Low-dose Cyclosporin a in uveitis a long-term follow-up

Seventy patients suffering from bilateral endogenous chronic uveitis or ocular Behcet's disease have been treated with 5 mg/kg/day Cyclosporin A. All patients were followed at regular intervals for up to eight years. In this group of patients, we observed that CsA is an effective drug for the treatment of intraocular inflammation. Patients have needed continuous treatment with CsA for an average period of 31 months. Exacerbations of the inflammatory processes have been observed in 95% of the patients on initial attempts to lower the CsA dosage. These exacerbations were controlled either by local treatment or a combination of low-dose systemic corticosteroids. Elevation of the serum creatinine was initially observed in all patients when under the higher doses of CsA. However, only 15 patients (21.4%) had levels which were higher than the upper normal limit. Elevation of the bilirubin level of 50% or more above baseline was observed in 45 patients (64.3%) but only 11 patients (15.7%) showed levels which were above the upper normal limit. During this period of follow-up, cure was achieved in 25 patients and no exacerbations were observed up to five years after discontinuation of treatment.     

Construction of a complete rabbit cornea substitute using a fibrin-agarose scaffold

PURPOSE: To construct a full-thickness biological substitute of the rabbit cornea by tissue engineering. METHODS: Ten rabbit corneas were surgically excised, and the three main cell types of the cornea (epithelial, stromal, and endothelial cells) were cultured. Genetic profiling of the cultured cells was performed by RT-PCR for the genes COL8 and KRT12. To develop an organotypic rabbit cornea equivalent, we used a sequential culture technique on porous culture inserts. First, endothelial cells were seeded on the base of the inserts. Then, a stroma substitute made of cultured keratocytes entrapped in a gel of human fibrin and 0.1% agarose was developed. Finally, cultured corneal epithelial cells were grown on the surface of the scaffold. Stratification of the epithelial cell layer was promoted by using an air-liquid culture technique. Corneal substitutes were analyzed by light and electron microscopy. RESULTS: All three types of corneal cells were efficiently cultured in the laboratory, expanded, and used to construct a full-thickness cornea substitute. Gene expression analyses confirmed that cultured endothelial cells expressed the COL8 gene, whereas epithelial cells expressed KRT12. Microscopic evaluation of the cornea substitutes demonstrated that epithelial cells tended to form a normal stratified layer and that stromal keratocytes proliferated rapidly in the stromal substitute. The endothelial monolayer exhibited a pattern similar to a normal corneal endothelium. CONCLUSIONS: These findings suggest that development of a full-thickness rabbit cornea model is possible in the laboratory and may open new avenues for research.     

Irrepressible saccades from a tectal lesion in a Rhesus monkey

We present a case of spontaneously occurring irrepressible saccades in an experimental Rhesus monkey. Though eye jerks are sometimes associated with cerebellar disease, central demyelination or brainstem lesions, there is little consensus on their neurological mechanisms. From neurological and anatomical investigation we report that these irrepressible saccades were caused by a discrete cerebrovascular accident that involved the rostral superior colliculus along with its commissure, and with minor invasion of periaqueductal gray and adjacent mesencephalic reticular formation. Other suspected structures, like the raphe interpositus, substantia nigra and the cerebellum, were unaffected.     

How is a grating detected on a narrowband noise masker?

Thresholds were measured for detecting 4 cpd gratings added to maskers consisting of nine sinusoidal components spanning 1 octave around the signal frequency. Phases of all mask components were randomized on every presentation. To assess their importance, contrast differences were either rendered unreliable by introducing contrast jitter between-intervals, or eliminated by equating contrast energy within the octave band across intervals and trials. The deleterious effects of contrast jitter and the similarity of grating detection and contrast discrimination thresholds argues that contrast cues are being used. Those cues are not the only ones available, because contrast jitter has less than the expected effect, and equating contrast energy only raises threshold a few dB. Computer simulations reveal that there is sufficient information in several spatial pattern cues to support detection performance.     

