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British Journal of Ophthalmology current issue



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Highlights from this issue

2017-08-23T04:20:51-07:00

Electrophysiological changes in 12-year-old children born moderate-to-late preterm: reduced VEP amplitude in MLP children (see page 1156)

Moderate-to-late preterm children at 12 years of age, with no history of retinopathy of prematurity, displayed reduced pattern-reversal visual evoked potential amplitudes compared with those of controls.

Biphasic growth of orbital volume in Chinese children (see page 1162)

The development of the orbital volume in childhood is biphasic. The first growth phase is before 3 and the second is from 7 to 12, with the speed in the first phase three times faster.

Retinal structure assessed by OCT as a biomarker of brain development in children born small for gestational age (see page 1168)

Thinner retinal ganglion cell and inner plexiform layers are related to lower grey and white matter volumes in brain MRI from school-age children born small for gestational age.

...



Leber congenital amaurosis/early-onset severe retinal dystrophy: clinical features, molecular genetics and therapeutic interventions

2017-08-23T04:20:51-07:00

Leber congenital amaurosis (LCA) and early-onset severe retinal dystrophy (EOSRD) are both genetically and phenotypically heterogeneous, and characterised clinically by severe congenital/early infancy visual loss, nystagmus, amaurotic pupils and markedly reduced/absent full-field electroretinograms. The vast genetic heterogeneity of inherited retinal disease has been established over the last 10 - 20 years, with disease-causing variants identified in 25 genes to date associated with LCA/EOSRD, accounting for 70–80% of cases, with thereby more genes yet to be identified. There is now far greater understanding of the structural and functional associations seen in the various LCA/EOSRD genotypes. Subsequent development/characterisation of LCA/EOSRD animal models has shed light on the underlying pathogenesis and allowed the demonstration of successful rescue with gene replacement therapy and pharmacological intervention in multiple models. These advancements have culminated in more than 12 completed, ongoing and anticipated phase I/II and phase III gene therapy and pharmacological human clinical trials. This review describes the clinical and genetic characteristics of LCA/EOSRD and the differential diagnoses to be considered. We discuss in further detail the diagnostic clinical features, pathophysiology, animal models and human treatment studies and trials, in the more common genetic subtypes and/or those closest to intervention.




Electrophysiological changes in 12-year-old children born MLP: reduced VEP amplitude in MLP children

2017-08-23T04:20:51-07:00

Aim

To study the electrophysiological changes in relation to fundus morphology in moderate-to-late preterm (MLP) children with no previous history of retinopathy of prematurity.

Methods

Visual acuity (VA), refraction and fundus variables measured by optical coherence tomography, pattern reversal visual evoked potentials and full-field electroretinography (ff-ERG) were obtained from 22 twelve-year-old MLP children (11 male, 11 female) and 21 full-term controls.

Results

There were no significant differences between the MLP and control groups in VA, refraction or optic disc parameters. There was a trend for thinner papillary retinal nerve fibre layer in the MLP group. Visual evoked potential amplitudes (P100) were lower in the MLP group than in controls, that is, right eye p=0.0027, left eye p=0.0037. No differences in latencies were found. After Bonferroni adjustment for multiple testing, no ff-ERG differences were noted between MLP and controls. Lower gestational age was correlated with smaller light-adapted 3.0 b-wave amplitudes (p=0.0076, r=0.565).

Conclusions

Our results indicate that moderate premature birth may affect visual evoked potential amplitudes without clear retinal structural changes in MLP children at 12 years of age.




Biphasic growth of orbital volume in Chinese children

2017-08-23T04:20:51-07:00

Objective

The aim of this study was to map out the developmental curve of the orbital volume of Chinese children aged 1–15 years.

Methods

CT scanning was performed on 109 children and the orbital volume, interlateral orbital rim distance (IORD), and extent of exophthalmos were measured on the CT images and plotted against age.

Results

The development of the orbit structure followed a biphasic pattern. The first growth phase was before 3 years and the second growth phase was between 7 years and 12 years of age. The growth speed in the first phase was about 3 times that of the second one (first vs second phase: 2.28 cm3/year vs 0.67 cm3/year for orbital volume, 5.01 mm/year vs 1.57 mm/year for IORD, 1.29 mm/year vs 0.42 mm/year for the exophthalmos). During development, there was no significant difference between the left and right orbits. There was no significant difference between boys and girls before 12 years of age. However, after 12 years of age, boys had significantly larger orbital volumes (22.16±2.28 cm3/year vs 18.57±1.16 cm3/year, p<0.001) and a greater IORD (96.29±3.18 mm/year vs 91.00±4.54 mm/year, p<0.001) than girls.

Conclusions

In Chinese children, the development of orbital volume follows a biphasic pattern and a sex difference becomes significant after the age of 12 years.




Retinal structure assessed by OCT as a biomarker of brain development in children born small for gestational age

2017-08-23T04:20:51-07:00

Purpose

To identify differences in neuronal tissue from retinal and brain structures in children born small for gestational age (SGA) with no abnormality in neonatal brain ultrasonography and no previous neurological impairment, and to evaluate the relationship between retinal structure and brain changes in school-age children born SGA.

