's blind live in developing countries. Retinal diseases are the most important causes of blindness (40–54%) in established economy nations while cataract (44–60%) and corneal diseases (8–25%) are the most common causes of blindness in countries with less developed economies. Keratitis during childhood, trauma, and keratitis during adulthood resulting in a vascularized corneal scar and adherent leucoma are the most frequent causes of corneal blindness in developing countries. Corneal diseases are responsible for 20% of childhood blindness. Nearly 80% of all corneal blindness is avoidable. The outcome of keratoplasty for vascularized corneal scar and adherent leucoma is unsatisfactory, necessitating repeat surgery in a high proportion of these cases. Other barriers for keratoplasty in these nations are suboptimal eye banking, lack of trained human resources, and infrastructure. Since the developing world carries most of the load of corneal blindness and the major causes of corneal blindness are corneal scar and active keratitis, development of corneal transplantation services need a comprehensive approach encompassing medical standards in eye banking, training of cornea specialists and eye banking personnel and exposure of ophthalmologists to care of corneal transplants for better follow-up care. However, concerted efforts should be made to develop and implement prevention strategies since most corneal blindness is preventable.
134 citations
TL;DR: CAG appears to be an effective modality for primary and recurrent pterygia and males and patients below 40 years face greater risk of recurrence, while bare sclera technique has an unacceptably high recurrence.
Abstract: To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. Retrospective analysis of medical records of 920 patients (989 eyes) with primary and recurrent pterygia operated between January 1988 and December 2001. The demographic variables, surgical technique (bare sclera, primary closure, amniotic membrane transplantation (AMT), conjunctival autograft (CAG), conjunctival–limbal autograft (CLAG), or surgical adjuvants), recurrences and postoperative complications were analysed. A total of 496 (53.9%) were male and 69 (7.5%) had bilateral pterygia. Bare sclera technique was performed in 267 (27.0%) eyes, primary conjunctival closure in 32 (3.2%), AMG in 123 (12.4%), CAG in 429 (43.4%), and CLAG in 70 (7.1%). Adjuvant mitomycin C was used in 44 (4.4%) cases. The mean duration of follow-up was 8.9±17.0 and 5.9±8.8 months for unilateral primary and recurrent pterygia, respectively. The overall recurrence rate was 178 (18.0%). Following primary and recurrent unilateral pterygium excision respectively, recurrences were noted in 46 (19.4%) and 1 (33.3%) eyes after bare sclera technique, five (16.7%) and 0 after primary closure, 28 (26.7%) and 0 with AMG, 42 (12.2%) and five (31.3%) with CAG, and nine (17.3%) and two (40%) with CLAG. Recurrences were significantly more in males with primary (23.3 vs10.7%, P<0.0001) and recurrent (26.7 vs0%, P=0.034) pterygia, and in those below 40 years (25.2 vs14.8%, P=0.003). CAG appears to be an effective modality for primary and recurrent pterygia. Males and patients below 40 years face greater risk of recurrence. Bare sclera technique has an unacceptably high recurrence. Prospective studies comparing CAG, CLAG, and AMG for primary and recurrent pterygia are needed.
123 citations
TL;DR: Infliximab is efficient and safe for the long-term management of refractory posterior uveitis, especially in patients with predominant retinal vasculitis and vitritis, and in one patient diagnosed with chronic idiopathic multifocal choroiditis the drug had no effect, and this patient was withdrawn from the study.
Abstract: To evaluate the long-term efficacy and safety of infliximab as treatment for noninfectious posterior uveitis. An open-label clinical trial including seven patients (12 eyes) with posterior uveitis refractory to conventional treatment regimens with corticosteroids and at least one immunosuppressive agent. Three intravenous doses of 5 mg/kg of infliximab were administered at weeks 0, 2, and 6. Infliximab infusion was repeated in patients undergoing a relapse of uveitis after initial remission. Improvement was defined as amelioration of visual acuity or disappearance of retinal exudates and/or haemorrhages, decreased macular oedema and/or vitreous opacities. All patients were followed up for at least 36 months. Six of the seven patients (five diagnosed with Behcet's disease and one diagnosed with sarcoidosis) showed a significant improvement after the first infliximab dose. Only in one patient diagnosed with chronic idiopathic multifocal choroiditis did the drug have no effect, and this patient was withdrawn from the study. At the end of follow-up, one eye had lost one line of vision and three eyes showed improved vision. All eyes had improved in terms of signs of inflammation. No adverse effects of treatment were observed. Infliximab is efficient and safe for the long-term management of refractory posterior uveitis, especially in patients with predominant retinal vasculitis and vitritis.
