1: Br J Ophthalmol. 2012 Jan 31; [Epub ahead of print] 

Visual improvement after corneal endothelial transplantation: are we seeing
better?

Anijeet DR, Rachdan D, Shah S.

Birmingham, UK.

PMID: 22296833  [PubMed - as supplied by publisher]

2: Br J Ophthalmol. 2012 Jan 31; [Epub ahead of print] 

In vivo analysis of conjunctiva in canaloplasty for glaucoma.

Mastropasqua L, Agnifili L, Salvetat ML, Ciancaglini M, Fasanella V, Nubile M,
Mastropasqua R, Zeppieri M, Brusini P.

Ophthalmic Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.

AimTo assess the epithelial features of the bulbar conjunctiva using in vivo
confocal microscopy in patients with glaucoma undergoing
canaloplasty.MethodsThirty consecutive patients with glaucoma were enrolled.
Canaloplasty was considered successful if the preoperative intraocular pressure
(IOP) was reduced by one-third. The conjunctiva was examined using confocal
laser-scanning microscopy 1 week before (baseline) and 12 weeks after surgery.
The mean density (MMD, cysts/mm(2)) and mean area (MMA, mum(2)) of conjunctival
microcysts and IOP were measured. Anterior segment optical coherence tomography
was performed to evaluate post-operative trabecular distension and scleral
modifications at the surgery site.ResultsTwelve weeks after surgery,
canaloplasty was successful in 23 patients (group 1) but unsuccessful in 7
(group 2). At baseline, IOP was 28.1+/-2.98 and 28.3+/-2.81 mm Hg, MMD was
10.61+/-4.31 and 11.35+/-5.6 and MMA was 2845.02+/-411.85 and 2700.56+/-518.85
in groups 1 and 2, respectively (p>0.05). Twelve weeks after canaloplasty, mean
IOP was 13.2+/-4.48 (p<0.05) and 24.6+/-3.48 mm Hg in groups 1 and 2,
respectively. In group 1, MMD and MMA were 37.86+/-21.4 and 11997.84+/-8630.35,
respectively, a fourfold increase compared to baseline (p<0.001); no significant
differences were found in group 2. Conjunctival bleb was not documented in any
case.ConclusionsConjunctival microcysts were evident in all glaucomatous eyes
prior to surgery, and tended to increase in density and surface area after
successful canaloplasty. These findings indicated enhanced aqueous humour
filtration across the sclera and conjunctiva after canaloplasty.

PMID: 22296832  [PubMed - as supplied by publisher]

3: Br J Ophthalmol. 2012 Jan 29; [Epub ahead of print] 

A shift in the balance of vascular endothelial growth factor and connective
tissue growth factor by bevacizumab causes the angiofibrotic switch in
proliferative diabetic retinopathy.

Van Geest RJ, Lesnik-Oberstein SY, Tan HS, Mura M, Goldschmeding R, Van Noorden
CJ, Klaassen I, Schlingemann RO.

Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

IntroductionIn proliferative diabetic retinopathy (PDR), vascular endothelial
growth factor (VEGF) and connective tissue growth factor (CTGF) may cause
blindness by neovascularisation followed by fibrosis of the retina. It has
previously been shown that a shift in the balance between levels of CTGF and
VEGF in the eye is associated with this angiofibrotic switch. This study
investigated whether anti-VEGF agents induce accelerated fibrosis in patients
with PDR, as predicted by this model.MethodsCTGF and VEGF levels were measured
by ELISA in 52 vitreous samples of PDR patients, of which 24 patients had
received intravitreal bevacizumab 1 week to 3 months before vitrectomy, and were
correlated with the degree of vitreoretinal fibrosis as determined clinically
and intra-operatively.ResultsCTGF correlated positively, and VEGF correlated
negatively with the degree of fibrosis. The CTGF/VEGF ratio was the strongest
predictor of fibrosis. Clinically, increased fibrosis was observed after
intravitreal bevacizumab.ConclusionsThese results confirm that the CTGF/VEGF
ratio is a strong predictor of vitreoretinal fibrosis in PDR, and show that
intravitreal anti-VEGF treatment causes increased fibrosis in PDR patients.
These findings provide strong support for the model that the balance of CTGF and
VEGF determines the angiofibrotic switch, and identify CTGF as a possible
therapeutic target in the clinical management of PDR.

PMID: 22289291  [PubMed - as supplied by publisher]

4: Br J Ophthalmol. 2012 Jan 27; [Epub ahead of print] 

Optic disc measurements in full term infants.

