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Year : 2017  |  Volume : 55  |  Issue : 2  |  Page : 156-160

Journal Scan: Compiled by R. Vasumathi

R K Eye Care Centre, Rasipuram, Namakkal, Tamil Nadu, India

Date of Web Publication26-Dec-2017

Correspondence Address:
Dr. R Vasumathi
R K Eye Care Centre, Rasipuram, Namakkal, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjosr.tjosr_5_17

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How to cite this article:
Vasumathi R. Journal Scan: Compiled by R. Vasumathi. TNOA J Ophthalmic Sci Res 2017;55:156-60

How to cite this URL:
Vasumathi R. Journal Scan: Compiled by R. Vasumathi. TNOA J Ophthalmic Sci Res [serial online] 2017 [cited 2019 Apr 25];55:156-60. Available from: http://www.tnoajosr.com/text.asp?2017/55/2/156/221454

Ozen S, Ozer MA, Akdemir MO. Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain. Graefes Arch Clin Exp Ophthalmol 2017;255:1173-7.

Purpose: This study aims to understand the effect of Vitamin B12 deficiency on neuropathic ocular pain (NOP) and symptoms in patients with dry eye disease (DED).

Methods: Patients with severe DED (without receiving topical artificial tears treatment) and ocular pain were enrolled (n = 90). Patients with severe DED and Vitamin B12 deficiency (Group 1, n = 45) received parenteral Vitamin B12 supplement + topical treatment (artificial tears treatment + cyclosporine), and patients with severe DED and normal serum Vitamin B12 level (Group 2, n = 45) received only topical treatment (artificial tears treatment + cyclosporine). Patients were evaluated by the ocular surface disease index (OSDI) questionnaire, 3rd question (have you experienced painful or sore eyes during last week?) score of OSDI as a pain determiner and pain frequency measure), tear break up time (TBUT), and Schirmer's type 1 test. We compared the groups' OSDI, TBUT, and Schirmer's test recordings at the first visit and after 12 weeks retrospectively.

Results: The OSDI score, 3rd OSDI question score, TBUT, and Schirmer's test results improved after 12 weeks (P < 0.001 for each group). The mean Vitamin B12 level at enrollment was 144.24 ± 43.36 pg/ml in group 1 and 417.53 ± 87.22 pg/ml in group 2. The mean Vitamin B12 level in group 1 reached to 450 ± 60.563 pg/ml after 12 weeks of treatment. The mean score changes between the groups were not statistically significant; however, the decrease in the OSDI questionnaire score (-30.80 ± 5.24) and 3rd OSDI question score (−2.82 ± 0.53) was remarkable in group 1. The mean TBUT increase was + 7.98 ± 2.90 s, and Schirmer's test result increase was + 12.16 ± 2.01 mm in group 1. The mean TBUT increase was + 6.18 ± 1.49 s, and Schirmer's test result increase was + 6.71 ± 1.47 mm in group 2.

Conclusions: These findings indicate that Vitamin B12 deficiency is related with NOP. It may be important to consider measuring the serum vitamin B12 level in patients with severe DED presenting with resistant ocular pain despite taking topical treatment.

Yildirim P, Garip Y, Karci AA, Guler T. Dry eye in Vitamin D deficiency: more than an incidental association. Int J Rheum Dis 2016;19:49-54.

Aim: The aim of this article is to demonstrate the relation between Vitamin D deficiency and dry eye and impaired tear function and to investigate the possible associations among clinical parameters of hypovitaminosis D with dry eye parameters.

Methods: Fifty premenopausal women with Vitamin D deficiency (serum Vitamin D levels <20 ng/mL) and 48 controls were included. Participants were assessed by Schirmer's test, tear break-up time test (TBUT), ocular surface disease index (OSDI), Stanford Health Assessment Questionnaire (HAQ), fatigue severity scale (FSS), and visual analog scale-pain (VAS-pain).

Results: Lower scores in Schirmer's test and TBUT and higher in OSDI were detected in patients with Vitamin D deficiency than in controls (P < 0.05). FSS was negatively correlated with Schirmer's test (r = −0.29; P = 0.038) and TBUT scores (r = −0.43; P = 0.002); VAS-pain was negatively correlated with TBUT scores (r = −0.32; P = 0.023). HAQ scores showed no significant correlation with dry eye parameters (P > 0.05). Vitamin D level was negatively correlated with OSDI (r = −0.49; P < 0.001), and positively with Schirmer's test (r = 0.45; P = 0.001) and TBUT scores (r = 0.30; P = 0.029).

