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2.
Retina ; 40(2): 290-298, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31972799

ABSTRACT

PURPOSE: To report the outcomes of eyes receiving surgical management for traumatic macular holes. To describe the preoperative and postoperative optical coherence tomography features of traumatic macular holes and to explore associations between preoperative clinical and optical coherence tomography features, and visual outcome. METHODS: Retrospective study of patients undergoing vitrectomy for traumatic macular hole and entered into the Australian and New Zealand Society of Retinal Specialists surgical registry. Preoperative clinical data, surgical details, and 3-month postoperative outcomes were recorded prospectively. Longer-term outcomes at 12 months were requested retrospectively, as were preoperative and postoperative optical coherence tomography scans. RESULTS: Hole closure was achieved in 91% (21/23) of patients with a single procedure. The average preoperative visual acuity was 20/120. At 3 months postoperatively, the mean visual acuity had improved to 20/70 (P < 0.001), 11/23 (48%) of eyes improved ≥15 letters, and the number of eyes with 20/40 acuity or better increased from 1/23 to 7/23. Eyes with worse visual outcomes (visual acuity < 20/80) had larger holes, worse preoperative acuity, and a greater extent of preoperative ellipsoid band attenuation than those with better postoperative visual acuity. CONCLUSION: Eyes receiving surgical management for traumatic macular hole achieved good anatomical results and approximately half had a substantial improvement in acuity. Ellipsoid band attenuation on preoperative optical coherence tomography and worse preoperative acuity were associated with poorer visual outcomes.


Subject(s)
Eye Injuries/complications , Macula Lutea/pathology , Retinal Perforations/surgery , Tomography, Optical Coherence/methods , Vitrectomy/methods , Adolescent , Adult , Aged , Eye Injuries/diagnosis , Eye Injuries/surgery , Female , Humans , Macula Lutea/surgery , Male , Middle Aged , Postoperative Period , Retinal Perforations/diagnosis , Retinal Perforations/etiology , Retrospective Studies , Treatment Outcome , Young Adult
3.
Retina ; 40(3): 546-551, 2020 Mar.
Article in English | MEDLINE | ID: mdl-30576303

ABSTRACT

PURPOSE: To determine the results of pars plana vitrectomy for giant retinal tear detachments using transscleral diode laser retinopexy and short-term postoperative tamponade with perfluoro-n-octane (PFnO). METHODS: Twenty consecutive patients with fresh giant retinal tears were enrolled in a single-arm prospective study. One case was withdrawn for technical reasons. The remainder all underwent pars plana vitrectomy, PFnO injection, transscleral diode laser retinopexy to the edge of the giant retinal tear, and short-term postoperative heavy liquid tamponade. None of the cases had scleral buckling or lensectomy. RESULTS: Nineteen cases (18 male and 1 female) with a mean age of 41 years (range 10-69 years) were followed up for a period of 6 months. Postoperative tamponade with PFnO was maintained for a mean of 7.6 days (range 4-21 days), after which it was exchanged for sulfur hexafluoride (SF6), perfluoropropane (C3F8) gas, or balanced salt solution. Final reattachment rate was 100%, with 3 (15.7%) patients requiring additional surgery. Best-corrected visual acuity at final follow-up was 20/40 or better in 11 eyes (58%), between 20/60 and 20/200 in 7 (37%), and 20/400 in 1 (5%). CONCLUSION: In this series of acute giant retinal tears, transscleral diode laser retinopexy together with the use of PFnO for short-term postoperative tamponade achieved excellent anatomical and visual results.


Subject(s)
Endotamponade/methods , Fluorocarbons/administration & dosage , Laser Therapy/methods , Lasers, Semiconductor/therapeutic use , Retina/surgery , Retinal Perforations/surgery , Vitrectomy/methods , Adolescent , Adult , Aged , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Period , Prospective Studies , Retina/pathology , Retinal Perforations/diagnosis , Sclera/surgery , Treatment Outcome , Visual Acuity , Young Adult
4.
Ir J Med Sci ; 189(1): 355-363, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31418155

ABSTRACT

BACKGROUND AND AIMS: To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success. METHODS: A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6 months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success. RESULTS: A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25-91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6 months post procedure. Macular status (chi-square test p = 0.15, X2 = 2.072) and lens status (chi-square test p = 0.2974, X2 = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X2 = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501). CONCLUSIONS: This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.