Kandasamy Y, Smith R, Wright IM, Hartley L.

The Townsville Hospital, Queensland, Australia.

BackgroundThe objectives of this study were to measure optic disc size in full
term infants and to determine whether this value is influenced by sex or birth
weight.MethodsRetinal images from a cohort of full term infants admitted to a
tertiary perinatal centre were obtained using a retinal camera. Optic disc size
was measured by carefully delineating the outline with a cursor using image
analysis software. MEDLINE was then systematically searched to compare the data
with other published articles.Results35 images of left and right eyes from 35
infants were assessed. An image from one eye per patient was then chosen for
analysis. The following results were found: mean birth weight 3050+/-706 g; mean
gestation 38.9+/-1.4 weeks. Mean optic disc area was 1.26+/-0.23 mm(2); mean
vertical diameter was 1.37+/-0.15 mm; and mean horizontal diameter was
1.14+/-0.12 mm. The vertical diameter of the optic disc was significantly longer
than the horizontal diameter (p<0.0001).ConclusionBirth weight and sex did not
influence the size of the optic disc in term infants. There were no differences
in optic disc measurements between male and female infants and between low birth
weight and normal birth weight infants.

PMID: 22286069  [PubMed - as supplied by publisher]

5: Br J Ophthalmol. 2012 Jan 23; [Epub ahead of print] 

Chemosensitivity of conjunctival melanoma cell lines to single chemotherapeutic
agents and combinations.

Westekemper H, Freistuehler M, Anastassiou G, Nareyeck G, Bornfeld N, Steuhl KP,
Scheulen ME, Hilger RA.

University Hospital Essen, Essen, Germany.

ObjectiveTwo conjunctival cell lines (CRMM-1 and CRMM-2) have been established
from recurrent conjunctival melanoma. The authors examined the chemosensitivity
of these cell lines to cytotoxic substances and combinations to identify
substances that inhibit cell growth efficiently in vitro.Material and
methodsCRMM-1 and CRMM-2 were exposed to cisplatin, mitomycin C (MMC),
all-trans-retinoic-acid (ATRA), fotemustine or imatinib for 24 h.
Sulforhodamine-B assays were used to assess the IC(50). Isobolograms were
performed to test possible synergism and antagonism with ATRA or
imatinib.ResultsCisplatin and MMC were efficient to inhibit the growth of CRMM-1
and CRMM-2. Combination of imatinib with MMC showed additive antitumoral effect
on both cell lines. Combined treatment of imatinib with fotemustine or cisplatin
resulted in antagonism. Strong antagonisms were also obtained with ATRA and
fotemustine or cisplatin in both cell lines. A synergism was found for ATRA and
mitomycin or imatinib in CRMM-2, in contrast to CRMM-1, where antagonism was
obtained.ConclusionsCisplatin and MMC inhibit cell growth in conjunctival
melanoma cell lines. The potential of ATRA was evident only in combination with
MMC or imatinib in CRMM-2 cells. Imatinib and mitomycin increased their
efficiency under combination therapy.

PMID: 22275346  [PubMed - as supplied by publisher]

6: Br J Ophthalmol. 2012 Jan 23; [Epub ahead of print] 

Reporting outcomes of randomised controlled trials.

Wilkins MR.

PMID: 22275345  [PubMed - as supplied by publisher]

7: Br J Ophthalmol. 2012 Jan 23; [Epub ahead of print] 

Combined iStent trabecular micro-bypass stent implantation and
phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term
study.

Arriola-Villalobos P, Martinez-de-la-Casa JM, Diaz-Valle D, Fernandez-Perez C,
Garcia-Sanchez J, Garcia-Feijoo J.

Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital
Clinico San Carlos (IdISSC), Madrid, Spain.

