Changes in Local Immune Functions in Mooren's Ulcer

Purpose: To the investigate changes in local immune functions of the cornea and the adjacent conjunctiva, and their roles in the mechanism of the disease. Method: The cornea and adjacent bulbar conjunctiva taken from 14 patients with Mooren's ulcer were stained immunohistochemically for CD3, CD4, CD8, HLA-DR, GD1 and CD25.Result: An aberrant expression of HLA-DR antigen by a large number of kerato-conjunctival epithelial cells and keratocytes in the corneal stroma was found. The CD4 /CD8 ratio is significantly higher than normal control. Conclusion: The aberrant expression of MHC- II antigen in the resident cells at the peripheral cornea and the adjacent conjunctiva, along with a raised local TH/ Ts ratio leading to an excessive autoimmune reactivity is possibly the direct cause of Mooren's ulcer. Eye Science 1996; 12: 33-35.     

Phacoemulsification in review: Optimization of cataract removal in an in vitro setting

Phacoemulsification, initially used in the late 1960s, continues to be the standard of care for cataract removal. An animal model was developed so that, in a controlled research setting, all the various machines, handpieces, tips, and settings could be investigated. As a general rule, the higher power, vacuum, and aspiration settings lead to optimally efficient phacoemulsification. In addition, both new phacoemulsification platforms and newly developed devices have been shown to improve efficiency. As a result, we recommend that the integration of these recent developments should be considered in future investigations.     

Lasers in Ophthalmology

In recent years,lasers have entered every fieldof medicine and especially so in ophthalmol-ogy.The scientific basis of lasers in ophthal-mology is based on three mechanisms:1.Photothermal effectLasers:argon,krypton,dye and diodeA thermal effect is generated when laserenergy is absorbed by pigment leading to in-creased vibration and therefore heat content.A     

Why is squint surgery in children in decline?

BACKGROUND:/aims: Paediatric squint surgery appears to be declining. This study aims to identify if this is so and, if so, why. METHODS: Retrospective review of (1) episodes of paediatric squint surgery in Scotland and Tayside, 1986-2001, (2) presentations to orthoptists (Tayside) during 1986 and 1996. RESULTS: (1) Overall, a 58% fall in surgery in Scotland and 59% in Tayside. For esotropia, a reduction of 63% (Scotland) and 69% (Tayside). (2) Incidence of esotropia was unchanged; surgery for these esotropes fell (from 55% to 30%) (p = 0.013). More children received maximum hypermetropic correction (p <0.001) and more developed stereopsis (p = 0.003). CONCLUSION: Childhood strabismus surgery, particularly for esotropia, is declining. The maximum hypermetropic correction has improved the functional results.     

Spectacle-Wear Compliance in School Children in Concepción Chile

Purpose: Although international policies promote programs for correction of refractive errors in school children, recent studies report low compliance with respect to spectacle wear. Our aim was to assess spectacle-wear compliance and identify associated visual factors among children participating in Chile’s school spectacle provision program.

Methods: A total of 270 school children were prescribed spectacles and monitored after 1 year. Visual acuity, refractive error, reasons for not wearing spectacles, and self-reported visual function were assessed. Compliance is reported as the proportion of children wearing spectacles at the 1-year visit. Factors associated with compliance and reasons for not wearing spectacles were examined using contingency table analyses. Logistic models were constructed to assess independently associated factors.

Results: Only 204 children (76%) participated in the 1-year follow-up. Mean age was 10 years (range 4–19 years); 58% were girls, 42% boys. Overall compliance was 58%. Spectacle use was independently associated with age and refractive error. Older children were less likely to be compliant (odds ratio, OR, 0.8, 95% confidence interval, CI, 0.76–0.92/year of increasing age). Compared with children with refractions of ?0.75 to +0.75 diopters, both myopic and hyperopic children were more compliant (OR 4.93, 95% CI 2.28–10.67 and OR 2.37, 95% CI 1.06–5.31, respectively). Primary reasons for not wearing spectacles included breakage/loss in younger children, and disliking the appearance in teenagers.

