脈絡膜破裂のある外傷性黄斑円孔への硝子体手術の1例

背景:脈絡膜破裂を伴った外傷性黄斑円孔に対し硝子体手術を行った一例を経験したので報告する.症例と所見:26歳女性,うちあげ花火が直接右眼にあたり鈍的外傷となった.初診時の矯正視力は0.01であり,白内障,前房出血,黄斑円孔,脈絡膜破裂に伴う黄斑下出血と網膜浮腫がみられた.3週間後黄斑円孔は拡大した.6週後の蛍光眼底造影にて黄斑部に及ぶ網膜循環障害を認めた.受傷6週間後にインドシアニングリーンを用いた内境界膜剥離術を行った.黄斑下手術は行わなかった.結果:術後黄斑円孔は閉鎖し,視力は0.5に改善した.重篤な術後合併症は見られなかった.結論:脈絡膜破裂のある外傷性黄斑円孔に対しても硝子体手術は有効であると考えられた.Background: We report a case of traumatic macular hole with choroidal rupture treated with vitrectomy. Case & findings: The patient was a 26-years-old female, who was hit by fireworks in the right eye. At the initial visit, objective symptoms were cataract, hyphema, macular hole, retinal edema, and subretinal hemorrhage following choroidal rupture. Best corrected visual acuity was 0.01 in the right eye. A macular hole developed within 3 weeks, and retinal circulatory disorder was detected in fluorescein angiography. 6 weeks later, pars plana vitrectomy with internal limited membrane peeling using indocyanine green was performed. Sub-retinal procedure in the macular was not included in the surgery. After the surgery, the macular hole was closed, and the best corrected visual acuity in the right eye improved to 0.5. No severe complications were seen postoperatively. Conclusion: Vitreous surgery was effective for traumatic macular hole with choroidal rupture

Anatomy and Pathology/Oncology Retinal Thickness and Axial Length

PURPOSE. To examine the relationships between axial length and foveal and peripheral retinal thickness. METHODS. Using optical coherence tomography, foveal retinal thickness was measured in participants of the population-based Beijing Eye Study without optic nerve or macula diseases. Inner and outer nuclear layer thickness as surrogate for retinal thickness was assessed in the fundus periphery in human globes enucleated due to malignant uveal melanoma or painful glaucoma. RESULTS. The study included 1117 individuals with a mean age of 64.2 6 9.7 years (range: 50-93 years) and mean axial length of 23.4 6 1.04 mm (range: 20.29-28.68 mm). In multivariate analysis, thicker central foveal thickness was associated with male sex (P < 0.001; standardized regression coefficient beta: À0.13; nonstandardized regression coefficient B: À5.84; 95% confidence interval (CI): À8.56, À3.13); urban region of habitation (P ¼ 0.02; beta: 0.07; B: 3.56; 95% CI: 0.55, 6.57); thinner lens thickness (P ¼ 0.01; beta: À0.08; B: À5.11; 95% CI: À9.01, À1.21); thinner subfoveal choroidal thickness (P ¼ 0.04; beta: À0.07; B: À0.01; 95% CI: À0.03, À0.001); and longer axial length (P < 0.001; beta: 0.18; B: 3.79; 95% CI: 2.41, 5.17). In the same multivariate model, superior, inferior, and temporal foveal thickness was not significantly associated with axial length (P ¼ 0.26, P ¼ 0.19, P ¼ 0.08, respectively), while thicker nasal foveal thickness was associated with longer axial length (P ¼ 0.009; beta: 0.09; B: 1.50; 95% CI: 0.37, 2.62). In the histomorphometric part of the study including 32 eyes (sagittal diameter: 27.0 6 4.2 mm; range: 22-37 mm), mean thickness of the inner and outer nuclear layers at the equator and at the midpoint equator/posterior pole decreased with longer axial length (P ¼ 0.004; beta: À0.48; and P ¼ 0.02; beta: À0.44, respectively). CONCLUSIONS. Myopic axial globe elongation was associated with retinal thinning in the equatorial and pre-equatorial region, while foveal retinal thickness was mostly unaffected by axial length. It suggests that axial elongation takes place predominantly in the equatorial and pre-equatorial region of the eye