Imaging a child's fundus without dilation using a handheld confocal scanning laser ophthalmoscope

Images of the fundus were acquired in children without pupil dilation using a prototype handheld confocal scanning laser ophthalmoscope (SLO). A 780-nm laser beam imaged a 20 degrees x 20 degrees area of the fundus while a 645-nm beam scanned a fixation target. Scorable images of the optic nerve, macula, and vessels were obtained in 67 (72%) of 93 eyes from pediatric patients with nystagmus, amblyopia, media opacities, or optic nerve or macular abnormalities. Images were obtained in all eyes of pediatric and adult controls. Unsuccessful imaging was associated with media opacities, high refractive error, and poor cooperation. Disadvantages of the SLO were the inability to detect optic nerve pallor or consistently image the periphery. Advantages of the SLO were seen in children with nystagmus, photophobia, eccentric fixation, cone dystrophy, and mild papilledema.     

中国城市人口需住院治疗的眼外伤病例回顾性分析

目的:阐明流行病学,眼外伤成因,严重眼外伤造成的视觉状况,在中国具有代表性的城市治疗7a后最终的视觉灵敏度。方法:大坪医院根据其2000-01/2006-12接收的眼外伤住院患者档案资料,开展了一项眼外伤临床案例回顾性分析活动。结果:开放性眼球损伤268例,其他294例为眼钝挫伤病例。眼外伤最常见的成因是金属(29.4%)、爆炸(14.6%)以及石头(13.9%)。在此次研究中,大多数的眼外伤患者最终的治疗结果并不乐观,他们当中,受过外伤的眼睛的最终视力治疗结果不及0.1。结论:眼外伤治疗方法在近几年中取得了很大的进展,但治疗结果不尽人意。     

Eyelid tumor as a recurrence of a gastric MALT-lymphoma

BACKGROUND: MALT Lymphoma of the conjunctiva, eyelid and orbit represents a primary manifestation of the disease in most of the cases. CASE REPORT: A 58-year-old male presented with a tumor in the left inferior eyelid. A full-thickness incisional biopsy was performed. Histopathologically, a lymphoid infiltrate involved the eyelid in its full width, with reactive follicles surrounded by small cells with irregular nucleus. Follicular colonization and lymphoepithelial lesions were detected. The tumor was CD20 positive. The molecular genetic analysis disclosed a monoclonal B-cell proliferation. The patient had a history of gastric MALT lymphoma treated 9 years ago and he had been otherwise in good health. The histopathologic features of the gastric tumor were identical to those of the eyelid lesion. Since the eyelid tumor represented a recurrence of the disease, treatment consisted of systemic chemotherapy. Complete tumor eradication was obtained. CONCLUSION: Ocular adnexal MALT-lymphomas may represent a recurrence of a distant primary MALT-lymphoma after a long disease-free period and, therefore, be an indication for systemic chemotherapy.     

The effect of strabismus on a young child''s selection of a playmate

PURPOSE: This study investigated the effect of strabismus on a child's playmate selection. METHODS: Photographs of orthotropic children aged 3-6 years were altered to simulate various magnitudes of strabismus. The pictures were arranged in pairs, one orthotropic child and one with strabismus. One hundred children aged 3-8 years viewed the photographs and were asked to select a playmate from each pair. RESULTS: Chi-squared analysis found 23 children showed evidence that strabismus influenced their choices (p < 0.07). Of these 23, 12 preferred playmates with strabismus and 11 preferred orthotropic playmates. Chi-squared analysis of all subjects combined found decisions were not based on the magnitude or direction of strabismus. CONCLUSIONS: As only 11% of the children consistently selected against playmates with strabismus, and about the same percentage preferred playmates with strabismus (12%), the presence of strabismus does not appear to be a significant factor in peer acceptance in this age group.     

