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Saxena R, Gupta V, Dhiman R, Joseph E, Agarkar S, Neena R, Magdalene D, Jethani J, Ganesh SC, Patil M, Gogri P, Gadaginamath S, Sen P, Sukhija J, Mishra D, Matalia JH, Sahu A, Kapoor S, Nishanth S, Chaurasia S, Pawar N, Deori N, Sivaraman V, Bordoloi A, Tibrewal S, Singh D, Prasad P, Phuljhele S, Sharma N. Low-dose atropine 0.01% for the treatment of childhood myopia: a pan-India multicentric retrospective study. Br J Ophthalmol 2024; 108:588-592. [PMID: 38290805 DOI: 10.1136/bjo-2023-324450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The objective of this study was to assess the efficacy of low-dose atropine 0.01% in controlling myopia progression among Indian children over a 2-year period. METHODS This retrospective study, conducted across 20 centres in India, monitored the progression of myopia over 2 years after initiating treatment with 0.01% atropine eye drops. This included children between 6 and 14 years with baseline myopia ranging from -0.5 D to -6 D, astigmatism≤-1.5 D, anisometropia ≤ -1 D and documented myopia progression of ≥0.5 D in the year prior to starting atropine. Subjects with any other ocular pathologies were excluded. RESULTS A total of 732 children were included in the data analysis. The mean age of the subjects was 9.3±2.7 years. The mean myopia progression at baseline (1 year before starting atropine) was -0.75±0.31 D. The rate of myopia progression was higher in younger subjects and those with higher baseline myopic error. After initiating atropine, myopia progression significantly decreased to -0.27±0.14 D at the end of the first year and -0.24±0.15 D at the end of the second year (p<0.001). Younger children (p<0.001) and higher baseline myopia (p<0.001) was associated with greater myopia progression and poor treatment response (p<0.001 for both). CONCLUSION Low-dose atropine (0.01%) effectively reduces myopia progression over 2 years in Indian children.
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Affiliation(s)
- Rohit Saxena
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Gupta
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rebika Dhiman
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Elizabeth Joseph
- Ophthalmology, Little Flower Hospital, Angamaly, Ernakulam, Kerala, India
| | - Sumita Agarkar
- Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - R Neena
- Giridhar Eye Institute, Kochi, Kerala, India
| | | | - Jitendra Jethani
- Pediatric Ophthalmology, Baroda Children Eyecare and Squint Clinic, Vadodara, Gujarat, India
| | - Sandra C Ganesh
- Paediatric Ophthalmology and Strabismus, Aravind Eye Care System, Coimbatore, Tamil Nadu, India
| | - Minal Patil
- Drishti Eye Institute, Dehardun, Uttrakahand, India
| | - Pooja Gogri
- Jyotirmay Eye Clinic, Thane, Maharashtra, India
| | | | - Pradhnya Sen
- Department of Paediatric Ophthalmology and Strabismus, Shri Sadguru Seva Sangh Trust Chitrakoot Centre, Chitrakoot, Madhya Pradesh, India
| | - Jaspreet Sukhija
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Mishra
- Regional institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jyoti H Matalia
- Pediatric Ophthalmology and strabismus, Narayana Nethralaya, Bangalore, India
| | - Anupam Sahu
- Pediatric Ophthalmology, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Smita Kapoor
- Pediatric Ophthalmology and Strabismus, Sankara Eye Hospital Coimbatore, Coimbatore, India
| | | | - Shweta Chaurasia
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Pawar
- Pediatric and Squint, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
- Kellogg Eye Centre, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Viswanathan Sivaraman
- Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Shailja Tibrewal
- Pediatric Ophthalmology and Strabismus, Shroff Charity Eye Hospital, New Delhi, Delhi, India
| | - Davinder Singh
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Prasad
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Jawaid I, Saunders K, Hammond CJ, Dahlmann-Noor A, Bullimore MA. Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners. Eye (Lond) 2024; 38:434-441. [PMID: 37717107 PMCID: PMC10858250 DOI: 10.1038/s41433-023-02718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/18/2023] Open
Abstract
The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the benefits of slowing myopia progression are considered against the side-effects of near blur and photophobia. More recently, randomised trials have focused on determining the optimum concentration of atropine leading to low-concentration atropine being used to manage myopia progression by practitioners across the world. Currently, in the United Kingdom, there is no licensed pharmacological intervention for myopia management. The aim of this review is to interpret the available data to inform clinical practice. We conducted a narrative review of the literature and identified peer-reviewed randomised controlled trials using the search terms 'myopia' and 'atropine', limited to the English language. We identified two key studies, which were the Atropine in the Treatment Of Myopia (ATOM) and Low-concentration Atropine for Myopia Progression (LAMP). Further studies were identified using the above search terms and the references from the identified literature. Atropine 0.01% has a modest effect on controlling axial length progression. Atropine 0.05% appears to be superior to atropine 0.01% in managing myopia progression. There is a dose-dependent rebound effect when treatment is stopped. Atropine is a well-tolerated, safe, and effective intervention. Treatment would be needed for several years and into adolescence, until axial length progression is stable.
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Affiliation(s)
- Imran Jawaid
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
| | - Kathryn Saunders
- School of Biomedical Sciences, Ulster University, Northern Ireland, UK
| | - Christopher J Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, King's College London, London, UK
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Bullimore MA, Brennan NA. Juvenile-onset myopia-who to treat and how to evaluate success. Eye (Lond) 2024; 38:450-454. [PMID: 37709925 PMCID: PMC10858167 DOI: 10.1038/s41433-023-02722-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia and the burden of lower degrees of myopia remains considerable. Effective treatments are available that slow progression and thus limit the final degree of myopia. In this review, the rationale for slowing progression is summarized, and a case made for treating all myopic children. Measurement of refractive error and axial length is reviewed, stressing the precision of optical biometry, but also the need for cycloplegic autorefraction. The factors influencing progression are considered and the available tools for interpretation of progression rate are discussed. Finally, the need to set attainable treatment goals is emphasized.
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Alacamli G. Response to: Brazilian guideline for pediatric cycloplegia and mydriasis. Arq Bras Oftalmol 2023; 87:0264. [PMID: 38088671 DOI: 10.5935/0004-2749.2023-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Goksu Alacamli
- Ophthalmology Departmant, Trakya University Faculty of Medicine and Education and Research Hospital, Edirne, Turkey
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Usmani E, Callisto S, Chan WO, Taranath D. Real-world outcomes of low-dose atropine therapy on myopia progression in an Australian cohort during the COVID-19 pandemic. Clin Exp Ophthalmol 2023; 51:775-780. [PMID: 37648227 DOI: 10.1111/ceo.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/30/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND To report the outcomes of low-dose atropine (0.01% and 0.05%) for preventing myopia progression in a real-world Australian cohort during the COVID-19 pandemic. METHODS Records of children presenting with myopia, from January 2016 to 2022, were retrospectively reviewed at a comprehensive ophthalmic practice. Children who discontinued treatment, ages >18, and cases with hereditary conditions were excluded. The rate of progression of myopia after treatment with atropine was compared with historical data to evaluate the effectiveness of the regime. RESULTS One hundred and one children (mean baseline spherical equivalent [SphE] [-3.70 +/- 2.09 D] and axial length [AL] [24.59 +/- 1.00 mm]) were analysed. The mean age of the children was 10.4 +/- 2.89 years and 61% were females. The average follow-up time was 17.9 +/- 12.5 months. The mean rate of progression of AL and SphE on 0.01% atropine eyedrops was 0.219 +/- 0.35 mm and - 0.250 +/- 0.86 D/year, respectively. 68.1% of the children treated with 0.01% atropine were mild progressors (<0.5 D change/year). Non-responders when commenced on a higher dose of atropine (0.05%) experienced a 93% (p = 0.012) and 30% reduction in SphE and AL growth rate, respectively. Family history, higher myopia or younger age at baseline and shorter duration of treatment were associated with steeper progression (p < 0.01). Both doses were well tolerated. CONCLUSIONS Low-dose atropine was shown to be beneficial in a real-world clinical setting, despite interruptions to follow-ups secondary to COVID-19 pandemic. A 0.05% dose of atropine may be effective in cases where 0.01% was ineffective.
