AIM:To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes.METHODS:Multistage random-cluster sampling was used to select 3098 non-indigenous Austr...AIM:To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes.METHODS:Multistage random-cluster sampling was used to select 3098 non-indigenous Australians aged 50 y or older(46.4%male)and 1738 indigenous Australians aged 40 y or older(41.1%male)from all levels of geographic remoteness in Australia.Participants underwent a standardised questionnaire to ascertain diabetes history,and a clinical examination to identify eye disease.We determined the prevalence of uncorrected refractive error,visually significant cataract,cataract surgery,age-related macular degeneration,glaucoma,ocular hypertension,retinal vein occlusion and epiretinal membrane among those with and without self-reported diabetes.RESULTS:Participants with self-reported diabetes had a higher prevalence of cataract surgery than those without diabetes(28.8%vs 16.9%,OR 1.78,95%CI:1.35-2.34 among non-indigenous Australians,and 11.3%vs 5.2%,OR 1.62,95%CI:1.22-2.14 among indigenous Australians).Diabetic retinopathy(DR)increased the odds of cataract surgery among self-reported diabetic indigenous and nonindigenous Australians(OR 1.89,P=0.004 and OR 2.33,P<0.001 respectively).Having diabetes for≥20 y and having vision-threatening DR increased the odds of cataract surgery among indigenous Australians with diabetes(OR 3.73,P=0.001 and 7.58,P<0.001,respectively).CONCLUSION:Most non-retinopathy ocular conditions are not associated with self-reported diabetes.However,to account for Australia’s worsening diabetes epidemic,interventions to reduce the impact of diabetes-related blindness should include increased cataract surgery services.展开更多
Dear Editor,We have studied with interest the publication"Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion"by Filippelli et al[1].The conclusion of this work is exci...Dear Editor,We have studied with interest the publication"Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion"by Filippelli et al[1].The conclusion of this work is exciting:the dialogue between gut and eye(brain)is now under the magnification lens and it deserves to continue the relationship studies,previously started by Filippelli et al[2]also on children.展开更多
目的探讨杞菊地黄丸治疗干眼症的效果。方法 2010年1月—2010年6月在PCO(Pennsylvania College of Optometry)眼科医院就诊的干眼症患者120例(240只眼),均以干眼为主诉,年龄45～72岁,身体健康无其他眼疾,无吸烟史,无接触镜佩戴史。所有...目的探讨杞菊地黄丸治疗干眼症的效果。方法 2010年1月—2010年6月在PCO(Pennsylvania College of Optometry)眼科医院就诊的干眼症患者120例(240只眼),均以干眼为主诉,年龄45～72岁,身体健康无其他眼疾,无吸烟史,无接触镜佩戴史。所有患者的McMonnies DEQ(McMonnies DryEye Questionnaire)量表评分为阳性,辨证为肝肾阴虚。随机分为杞菊地黄丸组和人工泪液组,各60例。分别予口服杞菊地黄丸,局部羧甲基纤维素钠滴眼液(Refresh Plus滴眼液)点眼,均治疗30 d。比较2组患者的治疗效果。结果1.泪液分泌试验(Schirmer I test,SIt):杞菊地黄丸组(14.27±1.41)mm/5 mins,人工泪液组(12.55±1.37)mm/5 mins(Z=-4.573,P=0.0000)。2.泪膜破裂时间(tear break-up time,TBUT):杞菊地黄丸组(18.07±3.58)s,人工泪液组(13.38±3.17)s(t=7.578,P=0.0000)。3.总有效率:杞菊地黄丸组96.70%,人工泪液组86.7%(Z=-3.310,P=0.001)。4.西医临床积分:杞菊地黄丸组6.27±3.27,人工泪液组9.47±3.57(Z=-4.87,P=0.000)。5.中医症状积分:杞菊地黄丸组3.10±1.398,人工泪液组3.81±1.387(Z=-2.370,P=0.018)。结论杞菊地黄丸治疗干眼症有效;除了西医常规的人工泪液外,也可以考虑使用相关的中医方法治疗干眼症。展开更多
e-related macular degeneration （AMD） causes irreversible loss of central vision for which there is no effective treatment. Incipient pathology is thought to occur in the retina for many years before AMD manifests fr...e-related macular degeneration （AMD） causes irreversible loss of central vision for which there is no effective treatment. Incipient pathology is thought to occur in the retina for many years before AMD manifests from midlife onwards to affect a large proportion of the elderly. Although genetic as well as non-genetic/environmental risks are recognized, its complex aetiology makes it difficult to identify susceptibility, or indeed what type of AMD develops or how quickly it progresses in different individuals. Here we summarize the literature describing how the Alzheimer＇s-linked amyloid beta （Aβ） group of misfolding proteins accumulate in the retina. The discovery of this key driver of Alzheimer＇s disease in the senescent retina was unexpected and surprising, enabling an altogether different perspective of AMD. We argue that Aβ fundamentally differs from other substances which accumulate in the ageing retina, and discuss our latest findings from a mouse model in which physiological amounts of Aβ were subretinally-injected to recapitulate salient features of early AMD within a short period. Our discoveries as well as those of others suggest the pattern of Aβ accumulation and pathology in donor aged/AMD tissues are closely reproduced in mice, including late-stage AMD phenotypes, which makes them highly attractive to study dynamic aspects of Aβ-mediated retinopathy. Furthermore, we discuss our findings revealing how Aβ behaves at single-cell resolution, and consider the long-term implications for neuroretinal function. We propose Aβ as a key element in switching to a diseased retinal phenotype, which is now being used as a biomarker for latestage AMD.展开更多
