Idiopathic Retinal Vasculitis, Aneurysms and Neuroretinitis: Clinical Improvement with Infliximab.

PURPOSE: Idiopathic retinal vasculitis, aneurysms and neuroretinitis is a rare vision-threatening condition. If untreated vision loss occurs due to complications of progressive retinal ischaemia including retinal neovascularisation, neovascular glaucoma and retinal exudation. Despite the proposed underlying inflammatory aetiology this condition demonstrates poor response to corticosteroid treatment. The aim was to describe two paediatric cases of idiopathic retinal vasculitis, aneurysms and neuroretinitis treated with infliximab. METHODS: Two case reports. RESULTS: Infliximab treatment led to resolution of aneurysmal dilatations and retinal vasculitis, and reversal of some retinal capillary non-perfusion. CONCLUSION: Early infliximab treatment should be considered in cases of idiopathic retinal vasculitis, aneurysms and neuroretinitis.

Serous retinal detachment caused by choroidal metastatic SLL: A case report.

86-year-old man presented with reduced vision in his right eye corresponding to large serous detachment. Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) showed diffusely thickened choroid. Concurrent diagnosis of small lymphocytic lymphoma diagnosed from submandibular node incited suspicion of choroidal metastasis. Successful response to chemotherapy clearly documented using EDI-OCT technology.

Risk factors for first presentation of glaucoma with significant visual field loss.

PURPOSE: To identify risk factors associated with visual field (VF) loss on first presentation of glaucoma. METHODS: A case-control study of 107 consecutive newly diagnosed glaucoma patients was performed. Information collected included demographic data, reasons for referral, ophthalmological assessment and VF testing. VF grading was based on Advanced Glaucoma Intervention Study (AGIS) scoring and was additionally classified for the presence of a nasal step, paracentral scotoma and/or arcuate scotoma. RESULTS: Demographic parameters were: mean age 59 years (standard deviation [SD] 14), mean deviation -4.37 dB (SD 4.5), intraocular pressure 21.4 mmHg (SD 6.6) and cup:disc ratio 0.69 (SD 0.1). Thirty-seven per cent of all participants had a positive family history of glaucoma. Older age was associated with a VF defect at presentation (mean age of 54 years with no VF defect, compared with 63 years for mild, moderate or severe VF defect, P = 0.0014). Multivariate logistic regression analysis identified positive family history (odds ratio [OR] 10.43; 95% confidence interval [CI] 1.67-67.49) and age (OR 1.15; 95% CI 1.06-1.26) as independent risk factors for VF loss at presentation. Fifty-six per cent had a paracentral VF defect at first diagnosis and 29% of patients showed evidence of substantial VF loss with AGIS score of >/=6 on initial presentation. CONCLUSIONS: Patients who have a positive family history of glaucoma are 10 times more likely to have a VF defect at the time of glaucoma diagnosis. An increased focus on family history may help identify these patients earlier and prevent significant visual loss at the time of presentation.

What do people with glaucoma know about their condition? A comparative cross-sectional incidence and prevalence survey.