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Affiliation(s)
- Eiman Usmani
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Stephanie Callisto
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Weng Onn Chan
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Deepa Taranath
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
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Wang F, Peng W, Jiang Z. Repeated Low-Level Red Light Therapy for the Control of Myopia in Children: A Meta-Analysis of Randomized Controlled Trials. Eye Contact Lens 2023; 49:438-446. [PMID: 37565498 DOI: 10.1097/icl.0000000000001020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Repeated low-level red light (RLRL) therapy has been suggested to be effective in children with myopia. However, evidence from randomized controlled trials (RCTs) is still limited. We performed a meta-analysis of RCTs to systematically evaluate the efficacy of RLRL on changes of axial length (AL) and cycloplegic spherical equivalent refraction (SER) in children with myopia. METHODS Relevant RCTs were obtained through a search of electronic databases including PubMed, Embase, Cochrane Library, Wanfang, and China National Knowledge Infrastructure from inception to September 15, 2022. A random-effects model was used to pool the results after incorporating the influence of potential heterogeneity. Subgroup analyses were performed according to the control treatment and follow-up duration. RESULTS A total of seven RCTs involving 1,031 children with myopia, aged 6 to 16 years, were included in the meta-analysis. Compared with control treatment without RLRL, treatment with RLRL was associated with a significantly reduced AL (mean difference [MD]: -0.25 mm, 95% confidence interval [CI]: -0.32 to -0.17, P <0.001; I 2 =13%) and a significantly increased cycloplegic SER (MD: 0.60 D, 95% CI: 0.44-0.76, P <0.001; I 2 =20%). Further subgroup analyses showed consistent results in studies comparing children wearing single vision lenses and those receiving active treatment including orthokeratology or low-dose atropine eye drops, as well as studies of treatment duration of 6 and 12 months. CONCLUSIONS Results of the meta-analysis suggested that RLRL treatment is effective for slowing down the progression of myopia in children aged 6 to 16 years.
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Affiliation(s)
- Fei Wang
- Department of Ophthalmology (F.W., Z.J.), The Second Hospital of Anhui Medical University, Hefei, China; and Hefei Institutes of Physical Science (W.P.), Chinese Academy of Sciences, Hefei, China
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Dahlmann-Noor A. Low-concentration atropine: Co-management of myopia in children and young people in the UK - prospective case series. Eur J Ophthalmol 2023; 33:NP140-NP141. [PMID: 37128630 DOI: 10.1177/11206721231172238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Annegret Dahlmann-Noor
- Moorfields Eye Hospital, Children's Service, London, UK
- NIHR Moorfields Biomedical Research Centre, London, UK
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Woreta FA, Lindsley KB, Gharaibeh A, Ng SM, Scherer RW, Goldberg MF. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev 2023; 3:CD005431. [PMID: 36912744 PMCID: PMC10010597 DOI: 10.1002/14651858.cd005431.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Traumatic hyphema is the entry of blood into the anterior chamber, the space between the cornea and iris, following significant injury to the eye. Hyphema may be associated with significant complications that uncommonly cause permanent vision loss. Complications include elevated intraocular pressure, corneal blood staining, anterior and posterior synechiae, and optic nerve atrophy. People with sickle cell trait or disease may be particularly susceptible to increases in intraocular pressure and optic atrophy. Rebleeding is associated with an increase in the rate and severity of complications. OBJECTIVES To assess the effectiveness of various medical interventions in the management of traumatic hyphema. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 3); MEDLINE Ovid; Embase.com; PubMed (1948 to March 2022); the ISRCTN registry; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The last date of the search was 22 March 2022. SELECTION CRITERIA Two review authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. We included randomized and quasi-randomized trials that compared various medical (non-surgical) interventions versus other medical interventions or control groups for the treatment of traumatic hyphema following closed-globe trauma. We applied no restrictions on age, gender, severity of the closed-globe trauma, or level of visual acuity at time of enrollment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane and assessed the certainty of evidence using GRADE. MAIN RESULTS We included 23 randomized and seven quasi-randomized studies with a total of 2969 participants. Interventions included antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. We found no evidence of an effect on visual acuity for any intervention, whether measured within two weeks (short term) or for longer periods. In a meta-analysis of two trials, we found no evidence of an effect of aminocaproic acid on long-term visual acuity (RR 1.03, 95% confidence interval (CI) 0.82 to 1.29) or final visual acuity measured up to three years after the hyphema (RR 1.05, 95% CI 0.93 to 1.18). Oral tranexamic acid appeared to provide little to no benefit on visual acuity in four trials (RR 1.12, 95% CI 1.00 to 1.25). The remaining trials evaluated the effects of various interventions on short-term visual acuity; none of these interventions was measured in more than one trial. No intervention showed a statistically significant effect (RRs ranged from 0.75 to 1.10). Similarly, visual acuity measured for longer periods in four trials evaluating different interventions was also not statistically significant (RRs ranged from 0.82 to 1.02). The evidence supporting these findings was of low or very low certainty. Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (RR 0.28, 95% CI 0.13 to 0.60), as assessed in six trials with 330 participants. A sensitivity analysis omitting two studies not using an intention-to-treat analysis reduced the strength of the evidence (RR 0.43, 95% CI 0.17 to 1.08). We obtained similar results for topical aminocaproic acid (RR 0.48, 95% CI 0.20 to 1.10) in two trials with 131 participants. We assessed the certainty of the evidence as low. Systemic tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (RR 0.33, 95% CI 0.21 to 0.53) in seven trials with 754 participants, as did aminomethylbenzoic acid (RR 0.10, 95% CI 0.02 to 0.41), as reported in one study. Evidence to support an associated reduction in risk of complications from secondary hemorrhage (i.e. corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no evidence of an effect on the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose. The number of days for the primary hyphema to resolve appeared to be longer with the use of systemic aminocaproic acid compared with no use, but this outcome was not altered by any other intervention. The available evidence on usage of systemic or topical corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials. We found no evidence of an effect between a single versus binocular patch on the risk of secondary hemorrhage or time to rebleed. We also found no evidence of an effect on the risk of secondary hemorrhage between ambulation and complete bed rest. AUTHORS' CONCLUSIONS We found no evidence of an effect on visual acuity of any of the interventions evaluated in this review. Although the evidence was limited, people with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhage. However, hyphema took longer to clear in people treated with systemic aminocaproic acid. There is no good evidence to support the use of antifibrinolytic agents in the management of traumatic hyphema, other than possibly to reduce the rate of secondary hemorrhage. The potentially long-term deleterious effects of secondary hemorrhage are unknown. Similarly, there is no evidence to support the use of corticosteroids, cycloplegics, or non-drug interventions (such as patching, bed rest, or head elevation) in the management of traumatic hyphema. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value.
