A 10-year review of histopathological findings of enucleated eyes from a tertiary-care center, Pakistan.

OBJECTIVE: To determine the histopathology of enucleated eye specimens. METHODS: The 10-year inventory was conducted at Aga Khan University Hospital, Karachi, and comprised all histopathology reports of enucleated eye specimens received from January 2007 to December 2016 by the Section of Histopathology, Department of Pathology. SPSS 19 was used for data analysis. RESULTS: A total of 232 ocular tissue specimens from 231 patients were evaluated. Ocular tumours were the most common histopathological diagnosis 186(80%). Among tumours, retinoblastoma was the most common 137(59%) followed by malignant melanoma 31(13%) and squamous cell carcinoma 15(6.5%). Overall, 16(6.9%) specimens had degenerative changes secondary to different ocular disorders. Staphyloma and Coat's disease was diagnosed in 3(1.3%) cases each. In 4(1.7%) cases, there was no formal diagnosis. CONCLUSIONS: Early identification of tumours may allow for conservative management and limit the need for enucleations.

Characteristics and Prevalence of Staphyloma Edges at Different Ages in Highly Myopic Eyes.

Purpose: The purpose of this study was to determine the characteristics of staphyloma edges in highly myopic eyes and how they progress. Methods: We conducted a cross-sectional analysis using baseline data and a longitudinal study with follow-up data from 256 patients (447 eyes) with high myopia, with a mean (SD) follow-up of 3.79 (0.78) years. Participants were divided into four age groups: children (<13), youth (13-24), mature (25-59), and elderly (>60). Ultrawide-field swept-source optical coherence tomography was used to analyze staphyloma edges, which were divided into four areas: nasal to the optic disc (OD), superior to the macula, inferior to the macula, and temporal to the macula. Results: Staphylomas were significantly more prevalent in the mature (42.49%) and the elderly (51.35%) groups than in the children (13%) and youth (9%) groups. Staphyloma edges were predominantly superior to the macula in the mature and elderly groups. In contrast, staphylomas were rare in children and youth, with their edges mainly located nasal to the OD. The edges of staphylomas located superior and temporal to the macula were more likely to be associated with myopic traction maculopathy. During the follow-up period, 11 new staphyloma edges developed primarily in the mature group (64%). Additionally, 12 edges had an increased degree of protrusion over time, with most cases occurring in the mature (75%) group. Conclusions: The prevalence and location of staphyloma edges show significant variations depending on age. As time progresses, staphyloma edges manifest at distinct sites and increase their protrusion, potentially playing a role in the emergence of fundus complications.

Prevalence, risk factors and impact of posterior staphyloma diagnosed from wide-field optical coherence tomography in Singapore adults with high myopia.

PURPOSE: To investigate the prevalence and risk factors of posterior staphyloma using wide-field optical coherence tomography (WF-OCT) in adults with high myopia in Singapore. DESIGN: Population-based cross-sectional study. METHODS: Adults with spherical equivalent (SE) ≤ -5D in either eye at the first visit of Singapore Epidemiology of Eye Diseases study and Singapore Prospective Study Program study were recruited. Posterior staphyloma was diagnosed using WF-OCT (PLEX® Elite9000, Carl Zeiss Meditec). Myopic macular degeneration (MMD), myopic traction maculopathy (MTM) and vision-related quality of life (VRQoL) were assessed using fundus photographs, DRI-Triton OCT (Topcon) and the Impact of Vision Impairment (IVI) questionnaire, respectively. Factors associated with posterior staphyloma were identified with multilevel, multivariable logistic regression. Impact of posterior staphyloma on MMD, MTM and visual function was analysed with multilevel, multivariable logistic regression and linear mixed model, respectively. RESULTS: Among the 225 eyes [mean SE = -6.5 ± 2.2 D, mean axial length (AL) = 26.2 ± 1.5 mm] of 117 participants (mean age = 60.3 ± 7.1 years), posterior staphyloma was detected in 47 (20.9%) eyes of 38 (32.5%) participants. Older age [odds ratio (OR), 1.18; 95% confidence interval (CI), 1.10-1.26], more myopic SE (0.63; 0.51-0.77) and increased AL (2.51; 1.69-3.73) were associated with higher prevalence of posterior staphyloma (all p < 0.001). Adults with posterior staphyloma had higher odds of MMD (2.67; 1.23-5.82; p = 0.013), MTM (3.79; 1.13-12.68; p = 0.031) and worse IVI Reading (ß = -1.44; -2.31 to 0.58; p = 0.001) scores. CONCLUSIONS: About one in three adults with high myopia had posterior staphyloma, which was associated with increased odds of having myopic maculopathy and a detrimental impact on VRQoL.

The relationship between scleral staphyloma and choroidal thinning in highly myopic eyes: The Beijing Eye Study.