PURPOSE: To assess and compare glaucoma knowledge between patients with established glaucoma, newly diagnosed glaucoma and the general population. METHODS: 208 glaucoma patients, 100 newly diagnosed glaucoma patients from three clinical centres and 100 controls from non-ophthalmology outpatient clinics, were recruited and completed a validated self-administered true/false questionnaire assessing glaucoma knowledge. Demographic data were also recorded. Glaucoma knowledge score, out of a maximum of 22, and odds ratios (OR) with 95% confidence intervals (CI) of survey characteristics associated with falling in the lowest quartile of the overall knowledge score was evaluated for each study group. RESULTS: Established glaucoma patients had (median 17, interquartile range 15-19) marginally but significantly (P < 0.05) greater glaucoma knowledge scores than new patients (median 16, interquartile range 13-18). Both of these groups scored significantly better than the control population (median 13, interquartile range 10-14, P < 0.05). Significant misconceptions regarding glaucoma include: 80% of all participants thought that topical medications could not have systemic side-effects, 48% of established glaucoma patients believed symptoms would warn them of disease progression. One-third of new patients considered blindness to be a common outcome of having glaucoma. For established patients, factors associated (P < 0.05) with a lesser likelihood of scoring in the lowest quartile of the total score included having family (OR 0.33, 95% CI 0.11-0.98) or friends (OR 0.28, 95% CI 0.06-0.97) with glaucoma, being referred by an optometrist compared with general practitioner (OR 0.21, 95% CI 0.08-0.57), speaking English at home (OR 0.13, 95% CI 0.04-0.49) and being seen in the private health-care sector (OR 0.13, 95% CI 0.04-0.42). CONCLUSION: Patients with established glaucoma have only slightly greater knowledge than newly diagnosed patients, with both patient groups harbouring significant misconceptions regarding glaucoma. Educational programmes and material should be tailored to address these misconceptions.

Differences in practice and personal profiles between male and female ophthalmologists.

PURPOSE: To assess practice profiles and attitudes towards career and family among ophthalmologists in Australia and New Zealand, with an emphasis on identifying gender differences. METHODS: A 43-part confidential survey addressing professional and personal issues was sent to all female ophthalmologists and to randomly selected age-matched male ophthalmologists, registered with the Royal Australian and New Zealand College of Ophthalmologists in 2005. RESULTS: A total of 254 (75%) of the surveys were returned, with no significant difference in response rate between genders. Differences in practice profiles were identified: females preferentially practise in the city (89.6% vs. 76.1%, P<0.001), work fewer hours (70% of males working 40 hours per week, compared with 41% of females, P<0.0001) and work part time (57.5% vs. 13.6%, P<0.0001). Female ophthalmologists earn less (average income being NZ/Aus$37,913 [95% confidence interval 25,600-50,226] less, P<0.0001); the difference remained significant (P<0.0001) even when adjusted for hours worked. Up to 93.3% of male ophthalmologists are married or in a stable relationship, compared with 75.6% of females (P=0.0003), and males are more likely to have children (P=0.0007). There was no significant difference in overall career satisfaction between male and female ophthalmologists; however, females expressed greater frustration with managing professional and family commitments, and unequal career advancement opportunities. CONCLUSION: Significant differences exist in practice profiles and personal circumstances between male and female ophthalmologists. Females appear to balance work and personal responsibilities by working fewer hours, and for lower income. Despite this, they are less likely to be in a stable relationship, or to have children. However, there is no difference between the two groups in overall career satisfaction.

Seropositivity rates for Bartonella henselae, Toxocara canis and Toxoplasma gondii in New Zealand blood donors.

BACKGROUND: Bartonella henselae, Toxocara canis and Toxoplasma gondii organisms can all cause vision-threatening posterior segment disease. Diagnosis relies heavily on clinical findings, but detection of antibodies in the patient's serum may be helpful in some cases. The significance of a positive serology result depends on the seroprevalence in the general population. Seroprevalence rates for these organisms vary widely around the world and this study aimed to determine the rates for a New Zealand population. METHODS: One hundred and forty healthy blood donors from the Waikato region in the North Island of New Zealand had their serum tested using an indirect latex agglutination test for detection of T. gondii antibodies, an indirect immunofluorescent assay for B. henselae antibodies and an enzyme-linked immunosorbent assay test for T. canis antibodies. RESULTS: Seropositivity rates for T. canis, T. gondii and B. henselae in this New Zealand population were 0.7 +/- 1.65%, 42.9 +/- 8.12% and 5 +/- 3.61%, respectively. CONCLUSION: Seropositivity rates for T. gondii and B. henselae in New Zealand are similar to rates reported in some other countries; however, T. canis seroprevalence may be lower than reported elsewhere in the world.