Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population.

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts' panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load. METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it. RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients' treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created. CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.

Microplastic contamination in Great Lakes fish.

Freshwater ecosystems, generally adjacent to human population and more contaminated relative to adjacent marine ecosystems, are vulnerable to microplastic contamination. We sampled 7 species of fish from Lake Ontario and Lake Superior and assessed their gastrointestinal (GI) tracts to quantify ingested microplastics and other anthropogenic particles. A subset of the microparticles were chemically analyzed to confirm polymer types and anthropogenic origins. We documented the highest concentration of microplastics and other anthropogenic microparticles ever reported in bony fish. We found 12,442 anthropogenic microparticles across 212 fish (8 species) from nearshore Lake Ontario, 943 across 50 fish (1 species) from Humber River, and 3094 across 119 fish (7 species) from Lake Superior. Fish from Lake Ontario had the greatest mean abundance of anthropogenic microparticles in their GI tracts (59 particles/fish [SD 104]), with up to 915 microparticles in a single fish. Fish from Lake Superior contained a mean [SD] of 26 [74] particles/fish, and fish from Humber River contained 19 [14] particles/fish. Most particles were microfibers. Overall, ≥90% of particles were anthropogenic, of which 35-59% were microplastics. Polyethylene (24%), polyethylene terephthalate (20%), and polypropylene (18%) were the most common microplastics. Ingestion of anthropogenic particles was significantly different among species within Lake Ontario (p < 0.05), and the abundance of anthropogenic particles increased as fish length increased in Lake Ontario (ρ = 0.62). Although we cannot extrapolate the concentration of microplastics in the water and sediments of these fish, the relatively high abundance of microplastics in the GI tracts of fish suggests environmental exposure may be above threshold concentrations for risk.

Contaminación por Microplásticos en Peces de los Grandes Lagos Resumen Los ecosistemas de agua dulce, generalmente contiguos a poblaciones humanas y más contaminados en relación con los ecosistemas marinos adyacentes, son vulnerables a la contaminación por microplásticos. Muestreamos siete especies de peces del Lago Ontario y del Lago Superior y analizamos sus tractos gastrointestinales (GI) para cuantificar los microplásticos ingeridos, además de otras partículas antropogénicas. Un subconjunto de las micropartículas fue analizado químicamente para confirmar los tipos de polímero y los orígenes antropogénicos. Documentamos la concentración más alta de microplásticos y de otras micropartículas antropogénicas jamás reportada en peces óseos. Encontramos 12,442 micropartículas antropogénicas en 212 peces (ocho especies) del Lago Ontario, 943 en 50 peces (una especie) en el Río Humber y 30,094 en 119 peces (siete especies) del Lago Superior. Los peces del Lago Ontario tuvieron la mayor abundancia promedio de micropartículas antropogénicas en sus tractos GI (59 partículas/pez [DS 104]), con hasta 915 micropartículas en un solo pez. Los peces del Lago Superior tuvieron un promedio [DS] de 26 [74] partículas/pez y los peces del Río Humber tuvieron 19 [14] partículas/pez. La mayoría de las partículas eran microfibras. En general, ≥90% de las partículas eran antropogénicas, de las cuales el 35-39% eran microplásticos. El polietileno (24%), el tereftalato de polietileno (20%) y el polipropileno (18%) fueron los microplásticos más comunes. La ingesta de partículas antropogénicas tuvo una diferencia significativa entre las especies del Lago Ontario (p < 0.05) y la abundancia de las partículas antropogénicas incrementó conforme aumentó la longitud de los peces en el Lago Ontario (ρ = 0.62). Aunque no podemos extrapolar la concentración de microplásticos en el agua y los sedimentos para estos peces, la abundancia relativamente alta de microplásticos en los tractos GI de los peces sugiere que la exposición ambiental puede estar por encima del umbral de concentraciones para el riesgo.

Diabetic macular oedema: evidence-based treatment recommendations for Asian countries.

