Aims:To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury.Methods:RetCam fundal images,cranial ultras...Aims:To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury.Methods:RetCam fundal images,cranial ultrasounds and magnetic resonance imaging(MRI)of 109 premature infants were analysed.The study cohort was divided into subgroups depending on the presence or absence of periventricular leucomalacia(PVL)and intraventricular haemorrhage(IVH).The control group consisted of infants with normal neuroimaging at term and 2 years of age.Using the image analysis software of the RetCam,optic disc diameter(ODD),optic disc area(ODA),and optic cup area(OCA)weremeasured at 33-34 weeks gestational age.As serial cranial ultrasonography had been performed,it was possible to date the brain injury in those infants with periventricular white matter(PVWM)damage.Results:Although there was a trend towards reducing ODD,ODA,and OCA with increasing severity of IVH,only the IVH 4 group differed significantly from the controls for these parameters(p=0.002,p=0.02,and p=0.04,respectively).44.4% of infants with grade 4 IVH had small discs.Only one patient had a large cup in a normal sized disc;this patient had IVH 4.In patients with PVWM damage,the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs.This difference was not significant(p=0.23).Conclusions:Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia.We found no association between disc morphology and timing of brain injury.展开更多
Background/aims:Eyes with burnt out disciform scars secondary to age related macular degeneration(AMD)are regarded as visually stable.The aim of this study is to report the subsequent development of atrophy of the ret...Background/aims:Eyes with burnt out disciform scars secondary to age related macular degeneration(AMD)are regarded as visually stable.The aim of this study is to report the subsequent development of atrophy of the retinal pigment epithelium(RPE)around the scars and discuss the possible basis.Methods:20 eyes from 18 patients were observed to develop atrophy around choroidal neovascularisation(CNV).A method of measuring expansion of the atrophy over time is described using the Topcon Imagenet 2000 system.An additional 10 clinicopathological examples were reviewed.Results:Clinically CNV became surrounded initially by a ring of pallor that progressed to an expanding band of atrophy of the RPE.It developed most rapidly in the first 3 years after CNV became quiescent but then continued to expand slowly to more than three times the size of the scar.Histopathological specimens showed large choroidal vessels entering the scars directly and a reduced number of small choroidal vessels beneath and around the scar Conclusions:Disciform scars may become surrounded by an expanding band of atrophy of the RPE,postulated to result from remodelling of the choroidal circulation.The ongoing enlargement of the resulting scotoma may need to be considered when planning management and assessing treatment outcomes.展开更多
Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent ref...Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent refractive state.Methods:293 low birth weight children who had been examined in the neonatal period were assessed at 10-12 years of age.The examination consisted of autorefraction,keratometry,and A-scan.Results of right eyes were compared with published normative data.Results:293 of the birth cohort of 572 children consented to participate.The average mean spherical equivalent(MSE)in the low birth weight cohort was+ 0.691 dioptre,significantly higher than the control data(+ 0.30D,p=0.02).The average change in MSE over the 10-12 year period was-1.00 dioptre(n=256),but only 62.1% of cases showed a shift in refractive error of the appropriate magnitude and direction.The presence of any retinopathy of prematurity(ROP)increases the risk of developing anisometropia sixfold.Conclusions:Low birth weight and ROP both significantly impact the refractive state in the long term.At age 10-12 years children born preterm have an increased prevalence of all refractive errors.In low birth weight children refractive state is relatively stable over the first decade of life with a shift towards myopia of 1 dioptre.展开更多
Aim:To investigate the safety and efficacy of β ray brachytherapy in treatment of vasoproliferative tumours of the retina(VTR).Methods:35 consecutive patients with symptomatic VTR were treated with a ruthenium-106(10...Aim:To investigate the safety and efficacy of β ray brachytherapy in treatment of vasoproliferative tumours of the retina(VTR).Methods:35 consecutive patients with symptomatic VTR were treated with a ruthenium-106(106Ru)plaque.Three tumours had been treated previously(two with cryotherapy;one with transpupillary thermotherapy).32 VTR(91.4%)were located in the lower half of the retina and all of them were found between the mid-periphery and the ora serrata.The mean tumour thickness was 2.8 mm.An exudative retinal detachment was present in 25 eyes(71.4%)and in 15 cases(42.9%)hard exudates were found in the macula.The major symptom was loss of vision(77.1%).Results:Brachytherapy was well tolerated by every patient.The mean applied dose was 416 Gy at the sclera and 108 Gy at the tumour apex.In all but four eyes(88.6%),it was possible to control the VTR activity.The median follow up time was 24 months.Three of the above mentioned four eyes with treatment failure had had secondary glaucoma before therapy.There was no case of radiation induced neuropathy or retinopathy.Cataract surgery was necessary for five patients.The development of epiretinal gliosis was the most common event during follow up(n=10,28.6%).The mean visual acuity decreased slightly(0.33 before and 0.29 after brachytherapy).Multivariate analysis showed that the presence of macular pathology before treatment was associated with a 6.1-fold risk of vision of 0.25 or better(p= 0.03).Conclusions:β ray brachytherapy with 1106Ru plaques was able to control the activity of VTR and retain vision.Cases with secondary glaucoma before treatment had a very poor prognosis.展开更多