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Affiliation(s)
- Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristina B Lindsley
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Almutez Gharaibeh
- Department of Special Surgery-Ophthalmology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Sueko M Ng
- Department of Ophthalmology, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Roberta W Scherer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Morton F Goldberg
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Liang X, Wei S, Li SM, An W, Du J, Sun Y, Gan J, Bai W, Cai Z, Song Q, Yin L, Wang N. Effect of Atropine 0.01% Eye Drops on the Difference in Refraction and Axial Length between Right and Left Eyes. Ophthalmic Res 2023; 66:496-505. [PMID: 36603556 DOI: 10.1159/000528878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study sought to determine whether the application of 0.01% atropine eye drops could impact the disparity in refraction and axial length (AL) between the right and left eyes in Chinese children. METHODS The study was designed as a double-blind, placebo-controlled randomized trial. A total of 220 children aged 6-12 years were recruited from the Beijing Tongren Hospital in Beijing, China. Participants were randomized in a 1:1 ratio and were prescribed 0.01% atropine or placebo eye drops to be administered once a night to both eyes for the duration of 1 year. The cycloplegic refraction and AL were recorded including baseline, 6 months, and again at the 12 months. RESULTS After 1-year follow-up period, 76 (69%) and 83 (75%) subjects of the initial 220 participants were identified as the 0.01% atropine and placebo groups, respectively. The inter-ocular difference in spherical equivalent refraction (SER) and AL demonstrated stable values in the 0.01% atropine treatment group (SER: p = 0.590; AL: p = 0.322) analyzed after 1 year, but found a significant increase (SER: p < 0.001; AL: p = 0.001) in the placebo group. Furthermore, over 1 year, eyes with greater myopia in the atropine group exhibited slower myopia progression (0.45 ± 0.44 D) than the lesser myopic eye (0.56 ± 0.44 D) (p = 0.003). CONCLUSION This study demonstrated that 0.01% atropine could maintain the inter-ocular SER and AL difference. And 0.01% atropine appeared to be more effective in delaying the progression of myopia in eyes with more myopia than in the less myopic eyes.
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Affiliation(s)
- Xintong Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Shifei Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Shi-Ming Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Wenzai An
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jialing Du
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yunyun Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jiahe Gan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weiling Bai
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Zhining Cai
- Department of Clinical Medicine, Capital Medical University, Beijing, China
| | - Qianqian Song
- Department of Clinical Medicine, Capital Medical University, Beijing, China
| | - Lei Yin
- Department of Ophthalmology, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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Ling CJM, Zhang KY, Taubenslag KJ, Alexander N, Champ K, Murali N. The Mydriatic Red Eye as the Initial Presentation of Syphilis. J Emerg Med 2022; 63:296-299. [PMID: 36038437 DOI: 10.1016/j.jemermed.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Syphilis is a sexually transmitted infection that has been increasing in prevalence since the early 2000s. Ocular involvement occurs in a minority of patients and must be in the differential diagnosis for patients who present with red eye and uveitis. CASE REPORT A 29-year-old woman presented to the emergency department with a painful, mydriatic red eye. Review of systems revealed a rash as well as a recent genital lesion and, on further questioning, she admitted to a history of intravenous drug use and high-risk sexual activity. Ophthalmology was consulted and the patient was diagnosed with bilateral uveitis. Serologic testing was positive for syphilis, and she was admitted and treated with intravenous penicillin, with resolution of her uveitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Red eye is a common ocular symptom in patients presenting to the emergency department. The differential diagnosis of the red eye is broad and can range from benign etiologies, such as conjunctivitis, to life- and sight-threatening conditions, such as endogenous endophthalmitis. Systemic diseases such as syphilis may present with primarily ocular symptoms, and ocular syphilis must be identified and managed appropriately to prevent devastating sequelae.
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Affiliation(s)
- Carlthan J M Ling
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland
| | - Kevin Y Zhang
- Creighton University Medical School, Omaha, Nebraska
| | - Kenneth J Taubenslag
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicole Alexander
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathryn Champ
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, Maryland
| | - Neeraja Murali
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Zhang XJ, Zhang Y, Yam JC. Reply to Comment on: The Association of Choroidal Thickening by Atropine with Treatment Effects for Myopia: Two-Year Clinical Trial of the LAMP Study. Am J Ophthalmol 2022; 241:291-292. [PMID: 35660424 DOI: 10.1016/j.ajo.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; 4/F, Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; 4/F, Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; 4/F, Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong
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Ranabhat S, Byanju R, Khadka S. Behcet's Disease with Absent HLA Serotyping and Pathergy Test. Kathmandu Univ Med J (KUMJ) 2021; 19:519-521. [PMID: 36259199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Behcet's disease is a multisystemic vasculitis of unknown etiopathogenesis characterized by recurrent acute inflammation. A 30-year male presented with progressive blurred vision in both eye for one month associated with photophobia, redness and ocular pain. On presentation best corrected visual acuity was 6/9 both eyes. Bilateral ocular examination of anterior segment demonstrated occasional cells. Treatment history of multiple joint pain along with oral aphthous ulcers. Erythematous papulopustular lesion over face, neck, trunk and genital ulcers were being treated. Irrespective of negative human leucocyte antigen B51 and pathergy, patient was diagnosed as Behcet's disease on the basis of clinical criteria and started with topical steroid and cycloplegic. At one-month, ocular symptoms were relieved. Behcet's disease is a rare, autoimmune disease, which lacks universal pathognomonic test and investigations, therefore diagnosis is primarily done with international criteria for Behcet's disease. Multidisciplinary approach certainly helps in early diagnosis and eliminating morbidity.