115 citations
TL;DR: Corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes, and subepithelial nerves were thicker in dry Eyes than control eyes.
Abstract: To evaluate the corneal sensitivity and nerve morphology in dry eyes. A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet–Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame. The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (P 0.05). Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.
TL;DR: Pressure readings with the Gat, NCT, and OBFT are all affected by CCT, with the NCT being the one most affected and the GAT the least, suggesting CCT an essential variable to consider in interpreting IOP readings, especially for the NCT measurements.
Abstract: To compare the intraocular pressure (IOP) measurements using the Goldmann applanation tonometer (GAT), noncontact tonometer (NCT), and ocular blood flow tonometer (OBFT), and to evaluate the effects of varying central corneal thickness (CCT) on the readings. Ultrasound pachymetry and tonometry were performed on 170 eyes. Using the corrected GAT values that took CCT into account as the standard, we calculated the NCT and OBFT measurement errors related to the CCT variable by a linear regression model. Group comparisons were performed with the χ2 test and one-way ANOVA test. The correlation between the various tonometer measurements was analysed by Pearson's correlation method. Both the NCT (r=0.872, P<0.001) and OBFT measurements (r=0.861, P<0.001) were highly correlated with the GAT measurements. IOP measurements using the three tonometers were all correlated with CCT (all P<0.001), with the NCT measurements showing the greatest regression coefficient (β=0.063, r=0.650) and the GAT measurements the least (β=0.037, r=0.496). A linear regression model indicated that a 10 μm change in CCT resulted in a NCT measurement deviation of 0.47–0.98 mmHg and an OBFT measurement deviation of 0.29–0.81 mmHg. Pressure readings with the GAT, NCT, and OBFT are all affected by CCT, with the NCT being the one most affected and the GAT the least. Our findings suggest CCT an essential variable to consider in interpreting IOP readings, especially for the NCT measurements.
TL;DR: The sleep apnoea syndrome is correlated with a proportional decrease in the RNFL, and decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.
Abstract: To determine the retinal nerve fibre layer (RNFL) thickness in patients with obstructive sleep apnoea syndrome (OSAS) in order to investigate the possibility of detecting early signs of glaucoma in this population. A total of 66 consecutive patients admitted for polysomnographic evaluation of suspected OSAS. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. Patients who had the disease were classified as having mild and severe OSAS, while patients who did not have the disease were classified as controls. All patients received physical, neurological, and ophthalmological evaluation including visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy with a three mirror contact lens, and fundus examination. After these examinations, patients with glaucoma and patients who had ophthalmological and/or systemic disease known to affect RNFL thickness were excluded from the study. The RNFL thickness was assessed with a scanning laser polarimeter (Nerve Fiber Analyzer GDx, Laser Diagnostic Technologies Inc., San Diego, CA, USA). A total of 34 patients with obstructive sleep apnoea (19 mild, 15 severe) and 20 age-matched controls were included in the study. The thickness of RNFL was reduced in patients with OSAS compared to controls. The decrease in RNFL was found to be correlated with the severity of sleep apnoea (r=0.78, P=0.01). The sleep apnoea syndrome is correlated with a proportional decrease in the RNFL. Decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.
TL;DR: The need for more work to establish the role of MRSA commensals and ocular infections is highlighted, with different strains infect young and old age groups with characteristic antimicrobial sensitivity.
