Predictive factors for exudation of quiescent choroidal neovessels detected by OCT angiography in the fellow eyes of eyes treated for a neovascular age-related macular degeneration

BackgroundTo identify predictive factors for exudation for quiescent choroidal neovessels (qCNV) in the fellow eyes of eyes treated for a neovascular age-related macular degeneration (AMD).MethodsProspective observational study. One hundred and forty-four contralateral eyes of 144 patients treated for wet AMD were analysed. At a baseline visit, multimodal imaging including dye angiographies and optical coherence tomography angiography (OCT-A) was performed in order to detect qCNV. Patients were followed up for 12 months with a monthly assessment. The manifestation of any type of exudation (either intra- or subretinal fluid or hyperreflective subretinal material) was monitored.ResultsThe prevalence of qCNV in the treatment-naive eyes was 15.9% with an incidence over a 12-month period of 2.8%. In total, 40.7% of the overall neovessels remained stable with no sign of exudation, while 59.3% presented some fluid during the follow-up. A statistically significant relationship was established for the following variables preceding the exudation: increase in central macular thickness (OR = 116; 95% CI [4.74; 50530] p = 0.038), increase in pigment epithelial detachment height (OR = 1.76; 95% CI [1.17; 3.18] p = 0.021) and width (OR = 1.53; 95% CI [1.12; 2.62] p = 0.042), increase in neovessels’ surface on OCT-A (OR = 6.32; 95% CI [1.62; 51.0] p = 0.033), emergence of a branching pattern (OR = 7.50; 95% CI[1.37; 61.5] p = 0.032) and appearance of a hypointense halo surrounding the lesion (OR = 10.00; 95% CI [1.41; 206] p = 0.048).ConclusionsThe risk of exudation in the treatment-naive fellow eyes of eyes treated for neovascular AMD was notably increased in the presence of qCNV. The biomarkers identified will help to detect their activation in order to ensure prompt antiangiogenic therapy.Subject terms: Risk factors, Tomography     

Postoperative severe visual impairment: surgical outcome of 165 patients with orbital tumours in the muscle cone

ObjectiveThis study aimed to evaluate the risk factors of postoperative severe vision impairment (PSVI) for a primary orbital tumour in the muscle cone.MethodsA retrospective analysis of the patients who underwent orbitotomy for primary intraconal tumours at the Tianjin Medical University Eye Hospital from January 2010 to December 2015.ResultsA total of 165 cases of orbitotomy for primary orbital tumours in the muscle cone were included in the study. Postoperatively, 12 cases with vision acuity ≤20/400 or ≥4 rows of vision decline and without any corrected effect were analysed as PSVI, including no light perception (NLP) for 3 cases. The multivariate logistic regression indicated that the tumour in orbital apex (P = 0.048, OR = 4.912, 95% CI: 1.011–23.866), severe optic nerve displacement (P = 0.030, OR = 6.007, 95% CI: 1.184–30.473) and intraoperative tight adhesion (P = 0.003, OR = 12.031, 95% CI: 2.282–63.441) were the independent risk factors for PSVI.ConclusionsThe incidence of PSVI for the intraconal tumour was 7.3%, and the incidence of NLP was 1.8%. The tumour in orbital apex, severe optic nerve displacement and intraoperative tight adhesion were independent risk factors for PSVI.Subject terms: Risk factors, Vision disorders, Surgery     

A surgical skills assessment rubric for pterygium surgery

PurposeTo introduce an assessment tool (rubric) for evaluating ophthalmology residents’ competency in pterygium surgery.MethodsA panel of experienced international surgeons collaborated and developed the rubric. After describing various stages of the procedure, the Dreyfus scale of skill acquisition was used for scoring each stage. After finalizing the rubric, two surgeons independently evaluated 20 masked pterygium surgery videos of 10 residents and scored the videos according to the rubric. The agreement between the scores of them was examined with the intra-class correlation coefficient test.ResultsThis rubric divides pterygium surgery into 13 different stages and covers the two most common techniques of pterygium surgery; conjunctival autograft and amniotic membrane transplant. The rubric showed face and content validity. Overall, an intraclass correlation coefficient of 0.90 (95% confidence interval 0.76–0.96, P < 0.001) was achieved between the two surgeons. The residents scored significantly higher on surgeries performed later in their rotation compared to the earlier surgeries (4.32 ± 0.35 vs 3.96 ± 0.31, P = 0.006). Certain stages of pterygium surgery were more strongly correlated with the residents’ past pterygium surgical experience.ConclusionThis study introduces an international rubric for assessing competency in pterygium surgery. In addition to face and content validity, this rubric shows high inter-rater reliability. This may be a useful tool for teaching and measuring competency in pterygium surgery.     