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Affiliation(s)
- S Ranabhat
- Department of Vitreo-retina, Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal
| | - R Byanju
- Department of Vitreo-retina, Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal
| | - S Khadka
- Department of Vitreo-retina, Nepal Eye Hospital, Kathmandu, Nepal
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Leonard BC, Kermanian CS, Michalak SR, Kass PH, Hollingsworth SR, Good KL, Maggs DJ, Thomasy SM. A Retrospective Study of Corneal Endothelial Dystrophy in Dogs (1991-2014). Cornea 2021; 40:578-583. [PMID: 32947393 PMCID: PMC7960559 DOI: 10.1097/ico.0000000000002488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To retrospectively evaluate the clinical data, diagnostic tests, treatments, and outcomes for dogs with corneal endothelial dystrophy (CED) and determine risk factors for CED when compared with a canine reference population. METHODS Medical records of 99 dogs (1991-2014) diagnosed with CED at the University of California Davis Veterinary Medical Teaching Hospital were reviewed and compared with 458,680 dogs comprising the general hospital population during the study period. Retrieved data included signalment, examination findings, diagnoses, treatments, and outcomes associated with CED. The exact Pearson χ2 test or exact Kruskal-Wallis test was used to compare parameters between the groups. Progression of corneal edema was assessed using 3 independent Kaplan-Meier curves, identifying clinically significant changes in corneal opacity. RESULTS Boston terriers, German wirehaired pointers, and Dachshunds were overrepresented in the CED-affected group, whereas Labradors were underrepresented. Dogs older than 11 years were overrepresented in the CED-affected group, whereas intact dogs were underrepresented. Surgical intervention was performed (n = 11) based on the severity of disease and secondary complications from CED. Median time to progression of corneal edema was 1) 368 days when an at-risk eye initially without edema developed edema at a subsequent visit, 2) 701 days when there was progression from mild to marked corneal edema, and 3) 340 days when there was progression from focal to diffuse corneal edema. CONCLUSIONS Many CED-affected dogs progress over months to years without surgical intervention, making dogs with CED a useful model for studying genetic predispositions and development of novel therapeutics for Fuchs endothelial corneal dystrophy.
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Affiliation(s)
- Brian C. Leonard
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Celine S. Kermanian
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Sarah R. Michalak
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Philip H. Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Steven R. Hollingsworth
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Kathryn L. Good
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - David J. Maggs
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Sara M. Thomasy
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
- Department of Ophthalmology & Vision Science, School of Medicine, University of California, Davis, Davis, CA
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Abstract
BACKGROUND This study aimed to investigate the short-term effect of cycloplegia on higher-order aberrations (HOAs) in school-age myopic children who received 0.25% atropine for cycloplegic refraction. METHODS We performed a retrospective chart review of 24 myopic children between the ages of 5 and 15 years, who had received one topical drop of 0.25% atropine for three consecutive nights before undergoing cycloplegic refraction. Auto-refraction, visual acuity, and HOAs measured with the iTrace aberrometer were compared before and after atropine use. To account for the effect of cycloplegia, the amount of HOAs under matching scanning sizes was compared. RESULTS There were statistically significant differences in the spherical equivalent, with a hyperopic shift after atropine use (p < 0.001). Corrected visual acuity and spherical aberrations showed no significant change under the respective pupil and scanning sizes before and after atropine use. Under identical scanning sizes, there was a significant change in total spherical aberration (from 0.03 to 0.06 μm, p = 0.044) and internal spherical aberration (from -0.10 to -0.05 μm, p = 0.049) after atropine use. Differences in corneal spherical aberration were insignificant. CONCLUSION The positive shift of spherical aberration induced by the inhibition of accommodation in myopic children may have a possible effect against myopic progression. Future studies can focus on the long-term effect on HOAs and impact on visual quality with lower concentrations of atropine.
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Affiliation(s)
- Yih-Shiuan Kuo
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - May-Yung Yen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Sue-Tien Ophthalmology Clinic, Yin Sue-Tien Medical foundation, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
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Shoshany TN, Michalak SM, Chinn RN, Staffa SJ, Hunter DG. Evaluating Amblyopia Treatment Success Using the American Academy of Ophthalmology IRIS50 Measures. Ophthalmology 2020; 127:836-838. [PMID: 32199623 DOI: 10.1016/j.ophtha.2020.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/10/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - David G Hunter
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
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Diaz-Cespedes RA, Toro-Giraldo D, Olate-Perez A, Hervas-Ontiveros A, Garcia-Delpech S, Udaondo-Mirete P. Contribution of the Visante ® OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:391-395. [PMID: 30738599 DOI: 10.1016/j.oftal.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.
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Affiliation(s)
| | - D Toro-Giraldo
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Olate-Perez
- Servicio de Oftalmología, Hospital Obispo Polanco de Teruel, Teruel, España
| | | | - S Garcia-Delpech
- Servicio de Oftalmología, Hospital Universitario y Politécnico de la Fe, Valencia, España
| | - P Udaondo-Mirete
- Servicio de Oftalmología, Hospital Universitario y Politécnico de la Fe, Valencia, España
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Bentata R, Chan H, Coste V, Delyfer MN, Chan G, Korobelnik JF. [Persistent pupillary membrane (Wachendorf membrane)]. J Fr Ophtalmol 2019; 42:808-810. [PMID: 31147100 DOI: 10.1016/j.jfo.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/13/2019] [Indexed: 11/18/2022]
Affiliation(s)
- R Bentata
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France.
| | - H Chan
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - M-N Delyfer
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - G Chan
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - J-F Korobelnik
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
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Abstract
BACKGROUND Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications can lead to permanent impairment of vision. People with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. OBJECTIVES To assess the effectiveness of various medical interventions in the management of traumatic hyphema. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); MEDLINE Ovid; Embase.com; PubMed (1948 to June 2018); the ISRCTN registry; ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The date of the search was 28 June 2018. SELECTION CRITERIA Two review authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical (non-surgical) interventions versus other medical intervention or control groups for the treatment of traumatic hyphema following closed-globe trauma. We applied no restrictions regarding age, gender, severity of the closed-globe trauma, or level of visual acuity at the time of enrollment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data for the primary outcomes, visual acuity and time to resolution of primary hemorrhage, and secondary outcomes including: secondary hemorrhage and time to rebleed; risk of corneal blood staining, glaucoma or elevated intraocular pressure, optic atrophy, or peripheral anterior synechiae; adverse events; and duration of hospitalization. We entered and analyzed data using Review Manager 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD). MAIN RESULTS We included 20 randomized and seven quasi-randomized studies with a total of 2643 participants. Interventions included antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest.We found no evidence of an effect on visual acuity for any intervention, whether measured within two weeks (short term) or for longer periods. In a meta-analysis of two trials, we found no evidence of an effect of aminocaproic acid on long-term visual acuity (RR 1.03, 95% confidence interval (CI) 0.82 to 1.29) or final visual acuity measured up to three years after the hyphema (RR 1.05, 95% CI 0.93 to 1.18). Eight trials evaluated the effects of various interventions on short-term visual acuity; none of these interventions was measured in more than one trial. No intervention showed a statistically significant effect (RRs ranged from 0.75 to 1.10). Similarly, visual acuity measured for longer periods in four trials evaluating different interventions was also not statistically significant (RRs ranged from 0.82 to 1.02). The evidence supporting these findings was of low or very low certainty.Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (RR 0.28, 95% CI 0.13 to 0.60) as assessed in six trials with 330 participants. A sensitivity analysis omitting two studies not using an intention-to-treat analysis reduced the strength of the evidence (RR 0.43, 95% CI 0.17 to 1.08). We obtained similar results for topical aminocaproic acid (RR 0.48, 95% CI 0.20 to 1.10) in two studies with 121 participants. We assessed the certainty of these findings as low and very low, respectively. Systemic tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (RR 0.31, 95% CI 0.17 to 0.55) in five trials with 578 participants, as did aminomethylbenzoic acid as reported in one study (RR 0.10, 95% CI 0.02 to 0.41). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e. corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no evidence of an effect in the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose. The number of days for the primary hyphema to resolve appeared to be longer with the use of systemic aminocaproic acid compared with no use, but this outcome was not altered by any other intervention.The available evidence on usage of systemic or topical corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials.We found no evidence of an effect between a single versus binocular patch or ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed. AUTHORS' CONCLUSIONS We found no evidence of an effect on visual acuity by any of the interventions evaluated in this review. Although evidence was limited, it appears that people with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema took longer clear in people treated with systemic aminocaproic acid.There is no good evidence to support the use of antifibrinolytic agents in the management of traumatic hyphema other than possibly to reduce the rate of secondary hemorrhage. Similarly, there is no evidence to support the use of corticosteroids, cycloplegics, or non-drug interventions (such as binocular patching, bed rest, or head elevation) in the management of traumatic hyphema. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value.
