Current Issue : April - June Volume : 2014 Issue Number : 2 Articles : 7 Articles
Background: Specific cross-reacting autoimmunity against recoverin or collapsin response mediator protein\r\n(CRMP)-5 is known to cause cancer-associated retinopathy or paraneoplastic optic neuropathy, respectively.\r\nWe report a rare case with small cell lung carcinoma developing bilateral neuroretinitis and unilateral focal outer\r\nretinitis positive for these antibodies.\r\nCase presentation: A 67-year-old man developed bilateral neuroretinitis and foveal exudation in the right eye.\r\nOptical coherence tomography showed a dome-shaped hyperreflective lesion extending from inner nuclear layer to\r\nthe photoreceptor layer at the fovea in the right eye. Single-flash electroretinography showed normal a-waves in\r\nboth eyes and slightly reduced b-wave in the left eye. Results of serological screening tests for infection were within\r\nnormal limits. The patient�s optic disc swelling and macular exudation rapidly improved after oral administration of\r\nprednisolone. Systemic screening detected lung small cell carcinoma and systemic chemotherapy was initiated.\r\nImmunoblot analyses using the patient�s serum detected autoantibodies against recoverin, CRMP-5, and a-enolase,\r\nbut not carbonic anhydrase II. Neuroretinitis once resolved after almost remission of carcinoma on imaging but it\r\nrecurred following the recurrence of carcinoma.\r\nConclusions: The development of neuroretinitis in this cancer patient with anti-retinal and anti-optic nerve\r\nantibodies depended largely on the cancer activity, suggesting the possible involvement of paraneoplastic\r\nmechanisms. Patients with paraneoplastic optic neuropathy and retinopathy are likely to develop autoimmune\r\nresponses against several antigens, thus leading to various ophthalmic involvements....
Background: Moorenââ?¬â?¢s ulcer is a severe ulcerative inflammation of the cornea. The exact pathogenesis remains\r\nunclear. Therefore many therapies of Moorenââ?¬â?¢s ulcer are recommended in literature. To shed more light on the\r\nongoing question of optimal treatment of severe progressive Moorenââ?¬â?¢s ulcer, we here report on a retrospective\r\ncase series of patients treated with systemic immunosuppressive therapy and additional amniotic membrane\r\ntransplantation.\r\nMethods: Medical records from seven patients (eleven eyes), 4 male and 3 female, with severe progressive\r\nMoorenââ?¬â?¢s ulcer were analysed retrospectively. The mean follow up was 88.4 Ã?± 80.8 months (range 12ââ?¬â??232 month).\r\nA HLA-typing was performed in all patients. A systemic immunosuppressive therapy was administered in all\r\npatients. The amniotic membrane was transplanted after the base of the ulcer was resected.\r\nResults: Multiple amniotic membrane transplantations were necessary in six patients. The visual outcome of all\r\npatients was poor. No patient achieved a visual acuity better than 20/630 Snellen chart. Five patients were positive\r\nfor HLA-DQ2 and four patients were positive for HLA-DR17(3).\r\nConclusions: The aggressive and highly inflammatory form of Moorenââ?¬â?¢s ulcer is difficult to treat and the\r\nprogression of the disease is hard to influence positively even under systemic immunosuppressive therapy.\r\nTherefore, the main intention of therapy is to achieve a stable epithelialized corneal surface without the risk of\r\nperforation. Amniotic membrane transplantation is not able to cure severe forms of Moorenââ?¬â?¢s ulcer. However it\r\nsupports the immunosuppressive therapy in acute situations as in critical corneal thinning....