Abstract: To determine the prevalence and clinical characteristics of external ocular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in an ophthalmic hospital in the UK. A retrospective analysis of the case notes of patients who had culture proven external ocular Staphylococcal infections during a 44-month period was undertaken. There were a total of 548 external eye infections caused by Staphylococcus aureus. Of these, 17 (3%) were MRSA positive. The most common presentation was conjunctivitis seen in six patients. All MRSA isolates were sensitive to chloramphenicol. Ofloxacin resistance was observed in all isolates from patients over the age of 50 years. All patients had an underlying history of either an ocular surface disease, malignancy, or a debilitating medical illness. MRSA is as yet an infrequent cause of external ocular infections. Patients typically have underlying ocular risk factors and/or are medically debilitated. Different strains infect young and old age groups with characteristic antimicrobial sensitivity. This study highlights the need for more work to establish the role of MRSA commensals and ocular infections.
TL;DR: The results support the use of a ‘patient-friendly’ approach of simultaneous cataract surgery with no prone postoperative posturing and the duration of preoperative symptoms, indocyanine green-assisted internal limiting membrane peeling, hole stage, and better preoperative visual acuity were associated with both anatomical success and regaining a postoperativeVisual acuity of 6/12 or better.
Abstract: The optimal method and timing of the surgical treatment for idiopathic macular holes remains unknown. The aim of this retrospective study was to identify factors associated with anatomical and visual success in macular hole surgery. Case records of 55 patients undergoing macular hole surgery at three units in the 2-year period up to July 2002 were reviewed to identify factors associated with anatomical and visual success. The following potential prognosticators were evaluated: patient age, hole stage, hole latency prior to surgery, preoperative acuity, simultaneous phacoemulsification, and intraocular lens implantation, internal limiting membrane peeling with and/or without indocyanine green, and postoperative posturing. The duration of preoperative symptoms, indocyanine green-assisted internal limiting membrane peeling, hole stage, and better preoperative visual acuity were associated with both anatomical success and regaining a postoperative visual acuity of 6/12 or better. The closure rate in patients undergoing surgery within 1 year of onset was 94.0%, and in those waiting 1 year or more it was 47.4%. Clinical governance and quality issues should dictate that NHS macular hole surgery is available to all within 1 year of onset. This study showed no adverse effect of ICG dye retinal staining. The results support the use of a ‘patient-friendly’ approach of simultaneous cataract surgery with no prone postoperative posturing.
TL;DR: Meibomian therapy with this device increases LLT in normal individuals, which implies a more stable tear film, reflected in subjective improvement in ocular comfort.
Abstract: This study measures changes in tear film lipid layer thickness (LLT) and ocular comfort in normal subjects after 10 min use of a novel device, which delivers meibomian therapy with latent heat. The device is designed to promote the release of meibomian sebum into the tear film by delivering latent heat to the eyelids, thus thickening the lipid layer. Normal lid movements are maintained, facilitating resurfacing of the tear film. A prospective, controlled, observer masked, single intervention trial in which 24 normal subjects were randomised into three groups. Group I underwent 10 min treatment with the activated device, Group II used the inactivated device for the same duration of time, and Group III had no intervention. The LLT of each subject was measured with a Keeler Tearscope® prior and subsequent to the 10-min period. Subjective alteration in ocular comfort was also assessed. Seven of eight subjects (87.5%) in Group I exhibited an increase in LLT. The mean LLT in this group showed a statistically significant increase (left eyes 1.0 levels, P<0.001, right eyes 0.9 levels, P<0.003) compared to Groups II and III. Six of eight subjects (75%) using the activated device experienced subjective improvement in ocular comfort. Meibomian therapy with this device increases LLT in normal individuals. This implies a more stable tear film, reflected in subjective improvement in ocular comfort.
TL;DR: Cytomegalovirus in aetiology of Posner–Schlossman syndrome: evidence from quantitative polymerase chain reaction.
Abstract: Cytomegalovirus in aetiology of Posner–Schlossman syndrome: evidence from quantitative polymerase chain reaction
TL;DR: The results of this preliminary study suggest that the possible alterations of plasma MDA levels may be associated with the pathogenesis of POAG, but further research is needed to understand the role of oxidative damage in this important disorder of aging.
Abstract: To investigate the role of oxidative stress and lipid peroxidation in the pathogenesis of primary open-angle glaucoma (POAG). The activities of myeloperoxidase (MPO), catalase (CAT), and the levels of plasma malondialdehyde (MDA) were measured in 40 (15 men and 25 women) patients with POAG and 60 (30 men and 30 women) healthy controls. There was no significant difference in the activities of CAT and MPO between the POAG patients and the controls. However, the plasma MDA level was significantly higher in patients than the controls. The results of this preliminary study suggest that the possible alterations of plasma MDA levels may be associated with the pathogenesis of POAG, but further research is needed to understand the role of oxidative damage in this important disorder of aging.
