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British Journal of Ophthalmology

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Quantitative assessment of central retinal thickness in recurrent neovascular age-related macular degeneration
We read with interest the article by Reznicek et al,1 which evaluated the fulfilment of retreatment criteria for recurrent neovascular age-related macular degeneration (AMD). We support the notion of qualitative optical coherence tomography (OCT) assessment of the retina. However, we will like to point out some factors that might have affected their conclusion that quantitative OCT-based retreatment criteria appeared not sensitive enough in a clinical setting. Reznicek et al1 mentioned that Stratus-OCT was used in the initial assessment of AMD; subsequently upon retreatment, the macula was assessed with spectral domain OCT...
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Chee Yee, C., Papakostas, T. D., Vavvas, D. G. Tags: Letters Source Type: research

On the origin of 'guttae'
Introduction The initial description of Fuchs’ endothelial corneal dystrophy (FECD) in 19101 was made without a slit-lamp biomicroscope and, thus, did not include ‘drop-like’ excrescences beneath the endothelium observed by Vogt in 1921 who is credited with coining the term ‘guttae’ (Latin for drops).2 The origin of gutta has remained obscure. Possible explanations could be that they arise as cellular secretions3 or as extrusions from weak areas in Descemet membrane (DM).4 Limited reports describe morphologies of guttae in FECD. Laing et al described five stages distinguished by size, abnormal...
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Son, H.-S., Villarreal, G., Meng, H., Eberhart, C. G., Jun, A. S. Tags: Letters Source Type: research

Morphologic alterations on posterior iris-claw intraocular lenses after traumatic disenclavation
Conclusions Traumatically dislocated iris-claw IOLs presented considerable alterations on the affected haptics, which might not guarantee a reliable re-enclavation. Therefore, we suggest an IOL replacement, instead of reenclavation, in cases of traumatic iris-claw disenclavation. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Brockmann, T., Gonnermann, J., Brockmann, C., Torun, N., Joussen, A. M., Bertelmann, E. Tags: Original articles - Laboratory science Source Type: research

A prospective study of acute corneal hydrops by in vivo confocal microscopy in a New Zealand population with keratoconus
Conclusions Corneal neovascularisation occurred in 20% of eyes in this pilot study and prolonged presence of presumed inflammatory cells was observed in these eyes. Further study of this potential association may enable identification of patients at risk of neovascularisation. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Lockington, D., Fan Gaskin, J. C., McGhee, C. N. J., Patel, D. V. Tags: Cornea, Ocular surface Original articles - Clinical science Source Type: research

Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty
Conclusions DMEK and retropupillar iris-claw IOL implantation provide good visual outcomes with a fast visual recovery and appear to be a feasible method for the management of bullous keratopathy but with higher graft detachment rates. Trial registration number NCT02020044. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Gonnermann, J., Maier, A.-K. B., Klamann, M. K. J., Brockmann, T., Bertelmann, E., Joussen, A. M., Torun, N. Tags: Ophthalmologic surgical procedures, Angle, Cornea, Intraocular pressure, Ocular surface, Glaucoma, Epidemiology Original articles - Clinical science Source Type: research

Fine needle diathermy occlusion of corneal vessels
Conclusions FND is effective in occluding established corneal vessels. Corneal microperforation is a potentially serious adverse event, but other adverse events, such as striae, whitening and intracorneal haemorrhages are reversible. It should be considered for established corneal vessels, and can be combined with antivascular endothelial growth factors. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Faraj, L. A., Elalfy, M. S., Said, D. G., Dua, H. S. Tags: Ophthalmologic surgical procedures, Cornea, Ocular surface Original articles - Clinical science Source Type: research

When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature
Conclusions Late traumatic flap complications after LASIK have become more frequent in China, although the prognosis of most cases is good. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Xiao, J., Jiang, C., Zhang, M., Jiang, H., Li, S., Zhang, Y., Li, Zhang Tags: Ophthalmologic surgical procedures Original articles - Clinical science Source Type: research