Background: A strong association exists between the use of tamsulosin and the occurance of intraoperative floppy\r\niris syndrome. Several methods were advocated to overcome the progressive intraopertive miosis.\r\nOur purpose was to investigate the effect of a mydriatic-cocktail soaked cellulose sponge on perioperative pupil\r\ndiameter in tamsulosin-treated patients undergoing elective cataract surgery.\r\nMethods: Patients using tamsulosin were dilated either with mydriatic-cocktail soaked sponge (group 1) or with\r\nconventional eyedrop regimen (group 2). Control patients not taking any a1 adrenergic receptor inhibtors were also\r\ndilated with mydriatic sponge (group 3).\r\nIn all groups oxybuprocain 0.4%, cocain 4%, tropicamide 1%, phenylephrine 10%, diclophenac 0.1% along with\r\nchloramphenicol 0.5% were used preoperatively.\r\nPupil diameter (mm) was measured preoperatively, after nucleus delivery, and before IOL implantation. Adverse\r\neffects associated with the use of sponge, minor and major intraoperative complications, the use of iris retractors\r\nand operation time were recorded.\r\nDifferences in general between groups were analyzed with a one way analysis of variance (ANOVA); differences\r\nbetween groups in proportions were assessed by Fisherââ?¬â?¢s exact test.\r\nResults: Mean pupil diameter (mm) was preopertively: 7.52 Ã?± 1.21, 7.30 Ã?± 1.55 and 7.99 Ã?± 0.96 (ANOVA: p = 0.079);\r\nafter nucleus delivery: 6 Ã?± 1.20, 6.29 Ã?± 1.12 and 6.52 Ã?± 0.81 (ANOVA: p = 0.123); before IOL implantation: 5.46 Ã?± 1.06,\r\n5.83 Ã?± 1.09 and 6.17 Ã?± 0.89 (ANOVA: p = 0.0291).\r\nNo adverse effect related to sponge use was detected. Frequency of minor complications, and iris hook use was\r\nsimilar in the two tamsulosin treated group. Operation time did not differ significantly in the three groups.\r\nConclusion: We have found that using a mydriatic cocktail-soaked wick ââ?¬â?? an alternative way to achieve intraoperative\r\nmydriasis for cataract surgery ââ?¬â?? was as effective and safe as the conventional repeated eyedrops regiment for\r\ntamsulosin treated patients....
Background: The cataract surgery rate (CSR) is a critical index used to show that cataract blindness is being\r\neliminated. It is considered to be tightly connected to social economic development; however, it is still extremely\r\nlow in developing countries such as China. Although Shanghai is the most economically developed city in China,\r\nits CSR and the obstacles for increasing its CSR have not been previously evaluated.\r\nMethods: A retrospective cross-sectional study was conducted. By analyzing the data in the ââ?¬Å?Shanghai Cataract\r\nOperations Databaseââ?¬Â from 2006 to 2009, the CSR in Shanghai was calculated. The numbers of cataract surgeries\r\nbetween urban and suburban districts as well as among various medical institutions were compared.\r\nResults: The CSR in Shanghai increased from 1741 in 2006 to 2210 in 2009, reflecting a 26.94% improvement.\r\nPhacoemulsification was the most frequent surgical choice for cataract removal, accounting for 94.93% of total\r\ncataract surgeries by 2009. In addition, by 2009, the CSR in urban districts had reached 5468, but only 532 in the\r\nsuburbs. During 2009, cataract surgery records in 68 district hospitals, 23 medical centers, and 6 private hospitals\r\ncomprised 32.05%, 52.33%, and 15.62%, respectively, of the total. There was a nearly 3.3-fold increase in the number\r\nof surgeries performed in private hospitals in the past four years. Furthermore, the average number of cataract\r\nsurgeries per doctor that took place in private hospitals per year reached 207, which exceeded the average of 145\r\nthat took place in medical centers.\r\nConclusions: Until 2009, the CSR in Shanghai remained below the rates of social development and fell short of\r\ntargets suggested by the World Health Organization (WHO). Furthermore, increasing the CSR in the suburbs as well\r\nas in district hospitals is an important issue that needs to be addressed....