Conclusion: We found greater compliance in spectacle wear than that reported in most published studies. Guidelines for provision of children’s spectacles should consider excluding children with mild refractive error and improving spectacle quality and appearance.     

Changes in Visual Function in the Elderly Population in the United States: 1995–2010

Purpose: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes).

Methods: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent).

Results: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma.

Conclusion: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.     

Telemedicine in Ophthalmology: A Useful Tool in Store-and-Forward Counselling?

Side by side with the progress in computers and imaging, telemedicine has already been used successfully in a large number of specialties of medicine. But high-quality images are not always suitable for transfer via modem because of their file size. The present experimental study was conducted to determine the effects of image compression by the JPEG algorithm on image quality and on the reliability of diagnosis after compression. Digital photographs of the retina were taken and the JPEG compressed images assessed by an experienced ophthalmologist. The present study showed a high reliability of diagnosis and a good agreement between the observations taken at the patient and at the computer. For this reason, JPEG image compression algorithm is suitable for reducing image size for producing high-quality images manageable for transmitting via modem in a store-and-forward teleophthalmological system.     

Trends in penetrating keratoplasty in the United States 1980–2005

In this review, we analyze the trends in corneal transplantation over the past 25 years in the United States. The most dramatic change was the progressive sharp increase in the number of corneal transplants performed during the 1980s, corresponding with the rise of pseudophakic bullous keratopathy (PBK) as the leading indication for keratoplasty. More recently, there has been a steady annual decline in total keratoplasties for more than a decade, corresponding with a decline in the cases performed for PBK, which still accounts for the highest percentage of cases done. Regrafts have been an increasingly important indication for keratoplasty, as older grafts fail. Keratoconus, Fuchs dystrophy, and other inherited diseases have remained consistent indications for keratoplasty during the last quarter century.     

Updates in Orbital Tumors

Orbital anatomy, the clinical features of orbital tumors, the recent development of the diagnosis and management of orbital tumors were described. The incidence of orbital tumors in Dr. Cipto Mangunkusumo Hospital in the past years were introduced. The principle of management of orbital tumors and their prognosis were discussed.     

Microvascular Changes in the Retrobulbar Optic Nerve in Idiopathic Intracranial Hypertension

Purpose : To examine the microvascular changes in the retrobulbar optic nerve in idio-pathic intracranial hypertension (PTC).Methods: Both optic nerves from a 29-year-old man with a two year history of PTC were examined histologically and morphometrically. A semi-automated image analysis system and paraphenylenediamine (PPD) stain were employed to resolve sufficiently the microvascular images for counts and measurement.Results: There were 150 vessels distributed in the optic nerves which revealed the following: The average lumen of the vessels in outer sectors were larger than those of the inner sector vessels (168. 17μm2vs. 46. 99μm2; p = 0. 0338;OD; and 251. 96μm2vs. 130.02μm2;p = 0.029;OS) while in the normal control optic nerve the outer and inner area lumens were reversed in size-differential, but this did not show a statistical difference. The thickness of the PTC optic nerve vessel walls in the outer sectors was also greater than that of the walls in the inner sectors (4. 95μm vs. 2. 67μm;     

Does in vitro susceptibility predict clinical outcome in bacterial keratitis?