Conclusion: Dry eye and impaired tear function in patients with Vitamin D deficiency may indicate a protective role of Vitamin D in the development of dry eye, probably by enhancing tear film parameters and reducing ocular surface inflammation.

Hosoda Y, Ooto S, Hangai M, Oishi A, Yoshimura N. Foveal photoreceptor deformation as a significant predictor of postoperative visual outcome in idiopathic epiretinal membrane surgery. Invest Ophthalmol Vis Sci 2015;56:6387-93.

Purpose: The purpose of this study was to determine whether the outer nuclear layer (ONL) deformation detected by spectral-domain optical coherence tomography (SD-OCT) is correlated with visual acuity before and after surgery in patients with idiopathic epiretinal membrane (ERM).

Methods: Forty-four eyes of 44 patients who underwent vitreous surgery for treatment of ERM were included. All patients underwent comprehensive ophthalmologic evaluations including measurement of best-corrected visual acuity (BCVA) and SD-OCT before and after surgery. The central foveal thickness (CFT), foveal ONL thickness, juxtafoveal ONL plus outer plexiform layer (OPL) thickness, photoreceptor outer segment thickness, and size of the disrupted interdigitation zone (IZ) line were measured. We defined the “photoreceptor deformation index” (PDI) as the ratio of foveal ONL thickness to the juxtafoveal ONL plus OPL thickness.

Results: Multiple regression analysis showed that the only significant predictor of preoperative mean logarithm of the minimum angle of resolution (logMAR) BCVA was preoperative CFT (P < 0.0001). Preoperative PDI (P < 0.0001) and disrupted IZ diameter (P = 0.0242) were positively correlated with logMAR at 3 months after surgery. PDI (P < 0.0001) and disrupted IZ diameter (P = 0.0351) were also positively correlated with logMAR BCVA at 6 months after surgery. The only significant predictor of logMAR at 12 months after surgery was preoperative PDI (P < 0.0001).

Conclusions: Preoperative PDI was most significantly correlated with postoperative BCVA. These results suggest that PDI is a novel parameter predicting visual outcome after surgery in eyes with ERM.

Aleman TS, Huang J, Garrity ST, Carter SB, Aleman WD, Ying GS, et al. Relationship between optic nerve appearance and retinal nerve fiber layer thickness as explored with spectral domain optical coherence tomography. Transl Vis Sci Technol 2014;3:4.

Purpose: To study the relationship between the appearance of the optic nerve and the retinal nerve fiber layer (RNFL) thickness determined by spectral domain optical coherence tomography (OCT).

Methods: Records from patients with spectral domain-OCT imaging in a neuroophthalmology practice were reviewed. Eyes with glaucoma/glaucoma suspicion, macular/optic nerve edema, pseudophakia, and with refractive errors >6D were excluded. Optic nerve appearance by slit lamp biomicroscopy was related to the RNFL thickness by spectral domain-OCT and to visual field results.

Results: Ninety-one patients (176 eyes; mean age: 49 ± 15 years) were included. Eighty-three eyes (47%) showed optic nerve pallor; 89 eyes (50.6%) showed RNFL thinning (sectoral or average peripapillary). Average peripapillary RNFL thickness in eyes with pallor (mean ± standard deviation = 76 ± 17 μm) was thinner compared to eyes without pallor (91 ± 14 μm, P < 0.001). Optic nerve pallor predicted RNFL thinning with a sensitivity of 69% and a specificity of 75%. Optic nerve appearance predicted RNFL thinning (with a sensitivity and specificity of 81%) when RNFL had thinned by ∼40%. Most patients with pallor had RNFL thinning with (66%) or without (25%) visual field loss; the remainder had normal RNFL and fields (5%) or with visual field abnormalities (4%).

Conclusions: Optic nerve pallor as a predictor of RNFL thinning showed fair sensitivity and specificity although it is optimally sensitive/specific only when substantial RNFL loss has occurred.

Allingham MJ, Mukherjee D, Lally EB, Rabbani H, Mettu PS, Cousins SW, et al. A quantitative approach to predict differential effects of anti-vegf treatment on diffuse and focal leakage in patients with diabetic macular edema: A pilot study. Transl Vis Sci Technol 2017;6:7.

Purpose: Semi-automated segmentation of fluorescein angiography (FA) was used to determine whether anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME) differentially affects microaneurysm (MA)–associated leakage, termed focal leakage, versus non-MA–associated leakage, termed diffuse leakage.