Methods

Two cohorts of children were recruited: 25 children born SGA and 25 children born with an appropriate birth weight according to gestational age. All the children underwent an ophthalmic examination, which included retinal imaging using spectral-domain optical coherence tomography, and a brain MRI. MRI images were automatically segmented and global and regional brain volumes were obtained.

Results

Although visual function did not differ between both groups, the complex ganglion cell and inner plexiform layers (GCL-IPL) was thinner in SGA children. Total intracranial volume, and global grey and white matter volumes in brain and cerebellum were correlated with birthweight centile, as were certain regional volumes (temporal and parietal lobes, hippocampus and putamen). Abnormal GCL-IPL measurements accurately identified SGA children with the most severe grey and white matter changes in the brain.

Conclusions

SGA children, both preterm and term born, showed evidence of structural abnormalities in the retina, which may be an accurate and non-invasive biomarker of neuronal damage in brain tissue.




Retinal sensitivity changes associated with diabetic neuropathy in the absence of diabetic retinopathy

2017-08-23T04:20:51-07:00

Purpose

To explore any relationship between the markers of early retinal neuronal damage and peripheral diabetic neuropathy in subjects with no diabetic retinopathy (DR).

Methods

A cross-sectional study in which type 2 diabetic subjects (n=743) without DR were studied. Visual functions including visual acuity, contrast sensitivity, colour vision, retinal sensitivity using microperimeter and retinal thicknesses by spectral domain optical coherence tomography were measured. Vibration perception thresholds of greater than or equal to 20 µV, measured by sensitometer using a biothesiometer probe, were defined as having peripheral diabetic neuropathy. Statistical analyses were performed using independent t-test, multivariate logistic regression and Pearson's correlation.

Results

Of 743 subjects who had no DR, 24.9% had diabetic neuropathy. Independent comparisons among subjects who had diabetic neuropathy compared with those who did not showed statistically significant retinal nerve fibre layer thinning (p=0.01), reduced contrast sensitivity (p=0.0001), reduced retinal sensitivity (p=0.03), impaired colour vision (p=0.04) and reduced visual acuity (p=0.0001). Multivariate analysis showed significant association between the mean retinal sensitivity (measured using a microperimeter) and diabetic neuropathy (adjusted OR (95% CI): 0.76 (0.60 to 0.95), p=0.01).

Conclusions

Significant association of neuroretinal dysfunction with the presence of diabetic neuropathy was noted among subjects with no DR.




Detection of posterior vortex veins in eyes with pathologic myopia by ultra-widefield indocyanine green angiography

2017-08-23T04:20:51-07:00

Aims

To analyse the characteristics of posterior vortex veins detected in highly myopic eyes by wide-field indocyanine green angiography (ICGA).

Methods

One hundred and fifty-eight consecutive patients (302 eyes) with high myopia (myopic refractive error >8.0 dioptres (D) or axial length ≥26.5 mm) were studied. Wide-field ICGA was performed with the Spectralis HRA module.

Results

Posterior vortex veins were found in 80 eyes (26%). The prevalence of posterior staphyloma was significantly higher in eyes in which posterior vortex vein was detected than in eyes without posterior vortex vein. The posterior vortex veins were classified into five types according to the site of exit from the eye; around the optic nerve in 28%, in the macular area in 17%, along the border of staphyloma in 6%, along the margin of macular atrophy or large peripapillary conus in 21%, and elsewhere in 28%. In one eye, two posterior vortex veins collected the choroidal venous blood from the entire fundus.

Conclusions

Wide-field ICGA can analyse the characteristic features of choroidal blood outflow system through posterior vortex veins in highly myopic eyes. They may play an important role as routes of choroidal outflow in highly myopic eyes.




Five-year progression of unilateral age-related macular degeneration to bilateral involvement: the Three Continent AMD Consortium report

2017-08-23T04:20:51-07:00

Purpose

To assess the 5-year progression from unilateral to bilateral age-related macular degeneration (AMD) and associated risk factors.

Design

Pooled data analyses of three prospective population-based cohorts, the Blue Mountains Eye Study, Beaver Dam Eye Study and Rotterdam Study.

Methods

Retinal photography and interview with comprehensive questionnaires were conducted at each visit of three studies. AMD was assessed following the modified Wisconsin AMD grading protocol. Progression to bilateral any (early and late) or late AMD was assessed among participants with unilateral involvement only. Factors associated with the progression were assessed using logistic regression models while simultaneously adjusting for other significant risk factors.

Results

In any 5-year duration, 19–28% of unilateral any AMD cases became bilateral and 27–68% of unilateral late AMD became bilateral. Factors associated with the progression to bilateral involvement of any AMD were age (per year increase, adjusted OR 1.07), carrying risk alleles of the complement factor H and age-related maculopathy susceptibility 2 genes (compared with none, OR 1.76 for 1 risk allele and OR 3.34 for 2+ risk alleles), smoking (compared with non-smokers, OR 1.64 for past and OR 1.67 for current smokers), and the presence of large drusen area or retinal pigmentary abnormalities in the first eye.