AIM： To explore the trends in the ophthalmic literature over a 5-year period in relation to country, research expenditure and demographics. METHODS： Articles published between 2009 and 2013 by the 20 highest-con...AIM： To explore the trends in the ophthalmic literature over a 5-year period in relation to country, research expenditure and demographics. METHODS： Articles published between 2009 and 2013 by the 20 highest-contributing countries in the 20 top- ranked ophthalmology journals were identified by their country of affiliation. The number of articles published and mean impact factor were measured per country for each year and trends explored using regression analysis with 5-year and 10-year forecasts calculated. Data on research expenditure was collected and tested for correlation with the number of articles and mean impact factor. RESULTS： The analysis included 19 338 articles. The USA, UK and Europe accounted for 60.2% of articles published, with the USA contributing 7388 articles （34.0%）. The USA also demonstrated the highest mean impact factor （3.5）. Research expenditure was significantly correlated with both research output （r=0,86, P〈0.001） and scholarly impact （r=0.42, P〈0.001）. China （P〈0.01）, Korea （P〈0.01） and India （P〈0.02） demonstrated a significant growth in research output over the study period. The research contribution of these three countries combined is forecasted to overtake that of Europe within ten years, with China expected to be the second-largest contributor within five years. These countries were also among those demonstrating the greatest growth in research expenditure. CONCLUSION： While the USA and European countries are major contributors of ophthalmic research, the productivity of some Asian countries is growing impressively. The contribution of China, Korea and Indiais forecasted to outweigh that of Europe by 2023. Research expenditure is highly correlated with research productivity and these trends reflect the differing economic priorities across the world.展开更多
AIM: To describe long term follow-up in a family with GUCY2D dominant cone dystrophy. METHODS: Optical coherence tomography scans and fundus autofluorescence images were obtained. Flash and pattern electroretinograms(...AIM: To describe long term follow-up in a family with GUCY2D dominant cone dystrophy. METHODS: Optical coherence tomography scans and fundus autofluorescence images were obtained. Flash and pattern electroretinograms(ERGs) and occipital pattern reversal visual evoked potentials were recorded. RESULTS: Two members of the same family(father and son) were identified to have the heterozygous R838 C mutation in the GUCY2D gene. The father presented at the age of 45 with bilateral bull’s eye maculopathy and temporal disc pallor. Over 13 y of serial follow up visits, the bull’s eye maculopathy progressed gradually into macular atrophy. Electrophysiological tests were significantly degraded suggesting poor macular function. Spectraldomain optical coherence tomography(SD-OCT) scans showed progressive loss and disruption of the ellipsoid layer at the foveal level. His son presented at the age of 16 with bilateral granular retinal pigment epithelial changes in both maculae. Electrophysiological testing was initially borderline normal but has gradually deteriorated to show reduced cone ERGs and macula function. SD-OCT demonstrated gradual macular thinning and atrophy bilaterally. Unlike his father, there was no disruption of the ellipsoid layer.CONCLUSION: Both family members exhibited gradual changes in their fundi, electrophysiological testing and multimodal imaging. Changes were milder than those observed in other mutations of the same gene.展开更多
Background: Mycobacterium (M) chelonei keratitis is a rare opportunistic eye infection that can cause significant morbidity when not being treated properly. The first case was documented by Gangadharam et al in 1978 a...Background: Mycobacterium (M) chelonei keratitis is a rare opportunistic eye infection that can cause significant morbidity when not being treated properly. The first case was documented by Gangadharam et al in 1978 and since then, a total of 49 cases were reported in the literature. One alarming fact is that more than 50% of cases were found in the Chinese population and mostly reported in recent years. The key to successful management of M. chelonei keratitis is early diagnosis by high index of suspicion. In order to alert ophthalmologists of this condition, we report a typical case of M. chelonei keratitis and review the literature of all the reported cases with special reference to its risk factors, treatments and outcome.Methods: The cases reported in the literature and a case of our own were reviewed and analyzed.Results: Our case was a 42-year-old gentleman who developed M. chlonei keratitis following pterygium surgery. He had typical clinical features of irregular infiltrates with radiating展开更多
AIM: To determine real life clinical outcomes in poorly responsive and treatment-nave neovascular age-related macular degeneration(nv AMD) patients using bimonthly fixed dosing aflibercept regimen.METHODS: This was a ...AIM: To determine real life clinical outcomes in poorly responsive and treatment-nave neovascular age-related macular degeneration(nv AMD) patients using bimonthly fixed dosing aflibercept regimen.METHODS: This was a retrospective study of 165 eyes with nv AMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata(PRN) ranibizumab/bevacizumab due to poor response(107 eyes), or treatment- nave( 58 eyes). Patients initially received 3-monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at month 0, 4, 10 and 12. Mean change in best-corrected visual acuity(BCVA) and central retinal thickness(CRT)from baseline were assessed using the Wilcoxon signedrank test. The proportion of patients maintaining BCVA(<15 letters loss) at 12 mo was also evaluated.RESULTS: Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and nave aflibercept groups respectively(P <0.01). BCVA was maintained in 95.3% of switched and 96.6% of nave patients. CRT at month 12 showed a decrease of -6.16 μm in the switched group and -35.36 μm in the nave group(P <0.01).Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6 mo, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.1 injections(nave group), 7.5 injections(switched group) and 4 clinic visits per year.CONCLUSION: Fixed bimonthly aflibercept is effective in both treatment-nave and poorly responsive nv AMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes.展开更多
