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By Yasir Imam Trainee in opthalmology with interest in vitreoretinal diseases
Namrata Sharma, Deepali Singhal, Prafulla Kumar Maharana, Rebika Dhiman, Himanshu Shekhar, Jeewan S Titiyal, Tushar Agarwal
The treatment of choice for cases of corneal opacity with significant cataract is often a triple procedure. However, in certain situations the chances of graft survival are poor, for example in cases with deep vascularization, secondary glaucoma, and healed viral keratitis. Under these circumstances, performing cataract surgery only might improve the visual acuity enough to maintain the patient's day-to-day activities. Performing cataract surgery, especially phacoemulsification, in these cases is challenging...
November 30, 2018: Journal of Cataract and Refractive Surgery
Paul Nderitu, Paul Ursell
PURPOSE: To compare iris hooks and a pupil expansion ring (Malyugin ring) in eyes with a small pupil. SETTING: Epsom and St. Helier University National Health Service Trust, London, United Kingdom. DESIGN: Retrospective case series. METHODS: Patients who had primary phacoemulsification cataract surgery from January 1, 2012, to December 30, 2016, were included. Combined procedures and surgeons with fewer than 50 cases were excluded...
December 7, 2018: Journal of Cataract and Refractive Surgery
Susan P Mollan, Brendan Davies, Nick C Silver, Simon Shaw, Conor L Mallucci, Benjamin R Wakerley, Anita Krishnan, Swarupsinh V Chavda, Satheesh Ramalingam, Julie Edwards, Krystal Hemmings, Michelle Williamson, Michael A Burdon, Ghaniah Hassan-Smith, Kathleen Digre, Grant T Liu, Rigmor Højland Jensen, Alexandra J Sinclair
The aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of idiopathic intracranial hypertension (IIH). METHODS: Between September 2015 and October 2017, a specialist interest group including neurology, neurosurgery, neuroradiology, ophthalmology, nursing, primary care doctors and patient representatives met. An initial UK survey of attitudes and practice in IIH was sent to a wide group of physicians and surgeons who investigate and manage IIH regularly...
October 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Jorge Ruiz-Medrano, Javier A Montero, Ignacio Flores-Moreno, Luis Arias, Alfredo García-Layana, José M Ruiz-Moreno
Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26...
November 1, 2018: Progress in Retinal and Eye Research
Hanna I Hyry, Jonathan C P Roos
The English High Court recently dismissed the Bayer pharmaceutical company's challenge against a regional clinical commissioning group's policy allowing NHS Trusts to use a cheaper, but unlicensed, alternative to a sight preserving eye treatment. This makes sober reading for companies marketing "on-label" sales of medicines which are more expensive than off-label or unlicensed alternatives. Unsurprisingly, Bayer has sought to appeal the judgement. The Court has also created legal uncertainty for the NHS: the test for lawfulness is shifted from the Clinical Commission Groups and their policies to individual trusts which must ensure that every unlicensed use is lawful...
November 29, 2018: Eye
Laura H P Wielders, Jan S A G Schouten, Bjorn Winkens, Frank J H M van den Biggelaar, Claudette A Veldhuizen, Oliver Findl, Joaquim C N Murta, Willem R O Goslings, Marie-José Tassignon, Maurits V Joosse, Ype P Henry, Alexander H F Rulo, José L Güell, Michael Amon, Thomas Kohnen, Rudy M M A Nuijts
PURPOSE: To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. SETTING: Twelve European study centers. DESIGN: Randomized clinical trial. METHODS: Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0...
April 2018: Journal of Cataract and Refractive Surgery
Michael W Belin, Li Lim, Rajesh K Rajpal, Farhad Hafezi, Jose A P Gomes, Beatrice Cochener
The initial published clinical report on riboflavin/ultraviolet A corneal cross-linking (CXL) for treatment of progressive keratoconus dates back to 2003. CXL has since then been widely used outside the United States for treatment of progressive keratoconus and post-laser in situ keratomileusis ectasia. The Food and Drug Administration (FDA) approved Avedro Inc.'s corneal cross-linking system (KXL) for treatment of patients with progressive keratoconus and post-laser in situ keratomileusis ectasia in April 2016...
October 2018: Cornea
Daniel D Esmaili, David S Boyer
Retinal vein occlusions are the second most common form of retinal vascular disease. Previously, laser treatment for branch retinal vein occlusion and intravitreal triamcinolone acetonide for central retinal vein occlusion were the standard of care. Recent studies have demonstrated that anti-vascular endothelial growth factor (anti-VEGF) agents have a superior safety and efficacy profile for the treatment of both branch and central retinal vein occlusions. The use of wide-field fluorescein angiography has also allowed better visualization of the retinal periphery...
2018: F1000Research
Giacomo Savini, Kenneth J Hoffer
Background: This review aims to explain the reasons why intraocular lens (IOL) power calculation is challenging in eyes with previous corneal refractive surgery and what solutions are currently available to obtain more accurate results. Review: After IOL implantation in eyes with previous LASIK, PRK or RK, a refractive surprise can occur because i) the altered ratio between the anterior and posterior corneal surface makes the keratometric index invalid; ii) the corneal curvature radius is measured out of the optical zone; and iii) the effective lens position is erroneously predicted if such a prediction is based on the post-refractive surgery corneal curvature...