PURPOSE: To determine whether clinical outcomes in bacterial keratitis are associated with antibiotic susceptibility. DESIGN: Retrospective, ancillary study using data and samples from a completed randomized clinical trial. METHODS: Forty-two patients were enrolled with culture-confirmed bacterial keratitis at Aravind Eye Hospital in South India. All patients received topical moxifloxacin and were randomized to receive either topical prednisolone phosphate or placebo. Outcomes included time to epithelialization, best spectacle-corrected visual acuity (BSCVA), and infiltrate/scar size at three months. Bacterial isolates were cultured, and minimum inhibitory concentration (MIC) to moxifloxacin was measured using Etests. Multiple linear regression was used to assess the effect of MIC on outcome, adjusting for enrollment characteristics. RESULTS: MIC was associated with three-month infiltrate/scar size: each two-fold increase in MIC was associated with a 0.33-mm average diameter increase in scar size (P=.01). MIC was not associated with three-month BSCVA (P=.71) or time to epithelialization (P=.35). CONCLUSIONS: MIC was associated with infiltrate/scar size in bacterial keratitis. An ongoing larger, multicenter trial should provide further information on whether this association is maintained across subgroups of organisms.     

Pattern of uveitis in Behçet’s disease in a referral center in Tunisia,North Africa

The purpose of this study was to analyze the pattern of uveitis in Behçet’s disease in Tunisia, North Africa. We retrospectively reviewed the clinical records of 62 patients (111 eyes) diagnosed with Behçet’s uveitis (BU) at the Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia, between January 1995 and December 2006. Forty-seven of 62 patients (75.8%) were men and 15 (24.2%) were women. Mean age at onset was 29.3 years. The average follow-up was 75.6 months. The most common extraocular clinical manifestations were recurrent oral ulcer in all patients and pseudofolliculitis in 52 patients (83.9%). Uveitis was bilateral in 79%. Initial best-corrected visual acuity was ≥20/40 in 41 affected eyes (36.9%) and <20/200 in 49 affected eyes (44.2%). Panuveitis (68 eyes, 61.3%) and posterior uveitis (38 eyes, 34.2%) were the most common forms, followed by anterior uveitis (five eyes, 4.5%). Retinal vasculitis was found in 89 eyes (80.2%). Most common complications included posterior synechiae (32.4%), cataract (31.5%), and cystoid macular edema (19.8%). Systemic corticosteroids were administered in 58 patients (93.5%). Immunosuppressive drugs were used in 22 patients (35.5%). Fifty-six affected eyes (50.5%) had final visual acuity ≥20/40 and 34 affected eyes (30.6%) had final visual acuity <20/200. In Tunisia, BU affects predominantly young men. Bilateral panuveitis associated with retinal vasculitis was the most common ocular manifestation. More than 50% of patients maintained a visual acuity of 20/40 or better, and immunosuppressive therapy probably contributed to the improvement of visual prognosis of these patients.     

Is there alteration in aortic stiffness in Leber hereditary optic neuropathy?

PURPOSE: Leber hereditary optic neuropathy (LHON) is recognized as the most common cause of isolated blindness in young men. The current study was designed to test whether LHON as a mitochondrial disease is associated with vascular functional alterations characterized by aortic elastic properties during echocardiography. METHODS: A total of 19 patients with typical features of LHON aged 42+/-13 years (10 males) were included. Their results were compared to 19 age- and gender-matched healthy controls. Aortic stiffness index was calculated from the echocardiographically derived aortic diameters and the clinical blood pressure data. RESULTS: In this patient population, the point mutation was present in 3460G>A position in five cases, in 11778G>A position in five cases, and in 14484T>C position in nine patients. Diastolic aortic diameter (26.0+/-2.5 mm vs 28.4+/-4.1 mm, p<0.05) and aortic stiffness index (5.1+/-2.6 vs 12.0+/-7.9, p<0.05) were significantly increased in LHON patients compared to controls. CONCLUSIONS: Aortic stiffness can be increased in LHON disease, but further studies are warranted to confirm these findings in a larger LHON patient population with a more reliable method focusing on the pathophysiologic background.     

Therapeutic Options in the Management of Glaucoma Simplex in the Third Millennium

Glaucoma is now considered a generic term for a group of ocular disoders manifestingas progressive optic neuropathy, usually hut not always, associated with elevated IOP, which is the main risk factor of optic neuropathy. In well-