4,258 results on '"Division of Ophthalmology"'
Search Results
2. A Clinical Trial of the Treatment of Fungal Corneal Ulcers With Povidone-Iodine
- Author
-
Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center and Sherwin J. Isenberg, Chief, Division of Ophthalmology
- Published
- 2014
3. Effects of Detergent-Based Protocols on Decellularization of Corneas With Sclerocorneal Limbus. Evaluation of Regional Differences
- Author
-
Santiago Medialdea, Ingrid Garzón, Miguel Gonzalez-Andrades, Miguel Alaminos, Mario Rivera-Izquierdo, Elena González-Andrades, Antonio Campos, Víctor Carriel, [González-Andrades,M, Carriel,V, Rivera-Izquierdo,M, Garzón,I, González-Andrades,E, Alaminos,M, Campos,A] Tissue Engineering Group, Department of Histology, University of Granada, Spain. Instituto de Investigación Biosanitaria ibs.GRANADA, Spain. [González-Andrades,M] Division of Ophthalmology, University Hospital San Cecilio, Granada, Spain. [Medialdea,S] Division of Ophthalmology, University Hospital Virgen de las Nieves, Granada, Spain., and Supported by grants from the Spanish Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (I+D+I) from the Spanish Ministry of Economy and Competitiveness (Instituto de Salud Carlos III), Grants FIS PI11/2680 and FIS PI11/1582 (cofinanced by FEDER funds, European Union), and by Grants PI-0462-2010 and P10-CTS-6060 from Consejería de Igualdad, Salud y Políticas Sociales and Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucia, Spain.
- Subjects
Pathology ,Lámina limitante anterior ,Decellularization protocols ,Anatomy::Sense Organs::Eye::Anterior Eye Segment::Cornea::Descemet Membrane [Medical Subject Headings] ,Lámina limitante posterior ,Extracellular matrix ,Benzalkonium chloride ,Tissue engineering ,Cornea regions ,Cornea ,Organisms::Eukaryota::Animals [Medical Subject Headings] ,Anatomy::Sense Organs::Eye::Anterior Eye Segment::Cornea::Bowman Membrane [Medical Subject Headings] ,Geographic difference ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Ophthalmologic Surgical Procedures::Refractive Surgical Procedures::Corneal Transplantation [Medical Subject Headings] ,Decellularization ,Dodecil sulfato de sodio ,Chemistry ,Chemicals and Drugs::Organic Chemicals::Amines::Quaternary Ammonium Compounds::Benzylammonium Compounds [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Artiodactyla::Swine [Medical Subject Headings] ,Compuestos de benzalconio ,Trasplante de córnea ,Chemicals and Drugs::Carbohydrates::Polysaccharides::Proteoglycans [Medical Subject Headings] ,medicine.anatomical_structure ,Anatomy::Sense Organs::Eye::Anterior Eye Segment::Cornea [Medical Subject Headings] ,Sclerocorneal Limbus ,medicine.drug ,medicine.medical_specialty ,Proteoglicanos ,Biomedical Engineering ,Chemicals and Drugs::Organic Chemicals::Alcohols::Glycols::Ethylene Glycols::Polyethylene Glycols::Octoxynol [Medical Subject Headings] ,Article ,Andrology ,Sodio ,medicine ,Chemicals and Drugs::Inorganic Chemicals::Elements::Metals, Alkali::Sodium [Medical Subject Headings] ,Anatomy::Sense Organs::Eye::Anterior Eye Segment::Cornea::Limbus Corneae [Medical Subject Headings] ,Chemicals and Drugs::Organic Chemicals::Alcohols::Fatty Alcohols::Dodecanol::Sodium Dodecyl Sulfate [Medical Subject Headings] ,Detergentes ,Sclerocorneal limbus ,Limbo de la córnea ,Chemicals and Drugs::Macromolecular Substances::Polymers::Biopolymers::Collagen [Medical Subject Headings] ,Octoxinol ,Porcinos ,eye diseases ,Córnea ,Ophthalmology ,Animales ,Colágeno ,Chemicals and Drugs::Chemical Actions and Uses::Specialty Uses of Chemicals::Surface-Active Agents::Detergents [Medical Subject Headings] ,sense organs ,Regional differences - Abstract
JOURNAL ARTICLE; PURPOSE In this work, we decellularized whole porcine corneas including the sclerocorneal limbus (SCL) and we evaluated regional differences in order to identify an efficient method to decellularize whole corneas for future clinical use. METHODS We analyzed the efficiency of four decellularization protocols based on benzalkonium chloride (BAK), Igepal, sodium dodecyl sulfate (SDS), and Triton X-100 detergents on whole porcine corneas. RESULTS Results showed that the decellularization efficiency of most protocols was low, with the specific protocol resulting in more efficient levels of decellularization being 0.1% SDS for 48 hours, especially in the medium and posterior cornea regions. A significant correlation was found between the decellularization efficiency and the concentration of agent used (P = 0.0174; r = 0.1540), but not for the incubation time (P > 0.05). The analysis of cornea components preservation demonstrated that all protocols were able to preserve the integrity of the Bowman's layer and Descemet's membrane. Although the collagen structure was partially altered, the global decellularization groups showing highest preservation of the ECM collagen contents and orientation were Igepal and SDS, with differences among the three regions of the cornea. All global groups showed high levels of proteoglycan and glycoprotein preservation after decellularization, with the best results were found in the SDS group followed by the Igepal group. CONCLUSIONS These results suggest that very powerful protocols are necessary for whole-cornea decellularization. For the generation of lamelar corneas for clinical use, decellularization regional differences should be taken into account. TRANSLATIONAL RELEVANCE Decellularized whole corneas may be potential therapeutic agents for lamelar keratoplasty. Yes
- Published
- 2015
4. MRP4 knockdown enhances migration, suppresses apoptosis, and produces aggregated morphology in human retinal vascular endothelial cells
- Author
-
Negi, Akira [Department of Surgery Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017 (Japan)]
- Published
- 2010
- Full Text
- View/download PDF
5. Effect of irradiation on neovascularization in rat skinfold chambers: Implications for clinical trials of low-dose radiotherapy for wet-type age-related macular degeneration
- Author
-
Tamai, Makoto [Department of Ophthalmology and Otolaryngology, Division of Ophthalmology and Visual Science, Tohoku University, Graduate School of Medicine and School of Medicine, Sendai (Japan)]
- Published
- 2004
- Full Text
- View/download PDF
6. Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuity
- Author
-
Pierre-Henry Gabrielle, Jay Chhablani, Dinah Zur, Patricio J. Rodríguez-Valdés, Ermete Giancipoli, Catharina Busch, Voraporn Chaikitmongkol, Matias Iglicki, Matus Rehak, Marco Lupidi, Zafer Cebeci, Ana Rita Santos, Małgorzata Ozimek, Paradee Kunavisarut, Inês Laíns, Mali Okada, Valentin Degenhardt, Adrian T. Fung, Samantha Fraser-Bell, Anna Sala-Puigdollers, Assaf Hilely, Anat Loewenstein, Department of Ophthalmology [Leipzig], University Hospital Leipzig, Royal Victorian Eye and Ear Hospital, Division of Ophthalmology, Tel Aviv Sourasky Medical Center [Te Aviv], Sackler Faculty of Medicine, Tel Aviv University [Tel Aviv], Discipline of Clinical Ophthalmology and Eye Health, The University of Sydney, Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey (ITESM)-Tecnológico de Monterrey (ITESM), Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University -Istanbul University, Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia-University of Perugia, Westmead Hospital [Sydney], Faculty of Medicine and Health Sciences, Macquarie University Hospital, Partenaires INRAE-Partenaires INRAE, Ophthalmology Department, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari-University of Sassari-Eye Clinic, University of Sassari-University of Sassari, Department of Biomedical Sciences, University of Sassari, Retina Division, Faculty of Medicine, Chiang Mai University (CMU)-Chiang Mai University (CMU)-Faculty of Medicine, Chiang Mai University (CMU)-Chiang Mai University (CMU), University of Coimbra [Portugal] (UC), Association for Innovation and Biomedical Research on Light and Image (AIBILI), Massachusetts Eye and Ear, Harvard Medical School [Boston] (HMS), Department of Orthoptics, Superior School of Health, Polytechnic Institute of Porto-Polytechnic Institute of Porto, Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, UPMC Eye Center, University of Pittsburgh (PITT), Pennsylvania Commonwealth System of Higher Education (PCSHE)-Pennsylvania Commonwealth System of Higher Education (PCSHE), L.V. Prasad Eye Institute, Partenaires INRAE, Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Heidelberg University Hospital [Heidelberg], Incumbent, Sydney A. Fox chair in Ophthalmology, Tel Aviv University [Tel Aviv]-Tel Aviv University [Tel Aviv], Private Retina Service, University of Buenos Aires [Argentina], and Repositório Científico do Instituto Politécnico do Porto
- Subjects
Male ,Vascular Endothelial Growth Factor A ,Visual acuity ,observation ,genetic structures ,goog visual acuity ,[SDV]Life Sciences [q-bio] ,Visual Acuity ,Observation ,Angiogenesis Inhibitors ,Diabetic macular oedema ,0302 clinical medicine ,Diabetic retinopathy ,Fluorescein Angiography ,intravitreal therapy ,diabetes ,Diabetes ,General Medicine ,Middle Aged ,Bevacizumab ,Treatment Outcome ,diabetic macular oedema ,Cohort ,Female ,medicine.symptom ,Tomography, Optical Coherence ,medicine.medical_specialty ,Fundus Oculi ,Macular Edema ,03 medical and health sciences ,Visual acuity loss ,Diabetes mellitus ,Ophthalmology ,Ranibizumab ,medicine ,Humans ,Good visual acuity ,[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,Retrospective Studies ,Diabetic Retinopathy ,macular oedema ,business.industry ,Intravitreal therapy ,Retrospective cohort study ,Odds ratio ,medicine.disease ,eye diseases ,Macular Oedema ,030221 ophthalmology & optometry ,sense organs ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
International audience; Purpose: To investigate clinical baseline characteristics and optical coherence tomography biomarkers predicting visual loss during observation in eyes with diabetic macular oedema (DMO) and good baseline visual acuity (VA). Methods: A sub-analysis of a 12-month, retrospective study, including patients with baseline VA ≤0.1 logMAR (≥20/25 Snellen) and centre-involving DMO. The primary outcome measure was the correlation between baseline characteristics and VA loss ≥10 letters during follow-up. Results: A total of 249 eyes were included in the initial study, of which 147 eyes were observed and 80 eyes received anti-vascular endothelial growth factor (VEGF) treatment at baseline. Visual acuity (VA) loss ≥10 letters occurred in 21.8% (observed cohort) and in 24.3% (treated cohort), respectively. Within observed eyes, presence of hyperreflective foci [HRF; odds ratio (OR): 3.18, p = 0.046], and disorganization of inner retina layers (DRIL; OR: 2.71, p = 0.026) were associated with a higher risk of VA loss ≥10 letters. In observed eyes with a combined presence of HRF, DRIL and ellipsoid zone (EZ) disruption, the risk of VA loss was further increased (OR: 3.86, p = 0.034). In eyes with combined presence of DRIL, HRF and EZ disruption, risk of VA loss was 46.7% (7/15 eyes) in the observed cohort, and 26.3% (5/19 eyes) in the treated cohort (p = 0.26). Conclusion: Patients with DMO and good baseline VA, managed by observation, are of increased risk for VA loss if DRIL, HRF and EZ disruption are present at baseline. Earlier treatment with anti-VEGF in these patients may potentially decrease the risk of VA loss at 12 months.