Aim:To survey existing ophthalmic follow up protocols in the United Kingdom for very low birth weight(VLBW)children.In addition,relative risk analysis was performed using data from a cohort study to assess which facto...Aim:To survey existing ophthalmic follow up protocols in the United Kingdom for very low birth weight(VLBW)children.In addition,relative risk analysis was performed using data from a cohort study to assess which factors(birth weight,gestational age,retinopathy of prematurity(ROP)status)led to a high risk of developing amblyogenic factors.Methods:Questionnaires were sent to every orthoptic department in the United Kingdom(n=288)for information on their policy on the follow up of VLBW children.Results:Responses were received from 125 departments(43%).There was a large variation in criteria used for follow up;21% of respondents using birth weight(BW)and gestational age(GA),22% using stage 3 or treated ROP,the remainder using a combination of these factors.There was no consensus regarding when follow up should commence(from 3 months to 3 years)or cease(1-8 years).Relative risk analysis revealed that birth weight under 1500 g,GA under 33 weeks,and the presence of severe ROP were significant risk factors for developing one or more amblyogenic factors.Conclusion:There is no consensus on whether VLBW children need to be reviewed.There is a greatly increased risk of ophthalmic deficits in those with severe ROP or severe neurological disorders,and also in those with mild or no ROP.Children in the latter group who are not routinely followed up,have a high risk of developing treatable refractive errors and strabismus.This raises the question of whether an additional screening examination is merited.展开更多
Aim:To evaluate the relative diagnostic strength of cup to disc(C/D)ratio,clinical disc damage likelihood scale(DDLS),a new clinical method of documenting glaucomatous optic disc changes,and Heidelberg retina tomograp...Aim:To evaluate the relative diagnostic strength of cup to disc(C/D)ratio,clinical disc damage likelihood scale(DDLS),a new clinical method of documenting glaucomatous optic disc changes,and Heidelberg retina tomograph(HRT-II)in patients with glaucoma,glaucoma suspects,and normal controls.Method:Consecutive observational case series.110 eyes from 110 patients categorised as glaucoma,glaucoma suspect,or normal were examined clinically to grade the DDLS score.HRT-II examination was performed by an examiner masked to the clinical examination findings.Optic disc parameters and Moorfields regression analysis findings were recorded.Stereophotographs of the optic disc were examined independently by two glaucoma specialists in masked fashion to determine the C/D ratio.Zeiss SITA Standard 24-2 visual fields were obtained within 3 months of HRT-II and clinical examination.For each patient,the eye with the worse mean deviation of the visual field test was enrolled in the study,and each field was additionally graded by the four level Hodapp-Parrish-II-Anderson staging.Specificity and sensitivity were calculated by receiver operating characteristic(ROC)curves.Results:Mean patient age was 58 years(SD 13.3)with 45 glaucoma patients,23 glaucoma suspects,and 42 normals.The mean deviation on Humphrey visual field assessment using SITA-Standard was-4.95 D(SD 5 D)Clinical examination using DDLS had the best predictive power with an area under the ROC curve value of 0.95 when glaucoma patients and suspects were separated from borderline or normals.This was followed by clinical examination of C/D ratio(0.84),and HRT-II Moorfields analysis(0.68).The order of diagnostic strength did not change when definite glaucoma was compared to borderline and normals.Conclusions:The DDLS grading performs well compared to C/D ratio and HRT-II evaluation.Attention to disc diameter and to rim width may increase the value of clinical optic disc examination.展开更多
Aim:To evaluate the efficacy,safety,and therapeutic effect of topical ciclosporin A 0.05% as a steroid sparing agent in steroid dependent allergic conjunctivitis.Methods:Prospective,randomised,double masked,placebo co...Aim:To evaluate the efficacy,safety,and therapeutic effect of topical ciclosporin A 0.05% as a steroid sparing agent in steroid dependent allergic conjunctivitis.Methods:Prospective,randomised,double masked,placebo controlled trial comparing signs,symptoms,and the ability to reduce or stop concurrent steroid in steroid dependent atopic keratoconjunctivitis and vernal keratoconjunctivitis using 0.05% topical ciclosporin A compared to placebo.Steroid drop usage perweek(drug score),symptoms,and clinical signs scores were the main outcome measures.Results:The study included an enrolment of 40 patients,18 with atopic keratoconjunctivitis and 22 with vernal keratoconjunctivitis.There was no statistical significant difference in drug score,symptoms,or clinical signs scores between the placebo and ciclosporin group at the end of the treatment period.No adverse reactions to any of the study formulations were encountered.Conclusions:Topical ciclosporin A 0.05% was not shown to be of any benefit over placebo as a steroid sparing agent in steroid dependent allergic eye disease.展开更多
