Optic disc morphology in primary open-angle glaucoma versus primary angle-closure glaucoma in South India.

Purpose: The aim of this study was to investigate the optic disc morphology in primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG) in South Indians. Methods: A total of 60 patients (60 eyes) with PACG and 52 patients (52 eyes) with POAG were included in a cross-sectional observational study. The glaucoma diagnosis was based on a glaucomatous appearance of the optic disc correlating with visual field defects. The glaucoma was graded as early, moderate, or severe, depending upon perimetric loss. All patients underwent an ophthalmic evaluation, including visual field examination and planimetric analysis of 30° stereoscopic color optic disc photographs. Results: The POAG and PACG groups did not differ significantly in a disc or rim area, rim width, and frequencies of disc hemorrhages or rim notches. However, early POAG group (n = 15) had a significantly deeper cup depth (P = 0.01), larger beta zone (P = 0.01), and a higher frequency of localized retinal nerve fiber layer (RNFL) defects (P = 0.02) than early PACG (n = 20). Conclusion: In the early stage of the disease, POAG compared to PACG may be characterized by deeper disc cupping, a larger beta zone of peripapillary atrophy, and a higher frequency of localized RNFL defects. Such differences in early glaucoma may suggest differences in pathophysiology in POAG and PACG.

COVID-19 and the Unfinished Agenda of VISION 2020.

PURPOSE: To critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020. DESIGN: Perspective supplemented with epidemiologic insights from available online databases. METHODS: We extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020. RESULTS: Over 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population. CONCLUSIONS: Despite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide.

Highlights from the 2019 International Myopia Summit on 'controversies in myopia'.

Myopia is an emerging public health issue with potentially significant economic and social impact, especially in East Asia. However, many uncertainties about myopia and its clinical management remain. The International Myopia Summit workgroup was convened by the Singapore Eye Research Institute, the WHO Regional Office for the Western Pacific and the International Agency for the Prevention of Blindness in 2019. The aim of this workgroup was to summarise available evidence, identify gaps or unmet needs and provide consensus on future directions for clinical research in myopia. In this review, among the many 'controversies in myopia' discussed, we highlight three main areas of consensus. First, development of interventions for the prevention of axial elongation and pathologic myopia is needed, which may require a multifaceted approach targeting the Bruch's membrane, choroid and/or sclera. Second, clinical myopia management requires co-operation between optometrists and ophthalmologists to provide patients with holistic care and a tailored approach that balances risks and benefits of treatment by using optical and pharmacological interventions. Third, current diagnostic technologies to detect myopic complications may be improved through collaboration between clinicians, researchers and industry. There is an unmet need to develop new imaging modalities for both structural and functional analyses and to establish normative databases for myopic eyes. In conclusion, the workgroup's call to action advocated for a paradigm shift towards a collaborative approach in the holistic clinical management of myopia.

Glaucoma.

Glaucoma is a heterogeneous group of diseases characterised by cupping of the optic nerve head and visual-field damage. It is the most frequent cause of irreversible blindness worldwide. Progression usually stops if the intraocular pressure is lowered by 30-50% from baseline. Its worldwide age-standardised prevalence in the population aged 40 years or older is about 3·5%. Chronic forms of glaucoma are painless and symptomatic visual-field defects occur late. Early detection by ophthalmological examination is mandatory. Risk factors for primary open-angle glaucoma-the most common form of glaucoma-include older age, elevated intraocular pressure, sub-Saharan African ethnic origin, positive family history, and high myopia. Older age, hyperopia, and east Asian ethnic origin are the main risk factors for primary angle-closure glaucoma. Glaucoma is diagnosed using ophthalmoscopy, tonometry, and perimetry. Treatment to lower intraocular pressure is based on topical drugs, laser therapy, and surgical intervention if other therapeutic modalities fail to prevent progression.

Intraocular Pressure Rise in Subjects with and without Glaucoma during Four Common Yoga Positions.