Based on the Beijing Eye Study 2011, a detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of subfoveal choroidal thickness (SFCT) and relative height of posterior scleral staphyloma. OCT images were obtained in 103 highly myopic eyes (≤-6.00 diopters) and 227 normal eyes. The mean SFCT in highly myopic eyes was 110.6 ± 85.2 µm (range, 3 to 395 µm). The SFCT of high myopia without posterior scleral staphyloma(55 eyes) was 157.79 ± 85.18 µm, which was significantly greater than that (54.94 ± 49.96 µm) of high myopia with posterior scleral staphyloma (48 eyes) (P < 0.001). In multivariate analysis, posterior scleral staphyloma was the most important factor of choroidal thinning in high myopia (F = 22.63; P < 0.001), then age (F = 19.14; P < 0.001), axial length (F = 17.37; P < 0.001) and gender (F = 17.31; P < 0.001). The SFCT in highly myopic eyes is very thin and undergoes further thinning with increasing age and axial length (refractive error). Posterior staphyloma formation was a key factor in choroidal thinning in highly myopic eyes and to be a good indicator for risk management of choroidal thinning. Abnormalities of the choroid may play a role in the pathogenesis of myopic degeneration.

[Secondary diseases in high myopia]. / Sekundärerkrankungen bei hoher Myopie.

BACKGROUND: Eyes with high myopia (axial length ≥ 26.5 mm) do not just have a different size. Due to morphological and structural changes there is a considerably increased risk for many different secondary diseases. OBJECTIVE: Determination of the incidence and mortality in high myopia, discussion of effects and clinical signs, presentation of treatment recommendations and counselling. MATERIAL AND METHODS: A systematic search of the literature was carried out and a discussion on basic principles and epidemiological investigations is presented. RESULTS: Findings due to high myopia are not in a closed state but undergo continuous changes. Choroidal neovascularization (adjusted prevalence 2.5-5%), staphyloma, foveoschisis and peripheral retinal degeneration are examples of problems contributing to the increased rate of visual impairment and blindness related to myopia. High myopia is associated with a clearly increased risk of retinal detachment after lens surgery (hazard ratio 6.1) and particularly more frequently in younger people. The associated primary open-angle glaucoma (odds ratio 2.46) is often recognized too late due to relatively low values of intraocular pressure. CONCLUSION: Understanding of atrophic areas and staphyloma has benefited from recent advances in imaging (e.g. magnetic resonance imaging, optical coherence tomography and wide-field imaging) that complement and explain histological findings. Knowledge of the associated risk profile is of major clinical relevance.

Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents.

We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.

Axial length and posterior staphyloma in Saudi Arabian cataract patients.

PURPOSE: To determine the axial length distribution and prevalence of posterior staphyloma in a group of Saudi Arabian patients having cataract extraction. SETTING: Tertiary care referral center. METHODS: Approximately 75% of all cataract patients at the eye hospital have preoperative B-scan ultrasonography. The last 1000 B-scans performed for any reason were screened for patients having uncomplicated cataract surgery; 629 cases were included. The relationship between the presence of posterior staphyloma and patient age, sex, and axial length was studied. RESULTS: There were 371 (59.0%) men and 258 (41.0%) women with a mean age of 62.4 years +/- 15.7 (SD). Posterior staphyloma was identified in 67 patients (10.7%). The presence of staphyloma was not significantly related to patient sex or age. Although the mean axial length was significantly longer in eyes with staphyloma (27.43 +/- 2.36 mm) than in those without (23.18 +/- 1.64 mm), 9.3% of eyes without staphyloma had an axial length longer than 25.0 mm. No staphylomas were present in eyes with an axial length shorter than 23.3 mm. The longest axial length in an eye without a staphyloma was 32.5 mm. CONCLUSIONS: Posterior staphyloma was present in a high percentage of Saudi Arabian patients having cataract extraction.

The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics.

