Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2131539
Christopher M. Maatouk, Resya Sastry, Rishi P. Singh
ABSTRACT Introduction Anti-VEGF agents have been demonstrated to be more effective than sham or laser in treating center-involving diabetic macular edema (DME) in short-term pivotal trials. The literature regarding long-term outcomes (5 years or more) of anti-VEGF treatments in DME is limited. Areas covered A literature search was conducted using the PubMed and Cochrane Library databases. Key words included ‘diabetic macular edema,’ ‘diabetic retinopathy,’ ‘vascular endothelial growth factor,’ ‘anti-VEGF,’ ‘long*,’ and ‘five-year.’ 21 articles were included in the final review that examined the 5-year visual and anatomic outcomes of anti-VEGF treatments in DME. Combined analysis of the mean 5-year change in visual acuity and central retinal thickness was conducted. Expert opinion Anti-VEGF agents provide significant vision and anatomic improvements to patients with DME through at least 5 years of treatment. Given their minimal adverse effect profile, superior impact on visual and anatomic outcomes, and likely cost benefit, anti-VEGF agents should be initiated as early as possible in individuals with clinically significant DME causing vision loss. Further work is required to identify early indicators of poor treatment response and to develop longer-acting anti-VEGF treatments.
{"title":"Long term outcomes following anti-VEGF therapy for diabetic macular edema","authors":"Christopher M. Maatouk, Resya Sastry, Rishi P. Singh","doi":"10.1080/17469899.2022.2131539","DOIUrl":"https://doi.org/10.1080/17469899.2022.2131539","url":null,"abstract":"ABSTRACT Introduction Anti-VEGF agents have been demonstrated to be more effective than sham or laser in treating center-involving diabetic macular edema (DME) in short-term pivotal trials. The literature regarding long-term outcomes (5 years or more) of anti-VEGF treatments in DME is limited. Areas covered A literature search was conducted using the PubMed and Cochrane Library databases. Key words included ‘diabetic macular edema,’ ‘diabetic retinopathy,’ ‘vascular endothelial growth factor,’ ‘anti-VEGF,’ ‘long*,’ and ‘five-year.’ 21 articles were included in the final review that examined the 5-year visual and anatomic outcomes of anti-VEGF treatments in DME. Combined analysis of the mean 5-year change in visual acuity and central retinal thickness was conducted. Expert opinion Anti-VEGF agents provide significant vision and anatomic improvements to patients with DME through at least 5 years of treatment. Given their minimal adverse effect profile, superior impact on visual and anatomic outcomes, and likely cost benefit, anti-VEGF agents should be initiated as early as possible in individuals with clinically significant DME causing vision loss. Further work is required to identify early indicators of poor treatment response and to develop longer-acting anti-VEGF treatments.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"307 - 319"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48561191","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: 10.1080/17469899.2022.2138346
Anita Syla Lokaj, Gazmend Kaçaniku, K. Spahiu, Faruk Semiz
ABSTRACT Background This study aimed to analyze the central corneal thickness (CCT) in diabetic patients with and without diabetic retinopathy (DR) by investigating the impacts of other CCT factors such as hemoglobin A1c (HbA1c) levels, diabetes mellitus (DM) duration, and the DR stages. The study also compared the results of two measuring devices – anterior segment-optical coherence tomography (AS-OCT) and ultrasound pachymetry (UP). However, the existing research possesses bias in revealing the precise measurement of CCT. Research design and methods The study enrolled 300 participants who were segregated into three equal groups: group A with DR, group B without DR, and the control group. The study tested the following formulated hypothesis, like the correlation between the age, duration, and HbA1c level of diabetic patients with DR and without DR. The effectiveness of the AS-OCT and UP was assessed through statistical analysis. Results The experiment revealed a considerable statistical difference in the formulated hypothesis and observed that AS-OCT had higher efficacy than UP in estimating CCT in all the groups. Conclusions The study recommends the prompt utilization of devices such as AS-OCT to precisely predict CCT. This could greatly benefit DM patients with retinopathy conditions for better decision-making and reliable measures during glaucoma surgery.