Value of a centralized surveillance system during a national epidemic of endophthalmitis

A centralized registry of cases was established when it became apparent that an outbreak of Candida parapsilosis endophthalmitis in California was due to intrinsic contamination of a nationally distributed ocular irrigation solution. The purposes were to detect cases, to identify patients at risk, to collect and disseminate clinical information regarding the infection, and to make available information and experience regarding treatment. As a result of these efforts, all patients exposed to the solution were reviewed by their physicians and numerous cases of infection were detected. In contrast, Food and Drug Administration-mandated procedures, traditionally focused on manufacturing standards, were effective in recalling the contaminated solution but failed to provide physicians with adequate information to identify and care for patients at risk.     

Trabeculectomy using a sutureless scleral tunnel technique: a preliminary study.

PURPOSE: This study was conducted to evaluate prospectively the surgical outcome in terms of intraocular pressure (IOP) control and safety of trabeculectomy using a sutureless scleral tunnel technique in patients with uncomplicated primary open-angle glaucoma (POAG). METHODS: Patients with POAG whose IOP was more than 21 mmHg with administration of maximally tolerated medications were recruited for this study. All patients underwent the sutureless scleral tunnel trabeculectomy under retrobulbar anesthesia. Intraoperative complications and postoperative visual acuity, IOP, bleb status, and complications were evaluated for a follow-up period of 1 year. RESULTS: Surgery was performed in 18 patients (20 eyes); 17 of the patients (19 eyes) completed the study (one patient was excluded because of defaulted follow-up). Mean IOP was 26.6 +/- 3.6 mmHg before surgery and 15.3 +/- 3.0 mmHg 1 year after surgery. No intraoperative complications were encountered. Mild hyphema (10.5%) and shallow anterior chamber (15.8%) were noted in the immediate postoperative period, but both were managed successfully with conservative treatment. The absolute success rate was 79.0%. CONCLUSION: The preliminary results of this study are encouraging. It appears that sutureless scleral tunnel trabeculectomy is a safe and effective drainage procedure for treating uncomplicated POAG. A larger-scale study with a longer follow-up period seems warranted.     

Responses to a dry eye questionnaire from a normal population

A dry eye questionnaire was completed by 500 patients who presented for the correction of refractive error. A sample of non-contact lens wearers was extracted (N = 177) and responses were compared between males and females, and between three subgroups according to age. Females responded at a significantly higher rate in regard to 4 of 24 questionnaire segments. Differences according to age were found for 5 of 24 questionnaire segments. Except for the question concerning arthritis, increased prevalence of dry eye findings in over-45-year-old females was not found in this normal population. These results, combined with those reported previously, validate the use of the questionnaire as a screening instrument that will enable ocular sicca cases to be identified.     

Epithelialization of a synthetic polymer in the feline cornea: a preliminary study

PURPOSE: This study examined the potential of a synthetic polymer to support stable epithelial growth when implanted in the feline cornea. METHODS: A perfluoropolyether-based polymer was cast into lenticules that were coated with collagen I and implanted in four feline corneas. Epithelial growth onto the lenticules was monitored clinically for 6 weeks, after which time the animals were killed, and three corneas were evaluated histologically. Immunohistochemistry was used to identify proteins associated with the formation of a basement membrane (laminin) and adhesion complexes (bullous pemphigoid antigen and collagen VII). Electron microscopy was used to examine the tissue-polymer interface for evidence of the assembly of these adhesive structures. RESULTS: Postoperative epithelial growth began on days 2 to 3, and lenticules were fully epithelialized by days 5 to 9. Lenticules were clinically well tolerated and histology showed epithelium consisting of multiple layers adherent to the lenticule's surface. Laminin, bullous pemphigoid antigen and collagen VII were identified at the tissue-polymer interface using immunohistochemistry. Ultrastructural examination showed evidence of assembly of these proteins into a recognizable basement membrane and hemidesmosomal plaques. CONCLUSIONS: A perfluoropolyether-based polymer coated with collagen I was implanted in the feline cornea and supported epithelial growth that showed signs of persistent adhesion, both clinically and histologically. This polymer shows potential for ophthalmic applications that require sustained epithelialization.     

Developing a preference-based Glaucoma Utility Index using a discrete choice experiment.