文摘Aims:To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury.Methods:RetCam fundal images,cranial ultrasounds and magnetic resonance imaging(MRI)of 109 premature infants were analysed.The study cohort was divided into subgroups depending on the presence or absence of periventricular leucomalacia(PVL)and intraventricular haemorrhage(IVH).The control group consisted of infants with normal neuroimaging at term and 2 years of age.Using the image analysis software of the RetCam,optic disc diameter(ODD),optic disc area(ODA),and optic cup area(OCA)weremeasured at 33-34 weeks gestational age.As serial cranial ultrasonography had been performed,it was possible to date the brain injury in those infants with periventricular white matter(PVWM)damage.Results:Although there was a trend towards reducing ODD,ODA,and OCA with increasing severity of IVH,only the IVH 4 group differed significantly from the controls for these parameters(p=0.002,p=0.02,and p=0.04,respectively).44.4% of infants with grade 4 IVH had small discs.Only one patient had a large cup in a normal sized disc;this patient had IVH 4.In patients with PVWM damage,the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs.This difference was not significant(p=0.23).Conclusions:Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia.We found no association between disc morphology and timing of brain injury.
文摘Background/aims:Eyes with burnt out disciform scars secondary to age related macular degeneration(AMD)are regarded as visually stable.The aim of this study is to report the subsequent development of atrophy of the retinal pigment epithelium(RPE)around the scars and discuss the possible basis.Methods:20 eyes from 18 patients were observed to develop atrophy around choroidal neovascularisation(CNV).A method of measuring expansion of the atrophy over time is described using the Topcon Imagenet 2000 system.An additional 10 clinicopathological examples were reviewed.Results:Clinically CNV became surrounded initially by a ring of pallor that progressed to an expanding band of atrophy of the RPE.It developed most rapidly in the first 3 years after CNV became quiescent but then continued to expand slowly to more than three times the size of the scar.Histopathological specimens showed large choroidal vessels entering the scars directly and a reduced number of small choroidal vessels beneath and around the scar Conclusions:Disciform scars may become surrounded by an expanding band of atrophy of the RPE,postulated to result from remodelling of the choroidal circulation.The ongoing enlargement of the resulting scotoma may need to be considered when planning management and assessing treatment outcomes.
文摘Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent refractive state.Methods:293 low birth weight children who had been examined in the neonatal period were assessed at 10-12 years of age.The examination consisted of autorefraction,keratometry,and A-scan.Results of right eyes were compared with published normative data.Results:293 of the birth cohort of 572 children consented to participate.The average mean spherical equivalent(MSE)in the low birth weight cohort was+ 0.691 dioptre,significantly higher than the control data(+ 0.30D,p=0.02).The average change in MSE over the 10-12 year period was-1.00 dioptre(n=256),but only 62.1% of cases showed a shift in refractive error of the appropriate magnitude and direction.The presence of any retinopathy of prematurity(ROP)increases the risk of developing anisometropia sixfold.Conclusions:Low birth weight and ROP both significantly impact the refractive state in the long term.At age 10-12 years children born preterm have an increased prevalence of all refractive errors.In low birth weight children refractive state is relatively stable over the first decade of life with a shift towards myopia of 1 dioptre.
文摘Aim:To investigate the safety and efficacy of β ray brachytherapy in treatment of vasoproliferative tumours of the retina(VTR).Methods:35 consecutive patients with symptomatic VTR were treated with a ruthenium-106(106Ru)plaque.Three tumours had been treated previously(two with cryotherapy;one with transpupillary thermotherapy).32 VTR(91.4%)were located in the lower half of the retina and all of them were found between the mid-periphery and the ora serrata.The mean tumour thickness was 2.8 mm.An exudative retinal detachment was present in 25 eyes(71.4%)and in 15 cases(42.9%)hard exudates were found in the macula.The major symptom was loss of vision(77.1%).Results:Brachytherapy was well tolerated by every patient.The mean applied dose was 416 Gy at the sclera and 108 Gy at the tumour apex.In all but four eyes(88.6%),it was possible to control the VTR activity.The median follow up time was 24 months.Three of the above mentioned four eyes with treatment failure had had secondary glaucoma before therapy.There was no case of radiation induced neuropathy or retinopathy.Cataract surgery was necessary for five patients.The development of epiretinal gliosis was the most common event during follow up(n=10,28.6%).The mean visual acuity decreased slightly(0.33 before and 0.29 after brachytherapy).Multivariate analysis showed that the presence of macular pathology before treatment was associated with a 6.1-fold risk of vision of 0.25 or better(p= 0.03).Conclusions:β ray brachytherapy with 1106Ru plaques was able to control the activity of VTR and retain vision.Cases with secondary glaucoma before treatment had a very poor prognosis.