{"title":"Prediction of a reliable method for the estimation of central corneal thickness in diabetic patients with and without diabetic retinopathy","authors":"Anita Syla Lokaj, Gazmend Kaçaniku, K. Spahiu, Faruk Semiz","doi":"10.1080/17469899.2022.2138346","DOIUrl":"https://doi.org/10.1080/17469899.2022.2138346","url":null,"abstract":"ABSTRACT Background This study aimed to analyze the central corneal thickness (CCT) in diabetic patients with and without diabetic retinopathy (DR) by investigating the impacts of other CCT factors such as hemoglobin A1c (HbA1c) levels, diabetes mellitus (DM) duration, and the DR stages. The study also compared the results of two measuring devices – anterior segment-optical coherence tomography (AS-OCT) and ultrasound pachymetry (UP). However, the existing research possesses bias in revealing the precise measurement of CCT. Research design and methods The study enrolled 300 participants who were segregated into three equal groups: group A with DR, group B without DR, and the control group. The study tested the following formulated hypothesis, like the correlation between the age, duration, and HbA1c level of diabetic patients with DR and without DR. The effectiveness of the AS-OCT and UP was assessed through statistical analysis. Results The experiment revealed a considerable statistical difference in the formulated hypothesis and observed that AS-OCT had higher efficacy than UP in estimating CCT in all the groups. Conclusions The study recommends the prompt utilization of devices such as AS-OCT to precisely predict CCT. This could greatly benefit DM patients with retinopathy conditions for better decision-making and reliable measures during glaucoma surgery.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"361 - 369"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43286773","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: 10.1080/17469899.2022.2126832
F. Jinadu, Iskilu Adekunle Jolaoso, Modupe balagun, T. Ottun, Ufuoma Oluwaseyi Olumodeji, A. Olumodeji
ABSTRACT Background We compared ultrasonic ocular axial length and vitreous chamber depth, and physical anthropometry in normal and myopic African adults due to sparse related data in this setting. Research design and methods This was a hospital-based, case-control study in which 175 myopes and 175 emmetropes, recruited by convenience sampling, at General Hospital Epe, Lagos, had their anthropometry and refractive status determined; and ocular axial length and vitreous chamber depth measured with A- and B-mode ocular ultrasonography. Data was analyzed using appropriate inferential statistics and level of significance set at 0.05. Results Mean ocular axial length in normal, mild, moderate and severe myopia was 22.45mm, 23.54mm, 23.79mm, and 25.56mm while mean vitreous chamber depth in normal, mild, moderate, and severe myopia was 15.45mm, 16.63mm, 16.84mm, and 18.68mm, respectively. Males had significantly longer axial length and vitreous chamber depth than females. Correlation between weight, height and BMI and refractive status among myopes was insignificant. There was consistency between A- and B-mode ultrasonography ocular axial length and vitreous chamber measurements with a Cronbach’s Alpha of 0.888 and 0.842, respectively (p<0.001). Conclusion Ocular axial length and vitreous chamber depth increased with the severity of myopia with no correlation of anthropometry with refractive status among African myopes.