PURPOSE: To estimate a utility-based glaucoma health outcome measure, known as the Glaucoma Utility Index. METHODS: Based on focus group studies, involving people with glaucoma, existing profile measures relevant to glaucoma were modified and a six-dimensional profile instrument was developed. Dimensions were: central and near vision; lighting and glare; mobility; activities of daily living; eye discomfort and other effects. Each dimension was assigned four levels (no difficulty; some difficulty; quite a lot of difficulty; and severe difficulty). The discrete choice experiment (DCE) approach was employed to move from this profile instrument to a preference-based utility measure. Experimental design techniques were used to derive a sample of health states for which preferences were elicited using the DCE. Four hundred and seventy-three people with glaucoma received the choice questionnaire. RESULTS: The regression analysis was based on 286 consistent responses to the DCE. The regression coefficients for three of the dimensions ("central and near vision," "mobility," and "activities of daily living") moved as expected. Moving from "no difficulty" to "severe difficulty" for central and near vision resulted in the most loss of utility, followed by activities of daily living and mobility. Systemic ("other effects") and local side effects were considered the least important. Utility weights were related to self-reported glaucoma state. Utility estimates moved in line with generic measures of health outcome. CONCLUSIONS: This study developed a preference-based utility measure (Glaucoma Utility Index) using the DCE approach. The index, estimated on the basis of 286 respondents, demonstrated both theoretical and convergent validity with other generic health outcome measures and measures of glaucoma severity. Further research investigating preferences by clinically defined glaucoma health status is indicated. Methodological research should focus on alternative methods of scaling for use within a generic Quality Adjusted Life Year framework.     

Performance of a new binocular wavefront aberrometer based on a self-imaging diffractive sensor

PURPOSE: To compare the performance of the Ophthonix Z-View diffractive aberrometer with two different Hartmann-Shack aberrometers. METHODS: The Ophthonix Z-View was compared with the Alcon LADARWave and VISX WaveScan using 4 model eyes and 68 human eyes. Comparisons using three fixed, single-surface model eyes each with a different wavefront pattern were used to determine higher order accuracy. Lower order accuracy, linearity, and higher order repeatability were tested with a fourth model eye with a movable retinal surface. Manifest refraction spherical equivalent and the calculated spherical equivalent refraction of the aberrometers were compared in 68 human eyes. RESULTS: The Z-View was more accurate with lower noise compared to the WaveScan and LADARWave systems for higher order measurements of the fixed model eyes. Total root-mean-square difference from surface topography derived average values for all model eye configurations were 0.48, 0.95, and 0.74 microm for the Z-View, WaveScan, and LADARWave aberrometers, respectively. Average inter-measurement standard deviations for the fixed model eyes were 0.024, 0.025, and 0.034 microm for the Z-View, WaveScan, and LADARWave aberrometers, respectively. Results were similar among the systems for measuring the movable retina surface model eye and comparing manifest refraction spherical equivalent of the patients. CONCLUSIONS: Data gathered using one variable and several fixed-parameter model eyes showed good correlation to predicted values for all of the aberrrometers with one exception. A significant difference was found in the measurement of one individual fixed model eye with one of the three aberrometers. The wavefront refraction provided by the Z-View correlated well with the results of manifest refraction.     

