Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2148656
Jacob G. Light, H. Anderson, Sunir J. Garg
ABSTRACT Introduction Pars plana vitrectomy is the basis of modern retina surgery, and for the last 40 years, has been achieved using the pneumatic guillotine cutter. Recently, a new vitrectomy design has been developed: the hypersonic vitrector. This technology utilizes ultrasound energy to liquefy vitreous in contrast to the mechanical segmentation of vitreous strands that characterizes pneumatic cutters. Areas covered This review provides a history of the development of vitrectomy and summarizes the critical elements of effective and safe vitrectomy systems. The article will describe the novel hypersonic vitrectomy design, discuss what the initial pre-clinical and in-human studies tell us about its performance compared to standard pneumatic cutters, and considers its role in the future of retina surgery. Expert opinion Hypersonic vitrectomy is the first novel way to segment vitreous since the development of pneumatic guillotine cutters. It has the potential to make vitrectomy more efficient both by reducing operating times as well as enabling surgeons to remove silicone oil and retained lens material all with one instrument. With concurrent advancements in guillotine cutters, hypersonic vitrectomy has a high bar to clear to demonstrate advantages that would result in widespread adoption.
{"title":"Hypersonic vitrectomy: a novel approach to vitreous removal","authors":"Jacob G. Light, H. Anderson, Sunir J. Garg","doi":"10.1080/17469899.2022.2148656","DOIUrl":"https://doi.org/10.1080/17469899.2022.2148656","url":null,"abstract":"ABSTRACT Introduction Pars plana vitrectomy is the basis of modern retina surgery, and for the last 40 years, has been achieved using the pneumatic guillotine cutter. Recently, a new vitrectomy design has been developed: the hypersonic vitrector. This technology utilizes ultrasound energy to liquefy vitreous in contrast to the mechanical segmentation of vitreous strands that characterizes pneumatic cutters. Areas covered This review provides a history of the development of vitrectomy and summarizes the critical elements of effective and safe vitrectomy systems. The article will describe the novel hypersonic vitrectomy design, discuss what the initial pre-clinical and in-human studies tell us about its performance compared to standard pneumatic cutters, and considers its role in the future of retina surgery. Expert opinion Hypersonic vitrectomy is the first novel way to segment vitreous since the development of pneumatic guillotine cutters. It has the potential to make vitrectomy more efficient both by reducing operating times as well as enabling surgeons to remove silicone oil and retained lens material all with one instrument. With concurrent advancements in guillotine cutters, hypersonic vitrectomy has a high bar to clear to demonstrate advantages that would result in widespread adoption.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"375 - 382"},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45798882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2147928
A. Borgia, R. Raimondi, G. Fossati, Francesco Paolo De Rosa, V. Romano, D. Borroni, L. Vigo, V. Scorcia, G. Giannaccare
ABSTRACT Introduction Dry eye disease (DED) is a multifactorial chronic condition with a broad spectrum of symptoms that can affect daily activities and quality of life. Areas covered New treatment approaches that target more systematically distinct parts of the pathophysiology would present new potential to effectively regulate signs and symptoms of DED. In this review, a comprehensive list of device-based treatments has been provided, according to their mechanism of action. Expert opinion Given the variability and complexity of DED, adjuvant treatments should be considered as a boost for patients who do not respond to first-line therapy. Most of those devices primarily target meibomian glands, using heat or mechanical energy to restore normal meibum flow. Although several treatments have been discussed in this review, further studies are needed to identify new options, evaluate current therapies in randomized clinical trials more extensively, and identify which subtypes of DED could benefit from any given therapy.