Effectiveness of screening preschool children for amblyopia: a systematic review

<p>Abstract</p> <p>Background</p> <p>Amblyopia and amblyogenic factors like strabismus and refractive errors are the most common vision disorders in children. Although different studies suggest that preschool vision screening is associated with a reduced prevalence rate of amblyopia, the value of these programmes is the subject of a continuing scientific and health policy discussion. Therefore, this systematic review focuses on the question of whether screening for amblyopia in children up to the age of six years leads to better vision outcomes.</p> <p>Methods</p> <p>Ten bibliographic databases were searched for randomised controlled trials, non-randomised controlled trials and cohort studies with no limitations to a specific year of publication and language. The searches were supplemented by handsearching the bibliographies of included studies and reviews to identify articles not captured through our main search strategy.</p> <p>Results</p> <p>Five studies met the inclusion criteria. Of these, three studies suggested that screening is associated with an absolute reduction in the prevalence of amblyopia between 0.9% and 1.6% (relative reduction: between 45% and 62%). However, the studies showed weaknesses, limiting the validity and reliability of their findings. The main limitation was that studies with significant results considered only a proportion of the originally recruited children in their analysis. On the other hand, retrospective sample size calculation indicated that the power based on the cohort size was not sufficient to detect small changes between the groups. Outcome parameters such as quality of life or adverse effects of screening have not been adequately investigated in the literature currently available.</p> <p>Conclusion</p> <p>Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication.</p

Comparison of Visual, Refractive and Aberrometic Outcomes of Intacs® Implant and Toric Implantable Collamer Lens (TICL) in Patients with Keratoconus: 4 Years Follow Up

Background: To assess the efficacy and clinical outcomes following the use of toric implantable collamer lens (TICL) and Intacs® implant in patients with mild keratoconus. Methods: This retrospective study evaluated 30 eyes of 30 patients with keratoconic and age of 25-35. These eyes were divided into group A (15 eyes), in which Visian Toric ICL™ was implanted, and group B (15 eyes), Intacs® implantation. The outcome and complications were evaluated. We assessed the visual, refractive, and aberrometric outcome in pre-operation and 6 month, and 1, 2, 3, and 4 year post-operation. Results: There was significant difference in the mean uncorrected and best corrected distance visual acuities between the groups (P < 0.01). An uncorrected distance visual acuity of 20/30 or better was achieved in 85% of eyes in the TICL group, and 20% of eyes in the Intacs® group; visual acuity of 20/20 or better in was seen in 80% and 15%, respectively. Intacs® implant produced a significant decrease in corneal refractive spherical equivalent and coma aberration (P < 0.01). Conclusion: Intacs® implant and TICL lens, both are useful, but it seems that the TICL is better and provides good visual and refractive outcomes; indicating that it is a more predictable procedure for refractive correction of keratoconus

Extraocular muscle afferent signals modulate visual attention.

PurposeExtraocular muscle afferent signals contribute to oculomotor control and visual localization. Prompted by the close links between the oculomotor and attention systems, it was investigated whether these proprioceptive signals also modulated the allocation of attention in space.MethodsA suction sclera contact lens was used to impose an eye rotation on the nonviewing, dominant eye. With their viewing, nondominant eye, participants (n = 4) fixated centrally and detected targets presented at 5° in the left or right visual hemifield. The position of the viewing eye was monitored throughout the experiment. As a control, visual localization was tested using finger pointing without visual feedback of the hand, whereas the nonviewing eye remained deviated.ResultsThe sustained passive rotation of the occluded, dominant eye, while the other eye maintained central fixation, resulted in a lateralized change in the detectability of visual targets. In all participants, the advantage in speed and accuracy for detecting right versus left hemifield targets that occurred during a sustained rightward eye rotation of the dominant eye was reduced or reversed by a leftward eye rotation. The control experiment confirmed that the eye deviation procedure caused pointing errors consistent with an approximately 2° shift in perceived eye position, in the direction of rotation of the nonviewing eye.ConclusionsWith the caveat of the small number of participants, these results suggest that extraocular muscle afferent signals modulate the deployment of attention in visual space

An observational study to assess if automated diabetic retinopathy image assessment software can replace one or more steps of manual imaging grading and to determine their cost-effectiveness.