文摘Aim:To survey existing ophthalmic follow up protocols in the United Kingdom for very low birth weight(VLBW)children.In addition,relative risk analysis was performed using data from a cohort study to assess which factors(birth weight,gestational age,retinopathy of prematurity(ROP)status)led to a high risk of developing amblyogenic factors.Methods:Questionnaires were sent to every orthoptic department in the United Kingdom(n=288)for information on their policy on the follow up of VLBW children.Results:Responses were received from 125 departments(43%).There was a large variation in criteria used for follow up;21% of respondents using birth weight(BW)and gestational age(GA),22% using stage 3 or treated ROP,the remainder using a combination of these factors.There was no consensus regarding when follow up should commence(from 3 months to 3 years)or cease(1-8 years).Relative risk analysis revealed that birth weight under 1500 g,GA under 33 weeks,and the presence of severe ROP were significant risk factors for developing one or more amblyogenic factors.Conclusion:There is no consensus on whether VLBW children need to be reviewed.There is a greatly increased risk of ophthalmic deficits in those with severe ROP or severe neurological disorders,and also in those with mild or no ROP.Children in the latter group who are not routinely followed up,have a high risk of developing treatable refractive errors and strabismus.This raises the question of whether an additional screening examination is merited.
文摘Aim:To evaluate the relative diagnostic strength of cup to disc(C/D)ratio,clinical disc damage likelihood scale(DDLS),a new clinical method of documenting glaucomatous optic disc changes,and Heidelberg retina tomograph(HRT-II)in patients with glaucoma,glaucoma suspects,and normal controls.Method:Consecutive observational case series.110 eyes from 110 patients categorised as glaucoma,glaucoma suspect,or normal were examined clinically to grade the DDLS score.HRT-II examination was performed by an examiner masked to the clinical examination findings.Optic disc parameters and Moorfields regression analysis findings were recorded.Stereophotographs of the optic disc were examined independently by two glaucoma specialists in masked fashion to determine the C/D ratio.Zeiss SITA Standard 24-2 visual fields were obtained within 3 months of HRT-II and clinical examination.For each patient,the eye with the worse mean deviation of the visual field test was enrolled in the study,and each field was additionally graded by the four level Hodapp-Parrish-II-Anderson staging.Specificity and sensitivity were calculated by receiver operating characteristic(ROC)curves.Results:Mean patient age was 58 years(SD 13.3)with 45 glaucoma patients,23 glaucoma suspects,and 42 normals.The mean deviation on Humphrey visual field assessment using SITA-Standard was-4.95 D(SD 5 D)Clinical examination using DDLS had the best predictive power with an area under the ROC curve value of 0.95 when glaucoma patients and suspects were separated from borderline or normals.This was followed by clinical examination of C/D ratio(0.84),and HRT-II Moorfields analysis(0.68).The order of diagnostic strength did not change when definite glaucoma was compared to borderline and normals.Conclusions:The DDLS grading performs well compared to C/D ratio and HRT-II evaluation.Attention to disc diameter and to rim width may increase the value of clinical optic disc examination.
文摘Aim:To evaluate the efficacy,safety,and therapeutic effect of topical ciclosporin A 0.05% as a steroid sparing agent in steroid dependent allergic conjunctivitis.Methods:Prospective,randomised,double masked,placebo controlled trial comparing signs,symptoms,and the ability to reduce or stop concurrent steroid in steroid dependent atopic keratoconjunctivitis and vernal keratoconjunctivitis using 0.05% topical ciclosporin A compared to placebo.Steroid drop usage perweek(drug score),symptoms,and clinical signs scores were the main outcome measures.Results:The study included an enrolment of 40 patients,18 with atopic keratoconjunctivitis and 22 with vernal keratoconjunctivitis.There was no statistical significant difference in drug score,symptoms,or clinical signs scores between the placebo and ciclosporin group at the end of the treatment period.No adverse reactions to any of the study formulations were encountered.Conclusions:Topical ciclosporin A 0.05% was not shown to be of any benefit over placebo as a steroid sparing agent in steroid dependent allergic eye disease.