查看更多>>摘要：Abstract Uncorrected refractive astigmatism degrades visual acuity. Spherical intraocular lenses (IOLs) leave astigmatic errors resident in the cornea manifest in refractive astigmatism. Toric IOLs, correcting for this corneal astigmatism, contribute to spectacle‐free vision in the pseudophakic eye. This review provides information to assist surgeons in a rational choice of eyes suitable for toric IOL implantation, methods of IOL cylinder power calculation, surgical techniques for toric IOLs and management of complications. With appropriate application of this information, correction of visually detrimental astigmatism can be achieved routinely.
Alexandra Z. CrawfordSimone E. N. FreundlichJoevy LimCharles N. J. McGhee...
10页
查看更多>>摘要：Abstract Background To investigate repair of iris defects by endocapsular implantation of an artificial iris, in relation to visual outcomes, safety profile and patient satisfaction. Methods Retrospective, consecutive case series from Greenlane tertiary teaching hospital and Eye Institute, Auckland, New Zealand. Medical records of patients implanted with an endocapsular artificial iris were reviewed and followed for minimum 3?months. Patient characteristics, surgical management, clinical outcomes and subjective responses were recorded. Results Nineteen artificial irises were implanted in 18 patients. Etiologies were iris melanotic lesion excision (73.7%), trauma (10.5%), congenital aniridia (10.5%) and Urrets‐Zavalia syndrome (5.3%). During postoperative follow‐up [14.1?±?12.4?months (range: 3 to 59?months)], best corrected visual acuity (BCVA) and intraocular pressure (IOP) did not change significantly [BCVA, 0.23 logarithm of the minimum angle of resolution (logMAR) (20/32 Snellen) preoperatively vs. 0.18 logMAR postoperatively (20/25 Snellen) (Z?=??0.222, p?=?0.824); IOP, 15?mmHg preoperatively vs. 17?mmHg postoperatively (Z?=?1.377, p?=?0.1447)]. Mild or self‐limiting complications included: elevated IOP (42.1%), cystoid macular oedema (15.8%); persisting postoperative uveitis (15.8%) and minor vaulting of the prosthesis (15.7%). Moderate or severe complications included significant vaulting of prosthesis requiring surgical revision (5.3%) and a single eye (5.3%) with trabeculectomy and corneal graft failure. 94.4% of patients were very satisfied with the cosmesis and would be highly likely to have the procedure again. Conclusions This study confirms that endocapsular insertion of an artificial iris is typically associated with good functional and cosmetic results and a relatively low risk of significant complications.
查看更多>>摘要：Abstract Background To measure quantitative autofluorescence (qAF) in patients under treatment with hydroxychloroquine (HCQ) and at risk of retinal toxicity but with no apparent signs of retinal toxicity and to compare it with that of untreated subjects. Methods Consecutive patients at risk for the development of HCQ retinal toxicity (duration of treatment >5?years or daily HCQ dose >5?mg/kg of actual body weight [ABW]) but no alterations on spectral domain—optical coherence tomography, short‐wavelength autofluorescence and 10–2 visual field examination were recruited. Healthy subjects matched by age and sex were also enrolled in the study. All subjects underwent qAF measurements in one eye. Images were analysed using the conventional qAF grid by Delori calculating the qAF of eight sectors of the intermediate ring and the mean of those values (qAF8). Results Thirty‐nine patients treated with HCQ (38 females, mean age 52.1?±?8.6?years) and 39 untreated subjects (38 females, mean age 51.2?±?8.6?years) were included. In both HCQ patients and untreated subjects, qAF8 was positively correlated with age (p?=?0.004). Although HCQ patients showed a higher mean qAF8 compared with untreated subjects (294.7?±?65.3 vs. 268.9?±?57.5), the difference was not significant (p?=?0.068). HCQ patients showed significantly higher mean qAF values in the inferior‐temporal, inferior and inferior‐nasal sectors of the intermediate ring of qAF grid compared with untreated subjects (all p?<?0.05). Conclusions These results suggest a possible preclinical increase of qAF values in inferior parafoveal sectors probably induced by HCQ exposure.
查看更多>>摘要：Abstract Background Development of a macular sector‐wise decision tree model (DTM) for the prediction of parafoveal scotoma. Methods This prospective study enrolled 126 patients with early‐stage open‐angle glaucoma (mean deviation ≥?6 decibels) without the signs of parafoveal scotoma on the 24‐2 visual field (VF) test (i.e., any abnormalities at the four innermost points). Based on the central 36 points of the 10‐2 pattern deviation plot, patients were classified as being with or without 10‐2 parafoveal scotoma. For the discrimination of patients from those without 10‐2 parafoveal scotoma, a macular ganglion cell‐inner plexiform layer (mGCIPL) sector‐wise DTM analysis was performed. Results Among 126 eyes without 24‐2 parafoveal scotoma, 10‐2 parafoveal scotoma was detected in 77 (61.1%) eyes. The balanced accuracy of DTM was best in the inferotemporal sector (0.9286; 95% CI, 0.7458–0.9697) and worst in the inferior sector (0.8373; 0.6484–0.9204). DTM revealed that even in the absence of VF abnormalities at the innermost 4 points on the 24‐2 test, (1) 10‐2 parafoveal scotoma should be strongly suspected when the adjacent 24‐2 perifoveal point in the correlated sector is abnormal; (2) if the 24‐2 perifoveal point is normal, and if the probability colour codes of the correlated mGCIPL sector are green, the probability of 10‐2 parafoveal scotoma is very low. Conclusions In clinical practice, the evaluation of the 24‐2 perifoveal test points along with the probability colour codes of mGCIPL can be a useful decision‐support tool in determining whether 10‐2 tests are needed for a given patient.