{"title":"Ultrasonic ocular dimensions and anthropometry in normal and myopic eyes: a case-control study","authors":"F. Jinadu, Iskilu Adekunle Jolaoso, Modupe balagun, T. Ottun, Ufuoma Oluwaseyi Olumodeji, A. Olumodeji","doi":"10.1080/17469899.2022.2126832","DOIUrl":"https://doi.org/10.1080/17469899.2022.2126832","url":null,"abstract":"ABSTRACT Background We compared ultrasonic ocular axial length and vitreous chamber depth, and physical anthropometry in normal and myopic African adults due to sparse related data in this setting. Research design and methods This was a hospital-based, case-control study in which 175 myopes and 175 emmetropes, recruited by convenience sampling, at General Hospital Epe, Lagos, had their anthropometry and refractive status determined; and ocular axial length and vitreous chamber depth measured with A- and B-mode ocular ultrasonography. Data was analyzed using appropriate inferential statistics and level of significance set at 0.05. Results Mean ocular axial length in normal, mild, moderate and severe myopia was 22.45mm, 23.54mm, 23.79mm, and 25.56mm while mean vitreous chamber depth in normal, mild, moderate, and severe myopia was 15.45mm, 16.63mm, 16.84mm, and 18.68mm, respectively. Males had significantly longer axial length and vitreous chamber depth than females. Correlation between weight, height and BMI and refractive status among myopes was insignificant. There was consistency between A- and B-mode ultrasonography ocular axial length and vitreous chamber measurements with a Cronbach’s Alpha of 0.888 and 0.842, respectively (p<0.001). Conclusion Ocular axial length and vitreous chamber depth increased with the severity of myopia with no correlation of anthropometry with refractive status among African myopes.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"343 - 351"},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46392369","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 : 2022-07-04DOI: 10.1080/17469899.2022.2108405
M. Packer
Independence from eyeglasses and contact lenses has significant value: ‘The global refractive surgery devices market size was valued at USD 168.2 million in 2020 and is expected to expand at a compound annual growth (CAGR) of 7.7% from 2021 to 2028’ [1]. In addition, ‘Global demand for refractive surgical procedures (laser refractive surgery, presbyopiacorrecting surgery, RLE [Refractive Lens Exchange], and phakic IOL implantation) is expected to grow at a compound annual rate of 9.6% from 2020 to 2025, with annual surgical volume increasing from 3.6 million to 5.8 million procedures’ [2]. Considering the United States alone, it has been reported that ‘The vision correction market generated professional service fees of over $5 billion in 2016 and by 2019 it increased to $6.3 billion mainly provided by independent eye care providers’ [3]. These numbers reflect the high levels of satisfaction achieved with refractive procedures. For example, ‘98.7% of all patients were satisfied or very satisfied after their LASIK surgery’ [4], and ‘99.4% of 1,542 patients surveyed’ stated that they would elect to have the EVO implantable collamer lens (ICL) again [5]. As options for refractive correction have increased, the range of potential surgical candidates has broadened. Today, procedures are available for virtually any type of refractive error, as well as presbyopia. Establishing candidacy for refractive surgery involves assessment of the patient’s motivation and medical condition. The ideal candidate is highly motivated and has a normal visual system apart from refractive error and/or presbyopia. Every incremental decrease in motivation or increase in pertinent findings alters the risk benefit ratio, until the balance swings away from intervention. However, risks related to physical findings may be mitigated by the choice of procedure. Common significant findings that increase surgical risk or impact the choice of procedure include ocular surface disease [6], signs that increase suspicion of corneal ectasia [7], corneal endothelial insufficiency [8], shallow anterior chamber depth or narrow anterior chamber angle [9], incipient or frank cataract [10], signs of ocular inflammation or uveitis [11], glaucoma [12], macular disorders [13], and predisposing lesions that increase the risk of retinal detachment [14]. Age and refractive error primarily determine the choice of procedure, while physical findings play an important secondary role. In addition, patient expectations may influence the decision. For example, knowledge of LASIK is widespread due to its high-profile introduction in the late 1990s [15], extensive marketing by corporate laser vision centers [16] and subsequent controversies regarding untoward outcomes [17]. Because it is commonly equated with refractive surgery, patients may arrive at the doctor’s office expecting to be offered LASIK and unaware that other options exist. All else being equal, it is sometimes easier for a doctor to simply agree
