Treatment modalities in Duane’s Retraction Syndrome

AIM: To assess the influence of near work, time outdoor and parental myopia on the prevalence of myopia in school children in Aba, Nigeria.METHODS: Primary and secondary school children aged between 8 and 15y were randomly recruited from 12 schools in Aba. Information on family history, near work and outdoor activity was obtained using myopia risk factor questionnaire. Cycloplegic refraction was performed using autorefraction technique. Myopia was defined as spherical equivalent refraction (SER) ≤-0.50 D in the poorer eye. Data were analysed for 1197 (male: 538 and female: 659) children with full relevant data.RESULTS: Risk of developing myopia was positively associated with parental myopia [Odds ratio (OR): 6.80; 95%CI, 2.76-16.74; P<0.001) for one myopic parent and (OR: 9.47; 95%CI, 3.88-23.13; P<0.001) for two myopic parents, longer daily reading hour (OR: 1.21; 95%CI, 1.03-1.42; P<0.020) and less time outdoors (OR: 0.8; 95%CI, 0.74-0.87; P<0.001). CONCLUSION: Parental history of myopia was the most important risk factor associated with myopia. In addition, children with both parents being myopic had increased odds of developing myopia than those with one myopic parent. It is recommended therefore, that children spend more time outdoors as this could reduce the prevalence and progression of myopia.     

Time spent in outdoor activities in relation to myopia prevention and control: a meta‐analysis and systematic review

Outdoor time is considered to reduce the risk of developing myopia. The purpose is to evaluate the evidence for association between time outdoors and (1) risk of onset of myopia (incident/prevalent myopia); (2) risk of a myopic shift in refractive error and c) risk of progression in myopes only. A systematic review followed by a meta‐analysis and a dose–response analysis of relevant evidence from literature was conducted. PubMed, EMBASE and the Cochrane Library were searched for relevant papers. Of the 51 articles with relevant data, 25 were included in the meta‐analysis and dose–response analysis. Twenty‐three of the 25 articles involved children. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were conducted. Mantel–Haenszel random‐effects model was used to pool the data for meta‐analysis. Statistical heterogeneity was assessed using the I² test with I² ≥ 50% considered to indicate high heterogeneity. Additionally, subgroup analyses (based on participant's age, prevalence of myopia and study type) and sensitivity analyses were conducted. A significant protective effect of outdoor time was found for incident myopia (clinical trials: risk ratio (RR) = 0.536, 95% confidence interval (CI) = 0.338 to 0.850; longitudinal cohort studies: RR = 0.574, 95% CI = 0.395 to 0.834) and prevalent myopia (cross‐sectional studies: OR = 0.964, 95% CI = 0.945 to 0.982). With dose–response analysis, an inverse nonlinear relationship was found with increased time outdoors reducing the risk of incident myopia. Also, pooled results from clinical trials indicated that when outdoor time was used as an intervention, there was a reduced myopic shift of ?0.30 D (in both myopes and nonmyopes) compared with the control group (WMD = ?0.30, 95% CI = ?0.18 to ?0.41) after 3 years of follow‐up. However, when only myopes were considered, dose–response analysis did not find a relationship between time outdoors and myopic progression (R² = 0.00064). Increased time outdoors is effective in preventing the onset of myopia as well as in slowing the myopic shift in refractive error. But paradoxically, outdoor time was not effective in slowing progression in eyes that were already myopic. Further studies evaluating effect of outdoor in various doses and objective measurements of time outdoors may help improve our understanding of the role played by outdoors in onset and management of myopia.     

角膜塑形镜治疗亚洲儿童近视有效性和安全性的Meta分析

目的：系统评价角膜塑形镜治疗亚洲儿童近视的有效性和安全性。

方法：检索The Cochrane Library、Medline、EMbase、CBM、CNKI、VIP和WanFang数据库,语种限定为中英文。采用Cochrane手册提供的偏倚风险评价工具和MINORS(methodological index for non-randomized studies)量表分别评价纳入文献(随机对照试验和对照试验)的质量; 采用漏斗图检测纳入文献的发表偏倚; 采用RevMan 5.3软件进行Meta分析。