- Published
- 2019
7. Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
- Author
-
Atchara Amphornphruet, Pierre-Henry Gabrielle, Jay Chhablani, Dinah Zur, Matus Rehak, Zafer Cebeci, Matias Iglicki, Jan-Darius Unterlauft, Isaac Hindi, Valentin Degenhardt, Marco Lupidi, Inês Laíns, Patricio J. Rodríguez-Valdés, Catharina Busch, Samantha Fraser-Bell, Aude Couturier, Ana Rita Santos, Ermete Giancipoli, Carlo Cagini, Kushal Agrawal, Giuseppe D'Amico Ricci, Valérie Mané-Tauty, Anat Loewenstein, Voraporn Chaikitmongkol, Laboratoire LTEE, University of Sydney, National University of Central Buenos Aires, Università degli Studi di Perugia (UNIPG), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Chiang Mai University (CMU), Università degli Studi di Sassari, Tecnológico de Monterrey (ITESM), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Université Bourgogne Franche-Comté [COMUE] (UBFC), Department of Ophthalmology, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Faculty of Medicine, Universidade de Coimbra, Association for Innovation and Biomedical Research on Light and Image (AIBILI), Harvard Medical School [Boston] (HMS), School of Allied Health, Australian Catholic University (ACU), Istanbul University, Rajavithi Hospital, Partenaires INRAE, University Hospital of Heidelberg, Division of Ophthalmology, Children’s Hospital of Philadelphia (CHOP ), Tel Aviv University [Tel Aviv], Jupiter Hospital, University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis] (UPMC), L.V. Prasad Eye Institute, and Repositório Científico do Instituto Politécnico do Porto
- Subjects
Male ,Vascular Endothelial Growth Factor A ,intravitreal ,Time Factors ,Visual acuity ,genetic structures ,implant ,Endocrinology, Diabetes and Metabolism ,Drug Resistance ,Visual Acuity ,Angiogenesis Inhibitors ,030204 cardiovascular system & hematology ,Long- term outcome ,0302 clinical medicine ,Endocrinology ,diabetic ,Medicine ,Dexamethasone implant ,Drug Implants ,Anti vegf ,anti-vegf ,Drug Substitution ,Real world outcomes ,Anti-VEGF therapy ,Intravitreal therapy ,Long-term outcome ,Refractory diabetic macular edema ,General Medicine ,Middle Aged ,[SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism ,3. Good health ,Bevacizumab ,Treatment Outcome ,Intravitreal Injections ,outcome ,Population study ,Female ,medicine.symptom ,medicine.drug ,medicine.medical_specialty ,Diabetic macular edema ,030209 endocrinology & metabolism ,dexamethasone ,Drug Administration Schedule ,Macular Edema ,03 medical and health sciences ,Ophthalmology ,Diabetes mellitus ,Internal Medicine ,Humans ,[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,Dexamethasone ,Aged ,Retrospective Studies ,long-term ,therapy ,Diabetic Retinopathy ,business.industry ,macular ,medicine.disease ,eye diseases ,refractory ,Implant ,business ,edema ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Part of the following topical collections: Eye Complications of Diabetes https://link.springer.com/journal/592/topicalCollection/AC_e856c0f49475c3b4ef0bb3dc0f1b780b. Supplementary material: https://static-content.springer.com/esm/art%3A10.1007%2Fs00592-019-01416-4/MediaObjects/592_2019_1416_MOESM1_ESM.docx; International audience; AIMS: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS: Multicenter, retrospective chart review comparing eyes with treatment-naive DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. RESULTS: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 microm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 microm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 microm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). CONCLUSIONS: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.
- Published
- 2019
8. Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
- Author
-
Patricio J. Rodríguez-Valdés, Voraporn Chaikitmongkol, Dinah Zur, Matias Iglicki, Matus Rehak, Zafer Cebeci, Atchara Amphornphruet, Pierre-Henry Gabrielle, Jay Chhablani, Marco Lupidi, Aude Couturier, Samantha Fraser-Bell, Isaac Hindi, Anat Loewenstein, Inês Laíns, Catharina Busch, Carlo Cagini, Ermete Giancipoli, Ana Rita Santos, Giuseppe D'Amico Ricci, Valérie Mané-Tauty, Kushal Agrawal, Repositório Científico do Instituto Politécnico do Porto, Laboratoire LTEE, Division of Ophthalmology, Children’s Hospital of Philadelphia (CHOP ), Tel Aviv University [Tel Aviv], University of Sydney, Harvard Medical School [Boston] (HMS), Faculty of Medicine, Universidade de Coimbra, Association for Innovation and Biomedical Research on Light and Image (AIBILI), Polytechnic Institute of Porto, Università degli Studi di Perugia (UNIPG), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Université Paris Diderot - Paris 7 (UPD7), Department of Biomedical Sciences, University of Sassari, Università degli Studi di Sassari, Istanbul University, Tecnológico de Monterrey (ITESM), Chiang Mai University (CMU), L V Prasad Eye Institute, Partenaires INRAE, and Universidad de Buenos Aires (UBA)
- Subjects
Male ,Vascular Endothelial Growth Factor A ,Visual acuity ,genetic structures ,Endocrinology, Diabetes and Metabolism ,[SDV]Life Sciences [q-bio] ,Drug Resistance ,Visual Acuity ,Angiogenesis Inhibitors ,Dexamethasone ,0302 clinical medicine ,Endocrinology ,[SDV.IDA]Life Sciences [q-bio]/Food engineering ,Medicine ,Treatment Failure ,Dexamethasone implant ,Drug Implants ,Anti vegf ,Drug Substitution ,Anti-VEGF therapy ,Intravitreal therapy ,Long-term outcome ,Refractory diabetic macular edema ,General Medicine ,Middle Aged ,Baseline characteristics ,Intravitreal Injections ,Female ,medicine.symptom ,medicine.drug ,medicine.medical_specialty ,Diabetic macular edema ,030209 endocrinology & metabolism ,Longterm outcome ,Drug Administration Schedule ,03 medical and health sciences ,Refractory ,Ophthalmology ,Diabetes mellitus ,Internal Medicine ,Humans ,[SPI.GPROC]Engineering Sciences [physics]/Chemical and Process Engineering ,Glucocorticoids ,Aged ,Retrospective Studies ,Macular edema ,Diabetic Retinopathy ,business.industry ,medicine.disease ,eye diseases ,Case-Control Studies ,030221 ophthalmology & optometry ,Implant ,business - Abstract
International audience; To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting. To be included in this retrospective multicenter, case-control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ae 5 letters or reduction in central subfield thickness (CST) ae> 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group. A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was - 0.4 +/- 10.8 letters (anti-VEGF group), and + 6.1 +/- 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 +/- 145.9 A mu m (anti-VEGF group) and - 92.8 +/- 173.6 A mu m (DEX group) (P < 0.001). Eyes in the DEX group were more likely to gain ae 10 letters (OR 3.71, 95% CI 1.19-11.61, P = 0.024) at month 12. In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy.
- Published
- 2018
9. Presenting features of primary angle-closure glaucoma in patients of mixed ethnic background
- Author
-
SALMON, J, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
genetic structures ,République Sud Africaine ,Homme ,República de Sudáfrica ,Angle closure glaucoma ,Ojo patología ,South Africa ,Afrique ,Eye disease ,Ethnie ,Primitive ,Facteur risque ,Etnia ,Primitivo ,Ethnic group ,Primitif ,Factor riesgo ,Oeil pathologie ,Glaucoma ángulo cerrado ,Glaucome angle fermé ,eye diseases ,Africa ,sense organs ,Risk factor ,Hombre ,Human - Abstract
The relative frequency with which patients present with acute or chronic angle-closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all «coloured» patients who presented to Groote Schuur Hospital with this diagnosis during a 5-year period. Of the 92 patients, 33 (36%) presented with acute angle-closure glaucoma and 59 (64%) with chronic angleclosure glaucoma. The level of intra-ocular pressure on presentation correlated well with the number of quadrants of angle closure (correlation coefficient: r=0,73, P
- Published
- 2017
- Full Text
- View/download PDF
10. Impact of systematic capacity building on cataract surgical service development in 25 hospitals
- Author
-
Rohit C Khanna, Paul Courtright, Katherine Judson, Thulsiraj Ravilla, Ken Bassett, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
medicine.medical_treatment ,Capacity building ,Cataract Extraction ,South Asia ,Financial management ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,lcsh:Ophthalmology ,Intervention (counseling) ,medicine ,Humans ,030212 general & internal medicine ,Productivity ,Asia, Southeastern ,Retrospective Studies ,Health Services Needs and Demand ,business.industry ,Equity (finance) ,Health Care Costs ,General Medicine ,Africa, Eastern ,Cataract surgery ,medicine.disease ,Outreach ,Ophthalmology ,Latin America ,lcsh:RE1-994 ,Africa ,030221 ophthalmology & optometry ,Observational study ,Medical emergency ,business ,Research Article - Abstract
Background: This study measured the effectiveness and cost of a capacity building intervention in 25 eye hospitals in South Asia, East Africa and Latin America over 4 years. The intervention involved eye care non-governmental organizations or high-performing eye hospitals acting as “mentors” to underperforming eye hospitals- “mentees” in 10 countries. Intervention activities included systematic planning and support for training and key equipment purchases as well as hospital-specific mentoring which focused on strengthening leadership, increasing the volume and equity of community outreach, improving surgical quality and volume, strengthening organizational and financial management and streamlining operational processes. Methods: This is a before and after observational study of the impact of this multi-dimensional process on hospital and individual productivity and financial sustainability after 4 years. Mentee hospitals reported data monthly using a standardized template. Key indicators included cataract surgery volume, cataract operations per surgeon, the proportion of direct paying cataract surgical patients, intervention program costs per additional surgery and cost per mentor. Results: By the end of the study period, the hospitals experienced a 69% average increase (range: −63% to 690%) in cataract surgical volume over baseline with 12 hospitals showing increases over 100%. Twenty-three hospitals experienced a 59% average increase in the number of cataract surgeries per surgeon with 10 hospitals showing increases over 100%. The proportion of paying patients increased in 8 of the 14 hospitals reporting this data. The average mentoring cost per additional surgery for these 25 hospitals was $5.39. An average of $36,489.99 was spent per mentor per year to support their work with mentees. Conclusions: The intervention resulted in proportionally similar increases in cataract surgical volume and productivity across diverse settings in three distinct geographic regions. Its wide applicability and moderate cost make it an attractive means to rapidly and substantially increase eye care services to meet VISION2020 goals.
