Abstract Background Low concentration atropine is widely prescribed to slow myopia progression in children, yet its short-term retinal and choroidal effects remain incompletely understood. This study aimed to evaluate short-term effects of a range of low atropine concentrations on axial length, retinal and choroidal thickness, and microvasculature. Methods In this double-masked, randomized study, twenty healthy adults received a single instillation of placebo, 0.01%, 0.025%, 0.05%, or 0.1% atropine in the right eye across five separate sessions. Retinal and choroidal thickness in the central 1.0 mm diameter and 1.0–3.0 mm annulus, perfusion density in the superficial and deep vascular complex and choriocapillaris in the central 1.0 mm and 1.0–2.5 mm annulus, foveal avascular zone and axial length were assessed at baseline and 1 h and 24 h after instillation. Results Participant mean age was 25.5 ± 3.4 years and mean refraction was − 1.9 ± 2.2 D. No significant changes in retinal or choroidal thickness or axial length were observed for any concentration or time point (P > 0.05). The superficial vascular plexus perfusion density in the 1.0–2.5 mm annulus showed significant decrease (P = 0.02) with time after atropine instillation, but not with concentration (P > 0.05); post hoc analysis showed significant decrease from baseline at 1 h (P = 0.03) compared to 24 h (P = 0.28). Conclusion These findings indicate that a single instillation of 0.01%–0.1% atropine does not alter axial length or retinal or choroidal thickness over 24 h, but may transiently affect superficial retinal perfusion in a time-dependent manner. Characterizing these short-term effects is important for a better understanding of the physiological responses to atropine in clinical and research settings.
Anna Artymowicz,1 Christina Douglas,2 Kimberly Cockerham2,3 1West Coast Eye Institute, Bakersfield, CA, USA; 2Southeast Eye Specialists, Knoxville, TN, USA; 3Senta Clinic, San Diego, CA, USACorrespondence: Anna Artymowicz, West Coast Eye Institute, 215 China Grade Loop, Bakersfield, CA, 93308, USA, Tel +1 (661) 393-2331, Email artywcei@gmail.comAbstract: Advances in telemedicine have allowed physicians to provide care in areas that were previously geographically or practically inaccessible. Roughly 70% of all US hospital have less than 200 bed capacity and nearly 50% have fewer than 100 beds. These smaller hospitals often do not have specialists available for bedside patient care, making them potential beneficiaries of telemedicine medical specialty services. In 2005, the American Stroke Association proposed implementing telemedicine services in effort to increase access to acute stroke care in neurologically underserved areas such as small hospitals. Tele-stroke services have since become established across the country and are now utilized by approximately 30% of US hospitals. By reducing the time between presentation and evaluation by a stroke specialist, tele-stroke programs have successfully increased patient access to life-saving treatment with tissue-plasminogen activator (t-PA) treatments. This change has been especially profound remote and underserved community hospitals. However in the evaluation of acute vision loss, an area where ophthalmology and stroke care overlap, increased reliance on tele-stroke services has contributed to some unique challenges. Acute vision has a complex differential and is commonly a result of conditions other than stroke. When tele-stroke services are engaged for the evaluation of acute vision loss, the neurologist is asked to make medical decisions without complete information about the eye. This situation can expose patients to costly or inappropriate testing, unnecessary hospitalizations, or lead to delayed diagnosis and treatment of non-neurologic conditions of the eye. The goal of this paper is to provide an overview of the overlap between stroke and vision loss, highlight the challenges inherent in using tele-stroke in evaluating acute vision loss and to offer our comments on how increased communication between emergency medicine, ophthalmology, and neurology services can ensure that patients with vision loss receive the highest standard of care in all hospitals.Keywords: telemedicine, tele-stroke, acute vision loss, tele-neurology, CRAO
Medical emergencies. Critical care. Intensive care. First aid
The purpose of the work was to evaluate the effectiveness of the drug Domizia Duo® (OTCPharm JSC), which is a fixed combination (dorzolamide 20 mg/ml and timolol 5 mg/ml) in the treatment of patients diagnosed with primary openangle glaucoma. The multicenter study involved 156 patients (280 eyes) with primary openangle glaucoma (POAG) (136 patients — 243 eyes), primary angleclosure glaucoma (PACG) (8 patients — 15 eyes), ocular hypertension (12 patients — 22 eyes). 37 doctors from 22 medical institutions took part in the study. Patients aged 55–75 years with firsttime POAG stages I–III, PAOG, ocular hypertension, as well as with abnormal intraocular pressure, patients with pseudophakia, if the diagnosis of glaucoma was made before cataract extraction and at least 6 months before the study, were included. According to the study results, intraocular pressure decreased significantly in all groups of patients and at all stages of treatment: primary openangle glaucoma, primary angleclosure glaucoma, ocular hypertension. In 136 patients (243 eyes) with POAG, a 28 % reduction in IOP was achieved at an initial level of 25 (22–28) mm Hg. In the group of patients with PCOG (8 patients, 15 eyes), a decrease in IOP by 19 % was shown with an initial intraocular pressure of 20.1 (19.1–23.0) mm Hg. The high effectiveness of the drug Domizia Duo® (OTCPharm JSC) was established at all stages of POAG, so at stage I of newly diagnosed POAG, the reduction in IOP was 35.5 % within a month after the start of therapy, at stage II of newly diagnosed POAG by 28 %, at stage III by 44.4 %, in the group of patients with ocular hypertension, the degree of reduction in intraocular pressure was 27 % at an initial level of 26 (23–27) mm Hg. The data obtained from the study prove the high effectiveness of the fixed combination (FC) Domizia Duo® (OTCPharm JSC) against the background of good tolerability in patients with primary openangle glaucoma (POAG) at stages I–III. The drug was also highly effective not only when prescribed as monotherapy, but also when switching from another drug or adding Domizia Duo® to treatment.
