The use of heterochromatic flicker photometry to determine macular pigment optical density in a healthy Australian population.

PURPOSE: To establish the normal macular pigment density (MPOD) in a healthy adult Australian sample using heterochromatic flicker photometry (HFP). METHODS: Macular pigment density was measured using heterochromatic flicker photometry in a total of 201 subjects ranging in age from 21 to 84 years with healthy macula. Fifty-seven of the healthy subjects also completed a food-frequency dietary questionnaire. Best-corrected visual acuity (BCVA) was measured using logMAR, chart and macular morphological profiles were assessed using high-resolution integrated Fourier-domain optical coherence tomography (OCT). RESULTS: The average MPOD value was 0.41 ± 0.20 (range 0.07-0.79). There was no statistically significant difference between values in the left and right eye, with good interocular agreement (0.41 vs 0.40, r = 0.893, p < 0.01). Age significantly predicted MPOD score (R (2) = 0.07, p < 0.05). A subgroup analysis of patients who completed the dietary questionnaire revealed a close correlation between higher diet scores and higher MPOD (r = 0.720 p = 0.031). There was no effect of smoking, gender, or iris colour on MPOD values. There was no significant correlation between BCVA, macular OCT profiles, and MPOD. CONCLUSION: Given that MPOD values are potentially affected by geographical variation, we have determined a mean MPOD value for healthy subjects in a population south of the equator, providing a reference point for future studies on Caucasian samples.

Intraocular bleeding in patients managed with novel oral anticoagulation and traditional anticoagulation: a network meta-analysis and systematic review.

BACKGROUND/AIM: To clarify the nature of the relationship between novel oral anticoagulants (NOACs) and traditional anticoagulation in respect to intraocular bleeding. METHODS: A comprehensive literature search up to October 2017 yielded 12 randomised controlled trials. Bayesian Markov chain Monte Carlo analysis was employed to investigate the relationship across multiple trials with varying NOACs. Random effects (informative priors) ORs were applied for the risk of intraocular bleeding due to various treatment measures. Mantel-Haenszel pairwise analyses were also performed. A total of 102 617 participants from 12 different randomised controlled trials. 11 746 received apixaban, 16 074 received dabigatran, 18 132 received edoxaban, 11 893 received rivaroxaban and 44 764 received warfarin. RESULTS: Edoxaban was significantly associated with a reduced risk of intraocular bleeding in comparison to warfarin (OR 0.59; 95% CI 0.34 to 0.98). All other findings were non-significant; however, apixaban was the only NOAC to trend with an increased event rate against warfarin. The Bayesian Markov chain Monte Carlo modelling indicated that edoxaban had the greatest chance of producing the lowest rate of bleeding (surface under the cumulative ranking curve 0.8642). Pooled pairwise analysis supported the network analysis results favouring edoxaban against warfarin (OR 0.59; 95% CI 0.39 to 0.90; p=0.02) as well as subgroup analysis of low-dose edoxaban versus warfarin (OR 0.43; 95% CI 0.24 to 0.78). CONCLUSION: The analysis suggests that edoxaban may be the paramount agent in reducing intraocular bleeding rates. Given a paucity of reporting data for this rare event, future research and confirmation is strongly recommended.

A case of subacute cutaneous lupus erythematosus as a result of ranibizumab (Lucentis) treatment.

Cutaneous lupus erythematosus is a previously undiagnosed side-effect of ranibizumab. Here, we present a case of an 82-year-old female Caucasian patient with wet age-related macular degeneration. Following a single intraocular injection of Lucentis (ranibizumab), she developed a subacute cutaneous lupus erythematosus which, with treatment, took nearly 12 months to resolve. This shows that cutaneous lupus erythematosus is a potential side-effect of many medications, including ranibizumab, as in our case and, in an aging population where polypharmacy is a growing reality, clinicians should be aware of how to diagnose and best manage such cases.

Atypical meningiomas--a case series.

Meningiomas, in particular the Atypical (grade 2), vary greatly in their behaviour and prognosis. Over a 19 year period, we operated on 169 meningiomas (on 86 patients) and of those, 9 cases of atypical meningiomas were found which met the 2007 World Health Organization (WHO) classification. The 9 patients represented 5.3% of all meningiomas. The average presenting age was 51 years and average follow-up was 103 months with 5 patients passing away between 38 and 219 months after diagnosis. The time to first recurrence was 24 months with 1 patient suffering 12 recurrences and 2 cases having metastases. Although we had a small number of atypical meningiomas, we believe our paper highlights the unpredictable and difficult nature of these tumours.