Returning to cataract surgery after a hiatus: a UK survey report

ObjectivesCataract surgeons may periodically take time away from operating which can lead to skills fade. There is a paucity of research investigating the experiences of returning cataract surgeons and how different individual circumstances impact on their return. Our aim was to investigate the subjective experiences of UK ophthalmologists simultaneously returning to surgery following the nationwide elective surgical hiatus due to the Covid-19 pandemic.MethodsAn online survey was nationally distributed between 01/09/2020 and 29/10/2020 to registered UK ophthalmologists. Participants indicating a surgical hiatus of 8 weeks or more were included.Results232 of 264 responses were analysed. Covid-19 was the most frequent reason for a surgical hiatus (median 15 weeks). Perceived operating difficulties were found in 29.1%. Transient anxiety (51.7%), reduced confidence, and perceived increased surgical time were commonplace. Trainees and females were more likely to encounter negative experiences (p < 0.001) and barriers to resource accessibility. Eyesi^® and online videos were the most available and accessed pre-return resources. Childcare was five times more likely to present as a barrier to resource access for females than males.ConclusionsTechnical skills fade such as capsulorhexis difficulties were commonly perceived by trainee surgeons in addition to transient anxiety, reported in more than half of all surgeons following a hiatus as short as 8 weeks.Eyesi^® simulation offers the potential to negate technical de-skilling. Few had formal return plans or awareness of RCOphth guidance. We believe there is scope for more specialised and targeted support for future returning cataract surgeons thereby optimising patient care.Subject terms: Epidemiology, Education, Technology     

Efficacy and safety of a steel drainage device implanted under a scleral flap

Objective: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS X200) implanted under a scleral flap for the surgical treatment of primary open-angle glaucoma (POAG).Study Design: Clinical, prospective, noncomparative, nonrandomized study. The efficacy and safety were evaluated on the full sample, with a minimum follow-up of 12 months (maximum 24, mean 18).Participants: Thirty-seven eyes of 35 patients.Methods: The Ex-PRESS device was implanted under a scleral flap in patients with POAG.Results: Preoperative intraocular pressure (IOP) was 27.6 (SD 8.7) mm Hg; at last follow-up, IOP was 12.4 (SD 3.4) mm Hg (55.1% reduction). The success rates (IOP < 18 mm Hg and < 15 mm Hg at last visit without medications) were 78.4% (29/37) and 70.3% (26/37), respectively. Kaplan-Meier analyses (probability of IOP < 18 mm Hg and < 15 mm Hg without medications) at last follow-up were 72.6% and 47.9%, respectively. Early postoperative complications were clinically mild and included postoperative IOP < 5 mm Hg: 12 cases at 1 day, 8 cases at 1 week, 3 cases at 1 month, 1 case at 3 months; serous choroidal detachment: 9 cases, of which 3 spontaneously resolved, whereas in 6 cases, hypotony and flat chamber were treated with viscoelastic injection in the anterior chamber. At last follow-up, 6 patients were treated with 2 IOP-lowering medications. No sight-threatening consequences of surgery were observed. There were 8 cases (21.6%, n = 37) of bleb needling.Conclusions: Our data support the efficacy and safety of the implantation of this device under a scleral flap. The IOP reduction obtained was significant and long standing and complications were mild.     

Orbital myiasis in a patient with a chronically exposed hydroxyapatite implant

We describe the clinical presentation of the first case, to our knowledge, of myiasis in an orbit with an exposed hydroxyapatite implant. We examined a 10-year-old boy with an 8-year exposure of an orbital implant. He had an infestation with maggots. The implant and the worms were surgically removed, allowing the socket to heal by secondary intention. The patient was able to wear a prosthesis 2 weeks later. The parasites were identified as belonging to Cochliomyia hominivorax, a fly responsible for the majority of cases of myiasis in the Western hemisphere.     

Profile of patients presenting at a low vision clinic in a developing country

ABSTRACT: BACKGROUND: Low vision is an important public health problem;however, very few low vision clinics are available to address the needs of low vision patientsin most developing countries. The purpose of this study was to describe the characteristics of patients attending the low vision clinic of a Nigerian tertiary hospital. METHODS: This was a prospective cross sectional study of all new patients seen at the low vision clinic over a 36 month period. Patients were administered with a structured questionnaire, and were examined and tested with low vision devices by the attending low vision specialist. Information on the demographic and clinical characteristics of the patients was recorded. RESULTS: A total of 193 new patients seen during the period were studied. The mean age was 41.4 years, and their ages ranged between 6 and 90 years with a male to female ratio of 1.9:1. Majority (58%) were aged below 50 years, 23.3% were children ([less than or equal to]15 years), while 21.8% were elderly patients ([greater than or equal to]65 years). The commonest cause of low vision was retinitis pigmentosa (16.6%); 14.5% had age related macular degeneration (ARMD); 9.8% had albinism; while only 1% had diabetic retinopathy. ARMD(45.2%) was the commonest cause in the elderly patients, while albinism (24.4%) and optic atrophy (24.4%) were the commonest in children. CONCLUSION: The demographic and clinical characteristics of low vision patients seen in this clinicare similar to that of patients in other developing countries, but different from those in developed countries. Elderly patients and females may be under-utilising low vision services. There is a need for further research into the determinants of low vision service utilisation in developing countries. This would further aid the planning and delivery of services to low vision patients in these countries.     

