doi: 10.1136/bjo.2007.117432pmid: 17709575
Using triamcinolone acetonide without preservative may improve safety
Collaer, Nanny; Stalmans, Peter
doi: 10.1136/bjo.2007.116350pmid: 17709577
Finding the true colour
doi: 10.1136/bjo.2007.116160pmid: 17709578
Differentiation between type 2 CNV and pure fibrinous tissue
Mori, Fumihiko; Eguchi, Shuichiro
doi: 10.1136/bjo.2007.116178pmid: 17709579
From the viewpoint of an Asian ophthalmologist
Cordeiro, M Francesca; Erskine, Lynda
doi: 10.1136/bjo.2007.116368pmid: 17709580
Links between developmental axonal guidance and neuroprotection may well establish ephrins as a major new area of future glaucoma research
Sitorus, R S; Abidin, M Sulaiman; Prihartono, Joedo
doi: 10.1136/bjo.2006.110445pmid: 17709582
Aims:To ascertain the causes of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java, to identify preventable and treatable causes and to evaluate temporal trends in the major causes.Methods:From a total of 504 students, 479 were examined. Data was collected using a modified World Heath Organization Prevention of Blindness (WHO/PBL) eye examination record for children.Results:The majority of the students (95%) were blind and 4.6% were severely visually impaired. The major anatomical site of BL/SVI was whole globe in 35.9%, retina in 18.9%, lens in 16.4% and cornea in 16.1%. The major underlying aetiology of BL/SVI was undetermined/unknown in 32.7% (mainly microphthalmia, anterior segment dysgenesis and cataract), hereditary factors 31.9% (mainly retinal dystrophies), and childhood disorders 28.5%.Avoidable causes of BL/SVI accounted for 59.9% of the total students, whereas measles blindness was the underlying condition for 23.1% of the preventable causes; cataract and glaucoma accounted for 15.5% and 8.2% of the treatable causes, respectively. Exploration on trends of SVI/BL among two different age groups <16 years and ⩾16 years suggested that childhood disorders and corneal factors have declined, while hereditary disorders have increased. Optic nerve disorder, although not counted as a major cause of blindness, seems to be on the increase.Conclusions:More than half of the BL/SVI causes are potentially avoidable. Cataract and corneal disorders related to measles or vitamin A deficiency were the major treatable and preventable causes. Declining proportions of childhood factors and corneal disorders over a period of 10–20 years could reflect improved vitamin A supplementation and measles vaccination coverage in Indonesia. This finding, and the increased proportion of hereditary disease causes, could suggest improving levels of socioeconomic development and health care services.
Kessy, Joackim P; Lewallen, Susan
doi: 10.1136/bjo.2006.112474pmid: 17709583
Aim:Many sub-Saharan African governments expect patients to contribute towards health care. We investigated what happens to patients who reported being too poor too pay for cataract surgery.Methods:Over 1 year, patients who did not accept cataract surgery after being advised to do so at outreach clinics were enrolled in a prospective cohort study, then followed-up to determine who returned. A subsample was traced for further interviews to learn what they had undertaken to try to obtain funds.Results:A total of 198 patients did not accept surgery and 157 (79%) of these stated the reason was lack of funds. At follow-up, 36 had returned for surgery, 32 with money and 4 with letters from village leaders verifying inability to pay. There was no association between age, sex, or blindness and returning. Interviews with a representative subsample revealed that 44% patients with stated poverty actually had other reasons for not accepting surgery; only 22% took advantage of a free waiver issued at the interview.Conclusions:Of patients who reported being too poor to pay for cataract surgery, 20% accessed funds after counselling. A significant proportion of those who did not return supplied other reasons for not accepting surgery when interviewed later at home, and did not use a free waiver granted at that time. Access to health care is a complex issue; however, this study does not support the notion that charging small fees for cataract surgery in this setting creates a major barrier to access. That said, it is important to find simple, valid methods to identify those too poor to pay for surgery if we hope to develop sustainable systems to achieve VISION 2020 targets.