Background: Poor health literacy is often a key cause of lack of or delayed uptake of health care services. The aim\r\nof this study was to assess the health literacy of common ocular diseases, namely cataract, glaucoma, night\r\nblindness, trachoma and diabetic retinopathy in Nepal.\r\nMethods: A cross sectional study of 1741 participants randomly selected from non-triaged attendants in the outpatient\r\nqueue at Tilganga Institute of Ophthalmology, a semi urban general population of Bhaktapur district of Kathmandu\r\nValley and patients attending rural outreach clinics. Participants responded to trained enumerators using verbally\r\nadministered, semi structured questionnaires on their awareness and knowledge of cataract, glaucoma, diabetic\r\nretinopathy, night blindness, and trachoma.\r\nResults: The awareness of cataract across the entire sample was 49.6%, night blindness was 48.3%, diabetic\r\nretinopathy was 29%, glaucoma was 21.3% and trachoma was 6.1%. Patients presenting to rural outreach clinics\r\nhad poorer awareness of cataract, glaucoma, diabetic retinopathy, night blindness and trachoma compared to\r\nthose from a semi-urban community and an urban eye hospital (p<0.05), Old age was directly associated with\r\npoorer awareness of cataract, glaucoma, night blindness, trachoma and diabetic retinopathy (p<0.05). Female gender\r\nwas associated with lower awareness of cataract, glaucoma, night blindness and trachoma (p<0.05). Literacy was\r\nassociated with greater awareness of cataract, glaucoma, diabetic retinopathy, night blindness and trachoma\r\n(p<0.05). Higher education was significantly associated with greater awareness of cataract, night blindness and\r\ntrachoma (p<0.05). Multivariate analysis found that the awareness of common ocular diseases was significantly\r\nassociated with level of education (p<0.05). Similarly, awareness of cataract, glaucoma, trachoma and night\r\nblindness was associated with female gender (p<0.05) whereas awareness of cataract, night blindness, trachoma\r\nand diabetic retinopathy was associated with age (p<0.05) but the awareness glaucoma and diabetic retinopathy\r\nwas associated with camps.\r\nConclusions: Low awareness of common ocular conditions is associated with factors such as female gender,\r\nold age, lower levels of education and rural habitation. A would be successful health promotion programs\r\nshould specifically target health determinants to promote health literacy and to ensure timely utilization of\r\neye care services....
Background: This study examined the refractive and visual outcome of wavefront-optimized laser in situ keratomileusis\r\n(LASIK) in eyes with low myopia and compound myopic astigmatism = 0.75 diopter (D).\r\nMethods: 153 eyes from 153 consecutive myopic patients (74 male, 79 female; mean age at surgery 40.4 �± 10.4 years)\r\nwho had a preoperative refractive cylinder = 0.75 D and a manifest sphere between -0.25 D and -2.75 D, and who had\r\ncompleted 4-month follow-up. Three subgroups defined by the magnitude of preoperative manifest refractive cylinder\r\n(0.25, 0.50, and 0.75 D) were formed. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and\r\npostoperatively. The astigmatic changes achieved were determined using the Alpins vector analysis.\r\nResults: After 4 months (120.0 �± 27.6 days) of follow-up, a mean uncorrected distant visual acuity of 0.07 �± 0.11 logMAR\r\nand a mean manifest refraction spherical equivalent of -0.06 �± 0.56 D were found. There was no statistically significant\r\ndifference in efficacy and safety between the preoperative cylinder groups. Astigmatic overcorrection for preoperative\r\ncylinder of = 0.50 D was suggested by the correction index, the magnitude of error, the index of success, and\r\nthe flattening index.\r\nConclusions: Low myopic eyes with a preoperative cylinder of = 0.50 D were significantly overcorrected with\r\nregard to cylinder correction when combined with low myopic LASIK. Accordingly, we are cautious in\r\nrecommending full astigmatic correction for eyes with low myopia and manifest cylinder of = 0.50 D....
Background: To identify risk factors for being a ââ?¬Å?reduced responderââ?¬Â to ranibizumab treatment in a clinical setting\r\nin patients with neovascular age-related macular degeneration.\r\nMethods: This retrospective study included 165 eyes of 165 consecutive patients with choroidal neovascularisation\r\nsecondary to neovascular, age-related macular degeneration. Eyes were treated with three intravitreal injections of\r\nranibizumab, followed by PRN (pro re nata) dosing thereafter. All patients were reevaluated every four weeks and\r\nthen followed for six months. Reduced responders were defined as patients with a loss in visual acuity of at least 1\r\nvisual acuity line at the last follow-up and/or persistent intraretinal or subretinal fluid or detectable choroidal\r\nneovascularisation at the last follow-up, compared to baseline.\r\nResults: Overall, 58 out of 165 eyes (35.2%) were considered to be reduced responders to treatment at the end of\r\nfollow-up. The initial CNV size at baseline was correlated with the risk of being a reduced responder at the end of\r\nfollow-up (p = 0.017).\r\nConclusion: We identified the initial lesion size as a predictor for a reduced response to treatment in this study.\r\nPatients with a large initial lesion size should be thoroughly informed about the possible poorer response to the\r\nintravitreal treatment....
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