Long-term follow-up of primary silicone oil tamponade for retinal detachment secondary to macular hole in highly myopic eyes: a prognostic factor analysis

PurposeTo investigate the risk factors associated with retinal detachment recurrence after first vitrectomy in high myopic eyes with macular hole retinal detachment (MHRD).MethodsPatients with high myopic eyes with MHRD who underwent pars plana vitrectomy and silicone oil (SO) tamponade with a follow-up period more than 12 months and more than 3 months after SO removal were included in this retrospective study. Logistic regression was performed to determine the risk factors associated with retinal re-detachment.ResultsA total of 45 eyes from 43 patients were included in this study (11 male and 34 female patients). The retinal re-detachment rate after the first removal of silicon oil was 35.5% (16/45) in a mean postoperative follow-up time of 35.64 ± 32.94 months. Complete macular atrophy on fundus photography (odds ratio (OR) = 17.021, 95% confidence interval (95% CI): 2.218–130.609, p = 0.006) was a risk factor for MHRD after SO removal, while internal limiting membrane (ILM) peeling (OR = 0.091, 95% CI: 0.013–0.633, p = 0.015) and duration of SO tamponade (OR = 0.667, 95% CI: 0.454–0.980, p = 0.039) were protective factors.ConclusionFor high myopic eyes with MHRD, complete macular atrophy was a significant risk factor for retinal re-detachment after silicon oil removal. ILM peeling and the duration of silicon oil tamponade were protective factors.Subject terms: Retinal diseases, Risk factors     

Association between obstructive sleep apnea and floppy eyelid syndrome: A systematic review and metaanalysis

RationaleObstructive sleep apnoea (OSA) has been linked to various ocular disorders, including floppy eyelid syndrome (FES). Previous studies have hypothesised the underlying association between the 2 , but results are currently still inconclusive.ObjectiveTo investigate the association between OSA and FES.MethodsFour databases (Pubmed, Embase, Scopus, and Cochrane Library) were searched from inception until 28 February 2022 for observational studies and randomized controlled trials assessing the association between OSA and FES. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of assessment using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to metaanalyze the associations.ResultsTwelve studies were included in the systematic review, of which nine were suitable for metaanalysis, with a combined cohort of 1,109 patients. Risk of bias was low to moderate. The overall analysis showed a significant positive association between OSA and FES (OR = 1.89, 95% CI = 1.27–2.83, I 2 = 44%). Further analysis revealed that the more severe the OSA was, the higher the risk of developing FES. Patients with severe OSA had the nominally highest risk of developing FES (OR = 3.06, 95% CI = 1.62–5.78, I 2 = 0%), followed by moderate OSA (OR = 2.53, 95% CI = 1.29–4.97, I 2 = 0%), and patients with mild OSA had the lowest risk (OR = 1.76, 95% CI = 0.85–3.62, I 2 = 0%).ConclusionOur metaanalysis reports a positive association between OSA and FES, with increasing severity of OSA correlating with a significantly higher risk of FES. More longitudinal studies with sufficient duration of follow-up are needed to better characterise the relationship between OSA and FES.     

Is there an association of socioeconomic deprivation with acute primary angle closure?