PURPOSE: To describe and compare the ocular signs in patients diagnosed with acne rosacea by the ophthalmologist with the ocular signs in the patients diagnosed with rosacea by the dermatologist. METHODS: We reviewed the medical records of 176 randomly selected patients diagnosed with rosacea at the University of California, Davis, Medical Center: 88 patients each from the Department of Dermatology and the Department of Ophthalmology. Of the 88 patients diagnosed with acne rosacea by a dermatologist, 22 (25%) had an ophthalmologic evaluation done prior to the study. In those patients without an ophthalmologic assessment, ocular complaints noted by the dermatologist were recorded. We recorded ocular signs including lid, conjunctival, corneal, episcleral, and scleral manifestations as well as charted observations of the iris, lens, intraocular pressures (IOPs), best corrected visual acuity (VA), and funduscopic examination. Age and sex were recorded from the initial ophthalmologic evaluation. The analysis was designed to compare the prevalence of signs and symptoms in two clinical settings. RESULTS: The prevalence of documented meibomian gland dysfunction (p < 0.001), telangiectasia (p = 0.004), and anterior blepharitis (p = 0.008) was significantly higher in ophthalmology patients when compared with dermatology patients. Of the conjunctival signs evaluated, only the presence of interpalpebral conjunctival hyperemia (p = 0.005) was found to be significantly higher in ophthalmology patients. The corneal, episcleral, scleral, and lens findings did not demonstrate a statistically significant difference between groups. CONCLUSION: The major and most easily observable ocular problems in rosacea patients presenting either to ophthalmology or dermatology are lid disease-related manifestations. As might be expected, eye signs and symptoms are more commonly noted in the eye clinic. A clinician's increased awareness of the common ocular findings of rosacea, however, may aid in earlier diagnosis and treatment of ocular rosacea.

Scleral ectasia in rhegmatogenous retinal detachment.

OBJECTIVE: To determine the relation between retinal tears and scleral ectasia. DESIGN: Prospective study. SETTING: University-based referral practice in Montreal. PATIENTS: Fifty-seven consecutive patients with primary rhegmatogenous retinal detachments undergoing scleral buckling surgery. Patients with a history of trauma or previous cryotherapy, laser treatment or other vitreoretinal procedures were excluded. Fifteen patients with diabetes mellitus undergoing primary vitrectomy and prophylactic scleral buckling for nonclearing vitreous hemorrhage constituted the control group. OUTCOME MEASURES: Presence of scleral ectasia, visual acuity, refractive error. RESULTS: Thirty-one of the study patients were phakic and 26 were aphakic or pseudophakic. Fifteen (48.4%) of the phakic patients were found to have scleral ectasia, compared with six (23.1%) of the aphakic/pseudophakic patients and two (13.3%) of the control patients (p < 0.05, chi 2 test). The most frequent location of ectasia was the superotemporal quadrant. Retinal tears occurred in the same quadrant as scleral ectasia in 12 (80.0%) of the phakic patients. CONCLUSIONS: Scleral ectasia may be causally related to rhegmatogenous retinal detachment in certain cases.

Subconjunctival haemorrhages in neonatal thoroughbred foals.

A survey of 169 neonatal thoroughbred foals revealed that 8.3 per cent had subconjunctival haemorrhages, but there was no indication of a relationship between retinal and subconjunctival haemorrhages. The haemorrhages were not related to any abnormality of the foals and there was no sex or eye predisposition. In most cases the haemorrhages were fresh and red, occurred mainly dorsally or dorsonasally and extended up to the limbus; they resolved completely within four to 10 days, depending on their initial severity and extent. They had no effect on the foals' vision in the short or long term. The incidence of subconjunctival haemorrhages was associated with foaling category, multiparity and country of birth.

The relationship between the types of axial elongation and the prevalence of lattice degeneration of the retina.

PURPOSE: To assess the relationship between the prevalence of lattice degeneration and the types of axial elongation. METHODS: Nine hundred seventy eyes of 542 highly myopic patients with axial length of 26.00-31.99 mm were evaluated by using A-scan axial length measurements and fundus examinations. Then the prevalence of lattice degeneration was compared between eyes with posterior staphyloma and those without posterior staphyloma. RESULTS: At each axial length, lattice degeneration was more frequent in eyes without posterior staphyloma (the entire eye elongates) than those with posterior staphyloma (only the posterior pole elongates). The difference was statistically significant (p<0.005-0.05). CONCLUSION: The prevalence of lattice degeneration is influenced by the types of axial elongation in high myopic eyes.

Spots before the eyes: a prevalence and clinicoradiological study of senile scleral plaques.

AIMS: To investigate the prevalence and clinical associations of senile scleral plaques. METHODS: Unselected, consecutive computed tomographic (CT) images of elderly people were reviewed for the presence of calcification indicating senile scleral plaques. RESULTS: No definite calcification was seen in 100 men or 100 women aged 60-69 years; equivocal changes were seen in one woman. There were three definite examples and one equivocal case of calcification in 100 women and four definite cases in 100 men aged 70-79 years. However, in a group of 71 men and women patients aged 80 years or more, 16 definite cases were seen, indicating a prevalence of 22%. CONCLUSIONS: Apart from advanced age, and a mild association with the extent of calcification of the carotid siphon, no clinical or radiological features were identified which consistently characterized a total of 28 patients with this form of ocular calcification; an association with cataract probably reflected simply the recruitment base. Scleral plaques would appear to be a degenerative phenomenon without clinical significance, most likely to be detected in patients presenting with unrelated ophthalmological complaints.