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Wong, James Chiun Lon; Thampy, Reshma; Cook, Anne
doi: 10.1136/bjophthalmol-2013-304436pmid: 24879806
Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative counselling is pertinent to informed consent and in addressing patients’ expectations. A retrospective review from one tertiary care centre was undertaken for a cohort of patients who were exenterated for orbital malignancy between 1998 and 2010. The cases were identified using an International Classification of Diseases 10th Revision (ICD-10)-derived database and were analysed using Prism statistical software (V.5.04). Cause of death was ascertained by liaising with the general practitioner and the National Registrar Office for Births, Deaths, and Marriages, Southport, UK. In total, 41 men and 32 women were identified. Mean age was 72 years with 47 cases living and 26 deceased at the time of review. The overall 5-year survival rate in this study was 64%. Kaplan–Meier analysis for basal cell carcinoma (BCC) against non-BCC returned a p value of 0.0199, with an HR of 0.3927 (CI 0.1788 to 0.8626). Kaplan–Meier analysis for cleared against non-cleared margins returned a p value of 0.2890, with an HR of 0.6571(CI 0.3024 to 1.428). Our results represent the highest 5-year survival data to date. However, the overall prognosis for patients who undergo orbital exenteration for malignancy remains poor. We hypothesise that the causes are multi-factorial. We recommend a multidisciplinary approach to the care of these patients, involving head and neck teams, oncology and other appropriate specialties, to optimise outcomes for this vulnerable patient group.
Snyder, Michael E; Perez, Mauricio A
doi: 10.1136/bjophthalmol-2013-304437pmid: 24814963
We present a novel iris repair technique for the management of iris transillumination defects secondary to iris pigment epithelium (IPE) loss, which includes iris oversewing over the defect through partial iris stromal bites with 10-0 polypropylene. This technique provides a healthy layer of iris covering the transillumination defect without the creation of new defects on the contiguous IPE.
Hirnschall, Nino; Norrby, Sverker; Weber, Maria; Maedel, Sophie; Amir-Asgari, Sahand; Findl, Oliver
doi: 10.1136/bjophthalmol-2013-304731pmid: 24518080
Background/aims To include intraoperative measurements of the anterior lens capsule of the aphakic eye into the intraocular lens power calculation (IPC) process and to compare the refractive outcome with conventional IPC formulae. Methods In this prospective study, a prototype operating microscope with an integrated continuous optical coherence tomography (OCT) device (Visante attached to OPMI VISU 200, Carl Zeiss Meditec AG, Germany) was used to measure the anterior lens capsule position after implanting a capsular tension ring (CTR). Optical biometry (intraocular lens (IOL) Master 500) and ACMaster measurements (Carl Zeiss Meditec AG, Germany) were performed before surgery. Autorefraction and subjective refraction were performed 3 months after surgery. Conventional IPC formulae were compared with a new intraoperatively measured anterior chamber depth (ACD) (ACDIntraOP) partial least squares regression (PLSR) model for prediction of the postoperative refractive outcome. Results In total, 70 eyes of 70 patients were included. Mean axial eye length (AL) was 23.3 mm (range: 20.6–29.5 mm). Predictive power of the intraoperative measurements was found to be slightly better compared to conventional IOL power calculations. Refractive error dependency on AL for Holladay I, HofferQ, SRK/T, Haigis and ACDintraOP PLSR was r2=−0.42 (p<0.0001), r2=−0.5 (p<0.0001), r2=−0.34 (p=0.010), r2=−0.28 (p=0.049) and r2<0.001 (p=0.866), respectively, Conclusions ACDIntraOP measurements help to better predict the refractive outcome and could be useful, if implemented in fourth-generation IPC formulae.