Diabetic macular oedema is the most common cause of diabetic retinopathy-induced vision loss. Efficacy of anti-vascular endothelial growth factor therapy in diabetic macular oedema has been demonstrated in randomized controlled trials. An Asian-specific guideline for diabetic macular oedema treatment is needed as patients in Asia tend to present with far more advanced disease than seen elsewhere in the world. Previous reviews of diabetic macular oedema management lacked a broader assessment of anti-vascular endothelial growth factor treatment choices and newer trials. Recent clinical trial data allow head-to-head comparisons between the different anti-vascular endothelial growth factor agents and treatment regimens. This review aims to summarize the clinical evidence related to various treatment regimens for clinicians, with a focus on anti-vascular endothelial growth factor therapies, and to provide guidance on the treatment of diabetic macular oedema in Asian patients.

Intravitreal Ranibizumab for Choroidal Neovascularization in Best's Vitelliform Macular Dystrophy in a 6-Year-Old Boy.

A 6-year-old boy with a family history of Best's vitelliform macular dystrophy presented with a unilateral choroidal neovascularization. He responded well to a single injection of intravitreal ranibizumab. His visual acuity improved from 6/18 to 6/9 in the affected eye. His condition remained stable for 1½ years after treatment.

Analysis of foveal avascular zone in colour fundus images for grading of diabetic retinopathy severity.

Diabetic retinopathy (DR) is a sight threatening complication due to diabetes mellitus that affects the retina. At present, the classification of DR is based on the International Clinical Diabetic Retinopathy Disease Severity. In this paper, FAZ enlargement with DR progression is investigated to enable a new and an effective grading protocol DR severity in an observational clinical study. The performance of a computerised DR monitoring and grading system that digitally analyses colour fundus image to measure the enlargement of FAZ and grade DR is evaluated. The range of FAZ area is optimised to accurately determine DR severity stage and progression stages using a Gaussian Bayes classifier. The system achieves high accuracies of above 96%, sensitivities higher than 88% and specificities higher than 96%, in grading of DR severity. In particular, high sensitivity (100%), specificity (>98%) and accuracy (99%) values are obtained for No DR (normal) and Severe NPDR/PDR stages. The system performance indicates that the DR system is suitable for early detection of DR and for effective treatment of severe cases.

Plasticity in salt tolerance traits allows for invasion of novel habitat by Japanese knotweed s. l. (Fallopia japonica and F.xbohemica, Polygonaceae).

Japanese knotweeds are among the most invasive organisms in the world. Their recent expansion into salt marsh habitat provides a unique opportunity to investigate how invasives establish in new environments. We used morphology, cytology, and AFLP genotyping to identify taxa and clonal diversity in roadside and salt marsh populations. We conducted a greenhouse study to determine the ability to tolerate salt and whether salt marsh populations are more salt tolerant than roadside populations as measured by the efficiency of PSII, leaf area, succulence, height, root-to-shoot ratio, and total biomass. Clonal diversity was extremely low with one F. japonica clone and five F. ×bohemica genotypes. The two taxa were significantly different in several traits, but did not vary in biomass or plasticity of any trait. All traits were highly plastic in response to salinity, but differed significantly among genets. Despite this variation, plants from the salt marsh habitats did not perform better in the salt treatment, suggesting that they are not better adapted to tolerate salt. Instead, our data support the hypothesis that plasticity in salt tolerance traits may allow these taxa to live in saline habitats without specific adaptation to tolerate salt.

Chemoreduction for intraocular retinoblastoma in Malaysia.