Adolescent idiopathic scoliosis (AIS) is a common and progressive spinal deformity in children that exhibits striking sexual dimorphism, with girls at more than fivefold greater risk of severe disease compared to boys. Despite its medical impact, the molecular mechanisms that drive AIS are largely unknown. We previously defined a female-specific AIS genetic risk locus in an enhancer near the PAX1 gene. Here, we sought to define the roles of PAX1 and newly identified AIS-associated genes in the developmental mechanism of AIS. In a genetic study of 10,519 individuals with AIS and 93,238 unaffected controls, significant association was identified with a variant in COL11A1 encoding collagen (α1) XI (rs3753841; NM_080629.2_c.4004C>T; p.(Pro1335Leu); p=7.07E–11, OR = 1.118). Using CRISPR mutagenesis we generated Pax1 knockout mice (Pax1-/-). In postnatal spines we found that PAX1 and collagen (α1) XI protein both localize within the intervertebral disc-vertebral junction region encompassing the growth plate, with less collagen (α1) XI detected in Pax1-/- spines compared to wild-type. By genetic targeting we found that wild-type Col11a1 expression in costal chondrocytes suppresses expression of Pax1 and of Mmp3, encoding the matrix metalloproteinase 3 enzyme implicated in matrix remodeling. However, the latter suppression was abrogated in the presence of the AIS-associated COL11A1P1335L mutant. Further, we found that either knockdown of the estrogen receptor gene Esr2 or tamoxifen treatment significantly altered Col11a1 and Mmp3 expression in chondrocytes. We propose a new molecular model of AIS pathogenesis wherein genetic variation and estrogen signaling increase disease susceptibility by altering a PAX1-COL11a1-MMP3 signaling axis in spinal chondrocytes.
Previous studies have demonstrated that low-intensity transcranial ultrasound stimulation (TUS) can eliminate hippocampal neural activity. However, until now, it has remained unclear how ultrasound modulates theta and gamma oscillations in the hippocampus under different behavioral states. In this study, we used ultrasound to stimulate the CA1 in mice in anesthesia, awake and running states, and we simultaneously recorded the local field potential of the stimulation location. We analyzed the power spectrum, phase-amplitude coupling (PAC) of theta and gamma oscillations, and their relationship with ultrasound intensity. The results showed that (i) TUS significantly enhanced the absolute power of theta and gamma oscillations under anesthesia and in the awake state. (ii) The PAC strength between theta and gamma oscillations is significantly enhanced under the anesthesia and awake states but is weakened under the running state with TUS. (iii) Under anesthesia, the relative power of theta decreases and that of gamma increases as ultrasound intensity increases, and the result under the awake state is opposite that under the anesthesia state. (iv) The PAC index between theta and gamma increases as ultrasound intensity increases under the anesthesia and awake states. The above results demonstrate that TUS can modulate theta and gamma oscillations in the CA1 and that the modulation effect depends on behavioral states. Our study provides guidance for the application of ultrasound in modulating hippocampal function.
Arshad M. Khanani, MD, MA, Raj K. Maturi, MD, Nika Bagheri, MD
et al.