Luithardt, Annette Franziska; Meisner, Christoph; Monhart, Matthias; Krapp, Elke; Mast, Andrea; Schiefer, Ulrich
doi: 10.1136/bjophthalmol-2013-304535pmid: 25053761
Aims To validate the EyeSuite version of German Adaptive Threshold Estimation (GATE), a new thresholding algorithm for automated static perimetry. Methods Specification of agreement and its clinical evaluation as validation criteria. Comparison of local differential luminance sensitivity (DLS) and test time values between the prototype version of GATE (GATEp) and a clinical trial version, implemented in EyeSuite (GATEe), by means of modified Bland–Altman plots. All examinations were performed on the Octopus 900 perimeter (Haag-Streit Inc., Köniz, Switzerland). Visually impaired patients (anterior ischaemic optic neuropathy [n=3], glaucomatous optic neuropathy [n=15], (post-)chiasmal visual pathway lesion [n=6], retinitis pigmentosa [n=6]) were either tested with grid 30A (30° excentricity, 83 test locations) or grid 84NO (90° excentricity, 109 test locations, patients with RP only). Results The comparison of local DLS values showed good-to-acceptable agreement between GATEp and GATEe (bias <2 dB, limits of agreement [LOA] <5 dB) and very good repeatability for GATEp (bias <0.5 dB, LOA<3 dB). Median test times for GATEp and GATEe were 7.8 and 8.8 min for the 30° grid and 6.7 and 7.8 min for the 90° grid. Conclusions GATEp and GATE, implemented in the commercially available EyeSuite software package (GATEe), show good agreement regarding local differential luminance sensitivity. GATEe can thus be also recommended for clinical practice. Clinical trial number NCT01265628.
Richman, Jesse; Zangalli, Camila; Lu, Lan; Wizov, Sheryl S; Spaeth, Eric; Spaeth, George L
doi: 10.1136/bjophthalmol-2014-305223pmid: 25053760
Aims (1) To determine the ability of a novel, internet-based contrast sensitivity test titled the Spaeth/Richman Contrast Sensitivity Test (SPARCS) to identify patients with glaucoma. (2) To determine the test-retest reliability of SPARCS. Methods A prospective, cross-sectional study of patients with glaucoma and controls was performed. Subjects were assessed by SPARCS and the Pelli-Robson chart. Reliability of each test was assessed by the intraclass correlation coefficient and the coefficient of repeatability. Sensitivity and specificity for identifying glaucoma was also evaluated. Results The intraclass correlation coefficient for SPARCS was 0.97 and 0.98 for Pelli-Robson. The coefficient of repeatability for SPARCS was ±6.7% and ±6.4% for Pelli-Robson. SPARCS identified patients with glaucoma with 79% sensitivity and 93% specificity. Conclusions SPARCS has high test-retest reliability. It is easily accessible via the internet and identifies patients with glaucoma well. Trial Registration: NCT01300949.
Chung, Esther; Demetriades, Anna M; Christos, Paul J; Radcliffe, Nathan M
doi: 10.1136/bjophthalmol-2014-305349pmid: 25057184
Background An optic disc haemorrhage (DH) has been associated with subsequent structural glaucoma progression, but it is unknown if there is structural progression prior to a DH. We evaluated a cohort of patients to determine whether structural progression occurs before a DH, after a DH or is simply associated with a DH. Methods Eyes meeting inclusion criteria were placed into two groups. Group 1 included eyes that each had a baseline photograph of the optic nerve and a photograph with a DH at follow-up. Group 2 included eyes that each had a photograph of the optic nerve with a DH at baseline and a photograph at follow-up. Flicker images were created and graded by two ophthalmologists for structural glaucomatous change. We compared the proportion of structural progressors between Groups 1 and 2. Patient characteristics were also compared between the two groups. Results 49 patients and 51 unique eyes were included. Groups 1 and 2 had 28 and 38 sets of photographs, respectively. The proportion of global progression in Groups 1 and 2 were 21.4% and 39.5%, respectively (p=0.12). No significant differences in any structural progression feature and patient characteristics (besides age at time of DH (p=0.04) between the two groups were found. Conclusions Patients show structural glaucomatous progression before and after the event of a disc haemorrhage without significant differences. This suggests that a DH is an ongoing structural progression in glaucoma and may not be a discrete event that leads to subsequent progression.
doi: 10.1136/bjophthalmol-2014-305039pmid: 25034048
Aims To investigate morphological changes in meibomian glands in patients with granular corneal dystrophy type 2 (GCD2) using non-invasive meibography. Methods Eleven patients (3 men and 8 women) with GCD2, and sex-matched and age-matched healthy volunteers as a controls were enrolled in this study. The diagnosis of GCD2 was confirmed by transforming growth factor β-induced (TGFBI) gene analysis using direct sequencing in exon 4 of TGFBI gene. Meibography was performed in the right eye of the studied cases. Meiboscore was determined according to the morphology of meibomian gland and classified into four grades; grade 0 (no meibomian gland loss), grade 1 (loss less than one-third the total area of meibomian glands), grade 2 (area loss between one-third and two-thirds of the total area), and grade 3 (area loss greater than two-thirds of the total). Results R124H mutation was detected in all patients with GCD2. Extinguishing or shortening of the meibomian glands was observed in patients with GCD2. The meiboscore was 3.8±1.3 in patients with GCD2 and 1.3±1.1 in the control group, showing significant difference between two groups (Mann–Whitney U-test, p=0.042). Conclusions In GCD2, corneal deposits, and also morphological abnormalities of meibomian glands, such as obstruction or shortening, were found. Since abnormal phospholipid deposition is noted in GCD2, these results are interesting because phospholipid is possibly secreted from the meibomian gland.