{"title":"Device-based therapies as a boost of conventional treatment in dry eye disease","authors":"A. Borgia, R. Raimondi, G. Fossati, Francesco Paolo De Rosa, V. Romano, D. Borroni, L. Vigo, V. Scorcia, G. Giannaccare","doi":"10.1080/17469899.2022.2147928","DOIUrl":"https://doi.org/10.1080/17469899.2022.2147928","url":null,"abstract":"ABSTRACT Introduction Dry eye disease (DED) is a multifactorial chronic condition with a broad spectrum of symptoms that can affect daily activities and quality of life. Areas covered New treatment approaches that target more systematically distinct parts of the pathophysiology would present new potential to effectively regulate signs and symptoms of DED. In this review, a comprehensive list of device-based treatments has been provided, according to their mechanism of action. Expert opinion Given the variability and complexity of DED, adjuvant treatments should be considered as a boost for patients who do not respond to first-line therapy. Most of those devices primarily target meibomian glands, using heat or mechanical energy to restore normal meibum flow. Although several treatments have been discussed in this review, further studies are needed to identify new options, evaluate current therapies in randomized clinical trials more extensively, and identify which subtypes of DED could benefit from any given therapy.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"387 - 393"},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43846676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2147927
Huma Khan, Hannah Khan, A. Aziz, Tyler M Ewing, A. Khanani
Age-related macular degeneration (AMD) is the leading cause of permanent vision loss in individuals over 50 years of age [1]. Advanced AMD can anatomically present as either neovascular (nAMD) or atrophic AMD. nAMD displays characteristic growth of abnormal vasculature that originates from the choroid or retina, resulting in macular neovascularization (MNV). MNV progression can lead to degeneration of photoreceptors, macular damage, and retinal pigment epithelium disruption [1]. If left untreated, MNV in nAMD can lead to leakage of fluid, lipid, and blood into the outer retina, resulting in irreversible vision loss [1]. Atrophic AMD can progress to geographic atrophy (GA), characterized by atrophy of choriocapillaris, retinal pigment epithelial cells, and macular photoreceptors [1].
{"title":"How could gene therapy change the way we treat age-related macular degeneration?","authors":"Huma Khan, Hannah Khan, A. Aziz, Tyler M Ewing, A. Khanani","doi":"10.1080/17469899.2022.2147927","DOIUrl":"https://doi.org/10.1080/17469899.2022.2147927","url":null,"abstract":"Age-related macular degeneration (AMD) is the leading cause of permanent vision loss in individuals over 50 years of age [1]. Advanced AMD can anatomically present as either neovascular (nAMD) or atrophic AMD. nAMD displays characteristic growth of abnormal vasculature that originates from the choroid or retina, resulting in macular neovascularization (MNV). MNV progression can lead to degeneration of photoreceptors, macular damage, and retinal pigment epithelium disruption [1]. If left untreated, MNV in nAMD can lead to leakage of fluid, lipid, and blood into the outer retina, resulting in irreversible vision loss [1]. Atrophic AMD can progress to geographic atrophy (GA), characterized by atrophy of choriocapillaris, retinal pigment epithelial cells, and macular photoreceptors [1].","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"371 - 374"},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2153119
C. McMonnies
ABSTRACT Introduction The potential for eye rubbing to contribute to keratoconus development and progression is well established, but the mechanisms of that association have not been fully elucidated. Areas covered This review examines mechanisms for rubbing-related corneal trauma from both anterior and posterior surface responses to elevated intraocular pressure. Apart from rubbing-related intraocular pressure elevation, consideration is given to other sources of elevation which may contribute to corneal bulging and cone formation. Mechanisms whereby intraocular pressure-related increased posterior corneal surface distending stress and stromal hydrostatic pressure may alter keratocyte functions and increase susceptibility to such stress are examined. Expert opinion Elevated intraocular pressure (IOP) that is associated with a chronic habit of abnormal rubbing (CHAR) can be a major contributor of keratoconus (KC) development and progression. Anterior corneal surface protection during rubbing due to Bell’s reflex in most patients, at least for the central and para-central cornea, increases the likelihood that IOP distending stress can be an important source of KC pathogenesis, perhaps even in patients who do not have abnormal rubbing habits. That the earliest pathological changes in KC occur at the posterior corneal surface is consistent with the significance of an IOP-related distending force mechanism for KC pathogenesis.