AimsTo evaluate the long-term efficacy and safety of combined cataract surgery
and Glaukos iStent implantation for coexistent open-angle glaucoma and
cataract.MethodsProspective, non-comparative, uncontrolled, non-randomised,
interventional case series study. Subjects older than 18 years with coexistent
uncontrolled mild or moderate open-angle glaucoma (including pseudoexfoliative
and pigmentary) and cataract underwent phacoemulsification and intraocular lens
implantation along with ab-interno gonioscopically guided implantation of one
Glaukos iStent. The variables recorded during a minimum of 3 years of follow-up
were: intraocular pressure (IOP), number of antiglaucoma medications and
best-corrected visual acuity.ResultsThe 19 patients enrolled were 58-88 years
old (mean age 74.6+/-8.44 years). Mean follow-up was 53.68+/-9.26 months. Mean
IOP was reduced from 19.42+/-1.89 mm Hg to 16.26+/-4.23 mm Hg (p=0.002) at the
end of follow up, indicating a 16.33% decrease in IOP. The mean number of
pressure-lowering medications used by the patients fell from 1.32+/-0.48 to
0.84+/-0.89 (p=0.046). In 42% of patients, no antiglaucoma medications were used
at the end of follow-up. Mean best-corrected visual acuity significantly
improved from 0.29+/-0.13 to 0.62+/-0.3 (p<0.001). No complications of surgery
were observed.ConclusionCombined cataract surgery and Glaukos iStent
implantation seems to be an effective and safe procedure to treat coexistent
open-angle glaucoma and cataract.

PMID: 22275344  [PubMed - as supplied by publisher]

8: Br J Ophthalmol. 2012 Jan 23; [Epub ahead of print] 

Authors' response: Eyelid avulsion repair with bi-canalicular silicone stenting
without medial canthal tendon reconstruction.

Tawfik HA, Elsamkary M.

Ain-Shams University, Cairo, Egypt.

PMID: 22275343  [PubMed - as supplied by publisher]

9: Br J Ophthalmol. 2012 Jan 23; [Epub ahead of print] 

IgE and eosinophil cationic protein (ECP) as markers of severity in the
diagnosis of atopic keratoconjunctivitis.

Wakamatsu TH, Satake Y, Igarashi A, Dogru M, Ibrahim OM, Okada N, Fukagawa K,
Shimazaki J, Fujishima H.

Keio University School of Medicine, Tokyo, Japan.

AimsTo evaluate tear and serum IgE and eosinophil cationic protein (ECP) as
severity markers for atopic keratoconjunctivitis (AKC).MethodsThirty eyes of 30
patients with AKC and 10 eyes of 10 healthy control subjects were examined in
this prospective study. All subjects underwent fluorescein staining,
conjunctival injection, conjunctival oedema and papillary formation grading.
Tear and serum IgE and ECP levels were measured, and correlations between them
investigated with reference to the ocular surface clinical parameters.ResultsThe
mean fluorescein scores, conjunctival injection, oedema scores and papillary
formation were significantly higher in AKC patients compared to controls
(p<0.05). Higher total IgE and ECP levels were detected in AKC tears compared
with the control group. Tear ECP levels showed a significant correlation with
fluorescein staining, conjunctival injection and oedema scores (r=0.70, 0.62 and
0.62, respectively). Tear IgE had no correlation with clinical signs. Serum IgE
and ECP levels were elevated in AKC patients but did not show any correlation
with clinical signs.ConclusionThis study suggests the presence of an
eosinophilic response in AKC disease independent of IgE sensitisation. Tear ECP
was a useful marker delineating the severity of ocular surface disease in AKC.

PMID: 22275342  [PubMed - as supplied by publisher]

10: Br J Ophthalmol. 2012 Jan 19; [Epub ahead of print] 

Clinical and molecular analysis of children with central pulverulent cataract
from the Arabian Peninsula.

Khan AO, Aldahmesh MA, Mohamed JY, Alkuraya FS.

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

AimTo clinically and genetically characterise central pulverulent cataract in a
consecutive cohort of children from the Arabian Peninsula who were referred for
ophthalmic evaluation.MethodsOphthalmic examination, homozygosity mapping in a
consanguineous family and candidate gene analysis.ResultsAll 16 children (4-16
years old, mean 9 years; seven girls and nine boys from 10 families) had
bilateral central nuclear dust-like lenticular opacities. Two patients (one
family) had cortical riders and six had associated strabismus. Cycloplegic
retinoscopy was usually hyperopic (13/16; right eye spherical equivalent +0.50
to +6.25 dioptres, mean +3.50) but was sometimes myopic (3/16; right eye
spherical equivalent -0.50 to -11.75, mean -6.50). In children with amblyopia
(5/16), the cause was significant uncorrected ametropias rather than the lens
opacities. Three patients had uncomplicated unilateral cataract surgery
suggested by an outside second opinion that did not improve best-corrected
visual acuity. Homozygosity mapping for one consanguineous family suggested the
candidate gene CRYBB1. Sequencing of this gene revealed a homozygous c.171del
mutation (p.N58Tfs*107) with a shared haplotype in all 16 children. In
asymptomatic carrier parents from five of the six families available for careful
slit-lamp examination, occasional central dot lenticular opacities were
documented.ConclusionsCentral pulverulent cataract in this consanguineous
population does not significantly impact visual acuity during early childhood,
can be associated with significant ametropias (with amblyopia and/or strabismus)
and is specific for a homozygous CRYBB1 founder mutation. Primary management in
children is typically spectacle correction based on cycloplegic retinoscopy to
treat significant refractive error rather than paediatric cataract surgery.