TL;DR: In mild burns, AMT alone restores corneal and conjunctival surfaces, and in moderate to severe burns, it probably reduces conjunctive scarring sequelae, but does not prevent the sequelae of limbal stem cell deficiency that requires further lim Bal stem cell transplantation.
Abstract: To evaluate the outcome of fresh amniotic membrane transplantation (AMT) for ocular surface reconstruction in acute chemical burns. A prospective study of 15 consecutive eyes with acute chemical burns was performed. In all, 10 eyes had lime burns and five eyes had acid burns. There were three eyes of grade II, four eyes of grade III and eight eyes of grade IV burns. AMT was performed within 3 weeks of injury. Patients were followed up for 10.14±4.41 months. All patients had immediate relief of pain postoperatively. Of 15 eyes, nine (60%) showed epithelialization within 1–4 weeks (15.33±9.91 days). The final visual acuity improved in 10 of 15 eyes (66.66%). Eyes with burns of grade II and III showed more visual improvement than those with grade IV burns. None of the eyes showed perforation. Symblepharon was seen in nine of 15 eyes (60%). Of 15 eyes, 12 (80%) experienced limbal stem cell deficiency and showed superficial corneal vascularization. Amniotic membrane transplantation with fresh amniotic membrane increases patient comfort and reduces inflammation. In mild burns, AMT alone restores corneal and conjunctival surfaces. In moderate to severe burns, it probably reduces conjunctival scarring sequelae, but does not prevent the sequelae of limbal stem cell deficiency that requires further limbal stem cell transplantation. In the acute stage, amniotic membrane transplantation probably has a protective role against the progressive melting and perforation.
TL;DR: Visual acuity increased in patients with exudative age-related macular degeneration at 1 month and 3 months after an intravitreal injection of 25 mg triamcinolone acetonide.
Abstract: To report on visual outcome of patients receiving an intravitreal injection of triamcinolone acetonide as treatment of progressive exudative age-related macular degeneration. The prospective comparative nonrandomized clinical interventional study included 187 consecutive patients with progressive exudative age-related macular degeneration, divided into a study group of 115 patients receiving an intravitreal injection of 25 mg triamcinolone acetonide, and a control group of 72 patients without treatment. The mean follow-up was 6.0±4.2 months. Visual acuity increased significantly (P=0.03) in the study group, and decreased significantly (P=0.01) in the control group, at 1 month and 3 months after start of the study. Between the study group and control group, the differences in change of visual acuity were significant (P=0.001). In the study group, the number of patients with an increase in visual acuity of 2 or more Snellen lines was significantly (P=0.001) larger than in the control group. Correspondingly, the number of patients with a decrease of 2 or more Snellen lines was significantly (P=0.007) smaller in the study group. In all, 43 (37.4%) patients of the study group experienced an increase in best visual acuity by 2 or more Snellen lines. Visual acuity increased in patients with exudative age-related macular degeneration at 1 month and 3 months after an intravitreal injection of 25 mg triamcinolone acetonide.
TL;DR: In this paper, the authors compared the results of deep sclerectomy (DS) vs DSCI with collagen implant (DSCI) Randomized prospective trial involving 26 eyes (13 patients) with medically uncontrolled primary and secondary open angle glaucoma.
