Journal: Eye (London, England)
PurposeTo evaluate the effect of orbital reconstruction and factors related to the effect of orbital reconstruction by assessing of orbital volume using orbital computed tomography (CT) in cases of orbital wall fracture.MethodsIn this retrospective study, 68 patients with isolated blowout fractures were evaluated. The volumes of orbits and herniated orbital tissues were determined by CT scans using a three-dimensional reconstruction technique (the Eclipse Treatment Planning System). Orbital CT was performed preoperatively, immediately after surgery, and at final follow ups (minimum of 6 months). We evaluated the reconstructive effect of surgery making a new formula, ‘orbital volume reconstruction rate’ from orbital volume differences between fractured and contralateral orbits before surgery, immediately after surgery, and at final follow up.ResultsMean volume of fractured orbits before surgery was 23.01±2.60 cm(3) and that of contralateral orbits was 21.31±2.50 cm(3) (P=0.005). Mean volume of the fractured orbits immediately after surgery was 21.29±2.42 cm(3), and that of the contralateral orbits was 21.33±2.52 cm(3) (P=0.921). Mean volume of fractured orbits at final follow up was 21.50±2.44 cm(3), and that of contralateral orbits was 21.32±2.50 cm(3) (P=0.668). The mean orbital volume reconstruction rate was 100.47% immediately after surgery and 99.17% at final follow up. No significant difference in orbital volume reconstruction rate was observed with respect to fracture site or orbital implant type. Patients that underwent operation within 14 days of trauma had a better reconstruction rate at final follow up than patients who underwent operation over 14 days after trauma (P=0.039).ConclusionComputer-based measurements of orbital fracture volume can be used to evaluate the reconstructive effect of orbital implants and provide useful quantitative information. Significant reduction of orbital volume is observed immediately after orbital wall reconstruction surgery and the reconstruction effect is maintained for more than minimum 6 months. Patients that undergo surgery within 14 days of trauma has better reconstruction rates at final follow up, which supports the need for early surgery.Eye advance online publication, 13 January 2017; doi:10.1038/eye.2016.311.
Glaucoma, a leading cause of irreversible blindness worldwide, is often not diagnosed until many years after disease onset. Early and objective diagnostic measures are yet missing. Besides the main risk factor, an elevated intraocular pressure (IOP), age, sex, and ethnicity are known to affect disease progression and severity. Furthermore, oxidative stress, elevated glutamate concentrations, and an autoimmune component are considered possible risk factors. We could identify several potential proteomic biomarkers in glaucoma and examine distinct changes in the glaucomatous human retina proteome. Using an experimental autoimmune glaucoma animal (EAG) model we could demonstrate an IOP-independent loss of retinal ganglion cells (RGC), which is accompanied by antibody depositions and increased levels of microglia. In a different animal model we showed that intermittent IOP elevations provoke neurodegeneration in the optic nerve and the retina and elicit changes of IgG autoantibody reactivities. The correlation between neuronal damage and changes in autoantibody reactivity suggests that autoantibody profiling could be a useful biomarker for glaucoma. In vivo studies on neuroretinal cells and porcine retinal explants demonstrated a protective effect of antibodies (eg, anti-GFAP) on RGC, which seems to be the result of reduced stress levels in the retina. We conclude that the absence of some autoantibodies in glaucoma patients reflects a loss of the protective potential of natural autoimmunity and may thus encourage neurodegenerative processes. Concluding, autoantibody profiles resemble useful biomarkers for diagnosis, progression and severity of glaucoma. Future longitudinal studies will help to improve early detection and enable better monitoring of disease progression.Eye advance online publication, 13 January 2017; doi:10.1038/eye.2016.300.
To define the safety profile of trainee trabeculectomy surgery in the United Kingdom. Surgical exposure for trainees in England is limited due to service requirements, the European working time directive constraints and increasing sub-specialisation of glaucoma surgery. Limited knowledge exists on the outcomes of supervised glaucoma surgery. The aim is to determine the safety of supervised trabeculectomy surgery performed by trainee ophthalmologists.
The introduction of low energy lighting and the widespread use of computer and mobile technologies have changed the exposure of human eyes to light. Occasional claims that the light sources with emissions containing blue light may cause eye damage raise concerns in the media. The aim of the study was to determine if it was appropriate to issue advice on the public health concerns. A number of sources were assessed and the exposure conditions were compared with international exposure limits, and the exposure likely to be received from staring at a blue sky. None of the sources assessed approached the exposure limits, even for extended viewing times.Eye advance online publication, 15 January 2016; doi:10.1038/eye.2015.261.