{"title":"Mechanisms of corneal trauma in response to rubbing and other intraocular pressure elevating activities in keratoconus","authors":"C. McMonnies","doi":"10.1080/17469899.2022.2153119","DOIUrl":"https://doi.org/10.1080/17469899.2022.2153119","url":null,"abstract":"ABSTRACT Introduction The potential for eye rubbing to contribute to keratoconus development and progression is well established, but the mechanisms of that association have not been fully elucidated. Areas covered This review examines mechanisms for rubbing-related corneal trauma from both anterior and posterior surface responses to elevated intraocular pressure. Apart from rubbing-related intraocular pressure elevation, consideration is given to other sources of elevation which may contribute to corneal bulging and cone formation. Mechanisms whereby intraocular pressure-related increased posterior corneal surface distending stress and stromal hydrostatic pressure may alter keratocyte functions and increase susceptibility to such stress are examined. Expert opinion Elevated intraocular pressure (IOP) that is associated with a chronic habit of abnormal rubbing (CHAR) can be a major contributor of keratoconus (KC) development and progression. Anterior corneal surface protection during rubbing due to Bell’s reflex in most patients, at least for the central and para-central cornea, increases the likelihood that IOP distending stress can be an important source of KC pathogenesis, perhaps even in patients who do not have abnormal rubbing habits. That the earliest pathological changes in KC occur at the posterior corneal surface is consistent with the significance of an IOP-related distending force mechanism for KC pathogenesis.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"405 - 414"},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45516388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-28DOI: 10.1080/17469899.2022.2142120
Ronald Cheung, Samantha So, Monali S. Malvankar-Mehta
ABSTRACT Objective The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Methods MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. Results Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815–0.987] and specificity was 0.960 [95% CI: 0.924–0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696–0.960] and specificity was 0.891 [95% CI: 0.807–0.942]. Conclusion The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration CRD42020219316
{"title":"Diagnostic accuracy of machine learning classifiers for cataracts: a systematic review and meta-analysis","authors":"Ronald Cheung, Samantha So, Monali S. Malvankar-Mehta","doi":"10.1080/17469899.2022.2142120","DOIUrl":"https://doi.org/10.1080/17469899.2022.2142120","url":null,"abstract":"ABSTRACT Objective The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Methods MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. Results Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815–0.987] and specificity was 0.960 [95% CI: 0.924–0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696–0.960] and specificity was 0.891 [95% CI: 0.807–0.942]. Conclusion The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration CRD42020219316","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"427 - 437"},"PeriodicalIF":0.7,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47318696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2139677
Daniel Egger, Reinhard Angermann, S. Waldstein
The introduction of intravitreal injections of anti-vascular endothelial growth factor (VEGF) has led to a new standard of care regarding the treatment of neovascular age-related macular degeneration (nAMD). Although VEGF inhibitors caused a paradigm shift in the management of these patients, the burden of frequent follow-up and direct as well as indirect costs of treatment remain a challenge for patients, healthcare systems, and societies. Initial treatment and particularly retreatment decisions still rest upon optical coherence tomography (OCT)-based biomarkers, especially the presence of subretinal fluid (SRF) and intraretinal fluid (IRF). A complete resolution of fluid is often considered a therapeutic target. However, in order to further reduce disease burden and adapt treatment frequency to the individual disease activity, this paradigm needs to be reconsidered.