- Published
- 2017
- Full Text
- View/download PDF
11. The gradual loss of vision
- Author
-
N Du Toit, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Refractive error ,genetic structures ,gradual, loss of vision, cataracts, refractive error, optic atrophy, glaucoma, age-related macular degeneration ,business.industry ,Public Health, Environmental and Occupational Health ,Primary health care ,Glaucoma ,gradual ,medicine.disease ,eye diseases ,loss of vision ,glaucoma ,Cataracts ,cataracts ,Medicine ,Optometry ,optic atrophy ,sense organs ,refractive error ,Family Practice ,business ,age-related macular degeneration - Abstract
Gradual loss of vision is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Patients present with chronic, slowly progressive and generally painless visual loss. The reduction in vision is usually bilateral, though frequently asymmetrical, and occurs over weeks to years. A goal-directed assessment of the patient presenting with gradual loss of vision is required. A history of the type of visual loss, e.g. central or peripheral, and whether it is worse for near vision or distance vision, is helpful. The examination should focus on visual acuity, confrontation visual field testing, pupil testing for the presence of an afferent pupil defect and assessment of the red reflex and fundoscopy. The more common conditions that cause gradual loss of vision can be divided into two groups based on the reversibility of the visual loss. Cataracts, refractive error, corneal blindness and early diabetic macular oedema are generally reversible. Optic atrophy, glaucoma, retinal degeneration and age-related macular degeneration usually cause permanent loss of vision. Most of these conditions are briefly discussed in this article. This has been performed at a level that is suitable to primary care.Keywords: gradual, loss of vision, cataracts, refractive error, optic atrophy, glaucoma, age-related macular degeneration
- Published
- 2013
12. Sudden loss of vision
- Author
-
N Du Toit, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Retinal Vascular Occlusion ,medicine.medical_specialty ,transient visual loss ,genetic structures ,Referral ,vitreous haemorrhage ,business.industry ,Public Health, Environmental and Occupational Health ,Primary health care ,Retinal detachment ,Vitreous haemorrhage ,Sudden visual loss ,medicine.disease ,eye diseases ,Surgery ,retinal detachment ,Migraine ,medicine ,sudden loss of vision ,Arteritis ,retinal vascular occlusion ,Family Practice ,Intensive care medicine ,business - Abstract
Sudden loss of vision, which causes consternation for both the patient and clinician, is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Sudden visual loss or obscuration which is transient may simply be a symptom of a dry eye or a migraine, but it may also be the onset of irreversible visual loss or a stroke. Most cases of sudden loss of vision are serious, require referral and have an associated underlying systemic disease. Visual loss is usually unilateral, but may be bilateral. This clinical problem may present a diagnostic challenge. No cause may be found in some instances. However, it is important to remember that the more sinister causes of sudden visual loss, such as temporal arteritis, carotid or cardiac emboli that cause retinal vascular occlusion, retinal detachment, vitreous haemorrhage and orbital masses, need to be identified early. Using the duration of the visual loss as the primary differentiating factor, with associated symptoms and signs as supplementary factors, the causes can be narrowed down. A thorough history, goal-directed examination, proper investigation and appropriate referral should enable early diagnosis and adequate management. This will prevent further ocular morbidity, and even patient mortality.
- Published
- 2013
13. The red eye
- Author
-
N Du Toit, L. van Zyl, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
medicine.medical_specialty ,genetic structures ,Photophobia ,business.industry ,Public Health, Environmental and Occupational Health ,Primary care physician ,Episcleritis ,medicine.disease ,scleritis ,eye diseases ,Keratitis ,primary health care ,keratitis ,Increased lacrimation ,Ophthalmology ,conjunctivitis ,medicine ,red eye ,sense organs ,Differential diagnosis ,Red eye ,medicine.symptom ,Family Practice ,business ,Scleritis - Abstract
The red eye is a clinical problem that is encountered regularly in most primary healthcare settings. A wide spectrum of diseases may cause a red eye. Fortunately, most are relatively benign, but many potentially sight-threatening conditions may manifest in a similar way. From the history and examination, the primary care physician must be able to differentiate between features that make primary care treatment possible and high-risk features that necessitate immediate referral. This article includes a discussion on features that distinguish benign from sight-threatening causes of red eye. Unilateral red eye, pain (a deep ache), deep redness, decreased visual acuity and photophobia signify more sinister causes. The red eye has an extensive differential diagnosis. Some of the common causes are conjunctivitis, subconjunctival haemorrhage, episcleritis, scleritis, anterior uveitis and acute glaucoma. Generally, patients who present with red eye can be divided into two groups: those who can be treated at primary care level and those who need secondary or tertiary level care. Other distinguishing features include a pattern to the redness, the type of discharge, the presence of increased lacrimation and photophobia, as well as corneal haze. However, these are not always easily employed as differentiating factors. Therefore, this article lists specific and basic features which can be used to identify the various causes of the red eye.
- Published
- 2013
14. Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania
- Author
-
Anthony Hall, Declare Mushi, Christina Mtuya, Kidayi Paulo, Heiko Philippin, Charles R. Cleland, Bernard Njau, Paul Courtright, William Makupa, Claudette Hall, Section Applied Social Psychology, RS: FPN WSP II, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Male ,Cross-sectional study ,Aftercare ,Tanzania ,Health Services Accessibility ,0302 clinical medicine ,Diabetic retinopathy ,Mass Screening ,030212 general & internal medicine ,SUB-SAHARAN AFRICA ,Aged, 80 and over ,Follow-up ,Diabetes ,Attendance ,CATARACT-SURGERY ,General Medicine ,Middle Aged ,BLINDNESS ,Screening ,Female ,INDIA ,Attitude to Health ,Research Article ,Retinopathy ,Adult ,medicine.medical_specialty ,Referral ,03 medical and health sciences ,Diabetes mellitus ,medicine ,Humans ,Mass screening ,Aged ,Insurance, Health ,BARRIERS ,business.industry ,Public health ,SERVICES ,medicine.disease ,Ophthalmology ,Cross-Sectional Studies ,Logistic Models ,Socioeconomic Factors ,Family medicine ,Africa ,030221 ophthalmology & optometry ,Patient Compliance ,Optometry ,business - Abstract
Background Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania. Methods All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up. Results Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis. Conclusions Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0288-z) contains supplementary material, which is available to authorized users.
- Published
- 2016
- Full Text
- View/download PDF
15. Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used?
- Author
-
Wanjiku Mathenge, Colin Cook, Susan Lewallen, Khumbo Kalua, Amir Bedri Kello, Paul Courtright, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Trichiasis ,Resource mobilization ,Eye Diseases ,Public Administration ,Health Personnel ,Population ,Psychological intervention ,Cataract Extraction ,Blindness ,Cataract ,Personnel Management ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Humans ,Medicine ,Operations management ,030212 general & internal medicine ,Human resources ,education ,Africa South of the Sahara ,Social policy ,education.field_of_study ,Primary Health Care ,business.industry ,Cataract surgeon ,Primary eye care ,Public Health, Environmental and Occupational Health ,Health services research ,Health Services ,Ophthalmologist ,Human resource management ,Africa ,Workforce ,Commentary ,030221 ophthalmology & optometry ,Health Resources ,business ,Delivery of Health Care - Abstract
With a global target set at reducing vision loss by 25% by the year 2019, sub-Saharan Africa with an estimated 4.8 million blind persons will require human resources for eye health (HReH) that need to be available, appropriately skilled, supported, and productive. Targets for HReH are useful for planning, monitoring, and resource mobilization, but they need to be updated and informed by evidence of effectiveness and efficiency. Supporting evidence should take into consideration (1) ever-changing disease-specific issues including the epidemiology, the complexity of diagnosis and treatment, and the technology needed for diagnosis and treatment of each condition; (2) the changing demands for vision-related services of an increasingly urbanized population; and (3) interconnected health system issues that affect productivity and quality. The existing targets for HReH and some of the existing strategies such as task shifting of cataract surgery and trichiasis surgery, as well as the scope of eye care interventions for primary eye care workers, will need to be re-evaluated and re-defined against such evidence or supported by new evidence.