AIM： To compare visual acuity and central macular thickness（CMT） changes in neovascular age-related macular degeneration patients treated with either 6weekly bevacizumab regimen or 4 weekly ranibizumab on an as req...AIM： To compare visual acuity and central macular thickness（CMT） changes in neovascular age-related macular degeneration patients treated with either 6weekly bevacizumab regimen or 4 weekly ranibizumab on an as required basis.·METHODS： Patients made an informed choice between bevacizumab 1.25 mg or ranibizumab 0.5 mg. The selected treatment was administered in the first 3 visits.Bevacizumab patients were followed-up 6 weekly and ranibizumab 4 weekly. Retreatment criteria was based on the reduction of 〉5 letters in the best-corrected visual acuity（BCVA）, the presence of retinal fluid on optical coherence tomography（OCT） or new retinal haemorrhage.·RESULTS： Visual acuity at 2y bevacizumab patients gained 7. 0 letters and ranibizumab 9. 2（ P = 0. 31, 95 %CI-6.4 to 2.0）. At 2y 86% of bevacizumab and 94%ranibizumab patients had not lost 15 letters or more（P =0.13）. Mean CMT decreased at 2y bevacizumab by 146 μm,ranibizumab 160 μm（P =0.72）. Mean number of injections was at 2y bevacizumzb 11.9, ranibizumab 10.3（P =0.023）.· CONCLUSION： Bevacizumab 6 weekly on an as required basis was not demonstrably non-inferior to ranibizumab 4 weekly pro re nata（prn） in terms of BCVA and change in CMT. In the bevacizumab group, one more injection was required in the second year compared to the ranibizumab group.展开更多
This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requiremen...This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.展开更多
Loss of central vision critical to everyday activities such as reading,face-recognition and driving due to damage in the central retina (the macula) is the leading cause of irreversible blindness amongst adults in the...Loss of central vision critical to everyday activities such as reading,face-recognition and driving due to damage in the central retina (the macula) is the leading cause of irreversible blindness amongst adults in the developed world.This condition,termed age-related macular degeneration (AMD),is a complex,chronic degenerative disease driven by a combination of genetic and lifestyle risk factors.Early signs of retinal changes in people as young as 30–40 years have been reported,although these individuals appear to be asymptomatic.However,by the age of 65,the disease is present in ~3% of individuals,which increases dramatically to affect 1/3 of individuals by the eighth decade of life.Early to intermediate AMD is estimated to affect ~150 million individuals globally,with another 10 million individuals suffering from end-stage,sight-threatening forms.These terminal stages are broadly grouped into dry (geographic atrophy,GA) or wet (choroidal neovascular,CNV) AMD (Sarks et al.,1988;Bird et al.,2014),with similar frequencies reported in patients.Recent advances in identifying genetic risk factors,including our discoveries in this field,indicate an initial shared pathology before progressing to aforementioned late-stage phenotypes.Currently,GA patients have no effective treatment,which may in part be due to the lack of good in vivo models for GA studies.Here,we summarize our new findings that describe an altogether new mouse model with GA-like features which shows progressive outer retinal pathology (Ibbett et al.,2019) that can be used to gain novel insights into GA and potentially as a tool for drug development.展开更多
AIM: To describe and evaluate a standardized protocol for measuring the choroidal thickness(Ch T) using enhanced depth imaging optical coherence tomography(EDI OCT).METHODS: Single 9 mm EDI OCT line scans across the f...AIM: To describe and evaluate a standardized protocol for measuring the choroidal thickness(Ch T) using enhanced depth imaging optical coherence tomography(EDI OCT).METHODS: Single 9 mm EDI OCT line scans across the fovea were used for this study. The protocol used in this study classified the EDI OCT images into four groups based on the appearance of the choroidal-scleral interface and suprachoroidal space. Two evaluation iterations of experiments were performed: first, the protocol was validated in a pilot study of 12 healthy eyes. Afterwards, the applicability of the protocol was tested in 82 eyes of patients with diabetes. Inter-observer and intra-observer agreements on image classifications were performed using Cohen’s kappa coefficient(κ). Intraclass correlation coefficient(ICC) and Bland-Altman’s methodology were used for the measurement of the Ch T.RESULTS: There was a moderate(κ=0.42) and perfect(κ =1) inter- and intra-observer agreements on image classifications from healthy eyes images and substantial(κ =0.66) and almost perfect(κ =0.86) agreements from diabetic eyes images. The proposed protocol showed excellent inter- and intra-observer agreements for the Ch T measurements on both, healthy eyes and diabetic eyes(ICC 】0.90 in all image categories). The Bland-Altman plot showed a relatively large Ch T measurement agreement in the scans that contained less visible choroidal outer boundary. CONCLUSION: A protocol to standardize Ch T measurements in EDI OCT images has been developed;the results obtained using this protocol show that the technique is accurate and reliable for routine clinical practice and research.展开更多
Dear Editor,My name is Georgios Tsokolas and I am currently working as Medical Retina Research Fellow at the Eye Unit of Southampton General Hospital in United Kingdom.