{"title":"The future of biomarkers in neovascular age-related macular degeneration: active disease or degenerative process?","authors":"Daniel Egger, Reinhard Angermann, S. Waldstein","doi":"10.1080/17469899.2022.2139677","DOIUrl":"https://doi.org/10.1080/17469899.2022.2139677","url":null,"abstract":"The introduction of intravitreal injections of anti-vascular endothelial growth factor (VEGF) has led to a new standard of care regarding the treatment of neovascular age-related macular degeneration (nAMD). Although VEGF inhibitors caused a paradigm shift in the management of these patients, the burden of frequent follow-up and direct as well as indirect costs of treatment remain a challenge for patients, healthcare systems, and societies. Initial treatment and particularly retreatment decisions still rest upon optical coherence tomography (OCT)-based biomarkers, especially the presence of subretinal fluid (SRF) and intraretinal fluid (IRF). A complete resolution of fluid is often considered a therapeutic target. However, in order to further reduce disease burden and adapt treatment frequency to the individual disease activity, this paradigm needs to be reconsidered.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"303 - 306"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41365542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2131541
Semih Ceylan, O. Özalp, E. Atalay
Dementia is defined as the irreversible deterioration of acquired cognitive abilities (executive functions, memory, language, visuospatial, and motor) because of progressive neurodegeneration. According to a report by the World Health Organization (WHO) in 2018, dementia ranks as the 7 most common worldwide cause of death. In 2018, the globally estimated number of people afflicted by dementia was 50 million, a figure which is expected to triple by the year 2050 [1]. The worldwide rapidly aging population and the resultant unprecedented rise in the incidence of dementia are anticipated to cause a greater burden in health expenditures both in underdeveloped and developed countries alike. Optical coherence tomography angiography (OCT-A) is a noninvasive and facile method for visualizing retinal and choroidal microcirculation obviating the need for administering a systemic contrast agent. Compared to other brain imaging modalities, such as positron emission tomography imaging, it is more cost-effective and rapidly allows layer-bylayer assessment of retinochoroidal microcirculation. In a routine retina clinic, OCT-A is mainly employed for the diagnosis and monitoring of age-related macular degeneration and diabetic retinopathy. It has also become a popular research tool for assessing peripapillary and macular microcirculation in glaucoma and other optic neuropathies with the hope of finding various vascular cues that may enable earlier disease diagnosis and/or the detection of its progression [2]. In addition to its indispensable role in a busy ophthalmology clinic, studies have shown that OCT-A may potentially be a highly useful ancillary tool in various other non-ophthalmic diseases that directly or indirectly impact retinal and/or choriocapillaris microcirculation, such as multiple sclerosis, Parkinson’s, and Alzheimer’s diseases [3].
{"title":"A peek at the window from the eye into the brain: potential use of OCT angiography in dementia","authors":"Semih Ceylan, O. Özalp, E. Atalay","doi":"10.1080/17469899.2022.2131541","DOIUrl":"https://doi.org/10.1080/17469899.2022.2131541","url":null,"abstract":"Dementia is defined as the irreversible deterioration of acquired cognitive abilities (executive functions, memory, language, visuospatial, and motor) because of progressive neurodegeneration. According to a report by the World Health Organization (WHO) in 2018, dementia ranks as the 7 most common worldwide cause of death. In 2018, the globally estimated number of people afflicted by dementia was 50 million, a figure which is expected to triple by the year 2050 [1]. The worldwide rapidly aging population and the resultant unprecedented rise in the incidence of dementia are anticipated to cause a greater burden in health expenditures both in underdeveloped and developed countries alike. Optical coherence tomography angiography (OCT-A) is a noninvasive and facile method for visualizing retinal and choroidal microcirculation obviating the need for administering a systemic contrast agent. Compared to other brain imaging modalities, such as positron emission tomography imaging, it is more cost-effective and rapidly allows layer-bylayer assessment of retinochoroidal microcirculation. In a routine retina clinic, OCT-A is mainly employed for the diagnosis and monitoring of age-related macular degeneration and diabetic retinopathy. It has also become a popular research tool for assessing peripapillary and macular microcirculation in glaucoma and other optic neuropathies with the hope of finding various vascular cues that may enable earlier disease diagnosis and/or the detection of its progression [2]. In addition to its indispensable role in a busy ophthalmology clinic, studies have shown that OCT-A may potentially be a highly useful ancillary tool in various other non-ophthalmic diseases that directly or indirectly impact retinal and/or choriocapillaris microcirculation, such as multiple sclerosis, Parkinson’s, and Alzheimer’s diseases [3].","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"295 - 297"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43549570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2138345
E. Abu, Odeefour A Ofori, S. Boadi-Kusi, S. Ocansey, Richard K Yankah, Selassie K Dzasimatu, A. Y. Awuku
ABSTRACT Background To investigate the impact of dry eye syndrome (DES) on dry eye-related quality of life (QoL) in patients with type 2 diabetes. Research design and methods Evaluation of DES included assessment of meibomian gland function, tear breakup time (TBUT), Schirmer test, fluorescein ocular surface staining, and Ocular Surface Disease Index (OSDI) scores. DES diagnosis was based on OSDI score ≥13, TBUT < 10s, and fluorescein staining. Results After adjusting for age, duration of diabetes, drug usage, and comorbidities, severity of DES symptomatology and signs resulted in poorer QoL of patients when comparing cases and controls. TBUT, meibum quality, and ocular surface staining were the objective clinical tests that significantly correlated with QoL. Poor QoL was also associated with the presence of eyelash and eyelid anomalies (eyelash: aOR = 2.58, CI = 1.49–4.47, p = 0.001; eyelids: aOR = 1.66, CI = 1.01–2.71, p = 0.04). Patients who had been previously diagnosed and treated for DES registered improved QoL measures. Conclusions Symptoms or clinical signs of DES resulted in poorer QoL in a clinical sample of type 2 diabetes patients, stressing the need for clinicians to evaluate such signs and symptoms in order to improve QoL.