{"title":"Refractive surgery current status: expanding options","authors":"M. Packer","doi":"10.1080/17469899.2022.2108405","DOIUrl":"https://doi.org/10.1080/17469899.2022.2108405","url":null,"abstract":"Independence from eyeglasses and contact lenses has significant value: ‘The global refractive surgery devices market size was valued at USD 168.2 million in 2020 and is expected to expand at a compound annual growth (CAGR) of 7.7% from 2021 to 2028’ [1]. In addition, ‘Global demand for refractive surgical procedures (laser refractive surgery, presbyopiacorrecting surgery, RLE [Refractive Lens Exchange], and phakic IOL implantation) is expected to grow at a compound annual rate of 9.6% from 2020 to 2025, with annual surgical volume increasing from 3.6 million to 5.8 million procedures’ [2]. Considering the United States alone, it has been reported that ‘The vision correction market generated professional service fees of over $5 billion in 2016 and by 2019 it increased to $6.3 billion mainly provided by independent eye care providers’ [3]. These numbers reflect the high levels of satisfaction achieved with refractive procedures. For example, ‘98.7% of all patients were satisfied or very satisfied after their LASIK surgery’ [4], and ‘99.4% of 1,542 patients surveyed’ stated that they would elect to have the EVO implantable collamer lens (ICL) again [5]. As options for refractive correction have increased, the range of potential surgical candidates has broadened. Today, procedures are available for virtually any type of refractive error, as well as presbyopia. Establishing candidacy for refractive surgery involves assessment of the patient’s motivation and medical condition. The ideal candidate is highly motivated and has a normal visual system apart from refractive error and/or presbyopia. Every incremental decrease in motivation or increase in pertinent findings alters the risk benefit ratio, until the balance swings away from intervention. However, risks related to physical findings may be mitigated by the choice of procedure. Common significant findings that increase surgical risk or impact the choice of procedure include ocular surface disease [6], signs that increase suspicion of corneal ectasia [7], corneal endothelial insufficiency [8], shallow anterior chamber depth or narrow anterior chamber angle [9], incipient or frank cataract [10], signs of ocular inflammation or uveitis [11], glaucoma [12], macular disorders [13], and predisposing lesions that increase the risk of retinal detachment [14]. Age and refractive error primarily determine the choice of procedure, while physical findings play an important secondary role. In addition, patient expectations may influence the decision. For example, knowledge of LASIK is widespread due to its high-profile introduction in the late 1990s [15], extensive marketing by corporate laser vision centers [16] and subsequent controversies regarding untoward outcomes [17]. Because it is commonly equated with refractive surgery, patients may arrive at the doctor’s office expecting to be offered LASIK and unaware that other options exist. All else being equal, it is sometimes easier for a doctor to simply agree","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"231 - 232"},"PeriodicalIF":0.7,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43843366","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 : 2022-07-04DOI: 10.1080/17469899.2022.2100763
S. Boneva, Julian Wolf, Peter Wieghofer, J. Sebag, C. Lange
ABSTRACT Introduction Vitreous hyalocyte functions have only recently been explored in-depth. These macrophage-like cells play critical roles in immunologic surveillance and physiology of the developing and adult eye. Areas covered Hyaloid vasculature involution during embryogenesis, synthesis and degradation of vitreous components during development and aging, and maintenance of vitreous transparency will be discussed. This article also reviews immunologic features during development and in the adult. Expert opinion Recent transcriptional analyses have demonstrated that despite similarity to other myeloid cell populations such as microglia and monocyte-derived macrophages, hyalocytes possess a distinct expression profile and molecular signature. Hyalocytes are important in hyaloid vasculature involution during development, ocular immune privilege and immune surveillance, synthesis and degradation of vitreous components, as well as migration and phagocytic activity during adulthood.