- Published
- 2016
16. Hidden Genetic Variation in LCA9-Associated Congenital Blindness Explained by 5'UTR Mutations and Copy-Number Variations of NMNAT1
- Author
-
Anne-Laure Todeschini, Françoise Meire, Maté Ongenaert, Mineo Kondo, Annelot Baert, Elfride De Baere, Takuro Fujimaki, Frauke Coppieters, Caroline Van Cauwenbergh, Akira Murakami, Marieke De Bruyne, Reiner A. Veitia, Hannah Verdin, Miriam Bauwens, Bart P. Leroy, Center for Medical Genetics [Ghent], Ghent University Hospital, Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Department of Ophthalmology, Juntendo University Graduate School of Medicine, Mie University, Ophthalmology, Hôpital Des Enfants Reine Fabiola, Division of Ophthalmology, Children’s Hospital of Philadelphia (CHOP ), Research Foundation Flanders (FWO) (FWO 3G079711, FWO/KAN/1520913N), Ghent University Special Research Fund (BOF15/GOA/011), Belspo IAP project P7/43 (Belgian Medical Genomics Initiative: BeMGI), and Medical Genetics
- Subjects
Male ,Untranslated region ,Génétique clinique ,Five prime untranslated region ,[SDV]Life Sciences [q-bio] ,Gene Expression ,DISEASE ,Chromosome Breakpoints ,Consanguinity ,0302 clinical medicine ,TOOL ,Nicotinamide-Nucleotide Adenylyltransferase ,Copy-number variation ,Child ,Research Articles ,Genetics (clinical) ,Genetics ,AMAUROSIS ,0303 health sciences ,5'-UTR ,5′UTR variants ,Intracellular Signaling Peptides and Proteins ,Chromosome Mapping ,5 ' UTR variants ,IMPERFECTA TYPE-V ,Exons ,DEGENERATION ,LCA9 ,Pedigree ,Phenotype ,PCR ,Female ,Biologie ,Research Article ,EXPRESSION ,DNA Copy Number Variations ,Genotype ,Locus (genetics) ,NMNAT1 ,Biology ,Leber congenital amaurosis ,MECHANISMS ,Young Adult ,03 medical and health sciences ,Alu Elements ,Retinitis pigmentosa ,Genetic variation ,RETINITIS-PIGMENTOSA ,medicine ,Humans ,RNA, Messenger ,Alu-mediated deletions ,Allele ,Gene ,Alleles ,Genetic Association Studies ,030304 developmental biology ,[SDV.GEN]Life Sciences [q-bio]/Genetics ,Alu‐mediated deletions ,Computational Biology ,Biology and Life Sciences ,Sequence Analysis, DNA ,medicine.disease ,eye diseases ,5 UTR variants ,Mutation ,030221 ophthalmology & optometry ,sense organs ,5' Untranslated Regions - Abstract
Leber congenital amaurosis (LCA) is a severe autosomal-recessive retinal dystrophy leading to congenital blindness. A recently identified LCA gene is NMNAT1, located in the LCA9 locus. Although most mutations in blindness genes are coding variations, there is accumulating evidence for hidden noncoding defects or structural variations (SVs). The starting point of this study was an LCA9-associated consanguineous family in which no coding mutations were found in the LCA9 region. Exploring the untranslated regions of NMNAT1 revealed a novel homozygous 5′UTR variant, c.-70A>T. Moreover, an adjacent 5′UTR variant, c.-69C>T, was identified in a second consanguineous family displaying a similar phenotype. Both 5′UTR variants resulted in decreased NMNAT1 mRNA abundance in patients' lymphocytes, and caused decreased luciferase activity in human retinal pigment epithelial RPE-1 cells. Second, we unraveled pseudohomozygosity of a coding NMNAT1 mutation in two unrelated LCA patients by the identification of two distinct heterozygous partial NMNAT1 deletions. Molecular characterization of the breakpoint junctions revealed a complex Alu-rich genomic architecture. Our study uncovered hidden genetic variation in NMNAT1-associated LCA and emphasized a shift from coding to noncoding regulatory mutations and repeat-mediated SVs in the molecular pathogenesis of heterogeneous recessive disorders such as hereditary blindness., SCOPUS: ar.j, FLWOA, info:eu-repo/semantics/published
- Published
- 2015
17. The eye in systemic disease
- Author
-
M Lenake, N Du Toit, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Systemic disease ,medicine.medical_specialty ,thyroid ophthalmopathy ,Referral ,genetic structures ,business.industry ,Public Health, Environmental and Occupational Health ,Primary care physician ,Diabetic retinopathy ,systemic disease ,herpes zoster ophthalmicus ,medicine.disease ,Dermatology ,eye diseases ,Surgery ,diabetic retinopathy ,Herpes Zoster Ophthalmicus ,Diabetes mellitus ,Intervention (counseling) ,medicine ,drugs and the eye ,Syphilis ,sense organs ,Family Practice ,business - Abstract
The eye is a unique organ which is often involved in systemic disease. Patients with systemic disease may first present with eye pathology, and patients with known systemic illnesses may need to have their eyes specifically checked for ocular complications. It is thus useful for the physician to be familiar with the ocular manifestations of common systemic diseases at primary care level. Diseases like diabetes, herpes zoster ophthalmicus and thyroid ophthalmopathy often involve the eyes, and if the eye signs are not identified early, the visual consequences can be devastating. Diabetic retinopathy is an important cause of blindness in this country. These, as well as common ocular manifestations of human immunodeficiency virus/acquired immune deficiency syndrome, syphilis, some dermatological conditions and the ocular side-effects of certain drugs, are discussed in this article. It is important for the primary care physician to be familiar with the spectrum of ocular involvement in systemic diseases since appropriate intervention and referral can be sight saving for the patient.
- Published
- 2014
18. Ocular trauma
- Author
-
Mustak, H, Du Toit, N, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
genetic structures ,injury to the eye ,ocular trauma ,Public Health, Environmental and Occupational Health ,open globe injury ,Family Practice ,traumatic vascular events ,eye diseases - Abstract
Ocular trauma is an important cause of unilateral blindness and visual impairment across the world. Most injuries are accidental, work-related injuries in developed countries, while assaults predominate as a cause in developing countries. Trauma may result in various forms of ocular injuries, ranging from minor insult to major functional impairment. Any ocular structure may be involved, and a careful, systematic approach to the examination of a patient is essential to avoid missing occult injury and resultant visual impairment. This paper highlights key points regarding the clinical evaluation of patients with ocular trauma and covers the presentation and primary care management of the more common ocular injuries.
- Published
- 2014
19. Diagnostic and clinical value of routine polymerase chain reaction analysis of intraocular fluid specimens in the diagnosis of suspected infectious posterior uveitis
- Author
-
Scheepers, Marius, Division of Ophthalmology, and Faculty of Health Sciences
- Published
- 2013
20. Primary health eye care knowledge among general practitioners working in the Cape Town Metropole
- Author
-
N Fernandes, N Du Toit, L M van Zyl, G Rogers, Division of Ophthalmology, Faculty of Health Sciences, and Division of Otorhinolaryngology
- Subjects
Response rate (survey) ,business.industry ,education ,Public Health, Environmental and Occupational Health ,Primary care ,Eye care ,ophthalmology ,Undergraduate curriculum ,Nursing ,general practitioners ,Cape ,Test score ,Primary health ,survey ,Medicine ,Family Practice ,business - Abstract
Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly, and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general.Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions, including a self-assessment section, was sent to each of 140 randomly chosen GPs in Cape Town.Results: A response rate of 79.2% was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2%). The mean test score was 52.5% (standard deviation [SD]: 22.2). The mean self-rating was 51.9% (SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9% of them would attend such courses. Also, 82% of GPs felt that primary care doctors, not optometrists, should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems, presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology.Keywords: survey; ophthalmology; general practitioners
- Published
- 2011
21. Toy gun injuries - more than meets the eye
- Author
-
Richards, J, Murray, A D N, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Socio-economic factors ,Eye injuries ,Toy guns ,human activities ,Children - Abstract
A MEDLINE search ascertained that damage to the eye caused by spring-loaded air guns shooting plastic projectiles has not yet been reported in the literature. A countrywide spate of eye injuries caused a large number of patients to present to our unit. Investigation was conducted into the nature of the injuries, features of the toy guns involved as well as social aspects relating to the injuries.
- Published
- 2003
22. Task shifting in primary eye care: how sensitive and specific are common signs and symptoms to predict conditions requiring referral to specialist eye personnel?
- Author
-
Wanjiku Mathenge, Hery Harimanitra Andriamanjato, Khumbo Kalua, Susan Lewallen, Paul Courtright, Division of Ophthalmology, and Faculty of Health Sciences
- Subjects
Adult ,Male ,medicine.medical_specialty ,Referral ,Eye Diseases ,cécité ,genetic structures ,Public Administration ,Decision Making ,Primary health care ,Signs and symptoms ,Eye care ,Sensitivity and Specificity ,Health administration ,03 medical and health sciences ,Afrique ,0302 clinical medicine ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,délégation de tâches ,Intensive care medicine ,Referral and Consultation ,soins de la vue primaires ,Primary Health Care ,business.industry ,Research ,Health services research ,Public Health, Environmental and Occupational Health ,ocular signs ,Primary Eye Care ,task shifting ,eye diseases ,3. Good health ,Ophthalmology ,signes oculaires ,ocular symptoms ,Africa ,030221 ophthalmology & optometry ,Optometry ,Female ,Task shifting ,business ,symptômes oculaires ,blindness - Abstract
BACKGROUND:The inclusion of primary eye care (PEC) in the scope of services provided by general primary health care (PHC) workers is a 'task shifting' strategy to help increase access to eye care in Africa. PEC training, in theory, teaches PHC workers to recognize specific symptoms and signs and to treat or refer according to these. We tested the sensitivity of these symptoms and signs at identifying significant eye pathology. METHODS: Specialized eye care personnel in three African countries evaluated specific symptoms and signs, using a torch alone, in patients who presented to eye clinics. Following this, they conducted a more thorough examination necessary to make a definite diagnosis and manage the patient. The sensitivities and specificities of the symptoms and signs for identifying eyes with conditions requiring referral or threatening sight were calculated. RESULTS: Sensitivities of individual symptoms and signs to detect sight threatening pathology ranged from 6.0% to 55.1%; specificities ranged from 8.6 to 98.9. Using a combination of symptoms or signs increased the sensitivity to 80.8 but specificity was 53.2. CONCLUSIONS: In this study, the sensitivity and specificity of commonly used symptoms and signs were too low to be useful in guiding PHC workers to accurately identify and refer patients with eye complaints. This raises the question of whether this task shifting strategy is likely to contribute to reducing visual loss or to providing an acceptable quality service.
- Full Text
- View/download PDF
23. Relationship Between Glaucoma and Chronic Stress Quantified by Allostatic Load Score in the All of Us Research Program.
- Author
-
Yoo K, Lee C, Baxter SL, and Xu BY
- Abstract
Purpose: To assess the relationship between glaucoma and allostatic load (AL), an established framework for quantifying the physiologic effects of chronic stress through measurements of systemic biomarkers., Design: Retrospective case-control study., Methods: Participants of the National Institutes of Health All of Us (AoU) Research Program with complete AL biomarker data between December 1984 to June 2022 and with (cases) or without (controls) primary glaucoma were identified. AL scores were calculated using the adapted Seeman AL scale consisting of 10 systemic biomarkers: body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, glomerular filtration rate, albumin, C-reactive protein, and homocysteine. AL score was defined as the number of biomarkers with measurements in the highest risk quartiles. Age was calculated as the median age at time of biomarker measurements. Logistic regression analysis was performed to assess the association between the earliest possible AL score and glaucoma adjusted for race/ethnicity. Mediation analysis was performed to estimate the relationship between race/ethnicity and glaucoma mediated by AL score., Results: The study cohort consisted of 349 (16.1%) cases and 1,819 (83.9%) controls with 52.7% females, 2.2% Asians, 10.7% Blacks, 10.0% Hispanics, and 72.5% non-Hispanic Whites. At the earliest timepoint (median [IQR] = 6.4 [1.9-12.2] years prior to diagnosis), cases had higher AL score than controls (3 [1-4] versus 2 [1-3], respectively; p<0.001). On multivariable analysis, higher AL score (OR=1.09 per point), Black race (OR=2.58), and Hispanic ethnicity (OR=2.12) conferred higher risk of glaucoma (p≤0.02). AL score partially mediated higher glaucoma risk among Blacks (7.5%) and Hispanics (5.0%) compared to non-Hispanic Whites. On subgroup analysis, higher AL score was significantly associated with primary open angle glaucoma (POAG; OR=1.11; p=0.01) but not primary angle closure glaucoma (PACG; p=0.87)., Conclusion: AoU participants with glaucoma had greater AL 6.4 years prior to diagnosis, and AL score partially mediated racial/ethnic differences in glaucoma risk. These findings suggest chronic stress may increase risk for glaucoma and contribute to racial disparities in glaucoma burden., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