Sunlamp use is a risk factor for uveal melanoma: a meta-analysis

ObjectiveAdvancements in the treatment of uveal melanoma have not improved survival; therefore, identifying modifiable risk factors is critical to improving outcomes. This study aims to investigate the association between sunlamp use and the development of uveal melanoma.DesignThis study is designed as a meta-analysis.MethodsLiterature was searched and reviewed through the MEDLINE (with both OVID and PubMed), EMBASE, MD Consult, and Web of Science databases. These databases were searched from 1966 to 2019 using the following keywords to identify articles examining risk factors for uveal melanoma: ultraviolet, sun, sunlight, uveal melanoma, eye cancer, eye melanoma, nevus, and risk factor. All articles were evaluated for inclusion based on methodology and data reporting association between sunlamp use and uveal melanoma. The Meta-analysis of Observational Studies in Epidemiology guidelines and the Newcastle-Ottawa Scale were used to assess data quality and validity. A random effects model was employed.ResultsA total of 5 studies, enrolling a total of 1753 uveal melanoma cases and 3399 controls were included in this meta-analysis. The results of this study showed a positive association between sunlamp use and uveal melanoma (odds ratio = 2.15; 95% confidence interval 1.27–3.64). Meta-regression of between study heterogeneity did not reveal a statistically significant association when publication year, site latitude, melanoma tissue location (specifically, inclusion of iris tumors), or control type (population versus clinic) were evaluated.ConclusionThis meta-analysis identified a statistically significant association between sunlamp use and uveal melanoma, supporting sunlamp use as a modifiable risk factor for uveal melanoma.     

Pharmacokinetic and toxicity investigations of a new intraocular lens with a dexamethasone drug delivery system: a pilot study

AIM: To investigate the short-term safety and pharmacokinetic behavior of a new intraocular lens containing a dexamethasone drug delivery system (IOL-DDS) in rabbit eyes. METHODS: A modified polymethylmethacrylate IOL containing a biodegradable dexamethasone DDS was implanted into the posterior chamber of the right eyes of 9 New Zealand white rabbits. Serial slitlamp and indirect ophthalmoscopic examinations (including grading of intraocular inflammation) were performed. After 3, 6 and 9 days, the rabbits were euthanized and the globes were removed for histological examination and for determination of dexamethasone levels in the aqueous humor and in the vitreous. Analysis of dexamethasone concentrations was performed by ELISA. RESULTS: Therapeutic concentrations of dexamethasone were detectable in the aqueous and vitreous of the study eyes throughout the 9-day period in all tested animals. The mean aqueous dexamethasone concentration (ng/ml, +/- SD) was 1,015.42 (+/- 43.05), 970.11 (+/- 32.47) and 757.58 (+/- 30.19) and the mean vitreous concentration (ng/ml, +/- SD) was 399.82 (+/- 38.05), 287.38 (+/-34.47) and 268.15 (+/- 32.00) at 3, 6 and 9 days after the surgical procedure, respectively. No corneal or retinal histological changes were observed during the study period. CONCLUSION: The IOL-DDS is effective in delivering therapeutic concentrations of dexamethasone to the aqueous and vitreous, without acute damage to the cornea and retina. Further controlled studies in the same animal model are under way to determine the potential value of this lens in the prevention and treatment of inflammation following cataract surgery.