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Ophthalmology

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News Article | June 19, 2017
Site: www.eurekalert.org

SAN FRANCISCO - June 19, 2017 -- A new study suggests that most people with acute conjunctivitis, or pink eye, are getting the wrong treatment. About 60 percent of patients are prescribed antibiotic eyedrops, even though antibiotics are rarely necessary to treat this common eye infection. About 20 percent receive an antibiotic-steroid eyedrop that can prolong or worsen the infection. The study is now online in Ophthalmology, the journal of the American Academy of Ophthalmology. This is the first study to assess antibiotic use for pink eye in a large, diverse segment of the United States. The findings are consistent with a nationwide trend of antibiotic misuse for common viral or mild bacterial conditions. It's a trend that increases costs to patients and the health care system and may promote antibiotic resistance. Researchers at the University of Michigan Kellogg Eye Center looked at data from a large managed care network in the United States. They identified the number of patients who filled antibiotic eyedrop prescriptions for acute conjunctivitis. Then they evaluated the characteristics of patients who filled a prescription compared with those who did not. Of approximately 300,000 patients diagnosed with acute conjunctivitis over a 14-year period, 58 percent filled a prescription for antibiotic eye drops. Among them, 20 percent filled a prescription for an antibiotic-steroid combination. Antibiotic-steroid drops are inappropriate for most patients with acute conjunctivitis because it may prolong or exacerbate certain types of viral infection. Even more troubling, the authors found that the odds of filling a prescription depended more on a patient's socioeconomic status than the patient's risk for developing a more serious eye infection. For example, patients who wear contact lenses and those diagnosed with HIV/AIDS. Pink eye affects 6 million people in the United States each year. There are three types: viral, bacterial, and allergic conjunctivitis. Antibiotics are rarely necessary to treat acute conjunctivitis. Most cases are caused by viral infections or allergies and do not respond to antibiotics. Antibiotics are often unnecessary for bacterial conjunctivitis because most cases are mild and would resolve on their own within 7 to 14 days without treatment. "This study opens the lid on overprescribing of antibiotics for a common eye infection," said lead author Nakul S. Shekhawat, M.D., M.P.H. "It shows that current treatment decisions for pink eye are not based on evidence, but are often driven more by the type of health care practitioner making the diagnosis and the patient's socioeconomic status than by medical reasons. The potential negative consequences are difficult to justify as we move toward focusing on value in health care." The authors say there are several reasons why antibiotics are over prescribed. It is a challenge to differentiate bacterial conjunctivitis from the viral and allergic forms. All three types may have overlapping features, such as a red eye, thin discharge, irritation, and sensitivity to light. Health care providers may tend to "err on the side of caution" and prescribe antibiotics "just in case." Patients are often unaware of the harmful effects of antibiotics and may falsely believe that antibiotics are necessary for the infection to resolve. The American Academy of Ophthalmology has issued guidance to the medical community on treatment for pink eye. The Academy tells health care providers to avoid prescribing antibiotics for viral conditions and to delay immediate treatment when the cause of conjunctivitis is unknown. About the American Academy of Ophthalmology The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org. Ophthalmology, the official journal of the American Academy of Ophthalmology, publishes original, peer-reviewed, clinically-applicable research. Topics include the results of clinical trials, new diagnostic and surgical techniques, treatment methods, technology assessments, translational science reviews and editorials. For more information, visit http://www. .


Morize A.,University of Paris Descartes | Bremond-Gignac D.,Ophthalmology | Daniel F.,University of Paris Descartes | Kapoula Z.,University of Paris Descartes
Investigative Ophthalmology and Visual Science | Year: 2017