Purpose: To establish the safety, tolerability, pharmacokinetics, and pharmacodynamics of an intravitreal injection of recombinant human complement factor H (CFH), GEM103, in individuals with genetically defined age-related macular degeneration (AMD) and geographic atrophy (GA). Design: Phase I single ascending-dose, open-label clinical trial (ClinicalTrials.gov identifier, NCT04246866). Participants: Twelve individuals 50 years of age or older with a confirmed diagnosis of foveal GA in the study eye. Methods: Participants were assigned to the increasing dose cohorts and received 1 50-μl intravitreal injection of GEM103 at doses of 50 μg/eye, 100 μg/eye, 250 μg/eye, or 500 μg/eye; dose escalation was dependent on the occurrence of dose-limiting toxicities. Main Outcome Measures: Safety assessments included ocular and systemic adverse events (AEs), ocular examinations, clinical laboratory and vital signs, and serum antidrug antibody levels. Biomarkers, measured in the aqueous humor (AH), included CFH and complement activation biomarkers factor Ba and complement component 3a. Results: No dose-limiting toxicities were reported, enabling escalation to the maximum study dose. No anti-GEM103 antidrug antibodies were detected during the study. Four participants experienced AEs; these were nonserious, mild or moderate in severity, and unrelated to GEM103. The AEs in 2 of these participants were related to the intravitreal injection procedure. No clinically significant ophthalmic changes and no ocular inflammation were observed. Visual acuity was maintained and stable throughout the 8-week follow-up period. No choroidal neovascularization occurred. CFH levels increased in a dose-dependent manner after GEM103 administration with supraphysiological levels observed at week 1; levels were more than baseline for 8 weeks or more in all participants receiving single doses of 100 μg or more. Complement activation biomarkers were reduced 7 days after dose administration. Conclusions: A single intravitreal administration of GEM103 (up to 500 μg/eye) was well tolerated in individuals with GA. Of the few mild or moderate AEs reported, none were determined to be related to GEM103. No intraocular inflammation or choroidal neovascularization developed. CFH levels in AH were increased and stable for 8 weeks, with pharmacodynamic data suggesting that GEM103 restored complement regulation. These results support further development in a repeat-dose trial in patients with GA with AMD.
Mrittika Sen, Santosh G Honavar, Sabyasachi Sengupta
et al.
Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
Pediatric intermediate uveitis (IU), usually idiopathic, can also be associated with tuberculosis (TB) and sarcoidosis. A 14-year-old girl was diagnosed with idiopathic IU after ruling out TB and sarcoid. She was treated with oral steroids and methotrexate (MTX) with good inflammation control. One year later, she presented with subretinal (SR) abscess. Lab tests were still negative but aqueous polymerase chain reaction confirmed TB. With antituberculosis treatment, complete resolution of the lesion was noted. The likelihood of a change in phenotype of ocular TB, from an IU to TB SR abscess or a possible reactivation of latent TB due to MTX are discussed.
A 3-year-old girl presented with bilateral asymmetrical partial heterochromia of iris and fundus. The parents also complained of bilateral hearing loss in the child. Suspecting an auditory-pigmentary syndrome, systemic and genetic evaluation was performed. The child had profound sensory-neural hearing loss. Targeted gene sequencing revealed a novel nonsense variation in exon 9 of the MITF gene (chr3:70008440A>T) that was pathogenic for Waardenburg syndrome (WS) type 2A. This case highlights the characteristics of the iris and fundus hypochromia, which may provide a clue toward the diagnosis of WS.
Kamyar Vaziri, Stephen G Schwartz, Krishna Kishor, Harry W Flynn Jr Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Endophthalmitis is an uncommon diagnosis but can have devastating visual outcomes. Endophthalmitis may be endogenous or exogenous. Exogenous endophthalmitis is caused by introduction of pathogens through mechanisms such as ocular surgery, open-globe trauma, and intravitreal injections. Endogenous endophthalmitis occurs as a result of hematogenous spread of bacteria or fungi into the eye. These categories of endophthalmitis have different risk factors and causative pathogens, and thus require different diagnostic, prevention, and treatment strategies. Novel diagnostic techniques such as real-time polymerase chain reaction (RT-PCR) have been reported to provide improved diagnostic results over traditional culture techniques and may have a more expanded role in the future. While the role of povidone-iodine in prophylaxis of postoperative endophthalmitis is established, there remains controversy with regard to the effectiveness of other measures, including prophylactic antibiotics. The Endophthalmitis Vitrectomy Study (EVS) has provided us with valuable treatment guidelines. However, these guidelines cannot be directly applied to all categories of endophthalmitis, highlighting the need for continued research into attaining improved treatment outcomes. Keywords: endophthalmitis, exogenous, endogenous, postoperative, intravitreal injection
Adnaan Haq, Bharat Kapoor, Maharatnam Logendran
et al.
A 67-year-old male who presented to the eye casualty department with deterioration in his vision was diagnosed with retinal angiomatous proliferation. After initial deterioration with ranibizumab intravitreal injections, we have demonstrated successful treatment and stabilised vision with ranibizumab and a single intravitreal triamcinolone injection. Stringent follow-up and top-up ranibizumab injections have stabilised his vision and have shown foveal improvement on optical coherence tomography imaging.