BackgroundSocioeconomic deprivation is known to increase the risk of late presentation of many diseases. This is the largest study in United Kingdom investigating the relationship between socioeconomic deprivation and acute primary angle closure (APAC).MethodsA retrospective review of case notes was conducted of 718 consecutive patients who underwent laser peripheral iridotomy (LPI) in Edinburgh (Princess Alexandra Eye Pavilion) and Fife (Queen Margaret Hospital) between 2015 and 2019. Baseline demographics including sex, age, ethnicity, pre-existing diabetes, use of anti-depressants, and family history of glaucoma were collected. Deprivation was scored using the Scottish Index of Multiple Deprivation (SIMD) Index 2020v2. A lower rank and decile indicate higher degrees of deprivation. We investigated differences in characteristics between patients who were referred routinely versus patients who referred as APAC.ResultsThe SIMD rank and deciles were consistently lower in patients who were referred urgently with APAC in both centres (P = <0.05) when compared to those referred routinely for LPI. On univariate and multivariate logistic regression, the presentation of APAC is negatively associated with SIMD Decile (OR = −0.101, 95% CI −0.178 to −0.026, P = 0.008) and family history of glaucoma (OR = −1.010, 95% CI −1.670 to −0.426, P = 0.001), and positively associated with age (OR = 0.029, 95% CI 0.009–0.049, P = 0.004).ConclusionsSocioeconomic deprivation is an important risk factors for patients presenting with APAC. Socioeconomic deprivation should be incorporated into the design of glaucoma services and considered when triaging patients for prophylactic and therapeutic LPI and cataract surgery.Subject terms: Epidemiology, Optic nerve diseases     

Estudio de la fiabilidad y la validez de los videooculógrafos VOG Perea® y GazeLab® y cálculo de los márgenes de variabilidad

ObjectiveTo determine the reliability and validity of VOG Perea® (VP) and GazeLab® (GL), their correlation and concordance with cover test (CT), and define the margins of variability of the measurement of angle deviation in primary position.MethodsForty-four orthotropic patients were included. Alternating prism CT, an examination with VP, and GL were performed. Intraclass correlation coefficient (ICC) was calculated to determine the reliability, and mean comparison was used to study validity. Correlation coefficient (R) between CT and each video-oculographer was calculated. Bland-Altman diagrams were used to determine concordance. All measurements were expressed in prismatic dioptres (PD).ResultsThe mean horizontal deviation was ?0.571 PD with CT; 0.22 PD with VP and 0.4 PD with GL. ICC was 0.246 (95% CI: [?0.402]-0.595) in GL and 0.984 [95% CI: 0.970-0.992)] in VP. Mean comparison between CT and GL was ?0.9286 (CI 95%: [?1.822]-[0.0355], P = .042) and ?0.8423 (95% CI: [?1.7190]-0.03450, P = .0593) for CT-VP. Correlation coefficient for VP was R = 0.5704 (95% CI: 0.319-0.747, P = .0001) and R = 0.4539 (95% CI: 0.174-0.666, P = .0025) for GL. Margins of variability for a single horizontal measurement in primary position with VP were ± 5.22 PD and ± 2 DP for GL.ConclusionBoth VP and GL are reliable and valid devices. Margins of variability for a horizontal measurement are ±5.22 PD in VP and ±2 PD in GL.     

Multicenter prospective validation study for international chronic ocular graft-versus-host disease consensus diagnostic criteria

PurposeTo validate the international chronic ocular graft-versus-host disease (GVHD) diagnostic criteria (ICCGVHD) compared to the National Institute of Health diagnostic criteria 2014 (NIH2014) for chronic ocular GVHD.MethodsBetween 2013 and 2019, the study enrolled 233 patients with or without chronic ocular GVHD combined with the presence or absence of systemic chronic GVHD in an internationally prospective multicenter and observational cohort from 9 institutions. All patients were evaluated for four clinical parameters of ICCGVHD.ResultsThe relation between the ICCGVHD score (0-11) and NIH2014 eye score (0–4) was relatively high (r = 0.708, 95% CI: 0.637–0.767, p < 0.001). The sensitivity and specificity of ICCGVHD for NIH 2014 for 233 patients were 94.3% (95% CI: 89.6%–98.1%) and 71.7% (95% CI: 63.0–79.5%), respectively (cutoff value of the ICCGVHD score = 6). The positive predictive value was 77.1% (95% CI: 71.1%–82.1%), and the negative predictive value was 87.0% (95% CI:81.6–92.5%). For the patients with systemic GVHD (n = 171), the sensitivity and specificity were 94.2% and 67.2%, respectively (ICCGVHD-score cutoff value = 6). By receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.903 (95% CI: 0.859–0.948). For patients without systemic GVHD (n = 62), the sensitivity and specificity were 100% and 76.7%, respectively (ICCGVHD-score cutoff value = 6). The AUC was 0.891 (95% CI 0.673–1.000).ConclusionsGood sensitivity, specificity, predictive value and correlation were found between ICCGVHD and NIH2014. ICCGVHD scores ≥6 can be useful to diagnose ocular GVHD with or without systemic GVHD for clinical research.     

Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery

AIM:To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS:Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes (15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age < 40y [P =0.085, odds ratio (OR) 3.609, 95% confidence interval (CI) 0.838-15.540] and amniotic membrane graft instead of conjunctival autograft (P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence. Multivariate analysis revealed that intraoperative mitomycin C (MMC) (P=0.072, OR 0.298, 95% CI 0.080-1.115) decreased the rate of recurrence.CONCLUSION:Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation (AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.     

Descemet stripping with automated endothelial keratoplasty: A comparative study of outcome in patients with preexisting glaucoma

PurposeTo compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma.MethodsFor this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication (55) or with previous glaucoma surgeries (64) with a time-matched group of all other DSAEK cases (179, control).ResultsWith a mean follow-up of 1.85 ± 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure (odds ratio OR = 12.35, 95% confidence interval CI [5.46–27.90], P < 0.001). Graft detachment was not associated with either history of glaucoma or glaucoma surgery (P > 0.05). Glaucoma on medication had no increased risks of graft failure compared to normal eyes (P = 0.38). However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries (OR = 4.26, 95% CI [1.87–9.71], P < 0.001). Medically managed glaucoma has increased risks of postoperative IOP elevation (OR = 2.39, 95% CI [1.25–4.57], P = 0.013), whereas surgically managed glaucoma has no significant elevation (P = 0.23). Elevation of IOP was not significantly correlated with graft failure (P = 0.21).ConclusionDSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival.     

Prevalence of pinguecula and pterygium in a general population in Spain

Purpose

To determine the prevalence of pinguecula and pterygium and to investigate their associations in a general adult population in North-Western Spain.

Methods

An age-stratified random sample of 1155 subjects ≥40 years was selected in O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (SD): 63.4 (14.5) years, range: 40–96 years, 37.0% males). An interview to collect history of systemic diseases and lifestyle details and a comprehensive ophthalmic evaluation in which pinguecula and pterygium were recorded was carried out. The prevalence of pinguecula and pterygium and their relationship with lifestyle factors and ocular and systemic diseases was investigated.

Results

The prevalence of pinguecula was 47.9% (95% confidence interval (CI): 43.9–51.9). This prevalence increased significantly with aging (P=0.002) and was higher in men (56.4% 95% CI: 50.0–62.7) than in women (42.7% 95% CI: 37.8–47.8) (P=0.001). The prevalence of pterygium was 5.9% (95% CI: 4.3–7.9). This prevalence also increased significantly with aging (P=0.005) and was 4.8% (95% CI: 2.6–8.4) in men and 6.5% (95% CI: 4.5–9.3) in women (P=0.346). After controlling for age and sex, pinguecula was associated with alcohol intake (adjusted odds ratio (OR_a): 3.08; 95% CI: 1.60–5.95), pterygium with fluorescein staining (OR_a: 2.64; 95% CI: 1.08–6.46) and both disorders with outer activity (OR_a: 2.07; 95% CI: 1.36–3.15 and 2.28; 95% CI: 1.04–4.98, respectively).

Conclusions

Pinguecula is far more common than pterygium. Alcohol consumption is strongly associated with pinguecula. Fluorescein staining is highly prevalent in subjects with pterygium. Both disorders increase with age and are associated with outer activity.     