Sayanagi, Kaori; Gomi, Fumi; Akiba, Masahiro; Sawa, Miki; Hara, Chikako; Nishida, Kohji
doi: 10.1136/bjophthalmol-2013-304658pmid: 25107899
Aim To observe the choroidal microstructure in polypoidal choroidal vasculopathy (PCV) using high-penetration optical coherence tomography (HP-OCT) with a long-wavelength light source that visualises tissue beneath the retinal pigment epithelium (RPE) and deep choroid, and to compare the findings with those of indocyanine green angiography (ICGA). Methods In this retrospective, non-invasive, observational case series, 19 eyes (18 patients) with PCV were observed using HP-OCT (swept source, 100 000 A-scans/s, 1060 nm wavelength) and ICGA. The HP-OCT scan protocol was a 3×3-mm or 6×6-mm square containing 256×256 or 512×128 A-scans. The choroidal thickness (CT) was measured using HP-OCT. Results ICGA showed 43 polypoidal lesions in 14 eyes and a vascular network in 17 eyes. HP-OCT showed 41 of the 43 polypoidal lesions visualised by ICGA as RPE rings with inner reflectivity and 15 eyes with a vascular network. Six eyes with RPE rings with inner reflectivity on HP-OCT were not visualised on ICGA images. The choroidal vascular network was dilated in 14 (33%) of 43 polypoidal lesions and 22 (47%) of 47 polypoidal lesions on ICGA and HP-OCT images, respectively. The mean CT at the fovea was 250 μm. The CT at the dilated choroidal vessels beneath the polypoidal lesions was significantly (p = 0.0095) thicker than that of the undilated choroidal vessels beneath the polypoidal lesions. Conclusions HP-OCT can visualise choroidal vascular abnormalities in eyes with PCV and should be useful for understanding the pathogenesis of these abnormalities.
Shenoy, Bhamy Hariprasad; Sachdeva, Virender; Kekunnaya, Ramesh
doi: 10.1136/bjophthalmol-2014-305166pmid: 25091956
Aim To evaluate safety profile and surgical outcomes of a novel modification of loop myopexy with silicone band for myopic strabismus fixus (MSF). Design Retrospective interventional case series. Methods A retrospective chart review of patients who underwent silicone band loop myopexy between January 2008 and December 2012 for MSF at a tertiary eye care centre was undertaken. A minimum of 2 months of follow-up after surgery was required for inclusion. Patients who underwent conventional suture loop myopexy and cases with incomplete details pertaining to the preoperative alignment and movement restriction were excluded. The main outcome measures were improvement in alignment postoperatively, improvement in extra-ocular motility postoperatively, and intraoperative and postoperative complications. Results 26 eyes of 15 patients (male (9):female (6)=1.5:1) underwent silicone band loop myopexy at a mean age of 27.8±16.4 years (range 7–72 years). Mean follow-up was 7.9±8.4 months (range 2–28 months, and median 4 months). 11 patients underwent bilateral loop myopexy whereas four patients underwent unilateral loop myopexy. 16 eyes underwent additional medial rectus (MR) recession. At the last follow-up, mean abduction limitation improved to −1.5±1.3 from −2.9±1.2, p=0.0000; mean elevation limitation improved to −1.2±0.9 from −2.8±1.1, p=0.0000; mean esotropia improved to 16.9±17.4 prism dioptres (PD) from 79.3±32.3PD, p=0.0000; and success (deviation ≤20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 8.9±10.1PD (range 0–25PD), which improved to 0.6±1.3PD (range 0–4PD), p=0.007. Conclusions Modified scleral fixated silicone band loop myopexy with or without MR recession is a safe and effective procedure in the management of MSF and improves alignment significantly.
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