Subject(s)
Retinal Detachment/diagnosis , Retinal Detachment/surgery , Visual Acuity/genetics , Aged , Female , Humans , Male , Retinal Detachment/pathology , Retrospective Studies , Time Factors , Treatment Outcome
5.
Biochim Biophys Acta Mol Cell Biol Lipids ; 1863(7): 750-761, 2018 07.
Article in English | MEDLINE | ID: mdl-29660533

ABSTRACT

The human retina is a complex structure of organised layers of specialised cells that support the transmission of light signals to the visual cortex. The outermost layer of the retina, the retinal pigment epithelium (RPE), forms part of the blood retina barrier and is implicated in many retinal diseases. Lysophosphatidic acid (LPA) is a bioactive lipid exerting pleiotropic effects in various cell types, during development, normal physiology and disease. Its producing enzyme, AUTOTAXIN (ATX), is highly expressed by the pigmented epithelia of the human eye, including the RPE. Using human pluripotent stem cell (hPSC)-derived retinal cells, we interrogated the role of LPA in the human RPE and photoreceptors. hPSC-derived RPE cells express and synthesize functional ATX, which is predominantly secreted apically of the RPE, suggesting it acts in a paracrine manner to regulate photoreceptor function. In RPE cells, LPA regulates tight junctions, in a receptor-dependent mechanism, with an increase in OCCLUDIN and ZONULA OCCLUDENS (ZO)-1 expression at the cell membrane, accompanied by an increase in the transepithelial resistance of the epithelium. High concentration of LPA decreases phagocytosis of photoreceptor outer segments by the RPE. In hPSC-derived photoreceptors, LPA induces morphological rearrangements by modulating the actin myosin cytoskeleton, as evidenced by Myosin Light Chain l membrane relocation. Collectively, our data suggests an important role of LPA in the integrity and functionality of the healthy retina and blood retina barrier.


Subject(s)
Blood-Retinal Barrier/physiology , Lysophospholipids/physiology , Photoreceptor Cells, Vertebrate/physiology , Retinal Diseases/pathology , Retinal Pigment Epithelium/metabolism , Cell Line , Cytoskeleton/metabolism , Humans , Phagocytosis/physiology , Phosphoric Diester Hydrolases/metabolism , Pluripotent Stem Cells , Retinal Diseases/surgery , Retinal Pigment Epithelium/cytology , Retinal Pigment Epithelium/pathology , Tight Junctions/metabolism , Vitrectomy
6.
Ophthalmol Retina ; 2(11): 1143-1151, 2018 11.
Article in English | MEDLINE | ID: mdl-31047553

ABSTRACT

PURPOSE: To present the visual and safety outcomes of surgery for primary idiopathic macular holes including predictors of visual acuity and the impact of combined phacovitrectomy surgery. DESIGN: Registry-style, prospective, nonrandomized, observational cohort study. PARTICIPANTS: Patients with idiopathic macular holes undergoing primary surgery. METHODS: Surgeons were invited to submit clinical details of all macular hole cases receiving surgery. Baseline demographic and clinical information, and details of surgical intervention were collected. Primary follow-up data were collected at 3 months postoperatively or before revision surgery, and surgeons were also asked to submit data at 12 and 24 months postoperatively. MAIN OUTCOME MEASURES: Visual acuity improvement ≥15 letters and ≥0 letters, change in mean visual acuity, visual acuity ≥70 letters (20/40), retinal detachment, and endophthalmitis. RESULTS: A total of 2455 eyes of 2366 patients were included in the study, and hole closure was achieved in 95.6% of eyes with a single procedure. Mean baseline vision was 48.3 letters. The proportion of successful eyes improving ≥15 letters at 3, 12, and 24 months was 59.1%, 69.4%, and 68.2%, respectively. The mean improvement in acuity at 3, 12, and 24 months was 16.0, 19.2, and 23.6 letters, and 92.4%, 93.4%, and 95.8% improved ≥0 letters at 3, 12, and 24 months, respectively. Eyes receiving SF6 gas had better visual acuities at all time points postoperatively (adjusted effect 3.4, 3.1, and 4.6 letters better at 3, 12, and 24 months vs. longer-acting gas, respectively). Combined phacovitrectomy in phakic eyes was associated with better corrected visual acuity postoperatively (vs. vitrectomy surgery alone), a difference that vanished when eyes went on to have subsequent cataract surgery. The rate of retinal detachment postoperatively was 1.3%, and the odds of detachment were greater in eyes receiving longer-acting gases versus SF6 gas (adjusted odds ratio, 2.2; 95% confidence interval, 1.04-4.77; P = 0.039). There were no reported cases of endophthalmitis. CONCLUSIONS: Macular hole surgery substantially improved acuity in approximately two thirds of patients and was seldom associated with loss of vision. SF6 gas was associated with better visual outcomes, an effect that warrants further study.