{"title":"Dry eye-related quality of life among type 2 diabetes patients: a hospital-based cross-sectional study","authors":"E. Abu, Odeefour A Ofori, S. Boadi-Kusi, S. Ocansey, Richard K Yankah, Selassie K Dzasimatu, A. Y. Awuku","doi":"10.1080/17469899.2022.2138345","DOIUrl":"https://doi.org/10.1080/17469899.2022.2138345","url":null,"abstract":"ABSTRACT Background To investigate the impact of dry eye syndrome (DES) on dry eye-related quality of life (QoL) in patients with type 2 diabetes. Research design and methods Evaluation of DES included assessment of meibomian gland function, tear breakup time (TBUT), Schirmer test, fluorescein ocular surface staining, and Ocular Surface Disease Index (OSDI) scores. DES diagnosis was based on OSDI score ≥13, TBUT < 10s, and fluorescein staining. Results After adjusting for age, duration of diabetes, drug usage, and comorbidities, severity of DES symptomatology and signs resulted in poorer QoL of patients when comparing cases and controls. TBUT, meibum quality, and ocular surface staining were the objective clinical tests that significantly correlated with QoL. Poor QoL was also associated with the presence of eyelash and eyelid anomalies (eyelash: aOR = 2.58, CI = 1.49–4.47, p = 0.001; eyelids: aOR = 1.66, CI = 1.01–2.71, p = 0.04). Patients who had been previously diagnosed and treated for DES registered improved QoL measures. Conclusions Symptoms or clinical signs of DES resulted in poorer QoL in a clinical sample of type 2 diabetes patients, stressing the need for clinicians to evaluate such signs and symptoms in order to improve QoL.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"353 - 359"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46823253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2137493
A. Kawali, Aayesha Khanum, P. Mahendradas, S. Sanjay, R. Shetty
ABSTRACT Introduction Varicella zoster virus (VZV) uveitis presenting as acute retinal necrosis with vasculitis is well known, but VZV-vasculitis without retinitis is rarely reported. Identification of such presentation can be challenging, especially when other signs of ocular VZV are absent. This is particularly important before considering immunomodulatory therapy for retinal vasculitis without systemic manifestations. Areas covered An online English language literature search for ‘VZV retinal vasculitis presenting without retinitis’ was made and case reports and case series published from 1995 to 2020 were reviewed. The search revealed 26 cases from 21 reports in 25 years. The clinical manifestation, morphology of vasculitis, visual and treatment outcomes were studied. Expert opinion Recent or old history of Herpes Zoster Ophthalmicus or chickenpox especially in young individuals should be elicited in isolated retinal vasculitis. Diagnostic relevance of PCR and serological tests should be investigated further in larger studies. Occlusive nature of vasculitis, including arteriolitis, is common in VZV infection. In chronic cases, end point of antiviral therapy remains unknown. Patients should be warned of grave visual prognosis despite adequate treatment. The importance of adjuvant anti-thrombotic therapy along with anti-viral and immunomodulatory therapy needs to be explored further.