Evaluation of a new optical biometry device for measurements of ocular components and its comparison with IOLMaster
Conclusions The repeatability and reproducibility of AL-Scan was excellent for all parameters, except WTW and PD. Excluding WTW, good agreement was found between the AL-Scan and IOLMaster. The 2.4-mm diameter K value may be the most reliable choice for calculation of IOL power with the AL-Scan. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Huang, J., Savini, G., Li, J., Lu, W., Wu, F., Wang, J., Li, Y., Feng, Y., Wang, Q. Tags: Lens and zonules Original articles - Clinical science Source Type: research

Cataract surgery outcomes in adult patients with Down's syndrome
Conclusions A high incidence of bilateral cataracts as well as white cataracts was observed in patients with Down's syndrome in our study. Although the surgical outcomes of cataract surgery were good, the visual outcomes were suboptimal in our cases due to associated ocular comorbidities. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Li, E. Y., Chan, T. C., Lam, N. M., Jhanji, V. Tags: Ophthalmologic surgical procedures, Angle, Cornea, Intraocular pressure, Lens and zonules, Ocular surface, Neurology, Glaucoma Original articles - Clinical science Source Type: research

Incidence of cystoid macular oedema in diabetic patients after phacoemulsification and free radical link to its pathogenesis
Conclusions The present results suggest that after phacoemulsification, the chance of development of CME in DR is more as compared to D. Moreover, the development of CME is significantly associated with decrease in antioxidant levels, increased ROS activities, hypertension, diabetic nephropathy, and hyperlipidaemia. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Samanta, A., Kumar, P., Machhua, S., Rao, G. N., Pal, A. Tags: Ophthalmologic surgical procedures, Lens and zonules, Retina Original articles - Clinical science Source Type: research

Cataract surgery in small adult eyes
Conclusions Microphthalmic eyes requiring high IOL power are rare, and their presence is often associated with other ocular congenital or acquired disorders. Overall, the clinical outcomes were satisfactory and the surgical procedure affected by a low complication rate. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Carifi, G., Safa, F., Aiello, F., Baumann, C., Maurino, V. Tags: Ophthalmologic surgical procedures, Eye (globe), Lens and zonules, Retina Original articles - Clinical science Source Type: research

Ocular adnexal lymphoma: validation of American Joint Committee on Cancer seventh edition staging guidelines
Conclusion AJCC seventh edition T category was predictive of DFS in patients with OAL. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Sniegowski, M. C., Roberts, D., Bakhoum, M., Mc Laughlin, P., Yin, V. T., Turturro, F., Esmaeli, B. Tags: Original articles - Clinical science Source Type: research

The impact of intermittent exotropia and surgery for intermittent exotropia on myopic progression among early school-aged children with myopia
Conclusions Whether patients with intermittent exotropia underwent surgical correction for intermittent exotropia did not influence the rate of myopic progression. There was no significant difference in the rate of myopic progression between patients with accompanying intermittent exotropia and myopia and those with myopia alone. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Shin, K. H., Hyun, S. H., Kim, I. N., Paik, H. J. Tags: Paediatrics, Muscles, Optic nerve, Neurology, Optics and refraction Original articles - Clinical science Source Type: research

In vivo analysis of the iris thickness by spectral domain optical coherence tomography
Conclusions SD-OCT is a suitable technique for iris thickness assessment. Thickness analysis must be carried out using a sectorial approach, taking into consideration anatomical variations existing between different iris regions. SD-OCT is a potentially useful tool for detecting iris thickness variations induced by pathological conditions such as Fuchs’ uveitis. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Invernizzi, A., Cigada, M., Savoldi, L., Cavuto, S., Fontana, L., Cimino, L., Aldigeri Tags: Original articles - Clinical science Source Type: research

Retinal nerve fibre layer and macular thickness analysis with Fourier domain optical coherence tomography in subjects with a positive family history for primary open angle glaucoma
Conclusions Our study shows that the eyes of subjects with a positive family history for POAG have significantly thinner RNFL and GCC than normal eyes and a more accurate follow-up has to be performed. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Rolle, T., Dallorto, L., Briamonte, C., Penna, R. R. Tags: Angle, Intraocular pressure, Glaucoma Original articles - Clinical science Source Type: research