PMID: 22267527  [PubMed - as supplied by publisher]

11: Br J Ophthalmol. 2012 Jan 18; [Epub ahead of print] 

Surgical outcome and risk stratification for primary retinal detachment repair:
results from the Scottish Retinal Detachment study.

Mitry D, Awan MA, Borooah S, Siddiqui MA, Brogan K, Fleck BW, Wright A, Campbell
H, Singh J, Charteris DG, Yorston D.

Edinburgh, UK.

ObjectivesTo report the early surgical outcome, risk of failure and predictive
value of rhegmatogenous retinal detachment (RRD) classification based on all
participants in the Scottish Retinal Detachment study.MethodsOver 2 years, all
incident cases of RRD in Scotland were approached for recruitment. Early
postoperative success was defined as an attached retina following one procedure
with a minimum follow-up of 6-8 weeks. Using a regression model, the influence
of clinical factors on the failure risk was estimated and the sensitivity and
specificity of the Royal College of Ophthalmologists (RCOphth) grading for RRD
and the vitrectomy in retinal detachment stratification risk formula (VR-SRF) in
predicting operative failure were assessed.ResultsPrimary outcome data were
available for 86.2% (975/1130) of patients. The overall primary success rate was
80.8% (95% CI 78.1 to 83.3%). The presence of preoperative proliferative
vitreoretinopathy of any degree and each additional clock hour of detachment
increased the risk of failure by an OR of 2.4 and 1.13 respectively (p<0.05). A
specificity of >95% in predicting early surgical failure was noted for highly
complex RRDs according to the VR-SRF formula and the RCOphth
classification.ConclusionsConsistent with previous series, the overall early
success rate of RRD repair was 80% after one operation. The type of surgical
repair did not influence overall success rates. Significant predictors of
failure are the presence of preoperative proliferative vitreoretinopathy of any
grade and the extent of detachment. The analytical value of current
classification systems in predicting failure is most useful in complex RRDs.

PMID: 22257789  [PubMed - as supplied by publisher]

12: Br J Ophthalmol. 2012 Jan 18; [Epub ahead of print] 

Anti-tubercular treatment is not required in latent tuberculosis.

Nazari H, Rao NA.

Doheny Eye Institute, University of Southern California, Los Angeles,
California, USA.

PMID: 22257788  [PubMed - as supplied by publisher]

13: Br J Ophthalmol. 2012 Jan 18; [Epub ahead of print] 

The nitric oxide donating triamcinolone acetonide NCX 434 does not increase
intraocular pressure and reduces endothelin-1 induced biochemical and functional
changes in the rabbit eye.

Impagnatiello F, Giambene B, Lanzi C, Pini A, Somma T, Bastia E, Ongini E,
Galassi F, Masini E.

Bresso, Milan, Italy.

BackgroundNCX 434 is a nitric oxide (NO)-donating triamcinolone acetonide (TA),
shown to enhance optic nerve head (ONH) oxygen saturation in non-human primate
eyes. Here, the effects of a single intravitreal (IVT) injection of TA were
compared with those of NCX 434 on intraocular pressure (IOP), retinal function
and retrobulbar haemodymamics in endothelin-1 (ET-1) induced ONH
ischaemia/reperfusion in rabbits. Biochemical changes were also assessed in the
aqueous humour and in retinal biopsies.MethodsIOP and resistivity index of
ophthalmic artery (RI-OA) were recorded using TonoPen and ecocolor Doppler,
respectively. Retinal function was assessed using photopic electroretinography.
Cytokine expression and oxidative stress markers were evaluated with immunoassay
techniques.ResultsAt 4 weeks post IVT treatment, TA increased IOP and RI-OA
while NCX 434 did not (IOP(Vehicle)=13.6+/-1.3, IOP(NCX 434)=16.9+/-2.2,
IOP(TA)=20.9+/-1.9 mm Hg; p<0.05 vs vehicle; RI-OA(Vehicle)=0.44+/-0.03;
RI-OA(NCX 434)=0.47+/-0.02; RI-OA(TA)=0.60+/-0.04). Both NCX 434 and TA reversed
ET-1 induced decrease in electroretinography amplitude to similar extents. NCX
434 attenuated ET-1 induced oxidative stress markers and nitrotyrosine in
retinal tissue, and interleukin-6 and tumour necrosis factor-alpha in aqueous
humour more effectively than TA.ConclusionNCX 434 attenuates ET-1 induced
ischaemia/reperfusion damage without increasing IOP, probably due to NO release.
If data are confirmed in other species and models, this compound could represent
an interesting new therapeutic option for retinal and ONH diseases, including
diabetic retinopathy.