PURPOSE. We hypothesized that saccade eye movement properties, particularly latency and binocular coordination, depend on vergence quality. METHODS. We studied 11 students clinically diagnosed for vergence disorders versus 8 healthy controls. Rehabilitation of vergence disorders was done with a novel research-based method, using vergence in midsagittal plane. Vergence and saccades were recorded in separate blocks, before and after five weekly rehabilitation sessions. RESULTS. Healthy controls showed higher accuracy and velocity of convergence and divergence relative to the vergence disorders group; then rehabilitation led to significant decrease of latency and increase of gain and peak velocity of vergence. Before rehabilitation of the vergence disorders, saccade parameters did not differ significantly from healthy controls, except the binocular coordination that was significantly deteriorated. Following vergence rehabilitation, saccade properties improved: The latency decreased significantly, the gain increased particularly at far, and the binocular coordination improved significantly. Latency and accuracy improved in a durable way, with values even better than the range of accuracy measured in healthy controls; binocular coordination of saccades, although improved, did not normalize. In healthy controls, binocular coordination was optimal at 40 cm (working distance), and the vergence disorders group showed improvement at 40 cm. Results confirm the hypothesis, which is further corroborated by the correlation between vergence and saccade latency. CONCLUSIONS. Results are in line with the hypothesis of permanent interaction between saccades and vergence, even when the task requires only saccades. Relevance of such interaction is emphasized by improvements of binocular saccades through the novel researchbased method of vergence rehabilitation. © 2017, Association for Research in Vision and Ophthalmology Inc. All rights reserved.


Oddone F.,Ophthalmology | Lucenteforte E.,University of Florence | Michelessi M.,Ophthalmology | Rizzo S.,University of Florence | And 3 more authors.
Ophthalmology | Year: 2016

Topic Macular parameters have been proposed as an alternative to retinal nerve fiber layer (RNFL) parameters to diagnose glaucoma. Comparing the diagnostic accuracy of macular parameters, specifically the ganglion cell complex (GCC) and ganglion cell inner plexiform layer (GCIPL), with the accuracy of RNFL parameters for detecting manifest glaucoma is important to guide clinical practice and future research. Methods Studies using spectral domain optical coherence tomography (SD OCT) and reporting macular parameters were included if they allowed the extraction of accuracy data for diagnosing manifest glaucoma, as confirmed with automated perimetry or a clinician's optic nerve head (ONH) assessment. Cross-sectional cohort studies and case-control studies were included. The QUADAS 2 tool was used to assess methodological quality. Only direct comparisons of macular versus RNFL parameters (i.e., in the same study) were conducted. Summary sensitivity and specificity of each macular or RNFL parameter were reported, and the relative diagnostic odds ratio (DOR) was calculated in hierarchical summary receiver operating characteristic (HSROC) models to compare them. Results Thirty-four studies investigated macular parameters using RTVue OCT (Optovue Inc., Fremont, CA) (19 studies, 3094 subjects), Cirrus OCT (Carl Zeiss Meditec Inc., Dublin, CA) (14 studies, 2164 subjects), or 3D Topcon OCT (Topcon, Inc., Tokyo, Japan) (4 studies, 522 subjects). Thirty-two of these studies allowed comparisons between macular and RNFL parameters. Studies generally reported sensitivities at fixed specificities, more commonly 0.90 or 0.95, with sensitivities of most best-performing parameters between 0.65 and 0.75. For all OCT devices, compared with RNFL parameters, macular parameters were similarly or slightly less accurate for detecting glaucoma at the highest reported specificity, which was confirmed in analyses at the lowest specificity. Included studies suffered from limitations, especially the case-control study design, which is known to overestimate accuracy. However, this flaw is less relevant as a source of bias in direct comparisons conducted within studies. Conclusions With the use of OCT, RNFL parameters are still preferable to macular parameters for diagnosing manifest glaucoma, but the differences are small. Because of high heterogeneity, direct comparative or randomized studies of OCT devices or OCT parameters and diagnostic strategies are essential. © 2016 American Academy of Ophthalmology.


Spiteri Cornish K.,University of Aberdeen | Lois N.,Queen's University of Belfast | Scott N.W.,University of Aberdeen | Burr J.,University of St. Andrews | And 6 more authors.
Ophthalmology | Year: 2014