{"title":"Hyalocyte functions and immunology","authors":"S. Boneva, Julian Wolf, Peter Wieghofer, J. Sebag, C. Lange","doi":"10.1080/17469899.2022.2100763","DOIUrl":"https://doi.org/10.1080/17469899.2022.2100763","url":null,"abstract":"ABSTRACT Introduction Vitreous hyalocyte functions have only recently been explored in-depth. These macrophage-like cells play critical roles in immunologic surveillance and physiology of the developing and adult eye. Areas covered Hyaloid vasculature involution during embryogenesis, synthesis and degradation of vitreous components during development and aging, and maintenance of vitreous transparency will be discussed. This article also reviews immunologic features during development and in the adult. Expert opinion Recent transcriptional analyses have demonstrated that despite similarity to other myeloid cell populations such as microglia and monocyte-derived macrophages, hyalocytes possess a distinct expression profile and molecular signature. Hyalocytes are important in hyaloid vasculature involution during development, ocular immune privilege and immune surveillance, synthesis and degradation of vitreous components, as well as migration and phagocytic activity during adulthood.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"249 - 262"},"PeriodicalIF":0.7,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48429843","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 : 2022-07-04DOI: 10.1080/17469899.2022.2118715
Kiyoung Kim, E. Kim, Do Gyun Kim, Seung-Young Yu
ABSTRACT Purpose To evaluate the efficacy and safety of intravitreal dexamethasone (DEX) implantation for diabetic macular edema (DME) that proved unresponsive to previous anti-vascular endothelial growth factor (VEGF) treatment. Methods This prospective interventional study recruited 91 patients with refractory DME after previous anti-VEGF treatments in one or both eyes. All patients were followed up for at least 12 months. Best-corrected visual acuity (BCVA), central subfield thickness (CST) and macular volume were measured. Results Over the 12 months, a mean of 2.1 ± 0.8 DEX implantations were administered per eye; 26 eyes (28.9%) received 1 implantation, 31 (34.4%) received 2, and 34 (36.7%) received 3. BCVA was significantly improved in the first 6 months, from 54.8 to 59.5 letters. Both CST and macular volume decreased significantly after DEX implantation and maintained these improvements for at least 12 months. Subjects who needed the second DEX implantation had a greater number of prior anti-VEGF injections than did those who needed only one implantation (6.0 vs 3.0). Conclusions Two-thirds of refractory DME required less than two DEX implantations to maintain a dry macula for 12 months. Early switching to intravitreal DEX can be considered as the second-line therapeutic option, especially during the COVID-19 pandemic.
摘要目的评价玻璃体内地塞米松（DEX）植入治疗糖尿病黄斑水肿（DME）的疗效和安全性，该水肿对先前的抗血管内皮生长因子（VEGF）治疗无效。方法本前瞻性介入研究招募了91例单眼或双眼接受过抗VEGF治疗的难治性DME患者。所有患者均接受了至少12个月的随访。测量最佳矫正视力（BCVA）、中心亚视野厚度（CST）和黄斑体积。结果在12个月内，平均每只眼睛植入2.1±0.8个DEX；26眼（28.9%）接受了1次植入，31眼（34.4%）接受了2次植入，34眼（36.7%）接受了3次植入。BCVA在前6个月显著改善，从54.8个字母增加到59.5个字母。DEX植入后，CST和黄斑体积均显著下降，并保持这些改善至少12个月。与只需要一次植入的受试者相比，需要第二次DEX植入的受受试者之前注射过更多的抗VEGF药物（6.0 vs 3.0）。结论三分之二的难治性DME需要少于两次的DEX植入才能维持干燥黄斑12个月。早期改用玻璃体内DEX可被视为二线治疗选择，尤其是在新冠肺炎大流行期间。
{"title":"The effect of intravitreal dexamethasone implantation on diabetic macular edema refractory to anti-vascular endothelial growth factor treatment","authors":"Kiyoung Kim, E. Kim, Do Gyun Kim, Seung-Young Yu","doi":"10.1080/17469899.2022.2118715","DOIUrl":"https://doi.org/10.1080/17469899.2022.2118715","url":null,"abstract":"ABSTRACT Purpose To evaluate the efficacy and safety of intravitreal dexamethasone (DEX) implantation for diabetic macular edema (DME) that proved unresponsive to previous anti-vascular endothelial growth factor (VEGF) treatment. Methods This prospective interventional study recruited 91 patients with refractory DME after previous anti-VEGF treatments in one or both eyes. All patients were followed up for at least 12 months. Best-corrected visual acuity (BCVA), central subfield thickness (CST) and macular volume were measured. Results Over the 12 months, a mean of 2.1 ± 0.8 DEX implantations were administered per eye; 26 eyes (28.9%) received 1 implantation, 31 (34.4%) received 2, and 34 (36.7%) received 3. BCVA was significantly improved in the first 6 months, from 54.8 to 59.5 letters. Both CST and macular volume decreased significantly after DEX implantation and maintained these improvements for at least 12 months. Subjects who needed the second DEX implantation had a greater number of prior anti-VEGF injections than did those who needed only one implantation (6.0 vs 3.0). Conclusions Two-thirds of refractory DME required less than two DEX implantations to maintain a dry macula for 12 months. Early switching to intravitreal DEX can be considered as the second-line therapeutic option, especially during the COVID-19 pandemic.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"281 - 287"},"PeriodicalIF":0.7,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41561313","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 : 2022-07-04DOI: 10.1080/17469899.2022.2108790