Conclusion

One in four to one in five unilateral any AMD cases, and up to one in two unilateral late AMD cases, progressed to bilateral in 5 years. Known AMD risk factors, including smoking, are significantly associated with the progression to bilateral involvement.




Choroid morphometric analysis in non-neovascular age-related macular degeneration by means of optical coherence tomography angiography

2017-08-23T04:20:51-07:00

Aims

To describe the vascular changes in patients affected by non-neovascular age-related macular degeneration (AMD), featuring reticular pseudodrusen (RPD), drusen, or both RPD and drusen by means of optical coherence tomography angiography (OCT-A).

Methods

Cross-sectional observational case series. Patients with non-neovascular AMD presenting at the Medical Retina Service of the Department of Ophthalmology, University Vita-Salute San Raffaele in Milan were recruited. Patients underwent best-corrected visual acuity, biomicroscopy, infrared reflectance, short-wavelength fundus autofluorescence and OCT-A (AngioPlex, CIRRUS HD-OCT 5000, Carl Zeiss Meditech, Dublin, USA). Main outcome was quantification of vessel density, stromal tissue, and vascular/stromal (V/S) ratio at the choriocapillaris (CC), the Sattler and Haller's and the whole choroid layers among different groups of patients with non-neovascular AMD by means of binarised OCT-A scans.

Results

45 eyes of 34 patients were enrolled (15 eyes of 11 patients with RPD, group 1; 15 eyes of 11 patients with drusen, group 2; 15 eyes of 12 patients with mixed phenotype, group 3). The CC, the Sattler and Haller's and the whole choroid vessel density were reduced in all groups of patients (p=0.023, p=0.007 and p=0.011 in group 1, group 2 and group 3 for the CC; p=0.021, p=0.037 and p=0.043 in group 1, group 2 and group 3 for the Sattler and Haller's density; p=0.016, p=0.002 and p<0.001 in group 1, group 2 and group 3 for the choroidal density), with significantly lower V/S ratios compared with healthy controls.

Conclusions

Patients with non-neovascular AMD show significant choroidal vascular depletion and fibrotic replacement, suggesting a possible role in the pathogenesis and progression of the disease.




Intravitreal ziv-aflibercept for the treatment of choroidal neovascularisation associated with conditions other than age-related macular degeneration

2017-08-23T04:20:51-07:00

Aim

To report the short-term outcomes of eyes with choroidal neovascularisation (CNV) associated with causes other than age-related macular degeneration (AMD) after treatment with intravitreal ziv-aflibercept (IVZ) injections.

Methods

This retrospective study included eyes with non-AMD-related CNV that were treated with IVZ (1.25 mg/0.05 mL) on a pro re nata basis. The primary outcome measure is the mean change in best-corrected visual acuity (BCVA) and secondary outcome measures include the mean change in central macular thickness (CMT) and adverse events.

Results

23 eyes of 19 patients with CNV due to high myopia (9), macular telangiectasia (4), central serous chorioretinopathy (3), choroidal osteoma (2), choroiditis (2), Best's disease (2) and idiopathic (1) were treated. The mean follow-up period was 4±1.9 months. The median number of IVZ injections was 1 (range, 1–3) and the median treatment-free interval at the time of the final visit was 3 months (range, 1–8). The mean BCVA improved from 0.67 LogMAR to 0.58 LogMAR (p=0.0507). Nine of 23 (39%) eyes had BCVA gains of at least 0.1 LogMAR, 11 (48%) eyes had stable BCVA (within 0.1 LogMAR of baseline) and 3 (13%) eyes had a BCVA decline of at least 0.1 LogMAR at the final visit. The mean CMT improved significantly from baseline until the final visit (22 vs 174.5 μm; p=0.037). No ocular or systemic adverse events were noted.

Conclusions

IVZ improves CMT in patients with CNV associated with causes other than AMD, but improvements in BCVA are modest.




Ultrasonic mirror image from ruthenium plaque facilitates calculation of uveal melanoma treatment dose

2017-08-23T04:20:51-07:00

Background/aims

To present a new method to determine dose depth and the distance from the concave side of the plaque to the tumour base in patients with uveal melanoma treated with ruthenium-106 based on ultrasonic mirror image.

Methods

We used the mirror image associated with ultrasound during plaque brachytherapy to determine intraobserver reproducibility and interobserver agreement between two surgeons. 230 eyes with primary uveal melanoma were included in a retrospective analysis to determine the distance from the plaque to the tumour base using ultrasound. A phantom study was used to illustrate the effects on radiation dose to apex of the tumour when the dose depth was incorrectly determined. Doses to apex of the tumour were determined using Plaque Simulator.

Results

The intraobserver variation in dose depth measurement with plaque was significantly lower than for measures without plaque (p<0.001). Agreement between the surgeons was better with a plaque in place. Distances from the plaque to the tumour base were distributed with mean=0.99 (median: 1, range: 0.1–2.9 mm). From the phantom study, it was clear that the tumour did not receive the prescribed 100 Gy if the dose depth was incorrectly determined.