5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence

To compare the efficacy of 5-fluorouracil (5-FU) with mitomycin C (MMC) in preventing pterygium recurrence when used as an adjuvant following pterygium excision with conjunctival autograft. Low-dose MMC combined with conjunctival autograft is an effective treatment for preventing recurrence following pterygium excision, but safety, cost, and availability limit its use in developing countries. There is a paucity of data on the efficacy of 5-FU when used in Africa as an adjuvant to conjunctival autograft following pterygium excision. This is a randomized controlled prospective trial using either 50 mg/ml 5-FU or 0.01% MMC. Eighty eyes of 80 subjects were studied. Forty-six subjects with a mean age 49.8 ± 13.8 years were treated with 5-FU (USD 13.0 per unit), while 34 patients with a mean age 51.9 ± 12.1 years were treated with MMC (USD 20.0 per unit). There was no significant difference in mean age between the two groups (p = 0.48). The ratio of male to female patients in both groups was similar at 0.92:1 for the 5-FU group and 1:1 for the MMC group (p = 0.85). Mean follow-up period was 35.2 ± 29.1 weeks. Recurrence rate in the 5-FU group was 8.7% compared to 11.8% in the MMC group (recurrence risk ratio = 0.71, 95% CI 0.17−3.1, p = 0.7). One patient from the MMC-treated group had corneoscleral melting. Other complications were mild and not sight threatening. In the prevention of pterygium recurrence, 5-FU appears to compare favorably with low-dose MMC when used as an adjuvant following pterygium excision and conjunctival autograft. Further studies are required to assess the long-term effect of using 5-FU in such cases.     

Comparable meibomian gland changes in patients with and without ocular graft-versus-host disease after hematopoietic stem cell transplantation

PurposeTo compare the presentation and severity of meibomian gland dysfunction (MGD) in patients with and without chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).MethodsThis prospective cross-sectional study included 79 patients (47 with coGVHD and 32 without) after allo-HSCT. All participants completed ocular surface disease index questionnaire, and received slit lamp, ocular surface interferometer, meibography and confocal microscopy examination. The prevalence and severity of MGD were compared between two groups and related factors were analyzed. Main outcome measures were lipid layer thickness (LLT) and meiboscore.ResultsSimilarly high prevalence of MGD was detected in coGVHD and non-coGVHD groups (87.2% vs 84.4%, P = 0.977). Among those with MGD, although patients without coGVHD had longer noninvasive break-up time [5.54 (2.87, 9.37) vs 2.29 (0.00, 3.82) s, P < 0.001], patients in two groups presented similarly decreased LLT (53.5 ± 22.3 vs 47.1 ± 25.2 nm, P = 0.286), increased meiboscore (2.7 ± 1.5 vs 3.5 ± 1.8, P = 0.060) and enlarged acinar unit area (1647.7 ± 942.9 vs 1808.8 ± 1211.5 μm², P = 0.592). Meibomian gland inflammation and fibrosis were observed in both groups, but more predominant in coGVHD group. Results were consistent when patients within a comparable post-HSCT time interval were compared. Regression analysis revealed neither LLT nor meiboscore was associated with coGVHD severity. LLT was positively correlated with systemic immunosuppressant use (β = 12.0, P = 0.044), while meiboscore was positively correlated with lymphoma (β = 1.78, P = 0.040) and matched unrelated donor (β = 1.59,P = 0.008).ConclusionsMGD was common and evident in patients after allo-HSCT. MGD is not different between coGVHD and non-coGVHD patients except more inflammation and fibrosis in the former.     

Risk factors for astigmatic components and internal compensation: the Nanjing Eye Study