Negative outcome Charles Bonnet Syndrome
Conclusions CBS is of longer duration than previously suspected with clinically relevant consequences in a third of those affected. Interventions that reduce the frequency, duration or fear of individual hallucination episodes and education prior to hallucination onset may help reduce negative outcome. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Cox, T. M., ffytche, D. H. Tags: Open access, Neurology Original articles - Clinical science Source Type: research

Evaluation of various machine learning methods to predict vision-related quality of life from visual field data and visual acuity in patients with glaucoma
Conclusions We found that it was advantageous to use machine learning methods to predict VRQoL accurately. These statistical methods could be used to help clinicians better understand patients’ VRQoL without the need for extra tests other than standard VA and VF. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Hirasawa, H., Murata, H., Mayama, C., Araie, M., Asaoka, R. Tags: Angle, Intraocular pressure, Glaucoma Original articles - Clinical science Source Type: research

Evaluating the safety of air travel for patients with scleral buckles and small volumes of intraocular gas
Conclusions Eyes with small volumes of intravitreal gas demonstrate significant IOP changes during atmospheric decompression in simulated flight. The presence of a scleral buckle significantly limits the magnitude of IOP change, suggesting that such patients can likely tolerate typical air travel without undue risk of dangerous IOP elevation. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Noble, J., Kanchanaranya, N., Devenyi, R. G., Lam, W.-C. Tags: Ophthalmologic surgical procedures Original articles - Clinical science Source Type: research

Consecutive case series with long-term follow-up of full macular translocation for myopic choroidal neovascularisation
Conclusions FMT for mCNV maintained the improvement in VA for more than 5 years. However, postoperative complications and progression of chorioretinal atrophy due to myopia still seem to limit the visual improvement after FMT for mCNV. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Sakimoto, S., Sakaguchi, H., Ohji, M., Gomi, F., Ikuno, Y., Fujikado, T., Kamei, M., Nishida, K. Tags: Choroid, Optic nerve, Optics and refraction Original articles - Clinical science Source Type: research

Risk of reactivation of toxoplasmic retinitis following intraocular procedures without the use of prophylactic therapy
Conclusions Our study shows that intraocular surgery did not result in a significant reactivation rate of toxoplasmic retinochoroiditis in the absence of preoperative prophylactic antitoxoplasmic therapy. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Heringer, G. C., Oueghlani, E., Dell'Omo, R., Curi, A. L. L., Orefice, F., Pavesio, C. E. Tags: Choroid, Retina Original articles - Clinical science Source Type: research

Proton beam irradiation for non-AMD CNV: 2-year results of a randomised clinical trial
Conclusions PBI is a safe and efficacious treatment for subfoveal CNV not due to AMD. The data with respect to visual outcomes and radiation complications trend in favour of the 16 CGE group, although differences do not reach statistical significance. PBI may be considered as an alternative to current therapies. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Chen, L., Kim, I. K., Lane, A. M., Gauthier, D., Munzenrider, J. E., Gragoudas, E. S., Miller, J. W. Tags: Choroid, Retina Original articles - Clinical science Source Type: research

Retinal vascular oximetry during ranibizumab treatment of central retinal vein occlusion
Conclusions Retinal venous oxygen saturation was markedly reduced in untreated CRVO and was roughly halfway normalised during intravitreal ranibizumab treatment. Retinal artery oxygen saturation was not reduced in CRVO. Trial registration number NCT01360385. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Traustason, S., la Cour, M., Larsen, M., Stefansson, Kiilgaard Tags: Retina Original articles - Clinical science Source Type: research

Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration
Conclusions In our population, switching to aflibercept therapy was not associated with a change in injection frequency nor improved visual acuity, but was associated with improved CMT at 6 months and 1 year. In patients who received at least 10 anti-VEGF injections in the year prior, transitioning to aflibercept was associated with a reduced injection frequency and CMT, suggesting potential cost savings in this population. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Messenger, W. B., Campbell, J. P., Faridi, A., Shippey, L., Bailey, S. T., Lauer, A. K., Flaxel, C. J., Hwang, T. S. Tags: Retina Original articles - Clinical science Source Type: research