PMID: 22257787  [PubMed - as supplied by publisher]

14: Br J Ophthalmol. 2012 Jan 18; [Epub ahead of print] 

Can virtual reality simulation help to determine the importance of stereopsis in
intraocular surgery?

Waqar S, Williams O, Park J, Modi N, Kersey T, Sleep T.

Torbay General Hospital, Torquay, UK.

AimTo establish the effect of acute loss of stereopsis on simulated intraocular
surgical performance.MethodsThis study was performed using the EYESi ophthalmic
surgical simulator. Thirty junior doctors with no previous ophthalmic surgical
experience were enrolled and distance visual acuity (Snellen), near visual
acuity and stereoacuity (Frisby) were recorded. All participants completed a
standard introductory programme on the forceps module to eliminate the learning
curve. They then undertook four attempts of level 4 forceps module binocularly
and another four monocularly to simulate an acute loss of stereopsis. Total
score, odometer movement, corneal area injured, lens area injured and total time
taken were recorded.ResultsMean age was 31 years (SD+/-9). None had amblyopia,
with all demonstrating distance visual acuity of 6/6 or better and N6 for near.
Mean stereopsis was 35 s of arc (SD+/-18). Average total score decreased from 60
while operating binocularly to 47 monocularly (p<0.05). Average corneal area
injured increased from 0.95 mm(2) to 2.30 mm(2) (p<0.05), average lens area
injured increased from 1.76 mm(2) to 3.53 mm(2) (p<0.05) and average time taken
increased from 69.6 s to 77.4 s (p<0.05).ConclusionThe importance of stereopsis
for intraocular surgery is difficult to establish in a live theatre setting
without compromising patient safety. Virtual reality simulators provide a safe
alternative. This study demonstrates a statistically significant decrease in
simulated intraocular surgical performance with acute loss of stereopsis in
potential ophthalmic training applicants. Caution is recommend in using these
results to advocate stereopsis testing as a screening tool in interviews because
some participants performed well despite an absence of stereopsis.

PMID: 22257786  [PubMed - as supplied by publisher]

15: Br J Ophthalmol. 2012 Jan 18; [Epub ahead of print] 

Brimonidine (Alphagan) associated anterior uveitis.

McKnight CM, Richards JC, Daniels D, Morgan WH.

Royal Perth Hospital, Perth, Western Australia, Australia.

PMID: 22257785  [PubMed - as supplied by publisher]

16: Br J Ophthalmol. 2012 Feb;96(2):179-84. 

Macular ischaemia: a contraindication for anti-VEGF treatment in retinal
vascular disease?

Manousaridis K, Talks J.

Department of Ophthalmology, Royal Victoria Infirmary, NHS Foundation Trust,
Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; 
kleanthis.manousaridis@googlemail.com.

Anti-vascular endothelial growth factor (anti-VEGF) therapy has been shown to be
effective at improving vision in patients with macular oedema due to diabetic
retinopathy and vein occlusions, but blocking VEGF at least in theory could be
detrimental to vascular integrity. For this reason, some patients with macular
ischaemia were excluded from studies showing the effectiveness of therapy. A
considerable number of patients present with mixed pathology of macular oedema
and macular ischaemia and it is often impossible to determine the degree to
which ischaemia accounts for decreased vision. In this review, the authors have
dealt with the specific question of whether or not there is evidence to support
potential worsening of the macular perfusion and visual function after anti-VEGF
treatment with bevacizumab or ranibizumab for macular oedema secondary to
diabetic retinopathy or retinal vein occlusions, especially if there is
coexisting macular ischaemia. The authors conclude that anti-VEGF therapy rarely
seems to further compromise the retinal circulation; however, worsening of
macular ischaemia in the long term cannot be definitely excluded, particularly
in eyes with significant ischaemia at baseline and after repeated intraocular
anti-VEGF injections. The decision to offer prolonged anti-VEGF treatment in
cases of significant coexisting macular ischaemia should not be based only on
measurements of macular thickness; instead repeat fluorescein angiograms should
be performed.