AIM: To investigate if there is any published evidence of impaired quality of life in conditions which are corrected by oculoplastic surgery and whether there is proven benefit in the quality of life such procedures. ...AIM: To investigate if there is any published evidence of impaired quality of life in conditions which are corrected by oculoplastic surgery and whether there is proven benefit in the quality of life such procedures. ·METHODS: We searched a number of databases to determine the level of evidence available for common conditions amenable to oculoplastic surgery. Search terms concentrated on quality of life measures rather than anatomical correction of deformities. ·RESULTS: The level of evidence available for different conditions was very variable. Certain conditions had extensive research documenting reduction in quality of life,with some evidence for improvement after surgery. Some other common conditions had little or no evidence supporting of reduction in quality of life to support the need for surgery. ·CONCLUSION: The evidence is sparse for quality of life improvement after some of our most commonly performed procedures. Many of these procedures are now being identified by primary care trusts(PCTs) as of "low clinical value",and are no longer being routinely commissioned in certain parts of the UK. There is a need to address this lack of evidence to determine whether oculoplastic surgery should continue to be commissioned by PCTs.展开更多
Approximately 10% of UK blindness registrations are attributed to glaucoma . The risk of glaucoma increases with age and it is estimated that the prevalence of chronic open angle glaucoma （COAG） is about 10% in whit...Approximately 10% of UK blindness registrations are attributed to glaucoma . The risk of glaucoma increases with age and it is estimated that the prevalence of chronic open angle glaucoma （COAG） is about 10% in white Europeans who are older than 70. There are an estimated 24.4 million people aged over 40 in England and around 489 000 people are currently affected by COAG.展开更多
Diabetic retinopathy (DR) is a complex multifactorial disease and one of the leading causes of visual impairment worldwide. DR pathogenesis is still not completely understood and, even if studies performed in the past...Diabetic retinopathy (DR) is a complex multifactorial disease and one of the leading causes of visual impairment worldwide. DR pathogenesis is still not completely understood and, even if studies performed in the past focused on microvascular dysfunction as the main event, growing body of scientific evidence has demonstrated an important role of inflammation and neurodegeneration in the onset and progression of DR. This review summarizes current literature on the role of inflammation in the pathogenesis and progression of DR. In particular, it focuses on clinical inflammatory biomarkers detectable with non-invasive retinal imaging, suggestive of a local inflammatory condition. Current available treatments are applicable only at advanced stages of disease, therefore, there is the need to detect biomarkers of subclinical or early DR that can help in DR management before irreversible damage occurs. A better understanding of inflammatory pathways involved in DR may permit to implement more specific and personalized therapeutic strategies and clinical biomarkers may be a helpful tool in the everyday clinical practice to direct the patient to the most appropriate treatment option.展开更多
Dear Editor,We describe,for the first time,the surgical management of two aphakic patients with corneal decompensation treated with concomitant ultrathin-Descemet stripping automated endothelial keratoplasty(UT-DSAEK)...Dear Editor,We describe,for the first time,the surgical management of two aphakic patients with corneal decompensation treated with concomitant ultrathin-Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and implantation of two different scleral-fixated(SF)intraocular lenses(IOLs),namely sutureless SF(SSF)Carlevale IOL(Soleko,Italy;Figure 1)or Morcher Type 90 L IOL(Morcher Gmb H,Germany;Figure 2).展开更多
Objective: Globally, Hepatitis B virus (HBV) infection remains a public health issue. It is a major cause of morbidity and mortality, especially in developing countries. Working in a healthcare setting particularly in...Objective: Globally, Hepatitis B virus (HBV) infection remains a public health issue. It is a major cause of morbidity and mortality, especially in developing countries. Working in a healthcare setting particularly in low resource area is a major risk factor for contracting HBV infection. Despite this, routine pre-operative screening for HBV infection has not yet practiced in many Nigerian hospitals. This study assessed the prevalence and associations of hepatitis B seropositivity in a rural south-eastern Nigerian population of ophthalmic surgical patients. Methods: This was a prospective cross-sectional survey of ophthalmic surgical patients at the Presbyterian Joint Hospital—a rural missionary eye care facility in south-eastern Nigeria, conducted between December 2012 and June 2013. Participant’s socio-demographic and clinical data and result of screening for hepatitis B surface antigen (HbSAg) were collected. Results: The participants (n = 100;males, 40;females, 50) were aged 52.9 SD ± 15.4 (range 1 - 88 years). They were predominantly farmers—45% and traders—26% who had cataract—58% and glaucoma—16% as their leading clinical diagnosis indicating ophthalmic surgical intervention. Of them only 2 (2.0%) were sero-positive for HbSAg. HBV seropositivity was not associated with age, gender or occupation. Conclusion: Though the prevalence of hepatitis B viral infection is low in this study, universal measures to prevent cross infection of the healthcare worker is indicated.展开更多
BACKGROUND AND OBJECTIVE: To report the outcome of patients 28 months followin g treatment with transpupillary thermotherapy (TTT) for classic and occult choro idal neovascularization (CNV) secondary to age-related ma...BACKGROUND AND OBJECTIVE: To report the outcome of patients 28 months followin g treatment with transpupillary thermotherapy (TTT) for classic and occult choro idal neovascularization (CNV) secondary to age-related macular degeneration. PA TIENTS AND METHODS: A nonrandomized pilot trial of 36 eyes of 33 patients was pe rformed. Eyes with angiographically defined CNV, 11 predominantly classical and 25 predominantly occult, were treated with large spot diode laser (810 nm) TTT f or 1 minute, the end point being no or minimal visible change. Outcome was asses sed with bestcorrected LogMAR visual acuity, clinical examination, and fluoresce in angiography. RESULTS: Patients were observed for a mean of 28.7 months (range , 18 to 40 months). The mean change in LogMAR visual acuity for predominantly cl assic membranes was-1.91 (standard deviation [SD]=4.3) and 5 of 11 (45.5%) eye s had a loss of 3 or more LogMAR lines. Predominantly classic membranes were clo sed in 9 of 11 eyes and stabilized in 2 of 11 eyes. The mean change in LogMAR vi sual acuity for predominantly occult membranes was-1.48 (SD=6.3) and 10 of 25 ( 40%) patients had a loss of 3 lines or more. Predominantly occult CNV was stabi lized in 25 of 25 cases, and recurrence developed in 2 of 25 cases; one of the l atter developed classic CNV. CONCLUSIONS: The mediumterm results for patients tr eated with TTT for both occult and classic CNV show good stability, with little visual loss and f ew recurrences. These data confirm the original findings of this study.展开更多