Abstract: To compare prospectively the results of deep sclerectomy (DS) vs deep sclerectomy with collagen implant (DSCI) Randomized prospective trial involving 26 eyes (13 patients) with medically uncontrolled primary and secondary open angle glaucoma. Collagen implant was randomly assigned to one eye of each patient. The mean follow-up period was 49.5 (SD 20) months for the DS-treated eyes, and 56.5 (SD 14) months for the DSCI-treated eyes (P=0.4). The mean preoperative intraocular pressure (IOP) was 24.1 (SD 7) mmHg for the DS-treated eyes, and 25.3 (SD 6) mmHg for the DSCI-treated eyes (P=0.5). The mean IOP at the first postoperative day was 6.4 (SD 3) mmHg for the DS-treated eyes, and 3.7 (SD 2) mmHg for the DSCI-treated eyes (P=0.05). The mean IOP at 12 months postoperative day was 15.4 (SD 3) mmHg for the DS group, and 10.4 (SD 4) mmHg for the DSCI-treated eyes (P=0.04), while at 48 months it was 16 (SD 3) mmHg for the DS group, and 10 (SD 4) mmHg for the DSCI-treated eyes (P=0.005). Complete success rate, defined as an IOP lower than 21 mmHg without medication, was 38% (5/13 patients) at 48 months for the DS-treated eyes, and 69% (9/13 patients) for the DSCI-treated eyes. Qualified success rate: patients who achieved IOP below 21 mmHg with or without medication, was 69% (9/13 patients) at 48 months and 100% (13/13 patients) for the DSCI group. The mean number of medications was reduced from 2.4 (SD 0.8) to 1.1 (SD 1) after DS, and was reduced from 2.2 (SD 0.7) to 0.4 (SD 0.6) in the DSCI group (P=0.001). For those eyes treated with DSCI, IOP was 3.21 mmHg lower than for those treated with DS (P<0.0001). The use of a collagen implant in DS seems to enhance the success rates, provides significantly lower IOP levels, and lowers the need for postoperative medications.
TL;DR: This study suggests that after an AK wound, MMP-1 is a key mediator of epithelial migration, while M MP-2 and -9, and to a lesser extent MMP -3, may participate in the remodelling of corneal stroma and the reformation of epithel basement membrane.
Abstract: To compare matrix metalloproteinase (MMP) localisation in anterior keratectomy (AK) and lamellar keratectomy (LK) wounds. Wounds were produced in one eye of 24 rabbits. The AK wounds were made to approximately 120 μm in depth and then allowed to re-epithelialise. The LK wounds were of similar depth, but the anterior stroma and epithelium were replaced after a second deeper keratectomy had been performed. Immunohistochemistry was used to localise the MMP-1, -2, -3, and -9 at intervals from 4 h to 14 days following surgery. The contralateral eyes acted as controls. After an AK wound MMP-1 was present at the leading edge of migrating epithelium after 18 h, while MMP-2 and -9 were localised behind the advancing epithelial edge. The presence of these enzymes rapidly fell to low levels after epithelial closure. There was only faint MMP-3 localisation between days 3 and 7. After an LK wound, MMP-1, -3, and -9 were not detected in the stromal interface, but MMP-2 was present at all time points. This study suggests that after an AK wound, MMP-1 is a key mediator of epithelial migration, while MMP-2 and -9, and to a lesser extent MMP-3, may participate in the remodelling of corneal stroma and the reformation of epithelial basement membrane. In contrast, an LK wound results in a much lower stimulus for MMP activation. The action of MMP-2 in stromal repair is thus partly independent of epithelial injury.
TL;DR: Increasing the number of operations, through close involvement with the community, and improved surgical outcomes, enables the cost of surgery to be reduced, leading to further growth in volume, and effective management enables the delivery of increasing the numbers of operations.
Abstract: Cataract remains the world's leading cause of blindness. In the developing world, many eye clinics provide cataract surgery for only a small proportion of those in need. This is partly because of low demand—caused by barriers related to awareness, bad services, cost, and distance—and partly because of deficiencies in the supply of services. This article reviews innovations in cataract surgery in poor countries that are intended to reverse this trend. Increasing the number of operations, through close involvement with the community, and improved surgical outcomes, enables the cost of surgery to be reduced, leading to further growth in volume. Recent innovations, such as low-cost intraocular lenses, and small-incision extracapsular cataract extraction, have contributed to improving the results of surgery without increasing the costs. Effective management enables the delivery of increasing the numbers of operations, while at the same time improving outcomes and controlling costs.
TL;DR: The pathogenetic steps to loss of neurons in glaucoma are increasingly understood and nonpressure lowering therapies are on the horizon.