Objective To determine whether internal limiting membrane (ILM) peeling improves anatomic and functional outcomes of full-thickness macular hole (FTMH) surgery when compared with the no-peeling technique. Design Systematic review and individual participant data (IPD) meta-analysis undertaken under the auspices of the Cochrane Eyes and Vision Group. Only randomized controlled trials (RCTs) were included. Participants and Controls Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling. Intervention Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling. Main Outcome Measures Primary outcome was best-corrected distance visual acuity (BCdVA) at 6 months postoperatively. Secondary outcomes were BCdVA at 3 and 12 months; best-corrected near visual acuity (BCnVA) at 3, 6, and 12 months; primary (after a single surgery) and final (after >1 surgery) macular hole closure; need for additional surgical interventions; intraoperative and postoperative complications; patient-reported outcomes (PROs) (EuroQol-5D and Vision Function Questionnaire-25 scores at 6 months); and cost-effectiveness. Results Four RCTs were identified and included in the review. All RCTs were included in the meta-analysis; IPD were obtained from 3 of the 4 RCTs. No evidence of a difference in BCdVA at 6 months was detected (mean difference, -0.04; 95% confidence interval [CI], -0.12 to 0.03; P = 0.27); however, there was evidence of a difference in BCdVA at 3 months favoring ILM peeling (mean difference, -0.09; 95% CI, -0.17 to -0.02; P = 0.02). There was evidence of an effect favoring ILM peeling with regard to primary (odds ratio [OR], 9.27; 95% CI, 4.98-17.24; P < 0.00001) and final macular hole closure (OR, 3.99; 95% CI, 1.63-9.75; P = 0.02) and less requirement for additional surgery (OR, 0.11; 95% CI, 0.05-0.23; P < 0.00001), with no evidence of a difference between groups with regard to intraoperative or postoperative complications or PROs. The ILM peeling was found to be highly cost-effective. Conclusions Available evidence supports ILM peeling as the treatment of choice for patients with idiopathic stage 2, 3, and 4 FTMH. © 2014 by the American Academy of Ophthalmology.


Gold D.R.,Ophthalmology | Zee D.S.,Ophthalmology
Seminars in Neurology | Year: 2016

Dizziness and vertigo are among the most common symptoms to bring a patient to a neurologist. Because symptoms are often vague and imprecise, a systematic approach is essential. By categorizing vestibular disorders based on timing, triggers, and duration, as well as through focused oculomotor and vestibular examinations, the vast majority of neuro-otologic diagnoses can be made at the bedside. Here the authors discuss historical and examination pearls for the most common neuro-otologic disorders. © Thieme Medical Publishers333 Seventh Avenue, New York, NY 10001, USA.


Mihajlovic M.,Bul. Zorana Djindjica 81 | Vlajkovic S.,Bul. Zorana Djindjica 81 | Jovanovic P.,Ophthalmology | Stefanovic V.,Bul. Zorana Djindjica 81
International Journal of Clinical and Experimental Pathology | Year: 2012

Primary mucosal melanomas arise from melanocytes located in mucosal membranes lining respiratory, gastrointestinal and urogenital tract. Although a majority of mucosal melanomas originate from the mucosa of the nasal cavity and accessory sinuses, oral cavity, anorectum, vulva and vagina, they can arise in almost any part of mucosal membranes. Most of mucosal melanomas occur in occult sites, which together with the lack of early and specific signs contribute to late diagnosis, and poor prognosis. Because of their rareness the knowledge about their pathogenesis and risk factors is insufficient, and also there are not well established protocols for staging and treatment of mucosal melanomas. Surgery is the mainstay of treatment, with trends toward more conservative treatment since radical surgery did not show an advantage for survival. Radiotherapy can provide better local control in some locations, but did not show improvement in survival. There is no effective systemic therapy for these aggressive tumors. Compared with cutaneous and ocular melanoma, mucosal melanomas have lowest percent of five-year survival. Recently revealed molecular changes underlying mucosal melanomas offer new hope for development of more effective systemic therapy for mucosal melanomas. Herein we presented a comprehensive review of various locations of primary melanoma along mucosal membranes, their epidemiological and clinical features, and treatment options. We also gave a short comparison of some characteristics of cutaneous and mucosal melanomas.


Chow S.-P.,Ophthalmology | Nastri A.,Royal Melbourne Hospital | Hardy T.,Ophthalmology
Clinical and Experimental Ophthalmology | Year: 2010

Abstract: Inflammatory myofibroblastic tumour (IMT) is a rare distinctive neoplasm of intermediate biological potential with a predilection for the abdominopelvic region and lung of children and young adults. It is histologically composed of spindle cells (myofibroblasts) in a myxoid to collagenous stroma with a prominent inflammatory infiltrate composed primarily of plasma cells and lymphocytes. Its pathogenesis is controversial. Arising most commonly in the lungs, only two cases of histopathologically confirmed IMT originating from the infratemporal and pterygopalatine fossae have been documented in the literature. Neither had orbital involvement. We now report the first case of IMT originating from the infratemporal fossa with orbital extension in a previously well 31-year-old woman. The patient presented with a 5-month history of intermittent right-sided headaches, progressive trismus and right lower lid swelling. She then developed right proptosis, diplopia and paraesthesia in the ophthalmic and maxillary divisions of her trigeminal nerve. Magnetic resonance imaging showed a soft tissue mass occupying most of the right infratemporal fossa with extension into pterygopalatine fossa and orbit. Provisional diagnosis from an open biopsy was nodular fasciitis. She underwent surgical debulking of the infratemporal fossa and lateral orbit through a coronal and trans-oral approach with trans-zygomatic access via total zygomatic osteotomy. Review of intraoperative specimens revised the diagnosis to IMT. Further management included systemic corticosteroids and adjuvant radiotherapy. © 2010 The Authors. Journal compilation © 2010 Royal Australian and New Zealand College of Ophthalmologists.