7.
Ophthalmology ; 123(5): 1129-36, 2016 05.
Article in English | MEDLINE | ID: mdl-26920098

ABSTRACT

PURPOSE: To determine whether sulfur hexafluoride (SF6) gas is noninferior to longer-acting gases in macular hole surgery and whether withholding postoperative face-down positioning (FDP) is noninferior to FDP. DESIGN: Registry-style, prospective, nonrandomized, observational cohort study. PARTICIPANTS: Patients with idiopathic macular holes undergoing primary surgery. METHODS: Surgeons were invited to submit clinical details of all macular hole cases receiving surgery. Baseline demographic and clinical information were collected, as well as details of surgical intervention and postoperative posturing advice. Primary follow-up data were collected 3 months postoperatively. MAIN OUTCOME MEASURES: Macular hole closure at 3 months. A noninferiority approach was used, with a noninferiority margin set at 5% decreased frequency of success. RESULTS: A total of 2456 eyes of 2367 patients were included in the study. Outcomes were available in 94.9% of cases (2330/2456). The rate of macular hole closure was 95.0% (2214/2330). Sulfur hexafluoride gas was found to be noninferior to longer-acting gases (95% confidence interval [CI] for adjusted effect on success, -1.76 to +2.25), and noninferiority was demonstrated regardless of macular hole size. Although withholding FDP was found to be noninferior to FDP for the study population as a whole (95% CI for adjusted effect on success, -4.21 to +0.64), the result was inconclusive in holes >400 µm in diameter (95% CI, -9.31 to +1.04). Lack of internal limiting membrane (ILM) peel, increasing hole size, hole duration ≥9 months, increasing age, and 20-gauge surgery all were associated with lower odds of success. Vitreous attachment to the hole margin was not associated with outcome when corrected for hole size, and combined phacovitrectomy surgery was not observed to affect the odds of success in phakic eyes. CONCLUSIONS: Sulfur hexafluoride gas tamponade was noninferior to longer-acting gases in the surgical management of macular hole. Withholding FDP was noninferior to FDP in holes ≤400 µm in diameter. In holes >400 µm in diameter, noninferiority of withholding FDP could not be concluded. We would advise caution if posturing is withheld in this group on the basis of the results of this study and of others.


Subject(s)
Endotamponade , Prone Position , Registries , Retinal Perforations/surgery , Sulfur Hexafluoride/administration & dosage , Vitrectomy , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Fluorocarbons/administration & dosage , Humans , Male , Middle Aged , Postoperative Care , Prospective Studies , Retinal Perforations/physiopathology , Time Factors , Visual Acuity/physiology
8.
Eur J Ophthalmol ; 26(4): 315-20, 2016 Jun 10.
Article in English | MEDLINE | ID: mdl-26692063

ABSTRACT

PURPOSE: To determine the prevalence of glaucoma among patients referred to a glaucoma service with suspicious disc photographs from the diabetic retinopathy (DR) screening program. METHODS: A clinical audit of all patients attending a single-center DR screening program in the Mater Misericordiae University Hospital, Dublin, between July 2010 and October 2011 was conducted with a minimum follow-up of 30 months. The DR screening service uses trained technician graders to assess 2-field color retinal photographs for the features of DR. Recently, the service was enhanced so that optic discs are also assessed for signs of glaucoma. RESULTS: In the 16-month study period, 3,697 diabetic patients were photographed. Following photograph grading, 91 (2.46%) were judged to require referral for assessment at the glaucoma clinic. Of these, 63 (69.23%) presented for assessment. Thirteen patients (20.63%) were diagnosed with glaucoma, comprising 7 cases of low-tension glaucoma and 6 cases of primary open-angle glaucoma. Thirty-six patients (57.14%) were classified as glaucoma suspects and 14 patients (22.22%) were discharged back to the DR screening program following normal ocular examination. Only 6 (9.52%) of the 63 patients examined had an intraocular pressure greater than 21 mm Hg. CONCLUSIONS: The assessment of DR screening photographs for signs of glaucomatous optic nerve damage should be considered as part of a strategy to improve glaucoma case detection and to reduce the burden of this disease on society.