Purpose: Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA).We reanalysed the anaesthetic practice for vitreoretina...Purpose: Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA).We reanalysed the anaesthetic practice for vitreoretinal surgery in our unit over a 19- month period. Methods: Atotal of 1003 patients undergoing vitreoretinal surgery between August 2000 and February 2002 were studied. Type of surgery, patient pain score to anaesthesia and surgery, need for sedation and incidence of complications related to the local anaesthetic were recorded. Comparisons were made between this case series and previous data from our unit. Results: In total, 920/1003 (91.7% ) patients had LA. Total operations comprised 418 vitrectomies, 518 retinopexies with or without vitrectomy and 67 buckling procedures. More patients under the age of 35 years had LA than previously (60.2 vs 35.7% , P < 0.001). In 920/920 (100% ) of cases, LA was administered via intraconal injection, compared to 164/1221 (13.4% ) of procedures previously. Significantly more patients under the age of 35 years required sedation (35.9% )- than did older patients (19.2% ). Overall, use of sedation was significantly increased since our previous study (20.2 vs 7.8% ). Anaesthesia and surgery were well tolerated by patients. There were no cases of orbital haemorrhage or ocular perforation. Complications included bradycardia requiring atropine 1/920 (0.1% ) and chemosis 88/920 (9.6% ). Conclusions: LA is well tolerated and effective even in younger patients. Sedation may well be required in younger patients and for procedures involving scleral buckling. The main indication for GA was patient preference. Despite this, such patients accounted for only 5.2% of the total.展开更多
基金Supported by Department of Health of the Australian Government,Novartis Australia and the Peggy and Leslie Cranbourne FoundationThe Principal Investigator,Dr Mohamed Dirani,is supported by an NHMRC Career Development Fellowship(No.1090466)supported by an Australian Postgraduate Award scholarship。
文摘AIM:To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes.METHODS:Multistage random-cluster sampling was used to select 3098 non-indigenous Australians aged 50 y or older(46.4%male)and 1738 indigenous Australians aged 40 y or older(41.1%male)from all levels of geographic remoteness in Australia.Participants underwent a standardised questionnaire to ascertain diabetes history,and a clinical examination to identify eye disease.We determined the prevalence of uncorrected refractive error,visually significant cataract,cataract surgery,age-related macular degeneration,glaucoma,ocular hypertension,retinal vein occlusion and epiretinal membrane among those with and without self-reported diabetes.RESULTS:Participants with self-reported diabetes had a higher prevalence of cataract surgery than those without diabetes(28.8%vs 16.9%,OR 1.78,95%CI:1.35-2.34 among non-indigenous Australians,and 11.3%vs 5.2%,OR 1.62,95%CI:1.22-2.14 among indigenous Australians).Diabetic retinopathy(DR)increased the odds of cataract surgery among self-reported diabetic indigenous and nonindigenous Australians(OR 1.89,P=0.004 and OR 2.33,P<0.001 respectively).Having diabetes for≥20 y and having vision-threatening DR increased the odds of cataract surgery among indigenous Australians with diabetes(OR 3.73,P=0.001 and 7.58,P<0.001,respectively).CONCLUSION:Most non-retinopathy ocular conditions are not associated with self-reported diabetes.However,to account for Australia’s worsening diabetes epidemic,interventions to reduce the impact of diabetes-related blindness should include increased cataract surgery services.
文摘Dear Editor,We have studied with interest the publication"Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion"by Filippelli et al[1].The conclusion of this work is exciting:the dialogue between gut and eye(brain)is now under the magnification lens and it deserves to continue the relationship studies,previously started by Filippelli et al[2]also on children.
基金funded by the National Centre for the Replacement Refinement&Reduction of Animals in Research(NC3R:Grant#NC/L001152/1)the Macular Society,UK,National Eye Research Centrethe Gift of Sight Appeal
文摘e-related macular degeneration （AMD） causes irreversible loss of central vision for which there is no effective treatment. Incipient pathology is thought to occur in the retina for many years before AMD manifests from midlife onwards to affect a large proportion of the elderly. Although genetic as well as non-genetic/environmental risks are recognized, its complex aetiology makes it difficult to identify susceptibility, or indeed what type of AMD develops or how quickly it progresses in different individuals. Here we summarize the literature describing how the Alzheimer＇s-linked amyloid beta （Aβ） group of misfolding proteins accumulate in the retina. The discovery of this key driver of Alzheimer＇s disease in the senescent retina was unexpected and surprising, enabling an altogether different perspective of AMD. We argue that Aβ fundamentally differs from other substances which accumulate in the ageing retina, and discuss our latest findings from a mouse model in which physiological amounts of Aβ were subretinally-injected to recapitulate salient features of early AMD within a short period. Our discoveries as well as those of others suggest the pattern of Aβ accumulation and pathology in donor aged/AMD tissues are closely reproduced in mice, including late-stage AMD phenotypes, which makes them highly attractive to study dynamic aspects of Aβ-mediated retinopathy. Furthermore, we discuss our findings revealing how Aβ behaves at single-cell resolution, and consider the long-term implications for neuroretinal function. We propose Aβ as a key element in switching to a diseased retinal phenotype, which is now being used as a biomarker for latestage AMD.