结果：共有7篇文献符合纳入排除标准,包含478例研究对象(角膜塑形镜组250例,对照组228例)。Meta分析结果显示：角膜塑形镜对控制眼轴长度增加方面优于单光镜,两组之间的差异具有统计学意义\〖WMD=-0.31,95%CI(-0.35,-0.26),P<0.001\〗。5篇文献观察了不良反应,均报道有中等程度角膜荧光素染色阳性的不良反应,一篇报道有1例患儿出现睑板腺囊肿,未见严重不良反应报道。

结论：角膜塑形镜可有效控制亚洲儿童近视的发展,且较为安全。     

Treatment patterns,visual acuity and quality‐of‐life outcomes of the WAVE study – A noninterventional study of ranibizumab treatment for neovascular age‐related macular degeneration in Germany

Purpose: To evaluate effectiveness, tolerability and safety of repeated intravitreal injections of 0.5 mg ranibizumab for the treatment of neovascular age‐related macular degeneration in routine medical practice in Germany. Methods: A noninterventional study with 3470 patients treated in 274 medical centres according to German guidelines, with monthly intravitreal injections of 0.5 mg ranibizumab during upload (3 months) followed by a maintenance phase (9 months) with reinjections if medically indicated. Results: Mean injection rate was 4.34 (SE = 0.05; median = 3.0). Best‐corrected visual acuity (BCVA) remained stable (mean change 0.02 LogMAR, SE = 0.01, p = 0.0169) and central retinal thickness (CRT) decreased (by ?78.9 μm, SE = 2.95 μm, p < 0.0001). The NEI‐VFQ 25 summary score showed a positive stabilization with a mean change of 0.73 (SE = 0.37, p = 0.0501) compared with baseline. Adverse events were documented for 6.5% of the patients with 3.9% of these events being classified as serious. Conclusions: The number of administered intravitreal injections of ranibizumab over the first year of treatment was very low but still achieved a stabilization of BCVA, a reduction in CRT and maintained vision‐related quality of life. The management of patients with neovascular AMD in Germany needs to be improved to achieve better treatment results.     

配戴角膜塑形镜和框架眼镜对近视儿童周边屈光度影响的随机对照临床试验

背景 临床实践发现角膜塑形镜具有延缓近视及眼轴长度进展的效果,但对于角膜塑形镜配戴的相关作用机制,特别是角膜塑型术对视网膜中心和周边的离焦作用机制尚不完全清楚. 目的 观察低中度近视儿童配戴角膜塑形镜和框架眼镜6个月后周边屈光度以及相对周边屈光度(RPR)的变化.方法 采用随机对照临床试验方法,于2014年6月至2015年1月在北京同仁眼科中心招募屈光度为-0.50～-6.00 D的低中度近视儿童100例,平均年龄(11.0±1.9)岁,均纳入右眼进行研究.受试者按入组顺序编号后由SAS统计软件PROC PLAN过程语句随机均分为角膜塑形镜组和框架眼镜组,每组50例50眼,戴镜时间均为6个月.采用开放视野红外自动验光仪分别测量戴镜前后中央0°、颞侧15°和30°、鼻侧15°和30°径线的屈光度,观察并比较各组受试眼戴镜前后周边屈光度和RPR(周边屈光度与中央屈光度差值)变化趋势. 结果 角膜塑形镜组和框架眼镜组受试者戴镜前屈光度分别为(-3.35±1.31)D和(-3.01±1.15)D,差异无统计学意义(P=0.201).角膜塑形镜组受试眼戴镜前鼻侧30°、鼻侧15°、中央0°、颞侧15°和颞侧30°径线周边屈光度分别为(-2.28±1.60)、(-3.28±1.41)、(-3.40±1.23)、(-3.38±1.12)和(-2.09±1.29)D,受试眼除颞侧30°外戴镜后6个月近视度数均下降,戴镜前后鼻侧30°、鼻侧15°、中央0°、颞侧15°屈光度变化值分别为(0.29±1.67)、(0.85±1.66)、(0.92±1.76)和(0.66±1.66)D,其中鼻侧15°、中央0°、颞侧15°与戴镜前相比差异均有统计学意义(均P＜0.05).框架眼镜组受试者戴镜前鼻侧30°、鼻侧15°、颞侧15°和颞侧30°径线周边屈光度分别为(-1.88±1.30)、(-2.66±1.18)、(-2.89±1.27)和(-1.94±1.31)D,戴镜后6个月上述各径线近视度数均增加,戴镜前后变化值分别为(-0.25±0.80)、(-0.43±0.67)、(-0.32±0.64)和(-0.22±0.75)D,与戴镜前比较差异均有统计学意义(均P＜0.05).角膜塑形镜组受试者戴镜前各径线RPR均为远视性离焦状态,戴镜后6个月颞侧15°和颞侧30°RPR变为近视性离焦状态.框架眼镜组受试者戴镜前各径线RPR均为远视性离焦状态,戴镜后各径线RPR均呈远视性离焦加深状态.结论 长期配戴角膜塑形镜能够使近视儿童的周边屈光度发生远视性漂移,视网膜周边呈现相对近视性离焦,而长期配戴框架眼镜则使周边屈光度发生近视漂移,视网膜周边远视性离焦加深.角膜塑形镜配戴可能通过改变周边屈光度而达到减缓近视进展的目的.     