Methods: A retrospective study was performed on 29 subjects treated with at least three consecutive injections of anti-VEGF agents for DME (mean 4.6 injections; range, 3-10) who underwent Heidelberg FA before and after anti-VEGF therapy. Inclusion criteria were macula center-involving DME and at least 3 consecutive anti-VEGF injections. Exclusion criteria were macular edema due to cause besides DME, anti-VEGF within 3 months of initial FA, concurrent treatment for DME besides anti-VEGF, and macular photocoagulation within 1 year. At each time point, total leakage was semiautomatically segmented using a modified version of a previously published software. MAs were identified by an expert grader and leakage within a 117 μm radius of each MA was classified as focal leakage. Remaining leakage was classified as diffuse leakage. The absolute and percent changes in total, diffuse, and focal leakage were calculated for each subject.

Results: Mean pretreatment total leakage was 8.2 mm 2 and decreased by a mean of 40.1% (P < 0.0001; 95% confidence interval [CI], [−28.6, −52.5]) following treatment. Diffuse leakage decreased by a mean of 45.5% (P < 0.0001; 95% CI, [−31.3, −59.6]) while focal leakage decreased by 17.9% (P = 0.02; 95% CI, [−1.0, −34.8]). The difference in treatment response between focal and diffuse leakage was statistically significant (P = 0.01).

Conclusions: Anti-VEGF treatment for DME results in decreased diffuse leakage but had relatively little effect on focal leakage as assessed by FA. This suggests that diffuse leakage may be a marker of VEGF-mediated pathobiology. Patients with predominantly focal leakage may be less responsive to anti-VEGF therapy. FA can define focal and diffuse subtypes of DME and these may respond differently to anti-VEGF treatment.

Abu El-Asrar AM, Berghmans N, Al-Obeidan SA, Mousa A, Opdenakker G, Van Damme J, et. al. The cytokine interleukin.6 and the chemokines CCL20 and CXCL13 are novel biomarkers of specific endogenous uveitic entities. Invest Ophthalmol Vis Sci 2016;57:4606-13.

Purpose: The purpose of this study was to determine the levels of the cytokines interleukin (IL)-1 β, IL-6, IL-21, IL-22, and IL-23 and the chemokines CXCL13, CCL19, CCL20, and CCL21 in aqueous humor (AH) samples from patients with specific uveitic entities.

Methods: Paired serum samples (n = 13) and AH samples (n = 111) from patients with active idiopathic granulomatous uveitis (IGU) or with uveitis associated with HLA-B27-related inflammation, Behçet's disease (BD), Vogt-Koyanagi-Harada (VKH) disease, or sarcoidosis and control patients were analyzed in two different multiplex assays.

Results: Cytokines IL-1 β, IL-21, IL-22, and IL-23 were not detected in any AH sample. Chemokine CCL21 concentrations in serum were significantly higher than those in AH. CCL19 levels in AH and serum were not significantly different. Levels of CCL20 and CXCL13 in AH were significantly higher than those in serum. IL-6 was not detected in serum samples. IL-6 AH levels were significantly higher in patients with HLA-B27-associated uveitis and in BD patients than in patients with VKH disease, sarcoidosis, and IGU (P < 0.0001). CCL20 AH levels were significantly higher in HLA-B27-associated uveitis than in BD, VKH, sarcoidosis, and IGU (P = 0.001) whereas CXCL13 AH levels were significantly higher in VKH disease and IGU than in HLA-B27-associated uveitis, BD, and sarcoidosis (P = 0.007).

Conclusions: IL-6-driven immune responses are more potent in HLA-B27-associated uveitis and BD than in VKH disease, sarcoidosis, and IGU. CCL20 appears to be a specific biomarker of HLA-B27-associated uveitis whereas CXCL13 appears to be a biomarker of VKH disease and IGU. These findings suggest that IL-6, CCL20, and CXCL13 could serve as drug targets for the treatment of specific clinical entities of endogenous uveitis.

Zhu X, He W, Zhang K, Lu Y. Factors influencing 1.year rotational stability of AcrySof Toric intraocular lenses. Br J Ophthalmol 2016;100:263-8.

Purpose: The purpose of this study is to investigate the 1-year rotational stability of AcrySof Toric intraocular lenses (IOLs) and factors influencing their stability.

Methods: This retrospective study enrolled 75 patients who underwent phacoemulsification and was implanted with an AcrySof Toric IOL for 1 year. Their preoperative clinical data were reviewed. The 1-year clinical outcomes included uncorrected visual acuity, best-corrected visual acuity, and residual astigmatism. Rotation of the IOL and the grade of anterior capsular opacification (ACO; graded from 0 = none to 3 = severe) were evaluated after mydriasis.