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Affiliation(s)
- Almutez Gharaibeh
- Faculty of Medicine, The University of JordanDepartment of Special Surgery‐OphthalmologyP.O. Box 13046AmmanJordan
| | - Howard I Savage
- Kaiser Permanente Largo Medical Center1221 Mercantile LaneLargoMarylandUSA20774
| | - Roberta W Scherer
- Johns Hopkins Bloomberg School of Public HealthDepartment of EpidemiologyRoom W6138615 N. Wolfe St.BaltimoreMarylandUSA21205
| | - Morton F Goldberg
- Johns Hopkins University School of MedicineWilmer Eye Institute600 N. Wolfe StreetMaumenee, 7th floorBaltimoreMarylandUSA21287
| | - Kristina Lindsley
- Johns Hopkins Bloomberg School of Public HealthDepartment of EpidemiologyRoom W6138615 N. Wolfe St.BaltimoreMarylandUSA21205
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Pittman HJ. A 49-Year-Old Male Private Snake Keeper With Venom-Spit Ophthalmia. J Emerg Nurs 2018; 45:712-714. [PMID: 30563705 DOI: 10.1016/j.jen.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/24/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
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Nunn A, Sturek JM, Reuss JE, Rein MF, Heysell SK. Subacute loss of vision in one eye · rash on hands and feet · plaques with scaling on genitals · Dx? J Fam Pract 2017; 66:E9-E11. [PMID: 29202152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 67-year-old man presented to the hospital with subacute loss of vision in his left eye. The visual changes began 2 weeks earlier, with a central area of visual loss that had since progressed to near complete vision loss in the left eye. Physical examination revealed patchy alopecia, a scaling and hyperkeratotic rash of his hands and feet, and blanching, erythematous plaques with associated scaling on the scrotum and glans penis. Ophthalmologic examination revealed 1/200 vision in his left eye with a large plaque occupying a substantial portion of the superior quadrant, smaller perifoveal plaques in both of his eyes, and a small infiltrate above the left optic nerve head. The patient also described fatigue, loss of taste, and an unintentional weight loss of 7 to 10 kg over the previous 6 months. He had seen his primary care provider 3 months prior for a burning sensation and scaling rash on his feet and hands, and was prescribed a topical steroid.
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Affiliation(s)
- Abigail Nunn
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Jeffrey M Sturek
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Joshua E Reuss
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Michael F Rein
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Ortiz Castillo JV, Teus Guezala MA. Efficacy and safety of pharmacological mydriasis in pre-term infants. Arch Soc Esp Oftalmol 2016; 91:204-205. [PMID: 26710659 DOI: 10.1016/j.oftal.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/20/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Affiliation(s)
- J V Ortiz Castillo
- Sección de retina del Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
| | - M A Teus Guezala
- Cátedra de Oftalmología por la Universidad de Alcalá, Alcalá de Henares, Madrid, España; Servicio de Oftalmología, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, España
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West S, Williams C. Amblyopia in children (aged 7 years or less). BMJ Clin Evid 2016; 2016:0709. [PMID: 26731564 PMCID: PMC4701128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7-8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for amblyopia in children aged 7 years or less? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 14 full publications. Of the 14 full articles evaluated, two systematic reviews were updated and three RCTs and two follow-up studies were added at this update. We performed a GRADE evaluation for nine PICO combinations. CONCLUSIONS In this systematic overview we categorised the efficacy for three interventions, based on information about the effectiveness and safety of glasses, occlusion, or penalisation with atropine.
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Shetty R, Deshpande K, Kemmanu V, Kaweri L. The Role of Aberrometry in Accommodative Spasm After Myopic Photorefractive Keratectomy. J Refract Surg 2015; 31:851-3. [PMID: 26653732 DOI: 10.3928/1081597x-20151118-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the role of aberrometry in a case of accommodative spasm following myopic photorefractive keratectomy (PRK). METHODS Observational case report. RESULTS One month following myopic PRK, a 33-year-old healthy woman complained of seeing multiple images and headache that interfered with her daily activities. Her corrected distance visual acuity (CDVA) was 20/40 in the right eye and 20/25 in the left eye with a manifest refraction of -0.75 -0.50 × 165° in the right eye and plano -0.50 × 20° in the left eye. Cycloplegic refraction was plano -0.50 × 165° in the right eye and plano -0.5 × 20° in the left eye. Ray tracing aberrometry showed variable refraction with increase in internal defocus, which after cycloplegia reduced from 1.019 to 0.142 µm in the right eye and 0.366 to 0.230 µm in the left eye. Total ocular aberrations decreased by 53.16% in the right eye (range: 1.511 to 0.708 µm) and 18.77% (range: 0.671 to 0.545 µm) in the left eye; corresponding simulated Snellen visual acuity charts also showed improvement. The patient was treated with one drop of cyclopentolate 1% three times a day for 6 weeks, following which headache and ghosting of images completely resolved. CONCLUSIONS Accommodative spasm should be considered in patients with visual disturbances of uncertain causes following myopic refractive surgery. Ray tracing aberrometry can serve as a diagnostic and educative tool in managing such patients.
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John D, Irodi A, John S, Kuriakose T, Jacob P. Unusual presentation of subretinal cysticercosis with hypopyon uveitis. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e17-9. [PMID: 25871533 DOI: 10.3928/01913913-20150311-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/14/2015] [Indexed: 11/20/2022]
Abstract
Subretinal cysticercosis presenting with anterior uveitis and hypopyon is rare. A 7-year-old boy presented with pain and hypopyon in the right eye. Ultrasonography showed a cystic lesion with scolex. Because visual prognosis was poor, he was treated conservatively. Timely diagnosis would facilitate early therapy and prevent visual loss.
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Recko M, Stahl ED. Childhood myopia: epidemiology, risk factors, and prevention. Mo Med 2015; 112:116-121. [PMID: 25958656 PMCID: PMC6170055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Our understanding of the dynamic interaction between the eye's growth and its ability to adapt to maintain vision has shown that childhood myopia is a significant prediction of progressive myopia and the potentially severe ocular comorbidities associated with it. It is important for us to better understand this process and its risk factors in order to better develop a prevention and treatment strategy. This article will discuss the epidemiology, risk factors and current therapeutic regimens for reducing myopic progression.