PURPOSE: To measure changes in intraocular pressure (IOP) in association with yoga exercises with a head-down position. METHODS: The single Center, prospective, observational study included 10 subjects with primary open-angle glaucoma and 10 normal individuals, who performed the yoga exercises of Adho Mukha Svanasana, Uttanasana, Halasana and Viparita Karani for two minutes each. IOP was measured by pneumatonometry at baseline and during and after the exercises. RESULTS: All yoga poses were associated with a significant (P < 0.01) rise in IOP within one minute after assuming the yoga position. The highest IOP increase (P < 0.01) was measured in the Adho Mukha Svanasana position (IOP increase from 17 ± 3.2 mmHg to 28 ± 3.8 mmHg in glaucoma patients; from 17 ± 2.8 mmHg to 29 ± 3.9 mmHg in normal individuals), followed by the Uttanasana position (17 ± 3.9 mmHg to 27 ± 3.4 mmHg (glaucoma patients) and from 18 ± 2.5 mmHg to 26 ± 3.6 mmHg normal individuals)), the Halasana position (18 ± 2.8 mmHg to 24 ± 3.5 mmHg (glaucoma patients); 18 ± 2.7 mmHg to 22 ± 3.4 mmHg (normal individuals)), and finally the Viparita Kirani position (17 ± 4 mmHg to 21 ± 3.6 mmHg (glaucoma patients); 17 ± 2.8 to 21 ± 2.4 mmHg (normal individuals)). IOP dropped back to baseline values within two minutes after returning to a sitting position. Overall, IOP rise was not significantly different between glaucoma and normal subjects (P = 0.813), all though glaucoma eyes tended to have measurements 2 mm Hg higher on average. CONCLUSIONS: Yoga exercises with head-down positions were associated with a rapid rise in IOP in glaucoma and healthy eyes. IOP returned to baseline values within 2 minutes. Future studies are warranted addressing whether yoga exercise associated IOP changes are associated with similar changes in cerebrospinal fluid pressure and whether they increase the risk of glaucoma progression. TRIAL REGISTRATION: ClinicalTrials.gov #NCT01915680.

Effects of matrine on proliferation and apoptosis of cultured retinoblastoma cells.

BACKGROUND: Extracted from the traditional Chinese medicine of Kushen, matrine is an alkaloid with potential anti-neoplastic and anti-inflammatory effects. Here, we examined the effect of matrine on proliferation and apoptosis of cultured retinoblastoma cells. METHODS: The retinoblastoma cell lines Y79, WERI-RB1 and SO-RB50 were treated with matrine in increasing concentrations from 0.2-1.1 mg/ml for 24 hours, and the cell proliferation rate was measured. The cells were exposed to matrine at 50% inhibition concentration (IC50) for 12, 24 and 48 hours. Cell cycle was analyzed by flow cytometry, concentration of proteins regulating cell cycle and apoptosis was determined by Western blot, apoptosis rate was measured by TUNEL staining, and cell morphology was assessed by electron transmission microscopy. RESULTS: The retinoblastoma cell lines Y79, WERI-RB1 and SO-RB50 showed an increased inhibition of cell proliferation with increasing matrine concentrations. Applying the IC50 concentration of matrine, the alteration of the cell cycle, including a reduced percentage of the S phase, was significantly (P < 0.01) associated with a longer treatment time by matrine. Correspondingly, the cell-cycle-associated proteins P21 and P27 were up-regulated and the protein cyclinD1 was down-regulated. The apoptosis-associated protein Bcl-2 was down-regulated, and Bax was up-regulated. In a similar manner, the apoptosis rate was significantly increased with longer treatment time. CONCLUSIONS: Matrine added to cultures of immortalized retinoblastoma cells led to a reduced tumor cell proliferation, decreased rate of mitosis and an increased tumor cell apoptosis, paralleled by corresponding changes in the proteins regulating the cell cycle or apoptosis.

The effect of ginkgo biloba on the rat retinal ganglion cell survival in the optic nerve crush model.