Ramke, Jacqueline; Palagyi, Anna; Naduvilath, Thomas; du Toit, Renee; Brian, Garry
doi: 10.1136/bjo.2006.106559pmid: 17709584
Aim:To estimate the prevalence and causes of blindness and low vision in people aged ⩾40 years in Timor-Leste.Method:A population-based cross-sectional survey using multistage cluster random sampling to identify 50 clusters of 30 people. A cause of vision loss was determined for each eye presenting with visual acuity worse than 6/18.Results:Of 1470 people enumerated, 1414 (96.2%) were examined. The age, gender and domicile-adjusted prevalence of functional blindness (presenting vision worse than 6/60 in the better eye) was 7.4% (95% CI 6.1 to 8.8), and for blindness at 3/60 was 4.1% (95% CI 3.1 to 5.1). The adjusted prevalence for low vision (better eye presenting vision of 6/60 or better, but worse than 6/18) was 17.7% (95% CI 15.7 to 19.7). Gender was not a risk factor for blindness or low vision, but increasing age, illiteracy, subsistence farming, unemployment and rural domicile were risk factors for both. Cataract was the commonest cause of blindness (72.9%) and an important cause of low vision (17.8%). Uncorrected refractive error caused 81.3% of low vision.Conclusion:Strategies that make good-quality cataract and refractive error services available, affordable and accessible, especially in rural areas, will have the greatest impact on vision impairment.
Maia, Mauricio; Farah, Michel Eid; Belfort, Rubens N; Penha, Fernando Marcondes; Lima Filho, Acácio A S; Aggio, Fabio Bom; Belfort, Rubens
doi: 10.1136/bjo.2007.115386pmid: 17383993
Aims:To evaluate the effects of intravitreal injection of preservative-free triamcinolone acetonide (PFTA) and TA containing preservative (KE).Methods:A retrospective review was conducted of 646 intravitreal 4 mg/0.1 ml steroid injections in 471 eyes. A total of 577 intravitreal injections of PFTA and 69 injections of KE were administered in non-randomised eyes. No supernatant removal from KE was performed. Non-infectious endophthalmitis was defined as pseudohypopyon/hypopyon with or without an inflammatory reaction that regressed after steroid eye drop instillation. Ocular hypertension was defined as more than 23 mm Hg with Goldman applanation tonometry. Patients were followed and examined 1, 7 and 28 days, and 3, 4, 6 and 12 months after injection and annually thereafter. Statistical analysis was performed using Fisher’s exact test and Χ2 test. p Values <0.05 were considered significant.Results:Both groups did not differ in demographics (p>0.05). Follow-up ranged from 6 to 57 months (mean 13, SD 7.5). Ocular hypertension was present in 127 eyes (20%), but both groups did not differ significantly (p = 0.167). Four eyes (3.15%) required trabeculectomy. Non-infectious endophthalmitis developed in 12 eyes (1.9%) and varied significantly in both groups (p = 0.005). One eye developed bacterial endophthalmitis (0.15%).Conclusions:Non-infectious endophthalmitis was observed significantly more often after KE injections (7.3%) than after PFTA injections (1.2%) (p<0.05). An inflammatory reaction was more clinically relevant in the KE group than in the PFTA group.
Haritoglou, Christos; Schumann, Ricarda G; Strauss, Rupert; Priglinger, Siegfried G; Neubauer, Aljoscha S; Kampik, Anselm
doi: 10.1136/bjo.2007.115113pmid: 17314149
Objective:To evaluate the staining characteristics of bromphenol blue used during vitreoretinal surgery in humans.Patients and methods:13 patients with epiretinal membranes were included. Before and after surgery a complete clinical examination including best corrected visual acuity, funduscopy, fluorescein angiography, OCT (Stratus), Goldmann perimetry and multifocal ERG as well as photography of the macular area was performed. Bromphenol blue was used in concentrations of 0.2% in most patients. Removed epiretinal tissue was evaluated using electron microscopy.Results:Using dye concentrations of 0.2% a good demarcation of epiretinal membranes was seen in 11/13 patients. Staining of vitreous remnants at the vitreous base was seen in all patients. No dye-related adverse events were seen during follow-up in the functional tests (VA, ERG, perimetry) performed. Histological evaluation of epiretinal membranes showed unremarkable aspects of epiretinal cellular layers and unremarkable retinal surface of the internal limiting membrane (ILM).Conclusion:Bromphenol blue appears to be a very helpful and safe tool in posterior segment surgery. The staining characteristics need to be further evaluated in prospective study settings and larger numbers of patients.
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