Conclusions

The dose depth in patients with uveal melanoma must be measured accurately for correct calculation of the radiation dose to the apex of the tumour. Repeated in vivo and in vitro ultrasound measurements of dose depth showed higher variance than measurements using the mirror image produced from a ruthenium plaque. Using the mirror image thus help to improve the dose calculation.




Longitudinal study of retinal status using optical coherence tomography after acute onset endophthalmitis following cataract surgery

2017-08-23T04:20:51-07:00

Purpose

To analyse the macula imaged with optical coherence tomography (OCT) in patients treated for acute postcataract endophthalmitis.

Methods

Patients presenting with acute postcataract endophthalmitis were included in this observational and multicentre study from January 2008 to December 2011. We recorded the following OCT data at the 3, 6 and 12-month visits: the central macular thickness, the perifoveal macular thickness, the central foveal point thickness and abnormalities of the outer retina, the macula and vitreoretinal interface.

Results

46 patients were included in the OCT analysis. From month 3 to 12, epiretinal membrane (ERM) prevalence increased from 26% to 39%, vitreomacular traction prevalence decreased from 12% to 6%, non-tractional macular oedema (ME) prevalence varied between 7% and 13%. Only macular thinning remained stable at 10%. At month 12, a significant correlation was found between non-tractional ME and capsular rupture (at the time of cataract extraction, p=0.03). Eyes with an ERM exhibited increased central macular thickness (p=0.001) and lower visual acuity (VA) (p=0.02) at M12 in comparison to the group with normal macula. OCT analysis showed a significant association between ERM and the alteration of the ellipsoid band (p=0.02), as well as the external limiting membrane (ELM, p=0.07) at M12.

Conclusions

ERM and ME were the main macular abnormalities diagnosed after 1 year of follow-up, associated with VA less than or equal to 20/40 in 50% of the cases. Ultrastructural abnormalities of the ELM and the ellipsoid band were frequently observed in those patients.




In vivo confocal microscopic characteristics of microsporidial keratoconjunctivitis in immunocompetent adults

2017-08-23T04:20:51-07:00

Background/aims

To describe in vivo confocal microscopy (IVCM) features of microsporidial keratoconjunctivitis in immunocompetent adult patients.

Methods

Patients suspected clinically to be suffering from microsporidial keratoconjunctivitis (ie, presence of unilateral follicular and/or papillary conjunctivitis in conjunction with multifocal, coarse corneal epitheliopathy) were subjected to IVCM with the Rostock Cornea Module of the Heidelberg Retinal Tomograph 3, and combined potassium hydroxide and calcofluor white (KOH+CFW) staining of the corneal scrapings, to detect the microsporidial spores. Detection of spores in corneal scrapings was considered as being confirmatory for microsporidial infection.

Results

Of a total of 10 patients screened, 8 patients (7 male, 1 female) demonstrated the presence of oval, non-budding microsporidial spores which fluoresced bluish white on combined KOH+CFW staining. IVCM in seven of these eight patients demonstrated multiple rosette-like clusters/plaque of epithelial cells, within which hyper-reflective, pinpoint oval intracellular bodies (similar to the spores seen on microbiological staining) were present. One patient who had been on prolonged treatment with topical steroids showed the presence of the oval bright bodies scattered diffusely within the epithelial cells, without rosette formation.

Conclusions

In microsporidial keratoconjunctivitis, IVCM is able to detect presence of bright, ovoid spore-like structures in the epithelial layers. Epithelial rosette formation is another characteristic feature seen in a majority of these patients. These features may be used as a reliable screening tool for starting therapy, precluding the need for corneal scrapings in a majority of patients.




Repeatability and agreement of ocular biometry measurements: Aladdin versus Lenstar

2017-08-23T04:20:51-07:00

Objective

To assess the repeatability and agreement between the Aladdin and Lenstar biometers.

Methods

Three consecutive measurements of the right eye of 102 subjects were acquired by the Aladdin (V.1.1.3) and the Lenstar (V.1.0.3), respectively, with a random order of which biometer to use first. Parameters compared included axial length (AL), anterior chamber depth (ACD), flat keratometry (Kf), steep keratometry (Ks), mean keratometry (Km), J0, J45 and white-to-white (WTW) distance. Intraocular lens (IOL) power formulas included SRK/T (Sanders-Retzlaff-Kraff/Theoretical), Holladay 1, Hoffer Q and Haigis. Repeatability (Sr), repeatability limit (r) and Bland-Altman limits of agreement (LoA) were calculated.

Results

Sr was marginally better with the Lenstar for AL (0.02 mm), ACD (0.02 mm) and WTW distance (0.07 mm), but Sr was marginally better with the Aladdin for Kf (0.10 dioptre (D)), J0 (0.07 D) and J45 (0.06 D). In terms of agreement, the mean difference was small and non-statistically significant between the two devices for ACD, Ks and J45. The mean difference for Kf, Km, J0 and WTW distance were all statistically significantly lower with the Aladdin than the Lenstar for the exception of WTW distance. The Bland-Altman LoA displayed narrow ranges implying good agreement with the exception for WTW distance. For IOL formulas, the mean difference was very small and not statistically significantly different. The LoA were narrow (within 0.50 D), implying acceptable use of each device interchangeably.