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Wallace DK, Lazar EL, Repka MX, Holmes JM, Kraker RT, Hoover DL, Weise KK, Waters AL, Rice ML, Peters RJ. A randomized trial of adding a plano lens to atropine for amblyopia. J AAPOS 2015; 19:42-8. [PMID: 25727586 PMCID: PMC4354879 DOI: 10.1016/j.jaapos.2014.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some children have residual amblyopia after treatment with atropine eyedrops for amblyopia due to strabismus and/or anisometropia. We conducted a randomized clinical trial to evaluate the effectiveness of augmenting the effect of atropine by changing the lens over the fellow eye to plano in children with residual amblyopia. METHODS A total of 73 children 3 to <8 years of age (mean, 5.8 years) with stable residual amblyopia (range, 20/32 to 20/160, mean 20/63(+1)) were enrolled after at least 12 weeks of atropine treatment of the fellow eye. Participants were randomly assigned to continuing weekend atropine alone or wearing a plano lens over the fellow eye (while continuing atropine). The primary outcome was assessed at 10 weeks, and participants were followed until improvement ceased. RESULTS At the 10-week primary outcome visit, amblyopic-eye visual acuity had improved an average of 1.1 lines with the plano lens and 0.6 lines with atropine only (difference adjusted for baseline visual acuity = + 0.5 line; 95% CI, -0.1 to +1.2). At the primary outcome or later visit when the best-measured visual acuity was observed, the mean amblyopic-eye improvement from baseline was 1.9 lines with the plano lens and 0.8 lines with atropine only. CONCLUSIONS When amblyopic-eye visual acuity stops improving with atropine treatment, there may be a small benefit to augmenting atropine therapy with a plano lens over the fellow eye. However, the effect was not statistically significant, and the large confidence interval raises the possibility of no benefit or a benefit larger than we observed. A larger study would be necessary to get a more precise estimate of the treatment effect.
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Samarai V, Haghighi N, Sharifi N. Pupil dilation with intra-cameral lidocaine versus topical midriatics during phacoemulsification. Glob J Health Sci 2014; 6:8-12. [PMID: 25363172 PMCID: PMC4796471 DOI: 10.5539/gjhs.v6n7p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/11/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate pupil dilation with intra-cameral injection of preservative-free lidocaine 1% (ICL) versus topical eye midriatics during phacoemulsification. METHODS This case-control study included 40 patients with similar bilateral senile cataract scheduled for phacoemulsification and intraocular lens (IOL) implantation. patient's first eye received topical midriatic eye drops as control group and next eye operated by intra cameral preservative free lidocaine 1% without any preoperative or intraoperative midriatics. We did not add epinephrine to the irrigating solution in either group. The first eyes received 3 drops of cyclopentolate 1% and tropicamide 1% each 5 minutes, with first dose 60 minutes before surgery. The horizontal pupil diameter was measured before and after pupil dilation using the same caliper with operation microscope total surgical time was recorded in both groups. RESULTS Patients included 20 male and 20 female with mean age of 72 and 70.9 years old .4 patients were diabetic and 11 cases had pseudo-exfoliation. Pupil diameter increased in both case and control groups significantly (P value<0.0) but the difference between mean increase in pupil size wasn't significantly different. Mean increase in pupil size was significantly greater in patients without pseudo-exfoliation (4.10 mm vs 3.85 mm, independent t test, P<0.05). There was no significant difference between diabetic and non- diabetic patients regarding of pre- and post-injection diameter of the pupil. CONCLUSION Intra-cameral preservative-free lidocaine 1% supply adequate midriasis during cataract surgery by itself.
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Klysik A, Korzycka D. Sub-Tenon injection of 2% lidocaine prevents intra-operative floppy iris syndrome (IFIS) in male patients taking oral α-adrenergic antagonists. Acta Ophthalmol 2014; 92:535-40. [PMID: 23890368 DOI: 10.1111/aos.12205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. METHODS From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α-adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra-cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and iris prolapse. RESULTS Intra-operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00). CONCLUSION Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α-adrenergic inhibitors as compared with intra-cameral lidocaine.
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Affiliation(s)
- Anna Klysik
- Department of Ophthalmology, Medical University of Lodz, Lodz, PolandDepartment of Ophthalmology, Hospital of the Ministry of Internal Affairs and Administration, Lodz, Poland
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Zhao K, Shi X. [Learn new version of Preferred Practice Pattern to further standardize the diagnosis and treatment of amblyopia]. Zhonghua Yan Ke Za Zhi 2014; 50:481-484. [PMID: 25312454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The introduction of Preferred Practice Patterns (PPP) into China has given ophthalmologists in China more opportunities to acquaint themselves with international clinical guidelines for eye care, including its developing principles, methods and the application value. It had brought significant effects on the fast improvement of clinical eye care and standardization of diagnosis and treatment of eye diseases in China, and promoted the international academic exchanges. The 2nd Chinese version of PPPs translated by Prof. Jialiang Zhao was officially published in November, 2013. The new version of PPP for amblyopia adopted the newest standard for grading of evidence strength and recommendation assessment, and emphasizes the practicability based on evidence. New explanations of the definition of amblyopia are added according to the recent research progresses in amblyopia. The diagnostic criteria of best visual acuity for bilateral amblyopia at different ages is given with new specifications. Comprehensive and practical suggestions on the examination methods for amblyopia are provided from the qualitative assessment of visual acuity, the choice of eye chart, to the use of cycloplegic agents. In the aspect of the treatment of amblyopia, based on the findings of recent multi-central random controlled clinical trials, not only strong recommendations are provided, but also the insufficiency of evidence supporting for some choices of therapy is pointed out. The necessity of the follow-up evaluation after the cessation of the treatment of amblyopia is emphasized too. In the aspect of the prevention of amblyopia, the new amblyopia PPP points out the importance of the early-period screening of amblyopia, and that the healthcare insurance plans should cover timely screening, treatment, and monitoring for recurrence of amblyopia. This article deciphers the essential contents of the new version of Chinese PPP for amblyopia, and aims to promote the standardization of the diagnosis and treatment of amblyopia with our ophthalmic colleagues in China.
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Affiliation(s)
- Kanxing Zhao
- Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Hospital and Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China.
| | - Xuefeng Shi
- Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Hospital and Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Agrawal H, Gupta SK, Dokania G, Dray PB, Aref AA, Traish A, David RJ. A neonate with bilateral corneal opacities and glaucoma. Pediatr Ann 2014; 43:60-3. [PMID: 24512154 DOI: 10.3928/00904481-20140127-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Myopia has been increasing in prevalence throughout the world, reaching over 90% in some East Asian populations. There is increasing evidence that whereas genetics clearly have an important role, the type of visual environment to which one is exposed to likely influences the onset, progression, and cessation of myopia. Consequently, attempts to either modify the environment or to reduce the exposure of the eye to various environmental stimuli to eye growth through the use of various optical devices are well under way at research centers around the globe. The most promising of current treatments include low-percentage atropine, bifocal soft contact lenses, orthokeratology, and multifocal spectacles. These methods are discussed briefly and are then categorized in terms of their expected degree of myopia progression control. A clinical strategy is presented for selecting the most effective treatment for the appropriate type of patient at the optimal stage of refractive development to achieve the maximum control of myopia progression.