文摘AIM： To explore the trends in the ophthalmic literature over a 5-year period in relation to country, research expenditure and demographics. METHODS： Articles published between 2009 and 2013 by the 20 highest-contributing countries in the 20 top- ranked ophthalmology journals were identified by their country of affiliation. The number of articles published and mean impact factor were measured per country for each year and trends explored using regression analysis with 5-year and 10-year forecasts calculated. Data on research expenditure was collected and tested for correlation with the number of articles and mean impact factor. RESULTS： The analysis included 19 338 articles. The USA, UK and Europe accounted for 60.2% of articles published, with the USA contributing 7388 articles （34.0%）. The USA also demonstrated the highest mean impact factor （3.5）. Research expenditure was significantly correlated with both research output （r=0,86, P〈0.001） and scholarly impact （r=0.42, P〈0.001）. China （P〈0.01）, Korea （P〈0.01） and India （P〈0.02） demonstrated a significant growth in research output over the study period. The research contribution of these three countries combined is forecasted to overtake that of Europe within ten years, with China expected to be the second-largest contributor within five years. These countries were also among those demonstrating the greatest growth in research expenditure. CONCLUSION： While the USA and European countries are major contributors of ophthalmic research, the productivity of some Asian countries is growing impressively. The contribution of China, Korea and Indiais forecasted to outweigh that of Europe by 2023. Research expenditure is highly correlated with research productivity and these trends reflect the differing economic priorities across the world.
基金Supported by Fight Against Blindness Charity Organization
文摘AIM: To describe long term follow-up in a family with GUCY2D dominant cone dystrophy. METHODS: Optical coherence tomography scans and fundus autofluorescence images were obtained. Flash and pattern electroretinograms(ERGs) and occipital pattern reversal visual evoked potentials were recorded. RESULTS: Two members of the same family(father and son) were identified to have the heterozygous R838 C mutation in the GUCY2D gene. The father presented at the age of 45 with bilateral bull’s eye maculopathy and temporal disc pallor. Over 13 y of serial follow up visits, the bull’s eye maculopathy progressed gradually into macular atrophy. Electrophysiological tests were significantly degraded suggesting poor macular function. Spectraldomain optical coherence tomography(SD-OCT) scans showed progressive loss and disruption of the ellipsoid layer at the foveal level. His son presented at the age of 16 with bilateral granular retinal pigment epithelial changes in both maculae. Electrophysiological testing was initially borderline normal but has gradually deteriorated to show reduced cone ERGs and macula function. SD-OCT demonstrated gradual macular thinning and atrophy bilaterally. Unlike his father, there was no disruption of the ellipsoid layer.CONCLUSION: Both family members exhibited gradual changes in their fundi, electrophysiological testing and multimodal imaging. Changes were milder than those observed in other mutations of the same gene.
基金Financial support:Supported in part by the Mrs.Annie Wong Eye Foundation
文摘Background: Mycobacterium (M) chelonei keratitis is a rare opportunistic eye infection that can cause significant morbidity when not being treated properly. The first case was documented by Gangadharam et al in 1978 and since then, a total of 49 cases were reported in the literature. One alarming fact is that more than 50% of cases were found in the Chinese population and mostly reported in recent years. The key to successful management of M. chelonei keratitis is early diagnosis by high index of suspicion. In order to alert ophthalmologists of this condition, we report a typical case of M. chelonei keratitis and review the literature of all the reported cases with special reference to its risk factors, treatments and outcome.Methods: The cases reported in the literature and a case of our own were reviewed and analyzed.Results: Our case was a 42-year-old gentleman who developed M. chlonei keratitis following pterygium surgery. He had typical clinical features of irregular infiltrates with radiating
文摘AIM: To determine real life clinical outcomes in poorly responsive and treatment-nave neovascular age-related macular degeneration(nv AMD) patients using bimonthly fixed dosing aflibercept regimen.METHODS: This was a retrospective study of 165 eyes with nv AMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata(PRN) ranibizumab/bevacizumab due to poor response(107 eyes), or treatment- nave( 58 eyes). Patients initially received 3-monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at month 0, 4, 10 and 12. Mean change in best-corrected visual acuity(BCVA) and central retinal thickness(CRT)from baseline were assessed using the Wilcoxon signedrank test. The proportion of patients maintaining BCVA(<15 letters loss) at 12 mo was also evaluated.RESULTS: Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and nave aflibercept groups respectively(P <0.01). BCVA was maintained in 95.3% of switched and 96.6% of nave patients. CRT at month 12 showed a decrease of -6.16 μm in the switched group and -35.36 μm in the nave group(P <0.01).Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6 mo, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.1 injections(nave group), 7.5 injections(switched group) and 4 clinic visits per year.CONCLUSION: Fixed bimonthly aflibercept is effective in both treatment-nave and poorly responsive nv AMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes.