Femtosecond (FS) laser vision correction procedure for moderate to high myopia: a prospective study of ReLEx® flex and comparison with a retrospective study of FS‐laser in situ keratomileusis

Purpose: To present our initial clinical experience with ReLEx^® flex (ReLEx) for moderate to high myopia. We compare efficacy, safety and corneal higher‐order aberrations after ReLEx with femtosecond laser in situ keratomileusis (FS‐LASIK). Methods: Prospective study of ReLEx compared with a retrospective study of FS‐LASIK. ReLEx is a new keratorefractive procedure, where a stromal lenticule is cut by a femtosecond laser and manually extracted. Forty patients were treated with ReLEx on both eyes. A comparable group of 41 FS‐LASIK patients were retrospectively identified. Visual acuity, spherical equivalent (SE) and corneal tomography were measured before and 3 months after surgery. Results: Preoperative SE averaged ?7.50 ± 1.16 D (ReLEx) and ?7.32 ± 1.09 D (FS‐LASIK). For all eyes, mean corrected distance visual acuity remained unchanged in both groups. For eyes with emmetropia as target refraction, 41% of ReLEx and 61% of FS‐LASIK eyes had an uncorrected distance visual acuity of logMAR ≤ 0.10 at day 1 after surgery, increasing to, respectively, 88% and 69% at 3 months. Mean SE was ?0.06 ± 0.35 D 3 months after ReLEx and ?0.53 ± 0.60 D after FS‐LASIK. The proportion of eyes within ±1.00 D after 3 months was 100% (ReLEx) and 85% (FS‐LASIK). For a 6.0‐mm pupil, corneal spherical aberrations increased significantly less in ReLEx than FS‐LASIK eyes. Conclusions: ReLEx is an all‐in‐one femtosecond laser refractive procedure, and in this study, results were comparable to FS‐LASIK. Refractive predictability and corneal aberrations at 3 months seemed better than or equal to FS‐LASIK, whereas visual recovery after ReLEx was slower.     

A population‐based study of macular thickness in full‐term children assessed with Stratus OCT: normative data and repeatability

Purpose: We aimed to determine normal macular thickness values, assessed with optical coherence tomography (OCT), in a population of full‐term children of normal birthweight. Methods: A total of 56 children, aged 5–16 years, randomly chosen from the population register, were examined with Stratus OCT. Only children with visual acuity < 0.2 logMAR, spherical equivalent of ? 3 to + 3 D and astigmatism < 2 D were included. The fast macular map protocol was used and three examinations were performed in each eye. One eye was then randomized for further analyses. Mean values for the nine ETDRS areas, foveal minimum thickness and macular volume were calculated for 55 eyes. Coefficients of variance and intraclass correlations were calculated for each area. Results: All children co‐operated well and no child was excluded for lack of concentration. Mean ± standard deviation central macular thickness was 204 ± 19 μm. Mean total macular volume was 7.11 ± 0.35 mm³. No correlations were found between age, gender and macular thickness. Coefficients of variance were < 2% and intraclass correlations were > 0.9 in all areas, except the foveal minimum. Conclusions: Normal values for macular thickness in healthy full‐term children were reported. As the Stratus OCT provides normal values only for adults, these data are a better alternative for comparison with children with retinal abnormalities. We concluded that OCT is suitable for examining the retina in children aged 5–16 years and has the same high level of repeatability as in adults.