24. Safety and efficacy of a novel 0.5% epinastine topical eyelid cream in allergic conjunctivitis: a phase 3 trial.
- Author
-
Fujishima H and Shoji J
- Abstract
Purpose: The high prevalence of allergic conjunctivitis in Japan necessitates novel, easy-to-use treatment options for prophylactic use. We evaluated the safety and efficacy of a newly-developed 0.5% epinastine topical eyelid cream to prevent the development of allergic conjunctivitis., Study Design: This was a phase 3, single-centre, double-masked, intra-patient randomised trial in asymptomatic adults (aged 20-65 years) with seasonal allergic conjunctivitis in Japan., Methods: The left and right eyes of eligible patients were randomised to receive a topical application of either 0.5% epinastine cream (~ 30 mg per dose) to one eye or placebo cream to the other (on the outer skin of the upper and lower eyelids) after a conjunctival antigen challenge (CAC) test. Symptom severity was assessed up to 24 h post-treatment. Primary efficacy endpoints were mean ocular itching and conjunctival hyperaemia severity scores in each eye; safety endpoints included adverse events (AEs) and adverse drug reaction (ADRs)., Results: In total, 30 patients (60 eyes) were included in the study. The 0.5% epinastine topical eyelid cream reduced mean ocular itching scores (difference in least squares means ± standard error, - 1.12 ± 0.214; p < 0.0001) and mean conjunctival hyperaemia scores (- 0.54 ± 0.197; p = 0.0097) 24 h after treatment versus placebo. The 0.5% epinastine topical eyelid cream was well tolerated, with no AEs or ADRs reported., Conclusion: With its novel route of administration, 0.5% epinastine topical eyelid cream may be considered a unique, easy-to-use, once-daily treatment option to prevent the onset of seasonal allergic conjunctivitis., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
25. Intravitreal Antibiotics versus Early Vitrectomy plus Intravitreal Antibiotics for Post-Injection Endophthalmitis: an IRIS® Registry (Intelligent Research in Sight).
- Author
-
Ross C, Ghauri S, Gilbert JB, Hu D, Ullanat V, Gong D, Greenberg PB, Eliott D, Elze T, Lorch A, Miller JW, and Krzystolik MG
- Abstract
Purpose: To determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections., Design: Retrospective cohort study PARTICIPANTS: Patients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® Registry between 2016 and 2020., Methods: Inclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and post-treatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis Distance Matching, accounting for the differences in VA at baseline and diagnosis., Main Outcome Measures: Post-treatment logMAR VA RESULTS: 1,044 patients diagnosed with post-injection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 [20/40-20/50] at baseline, 0.88 [∼20/150] at diagnosis, and 0.57 [20/70-20/80] post-treatment. There were no statistically significant differences in the visual outcomes between the two matched treatment groups (b = 0.05, p = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05, p = 0.452)., Conclusions: There was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for post-injection endophthalmitis. The findings support the use of either treatment strategy., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
26. Violating independence assumption in medical statistics.
- Author
-
Panos GD
- Subjects
- Humans, Data Interpretation, Statistical
- Abstract
Competing Interests: I declare no competing interests.
- Published
- 2024
- Full Text
- View/download PDF
27. Association between Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists Exposure and Intraocular Pressure Change: GLP-1 Receptor Agonists and Intraocular Pressure Change.
- Author
-
Hallaj S, Halfpenny W, Chuter BG, Weinreb RN, Baxter SL, and Cui QN
- Abstract
Objective: This study aims to provide data on the effects of glucagon-like peptide 1 receptor (GLP-1R) agonists on intraocular pressure (IOP)., Design: Retrospective clinical cohort study., Setting: Multicenter., Study Population: 1247 glaucoma surgery and treatment naïve eyes of 626 patients who were initiated on GLP-1R agonists compared to 1083 glaucoma surgery and treatment naïve eyes of 547 patients who were initiated on other oral antidiabetics., Observation Procedures: The University of California Health Data Warehouse was queried for patients exposed to GLP-1R agonists or other oral antidiabetics. Index date was defined as the date of first exposure to the medication. Eyes with at least one pre-exposure and one post-exposure tonometry record within 365 days of the index date were included in the analysis. Clinical and laboratory data elements were extracted from the database. Eyes were censored from the analysis upon exposure to glaucoma hypotensive medication or glaucoma surgery. ∆IOP was analyzed using a paired t-test. Regression analysis was conducted using generalized estimating equations (GEE) accounting for inter-eye correlation. Sensitivity analyses were performed to assess the robustness of the findings., Main Outcome Measures: Primary outcome measure was ∆IOP after exposure to the medication., Results: The median age of all included subjects was 66.2 years [IQR=18.3]; 607 (51.7%) were female, and 667 (56.9%) were Caucasian. Median pre-exposure IOP, HbA1c, and BMI were 15.2 mmHg [IQR=3.8], 7.5 [IQR=2.4], and 29.8 [IQR=9.4], respectively. 776 individuals (66.1%) had diabetes, with the median number of active oral antidiabetics being 1.0 [IQR=1.0], and 441 (37.5%) being insulin users. Several pre-exposure characteristics significantly differed between the GLP-1R agonist and the control group. The mean ∆IOP was -0.4±2.8 mmHg (paired t-test p<0.001) and -0.2±3.3 mmHg (paired t-test p = 0.297) in the GLP-1R agonist and other antidiabetics groups, respectively. Pre-exposure IOP was the only independent predictor of ΔIOP in multivariable GEE. Sensitivity analyses yielded similar results., Conclusions: Although GLP-1R agonists were significantly associated with a decrease in IOP in the paired analysis, they were not associated with ΔIOP in multivariable GEE. Moreover, the difference between the ΔIOP in the two groups was small. Future prospective studies following a standardized dose and delivery method may provide further insights., Competing Interests: Conflict of Interest Dr. Baxter reports consulting fees from Topcon and equipment support from Topcon and Optomed outside the submitted work. Dr. Cui reports a provisional patent application related to the topic of this study (publication number: US20220193201A1). SH, WH, and BGC: None. Dr. Weinreb reports consulting fees from Abbvie, Alcon, Balance, Editas, Eyenovia, iSTAR Medical, Nicox, and Topcon outside the submitted work. He also has stock options from Balance, Eyenovia, Iantrek, Implandata, and Toku outside the submitted work and intellectual property licensed from UCSD to Toromedes outside the submitted work., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
28. A historical timeline of the development and evolution of medical diagnostic ultrasonography.
- Author
-
Rajamani A, Arun Bharadwaj P, Hariharan S, Ragavan AV, Hassan A, Arvind H, and Huang S
- Abstract
Diagnostic ultrasonography has evolved to become an indispensable imaging tool that permits non-invasive evaluation of the whole body. In this narrative review, we present a historical timeline of the invention, development, and evolution of diagnostic medical ultrasound. It includes interesting fun facts that may help the reader identify with many of the incredible researchers in this field. This review is a tribute to the researchers who contributed to this amazing invention., (© 2024 The Author(s). Journal of Clinical Ultrasound published by Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
29. Keratin 8/18a.1 Expression Influences Embryonic Neural Crest Cell Dynamics and Contributes to Postnatal Corneal Regeneration in Zebrafish.
- Author
-
Williams AL and Bohnsack BL
- Subjects
- Animals, Gene Expression Regulation, Developmental drug effects, Zebrafish Proteins metabolism, Zebrafish Proteins genetics, Keratin-18 metabolism, Keratin-18 genetics, Tretinoin pharmacology, Tretinoin metabolism, Cell Movement genetics, Zebrafish genetics, Zebrafish metabolism, Neural Crest metabolism, Neural Crest cytology, Regeneration, Keratin-8 metabolism, Keratin-8 genetics, Cornea metabolism
- Abstract
A complete understanding of neural crest cell mechanodynamics during ocular development will provide insight into postnatal neural crest cell contributions to ophthalmic abnormalities in adult tissues and inform regenerative strategies toward injury repair. Herein, single-cell RNA sequencing in zebrafish during early eye development revealed keratin intermediate filament genes krt8 and krt18a.1 as additional factors expressed during anterior segment development. In situ hybridization and immunofluorescence microscopy confirmed krt8 and krt18a.1 expression in the early neural plate border and migrating cranial neural crest cells. Morpholino oligonucleotide (MO)-mediated knockdown of K8 and K18a.1 markedly disrupted the migration of neural crest cell subpopulations and decreased neural crest cell marker gene expression in the craniofacial region and eye at 48 h postfertilization (hpf), resulting in severe phenotypic defects reminiscent of neurocristopathies. Interestingly, the expression of K18a.1, but not K8, is regulated by retinoic acid (RA) during early-stage development. Further, both keratin proteins were detected during postnatal corneal regeneration in adult zebrafish. Altogether, we demonstrated that both K8 and K18a.1 contribute to the early development and postnatal repair of neural crest cell-derived ocular tissues.
- Published
- 2024
- Full Text
- View/download PDF
30. Lyme Disease and Papilledema: A Retrospective Study on Clinical Characteristics and Outcomes.
- Author
-
Vithayathil J, Virupakshaiah A, Liu G, Swami SK, Avery RA, Liu GT, and McGuire JL
- Abstract
Objective: Describe the clinical characteristics, treatment strategies, and outcome data of children with papilledema associated with Lyme disease at a large tertiary care pediatric hospital., Methods: Retrospective cohort study of children 1-18 years old who received care at our institution between 1995 and 2019 with concurrent diagnoses of papilledema and Lyme disease. Data were abstracted from records and prospective family surveys., Results: Among 44 children included (median age 9.7 years), 66% (29/44) had additional cranial neuropathies, and 78% (32/41) had cerebrospinal fluid pleocytosis. All children were treated with antibiotics (39% oral, 55% intravenous, 7% both); 61% (27/44) were also treated with oral acetazolamide. Symptoms fully resolved in 86% (30/35) of children with follow-up data. Proportion recovered did not significantly differ by antibiotic administration route or presence/absence of cerebrospinal fluid pleocytosis., Conclusions: Papilledema in Lyme disease may occur with or without cerebrospinal fluid pleocytosis. Most children recover without residual deficits following treatment, although exceptions exist., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
- Full Text
- View/download PDF
31. The epidemiology of nonpowder firearm-related eye trauma in the United States.
- Author
-
Gillette JS, Waldman O, Zaidat K, and Greenberg PB
- Subjects
- Humans, United States epidemiology, Incidence, Male, Eye Injuries epidemiology, Eye Injuries etiology, Eye Injuries diagnosis, Wounds, Gunshot epidemiology, Firearms statistics & numerical data
- Published
- 2024
- Full Text
- View/download PDF
32. Host urinary biomarkers in HIV positive and HIV negative patients with tubercular uveitis and other uveitic diseases.