2018: Eye and Vision (London, England)
Saba Al-Hashimi, Kendall Donaldson, Richard Davidson, Deepinder Dhaliwal, Mitchell Jackson, Jeremy Z Kieval, Larry Patterson, Karl Stonecipher, David R Hamilton
As cataract surgery continues to evolve, the intraoperative small pupil continues to pose challenges to even the most experienced cataract surgeon. Several steps can be taken preoperatively to decrease the chance of intraoperative miosis. Even so, the problem of miosis during cataract surgery remains a relatively common occurrence. This paper discusses many steps, both preoperative and intraoperative, that can make surgery technically easier and safer, thus maximizing the postoperative outcomes and patient satisfaction...
August 2018: Journal of Cataract and Refractive Surgery
Paul Nderitu, Paul Ursell
PURPOSE: To devise a comprehensive cataract surgery complexity score system for the selection of appropriate cases for trainees using evidence-based, validated risk factors for posterior capsule rupture, patient-specific factors, and complexity stratification recommendations to minimize complications, optimize outcomes, and maximize patient safety. SETTING: Epsom and St. Helier University National Health Service Trust, London, United Kingdom. DESIGN: Retrospective cohort study...
June 2018: Journal of Cataract and Refractive Surgery
Noriko Miyamoto, Michiko Mandai, Akio Oishi, Shunichiro Nakai, Shigeru Honda, Takafumi Hirashima, Hideyasu Oh, Yoshiko Matsumoto, Mamoru Uenishi, Yasuo Kurimoto
BACKGROUND/AIM: We previously reported that ranibizumab performed better on visual prognosis than photodynamic therapy (PDT) in a Ranibizumab ( L ucentis) A nd P hotodynamic T herapy O n P olypoidal choroidal vasculopathy (LAPTOP) study. To determine if the first-choice treatment, either PDT or intravitreal ranibizumab, has a long-term effect in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We reviewed medical records of patients randomised to either PDT (29 eyes) or ranibizumab (27 eyes) from July 2009 to June 2011 in LAPTOP study...
August 4, 2018: British Journal of Ophthalmology
Tien Y Wong, Jennifer Sun, Ryo Kawasaki, Paisan Ruamviboonsuk, Neeru Gupta, Van Charles Lansingh, Mauricio Maia, Wanjiku Mathenge, Sunil Moreker, Mahi M K Muqit, Serge Resnikoff, Juan Verdaguer, Peiquan Zhao, Frederick Ferris, Lloyd P Aiello, Hugh R Taylor
Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss...
October 2018: Ophthalmology
Alejandra L Daruich, Alexandre P Moulin, Hoai V Tran, Alexandre Matet, Francis L Munier
PURPOSE: To determine the prevalence, clinical characteristics and nature of subfoveal nodules in Coats' disease and the associated impact on the long-term visual outcome. METHODS: Consecutive cases of Coats' disease with foveal exudation were retrospectively reviewed. The presence of a subfoveal nodule or macular fibrosis was recorded. Clinical characteristics, retinal imaging, and outcome were analyzed by comparative analysis. The histopathological description of an enucleated eye with subfoveal nodule was performed...
August 2017: Retina
Douglas A Jabs
The uveitides are a collection of more than 30 diseases characterized by intraocular inflammation. Many cases of juvenile idiopathic arthritis-associated uveitis, many cases of intermediate uveitis, and most cases of posterior and panuveitides requiring treatment are treated with corticosteroids and immunosuppression. Disease-specific, time-updated modeling of clinical data for several uveitides suggests superior prevention of ocular complications and visual outcomes with immunosuppression. These studies also suggest that oral corticosteroids at doses low enough for safe long-term therapy (i...
February 2018: Ophthalmology
Ariana Austin, Tom Lietman, Jennifer Rose-Nussbaumer
Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and although culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungus and Acanthamoeba. Next-generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective...
November 2017: Ophthalmology
Ronald B Melles, Jack T Holladay, William J Chang
PURPOSE: To compare the accuracy of intraocular lens (IOL) calculation formulas (Barrett Universal II, Haigis, Hoffer Q, Holladay 1, Holladay 2, Olsen, and SRK/T) in the prediction of postoperative refraction using a single optical biometry device. DESIGN: Retrospective consecutive case series. PARTICIPANTS: A total of 13 301 cataract operations with an AcrySof SN60WF implant and 5200 operations with a SA60AT implant (Alcon Laboratories, Inc...
February 2018: Ophthalmology
Konstantinos D Andreanos, Kate Hashemi, Myrsini Petrelli, Konstantinos Droutsas, Ilias Georgalas, George D Kymionis
Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.
December 2017: Ophthalmology and Therapy
Chui Ming Gemmy Cheung, Jennifer J Arnold, Frank G Holz, Kyu Hyung Park, Timothy Y Y Lai, Michael Larsen, Paul Mitchell, Kyoko Ohno-Matsui, Shih-Jen Chen, Sebastian Wolf, Tien Yin Wong
TOPIC: The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance. CLINICAL RELEVANCE: In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population...
November 2017: Ophthalmology
Virgilio Galvis, Alejandro Tello, Alvaro I Ortiz, Luis C Escaf
Corneal cross-linking (CXL) is an option that in the last decade has demonstrated its efficacy and safety in halting the progression of keratoconus (KCN) and other corneal ectasias. Its indication has been extended beyond the classic definition that required evidence of KCN progression, especially in the presence of some risk factors for a possible progression (particularly the younger age). However, the results can be still somewhat variable today. There are several protocols, each with its own advantages and disadvantages...
2017: Clinical Ophthalmology
2017-07-21 10:45:10
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