PURPOSE: To investigate the effect of ginkgo biloba on the retinal ganglion cell survival in a rat optic nerve crush model. METHODS: Twenty-four Sprague-Dawley rats were divided randomly into a study group of 12 animals receiving intraperitoneal injections of ginkgo biloba and a control group of 12 animals receiving intraperitoneal saline injections. All injections were performed 1 hr before the optic nerve crush and daily afterwards. For each animal, the right optic nerve was crushed closely behind the globe for 60 seconds using a microclip with 40 g power. The left optic nerve was kept intact. At 23 days after the optic nerve crush, the retinal ganglion cells were labelled retrogradely by injecting 3% fluorogold into both sides of the superior colliculus of the brain. At 4 weeks after the optic nerve crush, the animals were killed. Photographs taken from retinal flat mounts were assessed for the number and density of the retinal ganglion cells. RESULTS: The survival rate, defined as the ratio of the retinal ganglion cell density in the right eye with the optic nerve crush divided by the retinal ganglion cell density in left eye without an optic nerve trauma, was significantly (p=0.035) higher in the study group with ginkgo biloba than in the control group (60.0+/-6.0% versus 53.5+/-8.0%). CONCLUSION: The results suggest that intraperitoneal injections of a ginkgo biloba extract given prior to and daily after an experimental and standardized optic nerve crush in rats were associated with a higher survival rate of retinal ganglion cells.

Low-power transpupillary thermotherapy combined with intravitreal triamcinolone acetonide for subfoveal choroidal neovascularization.

PURPOSE: To examine transpupillary thermotherapy combined with intravitreal triamcinolone for treatment of subfoveal choroidal neovascularization. METHODS: The clinical interventional, noncomparative, case series study included 14 patients (14 eyes) with choroidal neovascularization (age-related macular degeneration, n = 11; high myopia, n = 2; unknown reason, n = 1), who underwent transpupillary thermotherapy (75-150 mW, 60 s, 500-3,000 microm), followed by an intravitreal triamcinolone injection (10 mg). Follow-up was at least 6 months. RESULTS: Visual acuity increased by 3 lines in 3 (21%) eyes at 3 months, and in 3 (21%) eyes at 6 months of follow-up. None of the patients experienced a visual acuity loss of 3 or more lines. At the 6-month follow-up, mean visual acuity was improved by 1.36 +/- 1.16 lines. Retreatment by transpupillary thermotherapy was performed for 3 (21%) eyes at 3 months, and for 1 (7%) eye at 6 months of follow-up. CONCLUSIONS: Transpupillary thermotherapy combined with intravitreal triamcinolone may be a therapeutic option for choroidal neovascularization particularly if other treatment modalities are not available.

Identification of novel striatal genes by expression profiling in adult mouse brain.

Large-scale transcriptome analysis in the brain is a powerful approach to identify novel genes of potential interest toward understanding cerebral organization and function. We utilized the microarray technology to measure expression levels of about 24,000 genes and expressed sequence tags in mouse hippocampus, frontal cortex and striatum. Using expression profile obtained from whole brain as a reference, we categorized the genes into groups of genes either enriched in, or restricted to, one of the three areas of interest. We found enriched genes for each target area. Further, we identified 14 genes in the category of genes restricted to the striatum, among which were the orphan G protein-coupled receptor GPR88 and retinoic acid receptor-beta. These two genes were already reported to be selectively expressed in the striatum, thus validating our experimental approach. We selected 6 striatal-restricted genes, as well as 10 striatal-enriched candidates, that were previously undescribed. We analyzed their expression by in situ hybridization analysis in the brain, and quantitative RT-PCR in both brain and peripheral organs. Two of these unknown genes displayed a notable expression pattern. The striatal-restricted gene H3076B11 shows uniform expression throughout and uniquely in the striatum, representing a genuine striatal marker. The striatal-enriched gene 4833421E05Rik is preferentially expressed in the rostral striatum, and is also abundant in kidney, liver and lung. These two genes may contribute to some of the many striatal-controlled behaviors, including initiation of movement, habit formation, or reward and motivation.