Conclusions

High levels of repeatability and agreement were found between the Aladdin and Lenstar suggesting that the devices may be used interchangeably in normal eyes with refractive error.




Topical tacrolimus solution in autoimmune polyglandular syndrome-1-associated keratitis

2017-08-23T04:20:51-07:00

Purpose

To evaluate the efficacy of topical tacrloimus eye drops in the treatment of keratitis associated with autoimmune polyglandular syndrome (APS)-1.

Methods

This is a retrospective review of 10 patients with APS-1. The patients were treated with topical tacrolimus 0.01% solution at The Eye Center, between 1 March 2012 and 30 April 2016. The outcome measures included improvement in visual acuity, photophobia and keratitis following treatment. Clinical assessment was carried out before, during and on the last visit following initiation of therapy.

Results

A total of 10 patients were included. There were five male and five female patients. The mean age was 11 years with age range of 3–42 years. The mean duration of treatment with topical tacrolimus was 26 months (range 8–46 months). There was improvement of photophobia in 7 out of 10 patients following therapy with topical tacrolimus. In three patients, the photophobia was persistent. There was no clinically detectable improvement in the severity of keratitis in all patients. The mean best corrected visual acuity was 0.1 before and following therapy.

Conclusion

Topical tacrolimus is effective in reducing the photophobia in patients with APS-1-associated keratitis, but showed no effects on the severity of keratitis.




Efficacy of topical cysteamine in nephropathic cystinosis

2017-08-23T04:20:51-07:00

Purpose

The aim of this study is to evaluate the efficacy of topical cysteamine 0.55% eye drops in the treatment of corneal cystine crystal deposits in patients with nephropathic cystinosis.

Methods

Thirty-two patients with nephropathic cystinosis were prospectively included in the study. Patients with corneal cystinosis were treated with topical cysteamine 0.55% eye drops. They were examined before treatment, on each monthly visit and after treatment at the last follow-up. Photophobia was classified as grade 0 (none) for no photophobia, grade 1 (mild) for photophobia in bright light, grade 2 (moderate) for photophobia in room light and grade 3 (severe) for photophobia in dim light. Corneal cystine crystals were graded as grade 0=none, grade 1=1–10 crystals/mm2, grade 2=11–50 crystals/mm2, grade 3=more than 50 crystals/mm2. The main outcome measure was evaluation of photophobia and resolution of corneal cystine crystals.

Results

There were 13 male and 19 female patients. The mean age was 8 years with an age range of 8 months to 19 years. The mean follow-up period was 4.1 years with a range of 2–8 years. Improvement of photophobia was not clinically significant in symptomatic patients. Patients displayed statistically significant worsening of corneal cystine deposits during the follow-up period.

Conclusions

This study has shown that topical 0.55% cysteamine eye drops may have limited effects in decreasing the corneal cystine deposits in patients with severe forms of nephropathic cystinosis.

Trial registration number

NCT02766855, Results.




Evidence of central sensitisation in those with dry eye symptoms and neuropathic-like ocular pain complaints: incomplete response to topical anaesthesia and generalised heightened sensitivity to evoked pain

2017-08-23T04:20:51-07:00

Objective

To evaluate how closely neuropathic-like ocular pain (NOP) symptoms align with a metric of central sensitisation (ie, the presence of persistent ocular pain after topical anaesthetic placement) in individuals with dry eye (DE) symptoms.

Design

Cross-sectional study of 224 individuals with DE symptoms seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP descriptors and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Subsequent analyses were performed to examine for differences between those with and without ocular pain after topical anaesthetic placement.

Results

The mean age was 62 years with 91% being men. DE symptoms and NOP symptoms were higher in subjects with persistent ocular pain after anaesthesia. Most DE signs were not related to persistent pain, with the exception of meibum quality. Individuals with persistent ocular pain also demonstrated greater sensitivity to evoked pain at testing sites on the forehead and forearm. When examining receiver operator characteristic curves considering persistent pain as a gold standard for central sensitisation within the corneal pathway, intensity of ocular pain ratings, Ocular Surface Disease Index scores and sensitivity to light provided the most robust relationships, each with an area under the curve of 0.72.

Conclusions

Individuals with DE symptoms and persistent ocular pain after topical proparacaine (a marker of central sensitisation to pain) more frequently report NOP-like symptoms and demonstrate increased sensitivity to evoked pain.




Accelerated transepithelial corneal cross-linking for progressive keratoconus: a prospective study of 12 months

2017-08-23T04:20:51-07:00

Background/aims

To evaluate the clinical results of accelerated transepithelial corneal cross-linking (CXL) in Japanese patients with progressive keratoconus (KCN).