文摘AIM： To compare visual acuity and central macular thickness（CMT） changes in neovascular age-related macular degeneration patients treated with either 6weekly bevacizumab regimen or 4 weekly ranibizumab on an as required basis.·METHODS： Patients made an informed choice between bevacizumab 1.25 mg or ranibizumab 0.5 mg. The selected treatment was administered in the first 3 visits.Bevacizumab patients were followed-up 6 weekly and ranibizumab 4 weekly. Retreatment criteria was based on the reduction of 〉5 letters in the best-corrected visual acuity（BCVA）, the presence of retinal fluid on optical coherence tomography（OCT） or new retinal haemorrhage.·RESULTS： Visual acuity at 2y bevacizumab patients gained 7. 0 letters and ranibizumab 9. 2（ P = 0. 31, 95 %CI-6.4 to 2.0）. At 2y 86% of bevacizumab and 94%ranibizumab patients had not lost 15 letters or more（P =0.13）. Mean CMT decreased at 2y bevacizumab by 146 μm,ranibizumab 160 μm（P =0.72）. Mean number of injections was at 2y bevacizumzb 11.9, ranibizumab 10.3（P =0.023）.· CONCLUSION： Bevacizumab 6 weekly on an as required basis was not demonstrably non-inferior to ranibizumab 4 weekly pro re nata（prn） in terms of BCVA and change in CMT. In the bevacizumab group, one more injection was required in the second year compared to the ranibizumab group.
文摘This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.
基金supported by the Awards to JAR from the NC3R(NC/L0001152/1),Macular Society UK,National Eye Research Centre,Alzheimer’s Research UK(ARUK) South Coast Network,Fight for Sight,Retina UK and the Gift of Sight Appeal
文摘Loss of central vision critical to everyday activities such as reading,face-recognition and driving due to damage in the central retina (the macula) is the leading cause of irreversible blindness amongst adults in the developed world.This condition,termed age-related macular degeneration (AMD),is a complex,chronic degenerative disease driven by a combination of genetic and lifestyle risk factors.Early signs of retinal changes in people as young as 30–40 years have been reported,although these individuals appear to be asymptomatic.However,by the age of 65,the disease is present in ~3% of individuals,which increases dramatically to affect 1/3 of individuals by the eighth decade of life.Early to intermediate AMD is estimated to affect ~150 million individuals globally,with another 10 million individuals suffering from end-stage,sight-threatening forms.These terminal stages are broadly grouped into dry (geographic atrophy,GA) or wet (choroidal neovascular,CNV) AMD (Sarks et al.,1988;Bird et al.,2014),with similar frequencies reported in patients.Recent advances in identifying genetic risk factors,including our discoveries in this field,indicate an initial shared pathology before progressing to aforementioned late-stage phenotypes.Currently,GA patients have no effective treatment,which may in part be due to the lack of good in vivo models for GA studies.Here,we summarize our new findings that describe an altogether new mouse model with GA-like features which shows progressive outer retinal pathology (Ibbett et al.,2019) that can be used to gain novel insights into GA and potentially as a tool for drug development.
基金Supported by Foundation for the Prevention of Blindness
文摘AIM: To describe and evaluate a standardized protocol for measuring the choroidal thickness(Ch T) using enhanced depth imaging optical coherence tomography(EDI OCT).METHODS: Single 9 mm EDI OCT line scans across the fovea were used for this study. The protocol used in this study classified the EDI OCT images into four groups based on the appearance of the choroidal-scleral interface and suprachoroidal space. Two evaluation iterations of experiments were performed: first, the protocol was validated in a pilot study of 12 healthy eyes. Afterwards, the applicability of the protocol was tested in 82 eyes of patients with diabetes. Inter-observer and intra-observer agreements on image classifications were performed using Cohen’s kappa coefficient(κ). Intraclass correlation coefficient(ICC) and Bland-Altman’s methodology were used for the measurement of the Ch T.RESULTS: There was a moderate(κ=0.42) and perfect(κ =1) inter- and intra-observer agreements on image classifications from healthy eyes images and substantial(κ =0.66) and almost perfect(κ =0.86) agreements from diabetic eyes images. The proposed protocol showed excellent inter- and intra-observer agreements for the Ch T measurements on both, healthy eyes and diabetic eyes(ICC 】0.90 in all image categories). The Bland-Altman plot showed a relatively large Ch T measurement agreement in the scans that contained less visible choroidal outer boundary. CONCLUSION: A protocol to standardize Ch T measurements in EDI OCT images has been developed;the results obtained using this protocol show that the technique is accurate and reliable for routine clinical practice and research.
文摘Dear Editor,My name is Georgios Tsokolas and I am currently working as Medical Retina Research Fellow at the Eye Unit of Southampton General Hospital in United Kingdom.
文摘AIM: To investigate if there is any published evidence of impaired quality of life in conditions which are corrected by oculoplastic surgery and whether there is proven benefit in the quality of life such procedures. ·METHODS: We searched a number of databases to determine the level of evidence available for common conditions amenable to oculoplastic surgery. Search terms concentrated on quality of life measures rather than anatomical correction of deformities. ·RESULTS: The level of evidence available for different conditions was very variable. Certain conditions had extensive research documenting reduction in quality of life,with some evidence for improvement after surgery. Some other common conditions had little or no evidence supporting of reduction in quality of life to support the need for surgery. ·CONCLUSION: The evidence is sparse for quality of life improvement after some of our most commonly performed procedures. Many of these procedures are now being identified by primary care trusts(PCTs) as of "low clinical value",and are no longer being routinely commissioned in certain parts of the UK. There is a need to address this lack of evidence to determine whether oculoplastic surgery should continue to be commissioned by PCTs.
文摘Approximately 10% of UK blindness registrations are attributed to glaucoma . The risk of glaucoma increases with age and it is estimated that the prevalence of chronic open angle glaucoma （COAG） is about 10% in white Europeans who are older than 70. There are an estimated 24.4 million people aged over 40 in England and around 489 000 people are currently affected by COAG.