- Author
-
van der Westhuizen DP, Snyders CI, Kidd M, Walzl G, Chegou NN, and Smit DP
- Subjects
- Humans, Male, Female, Adult, Middle Aged, Coinfection urine, Diagnosis, Differential, HIV Seropositivity urine, HIV Seropositivity complications, HIV Seronegativity, Young Adult, Predictive Value of Tests, Urinalysis methods, Biomarkers urine, Uveitis urine, Uveitis microbiology, Uveitis diagnosis, Tuberculosis, Ocular urine, Tuberculosis, Ocular diagnosis, HIV Infections urine, HIV Infections complications
- Abstract
Purpose: To determine if host urinary biomarker profiles could distinguish between tubercular uveitis (TBU) and other uveitic diseases (OUD) in patients with and without HIV infection., Methods: Concentrations of 29 different host biomarkers were measured in urine samples using the Luminex platform. Data were analyzed to describe differences between patients diagnosed with and without TBU and with and without HIV co-infection., Results: One-hundred-and-eighteen urine samples were collected and 39% participants were diagnosed as TBU+. Mean age TBU+ was 39.3±13.6 years with 45.7% males. Anterior and panuveitis and unilateral involvement were most common. 32.6% were TBU+HIV+ (median CD4+=215) while 40.2% were OUD+HIV+ (median CD4+=234). Only sVEGF3 was decreased in TBU+ versus OUD+ (p=0.03), regardless of HIV status. Some biomarkers were significantly raised in HIV+ TBU+ compared to HIV- TBU+: sIL-6Rα, CD30, sRAGE , sTNFR I&-II, IP-10, MIP-1β, sEGFR and Ferritin. HIV+ OUD+ had increased sVEGFR3, CD30, sIL-6Rα, IP-10, sTNFR I&-II, Ferritin and Haptoglobin compared to HIV- OUD+. VEGF-A (p = 0.04) was decreased in HIV+ OUD+ versus HIV- OUD+., Conclusion: Decreased urinary concentrations of VEGFR3 were observed in TBU+ compared to TBU-. HIV+ individuals demonstrated increased concentrations of multiple urinary analytes when compared to HIV- patients with uveitis., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
33. Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction.
- Author
-
Lee G
- Abstract
Aim: Despite promising results from technological therapies like intense pulsed light application, warm compress therapy is a mainstay in meibomian gland dysfunction (MGD). However, applying warm compresses (WC) to the eyelids is palliative rather than curative and not always dispensed with specific instructions. The range of eyelid warming treatments available and lack of clear directives for use creates uncertainty for patients accustomed to explicit dosage information. This report examines data from clinical studies across the past 20 years to identify effective protocols for three types of WC-hot towel, microwavable eye mask, and self-heating eye mask (EM)., Method: Literature search for studies on WC and MGD published between 2004 and 2023 in English was conducted. Studies wherein hot towel, microwavable EM, and self-heating EM were used in a treatment arm were included and those wherein they served only as control or were used in conjunction with another intervention were excluded. 20 resulting studies were separated into 3 groups: 5 on temperature profiles of WC, 6 with single application of WC, and 9 with repeated applications. Study methods and outcomes were tabulated, and a qualitative review was performed, attending to WC protocol and efficacy, as indicated by measures of tear film, meibomian gland health, and dry eye questionnaires., Results: Data from the aforementioned studies revealed that each method can achieve target eyelid temperature of 40 °C. A single application of WC-ranging from 5 to 20 min-can significantly improve tear quality, while repeated applications significantly relieve symptoms associated with dry eyes from MGD and, in most studies, significantly improve meibomian gland health. Hot towels, however, require frequent reheating to maintain eyelid temperatures above 40 °C, rendering them relatively ineffective in longitudinal studies. Microwavable EM retain heat well across 10 min and were found to improve tear break-up time and/or meibomian gland score. Self-heating EM have variable activation times and were typically applied for longer periods, showing benefits akin to microwavable EM in short-term studies. Studies monitoring compliance indicate greater deviation from protocol with higher application frequencies or longer-term use. Evidence suggests superior heat retention and therapeutic effects on specific contributing factors in MGD (such as Demodex) with moist-heat compress., Conclusion: Considering decreased patience adherence to therapy with increased usage frequencies, and balancing needs to provide succinct instructions for various compress types, an advisable strategy is for patients to apply a moist-heat generating EM (microwavable or self-heating) to each eye for at least 10 min, prepared according to manufacturer's instructions., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
34. Lacrimal Obstruction in Craniosynostosis: Anatomical and Genetic Risk Factors.
- Author
-
Landau-Prat D, Taylor JA, Kalmar CL, Yu Y, Ying GS, Bartlett S, Swanson J, Revere K, Binenbaum G, Katowitz WR, and Katowitz JA
- Subjects
- Humans, Male, Female, Retrospective Studies, Risk Factors, Child, Preschool, Infant, Child, Craniosynostoses genetics, Craniosynostoses complications, Craniosynostoses surgery, Craniosynostoses diagnosis, Lacrimal Duct Obstruction genetics, Lacrimal Duct Obstruction diagnosis, Nasolacrimal Duct abnormalities, Nasolacrimal Duct surgery, Nasolacrimal Duct pathology
- Abstract
Purpose: To investigate whether patients with craniosynostosis exhibit higher rates of nasolacrimal duct obstruction (NLDO) and to explore potential risk factors., Methods: Retrospective review including all craniosynostosis patients treated at both the Divisions of Ophthalmology and Plastic, Reconstructive, and Oral Surgery at The Children's Hospital of Philadelphia between 2009 and 2020 was conducted. Synostosis characteristics, lacrimal disorders, and genetic data were collected. Main outcome measures were the rate of NLDO and associations with anatomical and syndromic/genetic risk factors., Results: The total of 767 participants had a mean age of 2.8 ± 3.8 years, 465 (60.6%) were males, 485 (63.2%) had no syndromic association; 631 (82.3%) had one major suture involved, 128 (17%) had involvement of 2 to 4 major sutures, and 429 (55.9%) underwent craniofacial surgery. Forty-eight (6.2%) patients had NLDO, which more prevalent in the genetic/syndromic group (11.0% vs. 3.5%, respectively, p < 0.001), with the highest prevalence observed in patients with Apert syndrome (n = 4, 30.8%). The genetic variants most associated with NLDO were EFNB1 (n = 1, 100%) and FGFR2 (n = 6, 19.4%). There was no association between NLDO and the number or types of sutures involved or a history of craniofacial surgery., Conclusions: Nasolacrimal duct obstruction is more common in patients with craniosynostosis compared to the general population. Having a putative syndrome or a putative genetic variant and female sex were risk factors for NLDO. Ophthalmic evaluations for all craniosynostosis patients and careful assessments of any symptoms of tearing are recommended., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)
- Published
- 2024
- Full Text
- View/download PDF
35. Ocular Inflammatory Events Following COVID-19 Vaccination in the Paediatric Population: A Multinational Case Series.
- Author
-
Testi I, Brandão-de-Resende C, De-La-Torre A, Concha-Del-Rio LE, Cheja-Kalb R, Mahendradas P, Habot-Wilner Z, Yalçındağ N, Markelj Š, Iriqat S, Portero A, Petrushkin H, Pavesio C, and Solebo AL
- Subjects
- Humans, Male, Female, Child, Adolescent, Child, Preschool, Visual Acuity physiology, Glucocorticoids therapeutic use, Uveitis diagnosis, Uveitis etiology, Immunosuppressive Agents therapeutic use, Immunosuppressive Agents adverse effects, Retrospective Studies, COVID-19 prevention & control, COVID-19 epidemiology, COVID-19 Vaccines adverse effects, Vaccination adverse effects, SARS-CoV-2
- Abstract
Background: Ocular inflammatory events following COVID-19 vaccination have been reported in the adult population., Methods: Multinational case series of patients under the age of 18 diagnosed with ocular inflammatory events within 28 days of COVID-19 vaccination., Results: Twenty individuals were included. The most common event was anterior uveitis ( n = 8, 40.0%), followed by intermediate uveitis (7 patients, 35%), panuveitis (4 patients, 20%), and posterior uveitis (1 patient, 5%). The event was noticed in the first week after vaccination in 11 patients (55.0%). Twelve patients (60.0%) had a previous history of intraocular inflammatory event. Patients were managed with topical corticosteroids ( n = 19, 95.0%), oral corticosteroids ( n = 10, 50.0%), or increased dose of immunosuppressive treatment ( n = 6, 30.0%). Thirteen patients (65.0%) had a complete resolution of the ocular event without complications. All patients had a final visual acuity unaffected or less than three lines of loss., Conclusion: Ocular inflammatory events may happen in the paediatric population following COVID-19 vaccination. Most events were successfully treated, and all showed a good visual outcome.
- Published
- 2024
- Full Text
- View/download PDF
36. DIAGNOSTIC YIELD OF AN INHERITED RETINAL DISEASE GENE PANEL IN RETINOPATHY OF UNKNOWN ORIGIN.
- Author
-
Abramowicz S, Meunier A, Postelmans L, Caspers L, Corazza F, De Bruyne M, Van de Sompele S, De Baere E, Leroy BP, Willermain F, and Draganova D
- Subjects
- Humans, Female, Retrospective Studies, Male, Middle Aged, Adult, Aged, Young Adult, Genetic Testing methods, Mutation, Eye Proteins genetics, Retinal Diseases genetics, Retinal Diseases diagnosis
- Abstract
Purpose: Evaluating the presence of class 3, 4, and 5 genetic variants in inherited retinal disease (IRD) genes in patients with retinopathy of unknown origin (RUO)., Methods: Multicentric retrospective study of RUO cases diagnosed between January 2012 and February 2022. General and ophthalmologic history, complete ophthalmologic examination, antiretinal antibodies, and IRD gene panel results were analyzed in every patient. Four RUO categories were defined: nonparaneoplastic autoimmune retinopathy, unilateral pigmentary retinopathy, asymmetrical pigmentary retinopathy, and acute zonal occult outer retinopathy., Results: The authors included 12 patients (9 females) across these four RUO categories. Mean age at inclusion was 45.6 years (20-68 years). Seven patients demonstrated class 3 variants in IRD genes. Of these, two also demonstrated class 5 variants in other IRD genes. The remaining five patients had negative panel results. IRD gene panel analysis allowed diagnosis refinement in 1 (8.3%) nonparaneoplastic autoimmune retinopathy patient in the RUO cohort. When considering the nonparaneoplastic autoimmune retinopathy subpopulation only, a higher diagnostic yield of 20% (1/5 patients) was achieved., Conclusion: Every suspected nonparaneoplastic autoimmune retinopathy patient should benefit from gene panel testing to not overlook undiagnosed IRDs. By contrast, unilateral pigmentary retinopathy, asymmetrical pigmentary retinopathy, and acute zonal occult outer retinopathy subpopulations did not benefit from genetic testing in this study.