Medhat A Bakr, Ussama A Moustafa, Majed Al-Subaie, Mohammed A Alfayyadh
ABSTRACT Background Childhood glaucoma is considered one of the main causes of irreversible blindness. Primary congenital glaucoma (PCG) is a rare disease; however, in Middle East countries such as Saudi Arabia, the incidence is high. Research design and methods A retrospective study was conducted at Dhahran Eye Specialist Hospital from September 2016 to March 2020 to evaluate the efficacy and safety of transscleral micropulse cyclophotocoagulation (TS-MPCPC) as a primary procedure in congenital glaucoma and as an adjuvant to prepare the patient for ultimate surgical intervention. Emergent ophthalmic examination under sedation or general anesthesia was done to evaluate the presence of PCG features, measure the intraocular pressure (IOP), horizontal corneal diameter (HCD), and to evaluate the optic disc. Results Twenty-one eyes were included in the study. Cup to disc ratio (CDR) was not decreased postoperatively, and it was found statistically non-significant. There was statistically significant decrease in IOP and horizontal corneal diameter (HCD) (p < 0.001, 0.014), respectively. The mean reduction in IOP was 36%. The final IOP was between 5 and 21 mmHg in all cases. Qualified success was achieved in 17 (81%) eyes and 4 (19%) eyes had surgical failure. Conclusion TS-MPCPC might have effective and safe implications for congenital glaucoma patients.
{"title":"The role trans-sclera MP-CPC as a primary treatment option in congenital glaucoma management","authors":"Medhat A Bakr, Ussama A Moustafa, Majed Al-Subaie, Mohammed A Alfayyadh","doi":"10.1080/17469899.2022.2108790","DOIUrl":"https://doi.org/10.1080/17469899.2022.2108790","url":null,"abstract":"ABSTRACT Background Childhood glaucoma is considered one of the main causes of irreversible blindness. Primary congenital glaucoma (PCG) is a rare disease; however, in Middle East countries such as Saudi Arabia, the incidence is high. Research design and methods A retrospective study was conducted at Dhahran Eye Specialist Hospital from September 2016 to March 2020 to evaluate the efficacy and safety of transscleral micropulse cyclophotocoagulation (TS-MPCPC) as a primary procedure in congenital glaucoma and as an adjuvant to prepare the patient for ultimate surgical intervention. Emergent ophthalmic examination under sedation or general anesthesia was done to evaluate the presence of PCG features, measure the intraocular pressure (IOP), horizontal corneal diameter (HCD), and to evaluate the optic disc. Results Twenty-one eyes were included in the study. Cup to disc ratio (CDR) was not decreased postoperatively, and it was found statistically non-significant. There was statistically significant decrease in IOP and horizontal corneal diameter (HCD) (p < 0.001, 0.014), respectively. The mean reduction in IOP was 36%. The final IOP was between 5 and 21 mmHg in all cases. Qualified success was achieved in 17 (81%) eyes and 4 (19%) eyes had surgical failure. Conclusion TS-MPCPC might have effective and safe implications for congenital glaucoma patients.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"289 - 294"},"PeriodicalIF":0.7,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47720121","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 : 2022-07-04DOI: 10.1080/17469899.2022.2124969
F. Kuhn
It is not a pretty picture. Today we have the finest tools for diagnostics and a full armamentarium of therapeutics including intraocular drugs, temporary keratoprosetheses (TKP), vitrectomy equipment and instruments; yet more and more patients find out that what determines their fate is indeed fate. Does the facility where s/he is taken keep its operationroom doors open afterhours? Even if yes, is the available staff well trained and all necessary tools accessible? In this publication I summarize my personal opinion regarding the decisions to be made for patients presenting with an open globe injury (OGI) – assuming that the facility is a 24/7 one with all the required logistics/infrastructure being optimal. This also means that the physician to make the decisions and perform the surgery is not an untrained, young resident (as unfortunately so often the case is) but a surgeon experienced in both ‘segments’ of the eye: i.e. a vitreoretinal specialist. If these criteria are not fulfilled, it may be preferable to transport/refer the patient to a different facility where conditions allow optimal treatment. Roughly half of eyes with an OGI require surgery on the posterior segment; if these pathologies cannot be addressed by the surgeon closing the wound, the delay may lead to irreversible damage.