Relation between changes in foveal choroidal thickness and 1-year results of ranibizumab therapy for polypoidal choroidal vasculopathy
Conclusions The subfoveal choroidal thickness decreased during ranibizumab therapy, which was associated with resolved polypoidal lesions and foveal retinal thickness, and may be associated with PCV activity. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Hikichi, T., Kitamei, H., Shioya, S., Higuchi, M., Matsushita, T., Kosaka, S., Matsushita, R., Takami, K., Ohtsuka, H. Tags: Choroid Original articles - Clinical science Source Type: research

Functional and anatomical outcome of eyes with neovascular age-related macular degeneration treated with intravitreal ranibizumab following an exit strategy regimen
Conclusions Even with a fixed treatment regime and a defined treatment exit strategy, only a small percentage of patients reach exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Menke, M. N., Zinkernagel, M. S., Ebneter, A., Wolf, S. Tags: Retina, Open access Original articles - Clinical science Source Type: research

Reducing the clinical burden of ranibizumab treatment for neovascular age-related macular degeneration using an individually planned regimen
Conclusions The observe-and-plan regimen significantly improved VA. This was obtained with fewer clinic visits compared with other regimens, which could ease the burden of nAMD treatment. Trial registration number Commission cantonale (VD) d'éthique de la recherché Clinique, Université de Lausanne, Protocole 351/11. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Mantel, I., Niderprim, S.-A., Gianniou, C., Deli, A., Ambresin, A. Tags: Retina, Open access Original articles - Clinical science Source Type: research

Predictive factors for non-response to intravitreal ranibizumab treatment in age-related macular degeneration
Conclusions Although most AMD responded to IVR, non-responders had initial clinical characteristics that might be informative for managing their treatment. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Suzuki, M., Nagai, N., Izumi-Nagai, K., Shinoda, H., Koto, T., Uchida, A., Mochimaru, H., Yuki, K., Sasaki, M., Tsubota, K., Ozawa, Y. Tags: Choroid, Retina, Open access, Editor's choice Original articles - Clinical science Source Type: research

Pre-Descemet's endothelial keratoplasty (PDEK)
This study demonstrates the practicality of the technique, termed pre-Descemet's endothelial keratoplasty (PDEK), which can be a viable option in endothelial keratoplasty with some potential advantages. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Agarwal, A., Dua, H. S., Narang, P., Kumar, D. A., Agarwal, A., Jacob, S., Agarwal, A., Gupta, A. Tags: Ophthalmologic surgical procedures Innovations Source Type: research

Incidence of periorbital necrotising fasciitis in the UK population: a BOSU study
Conclusion PNF is a rare, dangerous condition. This study identified an incidence of 0.24 per 1 000 000 per annum in the UK. β-haemolytic Streptococcus A is the most common causative organism. Mortality remains a potential outcome, and survivors suffer significant morbidity. Early intravenous antibiotic management with a consensus favouring penicillin and clindamycin combined with debridement. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Flavahan, P. W., Cauchi, P., Gregory, M. E., Foot, B., Drummond, S. R. Tags: Epidemiology Global issues Source Type: research

Diagnosing the severity of dry eye: a clear and practical algorithm
This report presents the ODISSEY European Consensus Group recommended algorithm for DED evaluation, which facilitates diagnosis of severe disease even in the event of discordance between signs and symptoms. It is intended that this algorithm will be useful in a clinical and developmental setting. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Baudouin, C., Aragona, P., Van Setten, G., Rolando, M., Irkec, M., Benitez del Castillo, J., Geerling, G., Labetoulle, M., Bonini, S., ODISSEY European Consensus Group members Tags: Open access Review Source Type: research

Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA)
Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due to the exponential increase in life expectancy and environmental risks. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies in medicine. The wide introduction of anti-VEGF therapy has le...
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Schmidt-Erfurth, U., Chong, V., Loewenstein, A., Larsen, M., Souied, E., Schlingemann, R., Eldem, B., Mones, J., Richard, G., Bandello, F. Tags: Public health, Retina, Open access Review Source Type: research

Atrial fibrillation and retinal vein or artery occlusion: looking beyond the eye
Vascular occlusion of a retinal artery or vein is a common cause of retinal vascular pathology with potential life-changing complications.1 2 Retinal vein occlusion (RVO) may differentiate itself from retinal artery occlusion (RAO) in terms of its aetiology and pathology, but both contribute to sight loss or even blindness. The pathogenesis of RAO is generally accepted to be directly related to atherosclerotic thromboembolism (80%) and cardiac embolism, rarely vasculitis, or thrombophilic states. Importantly, the pathogenesis of RAO and strokes or arterial thromboembolism has many similarities. Indeed, retinal emboli are c...
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Plunkett, O., Lip, P. L., Lip, G. Y. H. Tags: Public health, Retina, Vision, Neurology, Epidemiology Editorials Source Type: research

Treating glaucoma: the not-so-nice guidance
Chronic open-angle glaucoma (COAG) is an umbrella diagnosis encompassing chronic progressive optic neuropathies with distinctive changes at the optic nerve head and retinal nerve fibre layer that lead to progressive death of retinal ganglion cells, visual field defects and resultant disability.1 It is described as primary: unattributable to pre-existing ocular disease or congenital abnormality. Does the National Institute of Health and Care Excellence (NICE) guidance lead to our patients receiving appropriate treatment? (a) Who are we treating? Voltaire, an 18th century philosopher, famously wrote: "Doctors are men(sic) wh...
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Ackland, D., Kumaran, N., Zia, R. Tags: Angle, Intraocular pressure, Glaucoma Editorials Source Type: research

Highlights from this issue
Cystoid macular edema after phacoemulsification in diabetics Samanta et al1 report 65 diabetic patients with a variety of levels of retinopathy who underwent phacoemulsification. Although 47% of those without pre-existing retinopathy and 55% of those with pre-existing retinopathy (p<0.05) developed postoperative cystoid macular edema, there was a tendency for those with no pre-existing retinopathy to develop angiographic rather than clinical edema. Long-term follow-up of full macular translocation for myopic choroidal neovascularization Sakimoto2 and colleagues report 60 eyes with a mean of 72 months follow-up after ful...
Source: British Journal of Ophthalmology - August 18, 2014 Category: Opthalmology Authors: Barton, K., Jonas, J. B., Chodosh, J. Tags: At a glance Source Type: research

Anticoagulant and antiplatelet therapy during ocular surgery
We believe that some issues presented in the article by Kiire et al1 need to be corrected, and others deserve some further discussion. Authors in the paragraph on cataract surgery pointed the increased risk of suprachoroidal haemorrhage in patients with high myopia, glaucoma, diabetes, atherosclerotic vascular disease or hypertension referencing to the interesting study,2 which was based only on intracapsular (ICCE) and extracapsular (ECCE) cataract extractions. Both techniques are much more traumatic and are supplemented usually with more invasive than topical form of anaesthesia, however, rarely used today. The dominant ...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Grzybowski, A., Packer, M. Tags: Letters Source Type: research

Authors' response
We thank Grzybowski et al for their comments on our paper.1 The main contention of the authors is that patients undergoing cataract surgery with antiplatelet (Ap) and/or anticoagulant (Ac) medications should continue to receive these drugs based on evidence in the medical literature. In our paper, we clearly acknowledge that the predominant technique for lens extraction is phacoemulsification, and that the risk of complications related to bleeding is rare. In one of the papers2 referenced by Grzybowski et al, a small, but not insignificant, risk of intraoperative haemorrhage in patients undergoing cataract surgery is menti...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Mukherjee, R., Kiire, C. A., Ruparelia, N., Keeling, D., Prendergast, B., Norris, J. H. Tags: Letters Source Type: research