Methods

Thirty eyes of 19 patients (16 male, 3 female patients) with progressive KCN were included. The mean age was 24.9±7.0 (range 16–38) years. All patients received ultraviolet A radiation for 3 min at an irradiance of 30 mW/cm2. Patients were followed up on the first day, at 1 week and 2 weeks, and at 1 month, 3 months, 6 months and 12 months postoperatively. Clinical examinations included measures of uncorrected visual acuity, best corrected visual acuity (BCVA), average keratometry (AveK), maximum keratometry (Kmax), central corneal thickness, thinnest corneal thickness (TCT), endothelial cell density, intraocular pressure and non-mydriatic indirect fundus examination. Patients were asked to report any pain or discomfort at each visit.

Results

There were no intraoperative or postoperative complications. All 30 eyes finished the follow-up. After 12 months, there was a significant decrease in Kmax (p<0.0001), AveK (p=0.003) and TCT (p=0.002), and a significant improvement in BCVA (p=0.001). There were no other significant changes. Pain or foreign-body sensation following CXL appeared in the first 2 days, but lasted no more than 1 week in all cases.

Conclusions

There were no complications associated with accelerated transepithelial corneal CXL, and the clinical outcomes were appraisable in a 12-month follow-up.

Trial registration number

UMIN000009372.




A method for quantifying limbal stem cell niches using OCT imaging

2017-08-23T04:20:51-07:00

Aims

To evaluate the efficacy of Fourier domain-optical coherence tomography (FD-OCT) in imaging and quantifying the limbal palisades of Vogt and to correlate these images with histological findings.

Methods

The superior and inferior limbal region of both eyes of 50 healthy volunteers were imaged by FD-OCT. Images were processed and analysed using Matlab software. In vitro immunofluorescent staining of a cadaveric donor limbus was analysed to correlate the presence of stem cells in the visualised structures.

Results

FD-OCT could successfully visualise limbal crypts and the palisades of Vogt in the limbus region. Fluorescent labelling confirmed the presence of stem cells in these structures. The mean palisade ridge width (PR) and the mean interpalisade epithelial rete peg width (ERP) were both of the order of 72 μm, leading to a palisade density (PD) of about 7.4 palisades/mm. A significant difference in PR, ERP and PD was seen between the inferior and superior sides of the right eye and the superior sides of the left and right eye(p<0.05.). A significant influence of iris colour on parameters PR, ERP and PD was found, and of age on PD and ERP (p<0.05).

Conclusions

In vivo OCT imaging is a safe and effective modality to image the limbus and can be used to visualise the palisades of Vogt. Image processing using Matlab software enabled quantification and density calculation of imaged limbal palisades of Vogt. This technique may enhance targeted limbal biopsies for transplantation.




Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial

2017-08-23T04:20:51-07:00

Background

The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up.

Methods

We reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome.

Results

27.2% of subjects had nerve fibre layer haemorrhages in at least one eye. Five of seven, 71% of subjects that met criteria for treatment failure, had nerve fibre layer haemorrhages in at least one eye (Fisher's exact test: p=0.02). There was a good correlation between presence of nerve fibre layer haemorrhages and Frisén grade (Spearman's correlation, p=0.002; r=0.271). Subjects with nerve fibre layer haemorrhages had a higher cerebrospinal fluid pressure (40.0 mm water, p=0.04). There was poor correlation between nerve fibre layer haemorrhages at baseline and the perimetric mean deviation change at 6 months. Cotton wool spots were present in 4% of subjects, exudates in 3% and pseudodrusen in 4%.

Conclusions

Nerve fibre layer haemorrhages are common in patients with IIH with mild visual loss and correlate with the severity of the papilloedema. They occur more frequently in treatment failure subjects and therefore may be associated with poor visual outcomes.

Trial registration number

NCT01003639, Post-results.




Peripapillary perfused capillary density in primary open-angle glaucoma across disease stage: an optical coherence tomography angiography study

2017-08-23T04:20:51-07:00

Aims

To assess peripapillary perfused capillary density (PCD) in primary open-angle glaucoma (POAG) across stage of disease.

Methods

In this observational, cross-sectional study, 60 eyes with varying stages of POAG and 24 control eyes were imaged on a spectral domain optical coherence tomography angiography system (AngioVue, Optovue, Fremont, California, USA) generating images centred on the optic nerve head. Major blood vessels were removed using custom automated software. PCD was calculated as a percentage as the ratio of pixels associated with perfused capillaries to the total number of pixels in the corresponding region-of-interest (ROI). Analysis of covariance was used to compare PCD among the subject groups and control for possible covariates. Area under the receiver operating characteristic curve (AROC) and sensitivity at 95% specificity were calculated to assess the capability of PCD to distinguish mild glaucoma from control. The Pearson's product-moment correlation coefficient was used to assess correlations between PCD and circumpapillary retinal nerve fibre layer thickness (cpRNFLT) and visual field mean deviation (MD).

Results

PCD demonstrated a progressive stepwise decrease from control eyes throughout worsening POAG stage at all ROIs. PCD demonstrated AROC and sensitivity values comparable to cpRNFLT and visual field parameters and exhibited significant correlations with cpRNFLT and MD at all corresponding ROIs.

