Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 5 Articles
Investigations used to aid diagnosis and prognosticate outcomes in ocular inflammatory disorders are based on\r\ntechniques that have evolved over the last two centuries have dramatically evolved with the advances in molecular\r\nbiological and imaging technology. Our improved understanding of basic biological processes of infective drives of\r\ninnate immunity bridging the engagement of adaptive immunity have formed techniques to tailor and develop\r\nassays, and deliver targeted treatment options. Diagnostic techniques are paramount to distinguish infective from\r\nnon-infective intraocular inflammatory disease, particularly in atypical cases. The advances have enabled our ability\r\nto multiplex assay small amount of specimen quantities of intraocular samples including aqueous, vitreous or small\r\ntissue samples. Nevertheless to achieve diagnosis, techniques often require a range of assays from traditional\r\nhypersensitivity reactions and microbe specific immunoglobulin analysis to modern molecular techniques and\r\ncytokine analysis. Such approaches capitalise on the advantages of each technique, thereby improving the\r\nsensitivity and specificity of diagnoses. This review article highlights the development of laboratory diagnostic\r\ntechniques for intraocular inflammatory disorders now readily available to assist in accurate identification of\r\ninfective agents and appropriation of appropriate therapies as well as formulating patient stratification alongside\r\nclinical diagnoses into disease groups for clinical trials....
Despite their side-effects and the advent of systemic immunosuppressives and biologics, the use of corticosteroids\r\nremains in the management of patients with uveitis, particularly when inflammation is associated with systemic\r\ndisease or when bilateral ocular disease is present. The use of topical corticosteroids as local therapy for anterior\r\nuveitis is well-established, but periocular injections of corticosteroid can also be used to control mild or moderate\r\nintraocular inflammation. More recently, intraocular corticosteroids such as triamcinolone and steroid-loaded vitreal\r\ninserts and implants have been found to be effective, including in refractory cases. Additional benefits are noted\r\nwhen ocular inflammation is unilateral or asymmetric, when local therapy may preclude the need to increase the\r\nsystemic medication.\r\nImplants in particular have gained prominence with evidence of efficacy including both dexamethasone\r\nand fluocinolone loaded devices. However, an appealing avenue of research lies in the development of\r\nnon-corticosteroid drugs in order to avoid the side-effects that limit the appeal of injected corticosteroids.\r\nSeveral existing drugs are being assessed, including anti-VEGF compounds such as ranibizumab and bevacizumab,\r\nanti-tumour necrosis factor alpha antibodies such as infliximab, as well as older cytotoxic medications such as\r\nmethotrexate and cyclosporine, with varying degrees of success. Intravitreal sirolimus is currently undergoing phase\r\n3 trials in uveitis and other inflammatory pathways have also been proposed as suitable therapeutic targets.\r\nFurthermore, the advent of biotechnology is seeing advances in generation of new therapeutic molecules such as\r\nhigh affinity binding peptides or modified high affinity or bivalent single chain Fab fragments, offering higher\r\nspecificity and possibility of topical delivery....
Background: Icare PRO (ICP) is a new Rebound tonometer that is able to measure intraocular pressure (IOP) in\r\nboth sitting and reclining positions. In this study, the gold standard Goldmann tonometer (GAT) was compared to\r\nICP and Tono-Pen AVIA (TPA). Hypothesis was that repeatability of GAT is superior to ICP and TPA.\r\nMethods: 36 eyes of 36 healthy caucasian individuals, 13 male and 26 females, 17 right and 19 left eyes have\r\nbeen included in this prospective, randomized, cross-sectional study. The study was conducted at a single site\r\n(Dept. of Ophthalmology, UniversityHospital Zurich, Switzerland). Primary outcome measures were Intraclass\r\ncorrelation coefficients (ICC) and coefficients of variation (COV) and test-retest repeatability as visualized by\r\nBland-Altman analysis. Secondary outcome measures were IOP in sitting (GAT, ICP and TPA) and in reclining\r\n(ICP and TPA) position.\r\nResults: Mean IOP measured by GAT was 14.9�±3.5 mmHg. Mean IOP measured by ICP was 15.6�±3.1 mmHg (with\r\nTPA 14.8�±2.7 mmHg) in sitting and 16.5�±3.5 mmHg (with TPA 17.0�±3.0 mmHg) in reclining positions. COVs ranged\r\nfrom 2.9% (GAT) to 6.9% (ICP reclining) and ICCs from 0.819 (ICP reclining) to 0.972 (GAT).\r\nConclusions: Repeatability is good with all three devices. GAT has higher repeatability compared to the two\r\ntested hand-held devices with lowest COVs and highest ICCs. IOP was higher in the reclining compared to the\r\nsitting position....
Background: To determine the role played by vascular endothelial growth factor (VEGF) in polypoidal choroidal\r\nvasculopathy (PCV) based on an interventional immunology theory.\r\nMethods: Eyes with PCV were divided in a masked fashion into those with choroidal hyperpermeability (HP group)\r\nand those with normal choroidal permeability (NP group) based on the indocyanine green angiograms. The inter-rater\r\nagreement rate was evaluated using Fleissââ?¬â?¢ kappa. Patients were treated by intravitreal ranibizumab (IVB). The central\r\nchoroidal thickness and central foveal thickness (CFT) at the baseline and 7 days after the treatment were measured by\r\noptical coherence tomography.\r\nResults: Among the 57 consecutive eyes diagnosed with PCV, 42 eyes of 42 patients met the inclusion criteria\r\n(21 eyes/HP group vs 21 eyes /NP group). Central choroidal thickness in HP group was significantly thicker than that in\r\nthe NP group (P < .001, Mannââ?¬â??Whitney U test). The inter-rater agreement was high with a Fleissââ?¬â?¢ kappa = 0.95, P < .0001.\r\nThe percentage reduction in the CFT in HP group (14.0%) was significantly less than that in NP group (20.4%; P = .013,\r\nMannââ?¬â??Whitney U test).\r\nConclusions: Eyes with PCV that are associated with choroidal hyper-permeability may not be strongly associated with\r\nVEGF-related pathology, and may not respond favorably to anti-VEGF monotherapy...
Background: The aim of the project was to develop a novel method for diabetic retinopathy screening based on\r\nthe examination of tear fluid biomarker changes. In order to evaluate the usability of protein biomarkers for prescreening\r\npurposes several different approaches were used, including machine learning algorithms.\r\nMethods: All persons involved in the study had diabetes. Diabetic retinopathy (DR) was diagnosed by capturing 7-\r\nfield fundus images, evaluated by two independent ophthalmologists. 165 eyes were examined (from 119 patients),\r\n55 were diagnosed healthy and 110 images showed signs of DR. Tear samples were taken from all eyes and stateof-\r\nthe-art nano-HPLC coupled ESI-MS/MS mass spectrometry protein identification was performed on all samples.\r\nApplicability of protein biomarkers was evaluated by six different optimally parameterized machine learning\r\nalgorithms: Support Vector Machine, Recursive Partitioning, Random Forest, Naive Bayes, Logistic Regression,\r\nK-Nearest Neighbor.\r\nResults: Out of the six investigated machine learning algorithms the result of Recursive Partitioning proved to be\r\nthe most accurate. The performance of the system realizing the above algorithm reached 74% sensitivity and 48%\r\nspecificity.\r\nConclusions: Protein biomarkers selected and classified with machine learning algorithms alone are at present not\r\nrecommended for screening purposes because of low specificity and sensitivity values. This tool can be potentially\r\nused to improve the results of image processing methods as a complementary tool in automatic or semiautomatic\r\nsystems....
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