Authors' response: evaluation of choroidal thickness among patients with oculocutaneous albinism
We examined most of the patients during the afternoon (between 12:00 and 17:00) due to logistical availability reasons and this relative limitation of timing might have contributed to the consistency of our results. On the other hand, diurnal variation, as suggested by Chan et al, could have contributed to the difference between choroidal thickness measurements in our study and previous work,4 along with the other possible... (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Karabas, L., Esen, F., Celiker, H., Elcioglu, N., Cerman, E., Eraslan, M., Kazokoglu, H., Sahin, O. Tags: Letters Source Type: research

Evaluation of choroidal thickness among patients with oculocutaneous albinism
We read with interest on the article by Karabas et al1, which reported statistically significant decreased subfoveal choroidal thickness in patients with oculocutaneous albinism (OCA) as compared with age-controlled normal subjects. We would like to congratulate the authors on being the first to describe this among OCA subjects. However, there are relevant factors that we will like to point out. Karabas pointed out that their findings of choroidal thickness among the healthy control population were higher than other studies. Karabas reported subfoveal choroidal thickness of 349±70 µm and 151±31&nbs...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Chan, C. Y., Papakostas, T. D., Vavvas, D. Tags: Letters Source Type: research

Just how old is the modern dacrocystorhinostomy?
Dacrocystorhinostomy—DCR (Gr. αo-o-o-oμα, Dakryon: Tear, Kystis: Bag, Rhis: nose, Stoma: mouth/opening) is a surgical creation of an opening between the lacrimal sac and nasal cavity, or a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function. If the procedure fails, the option is to then insert a conjunctivo-DCR tube (eg, Lester Jones tube) as a conduit between tear film and nasal passage (figure 1). Current literature identifies Celsus and Galen as some of the earliest physicians to attempt surgical correction of epiphora by a...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Giasin, O., Yeo, D. C. M., Aguirre, A. Tags: Letters Source Type: research

Four haptics are better than two
Removal of the crystalline lens at the time of pars plana vitrectomy surgery is becoming an increasingly common surgical strategy in the management of vitreoretinal disease. Combined surgery provides enhanced peripheral retinal visualisation and the opportunity for a larger gaseous endotamponade and obviates the need for subsequent cataract surgery at a later date.1 These advantages only apply if there are not coexistent disadvantages. One of the reported anterior segment complications of combined surgery is pupillary capture of the lens optic, occurring in 1–2% of all cases.2 This occurs due to an induced pressure g...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Rahman, R., Khan, K. Tags: Letters Source Type: research

Patient perceptions during phacoemulsification cataract surgery: a proposal for routine preoperative patient counselling
Numerous studies have explored the visual perceptions in phacoemulsification cataract surgery.1–3 However, the patient experience is not simply limited to visual perceptions; auditory perceptions (including the phaco machine), facial touch including the flow of water down the face and the presence of a drape, in addition to others, also inevitably contribute to the overall patient experience. We devised a study to explore patient perceptions of routine phacoemulsification cataract surgery and to determine whether presurgical counselling of patients should routinely incorporate this information. Fifty patients undergo...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Khan, M. A., Tang, W. K. S., Tahhan, M. Tags: Letters Source Type: research

Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome
We read an interesting ‘Clinical science’ article by Dotan et al1 entitled ‘Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome’. After studying the manuscript there are some issues that come to mind. First, their prospective study was performed between May 2010 and November 2011. r-tPA was injected into patients who had undergone cataract surgery but whose condition had failed to respond to topical and subconjunctival steroid treatments. It was unclear why such a high number of patients required this treatment in a period as short as 18 ...
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Cakmak, H., Kocaturk, T. Tags: Letters Source Type: research

The reliability of parafoveal cone density measurements
Conclusions With the AOSLOs used here, reliable cone density measurements can be obtained between observers and between instruments. Additional work is needed to determine how these results vary with differences in image quality. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Liu, B. S., Tarima, S., Visotcky, A., Pechauer, A., Cooper, R. F., Landsem, L., Wilk, M. A., Godara, P., Makhijani, V., Sulai, Y. N., Syed, N., Yasumura, G., Garg, A. K., Pennesi, M. E., Lujan, B. J., Dubra, A., Duncan, J. L., Carroll, J. Tags: Open access Original articles - Laboratory science Source Type: research