Subject(s)
Diabetic Retinopathy/diagnosis , Glaucoma, Open-Angle/diagnosis , Low Tension Glaucoma/diagnosis , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Adult , Aged , Aged, 80 and over , Female , Glaucoma, Open-Angle/physiopathology , Humans , Intraocular Pressure/physiology , Low Tension Glaucoma/physiopathology , Male , Mass Screening , Middle Aged , Prevalence , Tonometry, Ocular , Visual Fields
9.
Diab Vasc Dis Res ; 12(2): 133-8, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25616704

ABSTRACT

BACKGROUND: The regulation of miR-126 by rs4636297 single nucleotide polymorphism (SNP) has been implicated in the pathogenesis of neovascularisation by promoting vascular endothelial growth factor, suggesting it could be associated with sight threatening diabetic retinopathy (STDR), but has not been previously investigated or reported. MATERIALS AND METHODS: A case control study of 531 individuals with diabetes was genotyped for the rs4636297 SNP, using the Sequenom iPLEX Gold chemistry. STDR included people with severe non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). Association was tested using logistic regression analysis, adjusting for confounding variables. RESULTS: In an additive model, the A allele of rs4636297 SNP is significantly associated with STDR compared to people with none or mild diabetic retinopathy (DR) (odds ratio (OR) = 2.02, 95% confidence interval (CI) = 1.22-3.35, p = 0.006). CONCLUSION: The A allele of rs4636297, known to be the non-functional allele for post-translational regulation of miR-126, is associated with STDR. This finding suggests that this locus would be a potential therapeutic target for inhibiting the development of DR.


Subject(s)
Diabetic Retinopathy/genetics , MicroRNAs/genetics , Polymorphism, Single Nucleotide , Vision, Ocular/genetics , Aged , Case-Control Studies , Chi-Square Distribution , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/physiopathology , Female , Gene Frequency , Genetic Association Studies , Genetic Predisposition to Disease , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Phenotype , Risk Factors
10.
Graefes Arch Clin Exp Ophthalmol ; 252(9): 1457-62, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25030241

ABSTRACT

BACKGROUND: Microbial keratitis (MK) is a sight-threatening emergency. Delayed diagnosis and treatment may exacerbate the condition and infection may spread to the posterior segment with resultant endophthalmitis. We describe the presentation, management, visual outcomes and microbial profiles of MK-associated endophthalmitis presenting to a tertiary referral centre. METHODS: Prospective collection of data on all patients presenting with presumed MK-associated endophthalmitis from 1997 to 2007, to the Royal Victorian Eye and Ear Hospital. Outcome measures included: visual acuity, microbial profiles, and management strategy. RESULTS: Thirty-seven cases of MK-associated endophthalmitis were identified over the study period, with a mean age of 73 years and 19 were male. Presenting acuities ranged from Snellen 2/60 to no perception of light (NPL). Thrity-four (91.9%) patients had a prior history of ocular disease. Identifiable non-ocular risk factors were present in 31 (83.8%), including steroid use, dementia, nursing home care or relative systemic immunosuppression. A culture positivity rate of 83.8% was recorded. The most common organisms identified included: Streptococcal species in 12 (32.4%), Pseudomonas aeruginosa in 11 (29.7%), and Staphylococcus aureus in eight (21.6%). Final acuities ranged from 6/36 to NPL. Sixteen (43.2%) eyes were eviscerated/enucleated as primary treatment. Overall, 23 (62.2%) patients required evisceration/enucleation, of which nine (39.1%) were due to Pseudomonas aeruginosa and seven (30.4%) to Streptococcal species (Streptococcal pneumonia). CONCLUSIONS: MK-associated endophthalmitis is a serious ocular condition occurring more frequently in elderly populations, and those with long standing severe pre-existing ocular disease. Visual outcomes are poor, often requiring evisceration/enucleation.