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Affiliation(s)
- T A Aller
- Private Practice, San Bruno, CA, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
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Abstract
BACKGROUND Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may lead to permanent impairment of vision. Patients with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. OBJECTIVES To assess the effectiveness of various medical interventions in the management of traumatic hyphema. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2013), EMBASE (January 1980 to August 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 August 2013. SELECTION CRITERIA Two authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical interventions versus other medical interventions or control groups for the treatment of traumatic hyphema following closed globe trauma. We applied no restrictions regarding age, gender, severity of the closed globe trauma, or level of visual acuity at the time of enrolment. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data for the primary and secondary outcomes. We entered and analyzed data using Review Manager 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as odds ratios and continuous outcomes as mean differences. MAIN RESULTS We included 20 randomized and seven quasi-randomized studies with 2643 participants in this review. Interventions included antifibrinolytic agents (oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. No intervention had a significant effect on visual acuity whether measured at two weeks or less after the trauma or at longer time periods. The number of days for the primary hyphema to resolve appeared to be longer with the use of aminocaproic acid compared with no use, but was not altered by any other intervention.Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.11 to 0.57), but a sensitivity analysis omitting studies not using an intention-to-treat (ITT) analysis reduced the strength of the evidence (OR 0.41, 95% CI 0.16 to 1.09). We obtained similar results for topical aminocaproic acid (OR 0.42, 95% CI 0.16 to 1.10). We found tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (OR 0.25, 95% CI 0.13 to 0.49), as did aminomethylbenzoic acid as reported in one study (OR 0.07, 95% CI 0.01 to 0.32). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e. corneal bloodstaining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no difference in the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose. The available evidence on usage of corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials.We found no difference in effect between a single versus binocular patch or ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed. AUTHORS' CONCLUSIONS Traumatic hyphema in the absence of other intraocular injuries uncommonly leads to permanent loss of vision. Complications resulting from secondary hemorrhage could lead to permanent impairment of vision, especially in patients with sickle cell trait/disease. We found no evidence to show an effect on visual acuity by any of the interventions evaluated in this review. Although evidence was limited, it appears that patients with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema in patients treated with aminocaproic acid take longer to clear.Other than the possible benefits of antifibrinolytic usage to reduce the rate of secondary hemorrhage, the decision to use corticosteroids, cycloplegics, or nondrug interventions (such as binocular patching, bed rest, or head elevation) should remain individualized because no solid scientific evidence supports a benefit. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value.
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Affiliation(s)
- Almutez Gharaibeh
- Department of Special Surgery-Ophthalmology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Howard I Savage
- Kaiser Permanente Largo Medical Center, Largo, Maryland, USA
| | - Roberta W Scherer
- Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morton F Goldberg
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristina Lindsley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dave P, Senthil S, Rao HL, Garudadri CS. Treatment Outcomes in Malignant Glaucoma. Ophthalmology 2013; 120:984-90. [PMID: 23375590 DOI: 10.1016/j.ophtha.2012.10.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/04/2012] [Accepted: 10/18/2012] [Indexed: 11/28/2022] Open
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Koktekir BE, Gedik S, Bakbak B. Bilateral severe anterior uveitis after unilateral selective laser trabeculoplasty. Clin Exp Ophthalmol 2012; 41:305-7. [PMID: 22957742 DOI: 10.1111/j.1442-9071.2012.02879.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
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Xu JT. [Research on whether atropine can be substituted by the powerful cycloplegic cyclopentolate]. Zhonghua Yan Ke Za Zhi 2012; 48:772-775. [PMID: 23141569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For a long time, atropine eye ointment has been widely used as the cycloplegic for children's optometry in China, while internationally, cyclopentolate gutta is widely used as the first choice for cycloplegic. In recent years, 1% cyclopentolate hydrochloride ocular humor has been introduced to our country. This effective and powerful cycloplegic has already been paid close attention to by domestic pedo-ophthalmologists. According to a serious of studies both home and abroad on the therapeutic effects of the own control drugs, the cycloplegia effect of cyclopentolate is close to the atropine. Cyclopentolate can be widely used for the cycloplegia before optometry for the Chinese children. However, the effect of cyclopentolate is still not as good as atropine. So, for the children with farsightedness within 7 years old, all esotropia children, Am children, and children who suffer from decreased vision acuteness and needs to be excluded from accommodative myopia, atropine eye ointment should be routinely used for cycloplegia before optometry. In this article, we also discuss the medication dosage, medication method, possible drug adverse reactions of cyclopentolate humor ocular and the coping measures at the same time.
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Affiliation(s)
- Jiang-tao Xu
- Department of Pediatric Ophthalmology, Kunming Children's Hospital, Kunming, China.
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36
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37
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Abstract
A series of Pediatric Eye Disease Investigator Group amblyopia treatment studies have concluded that the difference between patching and atropine penalization is inconsequential, and that there is no statistically significant difference between various amounts of prescribed patching. These results, representing mean behavior of groups of amblyopia patients, suggest that a broader range of initial treatments are appropriate than many previously believed; however, it is less clear how this informs treatment in individual cases.
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Shimada M, Young C, Tanen DA. Corneal ulcer associated with pepper spray exposure during military training. J Emerg Med 2011; 43:e149. [PMID: 22100497 DOI: 10.1016/j.jemermed.2011.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 07/29/2011] [Indexed: 11/18/2022]
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39
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Wallace DK, Kraker RT, Beck RW, Cotter SA, Davis PL, Holmes JM, Repka MX, Suh DW. Randomized trial to evaluate combined patching and atropine for residual amblyopia. ACTA ACUST UNITED AC 2011; 129:960-2. [PMID: 21746992 DOI: 10.1001/archophthalmol.2011.174] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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40
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Sy-Ongkeko JMB, Agahan ALD, Lopez JS, Dy-Liacco JU. Sympathetic ophthalmia in an infected post-scleral buckling eye. Ann Acad Med Singap 2011; 40:147-148. [PMID: 21603735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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41
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Abstract
Amblyopia is a condition of decreased monocular or binocular visual acuity caused by form deprivation or abnormal binocular interaction. Amblyopia is the most common cause of monocular vision loss in children with a prevalence of 2 to 5%. During the last decade, several prospective randomized studies have influenced our clinical management. Based on these studies, optimum refractive correction should be prescribed first. However, most patients will need additional occlusion therapy which is still considered the «gold standard» of amblyopia management. Now much lower doses have been shown to be effective. In moderate amblyopia, penalization with atropine is as effective as patching. New treatment modalities including perceptual learning, pharmacotherapy with levodopa and citicholine or transcranial magnetic stimulation have not yet been widely accepted.
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Affiliation(s)
- V Sturm
- Augenklinik, Universitätsspital Zürich, Zürich.