To assess the role of artificial intelligence (AI)-based automated software for detection of diabetic retinopathy (DR) and sight-threatening DR (STDR) by fundus photography taken using a smartphone-based device and validate it against ophthalmologist’s grading.
To analyze the risk of incident cataract (diagnosis or extraction) in patients with or without diabetes focusing on other comorbid conditions, antidiabetic drug use, and diabetes duration.
To investigate ocular exposures associated with household cleaning products in the United States.
Ocular evolution is an immense topic, and I do not expect to cover all the details of this process in this manuscript. I will present some concepts about some of the major steps in the evolutionary process to stimulate your thinking about this interesting and complex topic. In the prebiotic soup, vision was not inevitable. Eyes were not preordained. Nor were their shapes, sizes, or current physiology. Sight is an evolutionary gift but it was not ineluctable. The existence of eyes is so basic to our profession that we often do not consider how and why vision appeared or evolved on earth at all. Although vision is a principal sensory modality for at least three major phyla and is present in three or four more phyla, there are other sensory mechanisms that could have been and were occasionally selected instead. Some animals rely on other sensory mechanisms such as audition, echolocation, or olfaction that are much more effective in their particular niche than would be vision. We may not believe those sensory mechanisms to be as robust as vision, but the creatures using those skills would argue otherwise. Why does vision exist at all? And why is it so dominant at least in the number of species that rely upon it for their principal sensory mechanism? How did vision begin? What were the important steps in the evolution of eyes? How did eyes differentiate along their various paths, and why?Eye advance online publication, 20 October 2017; doi:10.1038/eye.2017.226.
The prevalence of myopia is increasing globally. Complications of myopia are associated with huge economic and social costs. It is believed that high myopia in adulthood can be traced back to school age onset myopia. Therefore, it is crucial and urgent to implement effective measures of myopia control, which may include preventing myopia onset as well as retarding myopia progression in school age children. The mechanism of myopia is still poorly understood. There are some evidences to suggest excessive expansion of Bruch’s membrane, possibly in response to peripheral hyperopic defocus, and it may be one of the mechanisms leading to the uncontrolled axial elongation of the globe. Atropine is currently the most effective therapy for myopia control. Recent clinical trials demonstrated low-dose atropine eye drops such as 0.01% resulted in retardation of myopia progression, with significantly less side effects compared to higher concentration preparation. However, there remain a proportion of patients who are poor responders, in whom the optimal management remains unclear. Proposed strategies include stepwise increase of atropine dosing, and a combination of low-dose atropine with increase outdoor time. This review will focus on the current understanding of epidemiology, pathophysiology in myopia and highlight recent clinical trials using atropine in the school-aged children, as well as the treatment strategy in clinical implementation in hyperopic, pre-myopic and myopic children.
Carotenoids are lipophilic isoprenoid pigments with a common C40H56core chemical structure that are naturally synthesized by many plants, algae, bacteria, and fungi. Humans and animals cannot synthesize carotenoids de novo and must obtain them solely through dietary sources. Among the more than 750 carotenoids in nature, only lutein, zeaxanthin, meso-zeaxanthin, and their oxidative metabolites selectively accumulate in the foveal region of the retina where they are collectively referred to as the macular pigment (MP) of the macula lutea. MP serves an ocular protective role through its ability to filter phototoxic blue light radiation and also via its antioxidant activity. These properties have led to the hypothesis that carotenoids may protect against the development of age-related macular degeneration (AMD), the most common cause of blindness in the aged population >60 years old. Epidemiological studies have supported this by showing that patients with lower concentrations of serum carotenoids and macular pigment optical density (MPOD) measurements are at a higher risk of developing AMD. Conversely, nutritional supplementation and diets rich in lutein and zeaxanthin readily impact MP concentrations and reduce the risk of progression to advanced AMD, and the AREDS2 supplement formulation containing 10 mg of lutein and 2 mg of zeaxanthin is the standard-of-care recommendation for individuals at risk for visual loss from advanced AMD. This article reviews the rich history of research on the MP dating back to the 1700s and outlines their potential for further therapeutic improvements for AMD in the future.