BACKGROUND: Diabetic retinopathy screening in England involves labour-intensive manual grading of retinal images. Automated retinal image analysis systems (ARIASs) may offer an alternative to manual grading. OBJECTIVES: To determine the screening performance and cost-effectiveness of ARIASs to replace level 1 human graders or pre-screen with ARIASs in the NHS diabetic eye screening programme (DESP). To examine technical issues associated with implementation. DESIGN: Observational retrospective measurement comparison study with a real-time evaluation of technical issues and a decision-analytic model to evaluate cost-effectiveness. SETTING: A NHS DESP. PARTICIPANTS: Consecutive diabetic patients who attended a routine annual NHS DESP visit. INTERVENTIONS: Retinal images were manually graded and processed by three ARIASs: iGradingM (version 1.1; originally Medalytix Group Ltd, Manchester, UK, but purchased by Digital Healthcare, Cambridge, UK, at the initiation of the study, purchased in turn by EMIS Health, Leeds, UK, after conclusion of the study), Retmarker (version 0.8.2, Retmarker Ltd, Coimbra, Portugal) and EyeArt (Eyenuk Inc., Woodland Hills, CA, USA). The final manual grade was used as the reference standard. Arbitration on a subset of discrepancies between manual grading and the use of an ARIAS by a reading centre masked to all grading was used to create a reference standard manual grade modified by arbitration. MAIN OUTCOME MEASURES: Screening performance (sensitivity, specificity, false-positive rate and likelihood ratios) and diagnostic accuracy [95% confidence intervals (CIs)] of ARIASs. A secondary analysis explored the influence of camera type and patients' ethnicity, age and sex on screening performance. Economic analysis estimated the cost per appropriate screening outcome identified. RESULTS: A total of 20,258 patients with 102,856 images were entered into the study. The sensitivity point estimates of the ARIASs were as follows: EyeArt 94.7% (95% CI 94.2% to 95.2%) for any retinopathy, 93.8% (95% CI 92.9% to 94.6%) for referable retinopathy and 99.6% (95% CI 97.0% to 99.9%) for proliferative retinopathy; and Retmarker 73.0% (95% CI 72.0% to 74.0%) for any retinopathy, 85.0% (95% CI 83.6% to 86.2%) for referable retinopathy and 97.9% (95% CI 94.9 to 99.1%) for proliferative retinopathy. iGradingM classified all images as either 'disease' or 'ungradable', limiting further iGradingM analysis. The sensitivity and false-positive rates for EyeArt were not affected by ethnicity, sex or camera type but sensitivity declined marginally with increasing patient age. The screening performance of Retmarker appeared to vary with patient's age, ethnicity and camera type. Both EyeArt and Retmarker were cost saving relative to manual grading either as a replacement for level 1 human grading or used prior to level 1 human grading, although the latter was less cost-effective. A threshold analysis testing the highest ARIAS cost per patient before which ARIASs became more expensive per appropriate outcome than human grading, when used to replace level 1 grader, was Retmarker £3.82 and EyeArt £2.71 per patient. LIMITATIONS: The non-randomised study design limited the health economic analysis but the same retinal images were processed by all ARIASs in this measurement comparison study. CONCLUSIONS: Retmarker and EyeArt achieved acceptable sensitivity for referable retinopathy and false-positive rates (compared with human graders as reference standard) and appear to be cost-effective alternatives to a purely manual grading approach. Future work is required to develop technical specifications to optimise deployment and address potential governance issues. FUNDING: The National Institute for Health Research (NIHR) Health Technology Assessment programme, a Fight for Sight Grant (Hirsch grant award) and the Department of Health's NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and the University College London Institute of Ophthalmology

Large Right Hypophyseal Aneurysm Causing a Junctional Scotoma

Right, multi-lobulated superior hypophyseal artery aneurysm measuring 1.6 x 1.2 x 2.2 cm with 6 mm neck causing a right junctional scotoma . Images from a brain CT with contrast, a brain CT angiography with contrast, cerebral angiogram, Humphrey visual fields and ocular fundus photographs are included.VBneurodisaneurysms, EECneurodisaneurysms, VPavpopticchiasm, EECavpopticchiasm, VBchiasmalvisualfielddefects, EECchiasmalvisualfielddefect