Relationship between age and peripapillary retinal nerve fibre layer thickness: An optical coherence tomography study

Objective: To evaluate the relationship between age and peripapillary retinal nerve fibre layer thickness in healthy Chinese subjects. Design: Cross-sectional study. Setting: Regional hospital, Hong Kong. Participants: Healthy volunteers (n=218) of Chinese ethnicity with spherical equivalent of -6 to +4 dioptres were recruited for study from October 2001 to March 2003. Ocular examination was carried out and measurements of peripapillary retinal nerve fibre layer thickness were performed using optical coherence tomography (Carl Zeiss Humphrey OCT 2 machine), in a circular pattern of 3.4 mm diameter, centred on the optic disc. Main outcome measures: Mean retinal nerve fibre layer thickness and age. Results: The mean age was 40 (standard deviation, 17; range, 11-69) years. The mean peripapillary retinal nerve fibre layer thickness was 111.6 (standard deviation, 18.5; range, 52.0-155.0) μm. Age correlated significantly with peripapillary retinal nerve fibre layer thickness (r= -0.28, P<0.0001). Conclusion: Mean peripapillary retinal nerve fibre layer thickness (based on optical coherence tomography) correlates negatively with age, which can interfere with the assessment and monitoring of glaucoma patients. An age-adjusted normogram may be necessary to interpret results.published_or_final_versio

Recurrent and consecutive non-arteritic optic neuropathy in a patient with protein S deficiency

A 50-year-old man with a history of protein S deficiency treated by long-term warfarin presented with right non-arteritic optic neuropathy. Following successful augmentation of warfarin to minimise the effect of thrombophilia, he had a recurrence in the right eye and involvement of the left eye 11 days after the initial onset. Further investigation showed a marginal blood lipid profile, which was treated with lipid-lowering agents. A combination of aetiologies was seen in this patient. Other unique factors, such as the short duration to recurrence and involvement of the fellow eye, are discussed.published_or_final_versio

The use of optical coherence tomography in the assessment of diabetic retinopathy and maculopathy

This review was performed to assess the use of optical coherence tomography in diabetic retinopathy and maculopathy and its application in the diagnosis and management of these conditions. A comprehensive literature search on MEDLINE was performed for studies published until 2013 with key words 'diabetes mellitus', 'optical coherence tomography', 'diabetic retinopathy', 'diabetic maculopathy', 'intersessional repeatability', 'diurnal variation' , 'fundus autofluorescence' and 'treatment'. Search results were limited to studies published in English and in human subjects only. The Early Treatment Diabetic Retinopathy Study established the current standard of care for diabetic retinopathy and maculopathy with the diagnosis based on slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography. There has been a recent shift to the use of optical coherence tomography in the qualitative and quantitative assessment of such diseases. Furthermore, the advancement of optical coherence tomography from time-domain to spectraldomain technology allows us to visualize pathological changes of diabetic maculopathy in details in different retinal layers. Such observed changes have been used to establish new classifications of diabetic maculopathy. The high sensitivity and quantitative nature of optical coherence tomography make it a highly popular modality used extensively to monitor disease progression and efficacy of new treatment modalities. Optical coherence tomography plays a crucial role in the modern clinical management of diabetic retinopathy and maculopathy. Its use has revolutionized the understanding and management of these eye diseases.published_or_final_versio

Retinal nerve fiber layer thickness after a single attack of primary acute angle-closure glaucoma measured with optical coherence tomography

BACKGROUND AND OBJECTIVE: After a single unilateral acute primary angle-closure glaucoma attack, retinal nerve fiber layer (RNFL) may be thinned. The current study measured the RNFL thickness using optical coherence tomography in eyes with normal visual fields after recovery from a single attack of acute primary angle-closure glaucoma. PATIENTS AND METHODS: Twenty-one patients and age-matched control subjects underwent optical coherence tomography scanning after recovery from a single unilateral acute primary angle-closure glaucoma attack. Data from the affected eyes, normal fellow eyes, and control subjects were compared. RESULTS: Average RNFL thickness was 91.3 ± 16.4 ìm in the affected eyes, 100.1 ± 16.4 μm in the fellow eyes, and 100.2 ± 16.7 μm in the control eyes. Significant thinning was present in the affected eyes compared to the fellow eyes (P = .001) and the control eyes (P = .04). CONCLUSION: RNFL thickness was found to be significantly thinner in the eyes with angle-closure glaucoma. Copyright ©SLACK Incorporated.link_to_subscribed_fulltex

Phase II study of an 'all-oral' regimen of capecitabine, idarubicin and cyclophosphamide for metastatic breast cancer - safety, efficacy and quality of life

Objective: Patients with metastatic breast cancer (MBC) generally have a poor prognosis. Many of these patients have a good performance status. A new all-oral regimen (XIC) was evaluated in a phase II trial. The impact of the regimen on the safety and efficacy of the drug, as well as quality of life (QOL) of the patients was assessed. Patients and Methods: From September 2000 to September 2001, informed consent was obtained from 20 heavily pretreated women with MBC. They were placed on a 6-week cycle regimen comprising capecitabine (X; 2,000 mg/m2/day in two divided doses for 2 weeks then 1 week rest), idarubicin (I; 10 mg/m2/day, days 1, 3 and 5) and cyclophosphamide (C; 100 mg/m2/day for 2 weeks then 1 week rest). Results:Toxicities were generally tolerable. One patient had grade III neutropenia, which was reversible on cessation of treatment. One patient (5%) had a complete response and 4 patients (20%) achieved partial responses, yielding an overall response rate of 25%. Eight patients (40%) had stable disease. Median time to disease progression and median survival time were 13.4 and 23.7 months, respectively. Global and physical EORTC QLQ-30 scores showed no significant decrease in QOL. Conclusion:This is a small-scale study. XIC was generally well tolerated and favoured by the patients. This moderately active and convenient 'all-oral' regimen deserves clinical trials at a wider scale. Copyright © 2005 S. Karger AG.link_to_subscribed_fulltex

Intravitreal ranibizumab for neovascular glaucoma: an interventional case series

Objective: To evaluate the efficacy of ranibizumab in treating neovascular glaucoma. Design: Prospective interventional case series. Participants: Six eyes of 6 patients. Method: Six eyes with refractory neovascular glaucoma were treated with one dose of 0.5 mg intravitreal ranibizumab followed by laser panretinal photocoagulation. Patients were divided into 2 groups based on angle status for comparison. Recurrence was defined as re-emergence of iris neovascularization, and an intraocular pressure of more than 21 mm Hg after stabilization. Results: The patients’ mean age was 59 years and the mean follow-up 23 weeks. Three eyes had open-angle glaucoma, and three had a closed-angle configuration glaucoma. In 5 (83%) of the eyes, neovascularization completely regressed within the first 48 hours of intravitreal ranibizumab injection. Overall mean intraocular pressure dropped from 27.0 mm Hg pretreatment to 18.3 mm Hg 1 week post–intravitreal ranibizumab. The mean anti-glaucoma drop usage decreased from 4.2 pre-treatment to 2.2 one month later. There was no recurrence throughout the initial 3 months, but 2 eyes with closed-angle configuration glaucoma recurred, with a mean time to recurrence of 14 weeks. Conclusions: These results suggested that intravitreal ranibizumab is a useful and safe adjunct in the management of neovascular glaucoma.link_to_OA_fulltex