Results: Of the 75 eyes analyzed, 29.33% had high myopia. Residual astigmatism at 1 year (−0.76 ± 0.47 dioptre [D]) was significantly reduced compared with the preoperative corneal astigmatism (2.08 ± 0.71 D). The mean absolute rotation of the IOL was 8.83 ± 5.26°. Toric IOL rotation was significantly and positively correlated with the degree of residual astigmatism in the T3 (Pearson's r = 0.552, P < 0.001) and T4 groups (Pearson's r = 0.622, P = 0.003). Regarding factors associated with IOL rotation, toric IOL rotation was positively correlated with axial length (AXL; Pearson's r = 0.335, P = 0.003) and negatively correlated with ACO grade (Spearman's r = −0.541, P < 0.001). On multiple linear regression analysis, only AXL (B = 0.889, P = 0.031) and ACO grade (B = −3.216, P < 0.001) were predictors of toric IOL rotation (R2 = 0.397).

Conclusions: Long AXL is a risk factor for toric IOL rotation while higher ACO grade may decrease toric IOL rotation, indicating that reducing the polishing of anterior capsule may improve the rotational stability of a toric IOL.

Hayashi K, Ogawa S, Manabe S, Yoshimura K. Binocular visual function of modified pseudophakic monovision. Am J Ophthalmol 2015;159:232-40.

Purpose: The purpose of this study is to compare binocular visual function of pseudophakic patients having modified monovision (0.75 diopter [D] anisometropia) with that of patients having conventional monovision (1.75 D anisometropia).

Design: This was prospective, observational study.

Methods: Eighty-two patients that underwent bilateral implantation of a monofocal intraocular lens were recruited at 3 months postoperatively. Modified monovision was simulated by adding a +0.75 D spherical lens to the nondominant eye while conventional monovision was simulated by adding a +1.75 D spherical lens. Binocular-corrected visual acuity (VA) at various distances, binocular contrast VA (contrast VA) and that with glare (glare VA), and stereoacuity were evaluated.

Results: With modified monovision, mean binocular-corrected intermediate VA at 1.0 m was 20/19 and near VA at 0.3 m was 20/51, and stereoacuity was 125 ± 100 s of arc. Mean binocular intermediate VA at 1.0 m was significantly better with modified monovision than with conventional monovision (P = 0.0001) while near VA and intermediate VA at 0.5 m were significantly worse (P < 0.0001). Mean binocular photopic and mesopic contrast VA and glare VA tended to be better with modified monovision than with conventional monovision, but the difference was not significant. Mean stereoacuity was significantly better with modified monovision than with conventional monovision (P = 0.0020).

Conclusions: Modified pseudophakic monovision provided excellent binocular VA from far to intermediate distances although near VA was worse than that with conventional monovision. Contrast VA with and without glare tended to be better, and stereoacuity was significantly better with modified monovision, suggesting that this method is useful for correcting presbyopia without marked impairment of binocular function.

Naeser K, Hjortdal JØ, Harris WF. Pseudophakic monovision: optimal distribution of refractions. Acta Ophthalmol 2014;92:270-5.

Purpose: The purpose of this study is to determine the optimal distribution of refractions in monofocal, pseudophakic monovision.

Methods: A previously reported mathematical method for describing defocus for a single eye (Acta Ophthalmol, 89, 2011, 111) is expanded to the binocular situation. The binocular distribution of refractions yielding the least defocus over the most extended fixation intervals is identified by mathematical optimization. The results are tested in a group of 22 pseudophakic patients.

Results: For the fixation interval 0.25–6.0 m, the optimal refractions are pure spheres of − 0.27 D for the distance eye and −1.15 D for near eye. The mathematically derived defocus structure is confirmed in the clinical series. Conclusions: Monovision with refractions of approximately −0.25 and −1.25 D may lead to spectacle independence for distance and intermediate vision. Binocular problems – such as monovision suppression, reduced stereoacuity, and binocular inhibition – are likely to be minimal with the suggested anisometropia of 1.0 D.

Caruso C, Ostacolo C, Epstein RL, Barbaro G, Troisi S, Capobianco D. Transepithelial corneal cross-linking with Vitamin E-enhanced riboflavin solution and abbreviated, low-dose UV-A: 24-month clinical outcomes. Cornea 2016;35:145-50.

Purpose: The purpose of this study is to report the clinical outcomes with 24-month follow-up of transepithelial cross-linking using a combination of a D-alpha-tocopheryl polyethylene-glycol 1000 succinate (Vitamin E-TPGS)-enhanced riboflavin solution and abbreviated low-fluence ultraviolet (UV)-A treatment.