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42
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Abstract
BACKGROUND Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g., corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may lead to permanent impairment of vision. Patients with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. OBJECTIVES The objective of this review was to assess the effectiveness of various medical interventions in the management of traumatic hyphema. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 6), MEDLINE (January 1950 to June 2010), EMBASE (January 1980 to June 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (http://clinicaltrials.gov). We searched the reference lists of identified trial reports to find additional trials. We also searched the ISI Web of Science Social Sciences Citation Index (SSCI) to find studies that cited the identified trials. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 25 June 2010. SELECTION CRITERIA Two authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical interventions to other medical interventions or control groups for the treatment of traumatic hyphema following closed globe trauma. There were no restrictions regarding age, gender, severity of the closed globe trauma or level of visual acuity at the time of enrollment. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data for the primary and secondary outcomes. We entered and analyzed data using Review Manager (RevMan) 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as odds ratios and continuous outcomes as mean differences. MAIN RESULTS Nineteen randomized and seven quasi-randomized studies with 2,560 participants were included in this review. Interventions included antifibrinolytic agents (oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, monocular versus bilateral patching, elevation of the head, and bed rest. No intervention had a significant effect on visual acuity whether measured at two weeks or less after the trauma or at longer time periods. The number of days for the primary hyphema to resolve appeared to be longer with the use of aminocaproic acid compared to no use, but was not altered by any other intervention.Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.11 to 0.5), but a sensitivity analysis omitting studies not using an intention-to-treat (ITT) analysis reduced the strength of the evidence (OR 0.41, 95% CI 0.16 to 1.09). We obtained similar results for topical aminocaproic acid (OR 0.42, 95% CI 0.16 to 1.10). We found tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (OR 0.25, 95% CI 0.13 to 0.49), as did aminomethylbenzoic acid as reported in a single study (OR 0.07, 95% CI 0.01 to 0.32). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e., corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compares with placebo. We found no difference in the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose. The available evidence on usage of corticosteroids, cycloplegics or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials.We found no difference in effect between a single versus binocular patch nor ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed. AUTHORS' CONCLUSIONS Traumatic hyphema in the absence of other intraocular injuries, uncommonly leads to permanent loss of vision. Complications resulting from secondary hemorrhage could lead to permanent impairment of vision, especially in patients with sickle cell trait/disease. We found no evidence to show an effect on visual acuity by any of the interventions evaluated in this review. Although evidence is limited, it appears that patients with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema in patients on aminocaproic acid take longer to clear.Other than the possible benefits of antifibrinolytic usage to reduce the rate of secondary hemorrhage, the decision to use corticosteroids, cycloplegics, or non-drug interventions (such as binocular patching, bed rest, or head elevation) should remain individualized because no solid scientific evidence supports a benefit. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value.
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Affiliation(s)
- Almutez Gharaibeh
- Department of Special Surgery-Ophthalmology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Howard I Savage
- Kaiser Permanente Largo Medical Center, Maryland, Largo, USA
| | - Roberta W Scherer
- Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Maryland, Baltimore, USA
| | - Morton F Goldberg
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Maryland, Baltimore, USA
| | - Kristina Lindsley
- Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Maryland, Baltimore, USA
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Islam N, Pavesio C. Uveitis (acute anterior). BMJ Clin Evid 2010; 2010:0705. [PMID: 21736765 PMCID: PMC2907596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Anterior uveitis is rare, with an annual incidence of 12/100,000 population, although it is more common in Finland (annual incidence of 23/100,000), probably because of genetic factors, such as high frequency of HLA-B27 in the population. It is often self-limiting, but can, in some cases, lead to complications such as posterior synechiae, cataract, glaucoma, and chronic uveitis. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of anti-inflammatory eye drops on acute anterior uveitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found six systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids, mydriatics, and non-steroidal anti-inflammatory drug eye drops.
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Gallego-Pinazo R, López-Sánchez E, Marín-Montiel J. [Hemorrhagic Descemet's membrane detachment after viscocanalostomy]. Arch Soc Esp Oftalmol 2010; 85:110-113. [PMID: 20619122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Viscocanalostomy is an option in the surgical treatment of glaucoma. This non-penetrating technique favours aqueous drainage through the Schlemm channel while avoiding filtering blebs and their related pathologies. Complications associated to this surgery are unusual, one of which is Decemet's membrane detachment (DMD) CLINICAL CASE: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose had undergone a viscocanalostomy of the left eye. In the immediate postoperative period we noticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and see attitude, we did not find improvement 15 days after surgery and corneal edema was established with vision decrease. We proceeded to a surgical reapplication by means of Descemet's membrane micropuncture and SF6 injection into the anterior chamber and achieving an anatomical and functional improvement DISCUSSION We believe that the intrusion of viscoelastic material into the supradescemetic was a consequence of the high-pressure during the high-density hyaluronate injection. Hemorrhagic DMD management is mainly determined by its location, size and evolution. In our case, the posterior endothelial micropuncture and descematopexy by means of 20% SF6 injection into the anterior chamber was useful in resolving this complication.
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Midilli R, Palamar M, Akyıldız S, Göde S. Diplopia secondary to septal infiltration anesthesia: two cases. Kulak Burun Bogaz Ihtis Derg 2010; 20:48-50. [PMID: 20163338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We describe two temporary diplopia cases secondary to local septal infiltration anesthesia during septoplasty operation. Both of the diplopia cases resolved without any treatment. Although diplopia was not refractory in our cases, when injecting anesthetics, special care must be taken to avoid injection either into the artery or to the vein.
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Affiliation(s)
- Raşit Midilli
- Department of Otolaryngology, Medicine Faculty of Ege University, Izmir, Turkey
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Gravier N. [Amblyopias, modalities of treatment]. Oftalmologia 2010; 54:110-112. [PMID: 21137200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Nicolas Gravier
- Kervision - Polyclinique de l'Atlantique, BP 40419, 44819 Nantes/Saint-Herblain cedex
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Davis J, Schecter SH, Sowka J. Eales' disease: the great masquerader. Optometry 2009; 80:354-359. [PMID: 19545848 DOI: 10.1016/j.optm.2008.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 07/05/2008] [Accepted: 10/17/2008] [Indexed: 05/28/2023]
Abstract
BACKGROUND Eales' disease, also known as idiopathic retinal periphlebitis, is a diagnosis of exclusion, mainly affecting men in the second through fourth decades of life. Although less common in the United States, Eales' disease is widespread in India and certain areas of the Middle East. CASE REPORT A healthy, 42-year-old Filipino man presented with reduced vision in the right eye of 2 days' duration and had recently had a nonrhegmatogenous retinal detachment diagnosed. Clinical findings included angle neovascularization, posterior vitritis, intraretinal hemorrhages, and retinal vascular sheathing in that eye. Systemic evaluation did not disclose an underlying etiology. Eales' disease was diagnosed. Treatment included topical steroids and cycloplegia, along with intravitreal triamcinolone acetonide injection, which yielded an improvement in the vasculitis and vitritis with subsequent visual improvement and stabilization. CONCLUSION Eales' disease should be considered as a differential diagnosis in patients with vasculitis and vitritis.
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Affiliation(s)
- Jeanmarie Davis
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida 33027, USA.
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Abstract
Allergic contact dermatitis due to mydriatic eyedrops is rare despite extensively used by ophthalmologists. Phenylephrine is responsible for most of the cases in the literature. We reported two other cases due to phenylephrine eyedrops with an unusual evolution characterized by chronic debilitating blepharoconjunctivitis.
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Affiliation(s)
- N Raison-Peyron
- Department of Dermatology and Allergology, Hôpital Saint Eloi, Montpellier, France.
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