Subject(s)
Corneal Ulcer , Endophthalmitis , Eye Infections, Bacterial , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Australia/epidemiology , Bacteria/isolation & purification , Ceftazidime/therapeutic use , Corneal Ulcer/diagnosis , Corneal Ulcer/epidemiology , Corneal Ulcer/microbiology , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Endophthalmitis/microbiology , Eye Enucleation , Eye Evisceration , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/microbiology , Female , Humans , Incidence , Male , Middle Aged , Prognosis , Prospective Studies , Risk Factors , Vancomycin/therapeutic use , Visual Acuity/physiology
11.
J Diabetes Complications ; 28(3): 419-25, 2014.
Article in English | MEDLINE | ID: mdl-24630762

ABSTRACT

The aim of this study was to perform a systematic meta-analysis of biomarkers investigated with diabetic retinopathy (DR) in the vitreous, and to explore the molecular pathway interactions of these markers found to be consistently associated with DR. Relevant databases [PubMed and ISI web of science] were searched for all published articles investigating molecular biomarkers of the vitreous associated with DR. Based on set exclusion/inclusion criteria available data from studies with human vitreous samples were extracted and used for our meta-analysis. The interactions of significant biomarkers in DR were investigated via STRING and KEGG pathway analysis. Our meta-analysis of DR identifies eleven biomarkers as potential therapeutic candidates alternate to current anti-VEGF therapy. Four of these are deemed viable therapeutic targets for PDR; ET receptors (ET A and ET B), anti-PDGF-BB, blocking TGF-ß using cell therapy and PEDF. The identification of supplementary or synergistic therapeutic candidates to anti VEGF in the treatment of DR may aid in the development of future treatment trials.


Subject(s)
Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/metabolism , Vitreous Body/metabolism , Becaplermin , Biomarkers/metabolism , Humans , Proto-Oncogene Proteins c-sis/metabolism , Receptor, Endothelin A/metabolism , Receptor, Endothelin B/metabolism , Transforming Growth Factor beta/metabolism
12.
Invest Ophthalmol Vis Sci ; 55(3): 1666-71, 2014 Mar 19.
Article in English | MEDLINE | ID: mdl-24526447

ABSTRACT

PURPOSE: Recent genome-wide association studies for diabetic retinopathy (DR) have identified novel single nucleotide polymorphisms (SNPs) associated with this potentially blinding disease. These markers could prove useful in risk profiling, if the association are validated by replication. To date, these associations have not been well assessed in independent cohorts. The objective of this study was to ascertain any association of these polymorphisms with advanced stages of DR. METHODS: A total of 463 patients who had either type 1 (n = 46) or 2 (n = 417) diabetes were genotyped for 24 SNPs previously implicated in DR. Cases (n = 163) were defined as people with severe nonproliferative DR or proliferative DR. Control participants (n = 300) with a confirmed duration of diabetes of at least 5 years had either no evidence of DR or only mild DR. RESULTS: Two SNPs (rs1073203 and rs4838605) were found to be significantly associated with DR in patients with diabetes after adjusting for covariants; rs1073203-G (P = 0.012, odds ratio [OR] = 0.317, 95% confidence interval [95% CI]: 0.129-0.778), rs1073203 in a dominant model (P = 0.005, OR = 0.251, 95% CI: 0.096-0.655), rs4838605 in an additive model (P = 0.047, OR = 1.650, 95% CI: 1.007-2.703), In a dominant model rs1073203 (P = 0.027, OR = 1.400, 95% CI: 0.101-0.857), was significantly associated with DR in type 2 diabetes after adjustment for covariants. This study was sufficiently powered to replicate previous findings. CONCLUSIONS: This study confirmed that two variants (rs1073203 and rs4838605) are associated with advanced stages of DR in our cohort. The underlying genes in these candidate regions provide interesting future gene association targets for understanding the pathogenesis of DR.