Retrobulbar catheter anesthesia as a routine technique for retinal and vitreoretinal surgery.

To ascertain the safety of the retrobulbar catheter technique for intraoperative local anesthesia and titratable postoperative analgesia, 1,423 consecutive retinal or vitreoretinal surgeries were reviewed. Using a commercially available retrobulbar needle, a 28-gauge flexible catheter was introduced into the retrobulbar space before surgery and was removed the next morning. When pain occurred, a local anesthetic was re-injected intraoperatively or postoperatively through the catheter. None of the patients had intraoperative or postoperative complications. The retrobulbar catheter anesthesia may be a relatively safe procedure for prolonged intraoperative anesthesia and titratable postoperative analgesia in retinal and vitreoretinal surgery.

Topical anesthesia for transpupillary silicone oil removal combined with cataract surgery.

PURPOSE: To assess safety of topical anesthesia for transpupillary silicone oil removal in combination with cataract surgery. SETTING: Department of Ophthalmology Mannheim, University of Heidelberg, Mannheim, Germany. METHODS: The clinical interventional study included 37 consecutive patients having transpupillary silicone oil removal combined with cataract surgery. Without exception, surgery was carried out in topical anesthesia for all patients. During the study period, there were no patients having transpupillary silicone oil removal in another type of local anesthesia than topical anesthesia. Topical anesthesia was achieved with oxybuprocaine 0.4% eyedrops installed 4 to 5 times prior to surgery. Cataract surgery was performed using the clear cornea technique with implantation of a foldable intraocular posterior chamber lens. Silicone oil was released through a planned posterior capsulotomy during cataract surgery prior to implantation of the intraocular lens (IOL). RESULTS: For all patients, surgery could be carried out in topical anesthesia without switching to peribulbar or any other type of anesthesia. None of the patients complained about severe pain intraoperatively or postoperatively. No severe complications such as expulsive hemorrhage, luxation of the IOL, or iris incarceration were encountered in any of the surgeries. CONCLUSION: Transpupillary silicone oil through a planned posterior capsulotomy during cataract surgery may be performed in topical surgery.

Topical versus peribulbar anaesthesia for cataract surgery.

BACKGROUND: To assess and compare the efficacy and safety of topical versus peribulbar anaesthesia in patients undergoing routine cataract surgery. METHODS: The unicentre, prospective, randomized, clinical interventional trial included 140 consecutive patients undergoing routine cataract surgery performed by one of two surgeons. The patients were randomly distributed to either peribulbar anaesthesia or topical anaesthesia. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. RESULTS: The study groups did not differ significantly in pain score (p=0.54), duration of surgery (p=0.52), anaesthesia-related intraoperative difficulties (p=0.17), postoperative visual acuity (p=0.94), overall intraoperative surgical complication rate, blood pressure rise (p=0.16) or blood oxygen saturation (p=0.74) CONCLUSIONS: Patient comfort and surgery-related complications did not differ between topical anaesthesia and peribulbar anaesthesia. As there are no significant differences between the two techniques in terms of subjective pain experienced by patients, intraoperative complications and postoperative visual outcome, and in view of the minimally invasive character of topical anaesthesia compared to peribulbar anaesthesia, the present study suggests the use of topical anaesthesia for routine cataract surgery.

Topical anesthesia for penetrating trabeculectomy.

PURPOSE: To evaluate the efficacy and clinical practicability of topical anesthesia in comparison with retrobulbar anesthesia for penetrating trabeculectomy. METHODS: The prospective single-surgeon clinical interventional trial included 20 consecutive patients, who were randomly distributed into a topical anesthesia group ( n=10) and a retrobulbar anesthesia group ( n=10). In the topical anesthesia group, patients received preoperatively oxybuprocaine 0.4% eye drops and cocaine hydrochloride eye drops 10%. The patients of the retrobulbar group received 5 ml mepivacaine 2% injected into the retrobulbar space. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. RESULTS: The topical anesthesia group and the retrobulbar anesthesia study group did not vary significantly in duration of surgery (21.5+/-3.37 min vs 20.2+/-4.46 min, P=0.31), preoperative intraocular pressure (32.2+/-14.62 mmHg vs 30.6+/-12.33 mmHg, P=0.22), postoperative intraocular pressure (8.0+/-4.47 mmHg vs 9.12+/-3.13 mmHg, P=0.64), subjective pain score by the patient (2.25+/-1.23 relative units vs 2.33+/-1.08 relative units ( P= 0.71), and practicability score by the surgeon (2.24+/-1.76 vs 2.56+/-1.58, P=0.82). CONCLUSIONS: In view of its clinical feasibility and its minimally invasive character, topical anesthesia may be an option for penetrating trabeculectomy.