PMID: 22250209  [PubMed - in process]

17: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

A new lacrimal bypass tube fixation method to prevent tube displacement in
conjunctivodacryocystorhinostomy (CDCR).

Chang M, Baek S, Lee TS.

Korea University College of Medicine, Seoul, Korea.

AimsTo evaluate the efficacy of a new lacrimal bypass tube fixation technique to
the conjunctiva and caruncle, preventing postoperative displacement of the tube
in conjunctivodacryocystorhinostomies (CDCRs).MethodsThe authors conducted 52
CDCR procedures by a new tube fixation technique using a 6-0 prolene suture
encircling the tube neck (encircling group). The suture was not removed during
the follow-up period. Over the same period, the authors carried out 51 CDCRs
with tube fixation using a 5-0 vicryl suture with the purse string procedure
(purse string group) and 71 conventional CDCRs with tube fixation to the skin
using a 6-0 nylon suture (control group). Postoperative complications, including
dislodgement and tube length problems, were recorded. The three groups were
statistically compared.ResultsAmong the 52 cases using the new fixation
technique, tube malpositions, including extrusions, had developed in only four
cases (7.7%) at 12 months after the operation. In the purse string and control
groups, the same complications developed in 11 (21.6%) and 22 cases (31.0%),
respectively. A statistically significant difference between these groups was
detected (p=0.008). Other complications, such as conjunctival granulomas and
tube obstruction, developed postoperatively in four cases (8.0%) in the
encircling group, and this did not differ significantly from that in the other
groups (p=0.193).ConclusionsThe authors believe that this encircling fixation
procedure can help in CDCRs for maintaining the location and orientation of the
tube during the early postoperative period.

PMID: 22247285  [PubMed - as supplied by publisher]

18: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

Use of mini-monoka stents for punctal/canalicular stenosis.

Hussain RN, Kanani H, McMullan T.

Northampton, UK.

BackgroundProximal lacrimal system stenosis may cause debilitating epiphora and
recurrent ocular infections. Mini-monoka stents are primarily used in the
management of canalicular lacerations. Evidence regarding their use to treat
punctal/canalicular stenosis is sparse. Compared with dacryocystorhinostomy, a
punctocanaliculoplasty with mini-monoka stenting is quicker, less invasive with
reduced postoperative complications/recovery time.AimsTo assess the
effectiveness of mini-monoka punctocanaliculoplasty for treatment of
punctal/canalicular stenosis.MethodsA retrospective case note analysis was
performed on 77 consecutive patients (123 eyes).Results73% of eyes had punctal
stenosis, 72% had canalicular stenosis; 46% had a combination of the above. 20%
had some degree of lid laxity and 29% had nasolacrimal duct stenosis. 101 eyes
(82%) had significant improvement in symptoms and were discharged without
further intervention. Excluding the patients with structural comorbidity the
success rate improved to 88%.ConclusionsMini-monoka punctocanaliculoplasty is an
effective, safe, simple and relatively non-invasive treatment strategy for the
management of epiphora secondary to punctal and/or canalicular stenosis.

PMID: 22241928  [PubMed - as supplied by publisher]

19: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

A clinical method to assess the effect of visual loss on the ability to perform
activities of daily living.

Wei H, Sawchyn AK, Myers JS, Katz LJ, Moster MR, Wizov SS, Steele M, Lo D,
Spaeth GL.

West China Hospital, Chengdu, Sichuan, China.

Background/aimsTo develop a clinically applicable, performance-based measure of
the ability to perform visually related activities.Methods99 patients with
glaucoma and 21 subjects with a normal ocular examination completed a nine-item
performance-based test (the Assessment of Ability Related to Vision (AARV)),
received a standard ophthalmic clinical examination and answered the questions
on the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ-25).
All combinations of two, three or four items of the full nine-item AARV test
were analysed, and their scores were compared with the full AARV scores and with
clinical measures.ResultsThe correlation of four items (detecting motion,
reading signs, finding objects and navigating an obstacle course) reduced test
time from 60+/-5 min to 14+/-4 min and yielded results highly related to the
nine-item test, including maintaining the relationship with clinical measures
and with the NEI-VFQ-25.ConclusionA compressed AARV correlates highly with the
full test, with a method of evaluating quality of life, and with clinical
measures, yet takes on average 14 min to perform. As such, it may provide a
clinically useful method of evaluating the worsening effects of illness and the
benefits of treatments that affect visual loss on the ability to perform
visually related activities.