查看更多>>摘要：Abstract Background Frequent intravitreal anti‐VEGF injections are impractical for many Aboriginal patients with diabetic macular oedema (DMO). The longer acting intravitreal dexamethasone implant (DEX‐implant) is approved for DMO but has not been assessed in an Aboriginal population. Methods This was a prospective, multicentre, randomised, single‐masked, non‐inferiority clinical trial. Aboriginal adults from Western Australia with DMO were randomised to receive 3‐monthly DEX‐implant, or monthly intravitreal bevacizumab. The primary outcome was the change in best corrected visual acuity (BCVA) at 12?months. Results The final endpoint was analysed for 24 DEX‐implant and 28 bevacizumab injection eyes. Mean BCVA improved by 4.0 letters (?0.08 LogMAR) in the DEX‐implant group and worsened by 5.5 letters (0.11 LogMAR) in the bevacizumab group. Before adjusting for cataract surgery, the upper bound of the two‐sided 90% CI for the DEX‐implant was 3.5 letters (0.07 LogMAR), which met non‐inferiority criteria. The BCVA of remote participants who received the DEX‐implant improved by 5.5 letters (0.11 LogMAR), compared to an 18.5 letter (0.37 LogMAR) decline for bevacizumab (p?=?0.04). The incidence of steroid‐induced ocular hypertension for the DEX‐implant was 33.3%. Conclusions Before adjusting for the effect of cataract surgery, the DEX‐implant was non‐inferior to bevacizumab for treating DMO in Aboriginal participants. In remote participants, the DEX‐implant surpassed non‐inferiority to achieve superior outcomes to bevacizumab. The incidence of steroid‐induced hypertension was comparable to that reported in non‐Aboriginal populations. We provide guidelines for the judicious use of DEX‐implant among Aboriginal people, and a framework for performing ophthalmic clinical trials in Aboriginal communities.
查看更多>>摘要：Abstract Background This study aimed to examine possible causal associations between various components of metabolic syndrome and glaucoma‐related phenotypes. Methods A two‐sample Mendelian randomisation study was conducted with the models of inverse‐variance weighted (IVW), maximum likelihood, weighted median and MR‐Egger regression. We accessed data from publicly available genome‐wide association studies for individual parameters of metabolic syndrome as the exposures and the data for glaucoma and its endophenotypes as the outcomes. Results Among 11 exposures and 6 outcomes examined in this Mendelian randomisation study, only fasting blood glucose level showed evidence of a causal influence on intraocular pressure. Results analysed by the IVW model suggested that each one‐SD increase in genetically predicted fasting blood glucose level was significantly associated with 0.80 SD elevation in intraocular pressure (β: 0.80, 95% CI: 0.38–1.22, p: 2.12e?4). The maximum likelihood model (β: 0.82, 95% CI: 0.39–1.25, p: 1.616e?4) also supported a significant causal effect. The weighted median model (β: 0.78, 95% CI: 0.17–1.39, p: 0.012) showed a nominally significant effect whereas the MR‐Egger model (β: 0.63, 95% CI: ?0.32–1.59, p: 0.212) showed a consistent direction of effect but was not statistically significant. Several sensitivity analyses indicated no evidence of directional horizontal pleiotropy that would bias the result. Conclusions This Mendelian randomisation study provides evidence for a causal role for genetically determined higher fasting blood glucose level in the development of increased intraocular pressure. This finding could be considered in the monitoring and control of intraocular pressure and may be instrumental in prevention strategies for ocular hypertension.
Stephanie L. WatsonMaria Cabrera‐AguasPauline Khoo
20页
查看更多>>摘要：Abstract Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface disease. Staphylococcus species, Pseudomonas aeruginosa, Fusarium species, Candida species and Acanthamoeba species are the most common causal organisms. Culture of corneal scrapes is the preferred initial test to identify the culprit organism. Polymerase chain reaction (PCR) tests and in vivo confocal microscopy can complement the diagnosis. Empiric therapy is typically commenced with fluoroquinolones, or fortified antibiotics for bacterial keratitis; topical natamycin for fungal keratitis; and polyhexamethylene biguanide or chlorhexidine for acanthamoeba keratitis. Herpes simplex keratitis is mainly diagnosed clinically; however, PCR can also be used to confirm the initial diagnosis and in atypical cases. Antivirals and topical corticosteroids are indicated depending on the corneal layer infected. Vision impairment, blindness and even loss of the eye can occur with a delay in diagnosis and inappropriate antimicrobial therapy.
NSTL
Wiley