Subject(s)
Diabetic Retinopathy/genetics , Genetic Predisposition to Disease , Genome-Wide Association Study , Polymorphism, Single Nucleotide , Aged , Cross-Sectional Studies , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/epidemiology , Female , Follow-Up Studies , Gene Frequency , Genetic Loci , Genotype , Humans , Male , Prevalence , Retrospective Studies , Victoria/epidemiology
13.
J Med Case Rep ; 5: 303, 2011 Jul 11.
Article in English | MEDLINE | ID: mdl-21745367

ABSTRACT

INTRODUCTION: Endophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces. It is classified as either endogenous or exogenous depending on the route of infection. Exogenous endophthalmitis results from direct inoculation as a complication of intra-ocular surgery, penetrating ocular trauma, intra-ocular foreign bodies, corneal ulceration and following a breach of ocular barriers from a periocular infection. We report a rare case of exogenous endophthalmitis with both unusual etiology and microbiology. CASE PRESENTATION: A 41-year-old Caucasian man with a history of depressive illness presented to our eye department with painful acute visual loss on a background history of chronic uveitis. Ocular examination revealed a dense fibrinous panuveitis with a suspicion of a focal lesion in the posterior segment. Microbiological sampling from his anterior chamber and posterior segment revealed a culture of Elizabethkingia meningoseptica. On closer questioning, he volunteered the occurrence of multiple episodes of deliberate needle ocular penetration. Following vitrectomy for associated retinal detachment, a final Snellen visual acuity of 6/60 was obtained. CONCLUSIONS: Elizabethkingia meningoseptica endophthalmitis is a rare condition, and visual results to date are poor.

14.
Clin Exp Ophthalmol ; 39(9): 878-84, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21631675

ABSTRACT

BACKGROUND: To evaluate the effect of perioperative anticoagulation and antiplatelet therapy on postoperative vitreous cavity haemorrhage following pars plana vitrectomy for diabetic eye disease. DESIGN: Retrospective chart review. PARTICIPANTS: 139 patients. METHODS: Retrospective collection of demographic, medical, surgical and postoperative data of all patients undergoing vitrectomy for diabetic eye disease at The Royal Victorian Eye and Ear Hospital. MAIN OUTCOME MEASURE: Correlation of the rates of persistent vitreous cavity haemorrhage and anticoagulation or antiplatelet treatment. RESULTS: Sixty-eight of 155 (43.9%) eyes of 139 patients were on anticoagulation or antiplatelet therapy prior to surgery. At the time of surgery, 29 (42.6%) were on therapy. Eight of 29 (27.6%) patients had significant persistent vitreous cavity haemorrhage in the postoperative period, with four (13.8%) requiring secondary surgery. Thirty-nine (57.4%) patients had discontinued therapy prior to surgery. Among these, four (10.3%) had persistent bleeding, of which three (7.7%) required additional surgery. Six of 87 (6.9%) patients not on any anticoagulation/antiplatelet therapy had persistent postoperative vitreous cavity haemorrhage, with none requiring further surgery. Patients on anticoagulation/antiplatelet therapy at the time of surgery were more likely to experience persistent haemorrhage and subsequent reoperation (OR = 4.8, P = 0.0045 and OR = 6.6, P = 0.024, respectively). CONCLUSION: Perioperative continuation of anticoagulation or antiplatelet treatment appears to increase the risk of persistent postoperative vitreous cavity haemorrhage and the necessity for vitreous cavity washout in this diabetic cohort. Appropriate preoperative cessation of treatment appeared to reduce this risk; however, caution must be taken with regard to the systemic risk associated with cessation of therapy.


Subject(s)
Anticoagulants/adverse effects , Diabetic Retinopathy/surgery , Platelet Aggregation Inhibitors/adverse effects , Postoperative Complications , Vitrectomy , Vitreous Hemorrhage/chemically induced , Adult , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Female , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Reoperation , Retrospective Studies , Risk Factors , Visual Acuity/physiology , Vitreous Hemorrhage/surgery , Young Adult
15.
Invest Ophthalmol Vis Sci ; 52(7): 3976-83, 2011 Jun 07.
Article in English | MEDLINE | ID: mdl-21467174