PMID: 22241927  [PubMed - as supplied by publisher]

20: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

Epidemiology, risk factors and management of paediatric diabetic retinopathy.

Sultan MB, Starita C, Huang K.

New York, New York, USA.

Diabetic retinopathy (DR), a common complication of both type 1 and type 2
diabetes, is rarely expressed at a level greater than background retinopathy
during childhood and adolescence. Epidemiological studies in paediatric diabetic
patients together with data from the Diabetes Control and Complications Trial
have demonstrated the importance of glycaemic control in delaying or preventing
the development of DR; thus, the incidence of DR has declined somewhat over the
past two decades. Both prepubertal and postpubertal years with diabetes
contribute to the overall probability of DR development. In addition to duration
of disease and degree of glycaemic control, other risk factors for DR
development include elevated blood pressure, lipid profiles, serum levels of
advanced glycation endproducts, evidence for early stage atherosclerosis,
increased calibre of retinal blood vessels and several genetic factors, such as
enzymes involved in glucose and lipid metabolism. Annual screening is
recommended, with mydriatic stereoscopic fundus photography being the most
sensitive detection method. Both pathophysiology and treatment in paediatric
populations are essentially the same as described for adult populations, with
treatment usually not required until adulthood is reached.

PMID: 22241926  [PubMed - as supplied by publisher]

21: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

Extraocular muscle insertion positions and outcomes of strabismus surgery:
correlation analysis and anatomical comparison of Western and Chinese
populations.

Lai YH, Wu WC, Wang HZ, Hsu HT.

Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,
Taiwan.

Background/aimsTo compare the insertion locations of extraocular muscles between
Taiwanese (Han Chinese) and Western populations and to determine whether
anatomical differences warrant different surgical guidelines.MethodsInsertion
locations were compared between a Taiwanese population of subjects who had
received surgical treatment for strabismus and a control group who had not.
Insertion locations and surgical outcomes in the strabismus group were also
compared with those reported in other countries.ResultsIn Taiwanese subjects,
extraocular muscle insertion locations were not significantly different between
strabismus subjects and controls. However, the distances from the insertion
location to the limbus of the inferior rectus, lateral rectus and superior
rectus were significantly shorter in the Taiwanese subjects than in Western
populations.ConclusionExtraocular muscle insertion locations for the Taiwanese
population in this study significantly differed from those reported in studies
of Western populations. Therefore, surgical guidelines for performing lateral
rectus recession to treat exotropia in Western populations may be inappropriate
for Taiwanese and other Asian populations.

PMID: 22241925  [PubMed - as supplied by publisher]

22: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

Conjunctival and corneal ulcerations: keep a sharp eye on nicorandil.

Trechot P, Bazard MC, Petitpain N, Trechot F, Javot L, Angioi K.

University Hospital of Nancy, Nancy, France.

PMID: 22241924  [PubMed - as supplied by publisher]

23: Br J Ophthalmol. 2012 Jan 12; [Epub ahead of print] 

Combination therapy with low-dose transpupillary thermotherapy and intravitreal
ranibizumab for neovascular age-related macular degeneration: a 24-month
prospective randomised clinical study.

Soderberg AC, Algvere PV, Hengstler JC, Soderberg P, Seregard S, Kvanta A.

Karolinska Institutet, St Eriks Eye Hospital, Stockholm, Sweden.