Conclusions

PCD displayed significant correlations with morphological and functional indices and exhibited diagnostic capabilities comparable to currently employed clinical variables. Our preliminary results suggest that PCD analysis may prove to be a useful tool in monitoring POAG across stage and identifying early POAG.




Outcome of repeat trabeculectomies: long-term follow-up

2017-08-23T04:20:51-07:00

Aim

To assess medium-term to long-term outcomes of a cohort of repeat trabeculectomy augmented with mitomycin C (MMC).

Methods

A prospective evaluation of consecutive separate site repeat MMC-augmented trabeculectomies undertaken at a single institution between October 2000 and December 2012. Information regarding visual acuity (VA), intraocular pressure (IOP), visual field progression, postoperative interventions, surgery complications and success of surgery are presented.

Complete and qualified (ie, with or without glaucoma medication) success rates were presented on the basis of three levels of IOP control: ≤21, ≤17 and ≤14 mm Hg without hypotony or reoperation.

Results

Fifty-six eyes of 56 patients were evaluated. Thirty-seven per cent of the cohort had a previously augmented trabeculectomy. Mean follow-up was 6.3±3.4 years. At 60-month follow-up, 56.1% of patients achieved complete success and 75.6% achieved qualified success at the ≤21 mm Hg target. Complete and qualified success rates were 53.7% and 73.2%, respectively at the ≤17 mm Hg target and 51.2% and 61.0%, respectively at the ≤14 mm Hg target. Mean preoperative IOP was 29.1±6.0 mm Hg. At the 60-month follow-up visit the mean IOP was 12.6±4.7 mm Hg. Requirement for topical medications dropped from a mean of 2.9 to 0.5 per patient. No medications were required in 68.3%.

Conclusions

Safe repeat trabeculectomy technique with antimetabolite titrated against the individual patients risk profile can result in improved results in the medium-term to long-term.




Mitomycin C-augmented trabeculectomy: subtenon injection versus soaked sponges: a randomised clinical trial

2017-08-23T04:20:51-07:00

Background/aims

To compare the efficacy and safety of subtenon injection of mitomycin C (MMC) with that of conventional application of MMC-soaked sponges in trabeculectomy.

Methods

In this multicentre randomised clinical trial, 80 consecutive open-angle glaucoma cases were randomised into two groups; group 1 received a subtenon injection of 0.1 mL of 0.01% MMC, while group 2 received 0.02% MMC-soaked sponges. Primary outcome measure was intraocular pressure (IOP), and secondary outcome measures were endothelial cell count (ECC) changes and bleb morphology according to the Indiana Bleb Appearance Grading Scale. Outcome measures were compared at 1, 3 and 6 months postoperatively. Complete and qualified success was defined as IOP within 6–15 mm Hg without and with medications at month 6, respectively.

Results

Mean preoperative IOP was 21.8±5.1 in group 1, which reduced to 10.3±3.7 mm Hg at final visit (p<0.001). Corresponding values for group 2 were 21.8±5 and 10.8±3.5 mm Hg respectively (p<0.001). Complete success was 82.5% in both groups, and qualified success was 0 and 2.5% in groups 1 and 2, respectively. (p=0.316) The blebs tended to be more diffuse, less vascularised and shallower in group 1, at month 6 (p=0.45,<0.001 and <0.007 respectively). ECCs did not change significantly at final visit (p=0.813).

Conclusions

Subtenon injection of MMC is a safe and effective alternative to the conventional soaked sponge method. This method produces more favourable bleb morphology after trabeculectomy.

Trial registration number

NCT02385370, Post-results.




The role of day one postoperative review of intraocular pressure in modern vitrectomy surgery

2017-08-23T04:20:51-07:00

Background

With the introduction of sutureless 23-gauge (23G) vitrectomy, the risks for elevated intraocular pressure (IOP) and the need for day 1 review of IOP are less certain.

Aims

To assess current practice for postoperative review in the vitreoretinal service at a large tertiary referral centre; to assess whether day 1 review detected complications altering patient management; to identify risk factors for IOP spikes postvitrectomy.

Methods

Retrospective, consecutive case note review of all patients undergoing 23G vitrectomy at the study institution between April and June 2013. Patients had assessment at either day 1, week 2 and month 2 or week 2 and month 2. Linear regression analysis was performed to identify risk factors for IOP elevation.

Results

200 (89%) cases met inclusion criteria. Of these, 176 (89.3%) had day 1 review, 24 (12%) were seen at week 2. Mean follow-up was 120 days (range 20–360). Two cases (1%) required urgent surgical intervention due to early IOP complications. Combined laser was the only risk factor for a day 1 IOP spike (p=0.005). In total, 44 patients (22%) were treated for elevated IOP within 2 weeks following vitrectomy. No long-term complications were detected in these patients.

Conclusions

Day 1 review detected adverse events in 0.5% of study patients. No long-term complications were reported in the 22% of patients who received treatment for early postoperative IOP elevation. This observation has led to the removal of routine day 1 review from the surgical care pathway following routine uncomplicated vitrectomy at the study institution.