{"title":"Decision-making when your patient has an open globe injury","authors":"F. Kuhn","doi":"10.1080/17469899.2022.2124969","DOIUrl":"https://doi.org/10.1080/17469899.2022.2124969","url":null,"abstract":"It is not a pretty picture. Today we have the finest tools for diagnostics and a full armamentarium of therapeutics including intraocular drugs, temporary keratoprosetheses (TKP), vitrectomy equipment and instruments; yet more and more patients find out that what determines their fate is indeed fate. Does the facility where s/he is taken keep its operationroom doors open afterhours? Even if yes, is the available staff well trained and all necessary tools accessible? In this publication I summarize my personal opinion regarding the decisions to be made for patients presenting with an open globe injury (OGI) – assuming that the facility is a 24/7 one with all the required logistics/infrastructure being optimal. This also means that the physician to make the decisions and perform the surgery is not an untrained, young resident (as unfortunately so often the case is) but a surgeon experienced in both ‘segments’ of the eye: i.e. a vitreoretinal specialist. If these criteria are not fulfilled, it may be preferable to transport/refer the patient to a different facility where conditions allow optimal treatment. Roughly half of eyes with an OGI require surgery on the posterior segment; if these pathologies cannot be addressed by the surgeon closing the wound, the delay may lead to irreversible damage.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"227 - 229"},"PeriodicalIF":0.7,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48321212","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 : 2022-05-04DOI: 10.1080/17469899.2022.2101449
S. Young, Nikhil Jain, A. Tatham
ABSTRACT Introduction Imaging technologies, especially optical coherence tomography (OCT), have an important role in glaucoma diagnosis and monitoring. This review aims to critically appraise recent developments in imaging of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macula in glaucoma. Areas covered The review focuses on imaging of the ONH, retina, and associated structures, identifying five broad themes; 1) imaging of the RNFL, ONH and macula; 2) OCT angiography (OCTA); 3) structure function analysis; 4) novel methods of retinal imaging (beyond OCT and OCTA); and 5) artificial intelligence (AI). The use of imaging for glaucoma diagnosis and progression analysis is discussed. Expert opinion Measurements of RNFL, macular, and ONH have shown similar ability to detect glaucoma, though the majority of OCT diagnostic ability studies are limited by case-control design. Macular and ONH parameters such as Bruch’s membrane opening-minimum rim width (BMO-MRW) may be more useful in eyes with unusual optic disc appearance or high myopia, though the limitations of normative reference databases should be appreciated. Imaging should not replace perimetry, particularly for monitoring progression. Devices are likely to be developed that test structure and function concurrently, with results integrated using Bayesian statistical approaches.