- Published
- 2024
- Full Text
- View/download PDF
37. Therapies for Inherited Retinal Dystrophies: What is Enough?
- Author
-
Leroy BP, Daly A, Héon E, Sahel JA, and Dollfus H
- Subjects
- Humans, Animals, Genetic Therapy methods, Retinal Dystrophies genetics, Retinal Dystrophies therapy
- Published
- 2024
- Full Text
- View/download PDF
38. Phakic intraocular Lens implantation in keratoconus patients.
- Author
-
Nowrouzi A, D'Oria F, Alió Del Barrio JL, and Alió JL
- Subjects
- Humans, Corneal Topography, Keratoconus physiopathology, Keratoconus surgery, Phakic Intraocular Lenses, Visual Acuity physiology, Lens Implantation, Intraocular, Refraction, Ocular physiology
- Abstract
Background: Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases., Aim: To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards)., Results: No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1., Conclusion: pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA., Competing Interests: Declaration of conflicting interestsThe authors have no financial interest in any product or or instrument, or drug mentioned in this article. The authors have not received any contribution as consultants, reviewers for any of the devices, or instruments mentioned in this article.
- Published
- 2024
- Full Text
- View/download PDF
39. Bilateral sequential ischemic retinopathy and optic neuropathy in IgG1 heavy chain deposition disease.
- Author
-
Finn MJ, Sharma A, Guenena M, Jiang Y, Savant SV, and Ramsey DJ
- Subjects
- Humans, Female, Aged, Optic Neuropathy, Ischemic diagnosis, Optic Neuropathy, Ischemic drug therapy, Optic Neuropathy, Ischemic etiology, Immunoglobulin G blood, Ischemia diagnosis, Ischemia drug therapy, Visual Acuity, Fundus Oculi, Immunoglobulin G4-Related Disease diagnosis, Immunoglobulin G4-Related Disease complications, Immunoglobulin G4-Related Disease drug therapy, Optic Nerve Diseases diagnosis, Optic Nerve Diseases drug therapy, Optic Nerve Diseases etiology, Antibodies, Monoclonal therapeutic use, Tomography, Optical Coherence, Fluorescein Angiography, Retinal Diseases diagnosis, Retinal Diseases drug therapy
- Abstract
Purpose: To report a case of progressive ischemic retinopathy and optic neuropathy in a patient with heavy chain deposition disease (HCDD), a rare form of monoclonal immunoglobulin deposition disease (MIDD)., Observations: Our case describes a 74-year-old woman diagnosed with IgG1 lambda HCDD. After treatment with daratumumab and intravenous IVIG therapy, the patient developed worsening ischemic retinopathy and optic neuropathy, neovascular glaucoma, and bilateral sequential vitreous hemorrhages, necessitating surgical intervention. We present multimodal imaging from the onset of ischemic retinopathy to end-stage maculopathy illustrated by optical coherence tomography (OCT) angiography. Despite discontinuing treatment with daratumumab and providing maximal ocular interventions to control the complications of neovascular disease, the patient's condition progressed, resulting in profound vision loss., Conclusions and Importance: Our case illustrates the potential for HCDD to cause end-organ disease, including ischemic retinopathy and optic neuropathy, possibly worsened by the patient's underlying cardiovascular risk factor status and medications. Daratumumab, a humanized IgG1 kappa monoclonal antibody that binds to CD38 used to treat specific blood cancers, has been reported to cause disturbances in retinal blood flow, including retinal artery and vein occlusions. It remains to be determined whether careful patient selection or dose adjustments and timing of HCDD treatments could protect vision by reducing the risk of these rare yet severe ocular complications., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
- Full Text
- View/download PDF
40. Pediatric and Adolescent Traumatic Macular Hole: A Systematic Review.
- Author
-
Helmy YAH, ElNahry AG, Zein OE, Charbaji S, Yonekawa Y, Mansour HA, Serhan HA, Al-Nawaflh M, Parodi MB, Williams BK, and Mansour AM
- Subjects
- Adolescent, Child, Humans, Tomography, Optical Coherence, Visual Acuity physiology, Eye Injuries physiopathology, Eye Injuries surgery, Eye Injuries diagnosis, Retinal Perforations surgery, Retinal Perforations physiopathology, Retinal Perforations diagnosis, Vitrectomy methods, Macula Lutea injuries
- Abstract
Purpose: The optimal management of pediatric traumatic macular holes (TMH) is unclear from lack of prospective randomized trials. The literature is divided into early (≤1month post-trauma), delayed (>1 month) pars plana vitrectomy (PPV), and observation. Our aim is to find which group can achieve best-superior spectacle corrected visual acuity (VA), visual gain, and time for hole closure., Design: Systematic review., Methods: This systematic review was registered with PROSPERO (ID:CRD42022383134). The databases searched from inception until July 31, 2023, were MEDLINE OVID, Scopus, Web of Science, Embase, and Google Scholar. The articles were screened for title and abstract then for full text. Risk of bias was also assessed. Three outcome measures were analyzed: final VA, visual gain, and time to closure of macular hole (MH). MH size was divided into small (≤250 µm), medium (>250-500 µm), and large (>500 µm)., Results: Ninety eight (98) studies with 234 patients in the PPV group and 87 patients in the observation group were included in the review. Final VA (logarithm of the minimum angle of resolution) and visual gain were respectively in PPV vs observation groups: (1) small MH 0.37 ± 0.52 vs 0.42 ± 0.56 (P = .484) and -0.96 ± 0.83 vs -0.49 ± 0.40 (P = .005); (2) medium MH 0.58 ± 0.39 vs 0.34 ± 0.34 (P = .06) and -0.36 ± 0.42 vs -0.74 ± 0.44 (P < .001); (3) large MH 0.62 ± 0.42 vs 0.59 ± 0.35 (P = .337) and -0.31 ± 0.48 vs -0.62 ± 0.37 (P = .11). Small TMH had comparable closure time: 3.21 ± 2.52 months vs 3.49 ± 4.43 (P = .954) in the PPV and observation groups. Early and late PPV yielded comparable final VA 0.67 ± 0.66 vs 0.54 ± 0.35 (P = .576) and visual gain -0.58 ± 0.69 vs -0.49 ± 0.48 (P = .242) in the PPV and observation groups., Conclusions: PPV was very effective in closing TMH and VA gain in children throughout a wide range of hole size. Early and delayed PPV yielded similar anatomic and visual results. Observation and PPV yielded comparable final VA and closure time. Clinicians can choose either early PPV or delayed PPV when healing biomarkers are absent on periodic optical coherence tomography., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
41. Refractive surgical approaches to keratoconus: A systematic review and network meta-analysis.
- Author
-
Niazi S, Doroodgar F, Hashemi Nazari S, Rahimi Y, Alió Del Barrio JL, Gatzioufas Z, Findl O, Vinciguerra P, Vinciguerra R, Moshirfar M, Ambrósio R Jr, and Alio JL
- Subjects
- Humans, Refractive Surgical Procedures methods, Network Meta-Analysis, Refraction, Ocular physiology, Corneal Topography, Keratoconus surgery, Keratoconus physiopathology, Keratoconus diagnosis, Visual Acuity physiology
- Abstract
Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning 4 distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages., Competing Interests: Declaration of Competing Interest On behalf of all authors and as the corresponding author, I hereby declare that there has been no conflicting interests of any type, at any time during the conduction of this project., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
42. The prevalence of visual axis opacification in the Swedish Pediatric Cataract Register.
- Author
-
Magnusson G, Gyllén J, Haargaard B, Nyström A, Rosensvärd A, Scurei C, Kjellström U, and Tornqvist K
- Subjects
- Humans, Sweden epidemiology, Male, Female, Infant, Child, Preschool, Prevalence, Follow-Up Studies, Retrospective Studies, Infant, Newborn, Lens Implantation, Intraocular, Lenses, Intraocular, Cataract epidemiology, Registries, Visual Acuity, Cataract Extraction statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Purpose: To report on the occurrence of postoperative visual axis opacification (VAO) in children younger than 5 years of age operated for cataract in Sweden, and to analyse correlations with age at surgery and surgical method., Methods: Data were derived from the Swedish Pediatric Cataract Register (PECARE). All children operated on between 1 January 2007 and 31 December 2020 were included. Follow-ups at 1, 2 and 5 years of age were analysed., Results: Cataract surgery were performed on 770 eyes belonging to 549 children (n = 282 boys, 51.4%); 327/770 (42.5%) of the children underwent surgery before 3 months of age and 216/770 (28%) before 6 weeks of age. Data on 881 follow-up visits were registered. At the follow up-visits at 1, 2 and 5 years of age, VAO was present in 154/349 (44.1%), 41/323 (12.7%) and 25/208 (12%). The majority of the children with VAO underwent cataract surgery before age 6 months, with a predominance before age 2 months. Primary IOL was implanted in 601/770 (78%) of eyes; 40.8% had an acrylic one-piece lens, 31.8% had a bag-in-the-lens IOL, 21.9% were aphakic and 5.2% had an acrylic three-piece lens. Implantation of a bag-in-the-lens IOL was related to a significantly lower occurrence of VAO compared to other types of IOL, including aphakia (p < 0.0002)., Conclusion: Our results are in accordance with the literature. Primary bag-in-the-lens IOL implantation before 2 years of age seems adequate and safe, with a low occurrence of VAO, and can thus be continued as routine in Sweden., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)
- Published
- 2024
- Full Text
- View/download PDF
43. Seropositive Neuromyelitis Optica Spectrum Disorder Presenting With Optic Nerve Sheath Enhancement and Optic Disc Edema Resembling Optic Nerve Sheath Meningioma.