PurposeTo determine the risk factors for total astigmatism (TA), anterior corneal astigmatism (ACA), and internal compensation in Chinese preschool children.MethodsIn the population-based Nanjing Eye Study, children were measured for noncycloplegic refractive error and for biometric parameters. Data from questionnaires and measures from right eyes were analyzed for determining risk factors for TA, ACA, and internal compensation from multivariate logistic regression models.ResultsOf 1327 children (66.8 ± 3.4 months, 53.2% male), older age of the child (OR = 0.95 for per month increase; P = 0.03), older paternal age at child birth (OR = 1.04 for per year increase; P = 0.03), paternal astigmatism (OR = 1.89; P = 0.003), maternal astigmatism (OR = 1.73, P = 0.008), and second-hand smoke exposure during pregnancy (OR = 1.64; P = 0.03) were associated with higher risk of TA, while partial breastfeeding (OR = 0.49, P = 0.006) or formula feeding (OR = 0.46, P = 0.003) were associated with lower risk of TA. Larger ratio of axial length to corneal radius (OR = 16.16 for per unit increase; P = 0.001), maternal working during pregnancy (OR = 1.27; P = 0.04), and cesarean delivery (OR = 1.68, P = 0.04) were associated with higher risk of ACA, while formula feeding was associated with lower risk of ACA (OR = 0.57, P = 0.01). Paternal astigmatism (OR = 0.50, P = 0.01) and assisted reproduction (OR = 0.56, P = 0.03) were associated with lower risk of horizontal or vertical internal compensation. More outdoor activity time (OR = 1.15 for per hour increase, P = 0.01) was associated with higher risk of oblique internal compensation while more nighttime sleep on weekends (OR = 0.83 for per hour increase, P = 0.01) was associated with lower risk of oblique internal compensation.ConclusionsOur study confirmed some previously reported risk factors and identified some novel risk factors for astigmatism including formula feeding for lower risk of both ACA and TA, and older paternal age at child birth for higher risk of TA.Subject terms: Risk factors, Paediatrics, Epidemiology     

Comparación entre el tonómetro de rebote IC200 y el tonómetro de aplanación Perkins en sujetos sanos y pacientes con glaucoma congénito

ObjectiveTo compare intraocular pressure (IOP) measurements obtained using the Icare 200? (IC200) rebound tonometer and the hand-held version of the Goldmann Applanation Tonometer (Perkins? tonometer, GAT) in patients with primary congenital glaucoma (PCG) and in healthy subjects.Material and methodsA total of 42 eyes of healthy subjects (G1) and 40 patients with PCG (G2) were analysed. The following clinical data were collected: gender, age, Cup/Disc ratio, central corneal thickness (CCT). IOP was determined in the examination room using the IC200 and GAT tonometers, in the same order.Agreement between both tonometers was determined using the intraclass correlation coefficient (ICC) and Bland-Altman plot. A linear regression analysis was used to establish the IOP was affected by the studied variables.ResultsMean IOP between both tonometers (IC200 minus GAT) was: G1 = 15.91 (2.57) mm Hg vs. 15.06 (2.12) mm Hg (mean difference, MD = 0.84 (0.50) mm Hg; P < .101) and G2 = 20.10 (6.37) vs.19.12 (5.62) (MD = 0.98 (1.36); P = .474).Excellent agreement was found between IC200 and GAT in both groups (ICC = G1: 0.875 (95% CI; 0.768-0.933; P < .001); G2: 0.924 (95% CI; 0.852-0.961; P < .001), and there was a statistically significant correlation between the IOP difference measured with IC200 and GAT and CCT in G1 (B = 0.021; 95% CI; 0.005–0.037; P = .008), but was not statistically significant in G2.ConclusionThere was excellent agreement between the IC200 and GAT tonometers, both in healthy subjects and PCG, with a trend to overestimate IOP when measured with IC200. There was no influence by CCT on IOP measurements in patients with PGC.     

Efficacy and safety of the mineralocorticoid receptor antagonist treatment for central serous chorioretinopathy: a systematic review and meta-analysis

ObjectivesWe performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous chorioretinopathy (CSC).MethodsWe searched the PubMed, Embase, and the Cochrane Library to identify relevant clinical studies published prior to March 2020. The primary outcome was change in best-corrected visual acuity (BCVA), and the secondary outcomes included the subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT).ResultsFive randomized controlled trials (RCT) and four cohort studies met the inclusion criteria with a total of 352 eyes. The MRA treatment was not superior to placebo in BCVA at 1 month (WMD = −0.06, 95% CI −0.15–0.02, P = 0.15, I² = 86%), 3 months (WMD = −0.04, 95% CI −0.14–0.06, P = 0.44, I² = 77%) and 6 months (WMD = −0, 95% CI −0.05–0.05, P = 0.92, I² = 0%). The MRA treatment resulted in significant reduction than the placebo in the SRF (WMD = −60.64, 95% CI −97.91 to −23.37, P = 0.001, I² = 49%), SFCT (WMD = −39.15, 95% CI −52.58 to −25.72, P < 0.001, I² = 0%), and CMT (WMD = −60.75, 95% CI −97.85 to −23.65, P = 0.01, I² = 53%).ConclusionsOur meta-analysis shows that the MRA treatment can improve anatomical structure in CSC patients, but it is not effective for achieving BCVA gain. The applicant of the MRA is safe and have no severe effect.Subject terms: Prognostic markers, Retinal diseases     