{"title":"The application of advanced imaging techniques in glaucoma","authors":"S. Young, Nikhil Jain, A. Tatham","doi":"10.1080/17469899.2022.2101449","DOIUrl":"https://doi.org/10.1080/17469899.2022.2101449","url":null,"abstract":"ABSTRACT Introduction Imaging technologies, especially optical coherence tomography (OCT), have an important role in glaucoma diagnosis and monitoring. This review aims to critically appraise recent developments in imaging of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macula in glaucoma. Areas covered The review focuses on imaging of the ONH, retina, and associated structures, identifying five broad themes; 1) imaging of the RNFL, ONH and macula; 2) OCT angiography (OCTA); 3) structure function analysis; 4) novel methods of retinal imaging (beyond OCT and OCTA); and 5) artificial intelligence (AI). The use of imaging for glaucoma diagnosis and progression analysis is discussed. Expert opinion Measurements of RNFL, macular, and ONH have shown similar ability to detect glaucoma, though the majority of OCT diagnostic ability studies are limited by case-control design. Macular and ONH parameters such as Bruch’s membrane opening-minimum rim width (BMO-MRW) may be more useful in eyes with unusual optic disc appearance or high myopia, though the limitations of normative reference databases should be appreciated. Imaging should not replace perimetry, particularly for monitoring progression. Devices are likely to be developed that test structure and function concurrently, with results integrated using Bayesian statistical approaches.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"183 - 197"},"PeriodicalIF":0.7,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45575561","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 : 2022-05-04DOI: 10.1080/17469899.2022.2098717
Didrika S. van de Wouw, Bram de Jong, I. van der Meulen, T. van den Berg
ABSTRACT Aim To quantify visual complaints by determining straylight values, to investigate the angular dependency of straylight, and to examine the use of straylight for clinical decision making in fish-eye disease (FED) patients. Research design and methods Straylight was measured in 10 patients with FED using the compensation comparison method (Oculus C-Quant). Additionally, the direct comparison method was used for four patients to measure straylight at different visual angles. Results Average straylight in untreated eyes with FED was 1.91 log(s). Penetrating keratoplasty and deep anterior Lamellar keratoplasty treated eyes had average straylight levels of 1.53 log(s) and 1.63 log(s), respectively. Straylight in FED was not strongly angle dependent. Conclusions Straylight was highly elevated (up to 24x age normal value) although visual acuity was relatively well preserved. For several patients, complaints were severe enough to undergo corneal transplantation resulting in reduced straylight and alleviation of complaints. Straylight in FED follows relatively normal angular dependence. We conclude that straylight measurements can support clinical decision-making by quantifying complaints about reduced visual quality, even if visual acuity remains normal.
{"title":"Straylight in fish-eye disease: visual quality and angular dependence of straylight","authors":"Didrika S. van de Wouw, Bram de Jong, I. van der Meulen, T. van den Berg","doi":"10.1080/17469899.2022.2098717","DOIUrl":"https://doi.org/10.1080/17469899.2022.2098717","url":null,"abstract":"ABSTRACT Aim To quantify visual complaints by determining straylight values, to investigate the angular dependency of straylight, and to examine the use of straylight for clinical decision making in fish-eye disease (FED) patients. Research design and methods Straylight was measured in 10 patients with FED using the compensation comparison method (Oculus C-Quant). Additionally, the direct comparison method was used for four patients to measure straylight at different visual angles. Results Average straylight in untreated eyes with FED was 1.91 log(s). Penetrating keratoplasty and deep anterior Lamellar keratoplasty treated eyes had average straylight levels of 1.53 log(s) and 1.63 log(s), respectively. Straylight in FED was not strongly angle dependent. Conclusions Straylight was highly elevated (up to 24x age normal value) although visual acuity was relatively well preserved. For several patients, complaints were severe enough to undergo corneal transplantation resulting in reduced straylight and alleviation of complaints. Straylight in FED follows relatively normal angular dependence. We conclude that straylight measurements can support clinical decision-making by quantifying complaints about reduced visual quality, even if visual acuity remains normal.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"17 1","pages":"221 - 225"},"PeriodicalIF":0.7,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44039692","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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