- Author
-
Marin AI, Zarubina AV, Bennett JL, and Subramanian PS
- Subjects
- Humans, Female, Diagnosis, Differential, Optic Nerve Neoplasms diagnosis, Optic Nerve Neoplasms complications, Meningeal Neoplasms diagnosis, Meningeal Neoplasms complications, Meningeal Neoplasms diagnostic imaging, Optic Nerve diagnostic imaging, Optic Nerve pathology, Tomography, Optical Coherence methods, Middle Aged, Autoantibodies blood, Adult, Neuromyelitis Optica diagnosis, Neuromyelitis Optica complications, Meningioma diagnosis, Meningioma complications, Meningioma diagnostic imaging, Papilledema diagnosis, Papilledema etiology, Magnetic Resonance Imaging methods
- Abstract
Competing Interests: The authors report no conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
44. Trends and Clinical Outcomes of Fungal Keratitis in Canada: A 20-year Retrospective Multicentre Study.
- Author
-
Ling JYM, Yeung SN, Chan CC, Trinh T, Antaki F, Harissi-Dagher M, Sivachandran N, Fava M, Légaré MÈ, and Iovieno A
- Subjects
- Humans, Retrospective Studies, Male, Female, Canada epidemiology, Middle Aged, Adult, Fungi isolation & purification, Keratitis epidemiology, Keratitis microbiology, Keratitis diagnosis, Corneal Ulcer microbiology, Corneal Ulcer epidemiology, Corneal Ulcer diagnosis, Risk Factors, Aged, Incidence, Young Adult, Eye Infections, Fungal epidemiology, Eye Infections, Fungal microbiology, Eye Infections, Fungal diagnosis, Eye Infections, Fungal drug therapy, Visual Acuity physiology, Antifungal Agents therapeutic use
- Abstract
Purpose: An increase in fungal and particularly filamentous keratitis has been observed in many geographic areas, mostly in contact lens wearers. This study seeks to characterize long-term trends in fungal keratitis in a continental climate area to provide guidance for diagnosis and treatment., Design: Retrospective multicentric case series., Methods: Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included. Charts were reviewed for patient demographics, risk factors, visual acuity, and treatments undertaken., Results: A total of 138 patients were identified: 75 had yeast keratitis while 63 had filamentous keratitis. Patients with yeast keratitis had more ocular surface disease (79% vs 28%) while patients with filamentous keratitis wore more refractive contact lenses (78% vs 19%). Candida species accounted for 96% of all yeast identified, while Aspergillus (32%) and Fusarium (26%) were the most common filamentous fungi species. The mean duration of treatment was 81 ± 96 days. Patients with yeast keratitis did not have significantly improved visual acuity with medical treatment (1.8 ± 1 LogMAR to 1.9 ± 1.5 LogMAR, P = .9980), in contrast to patients with filamentous keratitis (1.4 ± 1.2 LogMAR to 1.1 ± 1.3 LogMAR, P = .0093)., Conclusions: Fungal keratitis is increasing in incidence, with contact lenses emerging as one of the leading risk factors. Significant differences in the risk factors and visual outcomes exist between yeast keratitis and filamentous keratitis which may guide diagnosis and treatment., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
45. Risk Factors for Legal Blindness in 237 Japanese Patients with Exogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST.
- Author
-
Yoshimura A, Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Sugisawa T, Komuku-Yamamoto Y, and Gomi F
- Subjects
- Humans, Retrospective Studies, Male, Risk Factors, Female, Middle Aged, Japan epidemiology, Aged, Adult, Anti-Bacterial Agents therapeutic use, Aged, 80 and over, East Asian People, Endophthalmitis epidemiology, Endophthalmitis microbiology, Endophthalmitis diagnosis, Eye Infections, Bacterial epidemiology, Eye Infections, Bacterial microbiology, Eye Infections, Bacterial diagnosis, Visual Acuity physiology, Blindness etiology, Blindness epidemiology
- Abstract
Purpose: We investigated potential risk factors for visual prognosis in Japanese patients with exogenous endophthalmitis., Methods: In this retrospective observational multicenter cohort study, risk factors for legal blindness at 12 weeks after treatment initiation were evaluated based on patient characteristics, initial BCVA, causative events, pathogens, ocular symptoms, duration from symptom onset to initial treatment, and selected treatments., Results: Overall, 23.1% of eyes developed legal blindness. The six risk factors for legal blindness were presence of eye pain, pathogen identification, poor BCVA at the initial visit, longer duration from symptom onset to initial treatment, type of causative event, and type of causative pathogen. Regarding the type of causative pathogen, coagulase-negative staphylococci was associated with a better visual impairment outcome., Conclusion: Exogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatment, as well as other advances in medical knowledge and technology.
- Published
- 2024
- Full Text
- View/download PDF
46. Maculopathies Referred to Neuro-Ophthalmology Clinic as Optic Neuropathies: A Case Series.
- Author
-
Vosoughi AR, Donaldson L, Micieli JA, and Margolin EA
- Subjects
- Humans, Female, Male, Middle Aged, Adult, Aged, Adolescent, Retrospective Studies, Aged, 80 and over, Young Adult, Tomography, Optical Coherence methods, Diagnosis, Differential, Referral and Consultation, Visual Acuity physiology, Ophthalmology, Neurology, Optic Nerve Diseases diagnosis
- Abstract
Background: The clinical features of maculopathies and optic neuropathies often overlap: Both present with decreased visual acuity and variable loss of color vision; thus, maculopathy can be misdiagnosed as optic neuropathy, leading to patient harm. We aimed to determine what findings and/or tests were most helpful in differentiating between optic neuropathy and maculopathy., Methods: A retrospective chart review of consecutive patients over 4.5 years who were referred to neuro-ophthalmology clinics with the diagnosis of optic neuropathy but whose final diagnosis was maculopathy. Patient demographics, mode of presentation, clinical profile, complete ophthalmological examination, results of all ancillary testing, and final diagnosis were recorded., Results: A total of 47 patients (27 women) were included. The median age was 55 years (range, 18-85). Most referrals were by ophthalmologists (72.3%) and optometrists (12.8%). The diagnosis of maculopathy was made in 51.1% of patients at the time of first neuro-ophthalmic consultation. Only 6.4% patients (3) had relative afferent pupillary defect. Benign disc anomalies (tilted, myopic, small, or anomalous discs) were present in 34.0%, and 21.3% had pathologic disc changes unrelated or secondary to maculopathy. Macular ocular coherence tomography (OCT) was abnormal in 84.4% (with outer retinal pathology in 42.2% and inner retina pathology in 17.8%). Retinal nerve fiber layer (RNFL) thickness was normal in 82.6% of patients., Conclusions: Macular OCT is a high-yield test in differentiating between optic neuropathy and maculopathy and should be obtained in patients with suspected optic neuropathies who have normal RNFL thickness. Macular dystrophies, particularly cone dystrophies, unspecified retinal disorders, and macular degeneration were the most common mimics of optic neuropathy. The diagnosis was often present on OCT of the macula. The presence of coexistent benign and pathological disc anomalies may lead to maculopathy being misdiagnosed as optic neuropathy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by North American Neuro-Ophthalmology Society.)
- Published
- 2024
- Full Text
- View/download PDF
47. Federated Learning in Glaucoma: A Comprehensive Review and Future Perspectives.
- Author
-
Hallaj S, Chuter BG, Lieu AC, Singh P, Kalpathy-Cramer J, Xu BY, Christopher M, Zangwill LM, Weinreb RN, and Baxter SL
- Abstract
Current approaches to developing artificial intelligence (AI) models for widespread glaucoma screening have encountered several obstacles. First, glaucoma is a complex condition with a wide range of morphological and clinical presentations. There exists no consensus definition of glaucoma or glaucomatous optic neuropathy. Further, training effective deep learning algorithms poses numerous challenges, including susceptibility to overfitting and lack of generalizability on external data. Therefore, training data should ideally be sourced from large, well-curated, multi-client cohorts to ensure diversity in patient populations, disease presentations, and imaging protocols. However, the construction of centralized repositories for multimodal data faces hurdles such as concerns regarding data sharing, re-identification, storage, regulations, patient privacy, and intellectual property. Federated learning (FL) has emerged as a proposed solution to address some of these concerns by enabling data to remain locally hosted while facilitating distributed model training. This article aims to provide a comprehensive review of the existing literature on FL in the context of its applications for AI tasks related to glaucoma., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
48. Safety, efficacy, and clinical outcomes of transconjunctival intrascleral fixation of an intraocular lens.
- Author
-
Aljindan M, Hamdi A, Alali NM, Hashem F, and ALBalawi HB
- Subjects
- Humans, Female, Male, Middle Aged, Prospective Studies, Aged, Retrospective Studies, Adult, Suture Techniques, Intraocular Pressure physiology, Treatment Outcome, Follow-Up Studies, Lens Implantation, Intraocular methods, Sclera surgery, Visual Acuity, Lenses, Intraocular, Conjunctiva surgery
- Abstract
Background: Implantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane's double-needle technique and flanged haptics., Methods: Prospective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane's technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty., Results: The mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis., Conclusions: The transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
49. Ethical considerations for large language models in ophthalmology.
- Author
-
Kalaw FGP and Baxter SL
- Abstract
Purpose of Review: This review aims to summarize and discuss the ethical considerations regarding large language model (LLM) use in the field of ophthalmology., Recent Findings: This review of 47 articles on LLM applications in ophthalmology highlights their diverse potential uses, including education, research, clinical decision support, and surgical assistance (as an aid in operative notes). We also review ethical considerations such as the inability of LLMs to interpret data accurately, the risk of promoting controversial or harmful recommendations, and breaches of data privacy. These concerns imply the need for cautious integration of artificial intelligence in healthcare, emphasizing human oversight, transparency, and accountability to mitigate risks and uphold ethical standards., Summary: The integration of LLMs in ophthalmology offers potential advantages such as aiding in clinical decision support and facilitating medical education through their ability to process queries and analyze ophthalmic imaging and clinical cases. However, their utilization also raises ethical concerns regarding data privacy, potential misinformation, and biases inherent in the datasets used. Awareness of these concerns should be addressed in order to optimize its utility in the healthcare setting. More importantly, promoting responsible and careful use by consumers should be practiced., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
50. Differences in macular thickness associated with peripheral retinal vessel whitening in diabetic patients.
- Author
-
Kalaw FGP, Sharma P, Walker E, and Borooah S
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Adult, Case-Control Studies, Tomography, Optical Coherence methods, Macula Lutea diagnostic imaging, Macula Lutea pathology, Diabetic Retinopathy diagnostic imaging, Diabetic Retinopathy pathology, Retinal Vessels diagnostic imaging, Retinal Vessels pathology
- Abstract
This study aimed to determine the difference in macular thickness among patients with diabetes mellitus (DM) with and without peripheral retinal vessel whitening (PRVW). PRVW was defined by retinal vessel whitening outside the standard seven ETDRS fields. Subjects were divided into DM with PRVW, DM without PRVW, and normal age-matched controls. Optical coherence tomography scans were divided into total, inner, and outer retinal layer thicknesses and were compared in the macula's central, inner, and outer rings. Forty-seven eyes were included: DM with PRVW = 15, DM without PRVW = 16, and Controls = 16. Overall, the mean retinal thickness in patients with DM with PRVW was lower than in patients with DM without PRVW and controls. In the inner macula, DM patients with PRVW showed a significantly lower mean inner superior, nasal, inferior, and temporal macula compared to DM patients without PRVW (p = 0.014, 0.008, 0.005, < 0.001, respectively). DM patients with PRVW also showed a significantly lower mean outer superior, nasal, inferior, and temporal macula than controls (p = 0.005, 0.005, 0.016, 0.025, respectively). This study demonstrates that PRVW in DM patients may be associated with global structural changes to the macular region, promoting a decrease in inner and outer retinal thickness. Further studies should investigate the functional correlation with PRVW in DM patients in order to better understand its potential implications in diabetic patients., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.