Abstract: During the last 30 years, the definition of glaucoma as been revised to eliminate the inclusion of intraocular pressure. Open angle glaucoma is the second leading cause of blindness in the world, but the proportion of those with the disease who become blind is low. Diagnostic methods for glaucoma need improvement. The pathogenetic steps to loss of neurons in glaucoma are increasingly understood and non-pressure lowering therapies are on the horizon.
TL;DR: The use of intraoperative MMC during deep sclerectomy has a significant effect on the postoperative IOP and increases the probability of achieving target IOPs, however, the current technique of MMC application is associated with a higher incidence of avascular blebs and transconjunctival oozing.
Abstract: To investigate the comparative efficacy and safety of deep sclerectomy with and without intraoperative mitomycin C (MMC) application for lowering the intraocular pressure (IOP). A total of 71 eyes of 71 consecutive patients who had routine deep sclerectomy (DS), nonaugmented (DS-noMMC) or with mitomycin C (DS-MMC) augmentation (0.2?mg/ml for 2?min) and follow-up of 4 months or more were identified from an ongoing prospective database on glaucoma surgery. Indications for MMC use were the presence of risk factors for subconjunctival scarring and low target IOPs. MMC 0.2?mg/ml was applied in the sub-Tenons space for 2?min. There were 19 eyes in the DS-noMMC group and 52 eyes in the DS-MMC group. In 11 eyes (15.5%), the procedure was complicated by intraoperative perforation of the trabeculo-Descemet's window. Eyes in the DS-MMC group had significantly lower IOPs (MANOVA, P=0.04). Kaplan–Meier survival curve analysis showed that the probability of maintaining IOP below target IOP level, below 18?mmHg and below 14?mmHg at 1 year was 51, 67, and 35% for the DS-noMMC group and 80, 86, and 74% for the DS-MMC group. The survival rates of the DS-MMC group were not statistically significant (P=0.06) when the success criterion was maintaining an IOP less than 18?mmHg but were significant for the other criteria, namely IOP less than target levels (P=0.03) and less than 14?mmHg (P=0.03). Nd:YAG goniopuncture to lower IOP to target levels was done more frequently in the DS-noMMC group (13 eyes, 81%) than the DS-MMC group (20 eyes, 45%) and this difference was significant (P=0.03). The prevalence of avascular areas within filtration blebs and transconjunctival oozing of aqueous was significantly higher in the DS-MMC group (P<0.01). The use of intraoperative MMC during deep sclerectomy has a significant effect on the postoperative IOP and increases the probability of achieving target IOPs. However, our current technique of MMC application is associated with a higher incidence of avascular blebs and transconjunctival oozing.
TL;DR: Findings suggest that microvascular disease in the retina may result from processes distinct from dyslipidaemia, and elevated high-density lipoprotein cholesterol was associated with narrower retinal arterioles and venules and with increased odds of generalised arteriolar narrowing.
Abstract: There are few data on the effect of serum lipids on microvascular disease. This study assessed the relationships between serum lipid levels and microvascular disease, as seen in the retina, among participants who attended a population-based study in Australia (n=3654, aged 49+years). Diameters of retinal arterioles and venules were measured from digitised photographs of each participant to obtain an estimate of generalised arteriolar narrowing. Focal arteriolar narrowing, arteriovenous nicking, and retinopathy lesions (microaneurysms, haemorrhages, hard/soft exudates) were graded using a standard protocol. Fasting blood tests were performed in 89% of subjects. Adjusted means were calculated using general linear models. Logistic regression models were used to determine the odds ratios for retinal microvascular signs. After controlling for age, sex, body mass index, smoking, and mean arterial blood pressure, elevated high-density lipoprotein cholesterol was associated with narrower retinal arterioles (Ptrend=0.002) and venules (Ptrend=0.03) and with increased odds of generalised arteriolar narrowing (odds ratio 1.6, 95% confidence interval 1.1–2.2 for the highest vs the lowest quintile of high-density lipoprotein cholesterol). Serum triglyceride had a U-shaped relationship with venular diameter (Ptrend=0.003). We found no consistent pattern of association between serum total cholesterol or low-density lipoprotein cholesterol and any retinal microvascular signs. These findings suggest that microvascular disease in the retina may result from processes distinct from dyslipidaemia.
TL;DR: The inclusion of contrast sensitivity as an outcome measure in studies of patients with CNV due to AMD may provide a more complete understanding of the effects of treatment on visual function and the likely benefits for patients.