AimTo compare the effect of combined low-dose transpupillary thermotherapy (TTT)
and intravitreal ranibizumab with sham TTT and intravitreal ranibizumab in
patients with neovascular age-related macular degeneration (AMD).MethodsA
24-month, double-masked, randomised, active-controlled clinical trial. 100
patients with primary neovascular AMD were randomly assigned (1:1) to receive
intravitreal ranibizumab and sham TTT or intravitreal ranibizumab and low-dose
TTT. After an initial loading phase of ranibizumab patients were assigned to
receive quarterly low-dose TTT (136 mW/mm) or sham TTT for 24 months.
Retreatment with ranibizumab was allowed in both treatment groups using a
variable dosing regimen. The primary endpoint was the number of intravitreal
injections with ranibizumab. Secondary endpoints included change in best
corrected visual acuity (BCVA), central retinal thickness (CRT) and lesion
area.ResultsIn the per protocol (PP) population (78 patients) the mean number of
ranibizumab injections was 8.0 in the sham TTT group versus 6.3 in the TTT group
(p<0.05). The mean number of injections between 0-12 months and 13-24 months was
4.8 versus 4.6 (p>0.05) and 3.2 versus 1.7 (p<0.01) in the sham TTT and TTT
groups, respectively. There was no statistically significant difference in BCVA
(+4.0 vs +0.9 ETDRS letters), CRT (-49.9% vs -36.4%) or lesion area (-0.3% vs
-10.6%) between the treatment groups at the final examination. The results of
the intent-to-treat population (92 patients) were similar to the PP
population.ConclusionsTreatment with low-dose TTT significantly reduced the
number or intravitreal injections of ranibizumab over 24 months. The results
suggest that low-dose TTT can serve as an adjuvant in combination with
intravitreal ranibizumab for neovascular AMD.Clinical trial registration
numberThe trial is registered at http://clinicaltrails.gov (no NCT00599222).

PMID: 22241923  [PubMed - as supplied by publisher]

24: Br J Ophthalmol. 2012 Jan 4; [Epub ahead of print] 

Ischaemia in the Zinn-Haller circle and glaucomatous optic neuropathy in macaque
monkeys.

Hiraoka M, Inoue K, Ninomiya T, Takada M.

Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.

AimsTo elucidate the morphological features of optic neuropathy in an ischaemic
model of glaucoma in macaque monkeys.MethodsThe regional degenerative process
was investigated by experimentally occluding the paraoptic branches of the
lateral short posterior ciliary artery, that is, the circle of Haller and Zinn,
in 11 eyes. Morphological changes in nerve fibres in the lamina cribrosa were
evaluated by histopathology, immunocytochemistry and angiography, and the
findings were compared with those observed in an aged macaque with spontaneous
glaucomatous optic neuropathy.ResultsRetinal ganglion cell axons were grouped in
bundles and traversed through pores in columns of the lamina cribrosa. The
processes of astrocytes extended to the bundles, and capillaries branched in
surrounding connective tissue from the circular arterioles. Experimental
ischaemia induced time-dependent anoxic deterioration of phosphorylated fibres
in the temporal arcuate zone, accompanied by glial proliferation. A monkey with
spontaneous visual impairment had nerve fibre loss and gliosis with collagenous
proliferation in the temporal hemisphere, suggesting glaucomatous
neuropathy.ConclusionsCirculatory interference in the circle of Haller and Zinn
caused time-dependent deterioration in the area where anoxic segmental
degeneration is associated with pathogenesis of open-angle glaucoma.

PMID: 22223748  [PubMed - as supplied by publisher]

25: Br J Ophthalmol. 2012 Jan 4; [Epub ahead of print] 

Localising rectus muscle insertions using high frequency wide-field ultrasound
biomicroscopy.

Khan HA, Smith DR, Kraft SP.

The Hospital for Sick Children and University of Toronto, Toronto, Ontario,
Canada.

AimThe ultrasound biomicroscope (UBM) can accurately locate an extraocular
muscle (EOM) insertion. The authors compared the accuracy of the Sonomed UBM
(SUBM), a new 'wide-field ultrasound biomicroscope', with the older model
Humphrey UBM (HUBM) in localising EOM insertions and compared their ranges of
detection of muscle insertions.MethodsProspective, double-masked, observational
study of 27 patients undergoing primary (n=40 muscles) or repeat (n=10 muscles)
horizontal or vertical rectus muscle surgery. EOM insertional distances were
measured with SUBM, and then intraoperatively with callipers. A Bland-Altman
analysis and intraclass correlation coefficient were used to compare the SUBM
and surgical data.ResultsFor all muscles, the differences between SUBM and
surgery measurements were less than 1.0 mm. The mean of the SUBM insertion
distances was 6.67 mm (SD 1.65 mm) versus 6.7 mm (SD 1.6 mm) at surgery. The
intraclass correlation coefficient showed 'excellent' correlation between the
two sets of data and was higher than that reported with HUBM. The image quality
with the SUBM was superior to the HUBM, and its range of field was much larger
(14x18 mm vs 5x6 mm).ConclusionThe SUBM with its smaller, more manoeuvrable
probe handpiece and a wider scanning field was more accurate in detecting muscle
insertions compared with HUBM.

PMID: 22223747  [PubMed - as supplied by publisher]