The association between time spent on screens and reading with myopia,premyopia and ocular biometric and anthropometric measures in 6- to 7-year-old schoolchildren in Ireland

Purpose

More time spent on near tasks has consistently been associated with the promotion of myopia. The World Health Organization advises limiting daily screentime to less than 2 h for children aged five and over. This study explored the relationship between time spent on screens and reading/writing with refractive status, ocular biometric and anthropometric factors in 6- to 7-year-olds in Ireland.

Methods

Participants were 723 schoolchildren (377 boys [51.8%]), mean age 7.08 (0.45) years. The examination included cycloplegic autorefraction (1% cyclopentolate hydrochloride), ocular biometry (Zeiss IOLMaster), height (cm) and weight (kg). Screentime and reading/writing time were reported by parents/legal guardians by questionnaire. Myopia (≤−0.50D) and premyopia (>−0.50D ≤ 0.75D) risk assessments were performed using logistic regression, and multivariate linear regression was used to analyse continuous variables.

Results

Reported daily screentimes were 31% <1 h, 49.5% 1–2 h, 15.6% 2–4 h and 3.9% >4 h. Reading/writing times were 42.2% frequently, 48.0% infrequently and 9.8% seldom/never. Linear regression, controlling for age and ethnicity, revealed >2 h/day on screens was associated with a more myopic spherical equivalent [β = −1.15 (95% confidence intervals {CIs}: 1.62–0.69, p < 0.001)], increased refractive astigmatism (β = 0.29, CI: 0.06–0.51, p = 0.01), shorter corneal radius (β = 0.12, CI: 0.02–0.22, p = 0.02), higher axial length/corneal radius (β = 0.06, CI: 0.03–0.09, p < 0.001), heavier weight (β = 1.60, CI: 0.76–2.45, p < 0.001) and higher body mass index (BMI) (β = 1.10, CI: 0.28–1.12, p < 0.001). Logistic regression, controlling for age and ethnicity, revealed daily screentime >2 h was associated with myopia (OR = 10.9, CI: 4.4–27.2, p = 0.01) and premyopia (OR = 2.4, CI: 1.5–3.7, p < 0.001). Frequent reading/writing was associated with screentime ≤2 h/day (OR = 3.2, CI: 1.8–5.8, p < 0.001).

Conclusion

Increased screentime was associated with a more myopic refraction, higher axial length/corneal radius ratio, increased odds of myopia, premyopia, higher degrees of astigmatism, increased weight, BMI and decreased reading/writing time. Dedicated education programmes promoting decreased screentime in children are vital to prevent myopia and support eye and general health.     

Delayed administration of glial cell line-derived neurotrophic factor (GDNF) protects retinal ganglion cells in a pig model of acute retinal ischemia

