SUCCESSFUL SURGICAL TREATMENT OF MACULA-INVOLVING DEGENERATIVE RETINOSCHISIS BY VITRECTOMY AND DRAINAGE OF THE SCHISIS CAVITY.

PURPOSE: To demonstrate the potential for visual recovery after surgery for early foveal involvement by progressive degenerative retinoschisis. METHODS: Surgical case report. RESULTS: A 79-year-old woman was monitored over 4 years for degenerative retinoschisis in the inferotemporal periphery of both eyes. Over the course of follow-up, visual acuity in the left eye decreased from 20/40 to 20/100, concurrent with extension of the schisis cavity into the macula. Macular involvement was confirmed on optical coherence tomography imaging, and there was no rhegmatogenous retinal detachment. The patient elected to undergo 25-gauge pars plana vitrectomy and drainage of the schisis cavity. Eleven weeks after surgery, the macula remained attached, and the uncorrected visual acuity was 20/30. Fundus examination and spectral domain optical coherence tomography confirmed ongoing resolution of the macula-involving retinoschisis. CONCLUSION: Bullous degenerative retinoschisis is believed to result in an absolute scotoma that is not surgically correctable. Our patient's excellent visual recovery suggests that the synaptic integrity of the macular outer plexiform layer can be preserved and a permanent scotoma avoided if early macular involvement by progressive degenerative retinoschisis is surgically repaired.

Glaucoma Awareness and Knowledge Among Ethiopians in a Tertiary Eye Care Center.

INTRODUCTION: Glaucoma outcomes are closely associated with patients' awareness of the disease. However, little is known about glaucoma awareness and knowledge in Addis Ababa, a densely populated and ethnolinguistically diverse capital city in Ethiopia, the second largest country in Africa. METHODS: We performed a cross-sectional survey in the ophthalmology waiting room at St. Paul's Hospital, a tertiary care center in Addis Ababa. Respondents included patients, patient family members, and non-clinical staff. Participants were asked if they had read or heard about glaucoma to gauge basic awareness of the disease; those with awareness were asked to take a quiz to measure their objective glaucoma knowledge. We performed multivariable regression to identify factors associated with glaucoma awareness, quiz performance, and self-rated ability to use eye drops. RESULTS: Of 298 respondents, 145 (48.7%) were female, and the average age was 44.9 ± 17.2 years. A majority (167; 56.0%) had primary school or less than primary school education. Only 131 (44.0%) had basic glaucoma awareness. Of these, 95 (72.5%) knew that glaucoma causes permanent vision loss, 103 (78.6%) knew glaucoma is often asymptomatic in early stages, 62 (47.3%) identified elevated intraocular pressure as a glaucoma risk factor, and 124 (94.7%) knew glaucoma was treatable. A majority of this subset (126; 96.2%) said they would be willing to use medicated eye drops, and 130 (99.2%) indicated a willingness to undergo surgery if recommended. Education level was independently associated with glaucoma awareness (p < 0.001) and glaucoma quiz performance (p = 0.03). CONCLUSION: In a population sample from an ophthalmology waiting room in Addis Ababa, glaucoma awareness was poor and most strongly associated with education level. Educational interventions at public health and provider-patient levels are warranted. Our results suggest high receptiveness to both medical and surgical treatment.

Normative Exophthalmometry Measurements Vary Among Ethiopian Adults and the Major Ethiopian Ethnic Groups.

PURPOSE: Periocular and orbital anthropometric values vary among races. No studies have established normative exophthalmometry values for Ethiopians or the many Ethiopian ethnic groups. This study established a set of normative anthropometric values for exophthalmometry, and further evaluated whether these measurements differed based on sex or ethnic group. METHODS: A cross-sectional study was performed in the ophthalmology department at St. Paul's Hospital in Addis Ababa, Ethiopia. Two hundred ninety-six participants were recruited for the study. Sex, primary Ethiopian ethnic subgroup, and exophthalmometry measurements were recorded. Differences between ethnicities and sexes were evaluated using independent samples t test. RESULTS: Average proptosis for the total cohort was 15.88 ± 2.49 mm, with 582 eyes measured. Females (15.87 ± 2.53, n = 286) and males (15.89 ± 2.49, n = 296) were not significantly different in their proptosis measurements. Within the 3 largest ethnic groups measured, Amhara (16.12 ± 2.67, n = 204), Oromo (15.43 ± 2.51, n = 172), and Gurage (16.23 ± 2.59, n = 98), the difference in proptosis measurement was significant between the Amhara and Oromo groups (p = 0.01), and the Oromo and Gurage groups (p = 0.01). The only ethnic group that was significantly different between sexes was Gurage, of which average female proptosis was 15.51 ± 2.74 (n = 54), while male proptosis was 17.13 ± 2.11 (n = 44) (p < 0.01). CONCLUSIONS: Mean Ethiopian proptosis values vary across ethnicities, are similar to those measured in other African populations, but are lower than those established in African-American populations. This study provides an important resource that Ethiopian ophthalmologists can use when evaluating patients with suspected ophthalmic and orbital disease.