{"title":"Varicella zoster retinal vasculitis without retinitis: a literature review","authors":"A. Kawali, Aayesha Khanum, P. Mahendradas, S. Sanjay, R. Shetty","doi":"10.1080/17469899.2022.2137493","DOIUrl":"https://doi.org/10.1080/17469899.2022.2137493","url":null,"abstract":"ABSTRACT Introduction Varicella zoster virus (VZV) uveitis presenting as acute retinal necrosis with vasculitis is well known, but VZV-vasculitis without retinitis is rarely reported. Identification of such presentation can be challenging, especially when other signs of ocular VZV are absent. This is particularly important before considering immunomodulatory therapy for retinal vasculitis without systemic manifestations. Areas covered An online English language literature search for ‘VZV retinal vasculitis presenting without retinitis’ was made and case reports and case series published from 1995 to 2020 were reviewed. The search revealed 26 cases from 21 reports in 25 years. The clinical manifestation, morphology of vasculitis, visual and treatment outcomes were studied. Expert opinion Recent or old history of Herpes Zoster Ophthalmicus or chickenpox especially in young individuals should be elicited in isolated retinal vasculitis. Diagnostic relevance of PCR and serological tests should be investigated further in larger studies. Occlusive nature of vasculitis, including arteriolitis, is common in VZV infection. In chronic cases, end point of antiviral therapy remains unknown. Patients should be warned of grave visual prognosis despite adequate treatment. The importance of adjuvant anti-thrombotic therapy along with anti-viral and immunomodulatory therapy needs to be explored further.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"333 - 341"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46320556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2139678
M. Kole, J. C. Martinez‐Gutierrez, Francisio Sanchez, Rosa A. Tang, P. Chen
ABSTRACT Introduction Idiopathic intracranial hypertension (IIH) is a disease of excess cerebrospinal fluid (CSF) leading to rising intracranial pressure. Patients most commonly present with headache, tinnitus, papilledema, and vision loss. It most commonly affects young overweight females, a growing population. Traditional management has consisted of weight loss, medical management, surgical CSF diversion, and optic nerve sheath fenestration. In recent years, cerebral venous sinus stenosis has been described as an almost ubiquitously present potentiator of this disease. Venous sinus stenting to normalize cerebral venous outflow has emerged as a highly effective treatment. Areas covered In this review, the authors review the epidemiology and pathophysiology of IIH, as well as its common management strategies. The authors focus on the emergence of venous sinus stenting as a safe, effective, and minimally invasive strategy for managing IIH. Expert opinion IIH caused by venous sinus stenosis can be treated effectively and safely with endovascular stenting of the sinus. Given its low morbidity and failure rate relative to other traditional management strategies, evaluation for venous sinus stenosis should be pursued in this patient population, and referral to a neuro-endovascular specialist made if indicated.
{"title":"Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review","authors":"M. Kole, J. C. Martinez‐Gutierrez, Francisio Sanchez, Rosa A. Tang, P. Chen","doi":"10.1080/17469899.2022.2139678","DOIUrl":"https://doi.org/10.1080/17469899.2022.2139678","url":null,"abstract":"ABSTRACT Introduction Idiopathic intracranial hypertension (IIH) is a disease of excess cerebrospinal fluid (CSF) leading to rising intracranial pressure. Patients most commonly present with headache, tinnitus, papilledema, and vision loss. It most commonly affects young overweight females, a growing population. Traditional management has consisted of weight loss, medical management, surgical CSF diversion, and optic nerve sheath fenestration. In recent years, cerebral venous sinus stenosis has been described as an almost ubiquitously present potentiator of this disease. Venous sinus stenting to normalize cerebral venous outflow has emerged as a highly effective treatment. Areas covered In this review, the authors review the epidemiology and pathophysiology of IIH, as well as its common management strategies. The authors focus on the emergence of venous sinus stenting as a safe, effective, and minimally invasive strategy for managing IIH. Expert opinion IIH caused by venous sinus stenosis can be treated effectively and safely with endovascular stenting of the sinus. Given its low morbidity and failure rate relative to other traditional management strategies, evaluation for venous sinus stenosis should be pursued in this patient population, and referral to a neuro-endovascular specialist made if indicated.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"321 - 331"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42046283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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