Dietary vitamins and selenium diminish the development of mechanically induced osteoarthritis and increase the expression of antioxidative enzymes in the knee joint of STR/1N mice.

OBJECTIVE: To study the influence of dietary vitamins and selenium on mechanically-induced osteoarthritis (OA) and the expression of antioxidative enzymes in male STR/1N and Balb/c mice. Male STR/1N mice are prone to develop OA caused by a varus deformity-induced mechanical overload of the medial tibial plateau. METHODS: After 12 months of feeding (special diet supplemented with the vitamins E, C, A, B6, B2, and selenium) serial histological sections of the knee joints were evaluated for development of osteoarthritic changes (grade 0-4). Serum glutathione peroxidase activity (GSH-px) was measured photometrically. Expression of antioxidative enzymes was demonstrated by immunohistochemistry. RESULTS: All control STR/1N mice showed OA lesions (grade 3-4) while the special diet decreased OA incidence significantly down to approximately 65% (mostly grade 2). Even in Balb/c mice the incidence was decreased by the special diet from approximately 21% (control animals; grade 1) to approximately 14%. Serum GSH-px activity increased diet-dependently in both mouse strains but was generally higher in Balb/c mice. In both mouse strains the special diet increased the expression of GSH-px and Cu/Zn-SOD in articular cartilage while there was no expression of Mn-SOD. There was also a special diet-dependent increase in expression of GSH-px in the synovium of both mouse strains while an increase in expression of Mn-SOD and Cu/Zn-SOD could only be seen in the synovium of STR/1N mice. CONCLUSIONS: A diet supplemented with vitamins/selenium might be important in prevention or therapy of mechanically induced OA. We hypothesize that free oxygen radical species might be involved in the mechanical induction of OA.

Retrobulbar catheter technique for postoperative titratable analgesia after glaucoma surgery.

PURPOSE: To assess an indwelling retrobulbar catheter for delivery of intraoperative anesthesia and postoperative analgesia in patients undergoing painful cyclodestructive and retinal destructive procedures as treatment of neovascular glaucoma. PATIENTS AND METHODS: The prospective clinical interventional study included all 11 patients undergoing cyclocryocoagulation and/or retinal exocryocoagulation as treatment of neovascular glaucoma due to proliferate ischemic retinopathies. Using a commercially available retrobulbar needle with a diameter of 0.80 mm and a length of 38 mm, 7 mL of a local anesthetic were injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place. When the patients began to feel pain during or after surgery, 2 mL of a local anesthetic were reinjected through the catheter. The catheter was removed 24 hours after surgery. RESULTS: Due to increasing pain in the postoperative period, 8 (72.7%) patients received a reinjection 156.3 +/- 94.6 minutes after the preoperative injection. Seven (63.6%) patients requested a second reinjection 268.6 +/- 45.7 minutes after the preoperative injection, and three (27.3%) patients requested a third postoperative injection 333.3 +/- 79.1 minutes after the preoperative injection. Reinjection of the local anesthetic through the catheter markedly decreased the pain within 5 minutes of injection in all patients. CONCLUSIONS: Avoiding side effects of systemic analgesics and sedatives, an indwelling retrobulbar catheter for repeat postoperative injections of local anesthetics is useful and effective for titratable postoperative analgesia after painful cyclodestructive or retinal destructive surgery as treatment of neovascular glaucoma.