ABSTRACT

PURPOSE: The authors compared the visual gaze behaviors of glaucoma subspecialists with those of ophthalmology trainees during optic disc and retinal nerve fiber layer (RNFL) examination. METHODS: Seven glaucoma subspecialists and 23 ophthalmology trainees participated in the project. Participants were shown eight glaucomatous optic disc images with varied morphology. Eye movements during examination of the optic disc photographs were tracked. For each disc image, graders were asked to assign a presumptive diagnosis for probability of glaucoma. There was no time restriction. RESULTS: Overall, trainees spent more time looking at disc images than glaucoma subspecialists (21.3 [13.9-37.7] vs. 16.6 [12.7-19.7]) seconds; median [interquartile range (IQR)], respectively; P < 0.01) and had no systematic patterns of gaze behavior, and gaze behavior was unaltered by disc morphology or topographic cues of pathology. Experienced viewers demonstrated more systematic and ordered gaze behavior patterns and spent longer times observing areas with the greatest likelihood of pathology (superior and inferior poles of the optic nerve head and adjacent RNFL) compared with the trainees. For discs with focal pathology, the proportion of total time spent examining definite areas of pathology was 28.9% (22.4%-33.6%) for glaucoma subspecialists and 13.5% (12.2%-19.2%) for trainees (median [IQR]; P < 0.05). Furthermore, experts adapted their viewing habits according to disc morphology. CONCLUSIONS: Glaucoma subspecialists adopt systematic gaze behavior when examining the optic nerve and RNFL, whereas trainees do not. It remains to be elucidated whether incorporating systematic viewing behavior of the optic disc and RNFL into teaching programs for trainees may expedite their acquisition of accurate and efficient glaucoma diagnosis skills.


Subject(s)
Eye Movements , Internship and Residency/methods , Ophthalmology/education , Ophthalmology/methods , Ophthalmoscopy/methods , Fixation, Ocular , Glaucoma/pathology , Humans , Observer Variation , Ophthalmoscopy/statistics & numerical data , Optic Disk/pathology , Retina/pathology
16.
Optom Vis Sci ; 88(2): 263-8, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21217411

ABSTRACT

PURPOSE: Homonymous visual field defects (HVFD) are common and frequently occur after cerebrovascular accidents. They significantly impair visual function and cause disability particularly with regard to visual exploration. The purpose of this study was to assess a novel interventional treatment of monocular prism therapy on visual functioning in patients with HVFD of varied etiology using vision targeted, health-related quality of life (QOL) questionnaires. Our secondary aim was to confirm monocular and binocular visual field expansion pre- and posttreatment. METHODS: Twelve patients with acquired, documented HVFD were eligible to be included. All patients underwent specific vision-targeted, health-related QOL questionnaire and monocular and binocular Goldmann perimetry before commencing prism therapy. Patients were fitted with monocular prisms on the side of the HVFD with the base-in the direction of the field defect creating a peripheral optical exotropia and field expansion. After the treatment period, QOL questionnaires and perimetry were repeated. RESULTS: Twelve patients were included in the treatment group, 10 of whom were included in data analysis. Overall, there was significant improvement within multiple vision-related, QOL functioning parameters, specifically within the domains of general health (p < 0.01), general vision (p < 0.05), distance vision (p < 0.01), peripheral vision (p < 0.05), role difficulties (p < 0.05), dependency (p < 0.05), and social functioning (p < 0.05). Visual field expansion was shown when measured monocularly and binocularly during the study period in comparison with pretreatment baselines. CONCLUSIONS: Patients with HVFD demonstrate decreased QOL. Monocular sector prisms can improve the QOL and expand the visual field in these patients.


Subject(s)
Eyeglasses , Hemianopsia/physiopathology , Hemianopsia/rehabilitation , Adolescent , Adult , Female , Humans , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Quality of Life , Surveys and Questionnaires , Vision, Ocular , Visual Field Tests , Visual Fields , Young Adult
17.
Retina ; 30(10): 1721-5, 2010.
Article in English | MEDLINE | ID: mdl-20829741

ABSTRACT

PURPOSE: Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. METHODS: A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. RESULTS: Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD ± 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. CONCLUSION: Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.