文摘Diabetic retinopathy (DR) is a complex multifactorial disease and one of the leading causes of visual impairment worldwide. DR pathogenesis is still not completely understood and, even if studies performed in the past focused on microvascular dysfunction as the main event, growing body of scientific evidence has demonstrated an important role of inflammation and neurodegeneration in the onset and progression of DR. This review summarizes current literature on the role of inflammation in the pathogenesis and progression of DR. In particular, it focuses on clinical inflammatory biomarkers detectable with non-invasive retinal imaging, suggestive of a local inflammatory condition. Current available treatments are applicable only at advanced stages of disease, therefore, there is the need to detect biomarkers of subclinical or early DR that can help in DR management before irreversible damage occurs. A better understanding of inflammatory pathways involved in DR may permit to implement more specific and personalized therapeutic strategies and clinical biomarkers may be a helpful tool in the everyday clinical practice to direct the patient to the most appropriate treatment option.
文摘Dear Editor,We describe,for the first time,the surgical management of two aphakic patients with corneal decompensation treated with concomitant ultrathin-Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and implantation of two different scleral-fixated(SF)intraocular lenses(IOLs),namely sutureless SF(SSF)Carlevale IOL(Soleko,Italy;Figure 1)or Morcher Type 90 L IOL(Morcher Gmb H,Germany;Figure 2).
文摘Objective: Globally, Hepatitis B virus (HBV) infection remains a public health issue. It is a major cause of morbidity and mortality, especially in developing countries. Working in a healthcare setting particularly in low resource area is a major risk factor for contracting HBV infection. Despite this, routine pre-operative screening for HBV infection has not yet practiced in many Nigerian hospitals. This study assessed the prevalence and associations of hepatitis B seropositivity in a rural south-eastern Nigerian population of ophthalmic surgical patients. Methods: This was a prospective cross-sectional survey of ophthalmic surgical patients at the Presbyterian Joint Hospital—a rural missionary eye care facility in south-eastern Nigeria, conducted between December 2012 and June 2013. Participant’s socio-demographic and clinical data and result of screening for hepatitis B surface antigen (HbSAg) were collected. Results: The participants (n = 100;males, 40;females, 50) were aged 52.9 SD ± 15.4 (range 1 - 88 years). They were predominantly farmers—45% and traders—26% who had cataract—58% and glaucoma—16% as their leading clinical diagnosis indicating ophthalmic surgical intervention. Of them only 2 (2.0%) were sero-positive for HbSAg. HBV seropositivity was not associated with age, gender or occupation. Conclusion: Though the prevalence of hepatitis B viral infection is low in this study, universal measures to prevent cross infection of the healthcare worker is indicated.
文摘BACKGROUND AND OBJECTIVE: To report the outcome of patients 28 months followin g treatment with transpupillary thermotherapy (TTT) for classic and occult choro idal neovascularization (CNV) secondary to age-related macular degeneration. PA TIENTS AND METHODS: A nonrandomized pilot trial of 36 eyes of 33 patients was pe rformed. Eyes with angiographically defined CNV, 11 predominantly classical and 25 predominantly occult, were treated with large spot diode laser (810 nm) TTT f or 1 minute, the end point being no or minimal visible change. Outcome was asses sed with bestcorrected LogMAR visual acuity, clinical examination, and fluoresce in angiography. RESULTS: Patients were observed for a mean of 28.7 months (range , 18 to 40 months). The mean change in LogMAR visual acuity for predominantly cl assic membranes was-1.91 (standard deviation [SD]=4.3) and 5 of 11 (45.5%) eye s had a loss of 3 or more LogMAR lines. Predominantly classic membranes were clo sed in 9 of 11 eyes and stabilized in 2 of 11 eyes. The mean change in LogMAR vi sual acuity for predominantly occult membranes was-1.48 (SD=6.3) and 10 of 25 ( 40%) patients had a loss of 3 lines or more. Predominantly occult CNV was stabi lized in 25 of 25 cases, and recurrence developed in 2 of 25 cases; one of the l atter developed classic CNV. CONCLUSIONS: The mediumterm results for patients tr eated with TTT for both occult and classic CNV show good stability, with little visual loss and f ew recurrences. These data confirm the original findings of this study.
文摘Purpose: Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA).We reanalysed the anaesthetic practice for vitreoretinal surgery in our unit over a 19- month period. Methods: Atotal of 1003 patients undergoing vitreoretinal surgery between August 2000 and February 2002 were studied. Type of surgery, patient pain score to anaesthesia and surgery, need for sedation and incidence of complications related to the local anaesthetic were recorded. Comparisons were made between this case series and previous data from our unit. Results: In total, 920/1003 (91.7% ) patients had LA. Total operations comprised 418 vitrectomies, 518 retinopexies with or without vitrectomy and 67 buckling procedures. More patients under the age of 35 years had LA than previously (60.2 vs 35.7% , P < 0.001). In 920/920 (100% ) of cases, LA was administered via intraconal injection, compared to 164/1221 (13.4% ) of procedures previously. Significantly more patients under the age of 35 years required sedation (35.9% )- than did older patients (19.2% ). Overall, use of sedation was significantly increased since our previous study (20.2 vs 7.8% ). Anaesthesia and surgery were well tolerated by patients. There were no cases of orbital haemorrhage or ocular perforation. Complications included bradycardia requiring atropine 1/920 (0.1% ) and chemosis 88/920 (9.6% ). Conclusions: LA is well tolerated and effective even in younger patients. Sedation may well be required in younger patients and for procedures involving scleral buckling. The main indication for GA was patient preference. Despite this, such patients accounted for only 5.2% of the total.