Ten cases of Vitero-Retinal Surgery were studied to find actual cost incurred on patient care, so as to workout the modalities to develop package system for Vitero-Retinal Surgery. The cost analysis for the package had been divided into ‘primary cost’ in which cost of manpower, cost of consumable, cost of linen and laundering, cost of central sterile supply department (CSSD) and manifold was included. In “overhead cost”, building cost, cost of other fixed assets, electricity and water consumption, sanitation and air conditioning was included to find total cost for deriving the package cost.
Keisho Hirota1,2, Masayuki Akimoto1,3, Toshiaki Katsura21Department of Ophthalmology, Kyoto Medical Center, National Hospital Organization, 2Internal Medicine, Kyoto Medical Center, 3Clinical Research Center, Kyoto Medical Center, Kyoto, JapanPurpose: The report of a case of bilateral acute retinal necrosis after herpetic meningitis.Case report: A 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.Conclusion: Although cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.Keywords: acute retinal necrosis, herpetic meningitis, herpes simplex, varicella zoster virus
John Deepa, Kuriakose Thomas, Devasahayam Suresh
et al.
<b>Purpose:</b> The purpose was to study the dimensions of the foveal avascular zone (FAZ) using Heidelberg Retinal Angiogram-2 (HRA-2; Heidelberg Engineering GmBH, Dossenheim, Germany). <b>Materials and Methods:</b> An observational study of the FAZ area and circumference was done with fundus fluorescein angiography (FFA) using HRA-2 in 31 normal individuals. The FAZ was studied using both contrast-adjusted and nonadjusted methods. Contrast adjustment was done to obtain better visualization of the finer capillaries around the fovea enabling more precise measurements of the FAZ in normal eyes. <b>Results:</b> The mean area of the FAZ calculated by the contrast-adjusted method was 0.2753 mm <sup>2</sup> (±0.074) and the mean circumference was 2.22 mm (±0.048). By the conventional method, the area and circumference of the FAZ were 0.6241 mm <sup>2</sup> (±0.177) and 3.23 mm (±0.454), respectively. <b>Conclusion:</b> The measurements of area and circumference of FAZ using contrast-adjusted methods were significantly smaller than the conventional method.
Silvana Guerriero, Ermete Giancipoli, Lorenza Ciracì
et al.
Purpose. In Italy we say that the most unlucky things can happen to physicians when they get sick, despite the attention of colleagues. To confirm this rumor, we report the sad story of a surgeon with bilateral vitreitis and glaucoma unresponsive to traditional therapies. Methods/Design. Case report. Results. After one year of steroidal and immunosuppressive therapy, a vitrectomy, and a trabeculectomy for unresponsive bilateral vitreitis and glaucoma, MRI showed a multicentre primary central nervous system lymphoma, which was the underlying cause of the masquerade syndrome. Conclusions. All ophthalmologists and clinicians must be aware of masquerade syndromes, in order to avoid delays in diagnosis.
Aim: To identify the effect of using different coloured bars on reading time for the bar reading task, along with an assessment of subject experience with different colour bars. Methods: Inclusion criteria were: visual acuity better than 0.5 logMAR, presence of binocular single vision, and ability to understand and perform bar reading. Measurements were taken of visual acuity, near point of convergence, interpupillary distance, Bagolini glasses and prism fusion range. Bar reading was timed and undertaken with and without five coloured bars for N5 and N12 print. Results: Forty subjects were recruited with a mean age of 38.5 years (SD 12.4). Two were excluded because of poor visual acuity in one eye. There was no significant difference in bar reading task duration with or without the bar in place and for different colour bars. Eleven subjects perceived difficulty with the task, mostly relating to maintaining physiological diplopia appreciation of the bar. White was the most popular bar colour. Conclusions: Bar reading is a good indicator of binocular single vision and is useful as a home exercise. In our healthy controls no differences were seen when using different colour bars. A repeat of this study in a clinical population of symptomatic strabismic patients is required.
Alejandro Navas, Mayeli Muñoz-Ocampo, Enrique O. Graue-Hernández
et al.
We present a case of toric implantable collamer lens (TICL) spontaneous rotation in a patient with myopic astigmatism. A 23-year-old female underwent TICL implantation. Preoperative uncorrected visual acuity (UCVA) was 20/800 and 20/1200, respectively, with –7.75 –4.25 × 0° and –8.25 –5.25 × 180°. The left eye achieved an UCVA of 20/30. After 3 months of successful implantation of TICL in the left eye, the patient presented with a sudden decrease in visual acuity in the left eye. UCVA was 20/100 with a refraction of +2.50 –4.50 × 165°. We observed the toric marks with a 30° rotation from the original position and decided to reposition the TICL, obtaining a final UCVA of 20/25, which remained stable at 6 months’ follow-up. TICL can present a considerable rotation that compromises visual acuity. The relocation of TICL is a safe and effective procedure to recover visual acuity due to significant spontaneous TICL rotation.