Efficacy and dose-dependent safety of intra-arterial delivery of mesenchymal stem cells in a rodent stroke model.

Intra-arterial (IA) delivery of mesenchymal stem cells (MSCs) for acute ischemic stroke is attractive for clinical translation. However, studies using rat model of stroke have demonstrated that IA MSCs delivery can decrease middle cerebral artery (MCA) flow, which may limit its clinical translation. The goal of this study is to identify a dose of IA MSCs (maximum tolerated dose; MTD) that does not compromise MCA flow and evaluate its efficacy and optimal timing in a rat model of reversible middle cerebral artery occlusion (rMCAo). We sought to determine if there is a difference in efficacy of acute (1 h) versus sub-acute (24 h) IA MSCs treatment after rMCAo. Adult female Sprague-Dawley rats underwent rMCAo (90 min) and an hour later a single dose of MSCs (at de-escalating doses 1 × 10(6), 5 × 10(5), 2 × 10(5), 1 × 10(5) and 5 × 10(4)) was given using IA route. MSCs were suspended in phosphate buffered saline (PBS) and PBS alone was used for control experiments. We measured the percent change in mean laser Doppler flow signal over the ipsilateral MCA in de-escalating doses groups to determine MTD. The results demonstrated that the lowering of IA MSC dose to 1 × 10(5) and below did not compromise MCA flow and hence an IA MSC dose of 1 × 10(5) considered as MTD. Subsequently, 1 h and 24 h after rMCAo, rats were treated with IA MSCs or PBS. The 24 h delivery of IA MSCs significantly improved neurodeficit score and reduced the mean infarct volume at one month as compared to control, but not the 1 h delivery. Overall, this study suggests that the IA delivery of MSCs can be performed safely and efficaciously at the MTD of 1 × 10(5) delivered at 24 hours in rodent model of stroke.

Teaching ophthalmoscopy to medical students (the TOTeMS study).

PURPOSE: To determine medical student preferences for learning the ocular fundus examination and to assess their accuracy using different examination modalities. DESIGN: Prospective, randomized study of medical student education approaches. METHODS: First-year medical students received training in direct ophthalmoscopy using simulators and human volunteers. Students were randomized to receive vs not receive specific training on interpreting fundus photographs prior to accuracy assessments. Students' preferences for each of the 3 methods (direct ophthalmoscopy on simulators or human volunteers, or use of fundus photographs) and recognition of normal and abnormal fundus features were assessed. RESULTS: Of 138 first-year medical students, 119 (86%) completed all required elements. For learning ophthalmoscopy, 85 (71%) preferred humans to simulators. For learning relevant features of the ocular fundus, 92 (77%) preferred photographs to ophthalmoscopy on simulators or humans. Accuracy of answers was better when interpreting fundus photographs than when performing ophthalmoscopy on simulators (P < .001). Performance improved after specific teaching about assessing fundus photographs before testing (P = .02). Examination of the ocular fundus was found easier and less frustrating when using photographs than when using ophthalmoscopy on simulators or humans. Eighty-four students (70%) said they would prefer to have fundus photographs instead of using the ophthalmoscope during upcoming clinical rotations. CONCLUSIONS: Students preferred fundus photographs for both learning and examining the ocular fundus. Identification of ocular fundus features was more accurate on photographs compared to examination by direct ophthalmoscopy. In the future, the increasing availability of nonmydriatic ocular fundus photography may allow replacement of direct ophthalmoscopy in many clinical settings for non-ophthalmologists.