Abstract: Although visual acuity is the most frequently used primary outcome measure in clinical trials of treatments for choroidal neovascularisation (CNV) due to age-related macular degeneration (AMD), contrast sensitivity may provide valuable additional information. This paper reviews the evidence for using contrast sensitivity as a measure of visual function and as an outcome measure in clinical trials in patients with subfoveal CNV due to AMD. Medline database searches were performed to retrieve relevant articles on contrast sensitivity. In addition, articles were included from the authors' knowledge of the literature and from the reference lists of retrieved articles. The published literature demonstrates that contrast sensitivity is an important measure of visual function in patients with subfoveal CNV due to AMD. Most clinical trials of treatments for CNV due to AMD have reported visual acuity as the primary outcome. However, there is evidence that treatment (such as verteporfin therapy) may also provide additional benefits in terms of contrast sensitivity. These benefits may not be completely characterised by measurement of visual acuity alone. The inclusion of contrast sensitivity as an outcome measure in studies of patients with CNV due to AMD may provide a more complete understanding of the effects of treatment on visual function and the likely benefits for patients.
TL;DR: The rise in energy expenditure and urinary nitrogen excretion following surgery were significantly attenuated in malnourished rats, suggesting that malnutrition impairs the ability of the body to mobilise substrates to support inflammatory and reparative processes.
Abstract: This paper is concerned with malnutrition caused by inadequate intake of all the major nutrients rather than deficiency diseases relating to a single micronutrient. Three common situations are recognised: young children in third world countries with protein-energy malnutrition; adults in the same countries who are chronically adapted to subsisting on marginally inadequate diets; and patients who become malnourished as a result of chronic diseases. In all these situations infectious diseases are often also present, and this complicates the interpretation of biochemical and physiological observations. The metabolic response to starvation is primarily concerned with maintaining a supply of water-soluble substrates to supply energy to the brain. Thus there is an initial rise in metabolic rate, reflecting gluconeogenic activity. As fasting progresses, gluconeogenesis is suppressed to minimise muscle protein breakdown and ketones become the main fuel for the brain. With chronic underfeeding the basal metabolic rate per cell appears to fall, but the mechanistic basis for this is not clear. The main adaptation to chronic energy deficiency is slow growth and low adult body size, although the reduction in energy requirement achieved by this is partially offset by the preservation of the more metabolically active organs at the expense of muscle, which has a lower metabolic rate. The interaction between malnutrition and the metabolic response to trauma has been studied using an animal model. The rise in energy expenditure and urinary nitrogen excretion following surgery were significantly attenuated in malnourished rats, suggesting that malnutrition impairs the ability of the body to mobilise substrates to support inflammatory and reparative processes. However, the healing process in wounded muscle remained unimpaired in malnutrition, suggesting that this process has a high biological priority.
TL;DR: Using stringent perioperative and postoperative control of inflammation, patients with uveitis usually maintain high visual acuity over long-term follow-up, and the incidence of sight-threatening postoperative complications is low.
Abstract: To investigate the long-term visual results after cataract extraction in patients with uveitis, and to demonstrate the long-term viability of intraocular lenses. In all, 61 patients (72 eyes), with update clinical examination, were retrospectively evaluated. Comparison of preoperative, postoperative, and latest visual function including best-corrected Snellen visual acuity, progression of uveitis and its complications, need for postoperative medical or surgical interventions. After a minimum follow-up of 5 years (mean 7 years 7 months), 82% of eyes maintained a visual improvement of two Snellen lines, 74% maintained 6/9 or better, and 14% had 6/18 or worse. The mode acuity was better than 6/6. The prevalence of macular oedema or scarring was 24%, of posterior capsule opacification 96%, and of glaucoma drainage, 15%. We report the long-term follow-up of cataract extraction and intraocular lens (IOL) implantation performed by a single surgeon on patients with uveitis attending a regional tertiary referral uveitis clinic. Using stringent perioperative and postoperative control of inflammation, patients with uveitis usually maintain high visual acuity over long-term follow-up. The incidence of sight-threatening postoperative complications is low and no ongoing complication has been attributed to IOL implantation.