This study investigates whether intravitreal administration of glial cell line-derived neurotrophic factor (GDNF) enhances survival of NeuN positive retinal cells in a porcine model of retinal ischemia.16 pigs were subjected to an ischemic insult where intraocular pressure was maintained at 5 mmHg below mean arterial blood pressure for 2 h. The mean IOP during the ischemic insult was 79.5 mmHg (s.e.m. 2.1 mmHg, n = 15). Three days after the insult the pigs received an intravitreal injection of GDNF microspheres or blank microspheres. The pigs were evaluated by way of multifocal electroretinography (mfERG), quantification of NeuN positive cells and evaluation of the degree of retinal perivasculitis and inflammation 6 weeks after the insult.In the post-injection eyes (days 14, 28 and 42), the ratios of the iN1 and the iP2 amplitudes were 0.10 (95% CI: 0.05–0.15) and 0.09 (95% CI: 0.04–0.16) in eyes treated with blank microspheres, and 0.24 (95% CI: 0.18–0.32) and 0.23 (95% CI: 0.15–0.33) in eyes treated with GDNF microspheres. These differences were statistically significant (P < 0.05). The number of NeuN positive cells in the area of the visual streak area was significantly higher in eyes injected with GDNF microspheres compared to eyes injected with blank microspheres. In eyes injected with GDNF microspheres the ganglion cell count was 9.5/field (s.e.m.: 2.1, n = 8), in eyes injected with blank microspheres it was 3.5/field (s.e.m.: 1.2, n = 7). This difference was statistically significant (P < 0.05). There was also a significant difference (P < 0.01) in the degree of perivasculiitis between GDNF treated eyes (median perivasculitis score 1.5) and blank treated eyes (median perivasculitis score 3.0). In conclusion, injection of GDNF microspheres 3 days after an ischemic insult results in functional and morphological rescue of NeuN positive cells in a porcine model of acute ocular ischemia.     

Análisis morfométrico del endotelio de la córnea tras aplicación intraoperatoria de mitomicina C en la resección simple de pterigión: un estudio piloto

PurposeTo study the effects of mitomycin-C (MMC) on the corneal endothelium after pterygium surgery.MethodsProspective, interventional, nonrandomized, observer-masked study. Twenty patients (20 eyes) with primary pterygium underwent surgery with pterygium simple excision followed by 0.02% MMC application for 1 minute. Preoperative, 10-day, 1-month and 3-month postoperative specular microscopy were performed. Mean cell density, coefficient of variation of mean cell area and percentage of hexagonal cells were measured.ResultsMean endothelial cell densities before and 3 months after surgery were 2,240.37 SD 347.92 cells/mm² (range: 1,020 to 2,703) and 2,283.86 SD 425.13 cells/mm² (range: 1,001 to 2,837), respectively. Mean coefficient of variation before and 3 months after surgery were 32.63 SD 4.65 (range: 22 to 48) and 33.00 SD 4.75 (range: 23 to 51), respectively. Mean percentage of hexagonal cells before and 3 months after surgery were 54.58 SD 6.60 (range: 46 to 71) and 55.26 SD 8.89 (range: 38 to 76), respectively. No statistically significant differences were found in any of the parameters studied when compared to the preoperative values.ConclusionsA single intraoperative application of 0.02% MMC for 1 minute during pterygium simple excision surgery does not seem to cause substantial changes in corneal endothelial cell density at 3 months.     

Roles de polimorfismos de IL-8, -251A/T y +781C/T,nivel de IL-8, y el riesgo de degeneración macular asociada con la edad

ObjectiveTo clarify the association between IL-8 gene polymorphisms, IL-8 level, towards the risk of age-related macular degeneration (AMD).MethodsMeta-analysis was performed from available studies that investigated IL-8 −251A/T (rs4073) and +781C/T (rs2227306) polymorphisms and IL-8 levels in patients with AMD and controls.ResultsOverall, the pooled result showed a significant association between AMD with allelic (T vs. C; OR 1.53; p = 0.005), dominant (TT + CT vs. CC; OR 1.95; p = 0.017), homozygous (TT vs. CC; OR 2.03; p = 0.039) and heterozygous (CT vs. CC; OR 1.92; p = 0.032) models of rs2227306; while subgroup analysis revealed a significant association between rs2227306 with wet AMD in allelic (T vs. C; OR 1.69; p = 0.016), recessive (TT vs. CT + CC; OR 1.81; p = 0.00007), and homozygous (TT vs. CC; OR 2.64; p = 0.003) models. No significant association was observed between rs4073 with AMD in all inheritance models. In parallel, patients with AMD, particularly wet AMD had an elevated level of IL-8 compared to control.ConclusionThis meta-analysis suggests that patients with AMD or wet AMD have higher IL-8 levels compared to control, which is also supported by the evidence that carrier T allele of rs2227306 exhibited an increase in the risk of AMD or wet AMD. Thus, IL-8 +781C/T (rs2227306) polymorphism and the level of intraocular IL-8 may be useful as a biomarker for early detection and a therapeutic target of AMD.