Preoperative aqueous humour flare values do not predict proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment

2017-08-23T04:20:52-07:00

Background/aims

Patients with rhegmatogenous retinal detachment (RRD) who develop postoperative proliferative vitreoretinopathy (PVR) have been found to have higher preoperative laser flare values than patients with RRD who do not develop this complication. Measurement of laser flare has therefore been proposed as an objective, rapid and non-invasive method for identifying high-risk patients. The purpose of our study was to validate the use of preoperative flare values as a predictor of PVR risk in two additional patient cohorts, and to confirm the sensitivity and specificity of this method for identifying high-risk patients.

Methods

We combined data from two independent prospective studies: centre 1 (120 patients) and centre 2 (194 patients). Preoperative aqueous humour flare was measured with a Kowa FM-500 Laser Flare Meter. PVR was defined as redetachment due to the formation of traction membranes that required reoperation within 6 months of initial surgery. Logistic regression and receiver operating characteristic analysis determined whether higher preoperative flare values were associated with an increased risk of postoperative PVR.

Results

PVR redetachment developed in 21/314 patients (6.7%). Median flare values differed significantly between centres, therefore analyses were done separately. Logistic regression showed a small but statistically significant increase in odds with increasing flare only for centre 2 (OR 1.014; p=0.005). Areas under the receiver operating characteristic showed low sensitivity and specificity: centre 1, 0.634 (95% CI 0.440 to 0.829) and centre 2, 0.731 (95% CI 0.598 to 0.865).

Conclusions

Preoperative laser flare measurements are inaccurate in discriminating between those patients with RRD at high and low risk of developing PVR.




Aqueous humour dynamics and biometrics in the ageing Chinese eye

2017-08-23T04:20:52-07:00

Aims

This study evaluates ocular biometrics and aqueous humour dynamics (AHD) in healthy Chinese volunteers to determine how the various ocular parameters interact to maintain physiological intraocular pressure (IOP) at all ages.

Methods

Sixty-nine volunteers enrolled in this cross-sectional study and were categorised into young (20–30 years) and old (≥50 years) groups. Measurements included IOP, ocular biometrics and AHD. Data were analysed using mixed model with random sampling to account for both eyes from the same individual. Spearman’s rank correlation with bootstrap resampling was used to find associations between parameters.

Results

Compared with young subjects, old subjects had significantly (p<0.05) thinner corneas (CCT; 549.7±5.7 vs 530.6±5.3 µm; mean±SEM), shallower anterior chambers (3.14±0.05 vs 2.37±0.05 mm) and slower aqueous flow (Fa; 3.0±0.1 vs 2.7±0.1 µL/min). Uveoscleral outflow slowed (Fu; 1.0±0.2 vs 0.7±0.1) but not significantly. A positive linear association between IOP and episcleral venous pressure was found (young: R2=0.16; old: R2=0.08). Negative correlation between Fa and CCT (R2=0.06) and positive correlation between Fa and outflow facility (R2=0.08) was found in old participants.

Conclusions

In the healthy ageing Chinese eye, IOP remains unchanged, while Fa slows, which is counterbalanced by slowing of Fu. Aqueous humour exits the eye preferentially through the trabecular route at all ages. Ageing is also associated with shallowing of the anterior chamber and thinning of the cornea. A slower Fa with lower outflow facility supports existence of autoregulatory mechanisms.




Pigmentary retinopathy, rod-cone dysfunction and sensorineural deafness associated with a rare mitochondrial tRNALys (m.8340G>A) gene variant

2017-08-23T04:20:52-07:00

Background/Aim

The rare mitochondrial DNA (mtDNA) variant m.8340G>A has been previously reported in the literature in a single, sporadic case of mitochondrial myopathy. In this report, we aim to investigate the case of a 39-year-old male patient with sensorineural deafness who presented to the eye clinic with nyctalopia, retinal pigmentary changes and bilateral cortical cataracts.

Methods

The patient was examined clinically and investigated with autofluorescence, full-field electroretinography, electro-oculogram and dark adaptometry. Sequencing of the mitochondrial genome in blood and muscle tissue was followed by histochemical and biochemical analyses together with single fibre studies of a muscle biopsy to confirm a mitochondrial aetiology.

Results

Electrophysiology, colour testing and dark adaptometry showed significant photoreceptor dysfunction with macular involvement. Sequencing the complete mitochondrial genome revealed a rare mitochondrial tRNALys (MTTK) gene variant—m.8340G>A—which was heteroplasmic in blood (11%) and skeletal muscle (65%) and cosegregated with cytochrome c oxidase-deficient fibres in single-fibre studies.

Conclusion

We confirm the pathogenicity of the rare mitochondrial m.8340G>A variant the basis of single-fibre segregation studies and its association with an expanded clinical phenotype. Our case expands the phenotypic spectrum of diseases associated with mitochondrial tRNA point mutations, highlighting the importance of considering a mitochondrial diagnosis in similar cases presenting to the eye clinic and the importance of further genetic testing if standard mutational analysis does not yield a result.