Sato T.,Ophthalmology | Ito M.,National Defense Medical College | Ishida M.,Ophthalmology | Karasawa Y.,Ophthalmology
Investigative Ophthalmology and Visual Science | Year: 2010

PURPOSE. To investigate the phototoxicity of persistent indocyanine green (ICG) under continuous visible light illumination and to determine whether blocking peak absorbance wavelengths of ICG is cytoprotective. METHODS. Cultured quail Müller cells were exposed to 0 to 5 mg/mL ICG for 30 seconds or 10 minutes and then were cultured in a colorless medium for 24 hours with or without continuous fluorescent lamp illumination. Cells exposed to 5 mg/mL ICG for 10 minutes were cultured under illumination filtered through a dichroic mirror that blocks red to nearinfrared, green, or blue wavelengths. After microscopic observation, cell viability and cell death were evaluated. RESULTS. ICG exposure followed by illuminated culture induced severe morphologic changes in cells, significant reductions in cell viability, and increases in cell death from apoptosis compared with exposure to ICG or illumination alone or with no exposure. Although ICG exposure at higher concentrations caused cell damage in a dose- and time-dependent manner, an increase in cell viability was noted for cells exposed to lower ICG concentrations. Blocking red to near-infrared wavelengths prevented the decrease in cell viability and the increase in cell death in the culture exposed to ICG followed by illuminated culture. CONCLUSIONS. Continuous fluorescent lamp illumination enhanced the cytotoxicity of persistent ICG on Müller cells in a dose- and exposure time-dependent manner. Blocking peak absorbance wavelengths of ICG prevented photodynamic cytotoxicity of persistent ICG under continuous visible light illumination in vitro. This culture system could be used to study the mechanisms of prevention of unfavorable outcomes in ICG-assisted surgery. © Association for Research in Vision and Ophthalmology.


Beta-blockers are among the most important groups of drugs for glaucoma therapy. The advantages of beta-blockers are a good efficacy in primary and secondary types of glaucoma, different dosages, clinical experiences over decades, easy use in combination with all other glaucoma drugs, and low costs. Timolol is the most frequently used drug in fixed glaucoma medications. In comparison with other glaucoma drugs, beta-blockers have the most severe systemic side effects and may interact with other systemic medication. © Georg Thieme Verlag KG Stuttgart - New York.


De Pinho Paes Barreto R.,Federal University of Rio de Janeiro | Biancardi A.L.,Ophthalmology | Salgueiro M.J.,Federal University of Rio de Janeiro
International Ophthalmology | Year: 2012

We describe a case of chronic conjunctivitis related to phthiriasis palpebrarum. A 36 year-old female presented with gradual pruritus and painless ocular hyperaemia over the previous 3 months. On examination, nasal pterygium, conjunctival hyperaemia, oedema, and mild hypertrophy of the palpebral margin were observed. A slit-lamp examination revealed numerous creamy oval structures approximately 1 mm in diameter localised in the middle area of the lashes, and bloody crusts and a semi-transparent deposit were present in the superior palpebral margin. Based on the observation of numerous nits at the base of the eyelashes and the ectoparasite in the palpebral margin, a diagnosis of phthiriasis palpebrarum was made. The patient was referred to an infectologist for evaluation of other sexually transmitted diseases and examination of other body areas. She was successfully treated with oral ivermectin, shampoo for ciliary hygiene and artificial tears. Other recommendations to avoid re-infestation were made, such as changing, washing and sterilising clothes, towels and sheets daily. This report emphasizes the importance of the correct diagnosis and management of this disease, considered as sexually transmitted. © 2012 Springer Science+Business Media B.V.

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