In the last decade, chemotherapy in combination with focal therapy (chemoreduction) has been increasingly used in intraocular retinoblastoma to avoid enucleation and radiotherapy. The aim of this study was to assess the feasibility and outcome of chemoreduction in Malaysian children with retinoblastoma. This was a prospective study from August 2001 to January 2006. Twenty children (25 eyes) were given 4 cycles of chemoreduction, after which the response was assessed. Fourteen eyes showed a complete response, 10 eyes showed a partial response, and 1 eye had progressive disease. Twelve eyes developed progressive disease later, 9 after an initial complete response and 3 after a partial response. Overall, progressive disease occurred in 52%. There were 2 treatment failures, in Reese-Elsworth groups 3 and 4. Both eyes required enucleation. One eye in group 5 required second line chemotherapy to achieve a complete response. No eyes were irradiated. Five children (25%) defaulted follow-up, one of whom returned with disseminated disease. In conclusion, 4 cycles of chemoreduction achieved a durable complete response in only 12% of eyes. Chemoreduction is feasible in Malaysia but requires good patient compliance and close follow-up.

Laboratory investigation of the toxicity and interaction of pesticide mixtures in Daphnia magna.

The probabilistic ecological risk assessment-toxic equivalent (PERA-TE) combination approach is a relatively new risk assessment approach used to assess the toxicity and interaction of chemical mixtures. The validity and effectiveness of the PERA-TE combination approach has been tested previously in field microcosm studies using pesticide mixtures. The related laboratory studies described here, using Daphnia magna, were conducted to verify the conclusions made regarding the toxicity and interaction of the mixtures tested in the microcosms. Two types of pesticide mixture were assessed: the first consisted of pesticides with similar modes of action (chlorpyrifos, diazinon, and azinphos-methyl; OP mixture), and the second consisted of pesticides with different modes of action (chlorpyrifos, endosulfan, and trifluralin; CET mixture). Similar to the field studies, PERA-TE mixtures with a predetermined effect assessment criterion (10th centile of acute toxicity effects distributions) and proportional ratio (89:11 for binary mixture and 80:10:10 for ternary mixtures) were tested. Further assessment of the (PERA-) TE approach was achieved by altering the effect assessment criterion (to EC/LC(50) point estimates) and the proportional ratio of the pesticides in the mixture (to 50:25:25). Generally, but with some exceptions, basing mixtures on species-specific effect criteria and/or changing the proportional ratio of pesticides in the mixture redistributed the concentration of pesticides in the mixture to produce an equitoxic response. The ability to produce these equitoxic responses supported the conclusions drawn from the field studies: The pesticide toxicity in the OP and CET PERA-TE mixtures were effectively additive. Furthermore, it is shown that these alternative (PERA-) TE mixtures would be suitable to confirm or reject the interaction of chemicals in a PERA-TE mixture.

Toxicity of a complex mixture of atmospherically transported pesticides to Ceriodaphnia dubia.

The presence of several anthropogenic chemicals has been documented in the atmosphere of the Canadian prairies. The deposition of these chemicals as a mixture is of importance since little is known of the combined effects of these chemicals on aquatic organisms. This study was designed to evaluate the acute and chronic toxicity of a complex mixture of nine atmospherically transported pesticides to Ceriodaphnia dubia. The nine selected pesticides (bromoxynil, dicamba, 2,4-D, MCPA, triallate, trifluralin, pentachlorophenol, lindane, and 4,4'-DDT) were detected in appreciable quantities in dry atmospheric deposits. The concentration of each pesticide in the mixture was based on maximum measured daily dry deposition rates for central Canada, except for pentachlorophenol, which was estimated based on atmospheric concentrations. The 48-h LC50 estimate for C. dubia exposed to the pesticide mixture was 174.60 microg L(-1) (340 times the measured total dry deposition concentration). The estimated NOEC and LOEC for both survival and reproduction, as determined in the 7-d chronic toxicity test, were 51.3 (100 times) and 154 microg/L(-1) (300 times), respectively. A basic risk assessment, using the toxic unit approach, suggested that the toxicity of the pesticide mixture was mainly due to 4,4'-DDT. Overall, this atmospherically transported complex mixture of pesticides appears to pose a negligible toxicological risk to non-target aquatic invertebrates such as zooplankton.