DMEK lenticule preparation from donor corneas using a novel 'SubHyS' technique followed by anterior corneal dissection
Conclusions The DEGs can be preserved in a deturgescent medium for up to 7 days. The procedure provides a standardised, pre-validated (quality assured), pre-separated, no-touch, ready-to-use tissue and also reduces the preparation time. Further, the tissues can be trephined as per the surgeon’s convenience and can either be rolled or a contact lens could be used for final delivery of the DEG using a surgical glide. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Salvalaio, G., Parekh, M., Ruzza, A., Ferrari, S., Camposampiero, D., Ponzin, D. Tags: Ophthalmologic surgical procedures, Epidemiology Original articles - Laboratory science Source Type: research

Upregulation of Toll-like receptor 5 expression in the conjunctival epithelium of various human ocular surface diseases
Conclusions Although TLR5 was normally present on the basal and wing cells of conjunctival epithelium with spatially selective presence, it was expressed on not only the basal and wing cells but also the superficial cells in the conjunctival epithelium of patients with SJS, OCP or chemical eye burns, suggesting that TLR5 might be upregulated in the conjunctival epithelium of these diseases. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Yamada, K., Ueta, M., Sotozono, C., Yokoi, N., Inatomi, T., Kinoshita, S. Tags: Conjunctiva, Ocular surface Original articles - Laboratory science Source Type: research

Timing of congenital dacryostenosis resolution and the development of anisometropia
Conclusions Early spontaneous resolution of dacryostenosis was more likely to have a higher, not lower, rate of anisometropia than late spontaneous or surgical resolution. Further studies are warranted to clarify the relationship between infantile dacryostenosis and the development of hyperopic anisometropia. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Pyi Son, M. K., Hodge, D. O., Mohney, B. G. Tags: Paediatrics, Optic nerve, Optics and refraction Original articles - Clinical science Source Type: research

Intermediate uveitis in children and young adults: differences in clinical course, associations and visual outcome
Conclusions IU with onset in childhood and early adulthood showed a similar visual course at intermediate follow-up. Associated diseases and complication patterns differed between children and young adults. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Heinz, C., Schoonbrood, S., Heiligenhaus, A. Tags: Ciliary body, Lens and zonules, Retina, Neurology Original articles - Clinical science Source Type: research

Sympathetic ophthalmia following diode laser cyclophotocoagulation
Conclusions Sympathetic ophthalmia after diode CPC is rare and is seen in patients with a history of intraocular surgery with or without previous trauma. Early recognition of sympathetic ophthalmia and aggressive management with immunosuppressive therapy results in good outcomes for these patients. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Albahlal, A., Al Dhibi, H., Al Shahwan, S., Khandekar, R., Edward, D. P. Tags: Choroid Original articles - Clinical science Source Type: research

Choroidal schwannoma: a case series of five patients
Conclusions Choroidal schwannoma has a variety of clinical manifestations. Associated features include hard exudates, retinal feeder vessels and serous retinal detachment. Biopsy with immunohistochemistry is required for diagnosis. Tumours not amenable to resection may respond to photodynamic therapy. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Damato, B., Damato, E. M., Konstantinidis, L., Heimann, H., Coupland, S. E. Tags: Retina, Neurology Original articles - Clinical science Source Type: research

The utility of routine tuberculosis screening in county hospital patients with uveitis
Conclusions PPD skin test plays an important role in the diagnosis of TB-associated uveitis in high-risk groups, such as immigrants from TB endemic regions. (Source: British Journal of Ophthalmology)
Source: British Journal of Ophthalmology - July 18, 2014 Category: Opthalmology Authors: Hong, B. K., Khanamiri, H. N., Bababeygy, S. R., Rao, N. A. Tags: Epidemiology Original articles - Clinical science Source Type: research