Methods: In a nonrandomized clinical trial, 25 corneas of 19 patients with topographically proven, progressive, mild-to-moderate keratoconus over the previous 6 months were cross-linked, and all patients were examined at 1, 3, 6, 12, and 24 months. The treatments were performed using a patented solution of riboflavin and Vitamin E-TPGS, topically applied for 15 min, followed by two 5-minute UV-A treatments with separate doses both at fluence below 3 mW/cm 2 that were based on preoperative central pachymetry.

Results: During the 6-month pretreatment observation, the average Kmax increased by +1.99 ± 0.29 D (diopter). Postoperatively, the average Kmax decreased, changing by −0.55 ± 0.94 D, by −0.88 ± 1.02 D and by −1.01 ± 1.22 D at 6, 12, and 24 months. Postoperatively, Kmax decreased in 19, 20, and 20 of the 25 eyes at 6 months, 12 months, and 24 months, respectively. Refractive cylinder was decreased by 3 months postoperatively and afterward, changing by −1.35 ± 0.69 D at 24 months. Best spectacle-corrected visual acuity (BSCVA) improved at 6, 12, and 24 months, including an improvement of −0.19 ± 0.13 logarithm of the minimum angle of resolution units at 24 months. There was no reduction in endothelial cell count. No corneal abrasions occurred, and no bandage contact lenses or prescription analgesics were used during postoperative recovery.

Conclusions: Transepithelial cross-linking using the riboflavin-Vitamin E solution and brief, low-dose, pachymetry-dependent UV-A treatment safely stopped keratoconus progression.

Yang J, Cai L, Sun Z, Ye H, Fan Q, Zhang K, et al. Risk factors for and diagnosis of pseudophakic cystoid macular edema after cataract surgery in diabetic patients. J Cataract Refract Surg 2017;43:207-14.

Purpose: The purpose of this study is to evaluate the risk factors and potential diagnostic criteria for pseudophakic cystoid macular edema (CME) in diabetic patients after phacoemulsification.

Methods: Diabetic patients were followed for up to 6 months after cataract surgery and examined to evaluate their foveal thickness, macular sensitivity, and corrected distance visual acuity. Multiple statistical analyses were performed to determine risk factors and diagnostic criteria for pseudophakic CME.

Results: The duration, type of diabetes, stage of diabetic retinopathy, nuclear opalescence grading, glycosylated hemoglobin A1c (HbA1c), and ultrasound time were correlated with the change in foveal thickness and macular sensitivity after cataract surgery. Unsupervised data analysis showed 3 groups of patients as follows: nonpseudophakic CME, level 1 pseudophakic CME, and level 2 pseudophakic CME. Subclinical level one patient had a 30%–40% increase in foveal thickness 1-month postoperatively, while level two patients had at least a 40% increase in foveal thickness and a 20% decrease in macular sensitivity. The incidence of clinical pseudophakic CME was 3.2% in diabetic patients as per the diagnostic criteria. The change in macular sensitivity was more consistent and correlated with foveal thickness.

Conclusions: The duration, severity, type of diabetes, hardness of the lens, and HbA1c were risks for pseudophakic CME in diabetic patients after cataract surgery. A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity offer an objective and reliable diagnostic standard to report pseudophakic CME in diabetics.

van der Mooren M, Rosén R, Franssen L, Lundström L, Piers P. Degradation of visual performance with increasing levels of retinal stray light. Invest Ophthalmol Vis Sci 2016;57:5443-8.

Purpose: The purpose of this study is to quantify the effect of induced stray light on halo size, luminance threshold, and contrast sensitivity. Methods: Retinal stray light was induced in five healthy subjects using different photographic filters. The stray light induced ranged from levels observed in intraocular lenses with glistenings (low) to cataract level (high). The visual impact was measured for halo size, luminance detection threshold, and contrast sensitivity with and without a glare source. Results: The amount of retinal stray light induced by the different filters was similar when measured using the psychophysical method and optical bench method. Low amounts of induced stray light cause the halo size to increase by 21%, the luminance detection threshold to increase by 156%, and contrast sensitivity to decrease by 10% to 21% dependent on spatial frequency and presence of a glare source. The visual impact percentages for high amounts of induced stray light were, respectively, 76%, 2130%, and 30% to 49%. In the presence of a glare source, contrast sensitivity losses were larger and shifted to lower spatial frequencies. Conclusions: Low levels of retinal stray light can cause significant increases in halo sizes, elevations in luminance detection thresholds, and reductions in contrast sensitivity whether or not a glare source is present.

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