Subject(s)
Candidiasis, Invasive/etiology , Endophthalmitis/etiology , Eye Infections, Fungal/etiology , Fungemia/etiology , Substance Abuse, Intravenous/complications , Adult , Antifungal Agents/therapeutic use , Candida/isolation & purification , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Ceftazidime/therapeutic use , Drug Therapy, Combination , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Female , Fungemia/diagnosis , Fungemia/drug therapy , Humans , Male , Middle Aged , Prospective Studies , Referral and Consultation , Risk Factors , Vancomycin/therapeutic use , Visual Acuity/physiology , Vitrectomy , Young Adult
18.
Invest Ophthalmol Vis Sci ; 51(12): 6524-32, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20574016

ABSTRACT

PURPOSE: To evaluate the effect of the anti-VEGF-A monoclonal antibody bevacizumab on primary human Tenon's capsule fibroblasts (HTFs) in an in vitro model of wound healing. METHODS: Fibroblasts were cultured in RPMI media, and bevacizumab was administered at a concentration ranging from 0.25 to 12.5 mg/mL. Fibroblast viability and cell death were assessed using the MTT colorimetric assay, lactate dehydrogenase assay, BrdU assay, and live/dead assay. Fibroblast contractility was assessed in floating collagen gels. Morphologic changes were assessed by transmission electron microscopy. Antifibrosis activities were compared with 5-fluorouracil. RESULTS: Bevacizumab induced a significant dose-related reduction of HTF cell number at 12.5 mg/mL at 72 hours (P < 0.05). Under serum-free conditions, bevacizumab induced significant fibroblast cell death at concentrations greater than 7.5 mg/mL (P < 0.05). Bevacizumab caused a moderate inhibition of fibroblast gel contraction from baseline (P < 0.05). Scanning electron microscopy revealed marked vacuolization in bevacizumab-treated fibroblasts. CONCLUSIONS: Bevacizumab disrupted fibroblast proliferation, inhibited collagen gel contraction ability, and induced fibroblast cell death at concentrations greater than 7.5 mg/mL in serum-free conditions. These results demonstrated that bevacizumab inhibited a number of fibrosis activities in culture. These activities may underpin the antifibrosis effect proposed in vivo.


Subject(s)
Angiogenesis Inhibitors/pharmacology , Antibodies, Monoclonal/pharmacology , Apoptosis/drug effects , Cell Proliferation/drug effects , Fibroblasts/drug effects , Tenon Capsule/drug effects , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Antibodies, Monoclonal, Humanized , Bevacizumab , Cell Count , Cells, Cultured , DNA/biosynthesis , Dose-Response Relationship, Drug , Fibroblasts/ultrastructure , Humans , L-Lactate Dehydrogenase/metabolism , Microscopy, Electron , Microscopy, Fluorescence , Tenon Capsule/ultrastructure , Wound Healing/drug effects
19.
Nat Rev Neurol ; 6(4): 221-36, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20212512

ABSTRACT

Acquired optic neuropathies are a common cause of blindness in adults, and are associated with characteristic morphological changes at the optic nerve head. Accurate and prompt clinical diagnosis, supplemented with imaging where appropriate, is essential to optimize management of the optic neuropathy and to counsel the patient appropriately on its natural history. History taking, optic disc findings, visual field assessment and imaging of the nerve head and surrounding retinal nerve fiber layer are all paramount to achieving the correct diagnosis. This Review highlights the optic nerve head features that are common to the acquired optic neuropathies, and describes the features that can be used to differentiate these various conditions.


Subject(s)
Optic Disk/pathology , Optic Nerve Diseases/pathology , Humans
20.
Nat Rev Neurol ; 5(5): 277-87, 2009 May.
Article in English | MEDLINE | ID: mdl-19488085

ABSTRACT

Hereditary optic neuropathies are a prominent cause of blindness in both children and adults. The disorders in this group share many overlapping clinical characteristics, including morphological changes that occur at the optic nerve head. Accurate and prompt clinical diagnosis, supplemented with imaging when indicated, is essential for optimum management of the relevant optic neuropathy and appropriate counseling of the patient on its natural history. Patient history, visual field assessment, optic disc findings and imaging are the cornerstones of a correct diagnosis. This Review highlights the characteristic optic nerve head features that are common to the various hereditary optic neuropathies, and describes the features that enable the conditions to be differentiated.


Subject(s)
Optic Disk/pathology , Optic Nerve Diseases/genetics , Optic Nerve Diseases/pathology , Visual Fields/physiology , DNA, Mitochondrial/genetics , Diagnosis, Differential , Fluorescein Angiography/methods , Humans , Optic Nerve Diseases/complications
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